[Congressional Record Volume 151, Number 77 (Monday, June 13, 2005)]
[House]
[Pages H4358-H4361]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 PATIENT NAVIGATOR OUTREACH AND CHRONIC DISEASE PREVENTION ACT OF 2005

  Mr. GILLMOR. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 1812) to amend the Public Health Service Act to authorize a 
demonstration grant program to provide patient navigator services to 
reduce barriers and improve health care outcomes, and for other 
purposes, as amended.
  The Clerk read as follows:

                               H.R. 1812

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Patient Navigator Outreach 
     and Chronic Disease Prevention Act of 2005''.

     SEC. 2. PATIENT NAVIGATOR GRANTS.

       Subpart V of part D of title III of the Public Health 
     Service Act (42 U.S.C. 256) is amended by adding at the end 
     the following:

     ``SEC. 340A. PATIENT NAVIGATOR GRANTS.

       ``(a) Grants.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may make grants to eligible entities for the 
     development and operation of demonstration programs to 
     provide patient navigator services to improve health care 
     outcomes. The Secretary shall coordinate with, and ensure the 
     participation of, the Indian Health Service, the National 
     Cancer Institute, the Office

[[Page H4359]]

     of Rural Health Policy, and such other offices and agencies 
     as deemed appropriate by the Secretary, regarding the design 
     and evaluation of the demonstration programs.
       ``(b) Use of Funds.--The Secretary shall require each 
     recipient of a grant under this section to use the grant to 
     recruit, assign, train, and employ patient navigators who 
     have direct knowledge of the communities they serve to 
     facilitate the care of individuals, including by performing 
     each of the following duties:
       ``(1) Acting as contacts, including by assisting in the 
     coordination of health care services and provider referrals, 
     for individuals who are seeking prevention or early detection 
     services for, or who following a screening or early detection 
     service are found to have a symptom, abnormal finding, or 
     diagnosis of, cancer or other chronic disease.
       ``(2) Facilitating the involvement of community 
     organizations in assisting individuals who are at risk for or 
     who have cancer or other chronic diseases to receive better 
     access to high-quality health care services (such as by 
     creating partnerships with patient advocacy groups, 
     charities, health care centers, community hospice centers, 
     other health care providers, or other organizations in the 
     targeted community).
       ``(3) Notifying individuals of clinical trials and, on 
     request, facilitating enrollment of eligible individuals in 
     these trials.
       ``(4) Anticipating, identifying, and helping patients to 
     overcome barriers within the health care system to ensure 
     prompt diagnostic and treatment resolution of an abnormal 
     finding of cancer or other chronic disease.
       ``(5) Coordinating with the relevant health insurance 
     ombudsman programs to provide information to individuals who 
     are at risk for or who have cancer or other chronic diseases 
     about health coverage, including private insurance, health 
     care savings accounts, and other publicly funded programs 
     (such as Medicare, Medicaid, health programs operated by the 
     Department of Veterans Affairs or the Department of Defense, 
     the State children's health insurance program, and any 
     private or governmental prescription assistance programs).
       ``(6) Conducting ongoing outreach to health disparity 
     populations, including the uninsured, rural populations, and 
     other medically underserved populations, in addition to 
     assisting other individuals who are at risk for or who have 
     cancer or other chronic diseases to seek preventative care.
       ``(c) Prohibitions.--
       ``(1) Referral fees.--The Secretary shall require each 
     recipient of a grant under this section to prohibit any 
     patient navigator providing services under the grant from 
     accepting any referral fee, kickback, or other thing of value 
     in return for referring an individual to a particular health 
     care provider.
       ``(2) Legal fees and costs.--The Secretary shall prohibit 
     the use of any grant funds received under this section to pay 
     any fees or costs resulting from any litigation, arbitration, 
     mediation, or other proceeding to resolve a legal dispute.
       ``(d) Grant Period.--
       ``(1) In general.--Subject to paragraphs (2) and (3), the 
     Secretary may award grants under this section for periods of 
     not more than 3 years.
       ``(2) Extensions.--Subject to paragraph (3), the Secretary 
     may extend the period of a grant under this section. Each 
     such extension shall be for a period of not more than 1 year.
       ``(3) Limitations on grant period.--In carrying out this 
     section, the Secretary--
       ``(A) shall ensure that the total period of a grant does 
     not exceed 4 years; and
       ``(B) may not authorize any grant period ending after 
     September 30, 2010.
       ``(e) Application.--
       ``(1) In general.--To seek a grant under this section, an 
     eligible entity shall submit an application to the Secretary 
     in such form, in such manner, and containing such information 
     as the Secretary may require.
       ``(2) Contents.--At a minimum, the Secretary shall require 
     each such application to outline how the eligible entity will 
     establish baseline measures and benchmarks that meet the 
     Secretary's requirements to evaluate program outcomes.
       ``(f) Uniform Baseline Measures.--The Secretary shall 
     establish uniform baseline measures in order to properly 
     evaluate the impact of the demonstration projects under this 
     section.
       ``(g) Preference.--In making grants under this section, the 
     Secretary shall give preference to eligible entities that 
     demonstrate in their applications plans to utilize patient 
     navigator services to overcome significant barriers in order 
     to improve health care outcomes in their respective 
     communities.
       ``(h) Duplication of Services.--An eligible entity that is 
     receiving Federal funds for activities described in 
     subsection (b) on the date on which the entity submits an 
     application under subsection (e) may not receive a grant 
     under this section unless the entity can demonstrate that 
     amounts received under the grant will be utilized to expand 
     services or provide new services to individuals who would not 
     otherwise be served.
       ``(i) Coordination With Other Programs.--The Secretary 
     shall ensure coordination of the demonstration grant program 
     under this section with existing authorized programs in order 
     to facilitate access to high-quality health care services.
       ``(j) Study; Reports.--
       ``(1) Final report by secretary.--Not later than 6 months 
     after the completion of the demonstration grant program under 
     this section, the Secretary shall conduct a study of the 
     results of the program and submit to the Congress a report on 
     such results that includes the following:
       ``(A) An evaluation of the program outcomes, including--
       ``(i) quantitative analysis of baseline and benchmark 
     measures; and
       ``(ii) aggregate information about the patients served and 
     program activities.
       ``(B) Recommendations on whether patient navigator programs 
     could be used to improve patient outcomes in other public 
     health areas.
       ``(2) Interim reports by secretary.--The Secretary may 
     provide interim reports to the Congress on the demonstration 
     grant program under this section at such intervals as the 
     Secretary determines to be appropriate.
       ``(3) Reports by grantees.--The Secretary may require grant 
     recipients under this section to submit interim and final 
     reports on grant program outcomes.
       ``(k) Rule of Construction.--This section shall not be 
     construed to authorize funding for the delivery of health 
     care services (other than the patient navigator duties listed 
     in subsection (b)).
       ``(l) Definitions.--In this section:
       ``(1) The term `eligible entity' means a public or 
     nonprofit private health center (including a Federally 
     qualified health center (as that term is defined in section 
     1861(aa)(4) of the Social Security Act)), a health facility 
     operated by or pursuant to a contract with the Indian Health 
     Service, a hospital, a cancer center, a rural health clinic, 
     an academic health center, or a nonprofit entity that enters 
     into a partnership or coordinates referrals with such a 
     center, clinic, facility, or hospital to provide patient 
     navigator services.
       ``(2) The term `health disparity population' means a 
     population that, as determined by the Secretary, has a 
     significant disparity in the overall rate of disease 
     incidence, prevalence, morbidity, mortality, or survival 
     rates as compared to the health status of the general 
     population.
       ``(3) The term `patient navigator' means an individual who 
     has completed a training program approved by the Secretary to 
     perform the duties listed in subsection (b).
       ``(m) Authorization of Appropriations.--
       ``(1) In general.--To carry out this section, there are 
     authorized to be appropriated $2,000,000 for fiscal year 
     2006, $5,000,000 for fiscal year 2007, $8,000,000 for fiscal 
     year 2008, $6,500,000 for fiscal year 2009, and $3,500,000 
     for fiscal year 2010.
       ``(2) Availability.--The amounts appropriated pursuant to 
     paragraph (1) shall remain available for obligation through 
     the end of fiscal year 2010.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Ohio (Mr. Gillmor) and the gentleman from Ohio (Mr. Brown) each will 
control 20 minutes.
  The Chair recognizes the gentleman from Ohio (Mr. Gillmor).


                             General Leave

  Mr. GILLMOR. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on H.R. 1812, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Ohio?
  There was no objection.
  Mr. GILLMOR. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, I rise in strong support of H.R. 1812, the Patient 
Navigator Outreach and Chronic Disease Prevention Act of 2005.
  After the House passed similar legislation last fall, I would like to 
commend the initiative of the gentleman from Texas (Chairman Barton) in 
bringing H.R. 1812 before us again for consideration. I was very 
pleased to be a cosponsor of that bill last year, and I want to commend 
both the gentleman from New Jersey (Mr. Menendez) and the gentlewoman 
from Ohio (Ms. Pryce) for their sponsorship of the legislation this 
year.
  H.R. 1812 authorizes a 5-year demonstration program to evaluate the 
use of patient navigators. Patient navigator programs provide outreach 
to communities to encourage more individuals to seek preventative care 
and coordinate health care services for individuals who are at risk for 
or have a chronic disease.
  Specifically, the legislation requires trained individuals, or 
``patient navigators,'' to coordinate health care services and provider 
referrals, facilitate involvement of community organizations to provide 
assistance to patients, facilitate enrollment in clinical trials, help 
ensure prompt diagnostic care and treatment, and to coordinate with 
health insurance programs and conduct ongoing outreach to rural or 
health disparity populations for preventative

[[Page H4360]]

care. H.R. 1812 authorizes a total of $25 million over a 5-year period 
to conduct the demonstration project.
  Furthermore, this measure will be particularly helpful to sprawling 
districts such as my own in northwest Ohio, in which patients must 
drive or be driven by friends or family long distances for basic 
medical care and services.
  Madam Speaker, I again urge my colleagues to join me in supporting 
H.R. 1812.
  Madam Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Madam Speaker, I yield myself such time as I may 
consume.
  Too many Americans, as my friend from Ohio said, face financial 
barriers to health care. The American Cancer Society and other patient 
advocates support H.R. 1812 because they know that many Americans also 
face serious nonfinancial barriers; racial, cultural, linguistic and 
geographical barriers; barriers that have contributed to striking 
disparities across racial and ethnic lines in the incidence and 
treatment of cancer and other serious diseases.
  This is by no means a minor or inconsequential issue. It is a crisis, 
and addressing it should be one of our Nation's highest priorities. 
According to former Surgeon General David Satcher, more than 80,000 
African Americans die every year because of continuing disparities in 
health care; 80,000.
  African American and Latino adults are disproportionately more likely 
than whites to suffer from chronic conditions such as heart disease, 
cancer, asthma, depression, diabetes and high blood pressure. Modern 
medicine can combat these conditions, but only if it is available to 
those that need it. The earlier people receive preventative, diagnostic 
and treatment services, the better.
  Prevention and timely treatment are not only optimal from a public 
health perspective, they are optimal from a budget perspective. Timely 
care is cost-efficient care. The complexity and fragmentation of our 
health care system is perhaps the most daunting barrier of all. It 
exacerbates racial and ethnic disparities and reduces the efficiency of 
health care across the board.
  The patient navigator bill lays out a comprehensive strategy designed 
to foster prevention, early diagnosis and efficient treatment of 
serious illnesses. The goal is twofold: To reach those who are 
currently disenfranchised from the health care system, and to help ease 
the way for those who face a serious illness, an intimidating array of 
treatment options and uncertainty about the best course of action.
  This bill establishes a year-round community outreach program to 
promote cost-effective preventive services, including cancer screening. 
Early detection saves dollars, and, more importantly, saves lives.
  The program features culturally and linguistically competent patient 
navigators who are trained to assist and empower patients, serve as 
their advocates in negotiating our complicated and too often impersonal 
health care system, and help patients overcome barriers to health care 
services.
  With this legislation's passage, we can expect to see increased 
enrollment in clinical trials, greater community involvement and health 
awareness, a more coordinated approach to health care delivery, and 
enhanced access to timely health care services for racial and ethnic 
minorities.
  H.R. 1812 has the endorsement of the American Cancer Society, the 
National Association of Community Health Centers, the National Council 
of La Raza, the American Diabetes Association and the American Medical 
Association.
  I want to commend the gentleman from New Jersey (Mr. Menendez) and 
the gentlewoman from Ohio (Ms. Pryce) for their hard work on this 
legislation. I am pleased to support it.
  Mr. DINGELL. Madam Speaker, I rise in strong support of H.R. 1812, 
the Patient Navigator, Outreach, and Chronic Disease Prevention Act of 
2005. This legislation establishes a five-year, $25 million 
demonstration grant program to evaluate the use of ``patient 
navigators,'' who are individuals trained to assist persons who are at 
risk for or who have cancer or other chronic diseases. Assistance 
provided by patient navigators would include coordinating health care 
services for patients such as enrollment in clinical trials, 
facilitating community involvement, and coordinating health insurance 
ombudsman programs to improve health care options. Simply put, this 
bill reduces barriers to access and improves health care outcomes.
  H.R. 1812 ensures year-round outreach to target communities and funds 
culturally and linguistically competent patient navigators to conduct 
outreach, build relationships, and educate the public, while 
encouraging prevention screenings and follow-up treatment. It also 
ensures that navigators are available to help patients make their way 
through the health care system--offering a wide variety of services 
including translating technical medical terminology, making sense of 
their insurance, making appointments for referral screenings, 
following-up to make sure the patient keeps that appointment, or even 
accompanying a patient to a referral appointment.
  This bill will support the placement of patient navigators in a 
variety of health care settings. Eligible entities for patient 
navigators include community health centers, cancer centers, rural 
health clinics, academic health centers, and facilities operated by the 
Indian Health Service.
  This bill is supported by many patient advocate organizations, health 
care providers, and others, including the American Diabetes 
Association, the American Cancer Society, the National Hispanic Medical 
Association, the National Rural Health Association, and the National 
Association of Community Health Centers. I know that the bipartisan 
support for this bill involved the work of many of my colleagues. I 
would especially like to thank Representatives Menendez and Solis for 
their hard work on this legislation. I will support H.R. 1812 and I 
encourage all of my colleagues to do the same.
  Mrs. CHRISTENSEN. Madam Speaker, I rise today in support of H.R. 
1812, the Patient Navigator, Outreach, and Chronic Disease Prevention 
Act of 2005. I applaud my colleague, friend and chair of the Democratic 
Caucus, Congressman Robert Menendez of New Jersey for introducing this 
bill and getting it to the floor today. I also want to thank Chairman 
Barton and Ranking member Dingell for their support of measure.
  As you know, Madam Speaker, I have come to this floor on numerous 
occasions call attention to the racial and ethnic health disparities in 
this Nation. For years, research has told us that minorities and low-
income populations are the least likely to receive the health care they 
need to live a long, healthy life. There are many barriers to access 
which go beyond just the complex nature of the system.
  While I am pleased that today we have a bill that will begin to break 
down these barriers, and open up access to healthcare for many who 
might otherwise be left out, I would have to say though that I am 
deeply disappointed that the Committee did not see it fit to include 
some of the provisions that specifically addressed the additional 
barriers that people of racial and ethnic minority populations face, 
such as those related to language and unique cultural factors.
  Considering that people of this color bear such a disproportionate 
share of ill health and premature death, and that our lack of access 
contributes greatly to the skyrocketing cost of health care, it would 
have seemed to me to be only natural that a bill such as this would 
have sought to include the extra provisions that would ensure that 
every American would have the extra help, according to their need to 
get the health care services they need.
  Nevertheless the bill we are passing today while greatly modified 
meets an important need and I join the many organizations which support 
it in asking my colleagues to pass this bill, and then continue to work 
with Democrats and the minority caucuses to address all of the other 
deficiencies in the health care system that keep wellness out of the 
reach of people of color in this country.
  The bill before us provides that navigators will be available to help 
patients make their way through the health care system--whether it's 
translating technical medical terminology, making sense of their 
insurance, making appointments for referral screenings, following up to 
make sure the patient keeps that appointment, or even accompanying a 
patient to a referral appointment.
  Madam Speaker, I also want to acknowledge that the original concept 
for the legislation comes from Dr. Harold Freeman's ``navigator'' 
program, which he created while he was Director of Surgery at Harlem 
Hospital. It is our hope that Dr. Freeman's navigator concept and its 
laser shape focus on comprehensive modeling of prevention services will 
eventually be fully translated in legislative terms.
  I would also want at this time to recognize Brenda Pillars, the chief 
of staff to Congressman Towns who labored hard on this bill and who 
passed away last evening. Her passion for the health of all Americans 
but particularly the African American community, and her work in this 
body will be missed but long be remembered.
  In closing, Madam Speaker, I also want to thank Karissa Willhite of 
Mr. Menendez's office and John Ford and Cheryl Jaeger of the

[[Page H4361]]

Energy and Commerce Committee along with other staff that enabled this 
bill to come to the floor. I urge my colleagues to vote for its 
adoption.
  Ms. JACKSON-LEE of Texas. Madam Speaker, I rise today to speak in 
support of The Patient Navigator, Outreach and Chronic Disease 
Prevention Act of 2005. As a co-sponsor of the bill last year, I am 
fully aware of the benefits the bill will provide. Specifically, the 
bill would establish a 5-year, $25 million demonstration program for 
patient navigator services through Community Health Centers, National 
Cancer Institute centers, Indian Health Service centers, and Rural 
Health Clinics, as well as certain non-profit entities that provide 
patient navigator services.
  Further, the goal of a patient navigator is to improve health 
outcomes by helping patients, particularly in underserved communities, 
to overcome the barriers they face in getting early screening and 
appropriate follow-up treatment.
  Patient navigators are individuals who know the local community and 
can help patients navigate through the complicated health care system. 
They help with referrals and follow-up treatment and direct patients to 
programs and clinical trials that are available to help them get the 
treatment and care they need to fight cancer and other chronic 
diseases. In addition, the patient navigator guides patients to health 
coverage that they may be eligible to receive. They also conduct 
ongoing outreach to health disparity communities to encourage people to 
get screenings and early detection services.
  Racial and ethnic minorities benefit from patient navigators because 
they ensure that patients will have someone at their sides who 
understands their language, culture, and barriers to care, helping them 
get in to see a doctor early and work their way through our complicated 
health care system to get the coverage and treatment they need to stay 
healthy. The same applies to those in rural communities who face 
significant geographic barriers and limited access to care.
  Again, I strongly support this legislation and I hope my colleagues 
will do the same.
  Mr. GENE GREEN of Texas. Madam Speaker, I rise today in support of HR 
1812, the Patient Navigator legislation. This legislation would help 
reduce health disparities and barriers to health care through the 
increased use of patient navigators.
  Under the program, Community Health Centers, National Cancer 
Institute centers, Rural Health Clinics and other non-profit groups can 
utilize federal funding to help patients navigate through the complex 
health care system. Patient navigators can help to stem the rising 
number of uninsured in our country by helping individuals understand 
their eligibility for health care coverage. These kinds of services are 
needed throughout the country, but they are particularly helpful in 
underserved communities, where uninsured individuals too often put off 
health care either because of a lack of coverage or due to the 
difficulties in finding the appropriate health care home.
  In my hometown of Houston, patient navigators have made tremendous 
strides in helping patients find an appropriate health care home. Our 
Harris County Community Access Collaborative has implemented a 
Navigation Services program that has helped 31,000 patients find health 
care homes.
  In a related navigation service, the collaborative began an Ask Your 
Nurse phone service, whereby nurses are available 24 hours a day, 7 
days a week to steer patients to the best providers for their health 
care needs. Studies have shown that 57 percent of the diagnoses in 
Harris County safety net hospitals' emergency rooms could have been 
treated in our clinics and primary care physician offices. With this 
kind of ER overutilization, the Ask Your Nurse services are a welcome 
addition to the public health care infrastructure in our county and 
steer an average of 2,700 patients each month to the best health care 
provider for their condition.
  This legislation we consider today would allow other communities to 
replicate the successes we've achieved in Harris County. In addition, 
the legislation places an important emphasis on patient navigator 
services for individuals with cancer and other chronic conditions. For 
these diagnoses, it is extremely important that patients receive the 
scheduled follow-up treatment, and patient navigators can play a 
critical role in ensuring that patients receive the necessary care to 
successfully manage their health care conditions.
  I would like to thank my friend and Chairman, Joe Barton, for the bi-
partisan nature in which he shepherded this bill through committee. I 
offer particular thanks to Mr. Barton for his willingness to work with 
me to eliminate an unnecessary reference in the bill to the H-CAP 
program--a program that is important to me and my constituents. This is 
just one example of the lengths he will go to seek consensus, and I 
thank him for those efforts. With that, Madam Speaker, I encourage my 
colleagues to join me in supporting this bi-partisan legislation that 
will help many more Americans gain access to quality health care.
  Mr. MATHESON. Madam Speaker, thank you for the opportunity to share 
my remarks on H.R. 1812, the Patient Navigator Outreach and Chronic 
Disease Prevention Act. I rise in strong support of this important 
legislation.
  H.R. 1812 would authorize the Department of Health and Human Services 
to make grants for the development and operation of a pilot ``patient 
navigator program.'' This demonstration project would provide Community 
Health Centers, National Cancer Institute centers, Indian Health 
Service centers, Rural Health Clinics, and other health providers with 
funding to help patients ``navigate'' what can often be a complicated 
and confusing health care system.
  Under this legislation, patient navigators would help individual 
patients and their families overcome obstacles to the prompt diagnosis 
and treatment of their diseases by helping them understand the 
processes for receiving medical care and insurance, helping them 
coordinate referrals between different providers and specialists, 
helping them identify and possibly enroll in life-saving clinical 
trials, and even helping them manage their treatment plans.
  The bill ensures that particular attention is paid to patients with 
significant barriers to high-quality health care services including 
those who are geographically isolated, those with cultural or 
linguistic barriers, and the uninsured. In their endorsement of this 
important legislation, the American Cancer Society noted that despite 
notable advances in prevention interventions, screening technologies, 
and high-quality treatments, a disproportionate burden of cancer falls 
on the uninsured, those who live in rural areas, and minority and other 
medically underserved populations. These populations have higher risks 
of developing cancer and poorer chances of early diagnosis, optimal 
treatment, and survival.
  I believe that this pilot project will be helpful in providing 
patients with much-needed information. As receiving a diagnosis of 
cancer or another chronic disease can be overwhelming for an individual 
and their family members, this pilot project should ensure that 
information is available in an accessible, understandable format. I 
encourage my colleagues to support this legislation.
  Mr. BROWN of Ohio. Madam Speaker, I yield back the balance of my 
time.
  Mr. GILLMOR. Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Ohio (Mr. Gillmor) that the House suspend the rules and 
pass the bill, H.R. 1812, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________