[House Report 109-705]
[From the U.S. Government Publishing Office]



109th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     109-705

======================================================================



 
      NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM 
                      REAUTHORIZATION ACT OF 2006

                                _______
                                

 September 29, 2006.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Barton of Texas, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 5472]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 5472) to amend the Public Health Service Act to 
provide waivers relating to grants for preventive health 
measures with respect to breast and cervical cancers, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     6
Committee Oversight Findings.....................................     8
Statement of General Performance Goals and Objectives............     8
New Budget Authority, Entitlement Authority, and Tax Expenditures     8
Earmark..........................................................     8
Committee Cost Estimate..........................................     8
Congressional Budget Office Estimate.............................     8
Federal Mandates Statement.......................................     9
Advisory Committee Statement.....................................     9
Constitutional Authority Statement...............................     9
Applicability to Legislative Branch..............................    10
Section-by-Section Analysis of the Legislation...................    10
Changes in Existing Law Made by the Bill, as Reported............    10

                               Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``National Breast and Cervical Cancer 
Early Detection Program Reauthorization Act of 2006''.

SEC. 2. NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM.

  Title XV of the Public Health Service Act (42 U.S.C. 300k et seq.) is 
amended--
          (1) in section 1501(d)--
                  (A) in the heading, by striking ``2000'' and 
                inserting ``2020''; and
                  (B) by striking ``by the year 2000'' and inserting 
                ``by the year 2020'';
          (2) in section 1503, by adding at the end the following:
  ``(d) Waiver of Services Requirement on Division of Funds.--
          ``(1) In general.--The Secretary may waive the requirements 
        of paragraphs (1) and (4) of subsection (a) if the Secretary 
        finds that--
                  ``(A)(i) the State involved will use the waiver to 
                leverage private funds to supplement each of the 
                services or activities described in paragraphs (1) and 
                (2) of section 1501(a); or
                  ``(ii) the application of such requirements would 
                result in a barrier to the participation of qualifying 
                women in the services or activities described in 
                paragraphs (1) and (2) of section 1501(a);
                  ``(B) granting such a waiver to the State will not 
                reduce the number of women in the State who receive any 
                of the services or activities described in paragraphs 
                (1) and (2) of section 1501(a), including screening 
                procedures for both breast and cervical cancers; and
                  ``(C) granting such a waiver to the State will not 
                adversely affect the quality of any of the services or 
                activities described in paragraphs (1) and (2) of 
                section 1501(a).
          ``(2) Duration of waiver.--
                  ``(A) In general.--In granting waivers under 
                paragraph (1), the Secretary--
                          ``(i) shall grant such waivers for a period 
                        of 2 years; and
                          ``(ii) upon request of a State, may extend a 
                        waiver for additional 2-year periods in 
                        accordance with subparagraph (B).
                  ``(B) Additional periods.--The Secretary, upon the 
                request of a State that has received a waiver under 
                paragraph (1), shall, at the end of each 2-year waiver 
                period described in subparagraph (A), review 
                performance under the waiver and may extend the waiver 
                for an additional 2-year period if the Secretary finds 
                that--
                          ``(i)(I) the State involved will use the 
                        waiver to leverage private funds to supplement 
                        each of the services or activities described in 
                        paragraphs (1) and (2) of section 1501(a); or
                          ``(II) without an extension of the waiver, 
                        the application of the requirements of 
                        paragraphs (1) and (4) of subsection (a) would 
                        result in a barrier to the participation of 
                        qualifying women in the services or activities 
                        described in paragraphs (1) and (2) of section 
                        1501(a);
                          ``(ii) the waiver has not reduced, and 
                        granting the waiver extension will not reduce, 
                        the number of women in the State who receive 
                        any of the services or activities described in 
                        paragraphs (1) and (2) of section 1501(a); and
                          ``(iii) the waiver has not adversely 
                        affected, and granting the waiver extension 
                        will not adversely affect, the quality in the 
                        State of any of the services or activities 
                        described in paragraphs (1) and (2) of section 
                        1501(a).
          ``(3) Reporting requirements.--The Secretary shall include as 
        part of the evaluations and reports required under section 
        1508, the following:
                  ``(A) A description of the total amount of dollars 
                leveraged annually from private entities in States 
                receiving a waiver under this subsection and how these 
                amounts were used.
                  ``(B) With respect to States receiving a waiver under 
                this subsection, a description of--
                          ``(i) the percentage of the grant that is 
                        expended on services or activities described in 
                        paragraphs (1) and (2) of section 1501(a); and
                          ``(ii) the percentage of the grant that is 
                        expended on services or activities described in 
                        paragraphs (3) through (6) of section 1501(a).
                  ``(C) A description of the number of States receiving 
                waivers under this subsection annually.
                  ``(D) With respect to States receiving a waiver under 
                this subsection, a description of the number of women 
                receiving services under paragraphs (1), (2), and (3) 
                of section 1501(a) in programs before and after the 
                granting of such waiver.'';
          (3) in section 1504(a), by striking ``pursuant to paragraphs 
        (1) and (2) of section 1501(a)'' and inserting ``pursuant to 
        paragraphs (1), (2), and (3) of section 1501(a)''; and
          (4) in section 1510(a)--
                  (A) by striking ``and'' after ``$150,000,000 for 
                fiscal year 1994,''; and
                  (B) by inserting ``, and $250,000,000 for each of 
                fiscal years 2007 through 2011'' before the period at 
                the end.

                          Purpose and Summary

    The purpose of H.R. 5472, the National Breast and Cervical 
Early Detection Reauthorization Act of 2006, is to reauthorize 
the National Breast and Cervical Early Detection Program. In 
addition to reauthorizing the program, the bill would grant the 
Secretary of the Department of Health and Human Services (HHS) 
the authority to waive certain requirements, allowing grantees 
to expend more funding on education and outreach activities. 
Such waivers may be granted as long as certain conditions 
ensuring the leveraging of private funds and maintaining or 
expanding the number of women screened is met.

                  Background and Need for Legislation

    Established by Congress in 1991, the National Breast and 
Cervical Early Detection Reauthorization Program (NBCCEDP) 
provides free and low-cost breast and cervical cancer 
screenings to low-income, minority, or uninsured women. 
Following Federal clinical guidelines, the program targets 
women ages 18 to 64 for cervical cancer screening and ages 40 
to 64 for breast cancer screening. Services offered by the 
program include clinical breast examinations, mammograms, 
Papanikolaou or ``Pap'' tests, surgical consultations, and 
diagnostic testing. Administered by the Centers for Disease 
Control and Prevention (CDC), the NBCCEDP operates in all 50 
States, four U.S. territories, the District of Columbia, and 13 
American Indian and Alaska Native organizations. The NBCCEDP 
also works with local partners, including private charitable 
and non-profit organizations, which provide matching funds for 
screening, education, outreach, case management, and treatment 
services.
    According to the CDC, breast cancer is the second most 
commonly diagnosed cancer in the United States. It is second 
only to lung cancer as the most common cause of death among 
women. Yet breast cancer mortality has steadily declined since 
the late 1980s. Experts attribute much of the decline to 
increased mammography screening. It is estimated that timely 
mammography screening of women over 40 could prevent between 13 
to 15 percent of all deaths from breast cancer. When breast 
cancer is detected early, while still confined to the breast, 
the five-year survival rate is more than 95 percent.
    Similarly, cervical cancer was once the leading cause of 
death for women in the United States. Since the 1950s, however, 
there has been a 90 percent reduction in the mortality rate for 
cervical cancer. The National Cancer Institute of the National 
Institutes of Health has attributed this reduction to effective 
Pap smear screening.
    While recent international comparisons have shown that the 
United States healthcare system performs well in the area of 
breast and cervical cancer screening, diagnosis, and treatment, 
when compared with other industrialized nations, significant 
gaps remain. For example, studies conducted by the Institute of 
Medicine have shown that low-income women have lower screening 
rates, are 41 percent more likely to be diagnosed with late-
stage breast cancer, and three times more likely to die from 
breast cancer. According to the 2000 National Health Interview 
Survey, breast cancer screening rates are also lower than the 
national average among African American women, American Indian 
or Alaska Native women, Asian, Hispanic, Latino women. The 
survey also reports that only 38 percent of uninsured women 
interviewed said they had received a mammogram within the last 
two years, and only 35 percent of women with no usual source of 
health care reported having received a mammogram within the 
last two years.
    In recognition of the clear value of breast and cervical 
cancer screenings in reducing mortality from these diseases, 
the NBCCEDP is part of a multi-faceted effort to provide access 
to those women at highest risk. Since 1991, the NBCCEDP has 
served over 2.5 million women, provided over 5.8 million 
screening examinations including more than 2.8 million 
mammograms, and diagnosed more than 22,000 breast cancers and 
1,500 cervical cancers. The NBCCEDP currently performs 
screenings on more than 600,000 women annually. Partnering with 
State, local, and private entities, the NBCCEDP also provides 
education and outreach services to diverse populations of 
women. Research indicates that racial and ethnic minority women 
are less likely to have access to information about breast 
cancer or the financial resources to pay for important health 
services, including mammograms. Thus, the NBCCEDP makes a 
special effort to target racial and ethnic minority women for 
screening, outreach, and education efforts. As a result, over 
half of all women screened by the program are ethnic and racial 
minority women.
    In 2000, Congress passed the Breast and Cervical Cancer 
Treatment and Prevention Act. This legislation gave States the 
option to provide Medicaid coverage for treatment of women 
diagnosed with cancer through the NBCCEDP. In 2002, Congress 
passed the Native American Breast and Cervical Cancer Treatment 
Technical Amendment Act, which added Native American women to 
the optional Medicaid eligibility category. Currently, all 50 
States plus the District of Columbia have elected this option.
    Under current law, funded programs must spend at least 60 
percent of the cooperative agreement funds awarded on 
screening, referral, and follow-up services. The remaining 40 
percent of funds awarded may be allocated toward other 
infrastructure development activities, including public 
education, professional education, quality assurance, and 
surveillance and evaluation efforts. In addition, current law 
places an overall cap of 10 percent on administrative expenses 
to carry out all aspects of the programs.
    While the emphasis on service provision required by the 60/
40 split is appropriate for the vast majority of grantees, in 
programs serving smaller populations, unique challenges exist 
in implementing the required 60/40 split under existing law. 
The cap on program activities that are not administrative, 
particularly outreach and client recruitment, has made it 
difficult to reach some eligible women, especially in rural 
States.
    H.R. 5472, the National Breast and Cervical Cancer Early 
Detection Program Reauthorization Act of 2006, would 
reauthorize this program for five years and allow for a grant 
requirement waiver. H.R. 5472 would amend current law to allow 
for a waiver of the 60/40 requirement. The bill would require 
that programs requesting a waiver provide to the Secretary of 
Health and Human Services justification and documentation that 
the number of women who receive preventive health and early 
detection services would not be reduced in any way. For the 
small number of programs that would likely apply for and 
receive the waiver, added flexibility would allow programs to 
leverage their partnerships with private entities and maximize 
the donation of clinical services. The flexibility granted 
under the waiver would also allow more Federal resources to be 
directed towards ensuring that all program components are well 
implemented and managed.
    Since the program's inception in 1991, the NBCCEDP has 
contributed to an 18 percent increase in mammography use among 
women over age 50. The Committee generally affirms the 
recommendation of the Institute of Medicine, the U.S. 
Department of Health and Human Services through its Trans-HHS 
Cancer Health Disparities Progress Review Group, and such 
patient advocacy organizations such as the American Cancer 
Society and the Susan G. Komen Breast Cancer Foundation, that 
increased funds for the NBCCEDP are justified so that more 
women may have access to these vital cancer screening services. 
As a result, the bill provides an increase in the program's 
authorized funding level for fiscal years 2007 through 2011.
    Finally, under Section 1502 of the Public Health Service 
Act, States requesting NBCCEDP grant funds must make non-
Federal contributions toward the program costs. States may 
fulfill the match requirement with cash or in-kind 
contributions. The Committee is aware that CDC does not 
currently collect information on grantees as to whether or not 
matching funds are the result of State appropriations. The 
Committee directs CDC to collect additional data from grantees 
on the sources and types of matching funds and to include an 
analysis of those data in their annual report to Congress.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On Wednesday, September 27, 2006, the full Committee met in 
open markup session and ordered H.R. 5472 favorably reported to 
the House, amended, by a recorded vote of 45 yeas and 0 nays, a 
quorum being present.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no recorded votes taken on amendments offered to the 
measure. A motion by Mr. Barton to order H.R. 5472 favorably 
reported to the House, amended, was agreed to by a record vote 
of 45 yeas and 0 nays.


                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    The general goals and objectives of H.R. 5472 are to update 
and reauthorize the NBCCEDP program, granting the program 
increased flexibility to continue to provide vital cancer 
screening and referral services.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
5472, the National Breast and Cervical Cancer Early Detection 
Program Reauthorization Act of 2006, would result in no new or 
increased budget authority, entitlement authority, or tax 
expenditures or revenues.

                                Earmark

    In compliance with H. Res. 1000 as passed the House of 
Representatives on September 14, 2006, the Committee finds that 
H.R. 5472, the National Breast and Cervical Cancer Early 
Detection Program Reauthorization Act of 2006, contains no 
earmarks.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 28, 2006.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 5472, the National 
Breast and Cervical Cancer Early Detection Program 
Reauthorization Act of 2006.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Tim 
Gronniger.
            Sincerely,
                                          Donald B. Marron,
                                                   Acting Director.
    Enclosure.

H.R. 5472--National Breast and Cervical Cancer Early Detection Program 
        Reauthorization Act of 2006

    H.R. 5472 would modify the Public Health Service Act to 
authorize funding for breast and cervical cancer detection 
programs. It would authorize the appropriation of $250 million 
a year for fiscal years 2007 through 2011. The bill also would 
allow the Secretary of Health and Human Services to waive 
conditions of grants to states under certain circumstances. CBO 
estimates that implementing H.R. 5472 would cost $98 million in 
2007 and about $1 billion over the 2007-2011 period, assuming 
that the authorized amounts are appropriated and that spending 
for the specified activities follows historical patterns.
    H.R. 5472 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act. In 
some cases it would ease the conditions of grants that states 
receive for programs to detect breast and cervical cancer. H.R. 
5472 would not affect direct spending or receipts.
    The estimated budgetary impact of H.R. 5472 is shown in the 
following table. The costs of this legislation fall within 
budget function 550 (health).

----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2006    2007    2008    2009    2010    2011
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Budget Authority a..........................................     202       0       0       0       0       0
    Estimated Outlays...........................................     202     119      29       7       2       0
Proposed Changes:
    Estimated Authorization Level...............................       0     250     250     250     250     250
    Estimated Outlays...........................................       0      98     212     239     245     248
Spending Under H.R. 5472:
    Estimated Authorization Level a.............................     202     250     250     250     250     250
    Estimated Outlays...........................................     202     217     241     246     247     248
----------------------------------------------------------------------------------------------------------------
a The 2006 level is the amount allocated to the screening program for breast and cervical cancer.

    The CBO staff contact for this estimate is Tim Gronniger.
    This estimate was approved by Robert A. Sunshine, Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title of the Act as the 
``National Breast and Cervical Cancer Early Detection Program 
Reauthorization Act of 2006''.

Section 2. National Breast and Cervical Cancer Early Detection Program

    Section 2 of the bill amends Title XV of the Public Health 
Service Act by updating the year in current law respecting the 
existing coordinating committee regarding year 2000 health 
objectives from 2000 health objectives to year 2020 health 
objectives.
    Section 2 provides that the Secretary of the Department of 
Health and Human Services may waive the 60/40 funding 
requirement for grantees if the following conditions apply: (1) 
the State will use the waiver to leverage private funds; (2) 
keeping the 
60/40 requirement in place will result in a barrier to women 
seeking services; (3) granting the waiver will not reduce the 
number of women receiving screening services; and (4) granting 
the waiver will not adversely affect the quality of services.
    Section 2 provides that waivers shall last for two years. 
The Secretary may grant a renewal of a waiver for an additional 
two years if the following applies: (1) the State will use the 
waiver to leverage private funds; (2) without a waiver 
extension, a barrier to eligible women will result; (3) the 
waiver has not reduced the number of women receiving services; 
and (4) the waiver has not adversely affected the quality of 
services available.
    Section 2 also includes reporting requirements to ensure 
that the waivers are achieving their intended results. To this 
end, HHS will include the following in its required reports: 
(1) a description of the total amount of dollars leveraged 
annually from private entities in States that receive a waiver; 
(2) for States that receive waivers, the percentage of the 
grant that's spent on each service must be specified; (3) 
States participating in the waiver must be listed; and (4) 
States that receive waivers must include a description of the 
number of women receiving services.
    Section 2 updates priority language for low-income women to 
include outreach and education efforts.
    Section 2 authorizes for fiscal years 2007 to 2011, the 
program to be funded at $250,000,000 each year.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



    TITLE XV--PREVENTIVE HEALTH MEASURES WITH RESPECT TO BREAST AND 
                            CERVICAL CANCERS

SEC. 1501. ESTABLISHMENT OF PROGRAM OF GRANTS TO STATES.

  (a) * * *

           *       *       *       *       *       *       *

  (d) Coordinating Committee Regarding Year [2000] 2020 Health 
Objectives.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall establish a 
committee to coordinate the activities of the agencies of the 
Public Health Service (and other appropriate Federal agencies) 
that are carried out toward achieving the objectives 
established by the Secretary for reductions in the rate of 
mortality from breast and cervical cancer in the United States 
[by the year 2000] by the year 2020. Such committee shall be 
comprised of Federal officers or employees designated by the 
heads of the agencies involved to serve on the committee as 
representatives of the agencies, and such representatives from 
other public or private entities as the Secretary determines to 
be appropriate.

           *       *       *       *       *       *       *


SEC. 1503. REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF SERVICES.

  (a) * * *

           *       *       *       *       *       *       *

  (d) Waiver of Services Requirement on Division of Funds.--
          (1) In general.--The Secretary may waive the 
        requirements of paragraphs (1) and (4) of subsection 
        (a) if the Secretary finds that--
                  (A)(i) the State involved will use the waiver 
                to leverage private funds to supplement each of 
                the services or activities described in 
                paragraphs (1) and (2) of section 1501(a); or
                  (ii) the application of such requirements 
                would result in a barrier to the participation 
                of qualifying women in the services or 
                activities described in paragraphs (1) and (2) 
                of section 1501(a);
                  (B) granting such a waiver to the State will 
                not reduce the number of women in the State who 
                receive any of the services or activities 
                described in paragraphs (1) and (2) of section 
                1501(a), including screening procedures for 
                both breast and cervical cancers; and
                  (C) granting such a waiver to the State will 
                not adversely affect the quality of any of the 
                services or activities described in paragraphs 
                (1) and (2) of section 1501(a).
          (2) Duration of waiver.--
                  (A) In general.--In granting waivers under 
                paragraph (1), the Secretary--
                          (i) shall grant such waivers for a 
                        period of 2 years; and
                          (ii) upon request of a State, may 
                        extend a waiver for additional 2-year 
                        periods in accordance with subparagraph 
                        (B).
                  (B) Additional periods.--The Secretary, upon 
                the request of a State that has received a 
                waiver under paragraph (1), shall, at the end 
                of each 2-year waiver period described in 
                subparagraph (A), review performance under the 
                waiver and may extend the waiver for an 
                additional 2-year period if the Secretary finds 
                that--
                          (i)(I) the State involved will use 
                        the waiver to leverage private funds to 
                        supplement each of the services or 
                        activities described in paragraphs (1) 
                        and (2) of section 1501(a); or
                          (II) without an extension of the 
                        waiver, the application of the 
                        requirements of paragraphs (1) and (4) 
                        of subsection (a) would result in a 
                        barrier to the participation of 
                        qualifying women in the services or 
                        activities described in paragraphs (1) 
                        and (2) of section 1501(a);
                          (ii) the waiver has not reduced, and 
                        granting the waiver extension will not 
                        reduce, the number of women in the 
                        State who receive any of the services 
                        or activities described in paragraphs 
                        (1) and (2) of section 1501(a); and
                          (iii) the waiver has not adversely 
                        affected, and granting the waiver 
                        extension will not adversely affect, 
                        the quality in the State of any of the 
                        services or activities described in 
                        paragraphs (1) and (2) of section 
                        1501(a).
          (3) Reporting requirements.--The Secretary shall 
        include as part of the evaluations and reports required 
        under section 1508, the following:
                  (A) A description of the total amount of 
                dollars leveraged annually from private 
                entities in States receiving a waiver under 
                this subsection and how these amounts were 
                used.
                  (B) With respect to States receiving a waiver 
                under this subsection, a description of--
                          (i) the percentage of the grant that 
                        is expended on services or activities 
                        described in paragraphs (1) and (2) of 
                        section 1501(a); and
                          (ii) the percentage of the grant that 
                        is expended on services or activities 
                        described in paragraphs (3) through (6) 
                        of section 1501(a).
                  (C) A description of the number of States 
                receiving waivers under this subsection 
                annually.
                  (D) With respect to States receiving a waiver 
                under this subsection, a description of the 
                number of women receiving services under 
                paragraphs (1), (2), and (3) of section 1501(a) 
                in programs before and after the granting of 
                such waiver.

SEC. 1504. ADDITIONAL REQUIRED AGREEMENTS.

  (a) Priority for Low-Income Women.--The Secretary may not 
make a grant under section 1501 unless the State involved 
agrees that low-income women will be given priority in the 
provision of services and activities [pursuant to paragraphs 
(1) and (2) of section 1501(a)] pursuant to paragraphs (1), 
(2), and (3) of section 1501(a).

           *       *       *       *       *       *       *


SEC. 1510. FUNDING FOR GENERAL PROGRAM.

  (a) Authorization of Appropriations.--For the purpose of 
carrying out this title, there are authorized to be 
appropriated $50,000,000 for fiscal year 1991, such sums as may 
be necessary for each of the fiscal years 1992 and 1993, 
$150,000,000 for fiscal year 1994, [and] such sums as may be 
necessary for each of the fiscal years 1995 through 2003, and 
$250,000,000 for each of fiscal years 2007 through 2011.

           *       *       *       *       *       *       *


                                  
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