[DOCID: f:hr076.110]
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110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-76
======================================================================
NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM
REAUTHORIZATION ACT OF 2007
_______
March 27, 2007.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Dingell, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 1132]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 1132) 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.............................................. 4
Background and Need for Legislation.............................. 4
Hearings......................................................... 6
Committee Consideration.......................................... 6
Committee Votes.................................................. 6
Committee Oversight Findings..................................... 6
Statement of General Performance Goals and Objectives............ 6
New Budget Authority, Entitlement Authority, and Tax Expenditures 6
Earmarks and Tax and Tariff Benefits............................. 6
Committee Cost Estimate.......................................... 6
Congressional Budget Office Estimate............................. 7
Federal Mandates Statement....................................... 8
Advisory Committee Statement..................................... 8
Constitutional Authority Statement............................... 8
Applicability to Legislative Branch.............................. 8
Section-by-Section Analysis of the Legislation................... 8
Changes in Existing Law Made by the Bill, as Reported............ 9
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 2007''.
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 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.'';
(3) in section 1508--
(A) in subsection (a), by striking ``evaluations of
the extent to which'' and all that follows through the
period and inserting: ``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.''; and
(B) in subsection (b), by striking ``not later than 1
year after the date on which amounts are first
appropriated pursuant to section 1509(a), and annually
thereafter'' and inserting ``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''; and
(4) in section 1510(a)--
(A) by striking ``and'' after ``$150,000,000 for
fiscal year 1994,''; and
(B) by inserting ``, $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'' before
the period at the end.
Purpose and Summary
H.R. 1132, the National Breast and Cervical Cancer Early
Detection Program Reauthorization of 2007, amends the Public
Health Service Act to provide a five-year reauthorization of
the National Breast and Cervical Cancer Early Detection Program
(NBCCEDP), and in addition, to provide waivers relating to
grants for preventive health measures concerning breast and
cervical cancers.
Background and Need for Legislation
Established by Congress in 1991, the 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 between the ages
of 40 to 64 for breast cancer screening and between the ages of
18 to 64 for cervical cancer screening. Services offered by the
program include mammograms, clinical breast examinations,
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.
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. As a
result, over half of all women screened by the program are
ethnic and racial minorities.
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. Breast cancer mortality has steadily decreased since the
late 1980s, a trend that experts attribute to increased
mammography screening. It is estimated that timely mammography
screening of all women over the age of 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 (NCI) of the National
Institutes of Health (NIH) has attributed this decline to
effective Pap smear screening.
In recognition of the clear value of breast and cervical
cancer screenings in reducing mortality from these diseases,
the NBCCEDP is part of a multifaceted 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
screening on more than 600,000 women annually.
In 2000, Congress passed the Breast and Cervical Cancer
Treatment and Prevention Act. That 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. While the emphasis on
service provision required by the 60/40 split is appropriate
for the vast majority of grantees, unique challenges exist in
implementing the required 60/40 split for programs serving
smaller populations. 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. For this reason, H.R. 1132 would allow for a
grant 60/40 requirement waiver for no more than five States.
This legislation 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 will
increase as a result of a 60/40 requirement waiver. The 60/40
requirement waiver will have a duration that is not less than
one year but not more than two years. Additionally, H.R. 1132
allows the Secretary of HHS to grant a State a waiver
extension, upon their request, for a period that is not less
than one year but not more than two years.
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
recommendations 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 2008 through 2012.
At the time of Committee consideration, this bill had 66
cosponsors and is supported by the Susan G. Komen Breast Cancer
Foundation and the American Cancer Society.
Hearings
The Committee on Energy and Commerce has not held hearings
on the legislation.
Committee Consideration
On Tuesday, March 13, 2007, the Subcommittee on Health met
in open markup session and approved H.R. 1132 for full
Committee consideration, amended, by voice vote. On Thursday,
March 15, 2007, the full Committee met in open markup session
and ordered H.R. 1132 favorably reported to the House, amended,
by voice vote.
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 record votes taken on amendments or in connection
with ordering H.R. 1132 reported. A motion by Mr. Dingell to
order H.R. 1132 favorably reported to the House, amended, was
agreed to by a voice vote.
Committee Oversight Findings
Regarding 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 goals and objectives of H.R. 1132 are to update and
reauthorize the National Breast and Cervical Cancer Early
Detection Program, granting the program increased flexibility
to continue to provide vital cancer screening and referral
services.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Regarding compliance with clause 3(c)(2) of rule XIII of
the Rules of the House of Representatives, the Committee finds
that H.R. 1132 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Earmarks and Tax and Tariff Benefits
Regarding compliance with clause 9 of rule XXI of the Rules
of the House of Representatives, H.R. 1132 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.
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, March 23, 2007.
Hon. John D. Dingell,
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. 1132, the National
Breast and Cervical Cancer Early Detection Program
Reauthorization Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Tim
Gronniger.
Sincerely,
Peter R. Orszag.
Enclosure.
H.R. 1132--National Breast and Cervical Cancer Early Detection Program
Reauthorization Act of 2007
H.R. 1132 would modify the Public Health Service Act to
authorize funding for programs to detect breast and cervical
cancer. The bill also would set rules and conditions for grants
to states for cervical and breast cancer detection programs,
and would specify circumstances under which the Secretary of
Health and Human Services could waive those rules. The bill
would authorize the appropriation of $225 million in 2008 and
$1.25 billion over the 2008-2012 period. ($202 million was
appropriated for those programs for 2007.)
Based on historical spending patterns for those activities,
and assuming appropriation of the specified amounts, CBO
estimates that implementing H.R. 1132 would cost $86 million in
2008 and $1 billion over the 2008-2012 period. Enacting H.R.
1132 would not affect direct spending or receipts.
H.R. 1132 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act, and in
some cases it would ease the conditions of grants that states
receive for programs to detect breast and cervical cancer.
The estimated budgetary impact of H.R. 1132 is shown in the
following table. The costs of this legislation fall within
budget function 550 (health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------
2007 2008 2009 2010 2011 2012
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law:
Budget Authority \1\.................................. 202 0 0 0 0 0
Estimated Outlays..................................... 198 122 35 9 1 0
Proposed Changes:
Authorization Level................................... 0 225 245 250 255 275
Estimated Outlays..................................... 0 86 191 230 245 258
Spending Under H.R. 1132:
Authorization Level \1\............................... 202 225 245 250 255 275
Estimated Outlays..................................... 198 208 226 239 246 258
----------------------------------------------------------------------------------------------------------------
\1\ The 2007 level is the amount appropriated for that year for programs to detect breast and cervical cancer.
The CBO staff contact for this estimate is Tim Gronniger.
Public- and private-sector mandate statements were prepared by
Leo Lex and Peter Richmond, respectively. This estimate was
approved by Peter H. Fontaine, Deputy 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
the provisions of Article I, section 8, clause 1 that relate to
expending funds to provide for the general welfare of the
United States.
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 as the ``National
Breast and Cervical Cancer Early Detection Program
Reauthorization Act of 2007.''
Section 2. National Breast and Cervical Cancer Early Detection Program
Section 2 amends title XV of the Public Health Service Act
(42 U.S.C. 300k et seq.) by updating the 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 Health and Human
Services may waive the 60/40 funding requirement for no more
than five States if the following conditions apply: (1) the
State will use the waiver to leverage non-Federal funds; (2)
keeping the 60/40 requirement in place will result in a barrier
to women seeking services; (3) the Secretary determines that
granting such a waiver will increase the number of women in the
State that receive screening services; (4) the State will
maintain the average annual level of State fiscal year
expenditures for screening services for the period for which
the waiver is granted at a level not less than 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 at the option of the State, and upon
approval by the Secretary, the average level of the State
expenditures for such services for the 3-fiscal-year period
preceding the first fiscal year for which the waiver is
granted; and (5) granting the waiver will not adversely affect
the quality of services available.
Section 2 provides that waivers will last for a period that
is not less than one year but not more than two years. The
Secretary may grant a renewal of a waiver for an additional
period, of not less than one year but not more than two years,
if the following applies: (1) without a waiver extension, a
barrier to eligible women will result; (2) the State will use
the waiver to leverage non-Federal funds; (3) the waiver has
increased, and will continue to increase, the number of women
receiving services; (4) the waiver has not adversely affected
the quality of services available; and (5) the State has
maintained the average annual level of fiscal expenditures for
the screening services for the fiscal year preceding the first
fiscal year for which the waiver was granted or, with approval
by the Secretary, the average level of the State expenditures
for the 3-fiscal-year period preceding the first fiscal year
for which the waiver was granted.
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 non-Federal entities in States that receive a
waiver; (2) for States that receive waivers, the percentage of
the grant that is spent on each service must be specified; (3)
States receiving waivers must be specified; and (4) States that
receive waivers must include a description of the number of
women receiving services as well as the average annual level of
State fiscal expenditures for these services for the year
preceding the first year for which the waiver was granted.
Furthermore, Section 2 includes a limitation requiring that a
waiver shall not be used to increase the number of salaried
employees.
Section 2 also includes a sunset whereby the Secretary may
not grant a waiver or extension after September 30, 2012.
Section 2 authorizes appropriations of $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.
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] 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 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 the extent to
which States carrying out such programs are in compliance with
section 1501(a)(2) and with section 1504(c).] 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 to Congress.--The Secretary shall, [not later than
1 year after the date on which amounts are first appropriated
pursuant to section 1509(a), and annually thereafter] 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, submit to the
Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Labor and Human
Resources of the Senate, a report summarizing evaluations
carried out pursuant to subsection (a) during the preceding
fiscal year 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).
* * * * * * *
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,
$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.
* * * * * * *
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