HR 4541 — To reauthorize the Young Women’s Breast Health Education and Awareness Requires Learning Young Act of 2009.

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

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TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

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PART V--PROGRAMS RELATING TO BREAST HEALTH AND CANCER

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SEC. 399NN. YOUNG WOMEN'S BREAST HEALTH AWARENESS AND SUPPORT OF YOUNG 
 WOMEN DIAGNOSED WITH BREAST CANCER.

 (a) Public Education Campaign.--
 (1) In general.--The Secretary, acting through the 
 Director of the Centers for Disease Control and 
 Prevention, shall conduct a national evidence-based 
 education campaign to increase awareness of young 
 women's knowledge regarding--
 (A) breast health in young women of all 
 racial, ethnic, and cultural backgrounds;
 (B) breast awareness and good breast health 
 habits;
 (C) the occurrence of breast cancer and the 
 general and specific risk factors in women who 
 may be at high risk for breast cancer based on 
 familial, racial, ethnic, and cultural 
 backgrounds such as Ashkenazi Jewish 
 populations;
 (D) evidence-based information that would 
 encourage young women and their health care 
 professional to increase early detection of 
 breast cancers; and
 (E) the availability of health information 
 and other resources for young women diagnosed 
 with breast cancer.
 (2) Evidence-based, age appropriate messages.--The 
 campaign shall provide evidence-based, age-appropriate 
 messages and materials as developed by the Centers for 
 Disease Control and Prevention and the Advisory 
 Committee established under paragraph (4).
 (3) Media campaign.--In conducting the education 
 campaign under paragraph (1), the Secretary shall award 
 grants to entities to establish national multimedia 
 campaigns oriented to young women that may include 
 advertising through television, radio, print media, 
 billboards, posters, all forms of existing and 
 especially emerging social networking media, other 
 Internet media, and any other medium determined 
 appropriate by the Secretary.
 (4) Advisory committee.--
 (A) Establishment.--Not later than 60 days 
 after the date of the enactment of this 
 section, the Secretary, acting through the 
 Director of the Centers for Disease Control and 
 Prevention, shall establish an advisory 
 committee to assist in creating and conducting 
 the education campaigns under paragraph (1) and 
 subsection (b)(1).
 (B) Membership.--The Secretary, acting 
 through the Director of the Centers for Disease 
 Control and Prevention, shall appoint to the 
 advisory committee under subparagraph (A) such 
 members as deemed necessary to properly advise 
 the Secretary, and shall include organizations 
 and individuals with expertise in breast 
 cancer, disease prevention, early detection, 
 diagnosis, public health, social marketing, 
 genetic screening and counseling, treatment, 
 rehabilitation, palliative care, and 
 survivorship in young women.
 (b) Health Care Professional Education Campaign.--The 
Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, and in consultation with the 
Administrator of the Health Resources and Services 
Administration, shall conduct an education campaign among 
physicians and other health care professionals to increase 
awareness--
 (1) of breast health, symptoms, and early diagnosis 
 and treatment of breast cancer in young women, 
 including specific risk factors such as family history 
 of cancer and women that may be at high risk for breast 
 cancer, such as Ashkenazi Jewish population;
 (2) on how to provide counseling to young women about 
 their breast health, including knowledge of their 
 family cancer history and importance of providing 
 regular clinical breast examinations;
 (3) concerning the importance of discussing healthy 
 behaviors, and increasing awareness of services and 
 programs available to address overall health and 
 wellness, and making patient referrals to address 
 tobacco cessation, good nutrition, and physical 
 activity;
 (4) on when to refer patients to a health care 
 provider with genetics expertise;
 (5) on how to provide counseling that addresses long-
 term survivorship and health concerns of young women 
 diagnosed with breast cancer; and
 (6) on when to provide referrals to organizations and 
 institutions that provide credible health information 
 and substantive assistance and support to young women 
 diagnosed with breast cancer.
 (c) Prevention Research Activities.--The Secretary, acting 
through--
 (1) the Director of the Centers for Disease Control 
 and Prevention, shall conduct prevention research on 
 breast cancer in younger women, including--
 (A) behavioral, survivorship studies, and 
 other research on the impact of breast cancer 
 diagnosis on young women;
 (B) formative research to assist with the 
 development of educational messages and 
 information for the public, targeted 
 populations, and their families about breast 
 health, breast cancer, and healthy lifestyles;
 (C) testing and evaluating existing and new 
 social marketing strategies targeted at young 
 women; and
 (D) surveys of health care providers and the 
 public regarding knowledge, attitudes, and 
 practices related to breast health and breast 
 cancer prevention and control in high-risk 
 populations; and
 (2) the Director of the National Institutes of 
 Health, shall conduct research to develop and validate 
 new screening tests and methods for prevention and 
 early detection of breast cancer in young women.
 (d) Support for Young Women Diagnosed With Breast Cancer.--
 (1) In general.--The Secretary shall award grants to 
 organizations and institutions to provide health 
 information from credible sources and substantive 
 assistance directed to young women diagnosed with 
 breast cancer and pre-neoplastic breast diseases.
 (2) Priority.--In making grants under paragraph (1), 
 the Secretary shall give priority to applicants that 
 deal specifically with young women diagnosed with 
 breast cancer and pre-neoplastic breast disease.
 (e) No Duplication of Effort.--In conducting an education 
campaign or other program under subsections (a), (b), (c), or 
(d), the Secretary shall avoid duplicating other existing 
Federal breast cancer education efforts.
 (f) Measurement; Reporting.--The Secretary, acting through 
the Director of the Centers for Disease Control and Prevention, 
shall--
 (1) measure--
 (A) young women's awareness regarding breast 
 health, including knowledge of family cancer 
 history, specific risk factors and early 
 warning signs, and young women's proactive 
 efforts at early detection;
 (B) the number or percentage of young women 
 utilizing information regarding lifestyle 
 interventions that foster healthy behaviors;
 (C) the number or percentage of young women 
 receiving regular clinical breast exams; and
 (D) the number or percentage of young women 
 who perform breast self exams, and the 
 frequency of such exams, before the 
 implementation of this section;
 (2) not less than every 3 years, measure the impact 
 of such activities; and
 (3) submit reports to the Congress on the results of 
 such measurements.
 (g) Definition.--In this section, the term ``young women'' 
means women 15 to 44 years of age.
 (h) Authorization of Appropriations.--To carry out 
subsections (a), (b), (c)(1), and (d), there are authorized to 
be appropriated $9,000,000 for each of fiscal years 2022 
through [2026] 2031.

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 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] 
 programs 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 screenings, such as 
 navigation of health care services, implementation of 
 evidence-based or evidence-informed strategies to 
 increase breast and cervical cancer screening in health 
 care settings, and facilitation of access to health 
 care settings;
 (7) to reduce disparities in breast and cervical 
 cancer incidence, morbidity, and mortality, including 
 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.]

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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 consistent with relevant 
 evidence-based 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.]

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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 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 2025, 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 2025, 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] 2011, $275,000,000 for fiscal year 
2012, and $235,500,000 for each of fiscal years 2026 through 
2030.
 (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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