Jeanette Acosta Invest in Women’s Health Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1735 To provide women with increased access to preventive and life-saving cancer screening. IN THE SENATE OF THE UNITED STATES JUNE 5, 2019 Mrs. MURRAY (for herself, Ms. BALDWIN, Mrs. GILLIBRAND, Mrs. SHAHEEN, Mr. BOOKER, Ms. HARRIS, Mr. WYDEN, Mr. MERKLEY, Mr. PETERS, Ms. ROSEN, Ms. KLOBUCHAR, and Mr. BLUMENTHAL) introduced the fol- lowing bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To provide women with increased access to preventive and life-saving cancer screening. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Jeanette Acosta Invest 4 in Women’s Health Act of 2019’’. 5 SEC. 2. PURPOSE. 6 It is the purpose of this Act to provide women with 7 increased access to preventive and life-saving cancer 8 screening, including clinical breast exams and cervical, 9 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1735 IS ovarian, uterine, vaginal, and vulvar cancer screening, pro- 1 vided by leading women’s health care providers who— 2 (1) serve populations most at risk; and 3 (2) play an outsized role in the prevention and 4 detection of cancer in order to serve the goal of re- 5 ducing health care disparities among low-income 6 women and women of color, decrease health care 7 spending, and expand health literacy, access, and 8 education about the benefits of regular preventive 9 cancer screening for women. 10 SEC. 3. FINDINGS. 11 Congress finds as follows: 12 (1) Breast cancer is the leading cause of cancer 13 death in women under the age of 54, and the Amer- 14 ican Cancer Society recommends that women in 15 their 20s and 30s have a clinical breast exam at 16 least every 3 years. 17 (2) Ovarian cancer causes more deaths than 18 any other cancer of the female reproductive system, 19 but it accounts for only about 3 percent of all can- 20 cers in women. 21 (3) The cancers that most frequently impact 22 women include breast, uterine, ovarian, and cervical 23 cancer, and there were 331,394 new cases of these 24 cancers in 2015. 25 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1735 IS (4) Rates of incidence and death for gynecologic 1 cancers by race and ethnicity show that, while for 2 some cancers, like ovarian cancer, the rates of inci- 3 dence and death are similar among all races, for 4 other cancers, like cervical cancer, women of color 5 have a disproportionate rate of incidence. While the 6 incidence of uterine cancer is similar for White 7 women and women of color, rates of death for uter- 8 ine cancer are 2 times higher for Black women than 9 for White women. 10 (5) Prevention and cancer screening are the 11 best approaches to protecting women from cancer 12 and ensuring early detection and life-saving treat- 13 ment. Many deaths from breast and cervical cancers 14 could be avoided if cancer screening rates and diag- 15 nostic care and services increased among women at 16 risk. Deaths from these cancers occur disproportion- 17 ately among women who are uninsured or under- 18 insured. 19 (6) Due to enhanced screening, cervical cancer, 20 which used to be the leading cause of cancer death 21 for women in the United States, is now a much more 22 preventable and treatable cancer. It is also highly 23 curable when found and treated early. 24 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1735 IS (7) Increased access to education, information, 1 and preventive cancer screening increase women’s 2 ability to survive cancer. 3 (8) While more than 15 percent of cases of cer- 4 vical cancer are found in women over the age of 65, 5 it becomes less likely that women are tested for cer- 6 vical cancer ever or within the previous 5 years as 7 their age increases. 8 (9) Women’s health care providers that are pri- 9 marily engaged in family planning services, such as 10 Planned Parenthood health centers, provide nec- 11 essary screening tests, education, and information to 12 women, especially women of color who face the high- 13 est risks of breast cancer and other gynecologic can- 14 cers. 15 SEC. 4. STRENGTHENING ACCESS TO CANCER SCREENING 16 FOR WOMEN. 17 (a) IN GENERAL.—Part B of title III of the Public 18 Health Service Act (42 U.S.C. 243 et seq.) is amended 19 by inserting after section 317P the following: 20 ‘‘SEC. 317P–1. GRANTS FOR WOMEN’S HEALTH CARE PRO- 21 VIDERS. 22 ‘‘(a) IN GENERAL.—The Secretary is authorized to 23 make grants and to enter into contracts with public or 24 nonprofit private entities to expand preventive health serv- 25 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1735 IS ices, as provided for in the Preventive Services Guidelines 1 of the Health Resources and Service Administration that 2 were in effect on October 30, 2017, with an emphasis on 3 increasing access to critical, life-saving cancer screening, 4 Pap tests, human papillomavirus vaccination, and diag- 5 nostic tests for women with cancer symptoms, particularly 6 women of color. 7 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 8 is authorized to be appropriated to carry out this section, 9 $20,000,000 for each of fiscal years 2020 through 2023.’’. 10 (b) FUNDING.—There is authorized to be appro- 11 priated to carry out programs related to breast and 12 gynecologic cancers under title XIX of the Social Security 13 Act (42 U.S.C. 1396 et seq.) and title X of the Public 14 Health Service Act (42 U.S.C. 300 et seq.), and the Na- 15 tional Breast and Cervical Cancer Early Detection Pro- 16 gram, such sums as may be necessary for each of fiscal 17 years 2020 through 2023. 18 SEC. 5. EXPAND CANCER SCREENING PROVIDER TRAINING. 19 Part B of title III of the Public Health Service Act 20 (42 U.S.C. 243 et seq.), as amended by section 4, is fur- 21 ther amended by inserting after section 317P–1 the fol- 22 lowing: 23 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1735 IS ‘‘SEC. 317P–2. WOMEN’S HEALTH CARE PROVIDERS DEM- 1 ONSTRATION TRAINING PROJECT. 2 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 3 shall establish a demonstration program (referred to in 4 this section as the ‘program’) to award 3-year grants to 5 eligible entities for the training of physicians, nurse practi- 6 tioners, and other health care providers related to life-sav- 7 ing breast and gynecologic cancer screening for women. 8 ‘‘(b) PURPOSE.—The purpose of the program is to 9 enable each grant recipient to— 10 ‘‘(1) provide to licensed physicians, nurse prac- 11 titioners, and other health care providers, through 12 clinical training, education, and practice, the most 13 up-to-date clinical guidelines and research adopted 14 by the National Academies of Sciences, Engineering, 15 and Medicine in the area of preventive cancer 16 screening for breast and gynecologic cancers; 17 ‘‘(2) establish a model of training for physi- 18 cians, nurse practitioners, and other health care pro- 19 viders that specializes in women’s health care, with 20 a specific focus on breast and gynecologic cancer 21 screening, that may be replicated nationwide; and 22 ‘‘(3) train physicians, nurse practitioners, and 23 other health care providers to serve rural commu- 24 nities, low-income communities, and communities of 25 color in breast and gynecologic cancer screening. 26 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 1735 IS ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to receive 1 a grant under this section, an entity shall be— 2 ‘‘(1) an entity that receives funding under sec- 3 tion 1001; 4 ‘‘(2) an essential community provider primarily 5 engaged in family planning, as defined in section 6 156.235 of title 45, Code of Federal Regulations (or 7 any successor regulations); 8 ‘‘(3) an entity that furnishes items or services 9 to individuals who are eligible for medical assistance 10 under title XIX of the Social Security Act; or 11 ‘‘(4) an entity that, at the time of application, 12 provides cancer screening services under the Na- 13 tional Breast and Cervical Cancer Early Detection 14 Program of the Centers for Disease Control and 15 Prevention.’’. 16 SEC. 6. STUDY AND REPORT TO CONGRESS ON INCREASED 17 CANCER SCREENING FOR WOMEN. 18 (a) IN GENERAL.—The Secretary of Health and 19 Human Services (referred to in this section as the ‘‘Sec- 20 retary’’) shall conduct a study (and periodically update 21 such study) on increased access to women’s preventive life- 22 saving cancer screening across the United States, and, not 23 later than January 1, 2025, and every 5 years thereafter, 24 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 1735 IS the Secretary shall submit a report to Congress on such 1 study. 2 (b) CONTENTS.—The study and reports under sub- 3 section (a) shall include: 4 (1) A 50-State analysis of breast and 5 gynecologic cancer rates among women, including by 6 geographic area, income, race, and status of insur- 7 ance coverage. 8 (2) A 50-State analysis of cancer screening pro- 9 vided by women’s health care providers, including 10 clinical breast exams, other screening for breast can- 11 cer, and screening for cervical cancer, ovarian can- 12 cer, and other gynecologic cancers. 13 (3) An analysis of the awareness and avail- 14 ability of breast, cervical, ovarian, and other gyneco- 15 logical cancer screening options for women with dis- 16 proportionate rates of gynecological cancers, includ- 17 ing African-American women, Hispanic and Latina 18 women, and other disproportionately impacted 19 groups, according to the 50-State analyses described 20 in paragraphs (1) and (2). 21 (4) In consultation with the Comptroller Gen- 22 eral of the United States, estimated Federal savings 23 achieved through early detection of breast and 24 gynecologic cancer. 25 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 1735 IS (5) Analysis of how access to health care pro- 1 viders trained under the program described in sec- 2 tion 317P–2 of the Public Health Service Act, as 3 added by section 5, in comparison to other health 4 care providers, increased early detection of cancer 5 for women. 6 (6) Recommendations by the Secretary with re- 7 spect to the need for continued increased access to 8 women’s health care providers, such as the entities 9 described in section 317P–2(c) of the Public Health 10 Service Act, as added by section 4, who provide pre- 11 ventive care, including life-saving cancer screening. 12 (7) Recommendations for increasing screening 13 rates for women who are less likely to be screened 14 or treated for breast, cervical, ovarian, and other 15 gynecological cancers, including African-American 16 women, Hispanic and Latina women, and older 17 women. 18 SEC. 7. DEMONSTRATION PROJECT ON CO-TESTING FOR 19 HUMAN PAPILLOMAVIRUS AND CERVICAL 20 CANCER. 21 Part B of title III of the Public Health Service Act 22 (42 U.S.C. 243 et seq.), as amended by section 5, is fur- 23 ther amended by inserting after section 317P–2 the fol- 24 lowing: 25 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 1735 IS ‘‘SEC. 317P–3. DEMONSTRATION PROJECT ON CO-TESTING 1 FOR HUMAN PAPILLOMAVIRUS AND CER- 2 VICAL CANCER. 3 ‘‘(a) IN GENERAL.—The Secretary, in coordination 4 with the Director of the Centers for Disease Control and 5 Prevention and the Administrator of the Health Resources 6 and Services Administration, shall establish a 2-year dem- 7 onstration project on increasing the co-testing of human 8 papillomavirus and cervical cancer screenings to develop 9 models for increasing the rates of co-testing among women 10 with disproportionate rates of cervical cancer, including 11 African-American and Hispanic and Latina women. 12 ‘‘(b) USE OF FUNDS.—Entities receiving funds under 13 this section shall use such funds to— 14 ‘‘(1) increase access to co-testing of Human 15 papillomavirus and cervical cancer among patients 16 with disproportionate rates of cervical cancer, in- 17 cluding African American and Hispanic and Latina 18 women; 19 ‘‘(2) support culturally- and linguistically-ap- 20 propriate delivery models to such patients, including 21 through the provision of interpretation services; or 22 ‘‘(3) provide other services to improve health 23 outcomes with respect to such patients. 24 ‘‘(c) PRIORITIZATION.—Priority for funding available 25 under this section shall be given to entities serving low- 26 VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 1735 IS income, uninsured, and medically underserved populations 1 or populations with historically low rates of such co-test- 2 ing, such as older women. 3 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 4 a grant under this section, an entity shall be an entity 5 described in section 317P–2(c).’’. 6 Æ VerDate Sep 11 2014 22:02 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S1735.IS S1735 pamtmann on DSKBFK8HB2PROD with BILLS