,,ii #aaith ,,congress #b;d ,session ,s4 #eedf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #bd1 #bjbf,mrs4 ,murray 7for herself1 ,mrs4 ,shaheen1 ,mrs4 ,gillibrand1 ,mr4 ,blumenthal1 ,mr4 ,gallego1 ,mr4 ,booker1 ,mr4 ,van ,hollen1 ,ms4 ,baldwin1 ,ms4 ,klobuchar1 ,ms4 ,rosen1 ,mr4 ,wyden1 ,mr4 ,merkley1 ,mr4 ,whitehouse1 ,mr4 ,schiff1 and ,ms4 ,duckworth7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to provide women with increased access to preventive and life-saving cancer screening4 #a4 ,short title ,this ,act may be cited as the ,jeanette ,acosta ,invest in ,women's ,health ,act of #bjbf4 #b4 ,purpose ,it is the purpose of this ,act to provide women with increased access to preventive and life-saving cancer screening 7including clinical breast exams and breast1 cervical1 ovarian1 uterine1 vaginal1 and vulvar cancer screening71 as well as access to appropriate care and early detection 7including via diagnostic testing and treatment and provider education and awareness of best clinical practices71 provided by leading women's health care providers who-- 7#a7 serve populations most at risk of lacking access to preventive care2 and 7#b7 play an outsized role in the prevention and detection of cancer in order to serve the goal of increasing access to quality health screenings1 care1 and services1 reducing health care disparities and mortality rates among low-income women and women of color1 decreasing health care spending1 and expanding health literacy1 access1 and education about the benefits of regular preventive cancer screening for women4 #c4 ,findings ,congress finds as follows3 7#a7 ,breast cancer is the most common cancer in women in the ,united ,states and is the leading cause of cancer death in women aged #bj to #di in the ,united ,states4 7#b7 ,ovarian cancer causes more deaths than any other cancer of the female reproductive system1 but it accounts for only about #a4a percent of all cancers in women4 7#c7 ,there will be an estimated #dci1egj new cases of breast and gynecological cancers in the ,united ,states in #bjbf4 7#d7 ,rates of incidence and death for gynecologic cancers by race and ethnicity show that1 while for some cancers1 like ovarian cancer1 the rates of incidence and death are similar among all races1 for other cancers1 like cervical cancer1 women of color have disproportionate incidence and mortality rates4 ,while the incidence of uterine cancer is similar for ,white women and women of color1 rates of death for uterine cancer are #b times higher for ,black women than for ,white women4 ,native ,hawaiian and ,pacific ,islander women experience death rates up to #c4c times higher than ,white women from cervical1 stomach1 and uterine cancers4 7#e7 ,breast cancer rates are rising faster in ,asian ,american and ,pacific ,islander women than in any other racial or ethnic group in the ,united ,states4 7#f7 ,cervical cancer incidence and mortality rates are higher for women living in rural and underserved regions in the ,united ,states4 ,women living in such areas face unique barriers in accessing reproductive health care services to prevent and treat cervical cancer1 including a lack of practicing gynecologists in rural areas and challenges around transportation to preventive and follow-up appointments4 7#g7 ,prevention and cancer screening are the best approaches to protecting women from cancer and ensuring early detection and life-saving treatment4 ,many deaths from breast and cervical cancers could be avoided if cancer screening rates and diagnostic care and services increased among women at risk4 ,deaths from such cancers occur disproportionately among women who are uninsured or underinsured4 7#h7 ,due to enhanced screening1 cervical cancer is now a much more preventable and treatable cancer4 ,it is also highly curable when found and treated early4 7#i7 ,increased access to education2 information1 including information on the human papillomavirus vaccine2 and preventive cancer screenings1 resulting in timely and adequate treatment1 increase women's ability to survive cancer4 7#aj7 ,while more than #bj percent of cases of cervical cancer are found in women over the age of #fe1 it becomes less likely that women are tested for cervical cancer ever or within the previous #e years as their age increases4 7#aa7 ,women's health care providers that are primarily engaged in family planning services1 such as ,planned ,parenthood health centers1 provide necessary screening tests1 education1 and information to women1 especially women of color who face the highest risks of breast cancer and other gynecologic cancers4 7#ab7 ,access to preventive gynecological screening is also critical for transgender men who have comparable rates of susceptibility to cervical cancer as cisgender women1 but often have less access to preventive screenings4 7#ac7 ,discrimination and racism in health care continues to contribute to disparate rates of gynecological cancer in non-,white women4 ,black1 ,indigenous1 and other women of color die at higher rates from cervical cancer than ,white women1 even though fewer women overall die from cervical cancer4 7#ad7 ,black women with endometrial cancer often receive surgery less often than ,white women and are more likely to be diagnosed at an advanced stage of the disease1 contributing to disparities in mortality in ,black women4 #d4 ,strengthening access to cancer screening for women ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,p the following3 #cag,p-#a4 ,grants for women's health care providers 7a7 ,in general ,the ,secretary is authorized to make grants and to enter into contracts with public or nonprofit private entities to expand preventive health services1 including the cancer screening services required to be covered by group health plans and health insurance coverage pursuant to section #bgac7;a77#d74 ,in awarding such grants1 the ,secretary shall seek to increase access to critical1 life-saving cancer screening1 cervical cytology 7commonly referred to as ,pap tests71 human papillomavirus tests1 human papillomavirus and ,pap cotests1 self-collection for human papillomavirus testing1 human papillomavirus vaccinations1 and diagnostic tests for women with cancer symptoms1 particularly women of color4 7b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #bj1jjj1jjj for each of fiscal years #bjbg through #bjbi4 4 #e4 ,expanding cancer screening provider training ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq471 as amended by section #d1 is further amended by inserting after section #cag,p-#a the following3 #cag,p-#b4 ,women's health care providers demonstration training project 7a7 ,establishment of program ,the ,secretary shall establish a demonstration program to award #c-year grants to eligible entities for the training of physicians1 nurse practitioners1 physician assistants1 and other health care providers related to life-saving breast and gynecologic cancer screening for women1 including appropriate follow-up care and screening for abnormal results4 7b7 ,purpose ,the purpose of the program under this section is to enable each grant recipient to-- 7#a7 provide to licensed physicians1 nurse practitioners1 physician assistants1 and other health care providers1 through clinical training1 education1 and practice1 the most up-to-date clinical guidelines1 research1 and recommendations adopted by the ,united ,states ,preventive ,services ,task ,force in the area of preventive cancer screening for breast and gynecologic cancers1 including for women with dense breast tissue2 7#b7 establish a model of training for physicians1 nurse practitioners1 physician assistants1 and other health care providers that specialize in women's health care1 with a specific focus on breast and gynecologic cancer screening and follow up care1 that may be replicated nationwide2 7#c7 train physicians1 nurse practitioners1 physician assistants1 and other health care providers to serve rural and underserved communities1 low-income communities1 and communities of color in breast and gynecologic cancer screening and follow up care2 and 7#d7 provide implicit bias1 cultural competency1 and patient-centered communication training covering the ways in which structural racism and discrimination manifest within the medical field and perpetuate racial disparities in gynecologic cancer incidence and mortality rates and how to communicate with patients through a knowledgeable and culturally empathetic lens4 7c7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be-- 7#a7 an entity that receives funding under section #ajja or section #ajjc2 7#b7 an essential community provider1 as defined in section #aef4bce of title #de1 ,code of ,federal ,regulations 7or any successor regulations71 that is primarily engaged in family planning2 7#c7 an entity that furnishes items or services to individuals enrolled in a ,state ,medicaid program or waiver of such a plan2 or 7#d7 an entity that1 at the time of application1 provides cancer screening services under the ,national ,breast and ,cervical ,cancer ,early ,detection ,program under title ,,xv4 4 #f4 ,study and report to ,congress on increased cancer screening for women 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall-- 7#a7 conduct a study 7and periodically update such study7 on increased access to women's preventive life-saving cancer screenings across the ,united ,states2 and 7#b7 not later than #b years after the date of enactment of this ,act1 and every #e years thereafter1 submit a report to ,congress on such study4 7b7 ,contents ,the study and reports under subsection 7a7 shall include-- 7#a7 an analysis of breast and gynecologic cancer rates among women across all #ej ,states1 the ,district of ,columbia1 and the territories1 including by geographic area1 income1 employment status1 race1 ethnicity1 and status of insurance coverage2 7#b7 an analysis of cancer screenings provided by women's health care providers across all #ej ,states1 the ,district of ,columbia1 and the territories1 including clinical breast exams1 other screening for breast cancer1 and screening for cervical cancer1 ovarian cancer1 and other gynecologic cancers2 7#c7 with respect to women with disproportionate rates of gynecological cancers1 or who are less likely to receive screenings and care1 and broken down by categories of such women that include ,black women2 ,hispanic and ,latina women2 ,asian ,american1 ,native ,hawaiian1 and ,pacific ,islander women2 older women2 uninsured and underinsured women2 and women living in rural and underserved areas-- 7,a7 an analysis of the awareness1 availability1 and uptake of breast1 cervical1 ovarian1 and other gynecological cancer screening options2 7,b7 an analysis of how access to health care providers trained under the program described in section #cag,p-#b of the ,public ,health ,service ,act1 as added by section #e1 in comparison to other health care providers1 increased early detection of cancer and quality of cancer care for such women2 and 7,c7 recommendations for increasing screening rates for such women who are less likely to be screened or treated for breast1 cervical1 ovarian1 and other gynecological cancers2 7#d7 an analysis of how structural racism impacts access to cancer screening services1 correlates to the development of breast1 cervical1 ovarian1 and other gynecological cancers1 and exacerbates health care disparities for ,black women2 ,hispanic and ,latina women2 ,asian ,american1 ,native ,hawaiian1 and ,pacific ,islander women2 and other women of color2 7#e7 in consultation with the ,comptroller ,general of the ,united ,states1 estimated ,federal savings achieved through early detection of breast and gynecologic cancers2 7#f7 recommendations by the ,secretary with respect to the need for continued increased access to women's health care providers1 such as the entities described in section #cag,p-#b7;c7 of the ,public ,health ,service ,act1 as added by section #e1 who provide preventive care1 including life-saving cancer screenings2 and 7#g7 an evaluation of the demonstration project on co-testing for human papillomavirus and cervical cancer under section #cag,p-#c of the ,public ,health ,service ,act1 as added by section #g1 including the results of the demonstration project and a recommendation on whether expansion of the co-testing model described in such section #cag,p-#c would be advised in order to promote early intervention1 screening uptake1 and reduce cervical cancer deaths and racial and ethnic disparities4 #g4 ,demonstration project on co-testing for human papillomavirus and cervical cancer ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq471 as amended by section #e1 is further amended by inserting after section #cag,p-#b the following3 #cag,p-#c4 ,demonstration project on co-testing for human papillomavirus and cervical cancer 7a7 ,in general ,the ,secretary1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention and the ,administrator of the ,health ,resources and ,services ,administration1 as appropriate1 shall establish a #b-year demonstration project on increasing the cervical cancer screening co-testing of human papillomavirus and cervical cytology 7commonly referred to as ,pap tests7 to develop models for increasing the rates of co-testing among women with disproportionate rates of cervical cancer1 including ,black women2 ,hispanic and ,latina women2 and ,asian ,american1 ,native ,hawaiian1 and ,pacific ,islander women4 7b7 ,use of funds ,entities receiving an award under this section shall use such award to-- 7#a7 increase access to co-testing of human papillomavirus testing and cervical cancer among patients with disproportionate rates of cervical cytology1 including ,black women2 ,hispanic and ,latina women2 and ,asian ,american1 ,native ,hawaiian1 and ,pacific ,islander women2 7#b7 support culturally and linguistically appropriate delivery models to such patients1 including through the provision of interpretation services2 or 7#c7 provide other services to improve health outcomes with respect to such patients4 7c7 ,prioritization ,in making awards under this section1 the ,secretary shall give priority to eligible entities serving low-income1 uninsured1 or medically underserved populations 7as defined in section #ccj7;b77#c77 or populations with historically low rates of such co-testing1 such as older women4 7d7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be an entity described in section #cag,p-#b7;c74 4