Jeanette Acosta Invest in Women’s Health Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3129 To provide women with increased access to preventive and life-saving cancer screening. IN THE HOUSE OF REPRESENTATIVES JUNE 5, 2019 Mr. GOMEZ (for himself, Mr. AGUILAR, Ms. BARRAGA´N, Ms. BROWNLEY of California, Mr. DANNY K. DAVIS of Illinois, Mrs. DEMINGS, Ms. ESCOBAR, Ms. HAALAND, Mr. HASTINGS, Ms. JACKSON LEE, Mr. KHANNA, Ms. LEE of California, Mr. LUJA´N, Mrs. CAROLYN B. MALO- NEY of New York, Ms. MOORE, Mr. MORELLE, Mr. MOULTON, Ms. MUCARSEL-POWELL, Ms. NORTON, Mr. PETERS, Miss RICE of New York, Ms. SCHAKOWSKY, Mr. SOTO, Ms. VELA´ZQUEZ, Ms. WASSERMAN SCHULTZ, Mr. WELCH, Ms. PRESSLEY, Mr. BLUMENAUER, Mr. HIGGINS of New York, Mr. RASKIN, Mrs. FLETCHER, and Mr. GRIJALVA) intro- duced the following bill; which was referred to the Committee on Energy and Commerce 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 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 3129 IH SEC. 2. PURPOSE. 1 It is the purpose of this Act to provide women with 2 increased access to preventive and life-saving cancer 3 screening, including clinical breast exams and cervical, 4 ovarian, uterine, vaginal, and vulvar cancer screening, pro- 5 vided by leading women’s health care providers who— 6 (1) serve populations most at risk; and 7 (2) play an outsized role in the prevention and 8 detection of cancer in order to serve the goal of re- 9 ducing health care disparities among low-income 10 women and women of color, decrease health care 11 spending, and expand health literacy, access, and 12 education about the benefits of regular preventive 13 cancer screening for women. 14 SEC. 3. FINDINGS. 15 Congress finds as follows: 16 (1) Breast cancer is the leading cause of cancer 17 death in women under the age of 54, and the Amer- 18 ican Cancer Society recommends that women in 19 their 20s and 30s have a clinical breast exam at 20 least every 3 years. 21 (2) Ovarian cancer causes more deaths than 22 any other cancer of the female reproductive system, 23 but it accounts for only about 3 percent of all can- 24 cers in women. 25 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 3129 IH (3) The cancers that most frequently impact 1 women include breast, uterine, ovarian, and cervical 2 cancer, and there were 331,394 new cases of these 3 cancers in 2015. 4 (4) Rates of incidence and death for gynecologic 5 cancers by race and ethnicity show that, while for 6 some cancers, like ovarian cancer, the rates of inci- 7 dence and death are similar among all races, for 8 other cancers, like cervical cancer, women of color 9 have a disproportionate rate of incidence. While the 10 incidence of uterine cancer is similar for White 11 women and women of color, rates of death for uter- 12 ine cancer are 2 times higher for Black women than 13 for White women. 14 (5) Prevention and cancer screening are the 15 best approaches to protecting women from cancer 16 and ensuring early detection and life-saving treat- 17 ment. Many deaths from breast and cervical cancers 18 could be avoided if cancer screening rates and diag- 19 nostic care and services increased among women at 20 risk. Deaths from these cancers occur disproportion- 21 ately among women who are uninsured or under- 22 insured. 23 (6) Due to enhanced screening, cervical cancer, 24 which used to be the leading cause of cancer death 25 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 3129 IH for women in the United States, is now a much more 1 preventable and treatable cancer. It is also highly 2 curable when found and treated early. 3 (7) Increased access to education, information, 4 and preventive cancer screening increase women’s 5 ability to survive cancer. 6 (8) While more than 15 percent of cases of cer- 7 vical cancer are found in women over the age of 65, 8 it becomes less likely that women are tested for cer- 9 vical cancer ever or within the previous 5 years as 10 their age increases. 11 (9) Women’s health care providers that are pri- 12 marily engaged in family planning services, such as 13 Planned Parenthood health centers, provide nec- 14 essary screening tests, education, and information to 15 women, especially women of color who face the high- 16 est risks of breast cancer and other gynecologic can- 17 cers. 18 SEC. 4. STRENGTHENING ACCESS TO CANCER SCREENING 19 FOR WOMEN. 20 (a) IN GENERAL.—Part B of title III of the Public 21 Health Service Act (42 U.S.C. 243 et seq.) is amended 22 by inserting after section 317P the following: 23 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 3129 IH ‘‘SEC. 317P–1. GRANTS FOR WOMEN’S HEALTH CARE PRO- 1 VIDERS. 2 ‘‘(a) IN GENERAL.—The Secretary is authorized to 3 make grants and to enter into contracts with public or 4 nonprofit private entities to expand preventive health serv- 5 ices, as provided for in the Preventive Services Guidelines 6 of the Health Resources and Service Administration that 7 were in effect on October 30, 2017, with an emphasis on 8 increasing access to critical, life-saving cancer screening, 9 Pap tests, human papillomavirus vaccination, and diag- 10 nostic tests for women with cancer symptoms, particularly 11 women of color. 12 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 13 is authorized to be appropriated to carry out this section, 14 $20,000,000 for each of fiscal years 2020 through 2023.’’. 15 (b) FUNDING.—There is authorized to be appro- 16 priated to carry out programs related to breast and 17 gynecologic cancers under title XIX of the Social Security 18 Act (42 U.S.C. 1396 et seq.) and title X of the Public 19 Health Service Act (42 U.S.C. 300 et seq.), and the Na- 20 tional Breast and Cervical Cancer Early Detection Pro- 21 gram, such sums as may be necessary for each of fiscal 22 years 2020 through 2023. 23 SEC. 5. EXPAND CANCER SCREENING PROVIDER TRAINING. 24 Part B of title III of the Public Health Service Act 25 (42 U.S.C. 243 et seq.), as amended by section 4, is fur- 26 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 3129 IH ther amended by inserting after section 317P–1 the fol- 1 lowing: 2 ‘‘SEC. 317P–2. WOMEN’S HEALTH CARE PROVIDERS DEM- 3 ONSTRATION TRAINING PROJECT. 4 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 5 shall establish a demonstration program (referred to in 6 this section as the ‘program’) to award 3-year grants to 7 eligible entities for the training of physicians, nurse practi- 8 tioners, and other health care providers related to life-sav- 9 ing breast and gynecologic cancer screening for women. 10 ‘‘(b) PURPOSE.—The purpose of the program is to 11 enable each grant recipient to— 12 ‘‘(1) provide to licensed physicians, nurse prac- 13 titioners, and other health care providers, through 14 clinical training, education, and practice, the most 15 up-to-date clinical guidelines and research adopted 16 by the National Academies of Sciences, Engineering, 17 and Medicine in the area of preventive cancer 18 screening for breast and gynecologic cancers; 19 ‘‘(2) establish a model of training for physi- 20 cians, nurse practitioners, and other health care pro- 21 viders that specializes in women’s health care, with 22 a specific focus on breast and gynecologic cancer 23 screening, that may be replicated nationwide; and 24 VerDate Sep 11 2014 04:43 Jun 14, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 3129 IH ‘‘(3) train physicians, nurse practitioners, and 1 other health care providers to serve rural commu- 2 nities, low-income communities, and communities of 3 color in breast and gynecologic cancer screening. 4 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to receive 5 a grant under this section, an entity shall be— 6 ‘‘(1) an entity that receives funding under sec- 7 tion 1001; 8 ‘‘(2) an essential community provider primarily 9 engaged in family planning, as defined in section 10 156.235 of title 45, Code of Federal Regulations (or 11 any successor regulations); 12 ‘‘(3) an entity that furnishes items or services 13 to individuals who are eligible for medical assistance 14 under title XIX of the Social Security Act; or 15 ‘‘(4) an entity that, at the time of application, 16 provides cancer screening services under the Na- 17 tional Breast and Cervical Cancer Early Detection 18 Program of the Centers for Disease Control and 19 Prevention.’’. 20 SEC. 6. STUDY AND REPORT TO CONGRESS ON INCREASED 21 CANCER SCREENING FOR WOMEN. 22 (a) IN GENERAL.—The Secretary of Health and 23 Human Services (referred to in this section as the ‘‘Sec- 24 retary’’) shall conduct a study (and periodically update 25 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 3129 IH such study) on increased access to women’s preventive life- 1 saving cancer screening across the United States, and, not 2 later than January 1, 2025, and every 5 years thereafter, 3 the Secretary shall submit a report to Congress on such 4 study. 5 (b) CONTENTS.—The study and reports under sub- 6 section (a) shall include: 7 (1) A 50-State analysis of breast and 8 gynecologic cancer rates among women, including by 9 geographic area, income, race, and status of insur- 10 ance coverage. 11 (2) A 50-State analysis of cancer screening pro- 12 vided by women’s health care providers, including 13 clinical breast exams, other screening for breast can- 14 cer, and screening for cervical cancer, ovarian can- 15 cer, and other gynecologic cancers. 16 (3) An analysis of the awareness and avail- 17 ability of breast, cervical, ovarian, and other gyneco- 18 logical cancer screening options for women with dis- 19 proportionate rates of gynecological cancers, includ- 20 ing African-American women, Hispanic and Latina 21 women, and other disproportionately impacted 22 groups, according to the 50-State analyses described 23 in paragraphs (1) and (2). 24 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 3129 IH (4) In consultation with the Comptroller Gen- 1 eral of the United States, estimated Federal savings 2 achieved through early detection of breast and 3 gynecologic cancer. 4 (5) Analysis of how access to health care pro- 5 viders trained under the program described in sec- 6 tion 317P–2 of the Public Health Service Act, as 7 added by section 5, in comparison to other health 8 care providers, increased early detection of cancer 9 for women. 10 (6) Recommendations by the Secretary with re- 11 spect to the need for continued increased access to 12 women’s health care providers, such as the entities 13 described in section 317P–2(c) of the Public Health 14 Service Act, as added by section 4, who provide pre- 15 ventive care, including life-saving cancer screening. 16 (7) Recommendations for increasing screening 17 rates for women who are less likely to be screened 18 or treated for breast, cervical, ovarian, and other 19 gynecological cancers, including African-American 20 women, Hispanic and Latina women, and older 21 women. 22 VerDate Sep 11 2014 19:50 Jun 12, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 3129 IH SEC. 7. DEMONSTRATION PROJECT ON CO-TESTING FOR 1 HUMAN PAPILLOMAVIRUS AND CERVICAL 2 CANCER. 3 Part B of title III of the Public Health Service Act 4 (42 U.S.C. 243 et seq.), as amended by section 5, is fur- 5 ther amended by inserting after section 317P–2 the fol- 6 lowing: 7 ‘‘SEC. 317P–3. DEMONSTRATION PROJECT ON CO-TESTING 8 FOR HUMAN PAPILLOMAVIRUS AND CER- 9 VICAL CANCER. 10 ‘‘(a) IN GENERAL.—The Secretary, in coordination 11 with the Director of the Centers for Disease Control and 12 Prevention and the Administrator of the Health Resources 13 and Services Administration, shall establish a 2-year dem- 14 onstration project on increasing the co-testing of human 15 papillomavirus and cervical cancer screenings to develop 16 models for increasing the rates of co-testing among women 17 with disproportionate rates of cervical cancer, including 18 African-American and Hispanic and Latina women. 19 ‘‘(b) USE OF FUNDS.—Entities receiving funds under 20 this section shall use such funds to— 21 ‘‘(1) increase access to co-testing of Human 22 papillomavirus and cervical cancer among patients 23 with disproportionate rates of cervical cancer, in- 24 cluding African-American and Hispanic and Latina 25 women; 26 VerDate Sep 11 2014 04:43 Jun 14, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 3129 IH ‘‘(2) support culturally and linguistically appro- 1 priate delivery models to such patients, including 2 through the provision of interpretation services; or 3 ‘‘(3) provide other services to improve health 4 outcomes with respect to such patients. 5 ‘‘(c) PRIORITIZATION.—Priority for funding available 6 under this section shall be given to entities serving low- 7 income, uninsured, and medically underserved populations 8 or populations with historically low rates of such co-test- 9 ing, such as older women. 10 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 11 a grant under this section, an entity shall be an entity 12 described in section 317P–2(c).’’. 13 Æ VerDate Sep 11 2014 05:11 Jun 14, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H3129.IH H3129 pamtmann on DSKBFK8HB2PROD with BILLS