Closing the Health Care Gap Act of 2004 - Requires specified agencies to: (1) standardize health care quality measures across all Federal government programs; (2) standardize public reporting requirements; and (3) support data collection and reporting efforts in Federal and State agencies.
Allows the Secretary of Health and Human Services to award grants to improve access to health care for health care disparity populations and to support efforts to increase the enrollment and participation of eligible children in Medicaid and the State Children's Health Insurance Program.
Changes the name of the Office of Minority Health to the Office of Minority Health and Health Disparities and changes the duties of the Office and its associated advisory committee to include health disparities as a problem to study and address.
Provides grants to support: (1) health professions education for racial or ethnic minorities or health disparity populations; and (2) curricula development for cultural competency training.
Requires the Director of the Office of Minority Health and Health Disparities to: (1) develop and maintain an Internet clearinghouse to improve health care quality for individuals with specific cultural needs, limited English proficiency, or low functional health literacy; and (2) reduce or eliminate the duplication of efforts to translate materials.
Authorizes grants or assistance for and establishes programs and projects to address: (1) the analysis of the causes and sources of health care disparities and strategies to reduce disparities; (2) disease management; (3) the effective measurement of disparities; (4) the analysis and collection of health disparity data; and (5) the recruitment of minority scientists or research professionals to the health disparity field.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2091 Introduced in Senate (IS)]
108th CONGRESS
2d Session
S. 2091
To improve the health of health disparity populations.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 12, 2004
Mr. Frist (for himself, Ms. Landrieu, Mr. Cochran, Mr. DeWine, Mr.
Bond, Mr. Warner, Mr. Talent, and Mrs. Hutchison) introduced the
following bill; which was read twice and referred to the Committee on
Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To improve the health of health disparity populations.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Closing the Health
Care Gap Act of 2004''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND
ANALYSIS
Sec. 101. Standardized measures of quality health care.
Sec. 102. Data collection.
TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE
Sec. 201. Access and awareness grants.
Sec. 202. Innovative outreach programs.
TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION
Sec. 301. Office of Minority Health and Health Disparities.
TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING
Sec. 401. Workforce diversity and training.
Sec. 402. Higher education technical amendments.
Sec. 403. Model cultural competency curriculum development.
Sec. 404. Internet cultural competency clearinghouse.
TITLE V--ENHANCED RESEARCH
Sec. 501. Agency for Healthcare Research and Quality.
Sec. 502. National Institutes of Health.
TITLE VI--MISCELLANEOUS PROVISIONS
Sec. 601. Definitions.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The overall health of Americans has dramatically
improved over the last century, and Americans are justifiably
proud of the great strides that have been made in the health
and medical sciences.
(2) As medical science and technology have advanced at a
rapid pace, however, the health care delivery system has not
been able to provide consistently high quality care to all
Americans.
(3) In particular, people of lower socioeconomic status,
racial and ethnic minorities, and medically underserved
populations have experienced poor health and challenges in
accessing high quality health care.
(4) Recent studies have raised significant questions
regarding differences in clinical care provided to racial and
ethnic minorities and other health disparity populations. These
differences are often grouped together under the broad heading
of ``health disparities''.
(5) Studies indicate that a gap exists between ideal health
care and the actual health care that some Americans receive.
(6) Data collection, analysis, and reporting by race,
ethnicity, and primary language across federally supported
health programs are essential for identifying, understanding
the causes of, monitoring, and eventually eliminating health
disparities.
(7) Current health related data collection and reporting
activities largely reflect the efforts of the Department of
Health and Human Services. Despite considerable efforts by the
Department, data collection efforts governing racial, ethnic,
and health disparity populations remain inconsistent and
inadequate. They often quantify disparities but shed little
light on their causes.
(8) Many Americans, and particularly racial and ethnic
minorities and other health disparity populations, miss
opportunities for preventive medical care. Similarly,
management of chronic illnesses in these populations presents
unique challenges to the nation's health care system.
(9) The largest numbers of the medically underserved are
white individuals, and many of them have the same health care
access problems as do members of minority groups. Nearly
22,000,000 white individuals live below the poverty line with
many living in nonmetropolitan, rural areas such as Appalachia,
where the high percentage of countries designated as health
professional shortage areas (47 percent) and the high rate of
poverty contribute to disparity outcomes. However, there is a
higher proportion of racial and ethnic minorities in the United
States represented among the medically underserved.
(10) While much research examines the question of racial
and ethnic differences in health care, less is known about the
magnitude and extent of differences in the quality of health
care related to nonsocioeconomic factors. Only recently have
scientists and quality improvement experts begun to address the
issue of how best to measure, track, and improve quality of
health care in diverse populations. Additional research in order to
understand the causes of disparities and develop effective approaches
to eliminate these gaps in health care quality will be necessary.
(11) There is a need to ensure appropriate representation
of racial and ethnic minorities, and other health disparity
populations, in the health care professions and in the fields
of biomedical, clinical, behavioral, and health services
research.
(12) Preventable disparities in access to and quality of
health care are unacceptable. Health care delivered in the
United States should be care that is as safe, effective,
patient-centered, timely, efficient and equitable as possible.
TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND
ANALYSIS
SEC. 101. STANDARDIZED MEASURES OF QUALITY HEALTH CARE.
(a) In General.--
(1) Collaboration.--The Secretary of Health and Human
Services, the Secretary of Defense, the Secretary of Veterans
Affairs, the Director of the Indian Health Service, and the
Director of the Office of Personnel Management (referred to in
this section as the ``Secretaries'') shall work collaboratively
to establish uniform, standardized health care quality measures
across all Federal Government health programs. Such measures
shall be designed to assess quality improvement efforts with
regard to the safety, timeliness, effectiveness, patient-
centeredness, and efficiency of health care delivered across
all federally supported health care delivery programs including
those in which health care services are delivered to health
disparity populations.
(2) Development of measures.--Relying on earlier work by
the Secretary of Health and Human Services or others (including
work such as the Healthy People 2010 or the IOM Quality Chasm
reports) and with an emphasis on health conditions
disproportionately affecting health disparity populations and
taking into account health literacy and primary language and
cultural factors, the Secretaries shall develop standardized
sets of quality measures for--
(A) 5 common health conditions by not later than
January 1, 2006; and
(B) an additional 10 common health conditions by
not later than January 1, 2007.
(3) Pilot testing.--Each federally administered health care
program may conduct a pilot test of the quality measures
developed under paragraph (2) that shall include a collection
of patient-level data and a public release of comparative
performance reports.
(b) Public Reporting Requirements.--The Secretaries shall work
collaboratively to establish standardized public reporting requirements
for clinicians, institutional providers, and health plans in each of
the health programs described in subsection (a).
(c) Full Implementation.--The Secretaries shall work
collaboratively to prepare for the full implementation of all
standardized sets of quality measures and reporting systems developed
under subsections (a) and (b) by not later than January 1, 2009.
(d) Progress Report.--The Secretary of Health and Human Services
shall prepare an annual progress report that details the collaborative
efforts carried out under subsection (a).
(e) Comparative Quality Reports.--Beginning on January 1, 2008, in
order to make comparative quality information available to health care
consumers, including members of health disparity populations, health
professionals, public health officials, researchers, and other
appropriate individuals and entities, the Secretaries shall provide for
the pooling and analysis of quality measures collected under this
section. Nothing in this section shall be construed as modifying the
privacy standards under the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191).
(f) Ongoing Evaluation of Use.--The Secretary of Health and Human
Services shall ensure the ongoing evaluation of the use of the health
care quality measures established under this section.
(g) Existing Activities.--Notwithstanding any other provision of
law, the standardized measures and reporting activities described in
this section shall replace, to the extent practicable and appropriate,
any existing measurement and reporting activities currently utilized by
federally supported health care delivery programs.
(h) Evaluation.--
(1) Institute of medicine.--
(A) In general.--The Secretary of Health and Human
Services shall request the Institute of Medicine to
conduct an evaluation of the collaborative efforts of
the Secretaries to establish uniform, standardized
health care quality measures and reporting requirements
for federally supported health care delivery programs
as required under this section.
(B) Report.--Not later than 2 years after the date
of enactment of this Act, the Institute of Medicine
shall submit a report concerning the results of the
evaluation under subparagraph (A) to the Secretary.
(2) Regulations.--
(A) Proposed.--Not later than 18 months after the
date on which the report is submitted under paragraph
(1)(B), the Secretary shall publish proposed
regulations regarding the uniform, standardized health
care quality measures and reporting requirements
described in this section.
(B) Final regulations.--Not later than 3 years
after the date on which the report is submitted under
paragraph (1)(B), the Secretary shall publish final
regulations regarding the uniform, standardized health
care quality measures and reporting requirements
described in this section.
SEC. 102. DATA COLLECTION.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall--
(1) ensure that data collected under the medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) are accurate by race, ethnicity, and primary language and
available for inclusion in the National Health Disparities
Report;
(2) enforce State data collection and reporting by race,
ethnicity, and primary language for enrollees in the medicaid
program under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) and the State Children's Health Insurance Program
under title XXI of such Act (42 U.S.C. 1397aa et seq.) and
ensure that such data are available for inclusion in the
National Health Disparities Report;
(3) ensure that ongoing and any new program initiatives--
(A) collect and report data by race, ethnicity, and
primary language and provide technical assistance to
promote compliance;
(B) address technological difficulties;
(C) ensure privacy and confidentiality of data
collected; and
(D) implement effective educational strategies;
(4) expand educational programs to inform insurers,
providers, agencies and the public of the importance of data
collection by race, ethnicity, and primary language to
improving health care access and quality;
(5) raise awareness that these data are critical for
achieving Healthy People 2010 goals and essential to the
nondiscrimination requirements of title VI of the Civil Rights
Act (42 U.S.C. 2000d et seq.); and
(6) support research on existing best practices for data
collection.
(b) Grants for Data Collection by Health Plans, Health Centers, and
Hospitals.--
(1) In general.--The Secretary, acting through the Director
of the Agency for Healthcare Research and Quality, may support
or conduct not to exceed 20 demonstration programs to enhance
the collection, analysis, and reporting of the data required
under this section.
(2) Eligibility.--To be eligible to receive a grant under
this section an entity shall--
(A) be a health plan, federally qualified health
center or health center network, or hospital; and
(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such as information as the Secretary may
require.
(3) Use of funds.--A grantee shall use amounts received
under a grant under this subsection to--
(A) collect, analyze, and report data by race,
ethnicity, or other health disparity category for
patients served by the grantee, including--
(i) in the case of a hospital, emergency
room patients and patients served on an
inpatient or outpatient basis;
(ii) in the case of a health plan, data for
enrollees; and
(iii) in the case of a federally qualified
health center or health center network, primary
care, specialty care, and referrals;
(B) provide analyses of racial, ethnic and other
disparities in health and health care, including
specific disease conditions, diagnostic and therapeutic
procedures, or outcomes;
(C) improve health data collection and analysis for
additional population groups beyond the Office of
Management and Budget categories if such groups can be
aggregated into the minimum race and ethnicity
categories;
(D) develop mechanisms for sharing collected data,
subject to applicable privacy and confidentiality
regulations;
(E) develop educational programs to inform health
insurance issuers, health plans, health providers,
health-related agencies, patients, enrollees, and the
general public that data collection, analysis, and
reporting by race, ethnicity, and preferred language
are legal and essential for eliminating disparities in
health and health care; and
(F) ensure the evaluation of activities conducted
under this section.
TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE
SEC. 201. ACCESS AND AWARENESS GRANTS.
(a) Demonstration Projects.--The Secretary of Health and Human
Services (in this section referred to as the ``Secretary'') may award
contracts or competitive grants to eligible entities to support
demonstration projects designed to improve the health and health care
of health disparity populations through improved access to health care,
health care navigation assistance, and health literacy education.
(b) Eligible Entity Defined.--In this section the term ``eligible
entity'' means--
(1) a hospital;
(2) an academic institution;
(3) a State health agency;
(4) an Indian Health Service hospital or clinic, Indian
tribal health facility, or urban Indian facility;
(5) a nonprofit organization including a faith-based
organization or consortia, to the extent that a grant awarded
to such an entity is consistent with the requirements of
section 1955 of the Public Health Service Act (42 U.S.C. 300x-
65) relating to grant award to nongovernmental entities;
(6) a primary care practice-based research network as
defined by the Director of the Agency for Healthcare Research
and Quality;
(7) a Federally qualified health center (as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B))); or
(8) any other entity determined to be appropriate by the
Secretary.
(c) Application.--An eligible entity seeking a grant under this
section shall submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary may
require, including assurances that the eligible entity will--
(1) target patient populations that are members of racial
and ethnic minority groups or health disparity populations
through specific outreach activities;
(2) coordinate with appropriate community organizations and
include appropriate community participation in planning and
implementation of activities;
(3) coordinate culturally competent and appropriate care;
(4) include a plan to ensure that the entity will become
self-sustaining when funding under the grant terminates; and
(5) include quality and outcomes performance measures to
evaluate the effectiveness of activities funded under this
section to ensure that the activities are meeting their goals,
and disseminate findings from such evaluations.
(d) Priorities.--In awarding contracts and grants under this
section, the Secretary shall give priority to applicants that intend to
use amounts received under this section to carry out all programs
specified under subsection (e).
(e) Use of Funds.--An eligible entity shall use amounts received
under this section to carry out programs that involve at least 2 of the
following:
(1) Providing resources and guidance to individuals
regarding sources of health insurance coverage, as well as
information on how to obtain health coverage in the private
insurance market, through Federal and State programs, and
through other available coverage options.
(2) Providing patient navigator services to help
individuals better utilize their health coverage by working
through the health system to obtain appropriate quality care,
including programs in which--
(A) trained individuals (such as representatives
from the community, nurses, social workers, physicians,
or patient advocates) are assigned to act as contacts--
(i) within the community; or
(ii) within the health care system, to
facilitate access to health care services;
(B) partnerships are created with community
organizations (which may include hospitals, federally
qualified health centers or health center networks,
faith-based organizations, primary care providers, home
care, nonprofit organizations, health plans, or other
health providers determined appropriate by the
Secretary) to help facilitate access or to improve the
quality of care;
(C) activities are conducted to coordinate care and
preventive services and referrals;
(D) services are provided for translation,
interpretation, and other such linguistic services for
patients with limited English proficiency; or
(E) an entity receiving a grant under this section
negotiates on behalf of the patient with relevant
entities, or provides referrals and guides the patient
through the mediation or arbitration process, to
resolve issues that impede access to care.
(3) Promoting broad health awareness and prevention
efforts, including patient education and health literacy
programs to help increase a patient's knowledge of how to best
participate in such patient's and such patient's children's
treatment decisions.
(4) Enhancing preventive services and coordinated,
multidisciplinary disease management of chronic conditions,
such as diabetes mellitus, HIV/AIDS, asthma, cancer,
cardiovascular disease, and obesity.
(f) Report.--Not later than 3 years after the date an entity
receives a grant under this section and annually thereafter, the entity
shall provide to the Secretary a report containing the results of any
evaluation conducted pursuant to subsection (c)(5).
(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2005 through 2009.
SEC. 202. INNOVATIVE OUTREACH PROGRAMS.
(a) Grants To Promote Innovative Outreach and Enrollment Under
Medicaid and SCHIP.--Section 2104(e) of the Social Security Act (42
U.S.C. 1397dd(e)) is amended--
(1) by striking ``Amounts allotted'' and inserting the
following:
``(1) In general.--Subject to paragraph (2), amounts
allotted''; and
(2) by adding at the end the following:
``(2) Grants to promote innovative outreach and enrollment
efforts.--
``(A) In general.--Prior to September 30 of each
fiscal year, beginning with fiscal year 2004, the
Secretary shall reserve from any unexpended allotments
made to States under subsection (b) or (c) (including
any portion of such allotments that were redistributed
under subsection (f) or (g)) for a fiscal year that
would revert to the Treasury on October 1 of the
succeeding fiscal year but for the application of this
paragraph, the lesser of $50,000,000 or the total
amount of such unexpended allotments for purposes of
awarding grants under this paragraph for such
succeeding fiscal year to States or national, local,
and community-based public or nonprofit private
organizations to conduct innovative outreach and
enrollment efforts that are designed to increase the
enrollment and participation of eligible children under
this title and title XIX.
``(B) Priority for grants in certain areas.--In
making grants under subparagraph (A)(ii), the Secretary
shall give priority to grant applicants that propose to
target geographic areas--
``(i) with high rates of eligible but
unenrolled children, including such children
who reside in rural areas;
``(ii) with high rates of families for whom
English is not their primary language; or
``(iii) with high rates of racial and
ethnic minorities and health disparity
populations.
``(C) Application.--An organization that desires to
receive a grant under this paragraph shall submit an
application to the Secretary in such form and manner,
and containing such information, as the Secretary may
decide. Such application shall include quality and
outcomes performance measures to evaluate the
effectiveness of activities funded by a grant under
this paragraph to ensure that the activities are
meeting their goals, and disseminate findings from such
evaluations.''.
(b) Demonstrations To Reduce Health Disparities.--
(1) In general.--The Secretary of Health and Human Services
shall, through contracts or grants to public and private
entities, support demonstration programs for the purpose of
conducting interventions among health disparity populations
to--
(A) target, identify, and reduce or prevent
behavioral risk factors that contribute to health
disparities;
(B) promote translation, interpretation, and other
such linguistic services for patients with limited
English speaking proficiency;
(C) promote preventive services; or
(D) enhance coordinated, multidisciplinary disease
management of chronic conditions, such as diabetes
mellitus, HIV/AIDS, asthma, cancer, and obesity.
(2) Application.--An entity desiring a contract or grant
under paragraph (1) shall submit an application to the
Secretary of Health and Human Services in such form and manner,
and containing such information, as the Secretary may require.
(3) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this subsection such sums as
may be necessary for each of fiscal years 2005 through 2009.
TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION
SEC. 301. OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES.
(a) In General.--Section 1707 of the Public Health Service Act (42
U.S.C. 300u-6) is amended--
(1) by striking the section heading and inserting the
following:
``office of minority health and health disparities''; and
(2) in subsection (a)--
(A) by striking ``Office of Minority Health'' each
place that such appears and inserting ``Office of
Minority Health and Health Disparities''; and
(B) by striking ``for Minority Health'' and
inserting ``for Minority Health and Health
Disparities''.
(b) Duties.--Section 1707(b) of the Public Health Service Act (42
U.S.C. 300u-6(b)) is amended--
(1) in the matter preceding paragraph (1)--
(A) by inserting ``and health disparity
populations'' after ``groups'' and
(B) by striking ``for Minority Health'' and
inserting ``for Minority Health and Health
Disparities'';
(2) in paragraph (1)--
(A) by striking ``Establish'' and all that follows
through ``coordinate'' and inserting ``Coordinate'';
and
(B) by striking ``such individuals'' and inserting
``health disparities'';
(3) in paragraph (5), by inserting ``or health disparity
populations'' after ``minority groups'';
(4) in paragraph (6), by inserting ``or health disparity
population'' after ``minority group'';
(5) by striking paragraphs (7) and (9);
(6) by redesignating paragraphs (1), (2), (3), (4), (5),
(6), (8), and (10) as paragraphs (3), (4), (6), (7), (9), (10),
(11), and (12), respectively;
(7) by inserting before paragraph (3) (as so redesignated)
the following:
``(1) Establish specific short- and long-term goals and
objectives for analyzing the causes of health disparities and
addressing them, with a particular focus on the areas of health
promotion, disease prevention, chronic care and research.
``(2) Work with agencies within the Department of Health
and Human Services and with the Surgeon General to establish a
strategic plan to analyze and address the causes of health
disparities. The plan shall include recommendations to improve
the collection, analysis, and reporting of data at the Federal,
State, territorial, Tribal, and local levels, including how
to--
``(A) implement data collection while minimizing
the cost and administrative burdens of data collection
and reporting;
``(B) expand awareness of the importance of such
data collection to improving health care quality; and
``(C) provide researchers with greater access to
racial, ethnic, and other health disparity data.'';
(8) by inserting after paragraph (4) (as so redesignated),
the following:
``(5) Increase awareness of disparities in health care
among health care providers, health plans, and the public.'';
(9) in paragraph (6) (as so redesignated)--
(A) by striking ``Support'' and inserting ``In
cooperation with the appropriate agencies, support'';
(B) by inserting before the period the following:
``for--
``(A) expanding health care access;
``(B) improving health care quality; and
``(C) increasing health care educational
opportunity.'';
(10) by inserting after paragraph (7) (as so redesignated),
the following:
``(8) Consistent with section 102 of the Closing the Health
Care Gap Act of 2004, coordinate the classification and
collection of health care data to allow for the ongoing
analysis of the causes of disparities and monitoring of
progress toward the elimination of disparities.''; and
(11) by inserting after paragraph (12), as so redesignated,
the following:
``(13) Work with Federal agencies and departments outside
of the Department of Health and Human Services to maximize
program resources available to understand why disparities
exist, and effective ways to reduce and eliminate disparities.
``(14) Support a center for linguistic and cultural
competence to carry out the following:
``(A) With respect to individuals who lack
proficiency in speaking the English language, enter
into contracts with public and nonprofit private
providers of primary health services for the purpose of
increasing the access of such individuals to such
services by developing and carrying out programs to
provide bilingual or interpretive services.
``(B) Carry out programs to improve access to
health care services for individuals with limited
proficiency in speaking the English language.
Activities under this subparagraph shall include
developing and evaluating model projects.''.
(c) Advisory Committee.--Section 1707(c) of the Public Health
Service Act (42 U.S.C. 300u-6(c)) is amended--
(1) in paragraph (1), by inserting ``and Health
Disparities'' after ``Minority Health'';
(2) in paragraph (2), by inserting ``and health disparity
populations'' after ``minority group''; and
(3) in paragraph (4)(B)--
(A) by inserting ``and health disparities'' after
``minority health''; and
(B) by inserting ``and health disparity
populations'' after ``minority groups''.
(d) Duty Requirements.--Section 1707(d) of the Public Health
Service Act (42 U.S.C. 300u-6(d)) is amended--
(1) in paragraph (1)(A), by striking ``(b)(9)'' and
inserting ``(b)(14)'';
(2) in paragraph (1)(B), by striking ``(b)(10)'' and
inserting ``(b)(13)''; and
(3) in paragraph (3), insert ``take into account the unique
cultural or linguistic issues facing such populations and''
after ``subsection (b)''.
(e) Reports.--Section 1707(f) of the Public Health Service Act (42
U.S.C. 300u-6(f)) is amended--
(1) in paragraph (1)--
(A) by striking the subsection heading and
inserting ``Report on activities.--'';
(B) by striking ``1999'' and inserting ``2006'';
(C) by striking ``Committee on Energy and Commerce
of the House of Representatives, and to the Committee
on Labor and Human Resources of the Senate'' and
inserting ``appropriate committees of Congress''; and
(D) by inserting ``and health disparity
populations'' after ``racial and ethnic minority
groups'';
(2) in paragraph (2)--
(A) by striking ``1999'' and inserting ``2005'';
and
(B) by inserting ``and health disparity'' after
``minority health'';
(3) by redesignating paragraph (1) and (2) as paragraphs
(2) and (3), respectively; and
(4) by inserting after the subsection heading, the
following:
``(1) In general.--Not later than 1 year after the date of
enactment of the Closing the Health Care Gap Act of 2004, the
Secretary shall submit to the appropriate committees of
Congress, a report on the plan developed under subsection
(b)(2).''.
(f) Authorization of Appropriations.--Section 1707(h) of the Public
Health Service Act (42 U.S.C. 300u-6(h)) is amended--
(1) by striking ``Funding.--'' and all that follows through
the paragraph designation in paragraph (1); and
(2) by striking ``$30,000,000'' and all that follows
through the period and inserting ``$50,000,000 for fiscal year
2005, such sums as may be necessary for each of fiscal years
2006 through 2009.''.
TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING
SEC. 401. WORKFORCE DIVERSITY AND TRAINING.
(a) Purpose.--Part B of title VII of the Public Health Service Act
(42 U.S.C. 293 et seq.) is amended by inserting before section 736 the
following:
``SEC. 736A. PURPOSE OF PROGRAM.
``It is the purpose of this part to improve health care quality and
access in medically underserved communities, to improve the cultural
competence of health care providers by increasing minority
representation in the health professions, and to strengthen the
research and education programs of designated health professions
schools that disproportionately serve health disparity populations.''.
(b) Centers of Excellence.--Section 736 of the Public Health
Service Act (42 U.S.C. 293) is amended--
(1) by striking subsection (a) and inserting the following:
``(a) In General.--The Secretary shall make grants to, and enter
into contracts with, public and nonprofit private health or educational
entities, including designated health professions schools described in
subsection (c), for the purpose of assisting the schools in supporting
programs of excellence in health professions education for racial or
ethnic minority or health disparity populations.'';
(2) in subsection (b)--
(A) in paragraph (2), by striking ``under-
represented minority'' and inserting ``racial or ethnic
minority'';
(B) in paragraph (3), by striking ``under-
represented minority'' and inserting ``racial or ethnic
minority'';
(C) in paragraph (4), by striking ``minority
health'' and inserting ``health disparity'';
(D) in paragraph (5), by striking ``under-
represented minority groups'' and inserting ``racial or
ethnic minorities and health disparity populations'';
(E) in paragraph (6)--
(i) in the matter preceding subparagraph
(A), by striking ``under-represented minority''
and inserting ``individuals from racial or
ethnic minorities or health disparity
populations''; and
(ii) by striking ``and'' at the end;
(F) in paragraph (7), by striking the period and
inserting ``; and''; and
(G) by adding at the end the following:
``(8) to conduct accountability and other reporting
activities, as required by the Secretary.'';
(3) in subsection (c)--
(A) in paragraph (1)(B)--
(i) in clause (i), by striking ``under-
represented minority'' and inserting
``individuals from racial or ethnic minorities
or health disparity populations'';
(ii) in clause (ii), by striking ``under-
represented minority'' and inserting ``such'';
(iii) in clause (iii)--
(I) by striking ``under-represented
minority individuals'' the first place
that such appears and inserting ``such
students'';
(II) by striking ``such
individuals'' and inserting ``such
students''; and
(III) by striking ``under-
represented minority'' the second place
that such appears and inserting
``such''; and
(iv) in clause (iv), by striking ``under-
represented minority individuals'' and
inserting ``individuals from racial or ethnic
minorities or health disparity populations'';
and
(B) in paragraph (2)(B)--
(i) in clause (i), by striking ``under-
represented'' and inserting ``racial or''; and
(C) in paragraph (5)(B)--
(i) by striking ``under-represented'' and
inserting ``racial or''; and
(ii) by inserting ``or a health disparity
population'' after ``minorities'';
(4) in subsection (d)(1), by striking ``Under-Represented
Minority Health'' and inserting ``Minority Health and Health
Disparity'';
(5) in subsection (h)--
(A) in paragraph (1), by striking ``$26,000,000''
and all that follows and inserting ``$50,000,000 for
fiscal year 2005, and such sums as may be necessary for
each of fiscal years 2006 through 2009''; and
(B) in paragraph (2)--
(i) in subparagraph (C)--
(I) in the matter preceding clause
(i), by striking ``are $30,000,000 or
more'' and inserting ``exceed
$30,000,000 but are less than
$40,000,000''; and
(II) in clause (iv), by striking
``any remaining funds'' and inserting
``any remaining excess amount''; and
(ii) by adding at the end the following:
``(D) Funding in excess of $40,000,000.--If amounts
appropriated under paragraph (1) for a fiscal year are
$40,000,000 or more, the Secretary shall make
available--
``(i) not less than $16,000,000 for grants
under subsection (a) to health professions
schools that meet the conditions described in
subsection (c)(2)(A);
``(ii) not less than $16,000,000 for grants
under subsection (a) to health professions
schools that meet the conditions described in
paragraph (3) or (4) of subsection (c)
(including meeting conditions pursuant to
subsection (e));
``(iii) not less than $8,000,000 for grants
under subsection (a) to health professions
schools that meet the conditions described in
subsection (c)(5); and
``(iv) after grants are made with funds
under clauses (i) through (iii), any remaining
funds for grants under subsection (a) to health
professions schools that meet the conditions
described in paragraph (2)(A), (3), (4), or (5)
of subsection (c).''; and
(6) by adding at the end the following:
``(i) Evaluation.--
``(1) In general.--Not later than 1 year after the date of
enactment of the Closing the Health Care Gap Act of 2004, the
Secretary shall request that the Institute of Medicine evaluate
the effectiveness of the programs under this section in meeting
the purpose of this part. The Institute of Medicine shall
submit a report on the evaluation to the Secretary.
``(2) Working group.--Upon submission of the report under
paragraph (1), the Secretary shall convene a working group
composed of stakeholders, including designated health
professions schools described in subsection (c), to define
quality performance measures and reporting requirements of
grant recipients that shall be tied to the purpose of this
part.
``(3) Regulations.--Not later than 18 months after the date
the Institute of Medicine submits the report under paragraph
(1), the Secretary shall publish proposed regulations regarding
the quality performance measures and reporting requirements
described in paragraph (2). Not later than 3 years after the
date the Institute of Medicine submits the report under
paragraph (1), the Secretary shall publish final regulations
regarding the quality performance measures and reporting
requirements described in paragraph (2).''.
(c) Scholarships for Disadvantaged Students.--Section 737 of the
Public Health Service Act (42 U.S.C. 293a) is amended--
(1) in subsection (c), by striking ``under-represented
minority'' and inserting ``minority and health disparity''; and
(2) in subsection (d)(1)(B), by inserting ``or health
disparity'' after ``minority''.
(d) Loan Repayments and Fellowships Regarding Faculty Positions.--
Section 738(b) of the Public Health Service Act (42 U.S.C. 293b(b)) is
amended--
(1) in paragraph (1), by striking ``underrepresented'';
(2) in paragraph (3)(A), by striking ``underrepresented
minority individuals'' and inserting ``individuals from racial
or ethnic minorities or health disparity populations''; and
(3) by striking paragraph (5).
(e) National Health Service Corps.--
(1) Assignment.--Section 333(a)(3) of the Public Health
Service Act (42 U.S.C. 254f(a)(3)) is amended--
(A) in the second sentence--
(i) by striking ``shall give preference''
and inserting the following: ``shall--
``(A) give preference''; and
(ii) by striking the period and inserting
``; and''; and
(B) by adding at the end the following:
``(B) give preference to applications from entities
described in subparagraph (A) that serve individuals a majority
of whom are members of a racial or ethnic minority or other
health disparity population with annual incomes at or below
twice those set forth in the most recent poverty guidelines
issued by the Secretary pursuant to section 402(2) of the
Community Services Block Grant Act.''.
(2) Priorities.--Section 333A(a) of the Public Health
Service Act (42 U.S.C. 254f-1(a)) is amended--
(A) by redesignating paragraphs (1) through (3) as
paragraphs (2) through (4), respectively; and
(B) by inserting before paragraph (2) (as so
redesignated), the following:
``(1) give preference to applications as described in
section 333(a)(3);''.
(e) Authorization of Appropriations.--Section 740 of the Public
Health Service Act (42 U.S.C. 293d) is amended--
(1) in subsection (a), by striking ``2002'' and inserting
``2009'';
(2) in subsection (b), by striking ``2002'' and inserting
``2009'';
(3) in subsection (c), by striking ``2002'' and inserting
``2009''; and
(4) by striking subsection (d).
(f) Grants for Health Professions Education.--Section 741 of the
Public Health Service Act (42 U.S.C. 293e) is amended--
(1) in subsection (a)(2), in the first sentence by striking
``Unless'' and all that follows through ``the Secretary'' and
inserting ``The Secretary''; and
(2) in subsection (b), by striking ``$3,500,000'' and all
that follows through the period and inserting ``such sums as
may be necessary for each of fiscal years 2005 through 2009.''.
(g) Health Careers Opportunity Program.--Subpart 2 of part E of
title VII of the Public Health Service Act (42 U.S.C. 295 et seq.) is
amended--
(1) in section 770 by inserting ``(other than section
771)'' after ``this subpart'';
(2) by redesignating section 770 as section 771;
(3) by inserting after section 769 the following:
``SEC. 770. HEALTH CAREERS OPPORTUNITY PROGRAM.
``(a) In General.--The Secretary may make grants and enter into
cooperative agreements and contracts with eligible entities for any of
the following purposes:
``(1) Identifying and recruiting students who--
``(A) are from disadvantaged backgrounds or health
disparity populations; and
``(B) are interested in a career in the health
professions.
``(2) Providing counseling or other services designed to
assist such individuals in entering a health professions school
and successfully completing their education at such a school.
``(3) Providing, for a period prior to the entry of such
individuals into the regular course of education of such a
school, preliminary education designed to assist the
individuals in successfully completing such regular course of
education at such a school, or referring such individuals to
institutions providing such preliminary education.
``(b) Receipt of Award.--
``(1) Eligible entities; requirement of consortium.--The
Secretary may make an award under subsection (a) only if an
eligible entity meets the following conditions:
``(A) The eligible entity is a public or private
entity, and such entity has established a consortium
consisting of private community-based organizations and
health professions schools.
``(B) The health professions schools in the
consortium are schools of medicine or osteopathic
medicine, public health, nursing, dentistry, optometry,
pharmacy, allied health, or podiatric medicine, or
graduate programs in mental health practice (including
programs in clinical psychology).
``(C)(i) Except as provided in clause (ii), the
membership of the consortium includes not less than 1
nonprofit private community-based organization and not
less than 3 health professions schools.
``(ii) In the case of an eligible entity whose
exclusive activity under the award will be carrying out
1 or more programs described in subsection (a)(5), the
membership of the consortium includes not less than 1
nonprofit private community-based organization and not
less than 1 health professions school.
``(D) The members of the consortium have entered
into an agreement specifying--
``(i) that each of the members will comply
with the conditions upon which the award is
made; and
``(ii) whether and to what extent the award
will be allocated among the members.
``(2) Requirement of competitive awards.--Awards under
subsection (a) shall be made on a competitive basis.
``(c) Requirements.--The Secretary may make an award under
subsection (a) only if the Secretary determines that, in the case of
activities carried out under the award that prove to be effective
toward achieving the purposes of the activities--
``(1) the members of the consortium involved have or will
have the financial capacity to continue the activities,
regardless of whether financial assistance under subsection (a)
continues to be available; and
``(2) the members of the consortium demonstrate to the
satisfaction of the Secretary a commitment to continue such
activities, regardless of whether such assistance continues to
be available.
``(d) Objectives Under Awards.--Before making a first award to an
eligible entity under subsection (a), the Secretary shall establish
objectives regarding the activities to be carried out under the award,
which objectives are applicable until the next fiscal year for which
such award is made after a competitive process of review. In making an
award after such a review, the Secretary shall establish additional
objectives for the applicant.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated, such sums as
may be necessary for each of fiscal years 2005 through 2009.''.
SEC. 402. HIGHER EDUCATION TECHNICAL AMENDMENTS.
Section 326(c) of the Higher Education Act of 1965 (20 U.S.C.
1063b(c)) is amended--
(1) in paragraph (2), by inserting before the semicolon,
the following: ``, and for the acquisition and development of
real property that is adjacent to the campus to improve the
academic environment'';
(2) in paragraph (6), by striking ``and'' at the end;
(3) in paragraph (7), by striking the period and inserting
a semicolon; and
(4) by adding at the end the following:
``(8) Support of faculty exchanges, development, and
fellowship to enable attainment of advanced degrees in their
field of instruction; and
``(9) Tutoring, counseling, and student service programs
designed to improve academic success.''.
SEC. 403. MODEL CULTURAL COMPETENCY CURRICULUM DEVELOPMENT.
(a) Curricula Development and Model Curricula.--The Secretary of
Health and Human Services (in this section referred to as the
``Secretary'') may award grants to eligible entities for curricula
development for the training of health care providers and health
professions students regarding cultural competency, and for
demonstration projects to test new innovations for cultural competence
education model curricula for and identify additional barriers to
culturally appropriate care.
(b) Application.--Each eligible entity desiring a grant under
subsection (a) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may require.
(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2005 through 2009.
SEC. 404. INTERNET CULTURAL COMPETENCY CLEARINGHOUSE.
(a) Development.--The Director of the Office of Minority Health and
Health Disparities, with assistance from the Administrator of the
Agency for Healthcare Research and Quality, shall develop and maintain
an Internet clearinghouse to improve health care quality for
individuals with specific cultural needs or with limited English
proficiency or low functional health literacy and to reduce or
eliminate the duplication of effort to translate materials.
(b) Templates.--In developing the clearinghouse under subsection
(a), the Director of the Office of Minority Health and Health
Disparities shall develop, test, and make available templates for
standard documents that are necessary for patients and consumers to
access and make educated decisions about their health care, including--
(1) administrative and legal documents;
(2) clinical information such as how to take medications,
how to prevent transmission of a contagious disease, and other
prevention and treatment instructions; and
(3) patient education and outreach materials such as
immunization notices, health warnings, or screening notices.
(c) Online Library or Database.--The Director of the Office of
Minority Health and Health Disparities shall develop a readily
accessible online library or database with searchable clinically
relevant cultural information that is important for health care
providers to have on hand in the direct provision of medical care to
individuals from specific minority, ethnic, or other health disparity
groups.
TITLE V--ENHANCED RESEARCH
SEC. 501. AGENCY FOR HEALTHCARE RESEARCH AND QUALITY.
Part B of title IX of the Public Health Service Act (42 U.S.C.
299b) is amended by adding at the end the following:
``SEC. 918. ENHANCED RESEARCH WITH RESPECT TO HEALTH DISPARITIES.
``(a) Accelerating the Elimination of Disparities.--
``(1) In general.--The Secretary, acting through the
Director, may award grants or contracts to eligible entities
(as defined in paragraph (4)) for short-term research to
analyze the causes of disparities and identify or develop and
evaluate effective strategies in closing the health care gap
between minority and health disparity populations and
nonminority populations or non-health disparity populations.
``(2) Prompt use of research.--To ensure that research
described in paragraph (1) is effective and is disseminated and
applied promptly, the Director shall--
``(A) expand practice-based research networks
(primary care and larger delivery systems) to include
networks of delivery sites serving large numbers of
minority and health disparity populations including--
``(i) public hospitals;
``(ii) health centers; and
``(iii) other sites as determined
appropriate by the Director;
``(B) work with health care providers to identify
and develop those interventions for minority and health
disparity populations for which effective
implementation strategies are not clear; and
``(C) develop a broad virtual network of continuous
learning among health care providers (including
institutions that did not receive a grant or contract
under paragraph (1)) so that those participating in
research can share findings and experience throughout
the duration of such research and to facilitate
interest in and prompt adoption of such findings and
experience.
``(3) Technical assistance.--The Director of the Agency for
Healthcare Research and Quality shall provide technical
assistance to assist in the implementation of strategies of
evidence-based practices that will reduce health care
disparities.
``(4) Eligible entities.--In paragraph (1), the term
`eligible entities' means institutions with researchers who
have experience in conducting research relating to minority
health and health disparity populations.
``(5) Public hospitals.--In this subsection, the term
`public hospitals' means a hospital (as defined in section
1886(d)(1)(B) of the Social Security Act) that--
``(A) is owned or operated by a unit of State or
local government, is a public or private non-profit
corporation which is formally granted governmental
powers by a unit of State or local government, or is a
private non-profit hospital that has a contract with a
State or local government to provide health care
services to low income individuals who are not entitled
to benefits under title XVIII of the Social Security
Act or eligible for assistance under the State plan
under title XIX of the Social Security Act; and
``(B) for the most recent cost reporting period
that ended before the calendar quarter involved, had a
disproportionate share adjustment percentage (as
determined under section 1886(d)(5)(F) of the Social
Security Act) greater than 11.75 percent or was
described in section 1886(d)(5)F)(i)(II) of such Act.
``(b) Realizing the Potential of Disease Management.--
``(1) Public-private sector partnership to assess
effectiveness of existing data management strategies.--The
Director shall establish a public-private partnership to assess
the effectiveness of disease management strategies and identify
effective interventions and support strategies with respect to
minority and health disparity populations.
``(2) Effective management of patients with multiple
chronic diseases.--
``(A) Initiative for disease management
strategies.--The Director shall coordinate an
initiative to identify those chronic conditions for
which disease-specific disease management strategies
pose conflicts in preferred clinical interventions.
``(B) Research.--The Director, with support from
other agencies within the Department of Health and
Human Services shall conduct a program of research
based in community and primary-care settings to test and evaluate the
implications for patient outcomes of alternative approaches for
reconciling conflicts from disease-specific disease management
initiatives.
``(c) Development of Effective Measurement of Disparities.--
``(1) In general.--The Director shall conduct a
demonstration project to--
``(A) assess alternative strategies for identifying
population subgroups at highest risk of poor quality
and poor health;
``(B) improve data collection for health care
priority populations (as described in section
901(c)(1)(B));
``(C) improve the ability to identify the causes of
disparities; and
``(D) track progress in reducing health care
disparities with a focus on--
``(i) the minimum data set necessary to
track such progress; and
``(ii) the identification of measures for
which data currently being collected are
insufficient.
``(2) Report.--Not later than 3 years after the date the
demonstration project described in paragraph (1) receives
funding, the Director shall submit to the appropriate
committees of Congress a report containing the findings of the
demonstration project together with any policy recommendations.
``(d) Analysis of Racial, Ethnic, and Other Health Disparity
Data.--The Secretary, acting through the Director of the Agency for
Healthcare Research and Quality, and in coordination with the
Administrator of the Centers for Medicare & Medicaid Services and the
Director of the Centers for Disease Control and Prevention, shall
provide technical assistance to agencies of the Department of Health
and Human Services in meeting Federal standards for race, ethnicity,
and other health disparity data collection and analysis of racial,
ethnic, and other disparities in health and health care in Federally-
administered programs by--
``(1) identifying appropriate quality assurance mechanisms
to monitor for health disparities;
``(2) specifying the clinical, diagnostic, or therapeutic
measures which should be monitored;
``(3) developing new quality measures relating to racial,
ethnic, or other health disparities;
``(4) identifying the level at which data analysis should
be conducted; and
``(5) sharing data with external organizations for research
and quality improvement purposes.''.
SEC. 502. NATIONAL INSTITUTES OF HEALTH.
The Director of the National Institutes of Health, in consultation
with the Director of the National Center on Minority Health and Health
Disparities, shall expand and intensify research at the National
Institutes of Health relating to the sources of health and health care
disparities, and increase efforts to recruit minority scientists and
research professionals into the field of health disparity research.
TITLE VI--MISCELLANEOUS PROVISIONS
SEC. 601. DEFINITIONS.
(a) In General.--In this Act, including the amendments made by this
Act:
(1) Culturally competent.--
(A) In general.--The term ``culturally competent'',
with respect to the manner in which health-related
services, education, and training are provided, means
providing the services, education, and training in the
language and cultural context that is most appropriate
for the individuals for whom the services, education,
and training are intended, including as necessary the
provision of bilingual services.
(B) Modification.--The definition established in
subparagraph (A) may be modified as needed at the
discretion of the Secretary after providing a 30-day
notice to Congress.
(2) Minority health conditions.--The term ``minority health
conditions'', with respect to individuals who are members of
minority groups, means all diseases, disorders, and conditions
(including with respect to mental health and substance abuse)--
(A) unique to, more serious, or more prevalent in
such groups;
(B) for which the factors of medical risk or types
of medical intervention may be different for such
groups, or for which it is unknown whether such factors
or types are different for such individuals; or
(C) with respect to which there has been
insufficient research involving such individual members
of such groups as subjects or insufficient data on such
individuals.
(3) Minority health disparities research.--The term
``minority health disparities research'' means basic, clinical,
behavioral and health services research on minority health
conditions (as defined in paragraph (2)), including research to
prevent, diagnose, and treat such conditions.
(4) Minority.--The terms ``minority'' and ``minorities''
refer to individuals from a minority group.
(5) Minority group.--The term ``minority group'' has the
meaning given the term ``racial and ethnic minority group'' in
section 1707 of the Public Health Service Act (42 U.S.C. 300u-
6).
(b) Health Disparity Populations.--In this Act, including the
amendments made by this Act:
(1) Health disparity population.--The term ``health
disparity population'' has the meaning given such term in
section 903(d)(1) of the Public Health Service Act (42 U.S.C.
299a-1(d)(1)).
(2) Health disparities research.--The term ``health
disparities research'' shall include basic, clinical,
behavioral, and health services research on health disparity
populations (including individual members and communities of
such populations) that relates to health disparities as defined
under paragraph (1), including the causes of such disparities
and methods to prevent, diagnose, and treat such disparities.
Introduced in Senate
Sponsor introductory remarks on measure. (CR S1308-1309)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Sponsor introductory remarks on measure. (CR S4006)
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