MDEs_STAR Draft_Attachment 01

ATTACHMENT 1

Public Law 101-354, The Breast and Cervical Cancer Mortality Prevention Act of 1990

Title 42. The Public Health and Welfare
Chapter 6a. The Public Health Service
Preventive Health Measures with Respect to Breast and Cervical Cancers
42 U.S.C. § 300k (1998)
§ 300k. 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 management1;
(3) to develop and disseminate public information and education programs for the
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 of breast and cervical cancer;
(5) to establish mechanisms through which the States can monitor the quality of
screening procedures for breast and cervical cancer, including the interpretation of such
procedures; and
(6) to evaluate activities conducted under paragraphs (1) through (5) 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 non profit 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
1

Italicized text shows changes made by the Women's Health Research and Prevention
Amendments of 1998, Public Law 105-340, signed October 31, 1998.

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that would be paid under part B of title XVIII of the Social Security Act [42 U.S.C. §§
1395j et seq.] 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)](c) Coordinating committee regarding year 2000 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. 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.
§ 300l. Requirement of matching funds
(a) In general. The Secretary may not make a grant under section 1501 [42 U.S.C. §
300k] unless the State involved agrees, with respect to the costs to be incurred by the State in
carrying out the purpose described in such section, to make available non-Federal contributions
(in cash or in kind under subsection (b)) toward such costs in an amount equal to not less than $1
for each $3 of Federal funds provided in the grant. Such contributions may be made directly or
through donations from public or private entities.
(b) Determination of amount of non-Federal contribution.
(1) In general. Non-Federal contributions required in subsection (a) 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.
(2) Maintenance of effort. In making a determination of the amount of non-Federal
contributions for purposes of subsection (a), the Secretary may include only non-Federal
contributions in excess of the average amount of non-Federal contributions made by the
State involved toward the purpose described in section 1501 [42 U.S.C. § 300k] for the
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2-year period preceding the first fiscal year for which the State is applying to receive a
grant under such section.
(3) Inclusion of relevant non-Federal contributions for Medicaid. In making a
determination of the amount of non-Federal contributions for purposes of subsection (a),
the Secretary shall, subject to paragraphs (1) and (2) of this subsection, include any
non-Federal amounts expended pursuant to title XIX of the Social Security Act [42
U.S.C. § 1396 et seq.] by the State involved toward the purpose described in paragraphs
(1) and (2) of section 1501(a) [42 U.S.C. § 300k(a)].
§ 300l-1. Requirement regarding medicaid
The Secretary may not make a grant under section 1501 [42 U.S.C. § 300k] for a program in a
State unless the State plan under title XIX of the Social Security Act [42 U.S.C. §§ 1396 et seq.]
for the State includes the screening procedures specified in subparagraphs (A) and (B) of section
1503(a)(2) [42 U.S.C. § 300m(a)(2)(A), (B)] as medical assistance provided under the plan.
§ 300m. 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 [42 U.S.C. § 300k] 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) [42
U.S.C. § 300k(a)], including making available screening procedures for both breast and
cervical cancers;
(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) 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) [42 U.S.C. § 300k(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 [42 U.S.C. § 300k] 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.

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(c) Quality assurance regarding screening procedures. The Secretary may not make a
grant under section 1501 [42 U.S.C. § 300k] 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.
§ 300n. Additional required agreements
(a) Priority for low-income women. The Secretary may not make a grant under section
1501 [42 U.S.C. § 300k] unless the State involved agrees that low-income women will be given
priority in the provision of services and activities pursuant to paragraphs (1) and (2) of section
1501(a) [42 U.S.C. § 300k(a)].
(b) Limitation on imposition of fees for services. The Secretary may not make a grant
under section 1501 [42 U.S.C. § 300k] unless the State involved agrees that, if a charge is
imposed for the provision of services or activities under the grant, such charge-(1) will be made according to a schedule of charges that is made available to the
public;
(2) will be adjusted to reflect the income of the woman involved; and
(3) will not be imposed on any woman with an income of less than 100 percent of
the official poverty line, as established by the Director of the Office of Management and
Budget and revised by the Secretary in accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981 [42 U.S.C. § 9902(2)].
(c) Statewide provision of services.
(1) In general. The Secretary may not make a grant under section 1501 [42 U.S.C.
§ 300k] unless the State involved agrees that services and activities under the grant will be
made available throughout the State, including availability to members of any Indian tribe
or tribal organization (as such terms are defined in section 4 of the Indian
Self-Determination and Education Assistance Act [25 U.S.C. § 450b]).
(2) Waiver. The Secretary may waive the requirement established in paragraph (1)
for a State if the Secretary determines that compliance by the State with the requirement
would result in an inefficient allocation of resources with respect to carrying out the
purpose described in section 1501(a) [42 U.S.C. § 300k(a)].
(3) Grants to tribes and tribal organizations.
(A) The Secretary, acting through the Director of the Centers for Disease
Control and Prevention, may make grants to tribes and tribal organizations (as
such terms are used in paragraph (1)) for the purpose of carrying out programs
described in section 1501(a) [42 U.S.C. § 300k(a)]. This title applies to such a
grant (in relation to the jurisdiction of the tribe or organization) to the same extent
and in the same manner as such title applies to a grant to a State under section
1501 [42 U.S.C. § 300k] (in relation to the jurisdiction of the State).
(B) If a tribe or tribal organization is receiving a grant under subparagraph
(A) and the State in which the tribe or organization is located is receiving a grant
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under section 1501 [42 U.S.C. § 300k], the requirement established in paragraph
(1) for the State regarding the tribe or organization is deemed to have been waived
under paragraph (2).
(d) Relationship to items and services under other programs. The Secretary may not make
a grant under section 1501 [42 U.S.C. § 300k] unless the State involved agrees 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.
(e) Coordination with other breast and cervical cancer programs. The Secretary may not
make a grant under section 1501 [42 U.S.C. § 300k] unless the State involved agrees that the
services and activities funded through the grant shall be coordinated with other Federal, State, and
local breast and cervical cancer programs.
(f) Limitation on administrative expenses. The Secretary may not make a grant under
section 1501 [42 U.S.C. § 300k] unless the State involved agrees that not more than 10 percent
of the grant will be expended for administrative expenses with respect to the grant.
(g) Restrictions on use of grant. The Secretary may not make a grant under section 1501
[42 U.S.C. § 300k] unless the State involved agrees that the grant will not be expended to provide
inpatient hospital services for any individual.
(h) Records and audits. The Secretary may not make a grant under section 1501 [42
U.S.C. § 300k] unless the State involved agrees that-(1) the State will establish such fiscal control and fund accounting procedures as
may be necessary to ensure the proper disbursal of, and accounting for, amounts received
by the State under such section; and
(2) upon request, the State will provide records maintained pursuant to paragraph
(1) to the Secretary or the Comptroller of the United States for purposes of auditing the
expenditures by the State of the grant.
(I) Reports to Secretary. The Secretary may not make a grant under section 1501 [42
U.S.C. § 300k] unless the State involved agrees to submit to the Secretary such reports as the
Secretary may require with respect to the grant.
§ 300n-1. Description of intended uses of grant
The Secretary may not make a grant under section 1501 [42 U.S.C. § 300k] unless-(1) the State involved submits to the Secretary a description of the purposes for which the
State intends to expend the grant;
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(2) the description identifies the populations, areas, and localities in the State with a need
for the services or activities described in section 1501(a) [42 U.S.C. § 300k(a)];
(3) the description provides information relating to the services and activities to be
provided, including a description of the manner in which the services and activities will be
coordinated with any similar services or activities of public and nonprofit private entities; and
(4) the description provides assurances that the grant funds will be used in the most
cost-effective manner.
§ 300n-2. Requirement of submission of application
The Secretary may not make a grant under section 1501 [42 U.S.C. § 300k] unless an application
for the grant is submitted to the Secretary, the application contains the description of intended
uses required in section 1505 [42 U.S.C. § 300n-1], and the application is in such form, is made in
such manner, and contains such agreements, assurances, and information as the Secretary
determines to be necessary to carry out this title [42 U.S.C. §§ 300k et seq.].
§ 300n-3. Technical assistance and provision of supplies and services in lieu of grant funds
(a) Technical assistance. The Secretary may provide training and technical assistance with
respect to the planning, development, and operation of any program or service carried out
pursuant to section 1501 [42 U.S.C. § 300k]. The Secretary may provide such technical
assistance directly or through grants to, or contracts with, public and private entities.
(b) Provision of supplies and services in lieu of grant funds.
(1) In general. Upon the request of a State receiving a grant under section 1501
[42 U.S.C. § 300k], the Secretary may, subject to paragraph (2), provide supplies,
equipment, and services for the purpose of aiding the State in carrying out such section
and, for such purpose, may detail to the State any officer or employee of the Department
of Health and Human Services.
(2) Corresponding reduction in payments. With respect to a request described in
paragraph (1), the Secretary shall reduce the amount of payments under the grant under
section 1501 [42 U.S.C. § 300k] to the State involved by an amount equal to the costs of
detailing personnel (including pay, allowances, and travel expenses) and the fair market
value of any supplies, equipment, or services provided by the Secretary. The Secretary
shall, for the payment of expenses incurred in complying with such request, expend the
amounts withheld.
§ 300n-4. Evaluations and reports
(a) Evaluations. The Secretary shall, directly or through contracts with public private
entities, provide for annual evaluations of programs carried out pursuant to section 1501 [42
U.S.C. § 300k]. Such evaluations shall include evaluations of the extent to which States carrying

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out such programs are in compliance with section 1501(a)(2) [42 U.S.C. § 300k(a)(2)] and with
section 1504(c) [42 U.S.C. § 300n(c)].
(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) [42 U.S.C. § 300n-5(a)], 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 [42
U.S.C. §§ 300k et seq.] as the Secretary determines to be appropriate, including
recommendations regarding compliance by the States with section 1501(a)(2) [42 U.S.C. §
300k(a)(2)] and with section 1504(c) [42 U.S.C. § 300n(c)].
§ 300n-4a. Supplemental grants for additional preventive health services
(a) Demonstration projects. In the case of States receiving grants under section 1501 [42
U.S.C. § 300k], the Secretary, acting through the Director of the Centers for Disease Control and
Prevention, may make grants to not more than 3 such States to carry out demonstration projects
for the purpose of-(1) providing preventive health services in addition to the services authorized in
such section, including screenings regarding blood pressure and cholesterol, and including
health education;
(2) providing appropriate referrals for medical treatment of women receiving
services pursuant to paragraph (1) and ensuring, to the extent practicable, the provision of
appropriate follow-up services; and
(3) evaluating activities conducted under paragraphs (1) and (2) through
appropriate surveillance or program-monitoring activities.
(b) Status as participant in program regarding breast and cervical cancer. The Secretary
may not make a grant under subsection (a) unless the State involved agrees that services under the
grant will be provided only through entities that are screening women for breast or cervical cancer
pursuant to a grant under section 1501 [42 U.S.C. § 300k].
(c) Applicability of provisions of general program. This title [42 U.S.C. §§ 300k et seq.]
applies to a grant under subsection (a) to the same extent and in the same manner as such title
applies to a grant under section 1501[42 U.S.C. § 300k].
(d) Funding.
(1) In general. Subject to paragraph (2), for the purpose of carrying out this
section, there are authorized to be appropriated $ 3,000,000 for fiscal year 1994, and such
sums as may be necessary for each of the fiscal years 1995 through 2003.
(2) Limitation regarding funding with respect to breast and cervical cancer. The
authorization of appropriations established in paragraph (1) is not effective for a fiscal year
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unless the amount appropriated under section 1510(a) [42 U.S.C. § 300n-5(a)] for the
fiscal year is equal to or greater than $ 100,000,000.
§ 300n-5. Funding for general program
(a) Authorization of appropriations. For the purpose of carrying out this title [42 U.S.C.
§§ 300k et seq.], 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.
(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 [42 U.S.C. § 300n-3].

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