[House Report 118-525]
[From the U.S. Government Publishing Office]


118th Congress }                                             { Report
                        HOUSE OF REPRESENTATIVES
 2d Session    }                                             { 118-525

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



 
           SCREENING FOR COMMUNITIES TO RECEIVE EARLY AND 
          EQUITABLE NEEDED SERVICES FOR CANCER ACT OF 2024

                                _______
                                

  May 24, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

     Mrs. Rodgers of Washington, from the Committee on Energy and
                  Commerce, submitted the following

                              R E P O R T

                        [To accompany H.R. 3916]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3916) to amend the Public Health Service Act to 
reauthorize and improve the National Breast and Cervical Cancer 
Early Detection Program for fiscal years 2024 through 2028, and 
for other purposes, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Committee Action.................................................     3
Committee Votes..................................................     4
Oversight Findings and Recommendations...........................     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     6
Statement of General Performance Goals and Objectives............     6
Duplication of Federal Programs..................................     6
Related Committee and Subcommittee Hearings......................     6
Committee Cost Estimate..........................................     7
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     7
Advisory Committee Statement.....................................     7
Applicability to Legislative Branch..............................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     7

    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 ``Screening for Communities to Receive 
Early and Equitable Needed Services for Cancer Act of 2024'' or the 
``SCREENS for Cancer Act of 2024''.

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

  (a) Program of Grants to States.--Section 1501 of the Public Health 
Service Act (42 U.S.C. 300k) is amended--
          (1) in subsection (a)--
                  (A) in paragraph (2), by striking ``the provision of 
                appropriate follow-up services and support services 
                such as case management'' and inserting ``that 
                appropriate follow-up services are provided'';
                  (B) in paragraph (3), by striking ``programs for the 
                detection and control'' and inserting ``for the 
                prevention, detection, and control'';
                  (C) in paragraph (4), by striking ``the detection and 
                control'' and inserting ``the prevention, detection, 
                and control'';
                  (D) in paragraph (5)--
                          (i) by striking ``monitor'' and inserting 
                        ``ensure''; and
                          (ii) by striking ``; and'' and inserting a 
                        semicolon;
                  (E) by redesignating paragraph (6) as paragraph (9);
                  (F) by inserting after paragraph (5), the following:
          ``(6) to enhance appropriate support activities to increase 
        breast and cervical cancer screening, such as--
                  ``(A) patient navigation;
                  ``(B) implementation of evidence-based or evidence-
                informed strategies proven to increase breast and 
                cervical cancer screening in health care settings; and
                  ``(C) facilitating access to health care settings 
                that provide breast and cervical cancer screenings;
          ``(7) to reduce disparities in incidents of and deaths due to 
        breast and cervical cancer in populations with higher than 
        average rates;
          ``(8) to improve access to breast and cervical cancer 
        screening and diagnostic services and reduce related barriers, 
        including factors that relate to negative health outcomes; 
        and''; and
                  (G) in paragraph (9), as so redesignated, by striking 
                ``through (5)'' and inserting ``through (8)''; and
          (2) by striking subsection (d).
  (b) Requirements With Respect to Type and Quality of Services.--
Section 1503 of the Public Health Service Act (42 U.S.C. 300m) is 
amended--
          (1) in subsection (a)--
                  (A) in paragraph (1), by striking ``that, initially'' 
                and all that follows through the semicolon and 
                inserting ``that appropriate breast and cervical cancer 
                screening and diagnostic services are provided based on 
                national recommendations; and'';
                  (B) by striking paragraphs (2) and (4);
                  (C) by redesignating paragraph (3) as paragraph (2); 
                and
                  (D) in paragraph (2), as so redesignated, by striking 
                ``; and'' and inserting a period; and
          (2) by striking subsection (d).
  (c) Reports to Congress.--Section 1508(b) of the Public Health 
Service Act (42 U.S.C. 300n-4(b)) is amended--
          (1) in the heading, by striking ``Report'' and inserting 
        ``Reports'';
          (2) by striking ``1 year after the date of the enactment of 
        the National Breast and Cervical Cancer Early Detection Program 
        Reauthorization of 2007, and annually thereafter,'' and 
        inserting ``2 years after the date of enactment of the SCREENS 
        for Cancer Act of 2024, and every 5 years thereafter,'';
          (3) by striking ``Labor and Human Resources'' and inserting 
        ``Health, Education, Labor, and Pensions''; and
          (4) by striking ``preceding fiscal year'' and inserting 
        ``preceding 2 fiscal years in the case of the first report 
        after the date of enactment of the SCREENS for Cancer Act of 
        2024, and preceding 5 fiscal years for each report 
        thereafter,''.
  (d) Authorization of Appropriations.--Section 1510(a) of the Public 
Health Service Act (42 U.S.C. 300n-5(a)) is amended--
          (1) by striking ``and'' after ``2011,''; and
          (2) by inserting ``, and $275,000,000 for each of fiscal 
        years 2025 through 2029'' before the period at the end.

                          Purpose and Summary

    H.R. 3916 reauthorizes the National Breast and Cervical 
Cancer Early Detection Program and makes certain modifications 
and updates to the program and reporting requirements. The 
legislation reauthorizes the program for five fiscal years, 
from fiscal year 2025 through 2029.

                  Background and Need for Legislation

    This legislation reauthorizes the National Breast and 
Cervical Cancer Early Detection Program (NBCCEDP) that provides 
access to breast cancer screening and diagnostic services for 
low-income, uninsured, or underinsured people in all 50 states, 
the District of Columbia, two U.S. territories, five U.S.-
affiliated Pacific Islands and 13 tribes or tribal 
organizations. The legislation updates the program to improve 
the ability for women to access breast and cervical cancer 
screening services. The NCCEDP also provides public education, 
outreach, patient navigation, and care coordination services to 
increase breast and cervical cancer screening rates and reach 
underserved populations. For women aged 50 to 74 years old, 
breast cancer screening every 2 years reduces breast cancer 
deaths by 26 percent, or 7 deaths averted for every 1,000 women 
screened.\1\ When diagnosed at the earliest stage, almost 98 
percent of women diagnosed with breast cancer live for 5 years 
or more, compared to about 31 percent of those diagnosed at the 
most advanced stage.\2\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, ``Health and 
Economic Benefits of Breast Cancer Interventions'', National Center for 
Chronic Disease Prevention and Health Promotion (NCCDPHP), 2022. 
https://www.cdc.gov/chronicdisease/programs-impact/pop/breast-
cancer.htm.
    \2\Id.
---------------------------------------------------------------------------

                            Committee Action

    On February 14, 2024, the Subcommittee on Health held a 
hearing on H.R. 3916. The title of the hearing was 
``Legislative Proposals to Support Patients and Caregivers.'' 
The Subcommittee received testimony from:
           Andy Shih, PhD, Chief Science Officer, 
        Autism Speaks;
           Corey Feist, JD, MBA, Co-Founder and CEO, 
        Dr. Lorna Breen Heroes' Foundation;
           Joanne Pike, DrPH, President and CEO, 
        Alzheimer's Association;
           Gordon Tomaselli, MD, Former President, 
        American Heart Association; Marilyn and Stanley M. Katz 
        Dean, Emeritus and Professor of Medicine, Albert 
        Einstein College of Medicine; Adjunct Professor of 
        Medicine, Johns Hopkins University School of Medicine;
           Michelle Whitten, President, CEO, and Co-
        Founder, Global Down Syndrome Foundation;
           Randy Strozyk, President, American Ambulance 
        Association; and
           Christina Annunziata, MD, PhD, Senior Vice 
        President of Extramural Discovery Science, American 
        Cancer Society.
    On March 12, 2024, the Subcommittee on Health met in open 
markup session and forwarded H.R. 3916, as amended, to the full 
Committee by a record vote of 24 yeas and 0 nays.
    On March 20, 2024, the full Committee on Energy and 
Commerce met in open markup session and ordered H.R. 3916, as 
amended, favorably reported to the House by a record vote of 46 
yeas and 0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 

                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

              New Budget Authority, Entitlement Authority,
                          and Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 3916 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       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.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to improve 
the ability for communities to detect breast cancer and 
cervical cancer at early stages.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 3916 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 3916:
           On February 14, 2024, the Subcommittee on 
        Health held a hearing on H.R. 3916. The title of the 
        hearing was ``Legislative Proposals to Support Patients 
        and Caregivers.'' The Subcommittee received testimony 
        from:
                   Andy Shih, PhD, Chief Science 
                Officer, Autism Speaks;
                   Corey Feist, JD, MBA, Co-Founder 
                and CEO, Dr. Lorna Breen Heroes' Foundation;
                   Joanne Pike, DrPH, President and 
                CEO, Alzheimer's Association;
                   Gordon Tomaselli, MD, Former 
                President, American Heart Association; Marilyn 
                and Stanley M. Katz Dean, Emeritus and 
                Professor of Medicine, Albert Einstein College 
                of Medicine; Adjunct Professor of Medicine, 
                Johns Hopkins University School of Medicine;
                   Michelle Whitten, President, 
                CEO, and Co-Founder, Global Down Syndrome 
                Foundation;
                   Randy Strozyk, President, 
                American Ambulance Association; and
                   Christina Annunziata, MD, PhD, 
                Senior Vice President of Extramural Discovery 
                Science, American Cancer Society.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, 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. At the time this report was 
filed, the estimate was not available.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 3916 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

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

                  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 provides that the Act may be cited as the 
``Screening for Communities to Receive Early and Equitable 
Needed Services for Cancer Act of 2024'' or the ``SCREENS for 
Cancer Act of 2024''.

Section 2. National breast and cervical cancer early detection  
    program

    Section 2 amends Title XV of the Public Health Service Act 
to reauthorize the National Breast and Cervical Cancer Early 
Detection Program through fiscal year 2029. This section also 
makes updates to the program to reduce disparities and support 
certain activities that improve cancer screening rates.

         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 italics, and 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) In General.--The Secretary, acting through the Director 
of the Centers for Disease Control and Prevention, may make 
grants to States on the basis of an established competitive 
review process for the purpose of carrying out programs--
          (1) to screen women for breast and cervical cancer as 
        a preventive health measure;
          (2) to provide appropriate referrals for medical 
        treatment of women screened pursuant to paragraph (1) 
        and to ensure, to the extent practicable, [the 
        provision of appropriate follow-up services and support 
        services such as case management] that appropriate 
        follow-up services are provided;
          (3) to develop and disseminate public information and 
        education [programs for the detection and control] for 
        the prevention, detection, and control of breast and 
        cervical cancer;
          (4) to improve the education, training, and skills of 
        health professionals (including allied health 
        professionals) in [the detection and control] the 
        prevention, detection, and control of breast and 
        cervical cancer;
          (5) to establish mechanisms through which the States 
        can [monitor] ensure the quality of screening 
        procedures for breast and cervical cancer, including 
        the interpretation of such procedures[; and];
          (6) to enhance appropriate support activities to 
        increase breast and cervical cancer screening, such 
        as--
                  (A) patient navigation;
                  (B) implementation of evidence-based or 
                evidence-informed strategies proven to increase 
                breast and cervical cancer screening in health 
                care settings; and
                  (C) facilitating access to health care 
                settings that provide breast and cervical 
                cancer screenings;
          (7) to reduce disparities in incidents of and deaths 
        due to breast and cervical cancer in populations with 
        higher than average rates;
          (8) to improve access to breast and cervical cancer 
        screening and diagnostic services and reduce related 
        barriers, including factors that relate to negative 
        health outcomes; and
          [(6)] (9) to evaluate activities conducted under 
        paragraphs (1) [through (5)] through (8) through 
        appropriate surveillance or program-monitoring 
        activities.
  (b) Grant and Contract Authority of States.--
          (1) In general.--A State receiving a grant under 
        subsection (a) may, subject to paragraphs (2) and (3), 
        expend the grant to carry out the purpose described in 
        such subsection through grants to public and nonprofit 
        private entities and through contracts with public and 
        private entities.
          (2) Certain applications.--If a nonprofit private 
        entity and a private entity that is not a nonprofit 
        entity both submit applications to a State to receive 
        an award of a grant or contract pursuant to paragraph 
        (1), the State may give priority to the application 
        submitted by the nonprofit private entity in any case 
        in which the State determines that the quality of such 
        application is equivalent to the quality of the 
        application submitted by the other private entity.
          (3) Payments for screenings.--The amount paid by a 
        State to an entity under this subsection for a 
        screening procedure under subsection (a)(1) may not 
        exceed the amount that would be paid under part B of 
        title XVIII of the Social Security Act if payment were 
        made under such part for furnishing the procedure to a 
        woman enrolled under such part.
  (c) Special Consideration for Certain States.--In making 
grants under subsection (a) to States whose initial grants 
under such subsection are made for fiscal year 1995 or any 
subsequent fiscal year, the Secretary shall give special 
consideration to any State whose proposal for carrying out 
programs under such subsection--
          (1) has been approved through a process of peer 
        review; and
          (2) is made with respect to geographic areas in which 
        there is--
                  (A) a substantial rate of mortality from 
                breast or cervical cancer; or
                  (B) a substantial incidence of either of such 
                cancers.
  [(d) Coordinating Committee Regarding Year 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 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) Requirement of Provision of All Services by Date 
Certain.--The Secretary may not make a grant under section 1501 
unless the State involved agrees--
          (1) to ensure [that, initially and throughout the 
        period during which amounts are received pursuant to 
        the grant, not less than 60 percent of the grant is 
        expended to provide each of the services or activities 
        described in paragraphs (1) and (2) of section 1501(a), 
        including making available screening procedures for 
        both breast and cervical cancers;] that appropriate 
        breast and cervical cancer screening and diagnostic 
        services are provided based on national 
        recommendations; and
          [(2) subject to subsection (b), to ensure that--
                  [(A) in the case of breast cancer, both a 
                physical examination of the breasts and the 
                screening procedure known as a mammography are 
                conducted; and
                  [(B) in the case of cervical cancer, both a 
                pelvic examination and the screening procedure 
                known as a pap smear are conducted;]
          [(3)] (2) to ensure that, by the end of any second 
        fiscal year of payments pursuant to the grant, each of 
        the services or activities described in section 1501(a) 
        is provided[; and].
          [(4) to ensure that not more than 40 percent of the 
        grant is expended to provide the services or activities 
        described in paragraphs (3) through (6) of such 
        section.]
  (b) Use of Improved Screening Procedures.--The Secretary may 
not make a grant under section 1501 unless the State involved 
agrees that, if any screening procedure superior to a procedure 
described in subsection (a)(2) becomes commonly available and 
is recommended for use, any entity providing screening 
procedures pursuant to the grant will utilize the superior 
procedure rather than the procedure described in such 
subsection.
  (c) Quality Assurance Regarding Screening Procedures.--The 
Secretary may not make a grant under section 1501 unless the 
State involved agrees that the State will, in accordance with 
applicable law, assure the quality of screening procedures 
conducted pursuant to such section.
  [(d) Waiver of Services Requirement on Division of Funds.--
          [(1) In general.--The Secretary shall establish a 
        demonstration project under which the Secretary may 
        waive the requirements of paragraphs (1) and (4) of 
        subsection (a) for not more than 5 States, if--
                  [(A) the State involved will use the waiver 
                to leverage non-Federal funds to supplement 
                each of the services or activities described in 
                paragraphs (1) and (2) of section 1501(a);
                  [(B) the application of such requirement 
                would result in a barrier to the enrollment of 
                qualifying women;
                  [(C) the State involved--
                          [(i) demonstrates, to the 
                        satisfaction of the Secretary, the 
                        manner in which the State will use such 
                        waiver to expand the level of screening 
                        and follow-up services provided 
                        immediately prior to the date on which 
                        the waiver is granted; and
                          [(ii) provides assurances, 
                        satisfactory to the Secretary, that the 
                        State will, on an annual basis, 
                        demonstrate, through such documentation 
                        as the Secretary may require, that the 
                        State has used such waiver as described 
                        in clause (i);
                  [(D) the State involved submits to the 
                Secretary--
                          [(i) assurances, satisfactory to the 
                        Secretary, that the State will maintain 
                        the average annual level of State 
                        fiscal year expenditures for the 
                        services and activities described in 
                        paragraphs (1) and (2) of section 
                        1501(a) for the period for which the 
                        waiver is granted, and for the period 
                        for which any extension of such wavier 
                        is granted, at a level that is not less 
                        than--
                                  [(I) the level of the State 
                                fiscal year expenditures for 
                                such services and activities 
                                for the fiscal year preceding 
                                the first fiscal year for which 
                                the waiver is granted; or
                                  [(II) at the option of the 
                                State and upon approval by the 
                                Secretary, the average level of 
                                the State expenditures for such 
                                services and activities for the 
                                3-fiscal year period preceding 
                                the first fiscal year for which 
                                the waiver is granted; and
                          [(ii) a plan, satisfactory to the 
                        Secretary, for maintaining the level of 
                        activities carried out under the waiver 
                        after the expiration of the waiver and 
                        any extension of such waiver;
                  [(E) the Secretary finds that granting such a 
                waiver to a State will increase the number of 
                women in the State that receive each of the 
                services or activities described in paragraphs 
                (1) and (2) of section 1501(a), including 
                making available screening procedures for both 
                breast and cervical cancers; and
                  [(F) the Secretary finds that granting such a 
                waiver to a State will not adversely affect the 
                quality of each 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 that is not less than 1 year but 
                        not more than 2 years; and
                          [(ii) upon request of a State, may 
                        extend a waiver for an additional 
                        period that is not less than 1 year but 
                        not more than 2 years in accordance 
                        with subparagraph (B).
                  [(B) Additional period.--The Secretary, upon 
                the request of a State that has received a 
                waiver under paragraph (1), shall, at the end 
                of the waiver period described in subparagraph 
                (A)(i), review performance under the waiver and 
                may extend the waiver for an additional period 
                if the Secretary determines that--
                          [(i) without an extension of the 
                        waiver, there will be a barrier to the 
                        enrollment of qualifying women;
                          [(ii) the State requesting such 
                        extended waiver will use the waiver to 
                        leverage non-Federal funds to 
                        supplement the services or activities 
                        described in paragraphs (1) and (2) of 
                        section 1501(a);
                          [(iii) the waiver has increased, and 
                        will continue to increase, the number 
                        of women in the State that receive the 
                        services or activities described in 
                        paragraphs (1) and (2) of section 
                        1501(a);
                          [(iv) the waiver has not, and will 
                        not, result in lower quality in the 
                        State of the services or activities 
                        described in paragraphs (1) and (2) of 
                        section 1501(a); and
                          [(v) the State has maintained the 
                        average annual level of State fiscal 
                        expenditures for the services and 
                        activities described in paragraphs (1) 
                        and (2) of section 1501(a) for the 
                        period for which the waiver was granted 
                        at a level that is not less than--
                                  [(I) the level of the State 
                                fiscal year expenditures for 
                                such services and activities 
                                for the fiscal year preceding 
                                the first fiscal year for which 
                                the waiver is granted; or
                                  [(II) at the option of the 
                                State and upon approval by the 
                                Secretary, the average level of 
                                the State expenditures for such 
                                services and activities for the 
                                3-fiscal year period preceding 
                                the first fiscal year for which 
                                the waiver is granted.
          [(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 Non-Federal 
                entities in States receiving a waiver under 
                paragraph (1) and how these amounts were used.
                  [(B) With respect to States receiving a 
                waiver under paragraph (1), a description of 
                the percentage of the grant that is expended on 
                providing each of the services or activities 
                described in--
                          [(i) paragraphs (1) and (2) of 
                        section 1501(a); and
                          [(ii) paragraphs (3) through (6) of 
                        section 1501(a).
                  [(C) A description of the number of States 
                receiving waivers under paragraph (1) annually.
                  [(D) With respect to States receiving a 
                waiver under paragraph (1), a description of--
                          [(i) 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; and
                          [(ii) the average annual level of 
                        State fiscal expenditures for the 
                        services and activities described in 
                        paragraphs (1) and (2) of section 
                        1501(a) for the year preceding the 
                        first year for which the waiver was 
                        granted.
          [(4) Limitation.--Amounts to which a waiver applies 
        under this subsection shall not be used to increase the 
        number of salaried employees.
          [(5) Definitions.--In this subsection:
                  [(A) Indian tribe.--The term ``Indian tribe'' 
                has the meaning given the term in section 4 of 
                the Indian Health Care Improvement Act (25 
                U.S.C. 1603).
                  [(B) Tribal organization.--The term ``tribal 
                organization'' has the meaning given the term 
                in section 4 of the Indian Health Care 
                Improvement Act.
                  [(C) State.--The term ``State'' means each of 
                the several States of the United States, the 
                District of Columbia, the Commonwealth of 
                Puerto Rico, American Samoa, the Commonwealth 
                of the Northern Mariana Islands, the Republic 
                of the Marshall Islands, the Federated States 
                of Micronesia, the Republic of Palau, an Indian 
                tribe, and a tribal organization.
          [(6) Sunset.--The Secretary may not grant a waiver or 
        extension under this subsection after September 30, 
        2012.]

           *       *       *       *       *       *       *


SEC. 1508. EVALUATIONS AND REPORTS.

  (a) Evaluations.--The Secretary shall, directly or through 
contracts with public or private entities, provide for annual 
evaluations of programs carried out pursuant to section 1501. 
Such evaluations shall include evaluations of--
          (1) the extent to which States carrying out such 
        programs are in compliance with section 1501(a)(2) and 
        with section 1504(c); and
          (2) the extent to which each State receiving a grant 
        under this title is in compliance with section 1502, 
        including identification of--
                  (A) the amount of the non-Federal 
                contributions by the State for the preceding 
                fiscal year, disaggregated according to the 
                source of the contributions; and
                  (B) the proportion of such amount of non-
                Federal contributions relative to the amount of 
                Federal funds provided through the grant to the 
                State for the preceding fiscal year.
  (b)  [Report] Reports to Congress.--The Secretary shall, not 
later than [1 year after the date of the enactment of the 
National Breast and Cervical Cancer Early Detection Program 
Reauthorization of 2007, and annually thereafter,] 2 years 
after the date of enactment of the SCREENS for Cancer Act of 
2024, and every 5 years thereafter, submit to the Committee on 
Energy and Commerce of the House of Representatives, and to the 
Committee on [Labor and Human Resources] Health, Education, 
Labor, and Pensions of the Senate, a report summarizing 
evaluations carried out pursuant to subsection (a) during the 
[preceding fiscal year] preceding 2 fiscal years in the case of 
the first report after the date of enactment of the SCREENS for 
Cancer Act of 2024, and preceding 5 fiscal years for each 
report thereafter, and making such recommendations for 
administrative and legislative initiatives with respect to this 
title as the Secretary determines to be appropriate, including 
recommendations regarding compliance by the States with section 
1501(a)(2) and with section 1504(c).

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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, such sums as may be 
necessary for each of the fiscal years 1995 through 2003, 
$225,000,000 for fiscal year 2008, $245,000,000 for fiscal year 
2009, $250,000,000 for fiscal year 2010, $255,000,000 for 
fiscal year 2011, [and] $275,000,000 for fiscal year 2012, and 
$275,000,000 for each of fiscal years 2025 through 2029.
  (b) Set-Aside for Technical Assistance and Provision of 
Supplies and Services.--Of the amounts appropriated under 
subsection (a) for a fiscal year, the Secretary shall reserve 
not more than 20 percent for carrying out section 1507.

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                                  [all]