110th CONGRESS
1st Session
H. R. 1738
To amend the Public Health Service Act to establish a national
screening program at the Centers for Disease Control and Prevention and
to amend title XIX of the Social Security Act to provide States the option
to provide medical assistance for men and women screened and found to have
colorectal cancer or colorectal polyps.
IN THE HOUSE OF REPRESENTATIVES
March 28, 2007
Ms. GRANGER (for herself and Mr. WYNN) introduced the following bill; which
was referred to the Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act to establish a national
screening program at the Centers for Disease Control and Prevention and
to amend title XIX of the Social Security Act to provide States the option
to provide medical assistance for men and women screened and found to have
colorectal cancer or colorectal polyps.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Colorectal Cancer Prevention, Early Detection,
and Treatment Act of 2007'.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Colorectal cancer is the second leading cause of cancer deaths in
the United States for men and women combined.
(2) According to the American Cancer Society, in 2007, an estimated 153,760
new cases of colorectal cancer will be diagnosed in the United States
and this cancer will kill an estimated 52,180 individuals, constituting
almost 10 percent of all cancer deaths.
(3) Screening and early detection saves lives. When colorectal cancer
is diagnosed at an early stage, the 5-year survival rate is 90 percent.
(4) When colorectal cancer is not diagnosed until it has spread to distant
organs, the 5-year survival rate drops to 10 percent.
(5) Only 39 percent of colorectal cancer patients have their cancers detected
at an early stage.
(6) Despite the scientific evidence supporting the effectiveness of screening,
there is only a 50 percent screening rate of people in the United States
who are 50 years of age and older.
(7) Only 21 percent of those without health coverage in the United States
have currently been screened for colorectal cancer.
(8) Far too many avoidable deaths are occurring from a disease that can
be prevented through the early identification and removal of pre-cancerous
polyps, detectable only through colorectal cancer screenings.
(9) The Centers for Disease Control and Prevention is in its ninth year
of the Screen for Life: National Colorectal Cancer Action Campaign, which
informs men and women aged 50 years or older about the importance of having
regular colorectal cancer screening tests.
(10) If adults in the United States had received colorectal cancer screenings
as recommended, at least 31,500 deaths would have been prevented and 338,000
years of life would be gained this year.
(11) Colorectal cancer screening has been shown to be more cost effective
than screening for breast cancer and screening for cervical cancer, with
the potential to save between 30,000 and 44,000 lives a year if all individuals
who are 50 years of age or older got screened for colorectal cancer.
(12) Treatment costs for colorectal cancer are extremely high, and could
be significantly reduced with widespread screening for colorectal cancer.
Costs associated with treatment for colorectal cancer are estimated at
$8,400,000,000 for 2004.
(13) Colorectal cancer screening is not only life saving, it is cost-effective.
If recommended screenings were provided to an increased number of people
in the United States who are between the ages of 50 years and 64 years
of age, there would be a significant savings of billions of dollars to
the Medicare program in screening and treatment costs.
(14) In 2005, the Centers for Disease Control and Prevention established
a demonstration colorectal cancer screening program at five sites across
the United States to learn about the feasibility of delivering screening
and follow-up services to the population of low-income, uninsured, and
underinsured individuals. The demonstration program has already produced
many findings that can inform a national effort to screen this population
for colorectal cancer.
SEC. 2. PREVENTIVE HEALTH MEASURES WITH RESPECT TO COLORECTAL CANCER.
Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.)
is amended by inserting after section 317S the following new section:
`SEC. 317T. PREVENTIVE HEALTH MEASURES WITH RESPECT TO COLORECTAL CANCER.
`(a) Grant Program Authorization-
`(1) IN GENERAL- The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, may make grants to eligible entities
for the purpose of carrying out a program described in subsection (b).
An eligible entity that is a recipient of a grant under this subsection
may use such grant to carry out such programs directly or through grants
to, or contracts with, public and not-for-profit private entities.
`(2) ELIGIBLE ENTITY DEFINED- For purposes of this section, the term `eligible
entity' includes the following:
`(A) A State, including, in addition to the several States, the District
of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana
Islands, the Virgin Islands, American Samoa, and the Trust Territory
of the Pacific Islands.
`(B) An Indian tribe or tribal organization, as such terms are defined
in section 4 of the Indian Self-Determination and Education Assistance
Act.
`(1) IN GENERAL- Subject to paragraph (2), a program described in this
subsection is a program for planning or implementing the following:
`(A) Providing screenings for colorectal cancer to individuals who--
`(i) are 50 years of age or older; or
`(ii)(I) are under 50 years of age; and
`(II) are at high risk for such cancer.
`(B) Providing appropriate case management and referrals for medical
treatment of individuals screened pursuant to subparagraph (A).
`(C) Ensuring (directly or through coordination or an arrangement with
health care providers or programs) the full continuum of followup and
cancer care for individuals so screened, including appropriate follow-up
for abnormal tests, diagnostic services, therapeutic services, and treatment
of detected cancers and management of unanticipated medical complications.
`(D) Carrying out activities to improve the education, training, and
skills of health professionals (including allied health professionals)
in the detection and control of colorectal cancer, which activities
are carried out pursuant to the participation of the health professionals
in the program.
`(E) Establishing mechanisms through which the eligible entity involved
can monitor the quality of screening and diagnostic follow-up procedures
for colorectal cancer, including the interpretation of such procedures.
`(F) Evaluating the activities described in this subsection through
appropriate surveillance and program monitoring activities.
`(G) Developing and disseminating findings derived through such evaluations
and the collection of data on outcomes.
`(H) Developing and disseminating public information and education programs
for the detection and control of colorectal cancer and promoting the
benefits of receiving screenings through this program.
`(2) SUPPLEMENT NOT SUPPLANT- In the case of an eligible entity that implements
a universal colorectal screening program that funds activities described
in subparagraph (A), (B), or (C) of paragraph (1), such entity shall be
able to receive grant funds under subsection (a) only for purposes of--
`(A) carrying out those activities under this subsection that are not
so funded; or
`(B) supplementing (and not supplanting) funds made available by the
entity for such funded program.
`(c) Priority for Low-Income, Uninsured and Underinsured Individuals- A
grant may be made under subsection (a) to an eligible entity only if the
eligible entity agrees that, in providing screenings under subsection (b)(1)(A),
the eligible entity will give priority to low-income individuals who lack
adequate coverage under health insurance and health plans with respect to
screenings for colorectal cancer.
`(d) Special Consideration for Certain Applicants- In making grants under
subsection (a) for a fiscal year, the Secretary shall give special consideration
to the following eligible entities:
`(1) In the case of services under such subsection for women, to such
entities that, for such year, are grantees under title XV.
`(2) In the case of services under such subsection for men, to such entities
that, for such year, are grantees under section 317D.
`(3) To such entities that coordinate with other Federal, State, and local
colorectal cancer programs.
`(4) To such entities with an existing program to provide cancer screening
to individuals.
`(e) Use of Certain Standards Under Medicare Program- A grant may be made
under subsection (a) to an eligible entity only if the eligible entity provides,
as applicable, assurances as follows:
`(1) Screenings under subsection (b)(1)(A) will be carried out as preventive
health measures in accordance with evidence-based screening guidelines
and procedures as specified in section 1861(pp)(1) of the Social Security
Act.
`(2) An individual will be considered high risk for purposes of subsection
(b)(1)(A)(ii) only if the individual is high risk within the meaning of
section 1861(pp)(2) of such Act.
`(3) The payment made from the grant for a screening procedure under subsection
(b)(1)(A) will not exceed the amount that would be paid under part B of
title XVIII of such Act if payment were made under such part for furnishing
the procedure to an individual enrolled under such part.
`(f) Relationship to Items and Services Under Other Programs- A grant under
subsection (a) may be made to an eligible entity only if the eligible entity,
as applicable, provides assurances that the grant will not be expended to
make payment for any item or service to the extent that payment has been
made, or can reasonably be expected to be made, with respect to such item
or service--
`(1) under any State compensation program, under an insurance policy,
or under any Federal or State health benefits program; or
`(2) by an entity that provides health services on a prepaid basis.
`(g) Records and Audits- A grant under subsection (a) may be made to an
eligible entity only if the eligible entity provides assurances that the
eligible entity will--
`(1) establish such fiscal control and fund accounting procedures as may
be necessary to ensure proper disbursal of, and accounting for, amounts
received under subsection (a); and
`(2) upon request, provide records maintained pursuant to paragraph (1)
to the Secretary or the Comptroller General of the United States for purposes
of auditing the expenditures of the grant by the eligible entity.
`(h) Requirement of Matching Funds-
`(1) IN GENERAL- The Secretary may not make a grant under subsection (a)
to an eligible entity for a fiscal year unless the eligible entity agrees,
with respect to the costs to be incurred by the eligible entity for such
fiscal year in carrying out the activities described in subsection (b),
to make available non-Federal contributions (in cash or in kind under
paragraph (2)) toward such costs in an amount equal to not less than $1
for each $3 of Federal funds provided in the grant for such fiscal year.
Such contributions may be made directly or through donations from public
or private entities.
`(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION-
`(A) IN GENERAL- Non-Federal contributions required in paragraph (1)
may be in cash or in kind, fairly evaluated, including equipment or
services (and excluding indirect or overhead costs). Amounts provided
by the Federal Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not be included in
determining the amount of such non-Federal contributions.
`(B) MAINTENANCE OF EFFORT- In making a determination of the amount
of non-Federal contributions for purposes of paragraph (1), the Secretary
may include only non-Federal contributions in excess of the average
amount of non-Federal contributions made by the eligible entity involved
toward the activities described in subsection (b) for the 2-year period
preceding the first fiscal year for which the eligible entity is applying
to receive a grant under subsection (a).
`(C) INCLUSION OF RELEVANT NON-FEDERAL CONTRIBUTIONS FOR MEDICAID- In
making a determination of the amount of non-Federal contributions for
purposes of paragraph (1), the Secretary shall, subject to subparagraphs
(A) and (B) of this paragraph, include any non-Federal amounts expended
pursuant to title XIX of the Social Security Act by the eligible entity
involved toward the activities described in subparagraphs (A) and (B)
of subsection (b)(1).
`(i) Additional Requirements-
`(1) LIMITATION ON ADMINISTRATIVE EXPENSES- The Secretary may not make
a grant to an eligible entity under subsection (a) unless the eligible
entity provides assurances that not more than 10 percent of the grant
will be expended for administrative expenses with respect to the activities
funded by the grant.
`(2) STATEWIDE PROVISION OF SERVICES-
`(A) IN GENERAL- Subject to subparagraph (B), the Secretary may not
make a grant under subsection (a) to an eligible entity unless the eligible
entity provides assurances that any program funded by such grant will
be made available throughout the State, including availability to members
of an Indian tribe or tribal organization (as such terms are defined
in section 4 of the Indian Self-Determination and Education Assistance
Act).
`(B) WAIVER- The Secretary may waive the requirement under subparagraph
(A) for an eligible entity if the Secretary determines that compliance
by the eligible entity with the requirement would result in an inefficient
allocation of resources with respect to carrying out the purposes described
in subsection (a).
`(j) Technical Assistance and Provision of Supplies and Services in Lieu
of Grant Funds-
`(1) TECHNICAL ASSISTANCE- The Secretary may provide training and technical
assistance with respect to the planning, development, and operation of
any program funded by a grant under subsection (a). The Secretary may
provide such technical assistance directly to eligible entities or through
grants to, or contracts with, public and private entities.
`(2) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS-
`(A) IN GENERAL- Subject to subparagraph (B), upon the request of an
eligible entity receiving a grant under subsection (a), the Secretary
for the purpose of aiding the eligible entity to carry out a program
under subsection (b)--
`(i) may provide supplies, equipment, and services to the eligible
entity; and
`(ii) may detail to the eligible entity any officer or employee of
the Department of Health and Human Services.
`(B) CORRESPONDING REDUCTION IN PAYMENTS- With respect to a request
made by an eligible entity under subparagraph (A), the Secretary shall
reduce the amount of payments made under the grant under subsection
(a) to the eligible entity by an amount equal to the fair market value
of any supplies, equipment, or services provided by the Secretary and
the costs of detailing personnel (including pay, allowances, and travel
expenses) under subparagraph (A). The Secretary shall, for the payment
of expenses incurred in complying with such request, expend the amounts
withheld.
`(k) Reports- A grant under subsection (a) may be made only if the applicant
involved agrees to submit to the Secretary such reports as the Secretary
may require with respect to the grant.
`(l) Authorization of Appropriations-
`(1) IN GENERAL- For the purpose of carrying out this section, there are
authorized to be appropriated $50,000,000 for fiscal year 2008, and such
sums as may be necessary for each of the fiscal years 2009 through 2012.
`(2) SET-ASIDE FOR TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND
SERVICES- Of the amount appropriated under paragraph (1) for a fiscal
year, the Secretary shall reserve not to exceed 20 percent for carrying
out subsection (j).'.
SEC. 3. OPTIONAL MEDICAID COVERAGE OF CERTAIN PERSONS SCREENED AND FOUND
TO HAVE COLORECTAL CANCER.
(a) Coverage as Optional Categorically Needy Group-
(1) IN GENERAL- Section 1902(a)(10)(A)(ii) of the Social Security Act
(42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
(A) in subclause (XVIII), by striking `or' at the end;
(B) in subclause (XIX), by adding `or' at the end; and
(C) by adding at the end the following:
`(XX) who are described in subsection (dd) (relating to certain
persons screened and found to need treatment from complications
from screening or have colorectal cancer);'.
(2) GROUP DESCRIBED- Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended by adding at the end the following:
`(dd) Individuals described in this subsection are individuals who--
`(1) are not described in subsection (a)(10)(A)(i);
`(2) have not attained age 65;
`(3) have been screened for colorectal cancer and need treatment for complications
due to screening or colorectal cancer; and
`(4) are not otherwise covered under creditable coverage, as defined in
section 2701(c) of the Public Health Service Act.'.
(3) LIMITATION ON BENEFITS- Section 1902(a)(10) of the Social Security
Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph
(G)--
(A) by striking `and (XIV)' and inserting `(XIV)'; and
(B) by inserting `, and (XV) the medical assistance made available to
an individual described in subsection (dd) who is eligible for medical
assistance only because of subparagraph (A)(10)(ii)(XX) shall be limited
to medical assistance provided during the period in which such an individual
requires treatment for complications due to screening or colorectal
cancer' before the semicolon.
(4) CONFORMING AMENDMENTS- Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended in the matter preceding paragraph (1)--
(A) in clause (xii), by striking `or' at the end;
(B) in clause (xiii), by adding `or' at the end; and
(C) by inserting after clause (xiii) the following:
`(xiv) individuals described in section 1902(dd),'.
(b) Presumptive Eligibility-
(1) IN GENERAL- Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) is amended by inserting after section 1920B the following:
`OPTIONAL APPLICATION OF PRESUMPTIVE ELIGIBILITY PROVISIONS FOR CERTAIN
PERSONS WITH COLORECTAL CANCER
`Sec. 1920C. A State may elect to apply the provisions of section 1920B
to individuals described in section 1902(dd) (relating to certain colorectal
cancer patients) in the same manner as such section applies to individuals
described in section 1902(aa) (relating to certain breast or cervical cancer
patients).'.
(2) CONFORMING AMENDMENTS-
(A) Section 1902(a)(47) of the Social Security Act (42 U.S.C. 1396a(a)(47))
is amended--
(i) by striking `and' after `section 1920' and inserting a comma;
(ii) by striking `and' after `with such section' and inserting a comma;
and
(iii) by inserting before the semicolon at the end the following:
`, and provide for making medical assistance available to individuals
described in section 1920C during a presumptive eligibility period
in accordance with such section'.
(B) Section 1903(u)(1)(d)(v) of such Act (42 U.S.C. 1396b(u)(1)(d)(v))
is amended--
(i) by striking `or for' and inserting `, for'; and
(ii) by inserting before the period the following: `, or for medical
assistance provided to an individual described in section 1920C during
a presumptive eligibility period under such section'.
(e) Enhanced Match- The first sentence of section 1905(b) of the Social
Security Act (42 U.S.C. 1396d(b)) is amended--
(1) by striking `and' before `(4)'; and
(2) by inserting before the period at the end the following: `, and (5)
the Federal medical assistance percentage shall be equal to the enhanced
FMAP described in section 2105(b) with respect to medical assistance provided
to individuals who are eligible for such assistance only on the basis
of section 1902(a)(10)(A)(ii)(XX)'.
(f) Effective Date- The amendments made by this section apply to medical
assistance for items and services furnished on or after October 1, 2007,
without regard to whether final regulations to carry out such amendments
have been promulgated by such date.
END
