Health Equity and Accountability Act of 2012 - Amends the Public Health Service Act and the Social Security Act to expand the collection and analysis of data in programs of the Department of Health and Human Services (HHS).
Sets forth provisions to improve cultural competence in federal health care programs and services, including by establishing the Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care.
Requires the Secretary of Health and Human Services (Secretary) to engage in activities to improve health workforce diversity, including by: (1) establishing a working group, a technical clearinghouse, and an advisory committee on workforce diversity; (2) awarding grants to academic institutions; (3) establishing a health and health care disparities education program; and (4) providing for scholarships, student loan repayment and loan forgiveness, and research fellowships.
Health Empowerment Zone Act of 2012 - Provides for the establishment of health empowerment zones in communities that experience disproportionate disparities in health status and health care.
Requires the Secretary to engage in activities to improve the quality of and access to health care, including by expanding access to health care and health care insurance for immigrants, designating centers of excellence at public hospitals and other health systems serving minority patients, increasing Medicaid payments to territories and to Native Hawaiian health centers, and providing for border health grants.
Sets forth programs to reduce health disparities affecting minorities and rural residents. Establishes an Office of Minority Health in the Department of Veterans Affairs (VA).
Sets forth provisions to improve health for women and children, including by expanding access to federal programs for immigrant women and children, creating public awareness campaigns, engaging in activities to eliminate disparities in maternal health outcomes, and establishing programs to reduce teenage pregnancies, including contraception education and information programs and programs to support healthy adolescent development.
Directs the Secretary to develop a multisite gestational diabetes research project within the diabetes program of the Centers for Disease Control and Prevention (CDC).
Provides for community mental health and addiction services to be offered through federally-qualified behavioral health centers.
Lung Cancer Mortality Reduction Act of 2012 - Requires the Secretary to implement the Lung Cancer Mortality Reduction Program to achieve a reduction of at least 25% in the mortality rate of lung cancer by 2017.
Prostate Research, Outreach, Screening, Testing, Access, and Treatment Effectiveness Act of 2012 or the PROSTATE Act - Requires the Secretary of Veterans Affairs (VA) to take action to address prostate cancer, including by establishing the Interagency Prostate Cancer Coordination and Education Task Force.
Viral Hepatitis and Liver Cancer Control and Prevention Act of 2012 - Requires the Secretary to implement programs to address hepatitis B and hepatitis C.
Bone Marrow Failure Disease Research and Treatment Act of 2012 - Requires the Director of CDC to establish the National Acquired Bone Marrow Failure Disease Registry.
Requires the Director of the Agency for Healthcare Research and Quality to develop guidelines to screen minority patient populations which have a higher than average risk for many chronic diseases and cancers.
Establishes a program for participation by Medicaid beneficiaries in approved clinical trials.
Requires the Secretary to carry out activities to expand the Minority HIV/AIDS Initiative.
National Black Clergy for the Elimination of HIV/AIDS Act of 2012 - Provides for a program of grants to public health agencies and faith-based organizations to address HIV/AIDS in the African-American community.
Justice for the Unprotected Against Sexually Transmitted Infections among the Confined and Exposed Act or the JUSTICE Act - Permits community organizations to distribute sexual barrier protection devices (e.g., condoms) and to engage in sexually transmitted infection counseling and prevention education in federal correctional facilities.
Stop AIDS in Prison Act of 2012 - Requires the Bureau of Prisons to develop a comprehensive policy to provide HIV testing, treatment, and prevention for inmates.
Minority Diabetes Initiative Act - Requires the Secretary to award grants to provide treatment for diabetes in minority communities and to conduct and support research and other activities with respect to diabetes in minority populations.
Directs the Secretary to conduct research and other activities for the prevention of lung diseases, including asthma, pneumonia, and chronic obstructive pulmonary diseases.
Sets forth provisions regarding the use of health information technology to reduce health disparities, particularly in racial and ethnic minority communities.
Prohibits discrimination in federal health care programs or research activities.
Requires the Secretary to establish the Office of Health Disparities in the Office for Civil Rights and to establish civil rights compliance offices in each HHS agency that administers health programs.
Directs the President to enforce Executive Order 12898 (requiring federal actions to address environmental justice in minority and low-income populations) as federal law.
Amends the Department of Agriculture Reorganization Act of 1994 to establish in the Department of Agriculture (USDA) a Healthy Food Financing Initiative.
Directs the Comptroller General (GAO) to study the type and scope of health care services provided to racial and ethnic minorities affected by the explosion of the Deepwater Horizon drilling unit on April 20, 2010.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 2474 Introduced in Senate (IS)]
112th CONGRESS
2d Session
S. 2474
To improve the health of minority individuals, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 26, 2012
Mr. Akaka (for himself and Mr. Inouye) 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 minority individuals, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Equity and Accountability Act
of 2012''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
TITLE I--DATA COLLECTION AND REPORTING
Sec. 101. Amendment to the Public Health Service Act.
Sec. 102. Elimination of prerequisite of direct appropriations for data
collection and analysis.
Sec. 103. Collection of race and ethnicity data by the Social Security
Administration.
Sec. 104. Revision of HIPAA claims standards.
Sec. 105. National Center for Health Statistics.
Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific
Islanders and other underrepresented groups
in Federal health surveys.
Sec. 107. Geo-access study.
Sec. 108. Racial, ethnic, and linguistic data collected by the Federal
Government.
Sec. 109. Data collection and analysis grants to minority-serving
institutions.
Sec. 110. Standards for measuring sexual orientation and gender
identity in collection of health data.
Sec. 111. Optional collection of health data on immigrants and
individuals in their households.
Sec. 112. GAO study on compliance with existing FDA requirements to
present drug and device safety and
effectiveness data by sex, age, and racial
and ethnic subgroups.
Sec. 113. Improving health data regarding Native Hawaiians and other
Pacific Islanders.
Sec. 114. Simplified administrative reporting requirement for nutrition
assistance.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
Sec. 201. Definitions.
Sec. 202. Amendment to the Public Health Service Act.
Sec. 203. Federal reimbursement for culturally and linguistically
appropriate services under the Medicare,
Medicaid, and State Children's Health
Insurance Programs.
Sec. 204. Increasing understanding of and improving health literacy.
Sec. 205. Assurances for receiving Federal funds.
Sec. 206. Report on Federal efforts to provide culturally and
linguistically appropriate health care
services.
Sec. 207. English for speakers of other languages.
Sec. 208. Implementation.
Sec. 209. Language access services.
Sec. 210. Assistant Secretary of the Indian Health Service.
Sec. 211. Reauthorization of the Native Hawaiian Health Care
Improvement Act.
TITLE III--HEALTH WORKFORCE DIVERSITY
Sec. 301. Amendment to the Public Health Service Act.
Sec. 302. Hispanic-serving health professions schools.
Sec. 303. Loan repayment program of Centers for Disease Control and
Prevention.
Sec. 304. Cooperative agreements for online degree programs at schools
of public health and schools of allied
health.
Sec. 305. Sense of Congress on the mission of the National Health Care
Workforce Commission.
Sec. 306. Scholarship and fellowship programs.
Sec. 307. Advisory Committee on Health Professions Training for
Diversity.
Sec. 308. McNair Postbaccalaureate Achievement Program.
Sec. 309. Rules for determination of full-time equivalent residents for
cost reporting periods.
Sec. 310. Developing and implementing strategies for local health
equity.
Sec. 311. Loan forgiveness for mental and behavioral health social
workers.
TITLE IV--IMPROVEMENT OF HEALTH CARE SERVICES
Subtitle A--Health Empowerment Zones
Sec. 401. Short title.
Sec. 402. Findings.
Sec. 403. Designation of health empowerment zones.
Sec. 404. Assistance to those seeking designation.
Sec. 405. Benefits of designation.
Sec. 406. Definition.
Subtitle B--Other Improvements of Health Care Services
Chapter 1--Expansion of Coverage
Sec. 411. Amendment to the Public Health Service Act.
Sec. 412. Removing barriers to unsubsidized purchase of private
insurance in American Health Benefit
Exchanges.
Sec. 413. Study on the uninsured.
Sec. 414. Medicaid payment parity for the territories.
Sec. 415. Medicaid eligibility for citizens of Freely Associated
States.
Sec. 416. Extension of Medicare secondary payer.
Sec. 417. Border health grants.
Sec. 418. Removing Medicare barriers to health care.
Sec. 419. 100 percent FMAP for medical assistance provided by urban
Indian health centers.
Sec. 420. 100 percent FMAP for medical assistance provided to a Native
Hawaiian through a federally qualified
health center or a Native Hawaiian health
care system under the Medicaid program.
Chapter 2--Expansion of Access
Sec. 421. Grants for racial and ethnic approaches to community health.
Sec. 422. Critical access hospital improvements.
Sec. 423. Establishment of Rural Community Hospital (RCH) Program.
Sec. 424. Medicare remote monitoring pilot projects.
Sec. 425. Rural health quality advisory commission and demonstration
projects.
Sec. 426. Rural health care services.
Sec. 427. Community health center collaborative access expansion.
Sec. 428. Facilitating the provision of telehealth services across
State lines.
Sec. 429. Scoring of preventive health savings.
Sec. 430. Sense of Congress.
Sec. 431. Repeal of requirement for documentation evidencing
citizenship or nationality under the
Medicaid program.
Sec. 432. Office of Minority Health in Veterans Health Administration
of Department of Veterans Affairs.
Sec. 433. Access for Native Americans under PPACA.
Sec. 434. Study of DSH payments to ensure hospital access for low-
income patients.
TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES
Sec. 501. Grants to promote positive health behaviors in women and
children.
Sec. 502. Removing barriers to health care and nutrition assistance for
children, pregnant women, and lawfully
present individuals.
Sec. 503. Repeal of denial of benefits.
Sec. 504. Birth defects prevention, risk reduction, and awareness.
Sec. 505. Uniform State maternal mortality review committees on
pregnancy-related deaths.
Sec. 506. Eliminating disparities in maternity health outcomes.
Sec. 507. Decreasing the risk factors for sudden unexpected infant
death and sudden unexplained death in
childhood.
Sec. 508. Reducing teenage pregnancies.
Sec. 509. Gestational diabetes.
Sec. 510. Emergency contraception education and information programs.
Sec. 511. Supporting healthy adolescent development.
TITLE VI--MENTAL HEALTH
Sec. 601. Community Mental Health and Addiction Safety Net Equity Act.
Sec. 602. Minority Fellowship Program.
Sec. 603. Integrated Health Care Demonstration Program.
Sec. 604. Addressing racial and ethnic minority mental health
disparities research gaps.
TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES
Subtitle A--Cancer
Sec. 701. Lung Cancer Mortality Reduction.
Sec. 702. Expanding Prostate Cancer Research, Outreach, Screening,
Testing, Access, and Treatment
Effectiveness.
Sec. 703. Improved Medicaid coverage for certain breast and cervical
cancer patients in the territories.
Sec. 704. Cancer prevention and treatment demonstration for ethnic and
racial minorities.
Sec. 705. Reducing cancer treatment disparities within Medicare.
Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention
Sec. 711. Viral Hepatitis and Liver Cancer Control and Prevention.
Subtitle C--Acquired Bone Marrow Failure Diseases
Sec. 721. Acquired Bone Marrow Failure Diseases.
Subtitle D--Cardiovascular Disease, Chronic Disease, and Other Disease
Issues
Sec. 731. Guidelines for disease screening for minority patients.
Sec. 732. Coverage of the shingles vaccine under the Medicare program.
Sec. 733. CDC Wisewoman Screening Program.
Sec. 734. Report on cardiovascular care for women and minorities.
Sec. 735. Coverage of comprehensive tobacco cessation services in
Medicaid.
Sec. 736. Clinical research funding for oral health.
Sec. 737. Participation by Medicaid beneficiaries in approved clinical
trials.
Subtitle E--HIV/AIDS
Sec. 741. Findings.
Sec. 742. Addressing HIV/AIDS in communities of color.
Sec. 743. HIV/AIDS reduction in racial and ethnic minority communities.
Sec. 744. Repealing ineffective and incomplete abstinence-only
education program.
Sec. 745. Dental Education Loan Repayment Program.
Sec. 746. Report on the implementation of the national HIV/AIDS
strategy.
Sec. 747. Addressing HIV/AIDS in the African-American community.
Sec. 748. National Black Clergy for the Elimination of HIV/AIDS.
Sec. 749. Reducing the spread of sexually transmitted infections in
correctional facilities.
Sec. 750. Stop AIDS in prison.
Sec. 751. Services to reduce HIV/AIDS in racial and ethnic minority
communities.
Sec. 752. Health care professionals treating individuals with HIV/AIDS.
Sec. 753. Report on impact of HIV/AIDS in racial and ethnic minority
communities.
Sec. 754. Study on status of HIV/AIDS epidemic among African-Americans.
Subtitle F--Diabetes
Sec. 755. Treatment of diabetes in minority communities.
Sec. 756. Eliminating disparities in diabetes prevention access and
care.
Subtitle G--Lung Disease
Sec. 761. Expansion of the National Asthma Education and Prevention
Program.
Sec. 762. Asthma-related activities of the centers for disease control
and prevention.
Sec. 763. Influenza and pneumonia vaccination campaign.
Sec. 764. Chronic obstructive pulmonary disease action plan.
TITLE VIII--HEALTH INFORMATION TECHNOLOGY
Subtitle A--Reducing Health Disparities Through Health IT
Sec. 801. HRSA assistance to health centers for promotion of Health IT.
Sec. 802. Assessment of use of Health IT in racial and ethnic minority
communities.
Subtitle B--Modifications to Achieve Parity in Existing Programs
Sec. 811. Extending funding to strengthen the Health IT infrastructure
in racial and ethnic minority communities.
Sec. 812. Prioritizing regional extension center assistance to racial
and ethnic minority groups.
Sec. 813. Extending competitive grants for the development of loan
programs to facilitate adoption of
certified EHR technology by providers
serving racial and ethnic minority groups.
Subtitle C--Additional Research and Studies
Sec. 821. Data collection and assessments conducted in coordination
with minority-serving institutions.
Sec. 822. IOM study and report on privacy concerns of certain minority
populations.
Sec. 823. Study of health information technology in medically
underserved areas.
Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs
Sec. 831. Application of Medicare HITECH payments to hospitals in
Puerto Rico.
Sec. 832. Extending Physician Assistant Eligibility for Medicaid
Electronic Health Record Incentive
Payments.
TITLE IX--ACCOUNTABILITY AND EVALUATION
Sec. 901. Prohibition on discrimination in Federal assisted health care
services and research programs on the basis
of sex, race, color, national origin,
sexual orientation, gender identity, or
disability status.
Sec. 902. Treatment of Medicare payments under Title VI of the Civil
Rights Act of 1964.
Sec. 903. Accountability and transparency within the Department of
Health and Human Services.
Sec. 904. United States Commission on Civil Rights.
Sec. 905. Sense of Congress concerning full funding of activities to
eliminate racial and ethnic health
disparities.
Sec. 906. GAO and NIH reports.
TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
JUSTICE
Sec. 1001. Codification of Executive Order 12898.
Sec. 1002. Implementation of recommendations by Environmental
Protection Agency.
Sec. 1003. Grant program.
Sec. 1004. Additional research on the relationship between the built
environment and the health of community
residents.
Sec. 1005. Environment and public health restoration.
Sec. 1006. Healthy Food Financing Initiative.
Sec. 1007. GAO report on health effects of Deepwater Horizon oil rig
explosion in the Gulf Coast.
SEC. 3. FINDINGS.
The Congress finds as follows:
(1) The population of racial and ethnic minorities is
expected to increase over the next few decades, yet racial and
ethnic minorities have the poorest health status and face
substantial cultural, social, and economic barriers to
obtaining quality health care.
(2) Health disparities are a function of not only access to
health care, but also the social determinants of health--
including the environment, the physical structure of
communities, nutrition and food options, educational
attainment, employment, race, ethnicity, sex, geography,
language preference, immigrant or citizenship status, sexual
orientation, gender identity, socioeconomic status, or
disability status--that directly and indirectly affect the
health, health care, and wellness of individuals and
communities.
(3) By 2020, the Nation will face a shortage of health care
providers and allied health workers and this shortage
disproportionately affects health professional shortage areas
where many racial and ethnic minority populations reside.
(4) All efforts to reduce health disparities and barriers
to quality health services require better and more consistent
data.
(5) A full range of culturally and linguistically
appropriate health care and public health services must be
available and accessible in every community.
(6) Racial and ethnic minorities and underserved
populations must be included early and equitably in health
reform innovations.
(7) Efforts to improve minority health have been limited by
inadequate resources in funding, staffing, stewardship and
accountability. Targeted investments that are focused on
disparities elimination must be made in providing care and
services that are community-based, including prevention and
policies addressing social determinants of health.
(8) In 2011, the Department of Health and Human Services
developed the HHS Action Plan to Reduce Racial and Ethnic
Health Disparities and the National Stakeholder Strategy for
Achieving Health Equity, two strategic plans that represent the
country's first coordinated roadmap to reducing health
disparities. Along with the National Prevention Strategy and
the National Health Care Quality Strategy, these comprehensive
plans will work to increase the number of Americans who are
healthy at every stage of life.
(9) The Department of Health and Human Services also
developed other strategic planning documents to combat disease
disparities with a high impact on minority populations
including the National HIV/AIDS Strategy, and the Action Plan
for the Prevention, Care and Treatment of Viral Hepatitis.
(10) The Patient Protection and Affordable Care Act, as
amended by the Health Care and Education Reconciliation Act,
represents the biggest advancement for minority health in the
last 40 years.
TITLE I--DATA COLLECTION AND REPORTING
SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
(a) Purpose.--It is the purpose of this section to promote data
collection, analysis, and reporting by race, ethnicity, sex, primary
language, sexual orientation, disability status, gender identity, and
socioeconomic status among federally supported health programs.
(b) Amendment.--Title XXXIV of the Public Health Service Act, as
amended by titles II and III of this Act, is further amended by
inserting after subtitle A the following:
``Subtitle B--Strengthening Data Collection, Improving Data Analysis,
and Expanding Data Reporting
``SEC. 3431. HEALTH DISPARITY DATA.
``(a) Requirements.--
``(1) In general.--Each health-related program operated by
or that receives funding or reimbursement, in whole or in part,
either directly or indirectly from the Department of Health and
Human Services shall--
``(A) require the collection, by the agency or
program involved, of data on the race, ethnicity, sex,
primary language, sexual orientation, disability
status, gender identity, and socioeconomic status of
each applicant for and recipient of health-related
assistance under such program--
``(i) using, at a minimum, the standards
for data collection on race, ethnicity, sex,
primary language, sexual orientation,
disability status, gender identity, and
socioeconomic status developed under section
3101;
``(ii) collecting data for additional
population groups if such groups can be
aggregated into the minimum race and ethnicity
categories;
``(iii) additionally referring, where
practicable, to the standards developed by the
Institute of Medicine in `Race, Ethnicity, and
Language Data: Standardization for Health Care
Quality Improvement'; and
``(iv) where practicable, through self-
reporting;
``(B) with respect to the collection of the data
described in subparagraph (A), for applicants and
recipients who are minors, require communication
assistance in speech or writing, and for applicants and
recipients who are otherwise legally incapacitated,
require that--
``(i) such data be collected from the
parent or legal guardian of such an applicant
or recipient; and
``(ii) the primary language of the parent
or legal guardian of such an applicant or
recipient be collected;
``(C) systematically analyze such data using the
smallest appropriate units of analysis feasible to
detect racial and ethnic disparities, as well as
disparities along the lines of primary language, sex,
disability status, sexual orientation, gender identity,
and socioeconomic status in health and health care, and
report the results of such analysis to the Secretary,
the Director of the Office for Civil Rights, each
agency listed in section 3101(c)(1), the Committee on
Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate, and the Committee
on Energy and Commerce and the Committee on Ways and
Means of the House of Representatives;
``(D) provide such data to the Secretary on at
least an annual basis; and
``(E) ensure that the provision of assistance to an
applicant or recipient of assistance is not denied or
otherwise adversely affected because of the failure of
the applicant or recipient to provide race, ethnicity,
primary language, sex, sexual orientation, disability
status, gender identity, and socioeconomic status data.
``(2) Rules of construction.--Nothing in this subsection
shall be construed to--
``(A) permit the use of information collected under
this subsection in a manner that would adversely affect
any individual providing any such information; and
``(B) diminish existing or future requirements on
health care providers to collect data.
``(b) Protection of Data.--The Secretary shall ensure (through the
promulgation of regulations or otherwise) that all data collected
pursuant to subsection (a) are protected--
``(1) under the same privacy protections as the Secretary
applies to other health data under the regulations promulgated
under section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033)
relating to the privacy of individually identifiable health
information and other protections; and
``(2) from all inappropriate internal use by any entity
that collects, stores, or receives the data, including use of
such data in determinations of eligibility (or continued
eligibility) in health plans, and from other inappropriate
uses, as defined by the Secretary.
``(c) National Plan of the Data Council.--The Secretary shall
develop and implement a national plan to ensure the collection of data
in a culturally appropriate and competent manner, to improve the
collection, analysis, and reporting of racial, ethnic, sex, primary
language, sexual orientation, disability status, gender identity, and
socioeconomic status data at the Federal, State, territorial, tribal,
and local levels, including data to be collected under subsection (a),
and to ensure that data collection activities carried out under this
section are in compliance with the standards developed under section
3101. The Data Council of the Department of Health and Human Services,
in consultation with the National Committee on Vital Health Statistics,
the Office of Minority Health, Office on Women's Health, and other
appropriate public and private entities, shall make recommendations to
the Secretary concerning the development, implementation, and revision
of the national plan. Such plan shall include recommendations on how
to--
``(1) implement subsection (a) while minimizing the cost
and administrative burdens of data collection and reporting;
``(2) expand awareness among Federal agencies, States,
territories, Indian tribes, health providers, health plans,
health insurance issuers, and the general public that data
collection, analysis, and reporting by race, ethnicity, primary
language, sexual orientation, disability status, gender
identity, and socioeconomic status is legal and necessary to
assure equity and nondiscrimination in the quality of health
care services;
``(3) ensure that future patient record systems have data
code sets for racial, ethnic, primary language, sexual
orientation, disability status, gender identity, and
socioeconomic status identifiers and that such identifiers can
be retrieved from clinical records, including records
transmitted electronically;
``(4) improve health and health care data collection and
analysis for more population groups if such groups can be
aggregated into the minimum race and ethnicity categories,
including exploring the feasibility of enhancing collection
efforts in States for racial and ethnic groups that comprise a
significant proportion of the population of the State;
``(5) provide researchers with greater access to racial,
ethnic, primary language, sexual orientation, disability
status, gender identity, and socioeconomic status data, subject
to privacy and confidentiality regulations; and
``(6) safeguard and prevent the misuse of data collected
under subsection (a).
``(d) Compliance With Standards.--Data collected under subsection
(a) shall be obtained, maintained, and presented (including for
reporting purposes) in accordance with the 1997 Office of Management
and Budget Standards for Maintaining, Collecting, and Presenting
Federal Data on Race and Ethnicity (at a minimum).
``(e) Technical Assistance for the Collection and Reporting of
Data.--
``(1) In general.--The Secretary may, either directly or
through grant or contract, provide technical assistance to
enable a health care program or an entity operating under such
program to comply with the requirements of this section.
``(2) Types of assistance.--Assistance provided under this
subsection may include assistance to--
``(A) enhance or upgrade computer technology that
will facilitate racial, ethnic, primary language,
sexual orientation, disability status, gender identity,
and socioeconomic status data collection and analysis;
``(B) improve methods for health data collection
and analysis including additional population groups
beyond the Office of Management and Budget categories
if such groups can be aggregated into the minimum race
and ethnicity categories;
``(C) develop mechanisms for submitting collected
data subject to existing privacy and confidentiality
regulations; and
``(D) develop educational programs to inform health
insurance issuers, health plans, health providers,
health-related agencies, and the general public that
data collection and reporting by race, ethnicity,
primary language, sexual orientation, disability
status, gender identity, and socioeconomic status are
legal and essential for eliminating health and health
care disparities.
``(f) Analysis of 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, shall provide technical assistance to agencies of
the Department of Health and Human Services in meeting Federal
standards for health disparity data collection and for analysis of
racial and ethnic disparities in health and health care in public
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
and ethnic disparities and their overlap with other disparity
factors in health and health care;
``(4) identifying the level at which data analysis should
be conducted; and
``(5) sharing data with external organizations for research
and quality improvement purposes.
``(g) Definition.--In this section, the term `health-related
program' mean a program--
``(1) under the Social Security Act (42 U.S.C. 301 et seq.)
that pays for health care and services; and
``(2) under this Act that provides Federal financial
assistance for health care, biomedical research, or health
services research and or is designed to improve the public's
health.
``SEC. 3432. PROVISIONS RELATING TO NATIVE AMERICANS.
``(a) Establishment of Epidemiology Centers.--The Secretary shall
establish an epidemiology center in each service area to carry out the
functions described in subsection (b). Any new center established after
the date of the enactment of the Health Equity and Accountability Act
of 2012 may be operated under a grant authorized by subsection (d), but
funding under such a grant shall not be divisible.
``(b) Functions of Centers.--In consultation with and upon the
request of Indian tribes, tribal organizations, and urban indian
organizations, each service area epidemiology center established under
this subsection shall, with respect to such service area--
``(1) collect data relating to, and monitor progress made
toward meeting, each of the health status objectives of the
service, the Indian tribes, tribal organizations, and urban
indian organizations in the service area;
``(2) evaluate existing delivery systems, data systems, and
other systems that impact the improvement of Indian health;
``(3) assist Indian tribes, tribal organizations, and urban
indian organizations in identifying their highest priority
health status objectives and the services needed to achieve
such objectives, based on epidemiological data;
``(4) make recommendations for the targeting of services
needed by the populations served;
``(5) make recommendations to improve health care delivery
systems for Indians and urban Indians;
``(6) provide requested technical assistance to Indian
tribes, tribal organizations, and urban indian organizations in
the development of local health service priorities and
incidence and prevalence rates of disease and other illness in
the community; and
``(7) provide disease surveillance and assist Indian
tribes, tribal organizations, and urban Indian organizations to
promote public health.
``(c) Technical Assistance.--The Director of the Centers for
Disease Control and Prevention shall provide technical assistance to
the centers in carrying out the requirements of this subsection.
``(d) Grants for Studies.--
``(1) In general.--The Secretary may make grants to Indian
tribes, tribal organizations, urban indian organizations, and
eligible intertribal consortia to conduct epidemiological
studies of Indian communities.
``(2) Eligible intertribal consortia.--An intertribal
consortium is eligible to receive a grant under this subsection
if--
``(A) the intertribal consortium is incorporated
for the primary purpose of improving Indian health; and
``(B) the intertribal consortium is representative
of the Indian tribes or urban Indian communities in
which the intertribal consortium is located.
``(3) Applications.--An application for a grant under this
subsection shall be submitted in such manner and at such time
as the Secretary shall prescribe.
``(4) Requirements.--An applicant for a grant under this
subsection shall--
``(A) demonstrate the technical, administrative,
and financial expertise necessary to carry out the
functions described in paragraph (5);
``(B) consult and cooperate with providers of
related health and social services in order to avoid
duplication of existing services; and
``(C) demonstrate cooperation from Indian tribes or
urban Indian organizations in the area to be served.
``(5) Use of funds.--A grant awarded under paragraph (1)
may be used--
``(A) to carry out the functions described in
subsection (b);
``(B) to provide information to and consult with
tribal leaders, urban Indian community leaders, and
related health staff on health care and health service
management issues; and
``(C) in collaboration with Indian tribes, tribal
organizations, and urban Indian communities, to provide
the service with information regarding ways to improve
the health status of Indians.
``(e) Access to Information.--An epidemiology center operated by a
grantee pursuant to a grant awarded under subsection (d) shall be
treated as a public health authority for purposes of the Health
Insurance Portability and Accountability Act of 1996 (Public Law 104-
191; 110 Stat. 2033), as such entities are defined in part 164.501 of
title 45, Code of Federal Regulations (or a successor regulation). The
Secretary shall grant such grantees access to and use of data, data
sets, monitoring systems, delivery systems, and other protected health
information in the possession of the Secretary.''.
SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT APPROPRIATIONS FOR DATA
COLLECTION AND ANALYSIS.
Section 3101 of the Public Health Service Act (42 U.S.C. 300kk) is
amended--
(1) by striking subsection (h); and
(2) by redesignating subsection (i) as subsection (h).
SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL SECURITY
ADMINISTRATION.
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et
seq.) is amended by adding at the end the following:
``SEC. 1150C. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL
SECURITY ADMINISTRATION.
``(a) Requirement.--The Commissioner of Social Security, in
consultation with the Administrator of the Centers for Medicare &
Medicaid Services, shall--
``(1) require the collection of data on the race,
ethnicity, primary language, sex, and disability status of all
applicants for Social Security account numbers or benefits
under title II or part A of title XVIII and all individuals
with respect to whom the Commissioner maintains records of
wages and self-employment income in accordance with reports
received by the Commissioner or the Secretary of the Treasury--
``(A) using, at a minimum, the standards for data
collection on race, ethnicity, primary language, sex,
and disability status developed under section 3101 of
the Public Health Service Act;
``(B) where practicable, collecting data for
additional population groups if such groups can be
aggregated into the minimum race and ethnicity
categories; and
``(C) additionally referring, where practicable, to
the standards developed by the Institute of Medicine in
`Race, Ethnicity, and Language Data: Standardization
for Health Care Quality Improvement' (released August
31, 2009);
``(2) with respect to the collection of the data described
in paragraph (1) for applicants who are under 18 years of age
or otherwise legally incapacitated, require that--
``(A) such data be collected from the parent or
legal guardian of such an applicant; and
``(B) the primary language of the parent or legal
guardian of such an applicant or recipient be used;
``(3) require that such data be uniformly analyzed and
reported at least annually to the Commissioner of Social
Security;
``(4) be responsible for storing the data reported under
paragraph (3);
``(5) ensure transmission to the Centers for Medicare &
Medicaid Services and other Federal health agencies;
``(6) provide such data to the Secretary on at least an
annual basis; and
``(7) ensure that the provision of assistance to an
applicant is not denied or otherwise adversely affected because
of the failure of the applicant to provide race, ethnicity,
primary language, sex, and disability status data.
``(b) Protection of Data.--The Commissioner of Social Security
shall ensure (through the promulgation of regulations or otherwise)
that all data collected pursuant to subsection (a) are protected--
``(1) under the same privacy protections as the Secretary
applies to health data under the regulations promulgated under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033)
relating to the privacy of individually identifiable health
information and other protections; and
``(2) from all inappropriate internal use by any entity
that collects, stores, or receives the data, including use of
such data in determinations of eligibility (or continued
eligibility) in health plans, and from other inappropriate
uses, as defined by the Secretary.
``(c) Rule of Construction.--Nothing in this section shall be
construed to permit the use of information collected under this section
in a manner that would adversely affect any individual providing any
such information.
``(d) Technical Assistance.--The Secretary may, either directly or
by grant or contract, provide technical assistance to enable any health
entity to comply with the requirements of this section.''.
SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Health and Human Services shall revise
the regulations promulgated under part C of title XI of the Social
Security Act (42 U.S.C. 1320d et seq.), relating to the collection of
data on race, ethnicity, and primary language in a health-related
transaction, to require--
(1) the use, at a minimum, of the standards for data
collection on race, ethnicity, primary language, disability,
and sex developed under section 3101 of the Public Health
Service Act (42 U.S.C. 300kk); and
(2) the designation of the racial, ethnic, primary
language, disability, and sex code sets as required for claims
and enrollment data.
(b) Dissemination.--The Secretary of Health and Human Services
shall disseminate the new standards developed under subsection (a) to
all health entities that are subject to the regulations described in
such subsection and provide technical assistance with respect to the
collection of the data involved.
(c) Compliance.--The Secretary of Health and Human Services shall
require that health entities comply with the new standards developed
under subsection (a) not later than 2 years after the final
promulgation of such standards.
SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n))
is amended--
(1) in paragraph (1), by striking ``2003'' and inserting
``2016'';
(2) in paragraph (2), in the first sentence, by striking
``2003'' and inserting ``2016''; and
(3) in paragraph (3), by striking ``2002'' and inserting
``2016''.
SEC. 106. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE HAWAIIANS, OR PACIFIC
ISLANDERS AND OTHER UNDERREPRESENTED GROUPS IN FEDERAL
HEALTH SURVEYS.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317T the following:
``SEC. 317U. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE HAWAIIANS, OR
PACIFIC ISLANDERS AND OTHER UNDERREPRESENTED GROUPS IN
FEDERAL HEALTH SURVEYS.
``(a) National Strategy.--
``(1) In general.--The Secretary of Health and Human
Services, acting through the Director of the National Center
for Health Statistics (referred to in this section as `NCHS')
of the Centers for Disease Control and Prevention, and other
agencies within the Department of Health and Human Services as
the Secretary determines appropriate, shall develop and
implement an ongoing and sustainable national strategy for
oversampling Asian-Americans, Native Hawaiians, or Pacific
Islanders, and other underrepresented populations as determined
appropriate by the Secretary in Federal health surveys.
``(2) Consultation.--In developing and implementing a
national strategy, as described in paragraph (1), not later
than 180 days after the date of the enactment of the this
section, the Secretary--
``(A) shall consult with representatives of
community groups, nonprofit organizations,
nongovernmental organizations, and government agencies
working with Asian-Americans, Native Hawaiians, or
Pacific Islanders, and other underrepresented
populations; and
``(B) may solicit the participation of
representatives from other Federal departments and
agencies.
``(b) Progress Report.--Not later than 2 years after the date of
the enactment of this section, the Secretary shall submit to the
Congress a progress report, which shall include the national strategy
described in subsection (a)(1).''.
SEC. 107. GEO-ACCESS STUDY.
The Administrator of the Substance Abuse and Mental Health Services
Administration shall--
(1) conduct a study to--
(A) determine which geographic areas of the United
States have shortages of specialty mental health
providers; and
(B) assess the preparedness of speciality mental
health providers to deliver culturally and
linguistically appropriate, affordable, and accessible
services; and
(2) submit a report to the Congress on the results of such
study.
SEC. 108. RACIAL, ETHNIC, AND LINGUISTIC DATA COLLECTED BY THE FEDERAL
GOVERNMENT.
(a) Collection; Submission.--Not later than 90 days after the date
of the enactment of this Act, and January 31 of each year thereafter,
each department, agency, and office of the Federal Government that has
collected racial, ethnic, or linguistic data during the preceding
calendar year shall submit such data to the Secretary of Health and
Human Services.
(b) Analysis; Public Availability; Reporting.--Not later than April
30, 2012, and each April 30 thereafter, the Secretary of Health and
Human Services, acting through the Director of the National Institute
on Minority Health and Health Disparities and the Deputy Assistant
Secretary for Minority Health, shall--
(1) collect and analyze the racial, ethnic, and linguistic
data, including by stratifying such data by sex, submitted
under subsection (a) for the preceding calendar year;
(2) make publicly available such data and the results of
such analysis; and
(3) submit a report to the Congress on such data and
analysis.
SEC. 109. DATA COLLECTION AND ANALYSIS GRANTS TO MINORITY-SERVING
INSTITUTIONS.
(a) Authority.--The Secretary of Health and Human Services, acting
through the National Institute on Minority Health and Health
Disparities and the Office of Minority Health, may award grants to
access and analyze racial and ethnic, and where possible other health
disparity data, to monitor and report on progress to reduce and
eliminate disparities in health and health care. Such analysis under
the preceding sentence shall include stratifying such data by sex.
(b) Eligible Entity.--In this section, the term ``eligible entity''
means a historically Black college or university, an Hispanic-serving
institution, a tribal college or university, or an Asian-American,
Native American, or Pacific Islander-serving institution with an
accredited public health, health policy, or health services research
program.
SEC. 110. STANDARDS FOR MEASURING SEXUAL ORIENTATION AND GENDER
IDENTITY IN COLLECTION OF HEALTH DATA.
Section 3101(a) of the Public Health Service Act (42 U.S.C.
300kk(a)) is amended--
(1) in paragraph (1)(A), by inserting ``sexual orientation,
gender identity,'' before ``and disability status'';
(2) in paragraph (1)(C), by inserting ``sexual orientation,
gender identity,'' before ``and disability status''; and
(3) in paragraph (2)(B), by inserting ``sexual orientation,
gender identity,'' before ``and disability status''.
SEC. 111. OPTIONAL COLLECTION OF HEALTH DATA ON IMMIGRANTS AND
INDIVIDUALS IN THEIR HOUSEHOLDS.
Section 3101(a) of the Public Health Service Act (42 U.S.C.
300k(a)) is amended by adding at the end the following:
``(4) Optional uniform categories.--Not later than 12
months after the date of the enactment of this paragraph, the
Secretary shall--
``(A) enter into an arrangement with the Institute
of Medicine of the National Academies (or, if the
Institute of Medicine declines to enter into such an
arrangement, another appropriate entity) to--
``(i) conduct a study and develop
recommended standards for the optional
collection of data in major health surveys and
research on citizens, noncitizens, and citizens
living in noncitizen households, including
standards protecting the confidentiality and
security of personal information of respondents
and research subjects, to the full extent
permitted by law, in order to measure
disparities in health coverage, health care
access and quality, and health status among
these populations;
``(ii) in carrying out clause (i), address
how the protection of confidentiality and
security of personal information under such
clause interacts with immigration laws; and
``(iii) include ensuing study results and
recommended standards in a report to the
Secretary;
``(B) promulgate standards based on the
recommendations and results of subparagraph (A) for the
optional collection of data in major health surveys and
research; and
``(C) provide clear guidance that such data
categories are optional uniform categories and, if
collected, the entity and any person conducting the
survey or research shall--
``(i) adhere to the standards under
subparagraph (B);
``(ii) use the information only for the
purposes of measuring disparities in health
coverage, health care access and quality, and
health status among these populations;
``(iii) comply with all applicable laws and
policies regarding privacy, confidentiality and
security of the personal information of the
respondent or research subject and of the
family members of the respondent or research
subject; and
``(iv) not share that information with
other individuals or entities without the
express consent of the respondent or research
subject.''.
SEC. 112. GAO STUDY ON COMPLIANCE WITH EXISTING FDA REQUIREMENTS TO
PRESENT DRUG AND DEVICE SAFETY AND EFFECTIVENESS DATA BY
SEX, AGE, AND RACIAL AND ETHNIC SUBGROUPS.
(a) In General.--The Comptroller General of the United States shall
conduct a study investigating the extent to which sponsors of clinical
studies of investigational drugs, biologics, and devices and sponsors
of applications for approval or licensure of new drugs, biologics, and
devices comply with Food and Drug Administration requirements and
follow guidance for presentation of clinical study safety and
effectiveness data by sex, age, and racial and ethnic subgroups.
(b) Report by GAO.--
(1) Submission.--Not later than 18 months after the date of
the enactment of this Act, the Comptroller General shall
complete the study under subsection (a) and submit to the
Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate a report on the results of such
study.
(2) Contents.--The report required by paragraph (1) shall
include each of the following:
(A) An assessment of the extent to which the Food
and Drug Administration assists sponsors in complying
with the requirements and following the guidance
referred to in subsection (a).
(B) An assessment of the effectiveness of the Food
and Drug Administration's enforcement of compliance
with such requirements.
(C) An analysis of the extent to which females,
racial and ethnic minorities, and adults of all ages
are adequately represented in Food and Drug
Administration-approved clinical studies (at all
phases) so that product safety and effectiveness data
can be evaluated by sex, age, and racial and ethnic
subgroup.
(D) An analysis of the extent to which a summary of
product safety and effectiveness data disaggregated by
sex, age, and racial and ethnic subgroup is readily
available to the public in a timely manner by means of
the product label or the Food and Drug Administration's
Web site.
(E) Recommendations for--
(i) modifications to the requirements and
guidance referred to in subsection (a); or
(ii) oversight by the Food and Drug
Administration of such requirements.
(c) Report by HHS.--Not later than 6 months after the submission by
the Comptroller General of the report required under subsection (b),
the Secretary of Health and Human Services shall submit to the
Committee on Energy and Commerce of the House of Representatives and
the Committee on Health, Education, Labor, and Pensions of the Senate a
response to that report, including a corrective action plan as needed
to respond to the recommendations in that report.
(d) Definitions.--In this section:
(1) The term ``biologic'' has the meaning given to the term
``biological product'' in section 351(i) of the Public Health
Service Act (42 U.S.C. 262(i)).
(2) The term ``device'' has the meaning given to such term
in section 201(h) of the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 321(h)).
(3) The term ``drug'' has the meaning given to such term in
section 201(g) of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 321(g)).
SEC. 113. IMPROVING HEALTH DATA REGARDING NATIVE HAWAIIANS AND OTHER
PACIFIC ISLANDERS.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317U, as added, the
following:
``SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER HEALTH DATA.
``(a) Findings.--Congress makes the following findings:
``(1) Native Hawaiians and Other Pacific Islanders
(referred to in this subsection as `NHOPI') are identified as 1
of 6 specific racial or ethnic categories in the United States
Census. The other categories are African Americans, American
Indians/Alaska Natives, Asians, Caucasians, and Latinos/
Hispanics.
``(2) Native Hawaiians and the Pacific Jurisdictions have a
special legal relationship with the United States, which
requires careful consideration of consultation rights and
expectations that are based upon formal United States policy,
special treaties with the United States, and international law.
``(3) The NHOPI population is unique in that its peoples
have homelands in the Pacific yet many have moved to reside in
the continental United States and today are living in every
state of the United States. Yet, NHOPI are often `invisible' in
current Federal data collection, analysis, and reporting,
particularly those identifying health status.
``(b) Definitions.--In this section:
``(1) Community groups.--The term `community groups' means
groups of people which are organized at the community level and
are specific to NHOPI populations such as church groups, social
service groups, and cultural groups.
``(2) Designated organizations.--The term `designated
organizations' means organizations which are constituted to
represent NHOPI populations and which have statutory
responsibilities or community support for aspects of health and
health care.
``(3) Government representatives.--The term `government
representatives' mean government representatives from Pacific
Island Jurisdictions including American Samoa, Commonwealth of
the Northern Mariana Islands, Federated States of Micronesia,
Guam, Republic of Belau, and Republic of the Marshall Islands.
``(4) Native hawaiian and other pacific islander; nhopi.--
The terms `Native Hawaiian and Other Pacific Islander' and
`NHOPI' mean people having origins in any of the original
peoples of American Samoa, Commonwealth of the Northern Mariana
Islands, Federated States of Micronesia, Guam, Hawai`i,
Republic of the Marshall Islands, Republic of Belau, or any
other Pacific Islands.
``(c) Report.--
``(1) In general.--The Secretary shall submit to Congress a
report that describes factors that affect NHOPI health. Such
report shall describe--
``(A) the health disparities that affect such
population;
``(B) an assessment of the needs of such
population; and
``(C) an evaluation of the impact of such
disparities, and of efforts to address such
disparities, on the health of such population.
``(2) Resources; partnership.--In compiling the report
under paragraph (1), the Secretary shall use data available
from the National Center for Health Statistics. The report
shall be complied in partnership with the Native Hawaiian
Epidemiology Center.
``(d) National Strategy.--
``(1) In general.--Not later than 10 months after the date
of enactment of the Health Equity and Accountability Act of
2012, the Secretary, in consultation with representatives from
community groups, designated organizations, government
representatives of NHOPI populations, and other Federal
department representatives as determined appropriate by the
Secretary, shall develop, implement, and make public an ongoing
and sustainable national strategy for identifying and
evaluating the health status and health care needs of NHOPI
living on the continental United States, in Hawai`i, and in the
various Pacific Island Jurisdictions.
``(2) Content.--The national strategy developed under
paragraph (1) shall--
``(A) address gaps in quality, efficiency,
comparative effectiveness information, and health
outcomes measures and data aggregation techniques; and
``(B) enhance the use of health care data to
improve quality, efficiency, transparency, and
outcomes.
``(e) Implementation.--The Secretary shall ask the National Center
for Health Statistics, in partnership with the Native Hawaiian
Epidemiology Center, to develop and implement the national strategy
developed under subsection (d). The Secretary shall require other
agencies within the Department of Health and Human Services to assist
the National Center for Health Statistics in carrying out the preceding
sentence.
``(f) Report.--Not later than 2 years after the date of enactment
of the Health Equity and Accountability Act of 2012, the Secretary
shall submit to Congress a progress report on the activities conducted
under this section, including the national strategy for identifying and
evaluating the health status and health care needs of NHOPI
populations.''.
SEC. 114. SIMPLIFIED ADMINISTRATIVE REPORTING REQUIREMENT FOR NUTRITION
ASSISTANCE.
Section 11(a) of the Food and Nutrition Act of 2008 (7 U.S.C.
2020(a)) is amended by adding at the end the following:
``(5) Administrative reporting requirement relating to the
indigence exception for aliens.--In satisfaction of the
administrative reporting requirement under section 421(e)(2) of
the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (8 U.S.C. 1631(e)(2)), the Secretary shall accept
from the Attorney General for each fiscal year an aggregate
report that describes the quantity of exceptions granted in
that fiscal year under that section.''.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
SEC. 201. DEFINITIONS.
In this title, the definitions contained in section 3400 of the
Public Health Service Act, as added by section 202, shall apply.
SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
(a) Findings.--Congress finds the following:
(1) Effective communication is essential to meaningful
access to quality physical and mental health care.
(2) Research indicates that the lack of appropriate
language services creates languages barriers that result in
increased risk of misdiagnosis, ineffective treatment plans and
poor health outcomes for limited-English-proficient individuals
and individuals with communication disabilities such as
hearing, vision or print impairments.
(3) The number of limited-English-speaking residents in the
United States who speak English less than very well and,
therefore, cannot effectively communicate with health and
social service providers continues to increase significantly.
(4) The responsibility to fund language services in the
provision of health care and health care-related services to
limited-English-proficient individuals and individuals with
communication disabilities such as hearing, vision, or print
impairments is a societal one that cannot fairly be visited
solely upon the health care, public health or social services
community.
(5) Title VI of the Civil Rights Act of 1964 prohibits
discrimination based on the grounds of race, color or national
origin by any entity receiving Federal financial assistance. In
order to avoid discrimination on the grounds of national
origin, all programs or activities administered by the
Department must take adequate steps to ensure that their
policies and procedures do not deny or have the effect of
denying limited-English-proficient individuals with equal
access to benefits and services for which such persons qualify.
(6) Linguistic diversity in the healthcare and health-care-
related-services workforce is important for providing all
patients the environment most conducive to positive health
outcomes.
(7) All members of the health care and health-care-related-
services community should continue to educate their staff and
constituents about limited-English proficient and disability
communication issues and help them identify resources to
improve access to quality care for limited-English-proficient
individuals and individuals with communication disabilities
such as hearing, vision, or print impairments.
(8) Access to English as a second language and sign
language instructions is an important mechanism for ensuring
effective communication and eliminating the language barriers
that impede access to health care.
(9) Competent languages services in health care settings
should be available as a matter of course.
(b) Amendment.--The Public Health Service Act (42 U.S.C. 201 et
seq.) is amended by adding at the end the following:
``TITLE XXXIV--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
``SEC. 3400. DEFINITIONS.
``In this title:
``(1) Bilingual.--The term `bilingual' with respect to an
individual means a person who has sufficient degree of
proficiency in two languages.
``(2) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides.
``(3) Competent interpreter services.--The term `competent
interpreter services' means a translanguage rendition of a
spoken or signed message in which the interpreter comprehends
the source language and can communicate comprehensively in the
target language to convey the meaning intended in the source
language. The interpreter knows health and health-related
terminology and provides accurate interpretations by choosing
equivalent expressions that convey the best matching and
meaning to the source language and captures, to the greatest
possible extent, all nuances intended in the source message.
``(4) Competent translation services.--The term `competent
translation services' means a translanguage rendition of a
written document in which the translator comprehends the source
language and can write or sign comprehensively in the target
language to convey the meaning intended in the source language.
The translator knows health and health-related terminology and
provides accurate translations by choosing equivalent
expressions that convey the best matching and meaning to the
source language and captures, to the greatest possible extent,
all nuances intended in the source document.
``(5) Cultural competence.--The term `cultural competence'
means a set of congruent behaviors, attitudes, and policies
that come together in a system, agency, or among professionals
that enables effective work in cross-cultural situations. In
the preceding sentence--
``(A) the term `cultural' refers to integrated
patterns of human behavior that include the language,
thoughts, communications, actions, customs, beliefs,
values, and institutions of racial, ethnic, religious,
or social groups, including lesbian, gay, bisexual,
transgender and intersex individuals, and individuals
with physical and mental disabilities; and
``(B) the term `competence' implies having the
capacity to function effectively as an individual and
an organization within the context of the cultural
beliefs, behaviors, and needs presented by consumers
and their communities.
``(6) Effective communication.--The term `effective
communication' means an exchange of information between the
provider of health care or health-care-related services and the
recipient of such services who is limited in English
proficiency, or has a communication impairment such as a
hearing, vision, or learning impairment, that enables access,
understanding, and benefit from health care or health-care-
related services, and full participation in the development of
their treatment plan.
``(7) Grievance resolution process.--The term `grievance
resolution process' means all aspects of dispute resolution
including filing complaints, grievance and appeal procedures,
and court action.
``(8) Health care group.--The term `health care group'
means a group of physicians organized, at least in part, for
the purposes of providing physicians' services under the
Medicaid, SCHIP, or Medicare programs and may include a
hospital and any other individual or entity furnishing services
covered under the Medicaid, SCHIP, or Medicare programs that is
affiliated with the health care group.
``(9) Health-care services.--The term `health care
services' means services that address physical as well as
mental health conditions in all care settings.
``(10) Health care-related services.--The term `health-
care-related services' means human or social services programs
or activities that provide access, referrals or links to health
care.
``(11) Indian tribe.--The term `Indian tribe' means any
Indian tribe, band, nation, or other organized group or
community, including any Alaska Native village or group or
regional or village corporation as defined in or established
pursuant to the Alaska Native Claims Settlement Act (85 Stat.
688) (43 U.S.C. 1601 et seq.), which is recognized as eligible
for the special programs and services provided by the United
States to Indians because of their status as Indians.
``(12) Integrated health care delivery system.--The term
`integrated health care delivery system' means an
interdisciplinary system that brings together providers from
the primary health, mental health, substance use and related
disciplines to improve the health outcomes of an individual.
Providers may include but are not limited to hospitals, health,
mental health or substance use clinics and providers, home
health agencies, ambulatory surgery centers, skilled nursing
facilities, rehabilitation centers, and employed, independent
or contracted physicians.
``(13) Interpreting/interpretation.--The terms
`interpreting' and `interpretation' mean the transmission of a
spoken, written, or signed message from one language or format
into another, faithfully, accurately, and objectively.
``(14) Language access.--The term `language access' means
the provision of language services to an LEP individual or
individual with communication disabilities designed to enhance
that individual's access to, understanding of or benefit from
health care or health-care-related services.
``(15) Language or language access services.--The term
`language or language access services' means provision of
health care services directly in a non-English language,
interpretation, translation, signage, video recording, and
English or non-English alternative formats.
``(16) LEP.--The term `LEP' means limited-English
proficient.
``(17) LEP related data collection activities.--The term
`LEP related data collection activities' includes identifying,
collecting, storing, tracking, and analyzing primary language
data, and information on the methods used to meet the language
access needs of limited-English-proficient individuals.
``(18) Medicare, medicaid, and schip.--The terms
`Medicare', `Medicaid', and `SCHIP' means the respective
programs under titles XVIII, XIX, and XXI of the Social
Security Act.
``(19) Minority.--
``(A) In general.--The terms `minority' and
`minorities' refer to individuals from a minority
group.
``(B) Populations.--The term `minority', with
respect to populations, refers to racial and ethnic
minority groups.
``(20) Minority group.--The term `minority group' has the
meaning given the term `racial and ethnic minority group'.
``(21) Racial and ethnic minority group.--The term `racial
and ethnic minority group' means American Indians and Alaska
Natives, African-Americans (including Caribbean Blacks,
Africans and other Blacks), Asian-Americans, Hispanics
(including Latinos), and Native Hawaiians and other Pacific
Islanders.
``(22) On-site interpreting/interpretation.--The term `on-
site interpreting/interpretation' means a method of
interpreting or interpretation for which the interpreter is in
the physical presence of the provider of health care or health-
care-related services and the recipient of such services who is
limited in English proficiency or has a communication
impairment such as hearing, vision, or learning.
``(23) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(24) Sight translation.--The term `sight translation'
means the transmission of a written message in one language
into a spoken or signed message in another language, or an
alternative format in English or another language.
``(25) State.--The term `State' means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Indian tribes, the United States Virgin Islands,
Guam, American Samoa, and the Commonwealth of the Northern
Mariana Islands.
``(26) Telephonic interpretation.--The term `telephonic
interpretation' (also known as over the phone interpretation or
OPI) means a method of interpreting/interpretation for which
the interpreter is not in the physical presence of the provider
of health care or related services and the limited-English-
proficient recipient of such services but is connected via
telephone.
``(27) Translation.--The term `translation' means the
transmission of a written message in one language into a
written or signed message in another language, and includes
translation into another language or alternative format, such
as large print font, Braille, audio recording, or CD.
``(28) Video interpretation.--The term `video
interpretation' means a method of interpreting/interpretation
for which the interpreter is not in the physical presence of
the provider of health care or related services and the
limited-English-proficient recipient of such services but is
connected via a video hook-up that includes both audio and
video transmission.
``(29) Vital document.--The term `vital document' includes
but is not limited to applications for government programs that
provide health care services, medical or financial consent
forms, financial assistance documents, letters containing
important information regarding patient instructions (such as
prescriptions, referrals to other providers, and discharge
plans) and participation in a program (such as a Medicaid
managed care program), notices pertaining to the reduction,
denial, or termination of services or benefits, notices of the
right to appeal such actions, and notices advising limited-
English-proficient individuals and individuals with
communication disabilities of the availability of free language
services, alternative formats, and other outreach materials.
``SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVIDUALS WITH LIMITED
ENGLISH PROFICIENCY.
``(a) Purpose.--As provided in Executive Order 13166, it is the
purpose of this section--
``(1) to improve Federal agency performance regarding
access to federally conducted and federally assisted programs
and activities for individuals who are limited in their English
proficiency;
``(2) to require each Federal agency to examine the
services it provides and develop and implement a system by
which limited-English-proficient individuals can obtain
cultural competence and meaningful access to those services
consistent with, and without substantially burdening, the
fundamental mission of the agency;
``(3) to require each Federal agency to ensure that
recipients of Federal financial assistance provide cultural
competence and meaningful access to their limited-English-
proficient applicants and beneficiaries;
``(4) to ensure that recipients of Federal financial
assistance take reasonable steps, consistent with the
guidelines set forth in the Limited English Proficient Guidance
of the Department of Justice (as issued on June 12, 2002), to
ensure cultural competence and meaningful access to their
programs and activities by limited-English-proficient
individuals; and
``(5) to ensure compliance with title VI of the Civil
Rights Act of 1964 and that health care providers and
organizations do not discriminate in the provision of services.
``(b) Federally Conducted Programs and Activities.--
``(1) In general.--Not later than 120 days after the date
of enactment of this title, each Federal agency that carries
out health-care-related activities shall prepare a plan to
improve access cultural competence to the federally conducted,
health-are-related programs and activities of the agency by
limited-English-proficient individuals. Each Federal agency
must ensure that such plan is fully implemented not later than
one year after the date of enactment of this Act.
``(2) Plan requirement.--Each plan under paragraph (1)
shall include--
``(A) the steps the agency will take to ensure that
limited-English-proficient individuals have access to
the agency's federally conducted health care and
health-care-related programs and activities;
``(B) the policies and procedures for identifying,
assessing, and meeting the language needs and cultural
competence needs of its limited-English-proficient
beneficiaries served by federally conducted programs
and activities;
``(C) the steps the agency will take for its
federally conducted programs and activities to improve
cultural competence to provide a range of language
assistance options, notice to limited-English-
proficient individuals of the right to competent
language services, periodic training of staff,
monitoring and quality assessment of the language
services and, in appropriate circumstances, the
translation of written materials;
``(D) the steps the agency will take to ensure that
applications, forms, and other relevant documents for
its federally conducted programs and activities are
competently translated into the primary language of a
limited-English-proficient client where such materials
are needed to improve access to federally conducted and
federally assisted programs and activities for such a
limited-English-proficient individual; and
``(E) the resources the agency will provide to
improve cultural competence to assist recipients of
Federal funds to improve access to health care or
health-care-related programs and activities for
limited-English-proficient individuals.
Each agency shall send a copy of such plan to the Department of
Justice, which shall serve as the central repository of the
Agency's plans.
``(c) Federally Assisted Programs and Activities.--
``(1) In general.--Not later than 120 days after the date
of enactment of this title, each Federal agency providing
health-care-related Federal financial assistance shall ensure
that the guidance for recipients of Federal financial
assistance developed by the agency to ensure compliance with
title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et
seq.) is specifically tailored to the recipients of such
assistance. Each agency shall send a copy of such guidance to
the Department of Justice which shall serve as the central
repository of the Agency's plans. After approval by the
Department of Justice, each agency shall publish its guidance
document in the Federal Register for public comment.
``(2) Requirements.--The agency-specific guidance developed
under paragraph (1) shall take into account the types of health
care services provided by the recipients, the individuals
served by the recipients, and other factors set out in such
standards.
``(3) Existing guidances.--A Federal agency that has
developed a guidance for purposes of title VI of the Civil
Rights Act of 1964 shall examine such existing guidance, as
well as the programs and activities to which such guidance
applies, to determine if modification of such guidance is
necessary to comply with this subsection.
``(4) Consultation.--Each Federal agency shall consult with
the Department of Justice in establishing the guidances under
this subsection.
``(d) Consultations.--
``(1) In general.--In carrying out this section, each
Federal agency that carriers out health care and health-care-
related activities shall ensure that stakeholders, such as
limited-English-proficient individuals and their representative
organizations, recipients of Federal assistance, and other
appropriate individuals or entities, have an adequate
opportunity to provide input with respect to the actions of the
agency.
``(2) Evaluation.--Each Federal agency described in
paragraph (1) shall evaluate the--
``(A) particular needs of the limited-English-
proficient individuals served by the agency;
``(B) particular needs of the limited-English-
proficient individuals served by the agency's
recipients of Federal financial assistance; and
``(C) burdens of compliance with the agency
guidance and this section for the agency and its
recipients.
``SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES IN HEALTH CARE.
``Recipients of Federal financial assistance from the Secretary
shall, to the extent reasonable and practicable after applying the 4-
factor analysis described in title V of the Guidance to Federal
Financial Assistance Recipients Regarding Title VI Prohibition Against
National Origin Discrimination Affecting Limited-English Proficient
Persons (June 12, 2002)--
``(1) implement strategies to recruit, retain, and promote
individuals at all levels of the organization to maintain a
diverse staff and leadership that can provide culturally and
linguistically appropriate health care to patient populations
of the service area of the organization;
``(2) ensure that staff at all levels and across all
disciplines of the organization receive ongoing education and
training in culturally and linguistically appropriate service
delivery;
``(3) offer and provide language assistance services,
including trained bilingual staff and interpreter services, at
no cost to each patient with limited-English proficiency at all
points of contact, in a timely manner during all hours of
operation;
``(4) notify patients, in a culturally appropriate manner,
of their right to receive language assistance services in their
primary language;
``(5) ensure the competence of language assistance provided
to limited-English-proficient patients by interpreters and
bilingual staff, and ensure that family, particularly minor
children, and friends are not used to provide interpretation
services--
``(A) except in case of emergency; or
``(B) except on request of the patient, who has
been informed in his or her preferred language of the
availability of free interpretation services;
``(6) make available easily understood patient-related
materials, if such materials exist for non-limited-English-
proficient patients, including information or notices about
termination of benefits and post signage in the languages of
the commonly encountered groups or groups represented in the
service area of the organization;
``(7) develop and implement clear goals, policies,
operational plans, and management accountability and oversight
mechanisms to provide culturally and linguistically appropriate
services;
``(8) conduct initial and ongoing organizational
assessments of culturally and linguistically appropriate
services-related activities and integrate valid linguistic,
competence-related measures into the internal audits,
performance improvement programs, patient satisfaction
assessments, and outcomes-based evaluations of the
organization;
``(9) ensure that, consistent with the privacy protections
provided for under the regulations promulgated under section
264(c) of the Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d-2 note)--
``(A) data on the individual patient's race,
ethnicity, primary language, alternative format
preferences, and policy modification needs are
collected in health records, integrated into the
organization's management information systems, and
periodically updated; and
``(B) if the patient is a minor or is
incapacitated, the primary language of the parent or
legal guardian is collected;
``(10) maintain a current demographic, cultural, and
epidemiological profile of the community as well as a needs
assessment to accurately plan for and implement services that
respond to the cultural and linguistic characteristics of the
service area of the organization;
``(11) develop participatory, collaborative partnerships
with communities and utilize a variety of formal and informal
mechanisms to facilitate community and patient involvement in
designing and implementing culturally and linguistically
appropriate services-related activities;
``(12) ensure that conflict and grievance resolution
processes are culturally and linguistically sensitive and
capable of identifying, preventing, and resolving cross-
cultural conflicts or complaints by patients;
``(13) regularly make available to the public information
about their progress and successful innovations in implementing
the standards under this section and provide public notice in
their communities about the availability of this information;
and
``(14) if requested, regularly make available to the head
of each Federal entity from which Federal funds are received,
information about their progress and successful innovations in
implementing the standards under this section as required by
the head of such entity.
``SEC. 3403. ROBERT T. MATSUI CENTER FOR CULTURAL AND LINGUISTIC
COMPETENCE IN HEALTH CARE.
``(a) Establishment.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall establish and
support a center to be known as the `Robert T. Matsui Center for
Cultural and Linguistic Competence in Health Care' (referred to in this
section as the `Center') to carry out the following activities:
``(1) Interpretation services.--The Center shall provide
resources via the Internet to identify and link health care
providers to competent interpreter and translation services.
``(2) Translation of written material.--
``(A) The Center shall provide, directly or through
contract, vital documents from competent translation
services for providers of health care and health-care-
related services at no cost to such providers.
Materials may be submitted for translation into non-
English languages. Translation services shall be
provided in a timely and reasonable manner and in
accordance with the guidelines and standards set forth
in subsection (c) when such standards become available.
The quality of such translation services shall be
monitored and reported publicly.
``(B) For each form developed or revised by the
Secretary that will be used by LEP individuals in
health care or health-care-related settings, the Center
shall translate the form, at a minimum, into the top 15
non-English languages in the United States according to
the most recent data from the American Community Survey
or its replacement. The translation must be completed
within 45 days of the Secretary receiving final
approval of the form from the Office of Management and
Budget.
``(3) Toll-free customer service telephone number.--The
Center shall provide, through a toll-free number, a customer
service line for LEP individuals--
``(A) to obtain information about federally
conducted or funded health programs, including
Medicare, Medicaid, and SCHIP;
``(B) to obtain assistance with applying for or
accessing these programs and understanding Federal
notices written in English; and
``(C) to learn how to access language services.
``(4) Health information clearinghouse.--
``(A) In general.--The Center shall develop and
maintain an information clearinghouse to facilitate the
provision of language services by providers of health
care and health-care-related services to reduce medical
errors, improve medical outcomes, to improve cultural
competence, reduce health care costs caused by
miscommunication with individuals with limited-English
proficiency, and reduce or eliminate the duplication of
effort to translate materials. The clearinghouse shall
make such information available on the Internet and in
print. Such information shall include the information
described in the succeeding provisions of this
paragraph.
``(B) Document templates.--The Center shall collect
and evaluate for accuracy, develop, 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 the
following:
``(i) Administrative and legal documents,
including--
``(I) intake forms;
``(II) Medicare, Medicaid, and
SCHIP forms, including eligibility
information;
``(III) forms informing patient of
HIPAA compliance and consent; and
``(IV) documents concerning
informed consent, advanced directives,
and waivers of rights.
``(ii) Clinical information, such as how to
take medications, how to prevent transmission
of a contagious disease, and other prevention
and treatment instructions.
``(iii) Public health, patient education,
and outreach materials, such as immunization
notices, health warnings, or screening notices.
``(iv) Additional health or health-care-
related materials as determined appropriate by
the Director of the Center.
``(C) Structure of forms.--The operating the
clearinghouse, the Center shall--
``(i) ensure that the documents posted in
English and non-English languages are
culturally appropriate;
``(ii) allow public review of the documents
before dissemination in order to ensure that
the documents are understandable and culturally
appropriate for the target populations;
``(iii) allow health care providers to
customize the documents for their use;
``(iv) facilitate access to these
documents;
``(v) provide technical assistance with
respect to the access and use of such
information; and
``(vi) carry out any other activities the
Secretary determines to be useful to fulfill
the purposes of the clearinghouse.
``(D) Language assistance programs.--The Center
shall provide for the collection and dissemination of
information on current examples of language assistance
programs and strategies to improve language services
for LEP individuals, including case studies using de-
identified patient information, program summaries, and
program evaluations.
``(E) Cultural and linguistic competence
materials.--The Center shall provide information
relating to culturally and linguistically competent
health care for minority populations residing in the
United States to all health care providers and health-
care-related services at no cost. Such information
shall include--
``(i) tenets of culturally and
linguistically competent care;
``(ii) cultural and linguistic competence
self-assessment tools;
``(iii) cultural and linguistic competence
training tools;
``(iv) strategic plans to increase cultural
and linguistic competence in different types of
providers of health care and health-care-
related services, including regional
collaborations among health care organizations;
and
``(v) cultural and linguistic competence
information for educators, practitioners, and
researchers.
``(F) Information about progress.--The Center shall
regularly collect and make publicly available
information about the progress of entities receiving
grants under section 3404 regarding successful
innovations in implementing the obligations under this
subsection and provide public notice in the entities'
communities about the availability of this information;
``(b) Director.--The Center shall be headed by a Director who shall
be appointed by, and who shall report to, the Director of the Agency
for Healthcare Research and Quality.
``(c) Interpretation and Translation Guidelines and Standards.--The
Center shall convene a working group to develop and adopt
interpretation and translation quality guidelines and standards for use
by the Center. The guidelines and standards must be sufficient to
ensure that LEP individuals have the equal opportunity to benefit from
health care services to the same extent as non-LEP individuals. The
guidelines and standards shall address the training, assessment, and
certification of individuals to provide competent interpreter and
translator services to work in health care and health-care-related
settings and of bilingual staff who provide services directly in non-
English languages. The working group may develop different guidelines
and standards for bilingual staff, interpreters, and translators.
``(d) Membership.--
``(1) Qualifications.--The Working Group shall consist of
14 members as follows:
``(A) Four members from organizations that advocate
on behalf of LEP individuals.
``(B) One member who represents a professional
interpreter association (that is not the National
Council on Interpreting in Health Care) or translator
association.
``(C) One member from a nonprofit community-based
organization that provides language services.
``(D) Three members recommended by the National
Council on Interpreting in Health Care, including one
who individual who is a professional interpreter.
``(E) Four members who are health care or mental
health providers or represent health care provider
associations, including one individual who represents a
health care practice of fewer than 5 clinicians.
``(F) One member who works in or has extensive
knowledge of issues related to health care risk
management.
``(2) Geographic representation.--The membership of the
Working Group shall reflect a broad geographic representation
including both urban and rural representatives, including
representatives of the United States territories.
``(3) Prohibited appointments.--Members of the Working
Group shall not include Members of Congress or other elected
Federal, State, or local government officials.
``(4) Vacancies.--Any vacancies in the Working Group shall
not affect the power and duties of the Working Group but shall
be filled in the same manner as the original appointment.
``(5) Subcommittees.--The Working Group may establish
subcommittees if doing so increases the efficiency of the
Working Group in completing its tasks, including subcommittees
to develop different guidelines and standards for interpreters,
translators, and bilingual staff.
``(6) Advisory panel to the working group.--The Working
Group shall consult with the Advisory Panel in the development
of the guidelines and standards. The Advisory Panel shall
include--
``(A) representatives from the American Translators
Association, Association of Language Companies, the
National Center for State Courts, and States which have
developed interpreter standards such as California,
Massachusetts, and Oregon who have experience in the
development or implementation of their organizations'
interpreter and translator certification programs;
``(B) Federal agencies including the Office for
Civil Rights, the Office of Minority Health, the
Centers for Medicare & Medicaid Services, and the
National Institute on Minority Health and Health
Disparities; and
``(C) other individuals or entities determined
appropriate by the Secretary who have specific
expertise that will be useful to the Working Group.
``(7) Publication.--
``(A) Draft standards.--Not later than 18 months
after the date of enactment of this title, the Working
Group shall--
``(i) prepare and make available to the
public through the Internet, the Federal
Register, and other appropriate public
channels, a proposed set of interpretation and
translation guidelines and standards for
training, assessment, and certification; and
``(ii) accept public comment on such
guidelines and standards for a period of not
less than 90 days.
``(B) Final standards.--Not later than 120 days
after the expiration of the public comment period
described in subparagraph (A), the Director of the
Agency for Healthcare Research and Quality shall
publish, after consultation with and the approval of
the Working Group, final guidelines and standards in
the Federal Register and on the Internet.
``(C) Testing development.--Not later than 120 days
after the publication of the final recommendations
described in subparagraph (B), the Director of the
Agency for Healthcare Research and Quality shall, if
deemed necessary by the Working Group, enter into a
contract with an entity experienced in the development
of designing certification tests in language related
fields to develop such tests as may be necessary to
implement the guidelines and standards.
``(D) Pilot project.--
``(i) Not later than 120 days after
completion of the test development described in
subparagraph (C) or after publication of the
final guidelines and standards, whichever is
later, the Secretary shall design, fund, and
implement a pilot project in up to 50
geographically and demographically diverse
sites, two of which must be in the United
States territories, to test and evaluate
implementation of the recommendations.
``(ii) The Secretary shall consult with the
Working Group and the Advisory Panel in
development of the pilot project and report
progress to the Working Group on an ongoing
basis.
``(iii) The pilot project shall include
interpreters and translators working with
various provider types, including small group
practices, hospitals, mental health and
substance use clinics, and community health
clinics, and shall include broad geographic
representation including both urban and rural
representatives.
``(iv) The pilot project shall operate for
not less than 2 nor more than 4 years, as
determined by the Secretary.
``(v) If the Working Group determines that
any revisions to guidelines and standards are
necessary as a result of the pilot project, it
shall revise such guidelines and standards and
the Director of the Agency for Healthcare
Research and Quality shall publish the
revisions in the Federal Register for notice
and comment. Not later than 120 days after the
expiration of the public comment period on such
revisions, the Director of the Agency for
Healthcare Research and Quality shall publish,
after consultation with and the approval of the
Working Group, final revisions to the
guidelines and standards in the Federal
Register and on the Internet.
``(8) Administration.--
``(A) Chairperson.--Not later than 15 days after
the date on which all members of the Working Group have
been appointed under subsection (d), the Working Group
shall designate its chairperson.
``(B) Compensation.--While serving on the business
of the Working Group (including travel time), a member
of the Working Group or the Advisory Panel shall be
entitled to compensation at the per diem equivalent of
the rate provided for level IV of the Executive
Schedule under section 5315 of title 5, United States
Code, and while so serving away from home and the
member's regular place of business, a member may be
allowed travel expenses, as authorized by the
chairperson of the Working Group. For purposes of pay
and employment benefits, rights, and privileges, all
personnel of the Working Group shall be treated as if
they were employees of the House of Representatives.
``(C) Information from federal agencies.--The
Working Group may secure directly from any Federal
department or agency such information as the Working
Group considers necessary to carry out this section.
Upon request of the Working Group, the head of such
department or agency shall furnish such information.
Any information that contains individually identifiable
information received by the Working Group shall not be
disseminated or disclosed outside of the Working Group
and shall not be used except by the Working Group.
``(D) Detail.--Not more than 10 Federal Government
employees employed by the Department of Health and
Human Services may be detailed to staff the Working
Group under this section without further reimbursement.
Any detail of an employee shall be without interruption
or loss of civil service status or privilege.
``(E) Temporary and intermittent services.--The
Working Group may procure temporary and intermittent
services under section 3109(b) of title 5, United
States Code, at rates for individuals which do not
exceed the daily equivalent of the annual rate of basic
pay prescribed for level V of the Executive Schedule
under section 5316 of such title.
``(9) Deemed status.--
``(A) Certification by private organization.--If a
private accreditation organization establishes
training, assessment, or certification standards for
interpreters or translators in health care which the
Secretary determines are at least equivalent to the
training, assessment, or certification standards
promulgated by the Secretary as described in subsection
(c), the Secretary shall find that all organizations or
individuals accredited by such organization comply also
with the standard described in subsection (c) if--
``(i) such organization or individual
authorizes the organization to release to the
Secretary upon the Secretary's request (or such
State agency as the Secretary may designate) a
copy of the most current accreditation survey
of such organization or individual made by the
organization, together with any other
information directly related to the survey as
the Secretary may require (including corrective
action plans); and
``(ii) such organization releases such a
copy and any such information to the Secretary.
``(B) Certification by a state or locality.--If a
State or locality has or establishes training,
assessment, or certification standards for interpreters
or translators in health care which the Secretary
determines are at least equivalent to the training,
assessment, or certification standards promulgated by
the Secretary as described in subsection (c), the
Secretary shall find that all organizations or
individuals accredited by such State or locality comply
also with the standard described in subsection (c) if--
``(i) such organization or individual
authorizes the State or locality to release to
the Secretary upon his request (or such State
agency as the Secretary may designate) a copy
of the most current accreditation survey of
such organization or individual made by such
State or locality, together with any other
information directly related to the survey as
the Secretary may require (including corrective
action plans); and
``(ii) such State or locality releases such
a copy and any such information to the
Secretary.
``(C) Timely action on application.--The Secretary
shall determine, within 210 days after the date the
Secretary receives an application by a private
accrediting organization, State, or locality whether
the process of the private accrediting organization,
State, or locality meets the requirements with respect
to training, assessment, or certification standards for
interpreters or translators with respect to which
standards the application is made. The Secretary may
not deny an application on the basis that it seeks to
meet the requirements with respect to only one, or more
than one, training, assessment, or certification
standards for interpreters or translators.
``(D) Disclosure of accreditation survey.--The
Secretary may not disclose any accreditation survey
made and released to him by the National Council on
Interpreting in Health Care or any State or locality of
an accredited organization or individual, except that
the Secretary may disclose such a survey and
information related to such a survey to the extent such
survey and information relate to an enforcement action
taken by the Secretary.
``(E) Deficiencies.--If the Secretary finds that an
accredited organization or individual has significant
deficiencies (as defined in regulations pertaining to
the training, assessment, or certification standards),
the organization or individual shall, after the date of
notice of such finding to the organization and for such
period as may be prescribed in regulations, be deemed
not to meet the conditions or requirements the
organization or individual has been treated as meeting
pursuant to subparagraph (A).
``(e) Availability of Language Access.--The Director shall
collaborate with the Administrator of the Office of Minority Health,
the Administrator of the Centers for Medicare & Medicaid Services, and
the Administrator of the Health Resources and Services Administration
to notify health care providers and health care organizations about the
availability of language access services by the Center.
``(f) Education.--The Secretary, directly or through contract,
shall undertake a national education campaign to inform providers, LEP
individuals, health professionals, graduate schools, and community
health centers about--
``(1) Federal and State laws and guidelines governing
access to language services;
``(2) the value of using trained interpreters and the risks
associated with using family members, friends, minors, and
untrained bilingual staff;
``(3) funding sources for developing and implementing
language services; and
``(4) promising practices to effectively provide language
services.
``SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC COMPETENCE GRANTS.
``(a) In General.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall award grants to
eligible entities to enable such entities to design, implement, and
evaluate innovative, cost-effective programs to improve cultural
competence and language access in health care for individuals with
limited-English proficiency. The Director of the Agency for Healthcare
Research and Quality shall coordinate with, and ensure the
participation of, other agencies including but not limited to the
Health Resources and Services Administration, the Center on Minority
Health and Health Disparities at the National Institutes of Health, and
the Office of Minority Health, regarding the design and evaluation of
the grants program.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) be--
``(A) a city, county, Indian tribe, State,
territory or subdivision thereof;
``(B) an organization described in section
501(c)(3) of the Internal Revenue Code of 1986;
``(C) a community health, mental health, or
substance use center or clinic;
``(D) a solo or group physician practice;
``(E) an integrated health care delivery system;
``(F) a public hospital;
``(G) a health care group, university, or college;
or
``(H) other entity designated by the Secretary; and
``(2) prepare and submit to the Secretary an application,
at such time, in such manner, and accompanied by such
additional information as the Secretary may require.
``(c) Use of Funds.--An entity shall use funds received under a
grant under this section to--
``(1) develop, implement, and evaluate models of providing
competent interpretation services through on-site
interpretation, telephonic interpretation, or video
interpretation;
``(2) implement strategies to recruit, retain, and promote
individuals at all levels of the organization to maintain a
diverse staff and leadership that can promote and provide
language services to patient populations of the service area of
the organization;
``(3) develop and maintain a needs assessment that
identifies the current demographic, cultural, and
epidemiological profile of the community to accurately plan for
and implement language services needed in service area of the
organization;
``(4) develop a strategic plan to implement language
services;
``(5) develop participatory, collaborative partnerships
with communities encompassing the LEP patient populations being
served to gain input in designing and implementing language
services;
``(6) develop and implement grievance resolution processes
that are culturally and linguistically sensitive and capable of
identifying, preventing, and resolving complaints by LEP
individuals; or
``(7) develop short-term medical mental health
interpretation training courses and incentives for bilingual
health care staff who are asked to interpret in the workplace;
``(8) develop formal training programs, including continued
professional development and education programs as well as
supervision, for individuals interested in becoming dedicated
health care interpreters and culturally competent providers;
``(9) provide staff language training instruction, which
shall include information on the practical limitations of such
instruction for non-native speakers;
``(10) develop policies that address compensation in salary
for staff who receive training to become either a staff
interpreter or bi-lingual provider;
``(11) develop other language assistance services as
determined appropriate by the Secretary;
``(12) develop, implement, and evaluate models of improving
cultural competence; and
``(13) ensure that, consistent with the privacy protections
provided for under the regulations promulgated under section
264(c) of the Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d-2 note), and any applicable State
privacy laws, data on the individual patient or recipient's
race, ethnicity, and primary language are collected (and
periodically updated) in health records and integrated into the
organization's information management systems or any similar
system used to store and retrieve data.
``(d) Priority.--In awarding grants under this section, the
Secretary shall give priority to entities that primarily engage in
providing direct care and that have developed partnerships with
community organizations or with agencies with experience language
access.
``(e) Evaluation.--
``(1) An entity that receives a grant under this section
shall submit to the Secretary an evaluation that describes, in
the manner and to the extent required by the Secretary, the
activities carried out with funds received under the grant, and
how such activities improved access to health and health-care-
related services and the quality of health care for individuals
with limited-English proficiency. Such evaluation shall be
collected and disseminated through the Robert T. Matsui Center
for Cultural and Linguistic Competence in Health Care
established under section 3403. The Director of the Agency for
Healthcare Research and Quality shall notify grantees of the
availability of technical assistance for the evaluation and
provide such assistance upon request.
``(2) The Director of the Agency for Healthcare Research
and Quality shall evaluate or arrange with other individuals or
organizations to evaluate projects funded under this section.
``SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COMPETENCE.
``(a) In General.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall expand research
concerning language access in the provision of health care.
``(b) Eligibility.--The Director of the Agency for Healthcare
Research and Quality may conduct the research described in subsection
(a) or enter into contracts with other individuals or organizations to
do so.
``(c) Use of Funds.--Research under this section shall be designed
to do one or more of the following:
``(1) To identify the barriers to mental and behavioral
services that are faced by LEP individuals.
``(2) To identify health care providers' and health
administrators' attitudes, knowledge, and awareness of the
barriers to quality health care services that are faced by LEP
individuals.
``(3) To identify optimal approaches for delivering
language access.
``(4) To identify best practices for data collection,
including--
``(A) the collection by providers of health care
and health-care-related services of data on the race,
ethnicity, and primary language of recipients of such
services, taking into account existing research
conducted by the Government or private sector;
``(B) the development and implementation of data
collection and reporting systems; and
``(C) effective privacy safeguards for collected
data.
``(5) To develop a minimum data collection set for primary
language.
``(6) To evaluate the most effective ways in which the
Department can create or coordinate, and then subsidize or
otherwise fund telephonic interpretation providers for health
care providers, taking into consideration, among other factors,
the flexibility necessary for such a system to accommodate
variations in--
``(A) provider type;
``(B) languages needed and their frequency of use;
``(C) type of encounter;
``(D) time of encounter, including regular business
hours and after hours; and
``(E) location of encounter.''.
SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES UNDER THE MEDICARE, MEDICAID, AND
STATE CHILDREN'S HEALTH INSURANCE PROGRAMS.
(a) Language Access Grants for Medicare Providers.--
(1) Establishment.--
(A) In general.--Not later than 6 months after the
date of the enactment of this Act, the Secretary of
Health and Human Services (in this section referred to
as the ``Secretary''), acting through the Centers for
Medicare & Medicaid Services and in consultation with
the Center for Medicare and Medicaid Innovation, shall
establish demonstration program under which the
Secretary shall award grants to eligible Medicare
service providers to improve communication between such
providers and limited-English-proficient Medicare
beneficiaries, including beneficiaries who live in
diverse and underserved communities.
(B) Application of innovation rules.--The
demonstration project under subparagraph (A) shall be
conducted in a manner that is consistent with the
applicable provisions of subsections (b), (c), and (d)
of section 1115A of the Social Security Act.
(C) Number of grants.--To the extent practicable,
the Secretary shall award not less than 24 grants under
this subsection.
(D) Grant period.--Except as provided under
paragraph (2)(D), each grant awarded under this
subsection shall be for a 3-year period.
(2) Eligibility requirements.--To be eligible for a grant
under this subsection, an entity must meet the following
requirements:
(A) Medicare provider.--The entity must be--
(i) a provider of services under part A of
title XVIII of the Social Security Act;
(ii) a provider of services under part B of
such title;
(iii) a Medicare Advantage organization
offering a Medicare Advantage plan under part C
of such title; or
(iv) a PDP sponsor offering a prescription
drug plan under part D of such title.
(B) Underserved communities.--The entity must serve
a community that, with respect to necessary language
services for improving access and utilization of health
care among limited-English proficient individuals, is
disproportionally underserved.
(C) Application.--The entity must prepare and
submit to the Secretary an application, at such time,
in such manner, and accompanied by such additional
information as the Secretary may require.
(D) Reporting.--In the case of a grantee that
received a grant under this subsection in a previous
year, such grantee is only eligible for continued
payments under a grant under this subsection if the
grantee met the reporting requirements under paragraph
(9) for such year. If a grantee fails to meet the
requirement of such paragraph for the first year of a
grant, the Secretary may terminate the grant and
solicit applications from new grantees to participate
in the demonstration program.
(3) Distribution.--To the extent feasible, the Secretary
shall award--
(A) at least 6 grants to providers of services
described in paragraph (2)(A)(i);
(B) at least 6 grants to service providers
described in paragraph (2)(A)(ii);
(C) at least 6 grants to organizations described in
paragraph (2)(A)(iii); and
(D) at least 6 grants to sponsors described in
paragraph (2)(A)(iv).
(4) Considerations in awarding grants.--
(A) Variation in grantees.--In awarding grants
under this subsection, the Secretary shall select
grantees to ensure the following:
(i) The grantees provide many different
types of language services.
(ii) The grantees serve Medicare
beneficiaries who speak different languages,
and who, as a population, have differing needs
for language services.
(iii) The grantees serve Medicare
beneficiaries in both urban and rural settings.
(iv) The grantees serve Medicare
beneficiaries in at least two geographic
regions, as defined by the Secretary.
(v) The grantees serve Medicare
beneficiaries in at least two large
metropolitan statistical areas with racial,
ethnic, and economically diverse populations.
(B) Priority for partnerships with community
organizations and agencies.--In awarding grants under
this subsection, the Secretary shall give priority to
eligible entities that have a partnership with--
(i) a community organization; or
(ii) a consortia of community
organizations, state agencies, and local
agencies,
that has experience in providing language services.
(5) Use of funds for competent language services.--
(A) In general.--Subject to subparagraph (E), a
grantee may only use grant funds received under this
subsection to pay for the provision of competent
language services to Medicare beneficiaries who are
limited-English proficient.
(B) Competent language services defined.--For
purposes of this subsection, the term ``competent
language services'' means--
(i) interpreter and translation services
that--
(I) subject to the exceptions under
subparagraph (C)--
(aa) if the grantee
operates in a State that has
statewide health care
interpreter standards, meet the
State standards currently in
effect; or
(bb) if the grantee
operates in a State that does
not have statewide health care
interpreter standards, utilizes
competent interpreters who
follow the National Council on
Interpreting in Health Care's
Code of Ethics and Standards of
Practice; and
(II) that, in the case of
interpreter services, are provided
through--
(aa) on-site
interpretation;
(bb) telephonic
interpretation; or
(cc) video interpretation;
and
(ii) the direct provision of health care or
health-care-related services by a competent
bilingual health care provider.
(C) Exceptions.--The requirements of subparagraph
(B)(i)(I) do not apply--
(i) to a Medicare beneficiary who is
limited-English-proficient who has been
informed, in the beneficiary's primary
language, of the availability of free
interpreter and translation services and who,
instead, requests that a family member, friend,
or other person provide such services, if the
grantee documents such request in the
beneficiary's medical record; or
(ii) in the case of a medical emergency
where the delay directly associated with
obtaining a competent interpreter or
translation services would jeopardize the
health of the patient.
Subparagraph (C)(ii) shall not be construed to exempt
emergency rooms or similar entities that regularly
provide health care services in medical emergencies to
limited-English-proficient patients from any applicable
legal or regulatory requirements related to providing
competent interpreter and translation services without
undue delay.
(D) MA organizations and pdp sponsors.--If a
grantee is a Medicare Advantage organization or a PDP
sponsor, such entity must provide at least 50 percent
of the grant funds that the entity receives under this
subsection directly to the entity's network providers
(including physicians and pharmacies) for the purpose
of providing support for such providers to provide
competent language services to Medicare beneficiaries
who are limited-English proficient.
(E) Administrative and reporting costs.--A grantee
may use up to 10 percent of the grant funds to pay for
administrative costs associated with the provision of
competent language services and for reporting required
under paragraph (9).
(6) Determination of amount of grant payments.--
(A) In general.--Payments to grantees under this
subsection shall be calculated based on the estimated
numbers of limited-English-proficient Medicare
beneficiaries in a grantee's service area utilizing--
(i) data on the numbers of limited-English-
proficient individuals who speak English less
than ``very well'' from the most recently
available data from the Bureau of the Census or
other State-based study the Secretary
determines likely to yield accurate data
regarding the number of such individuals in
such service area; or
(ii) data provided by the grantee, if the
grantee routinely collects data on the primary
language of the Medicare beneficiaries that the
grantee serves and the Secretary determines
that the data is accurate and shows a greater
number of limited-English-proficient
individuals than would be estimated using the
data under clause (i).
(B) Discretion of secretary.--Subject to
subparagraph (C), the amount of payment made to a
grantee under this subsection may be modified annually
at the discretion of the Secretary, based on changes in
the data under subparagraph (A) with respect to the
service area of a grantee for the year.
(C) Limitation on amount.--The amount of a grant
made under this subsection to a grantee may not exceed
$500,000 for the period under paragraph (1)(D).
(7) Assurances.--Grantees under this subsection shall--
(A) ensure that clinical and support staff receive
appropriate ongoing education and training in
linguistically appropriate service delivery;
(B) ensure the linguistic competence of bilingual
providers;
(C) offer and provide appropriate language services
at no additional charge to each patient with limited-
English proficiency for all points of contact between
the patient and the grantee, in a timely manner during
all hours of operation;
(D) notify Medicare beneficiaries of their right to
receive language services in their primary language;
(E) post signage in the primary languages commonly
used by the patient population in the service area of
the organization; and
(F) ensure that--
(i) primary language data is collected for
recipients of language services and such data
is consistent with standards developed under
title XXXIV of the Public Health Service Act,
as added by section 202 of this Act, to the
extent such standards are available upon the
initiation of the demonstration program; and
(ii) consistent with the privacy
protections provided under the regulations
promulgated pursuant to section 264(c) of the
Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d-2 note), if the
recipient of language services is a minor or is
incapacitated, primary language data is
collected on the parent or legal guardian of
such recipient.
(8) No cost sharing.--Limited-English-proficient Medicare
beneficiaries shall not have to pay cost-sharing or co-payments
for competent language services provided under this
demonstration program.
(9) Reporting requirements for grantees.--Not later than
the end of each calendar year, a grantee that receives funds
under this subsection in such year shall submit to the
Secretary a report that includes the following information:
(A) The number of Medicare beneficiaries to whom
competent language services are provided.
(B) The primary languages of those Medicare
beneficiaries.
(C) The types of language services provided to such
beneficiaries.
(D) Whether such language services were provided by
employees of the grantee or through a contract with
external contractors or agencies).
(E) The types of interpretation services provided
to such beneficiaries, and the approximate length of
time such service is provided to such beneficiaries.
(F) The costs of providing competent language
services.
(G) An account of the training or accreditation of
bilingual staff, interpreters, and translators
providing services funded by the grant under this
subsection.
(10) Evaluation and report to congress.--Not later than 1
year after the completion of a 3-year grant under this
subsection, the Secretary shall conduct an evaluation of the
demonstration program under this subsection and shall submit to
the Congress a report that includes the following:
(A) An analysis of the patient outcomes and the
costs of furnishing care to the limited-English-
proficient Medicare beneficiaries participating in the
project as compared to such outcomes and costs for
limited-English-proficient Medicare beneficiaries not
participating, based on the data provided under
paragraph (9) and any other information available to
the Secretary.
(B) The effect of delivering language services on--
(i) Medicare beneficiary access to care and
utilization of services;
(ii) the efficiency and cost effectiveness
of health care delivery;
(iii) patient satisfaction;
(iv) health outcomes; and
(v) the provision of culturally appropriate
services provided to such beneficiaries.
(C) The extent to which bilingual staff,
interpreters, and translators providing services under
such demonstration were trained or accredited and the
nature of accreditation or training needed by type of
provider, service, or other category as determined by
the Secretary to ensure the provision of high-quality
interpretation, translation, or other language services
to Medicare beneficiaries if such services are expanded
pursuant to subsection (c) of section 1907 of this Act.
(D) Recommendations, if any, regarding the
extension of such project to the entire Medicare
program, subject the to provision of section 1115A(c)
of the Social Security Act.
(b) Language Services Under the Medicare Program.--
(1) Subsection (aa)(1) of section 1861 of the Social
Security Act (42 U.S.C. 1395x) is amended--
(A) in subparagraph (B), by striking the ``and'' at
the end;
(B) in subparagraph (C), by inserting ``and'' after
the comma at the end; and
(C) by inserting after subparagraph (C) the
following:
``(D) language services as defined in subsection
(iii),''.
(2) Section 1833(a) of the Social Security Act (42 U.S.C.
1395l(a)) is amended--
(A) by striking ``and'' at the end of paragraph
(8);
(B) by redesignating paragraph (9) as paragraph
(10); and
(C) by inserting after paragraph (8) the following
new paragraph:
``(9) in the case of language services described in section
1861(iii), 100 percent of the reasonable charges for such
services, as determined in consultation with the Medicare
Payment Advisory Commission; and''.
(3) Section 1832(a)(2) of such Act (42 U.S.C. 1395k(a)(2))
is amended--
(A) by striking ``and'' at the end of subparagraph
(I);
(B) by striking the period at the end of
subparagraph (J) and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(K) language services (as defined in section
1861(iii)) furnished by a interpreter or translator.''.
(4) Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended by adding at the end the following new
subsection:
``Language Services and Related Terms
``(iii)(1) Language Services Defined.--The term `language services'
has the same meaning given `language or language access services' in
section 3400 of the Public Health Service Act.
``(2) Interpreter Services Defined.--For purposes of this
subsection, the term `interpreter services' has the meaning given
`competent interpreter services' under section 3400(3) of the Public
Health Service Act.
``(3) Interpreter Defined.--The term `interpreter'--
``(A) means an individual--
``(i) who faithfully, accurately, and objectively
transmits a spoken message from one language into
another language; and
``(ii) who knows health and health-related
terminology in both languages; and
``(B) includes individuals who provide in-person,
telephonic, and video interpretation.
``(4) Translation Defined.--The term `translation' means the
transmission of a written message in one language into a written
message in another language that retains the intended meaning of the
original message.
``(5) Limited-English-proficient and LEP Defined.--The terms
`Limited-English-proficient' and `LEP' have the meaning given the term
`limited english proficient' under section 9101(25) of the Elementary
and Secondary Education Act of 1965, except that subparagraphs (A),
(B), and (D) of such section shall not apply.''.
(5) Waiver of budget neutrality.--For the 3-year period
beginning on the date of enactment of this section, the budget
neutrality provision of section 1848(c)(2)(B)(ii) of the Social
Security Act (42 U.S.C. 1395w-4(c)(2)(B)(ii)) shall not apply
to language services (as such term is defined in section
1861(iii) of such Act, as added by paragraph (4)).
(c) Medicare Part C and Part D.--
(1) Medicare part c.--Section 1852 of the Social Security
Act (42 U.S.C. 1395ww-22) is amended by adding at the end the
following new subsection:
``(m) Provision of Effective Language Services.--
``(1) In general.--Each Medicare Advantage organization
that offers a Medicare Advantage plan under this part shall
provide effective language services to enrollees in such plan.
``(2) Reporting requirements.--A Medicare Advantage
organization shall annually submit to the Secretary a report
that contains information on the internal policies and
procedures of Medicare Advantage plans offered by the
organization related to recruitment and retention efforts
directed to workforce diversity and linguistically and
culturally appropriate provision of services in each of the
following contexts:
``(A) The collection of data in a manner that meets
the requirements of title I of the Health Equity and
Accountability Act of 2012, regarding the enrollee
population.
``(B) Education of staff and contractors who have
routine contact with enrollees regarding the various
needs of the diverse enrollee population.
``(C) Evaluation of the plan's language services
programs and services with respect to the plan's
enrollee population, such as through analysis of
complaints or satisfaction survey results.
``(D) Methods by which the plan provides to the
Secretary information regarding the ethnic diversity of
the plan's enrollee population.
``(E) The periodic provision of educational
information to plan enrollees on the plan's language
services and programs.''.
(2) Medicare part d.--Section 1860D-4 of the Social
Security Act (42 U.S.C. 1395w-104) is amended by adding at the
end the following new subsection:
``(m) Provision of Effective Language Services.--The provisions of
section 1852(m) shall apply to a PDP sponsor (and a prescription drug
plan offered by such sponsor) in the same manner as such provisions
apply to a Medicare Advantage organization (and a Medicare Advantage
plan offered by such organization.''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
the date of enactment of this Act.
(d) Improving Language Services in Medicaid and SCHIP.--
(1) Section 1903(a)(2)(E) of the Social Security Act (42
U.S.C. 1396b(a)(2)(E)) is amended by--
(A) striking ``75'' and inserting ``90'';
(B) striking ``translation or interpretation
services'' and inserting ``language services''; and
(C) striking ``children of families'' and inserting
``individuals''.
(2) Section 1902(a)(10)(A) of the Social Security Act (42
U.S.C. 1396a(a)(10)(A)) is amended, in the matter preceding
clause (i), by striking ``and (28)'' and inserting ``(28), and
(29)''.
(3) Section 1905(a) of the Social Security Act (42 U.S.C.
1396d(a)) is amended by--
(A) in paragraph (28), by striking ``and'' at the
end;
(B) by redesignating paragraph (29) as paragraph
(30); and
(C) by inserting after paragraph (28) the following
new paragraph:
``(29) language services, as such term is defined in
section 1861(iii), provided in a timely manner to limited-
English-proficient individuals who need such services; and''.
(4) Section 1916(a)(2) of the Social Security Act (42
U.S.C. 1396o(2)) is amended by--
(A) by striking ``or'' at the end of subparagraph
(D);
(B) by striking ``; and'' at the end of
subparagraph (E) and inserting ``, or''; and
(C) by adding at the end the following new
subparagraph:
``(F) language services described in section
1905(a)(29); and''.
(5) Section 2103 of the Social Security Act (42 U.S.C.
1397cc) is amended--
(A) in subsection (a), in the matter before
paragraph (1), by striking `` and (7)'' and inserting
``(7), and (9)''; and
(B) in subsection (c), by adding at the end the
following new paragraph:
``(9) Language services.--The child health assistance
provided to a targeted low-income child shall include coverage
of language services, as such term is defined in section
1861(iii), provided in a timely manner to limited-English-
proficient individuals who need such services.''; and
(C) in subsection (e)(2)--
(i) in the heading, by striking
``Preventive'' and inserting ``Certain''; and
(ii) by inserting ``, subsection (c)(9),''
after ``subsection (c)(1)(C)''.
(6) Section 2110(a)(27) of the Social Security Act (42
U.S.C. 1397jj) is amended by striking ``translation'' and
inserting ``language services as described in section
2103(c)(9)''.
(7) Pursuant to the reporting requirement described in
section 2107(b)(1) of the Social Security Act (42 U.S.C.
1397gg(b)(1)), the Secretary of Health and Human Services shall
require that States collect data on--
(A) the primary language of individuals receiving
child health assistance under title XXI of the Social
Security Act; and
(B) in the case of such individuals who are minors
or incapacitated, the primary language of the
individual's parent or guardian.
(8) Section 2105 of the Social Security Act (42 U.S.C.
1397ee(c)) is amended--
(A) in subsection (a)(1), in the matter preceding
subparagraph (A), by striking ``75'' and inserting
``90''; and
(B) in subsection (c)(2)(A), by inserting before
the period ``, except that expenditures pursuant to
clause (iv) of subparagraph (D) of such paragraph shall
not count towards this total''.
(e) Funding Language Services Furnished by Providers of Health Care
and Health-Care-Related Services That Serve High Rates of Uninsured LEP
Individuals.--
(1) Payment of costs.--
(A) In general.--Subject to subparagraph (B), the
Secretary of Health and Human Services shall make
payments (on a quarterly basis) directly to eligible
entities to support the provision of language services
to limited-English-proficient individuals in an amount
equal to an entity's eligible costs (as defined under
paragraph (3)) for such services for the quarter.
(B) Funding.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the
Secretary of Health and Human Services such sums as may
be necessary for each of fiscal years 2012 through
2016.
(C) Relation to medicaid dsh.--Payments under this
subsection shall not offset or reduce payments under
section 1923 of the Social Security Act, nor shall
payments under such section be considered when
determining uncompensated costs associated with the
provision of language services.
(2) Eligible entity.--In order to receive grants under this
paragraph, an entity must--
(A) be a Medicaid provider that is--
(i) a physician;
(ii) a hospital with a low-income
utilization rate (as defined in section
1923(b)(3) of the Social Security Act (42
U.S.C. 1396r-4(b)(3))) of greater than 25
percent; or
(iii) 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)));
(B) provide language services to at least 8 percent
of the entity's total number of patients, not later
than 6 months after the date of the enactment of the
Act; and
(C) prepare and submit an application to the
Secretary, at such time, in such manner, and
accompanied by such information as the Secretary may
require to ascertain the entity's eligibility for
funding under this subsection.
(3) Eligible costs defined.--
(A) In general.--In this subsection, the term
``eligible costs'' means, with respect to an eligible
entity that provides language services to LEP
individuals, the product of--
(i) the average per person cost of language
services, determined according to the
methodology devised under subparagraph (B); and
(ii) the number of limited-English-
proficient individuals who are provided
language services by the entity and for whom no
reimbursement is available for such services
under the amendments made by subsections (a),
(b), (c), or (d) or by private health
insurance.
(B) Methodology.--
(i) In general.--The Secretary shall
establish a methodology to determine the
average per person cost of language services.
(ii) Different entities.--In establishing
such methodology, the Secretary may establish
different methodologies for different types of
eligible entities.
(iii) No individual claims.--The Secretary
may not require eligible entities to submit
individual claims for language services for
individual patients as a requirement for
payment under this subsection.
(4) Data collection instrument.--For purposes of this
subsection, the Secretary shall create a standard data
collection instrument that is consistent with any existing
reporting requirements by the Secretary or relevant accrediting
organizations regarding the number of individuals to whom
language access are provided.
(5) Reporting requirements.--Entities receiving payment
under this subsection shall provide the Secretary with a
quarterly report on how the entity used such funds. Such report
shall contain aggregate (and may not contain individualized)
data collected using the instrument under paragraph (4) and
shall otherwise be in a form and manner determined by the
Secretary.
(6) Language services.--For purposes of this subsection,
the term ``language services'' has the meaning given such term
in section 1861(iii) of the Social Security Act.
(7) Guidelines and report.--
(A) Establishment.--Not later than 6 months after
the date of enactment of this Act, the Secretary of
Health and Human Services shall establish and
distribute guidelines concerning the implementation of
this subsection.
(B) Report.--Not later than 2 years after the date
of enactment of this Act, and every 2 years thereafter,
the Secretary shall submit a report to Congress
concerning the implementation of this subsection.
(f) Application of Civil Rights Act of 1964 and Other Laws.--
Nothing in this section shall be construed to limit otherwise existing
obligations of recipients of Federal financial assistance under title
VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et seq.) or other
laws that protect the civil rights of individuals.
(g) Effective Date.--
(1) In general.--Except as otherwise provided and subject
to paragraph (2), the amendments made by this section shall
take effect on January 1, 2013.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
SEC. 204. INCREASING UNDERSTANDING OF AND IMPROVING HEALTH LITERACY.
(a) In General.--The Secretary, acting through the Director of the
Agency for Healthcare Research and Quality and the Administrator of the
Health Resources and Services Administration, in consultation with the
Director of the National Institute on Minority Health and Health
Disparities and the Office of Minority Health, shall award grants to
eligible entities to improve health care for patient populations that
have low functional health literacy.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
(1) be a hospital, health center or clinic, health plan, or
other health entity (including a nonprofit minority health
organization or association); and
(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
(c) Use of Funds.--
(1) Agency for healthcare research and quality.--Grants
awarded under subsection (a) through the Agency for Healthcare
Research and Quality shall be used--
(A) to define and increase the understanding of
health literacy;
(B) to investigate the correlation between low
health literacy and health and health care;
(C) to clarify which aspects of health literacy
have an effect on health outcomes; and
(D) for any other activity determined appropriate
by the Director of the Agency.
(2) Health resources and services administration.--Grants
awarded under subsection (a) through the Health Resources and
Services Administration shall be used to conduct demonstration
projects for interventions for patients with low health
literacy that may include--
(A) the development of new disease management
programs for patients with low health literacy;
(B) the tailoring of existing disease management
programs addressing mental, physical, oral, and
behavioral health conditions for patients with low
health literacy;
(C) the translation of written health materials for
patients with low health literacy;
(D) the identification, implementation, and testing
of low health literacy screening tools;
(E) the conduct of educational campaigns for
patients and providers about low health literacy; and
(F) other activities determined appropriate by the
Administrator of the Health Resources and Services
Administration.
(d) Definitions.--In this section, the term ``low health literacy''
means the inability of an individual to obtain, process, and understand
basic health information and services needed to make appropriate health
decisions.
SEC. 205. ASSURANCES FOR RECEIVING FEDERAL FUNDS.
(a) In General.--Entities that receive Federal funds under sections
201 or 202 (including under the amendments made by such section), in
order to ensure the right of LEP individuals to receive access to
quality health care, shall--
(1) ensure that appropriate clinical and support staff
receive ongoing education and training in linguistically
appropriate service delivery;
(2) offer and provide appropriate language services at no
additional charge to each patient with limited-English
proficiency at all points of contact, in a timely manner during
all hours of operation;
(3) notify patients of their right to receive language
services in their primary language; and
(4) utilize only competent interpreter or translation
services which--
(A) until adoption of the Interpreter and
Translator Guidelines and Standards described in
section 3403(c) of the Public Health Service Act, are
defined in section 3400 of the Public Health Service
Act; and
(B) after adoption of the Interpreter and
Translator Guidelines and Standards described in
section 3403(c) of the Public Health Service Act, meet
those guidelines and standards;
(b) Exemptions.--The requirements of subsection (a)(4) shall not
apply as follows:
(1) When a patient (who has been informed in his or her
primary language of the availability of free interpreter and
translation services) requests the use of family, friends, or
other persons untrained in interpretation or translation if the
following conditions are met:
(A) The interpreter requested by the patient is
over the age of 18.
(B) The recipient informs the patient that he or
she has the option of having the recipient provide an
interpreter for him/her without charge, or of using
his/her own interpreter.
(C) The recipient informs the patient that the
recipient may not require an LEP person to use a family
member or friend as an interpreter.
(D) The recipient evaluates whether the person the
patient wishes to use as an interpreter is competent.
If the recipient has reason to believe that the
interpreter is not competent, the recipient provides
the recipient's own interpreter to protect the
recipient from liability if the patient's interpreter
is later found not competent.
(E) If the recipient has reason to believe that
there is a conflict of interest between the interpreter
and patient, the recipient may not use the patient's
interpreter.
(F) The recipient has the patient sign a waiver,
witnessed by at least 1 individual not related to the
patient, that includes the information stated in
subparagraphs (A) through (E) and is translated into
the patient's language.
(2) When a medical emergency exists and the delay directly
associated with obtaining competent interpreter or translation
services would jeopardize the health of the patient but only
until a competent interpreter or translation service is
available; however, nothing in this subsection shall exempt
emergency rooms or similar entities that regularly provide
health care services in medical emergencies from having in
place systems to provide competent interpreter and translation
services without undue delay.
SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY AND
LINGUISTICALLY APPROPRIATE HEALTH CARE SERVICES.
Not later than 1 year after the date of enactment of this Act and
annually thereafter, the Secretary of Health and Human Services shall
enter into a contract with the Institute of Medicine for the
preparation and publication of a report that describes Federal efforts
to ensure that all individuals with limited-English proficiency have
meaningful access culturally competent to health care and health-care-
related services. Such report shall include--
(1) a description and evaluation of the activities carried
out under this Act;
(2) a description and analysis of best practices, model
programs, guidelines, and other effective strategies for
providing access to culturally and linguistically appropriate
health care services;
(3) recommendations on the development and implementation
of policies and practices by providers of health care and
health-care-related services for limited-English-proficient
individuals;
(4) a description of the effect of providing language
services on quality of health care and access to care; and
(5) a description of the costs associated with or savings
related to the provision of language services.
SEC. 207. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES.
(a) Grants Authorized.--The Secretary of Education is authorized to
provide grants to eligible entities for the provision of English as a
second language (hereafter referred to as ``ESL'') instruction and
shall determine, after consultation with appropriate stakeholders, the
mechanism for administering and distributing such grants.
(b) Eligible Entity Defined.--For purposes of this section, the
term ``eligible entity'' means a State or community-based organization
that employs, and serves, minority populations.
(c) Application.--An eligible entity may apply for a grant under
this section by submitting such information as the Secretary may
require and in such form and manner as the Secretary may require.
(d) Use of Grant.--As a condition of receiving a grant under this
section, an eligible entity shall--
(1) develop and implement a plan for assuring the
availability of ESL instruction that effectively integrates
information about the nature of the United States health care
system, how to access care, and any special language skills
that may be required for them to access and regularly negotiate
the system effectively;
(2) develop a plan, including, where appropriate, public-
private partnerships, for making ESL instruction progressively
available to all individuals seeking instruction; and
(3) maintain current ESL instruction efforts by using the
additional funds to supplement rather than supplant any funds
expended for ESL instruction in the State as of January 1,
2006.
(e) Additional Duties of the Secretary.--The Secretary of Education
shall--
(1) collect and publicize annual data on how much Federal,
State, and local governments spend on ESL instruction;
(2) collect data from State and local governments to
identify the unmet needs of English language learners for
appropriate ESL instruction, including--
(A) the preferred written and spoken language of
such English language learners;
(B) the extent of waiting lists including how many
programs maintain waiting lists and, for programs that
do not have waiting lists, the reasons why not;
(C) the availability of programs to geographically
isolated communities;
(D) the impact of course enrollment policies,
including open enrollment, on the availability of ESL
instruction;
(E) the number individuals in the State and each
participating locality;
(F) the effectiveness of the instruction in meeting
the needs of individuals receiving instruction and
those needing instruction;
(G) as assessment of the need for programs that
integrate job training and ESL instruction, to assist
individuals to obtain better jobs; and
(H) the availability of ESL slots by State and
locality;
(3) determine the cost and most appropriate methods of
making ESL instruction available to all English language
learners seeking instruction; and
(4) within 1 year of the date of enactment of this Act,
issue a report to Congress that assesses the information
collected in paragraphs (1), (2), and (3) and makes
recommendations on steps that should be taken to progressively
realize the goal of making ESL instruction available to all
English language learners seeking instruction.
SEC. 208. IMPLEMENTATION.
(a) General Provisions.--
(1) A State shall not be immune under the Eleventh
Amendment of the Constitution of the United States from suit in
Federal court for failing to provide the language access funded
pursuant to this title.
(2) In a suit against a State for a violation of this
title, remedies (including remedies at both at law and in
equity) are available for such a violation to the same extent
as such remedies are available for such a violation in the suit
against any public or private entity other than a State.
(b) Rule of Construction.--Nothing in this title shall be construed
to limit otherwise existing obligations of recipients of Federal
financial assistance under title VI of the Civil Rights Act of 1964 (42
U.S.C. 2000(d) et seq.) or any other statute.
SEC. 209. LANGUAGE ACCESS SERVICES.
(a) Essential Benefits.--Section 1302(b)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended
by adding at the end the following:
``(K) Language access services, including oral
interpretation and written translations.''.
(b) Employer-Sponsored Minimum Essential Coverage.--Section
36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended by adding
at the end the following:
``(v) Coverage must include language access
and services.--Except as provided in clause
(iii), an employee shall not be treated as
eligible for minimum essential coverage if such
coverage consists of an eligible employer-
sponsored plan (as defined in section
5000A(f)(2)) and the plan does not provide
coverage for language access services,
including oral interpretation and written
translations.''.
(c) Quality Reporting.--Section 2717(a)(1) of the Public Health
Service Act (42 U.S.C. 300gg-17(a)(1)) is amended--
(1) by striking ``and'' at the end of subparagraph (C);
(2) by striking the period at the end of subparagraph (D)
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(E) reduce health disparities through the
provision of language access services, including oral
interpretation and written translations.''.
(d) Regulations Regarding Internal Claims and Appeals and External
Review Processes for Health Plans and Health Insurance Issuers.--The
Secretary of the Treasury, the Secretary of Labor, and the Secretary of
Health and Human Services shall amend the regulations in section
54.9815-2719T(e) of title 26, Code of Federal Regulations, section
2590.715-2719(e) of title 29, Code of Federal Regulations, and section
147.136(e) of title 45, Code of Federal Regulations, respectively, to
require group health plans and health insurance issuers offering group
or individual health insurance coverage to which such sections apply--
(1) to provide oral interpretation services without any
threshold requirements;
(2) to provide in the English versions of all notices a
statement prominently displayed in not less than 15 non-English
languages clearly indicating how to access the language
services provided by the plan or issuer; and
(3) with respect to written translations of notices, to
apply a threshold that 5 percent of the population or at least
500 individuals per service area are literate only in the same
non-English language in lieu of 10 percent or more residing in
a county.
SEC. 210. ASSISTANT SECRETARY OF THE INDIAN HEALTH SERVICE.
(a) In General.--Section 5315 of title 5, United States Code, is
amended in the matter relating to the Assistant Secretaries of Health
and Human Services by striking ``(6)'' and inserting ``(7), 1 of whom
shall be the Assistant Secretary of the Indian Health Service''.
(b) Conforming Amendments.--
(1) Positions at level v.--Section 5316 of title 5, United
States Code, is amended by striking ``Director, Indian Health
Service, Department of Health and Human Services.''.
(2) References.--Any reference in a law, regulation,
document, paper, or other record of the United States to the
Director of the Indian Health Service shall be deemed to be a
reference to the Assistant Secretary of the Indian Health
Service.
SEC. 211. REAUTHORIZATION OF THE NATIVE HAWAIIAN HEALTH CARE
IMPROVEMENT ACT.
(a) Native Hawaiian Health Care Systems.--Section 6(h)(1) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(h)(1)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
(b) Administrative Grant for Papa Ola Lokahi.--Section 7(b) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11706(b)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
(c) Native Hawaiian Health Scholarships.--Section 10(c) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11709(c)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
TITLE III--HEALTH WORKFORCE DIVERSITY
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as added by section
202, is amended by adding at the end the following:
``Subtitle A--Diversifying the Health Care Workplace
``SEC. 3411. REPORT ON WORKFORCE DIVERSITY.
``(a) In General.--Not later than July 1, 2012, and biannually
thereafter, the Secretary, acting through the director of each entity
within the Department of Health and Human Services, shall prepare and
submit to the Committee on Health, Education, Labor, and Pensions of
the Senate and the Committee on Energy and Commerce of the House of
Representatives a report on health workforce diversity.
``(b) Requirement.--The report under subsection (a) shall contain
the following information:
``(1) A description of any grant support that is provided
by each entity for workforce diversity initiatives with the
following information--
``(A) the number of grants made;
``(B) the purpose of the grants;
``(C) the populations served through the grants;
``(D) the organizations and institutions receiving
the grants; and
``(E) the tracking efforts that were used to follow
the progress of participants.
``(2) A description of the entity's plan to achieve
workforce diversity goals that includes, to the extent relevant
to such entity--
``(A) the number of underrepresented minority
health professionals that will be needed in various
disciplines over the next 10 years to achieve
population parity;
``(B) the level of funding needed to fully expand
and adequately support health professions pipeline
programs;
``(C) the impact such programs have had on the
admissions practices and policies of health professions
schools;
``(D) the management strategy necessary to
effectively administer and institutionalize health
profession pipeline programs; and
``(E) the impact that the Government Performance
and Results Act (GPRA) has had on evaluating the
performance of grantees and whether the GPRA is the
best assessment tool for programs under titles VII and
VIII.
``(3) A description of measurable objectives of each entity
relating to workforce diversity initiatives.
``(c) Public Availability.--The report under subsection (a) shall
be made available for public review and comment.
``SEC. 3412. NATIONAL WORKING GROUP ON WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Bureau of
Health Professions within the Health Resources and Services
Administration, shall award a grant to an entity determined appropriate
by the Secretary for the establishment of a national working group on
workforce diversity.
``(b) Representation.--In establishing the national working group
under subsection (a):
``(1) The grantee shall ensure that the group has
representatives of the following:
``(A) The Health Resources and Services
Administration.
``(B) The Department of Health and Human Services
Data Council.
``(C) The Office of Minority Health.
``(D) The Bureau of Labor Statistics of the
Department of Labor.
``(E) The Public Health Practice Program Office--
Office of Workforce Policy and Planning.
``(F) The National Institute on Minority Health and
Health Disparities.
``(G) The Agency for Healthcare Research and
Quality.
``(H) The Institute of Medicine Study Committee for
the 2004 workforce diversity report.
``(I) The Indian Health Service.
``(J) Minority-serving academic institutions.
``(K) Consumer organizations.
``(L) Health professional associations, including
those that represent underrepresented minority
populations.
``(M) Researchers in the area of health workforce.
``(N) Health workforce accreditation entities.
``(O) Private foundations that have sponsored
workforce diversity initiatives.
``(2) The grantee shall ensure that, in addition to the
representatives under paragraph (1), the group has not less
than 5 health professions students representing various health
profession fields and levels of training.
``(c) Activities.--The working group established under subsection
(a) shall convene at least twice each year to complete the following
activities:
``(1) Review current public and private health workforce
diversity initiatives.
``(2) Identify successful health workforce diversity
programs and practices.
``(3) Examine challenges relating to the development and
implementation of health workforce diversity initiatives.
``(4) Draft a national strategic work plan for health
workforce diversity, including recommendations for public and
private sector initiatives.
``(5) Develop a framework and methods for the evaluation of
current and future health workforce diversity initiatives.
``(6) Develop recommended standards for workforce diversity
that could be applicable to all health professions programs and
programs funded under this Act.
``(7) Develop curriculum guidelines for diversity training.
``(8) Develop a strategy for the inclusion of community
members on admissions committees for health profession schools.
``(9) Other activities determined appropriate by the
Secretary.
``(d) Annual Report.--Not later than 1 year after the establishment
of the working group under subsection (a), and annually thereafter, the
working group shall prepare and make available to the general public
for comment, an annual report on the activities of the working group.
Such report shall include the recommendations of the working group for
improving health workforce diversity.
``SEC. 3413. TECHNICAL CLEARINGHOUSE FOR HEALTH WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Office of
Minority Health, and in collaboration with the Agency for Healthcare
Research and Quality, the Bureau of Health Professions within the
Health Resources and Services Administration, and the National
Institute on Minority Health and Health Disparities, shall establish a
technical clearinghouse on health workforce diversity within the Office
of Minority Health and coordinate current and future clearinghouses.
``(b) Information and Services.--The clearinghouse established
under subsection (a) shall offer the following information and
services:
``(1) Information on the importance of health workforce
diversity.
``(2) Statistical information relating to underrepresented
minority representation in health and allied health professions
and occupations.
``(3) Model health workforce diversity practices and
programs.
``(4) Admissions policies that promote health workforce
diversity and are in compliance with Federal and State laws.
``(5) Lists of scholarship, loan repayment, and loan
cancellation grants as well as fellowship information for
underserved populations for health professions schools.
``(6) Foundation and other large organizational initiatives
relating to health workforce diversity.
``(c) Consultation.--In carrying out this section, the Secretary
shall consult with non-Federal entities which may include minority
health professional associations to ensure the adequacy and accuracy of
information.
``SEC. 3414. SUPPORT FOR INSTITUTIONS COMMITTED TO WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration and the Centers for
Disease Control and Prevention, shall award grants to eligible entities
that demonstrate a commitment to health workforce diversity.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be an educational institution or entity that
historically produces or trains meaningful numbers of
underrepresented minority health professionals, including--
``(A) historically Black colleges and universities;
``(B) Hispanic-serving health professions schools;
``(C) Hispanic-serving institutions;
``(D) tribal colleges and universities;
``(E) Asian-American, Native American, and Pacific
Islander-serving institutions;
``(F) institutions that have programs to recruit
and retain underrepresented minority health
professionals, in which a significant number of the
enrolled participants are underrepresented minorities;
``(G) health professional associations, which may
include underrepresented minority health professional
associations; and
``(H) institutions--
``(i) located in communities with
predominantly underrepresented minority
populations;
``(ii) with whom partnerships have been
formed for the purpose of increasing workforce
diversity; and
``(iii) in which at least 20 percent of the
enrolled participants are underrepresented
minorities; and
``(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under a grant under
subsection (a) shall be used to expand existing workforce diversity
programs, implement new workforce diversity programs, or evaluate
existing or new workforce diversity programs, including with respect to
mental health care professions. Such programs shall enhance diversity
by considering minority status as part of an individualized
consideration of qualifications. Possible activities may include--
``(1) educational outreach programs relating to
opportunities in the health professions;
``(2) scholarship, fellowship, grant, loan repayment, and
loan cancellation programs;
``(3) postbaccalaureate programs;
``(4) academic enrichment programs, particularly targeting
those who would not be competitive for health professions
schools;
``(5) kindergarten through 12th grade and other health
pipeline programs;
``(6) mentoring programs;
``(7) internship or rotation programs involving hospitals,
health systems, health plans and other health entities;
``(8) community partnership development for purposes
relating to workforce diversity; or
``(9) leadership training.
``(d) Reports.--Not later than 1 year after receiving a grant under
this section, and annually for the term of the grant, a grantee shall
submit to the Secretary a report that summarizes and evaluates all
activities conducted under the grant.
``(e) Definition.--In this section, the term `Asian-American,
Native American, and Pacific Islander-serving institutions' has the
same meaning as the term `Asian American and Native American Pacific
Islander-serving institution' as defined in section 371(c) of the
Higher Education Act of 1965 (20 U.S.C. 1067q(c)).
``SEC. 3415. CAREER DEVELOPMENT FOR SCIENTISTS AND RESEARCHERS.
``(a) In General.--The Secretary, acting through the Director of
the National Institutes of Health, the Director of the Centers for
Disease Control and Prevention, the Commissioner of Food and Drugs, and
the Director of the Agency for Healthcare Research and Quality, shall
award grants that expand existing opportunities for scientists and
researchers and promote the inclusion of underrepresented minorities in
the health professions.
``(b) Research Funding.--The head of each entity within the
Department of Health and Human Services shall establish or expand
existing programs to provide research funding to scientists and
researchers in training. Under such programs, the head of each such
entity shall give priority in allocating research funding to support
health research in traditionally underserved communities, including
underrepresented minority communities, and research classified as
community or participatory.
``(c) Data Collection.--The head of each entity within the
Department of Health and Human Services shall collect data on the
number (expressed as an absolute number and a percentage) of
underrepresented minority and nonminority applicants who receive and
are denied agency funding at every stage of review. Such data shall be
reported annually to the Secretary and the appropriate committees of
Congress.
``(d) Student Loan Reimbursement.--The Secretary shall establish a
student loan reimbursement program to provide student loan
reimbursement assistance to researchers who focus on racial and ethnic
disparities in health. The Secretary shall promulgate regulations to
define the scope and procedures for the program under this subsection.
``(e) Student Loan Cancellation.--The Secretary shall establish a
student loan cancellation program to provide student loan cancellation
assistance to researchers who focus on racial and ethnic disparities in
health. Students participating in the program shall make a minimum 5-
year commitment to work at an accredited health profession school. The
Secretary shall promulgate additional regulations to define the scope
and procedures for the program under this subsection.
``SEC. 3416. CAREER SUPPORT FOR NON-RESEARCH HEALTH PROFESSIONALS.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, the Administrator of
the Substance Abuse and Mental Health Services Administration, the
Administrator of the Health Resources and Services Administration, and
the Administrator of the Centers for Medicare and Medicaid Services
shall establish a program to award grants to eligible individuals for
career support in non-research-related health care.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an individual shall--
``(1) be a student in a health professions school, a
graduate of such a school who is working in a health
profession, or a faculty member of such a school; and
``(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--An individual shall use amounts received under
a grant under this section to--
``(1) support the individual's health activities or
projects that involve underserved communities, including racial
and ethnic minority communities;
``(2) support health-related career advancement activities;
``(3) to pay, or as reimbursement for payments of, student
loans for individuals who are health professionals and are
focused on health issues affecting underserved communities,
including racial and ethnic minority communities; and
``(4) to establish and promote leadership training programs
to decrease health disparities and to increase cultural
competence with the goal of increasing diversity in leadership
positions.
``(d) Definition.--In this section, the term `career in non-
research-related health care' means employment or intended employment
in the field of public health, health policy, health management, health
administration, medicine, nursing, pharmacy, psychology, social work,
psychiatry, other mental and behavioral health, allied health,
community health, social work, or other fields determined appropriate
by the Secretary, other than in a position that involves research.
``SEC. 3417. RESEARCH ON THE EFFECT OF WORKFORCE DIVERSITY ON QUALITY.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, in collaboration with the Deputy Assistant
Secretary for Minority Health and the Director of the National
Institute on Minority Health and Health Disparities, shall award grants
to eligible entities to expand research on the link between health
workforce diversity and quality health care.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) be a clinical, public health, or health services
research entity or other entity determined appropriate by the
Director; and
``(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under a grant awarded under
subsection (a) shall be used to support research that investigates the
effect of health workforce diversity on--
``(1) language access;
``(2) cultural competence;
``(3) patient satisfaction;
``(4) timeliness of care;
``(5) safety of care;
``(6) effectiveness of care;
``(7) efficiency of care;
``(8) patient outcomes;
``(9) community engagement;
``(10) resource allocation;
``(11) organizational structure;
``(12) compliance of care; or
``(13) other topics determined appropriate by the Director.
``(d) Priority.--In awarding grants under subsection (a), the
Director shall give individualized consideration to all relevant
aspects of the applicant's background. Consideration of prior research
experience involving the health of underserved communities shall be
such a factor.
``SEC. 3418. HEALTH DISPARITIES EDUCATION PROGRAM.
``(a) Establishment.--The Secretary, acting through the National
Institute on Minority Health and Health Disparities and in
collaboration with the Office of Minority Health, the Office of the
Surgeon General, the Office for Civil Rights, the Centers for Disease
Control and Prevention, the Centers for Medicare & Medicaid Services,
the Health Resources and Services Administration, and other appropriate
public and private entities, shall establish and coordinate a health
and health care disparities education program to support, develop, and
implement educational initiatives and outreach strategies that inform
health care professionals and the public about the existence of and
methods to reduce racial and ethnic disparities in health and health
care.
``(b) Activities.--The Secretary, through the education program
established under subsection (a) shall, through the use of public
awareness and outreach campaigns targeting the general public and the
medical community at large--
``(1) disseminate scientific evidence for the existence and
extent of racial and ethnic disparities in health care,
including disparities that are not otherwise attributable to
known factors such as access to care, patient preferences, or
appropriateness of intervention, as described in the 2002
Institute of Medicine Report entitled `Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care', as
well as the impact of disparities related to age, disability
status, socioeconomic status, sex, gender identity, and sexual
orientation on racial and ethnic minorities;
``(2) disseminate new research findings to health care
providers and patients to assist them in understanding,
reducing, and eliminating health and health care disparities;
``(3) disseminate information about the impact of
linguistic and cultural barriers on health care quality and the
obligation of health providers who receive Federal financial
assistance to ensure that people with limited-English
proficiency have access to language access services;
``(4) disseminate information about the importance and
legality of racial, ethnic, disability status, socioeconomic
status, sex, gender identity, and sexual orientation, and
primary language data collection, analysis, and reporting;
``(5) design and implement specific educational initiatives
to health care providers relating to health and health care
disparities; and
``(6) assess the impact of the programs established under
this section in raising awareness of health and health care
disparities and providing information on available
resources.''.
SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.
Part B of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.) is amended by adding at the end the following:
``SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award grants
to Hispanic-serving health professions schools for the purpose of
carrying out programs to recruit Hispanic individuals to enroll in and
graduate from such schools, which may include providing scholarships
and other financial assistance as appropriate.
``(b) Eligibility.--In subsection (a), the term `Hispanic-serving
health professions school' means an entity that--
``(1) is a school or program under section 799B;
``(2) has an enrollment of full-time equivalent students
that is made up of at least 9 percent Hispanic students;
``(3) has been effective in carrying out programs to
recruit Hispanic individuals to enroll in and graduate from the
school;
``(4) has been effective in recruiting and retaining
Hispanic faculty members;
``(5) has a significant number of graduates who are
providing health services to medically underserved populations
or to individuals in health professional shortage areas; and
``(6) Regional Hispanic Centers of Excellence.''.
SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR DISEASE CONTROL AND
PREVENTION.
Section 317F(c) of the Public Health Service Act (42 U.S.C. 247b-
7(c)) is amended--
(1) by striking ``and'' after ``1994,''; and
(2) by inserting before the period the following:
``$750,000 for fiscal year 2012, and such sums as may be
necessary for each of the fiscal years 2013 through 2017.''.
SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS AT SCHOOLS
OF PUBLIC HEALTH AND SCHOOLS OF ALLIED HEALTH.
Part B of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.), as amended by section 302, is further amended by adding at
the end the following:
``SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS.
``(a) Cooperative Agreements.--The Secretary, acting through the
Administrator of the Health Resources and Services Administration, in
consultation with the Director of the Centers for Disease Control and
Prevention, the Director of the Agency for Healthcare Research and
Quality, and the Deputy Assistant Secretary for Minority Health, shall
award cooperative agreements to schools of public health and schools of
allied health to design and implement online degree programs.
``(b) Priority.--In awarding cooperative agreements under this
section, the Secretary shall give priority to any school of public
health or school of allied health that has an established track record
of serving medically underserved communities.
``(c) Requirements.--Awardees must design and implement an online
degree program, that meet the following restrictions:
``(1) Enrolling individuals who have obtained a secondary
school diploma or its recognized equivalent.
``(2) Maintaining a significant enrollment of
underrepresented minority or disadvantaged students.''.
SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE NATIONAL HEALTH CARE
WORKFORCE COMMISSION.
It is the sense of Congress that the National Health Care Workforce
Commission established by section 5101 of the Patient Protection and
Affordable Care Act should, in carrying out its assigned duties under
that section, give attention to the needs of racial and ethnic
minorities, individuals with lower socioeconomic status, individuals
with mental, developmental, and physical disabilities, lesbian, gay,
bisexual and transgender populations, and individuals who are members
of multiple minority or special population groups.
SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.
Subtitle A of title XXXIV of the Public Health Service Act, as
amended by section 301, is further amended by inserting after section
3418 the following:
``SEC. 3419. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.
``(a) In General.--The Administrator of the Health Resources and
Services Administration and the Director of the Centers for Disease
Control and Prevention, in collaboration with the Deputy Assistant
Secretary for Minority Health, shall award grants to eligible entities
to increase awareness among postprimary and postsecondary students of
career opportunities in the health professions.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) be a clinical, public health or health services
organization, community-based or nonprofit entity, or other
entity determined appropriate by the Director of the Centers
for Disease Control and Prevention;
``(2) serve a health professional shortage area, as
determined by the Secretary;
``(3) work with students, including those from racial and
ethnic minority backgrounds, that have expressed an interest in
the health professions; and
``(4) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Grant awards under subsection (a) shall be
used to support internships that will increase awareness among students
of non-research-based and career opportunities in the following health
professions:
``(1) Medicine.
``(2) Nursing.
``(3) Public Health.
``(4) Pharmacy.
``(5) Health administration and management.
``(6) Health policy.
``(7) Psychology.
``(8) Dentistry.
``(9) International health.
``(10) Social work.
``(11) Allied health.
``(12) Psychiatry.
``(13) Hospice care.
``(14) Other professions deemed appropriate by the Director
of the Centers for Disease Control and Prevention.
``(d) Priority.--In awarding grants under subsection (a), the
Director of the Centers for Disease Control and Prevention shall give
priority to those entities that--
``(1) serve a high proportion of individuals from
disadvantaged backgrounds;
``(2) have experience in health disparity elimination
programs;
``(3) facilitate the entry of disadvantaged individuals
into institutions of higher education; and
``(4) provide counseling or other services designed to
assist disadvantaged individuals in successfully completing
their education at the postsecondary level.
``(e) Stipends.--The Secretary may approve stipends under this
section for individuals for any period of education in student-
enhancement programs (other than regular courses) at health professions
schools, programs, or entities, except that such a stipend may not be
provided to an individual for more than 6 months, and such a stipend
may not exceed $20 per day (notwithstanding any other provision of law
regarding the amount of stipends).
``SEC. 3420. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, in collaboration with the Deputy Assistant Secretary
for Minority Health, shall award scholarships to postsecondary students
who seek a career in public health.
``(b) Eligibility.--To be eligible to receive a scholarship under
subsection (a) an individual shall--
``(1) have experience in public health research or public
health practice, or other health professions as determined
appropriate by the Director of the Centers for Disease Control
and Prevention;
``(2) reside in a health professional shortage area as
determined by the Secretary;
``(3) have expressed an interest in public health;
``(4) demonstrate promise for becoming a leader in public
health;
``(5) secure admission to a 4-year institution of higher
education;
``(6) comply with subsection (f); and
``(7) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under an award under
subsection (a) shall be used to support opportunities for students to
become public health professionals.
``(d) Priority.--In awarding grants under subsection (a), the
Director shall give priority to those students that--
``(1) are from disadvantaged backgrounds;
``(2) have secured admissions to a minority-serving
institution; and
``(3) have identified a health professional as a mentor at
their school or institution and an academic advisor to assist
in the completion of their baccalaureate degree.
``(e) Scholarships.--The Secretary may approve payment of
scholarships under this section for such individuals for any period of
education in student undergraduate tenure, except that such a
scholarship may not be provided to an individual for more than 4 years,
and such scholarships may not exceed $10,000 per academic year
(notwithstanding any other provision of law regarding the amount of
scholarship).
``SEC. 3420A. PATSY MINK HEALTH AND GENDER RESEARCH FELLOWSHIP PROGRAM.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, in collaboration with the Deputy Assistant Secretary
for Minority Health, the Administrator of the Substance Abuse and
Mental Health Services Administration, the Director of the Indian
Health Service, the Director of the National Institutes of Health, and
the Director of the Agency for Healthcare Research and Quality, shall
award research fellowships to post-baccalaureate students to conduct
research that will examine gender and health disparities and to pursue
a career in the health professions.
``(b) Eligibility.--To be eligible to receive a fellowship under
subsection (a) an individual shall--
``(1) have experience in health research or public health
practice;
``(2) reside in a health professional shortage area as
determined by the Secretary;
``(3) have expressed an interest in the health professions;
``(4) demonstrate promise for becoming a leader in the
field of women's health;
``(5) secure admission to a health professions school or
graduate program with an emphasis in gender studies;
``(6) comply with subsection (f); and
``(7) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under an award under
subsection (a) shall be used to support opportunities for students to
become researchers and advance the research base on the intersection
between gender and health.
``(d) Priority.--In awarding grants under subsection (a), the
Director of the Centers for Disease Control and Prevention shall give
priority to those applicants that--
``(1) are from disadvantaged backgrounds; and
``(2) have identified a mentor and academic advisor who
will assist in the completion of their graduate or professional
degree and have secured a research assistant position with a
researcher working in the area of gender and health.
``(e) Fellowships.--The Director of the Centers for Disease Control
and Prevention may approve fellowships for individuals under this
section for any period of education in the student's graduate or health
profession tenure, except that such a fellowship may not be provided to
an individual for more than 3 years, and such a fellowship may not
exceed $18,000 per academic year (notwithstanding any other provision
of law regarding the amount of fellowship).
``SEC. 3420B. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP
PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, in collaboration with the Deputy Assistant
Secretary for Minority Health, shall award research fellowships to
college students or recent graduates to advance their understanding of
international health.
``(b) Eligibility.--To be eligible to receive a fellowship under
subsection (a) an individual shall--
``(1) have educational experience in the field of
international health;
``(2) reside in a health professional shortage area as
determined by the Secretary;
``(3) demonstrate promise for becoming a leader in the
field of international health;
``(4) be a college senior or recent graduate of a four-year
higher education institution;
``(5) comply with subsection (f); and
``(6) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under an award under
subsection (a) shall be used to support opportunities for students to
become health professionals and to advance their knowledge about
international issues relating to health care access and quality.
``(d) Priority.--In awarding grants under subsection (a), the
Director shall give priority to those applicants that--
``(1) are from a disadvantaged background; and
``(2) have identified a mentor at a health professions
school or institution, an academic advisor to assist in the
completion of their graduate or professional degree, and an
advisor from an international health non-governmental
organization, private volunteer organization, or other
international institution or program that focuses on increasing
health care access and quality for residents in developing
countries.
``(e) Fellowships.--The Secretary shall approve fellowships for
college seniors or recent graduates, except that such a fellowship may
not be provided to an individual for more than 6 months, may not be
awarded to a graduate that has not been enrolled in school for more
than 1 year, and may not exceed $4,000 per academic year
(notwithstanding any other provision of law regarding the amount of
fellowship).
``SEC. 3420C. EDWARD R. ROYBAL HEALTH CARE SCHOLAR PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, the Director of the Centers for Medicaid &
Medicare, and the Administrator for Health Resources and Services
Administration, in collaboration with the Deputy Assistant Secretary
for Minority Health, shall award grants to eligible entities to expose
entering graduate students to the health professions.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) be a clinical, public health or health services
organization, community-based or nonprofit entity, or other
entity determined appropriate by the Director of the Agency for
Healthcare Research and Quality;
``(2) serve in a health professional shortage area as
determined by the Secretary;
``(3) work with students obtaining a degree in the health
professions; and
``(4) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under a grant awarded under
subsection (a) shall be used to support opportunities that expose
students to non-research-based health professions, including--
``(1) public health policy;
``(2) health care and pharmaceutical policy;
``(3) health care administration and management;
``(4) health economics; and
``(5) other professions determined appropriate by the
Director of the Agency for Healthcare Research and Quality.
``(d) Priority.--In awarding grants under subsection (a), the
Director of the Agency for Healthcare Research and Quality shall give
priority to those entities that--
``(1) have experience with health disparity elimination
programs;
``(2) facilitate training in the fields described in
subsection (c); and
``(3) provide counseling or other services designed to
assist such individuals in successfully completing their
education at the postsecondary level.
``(e) Stipends.--The Secretary may approve the payment of stipends
for individuals under this section for any period of education in
student-enhancement programs (other than regular courses) at health
professions schools or entities, except that such a stipend may not be
provided to an individual for more than 2 months, and such a stipend
may not exceed $100 per day (notwithstanding any other provision of law
regarding the amount of stipends).''.
SEC. 307. ADVISORY COMMITTEE ON HEALTH PROFESSIONS TRAINING FOR
DIVERSITY.
(a) Establishment.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall establish an
advisory committee to be known as the Advisory Committee on Health
Professions Training for Diversity (in this section referred to as the
``Advisory Committee'').
(b) Composition.--
(1) In general.--The Secretary shall determine the
appropriate number of individuals to serve on the Advisory
Committee. Such individuals shall not be officers or employees
of the Federal Government.
(2) Appointment.--Not later than 60 days after the date of
enactment of this section, the Secretary shall appoint the
members of the Advisory Committee from among individuals who
are health professionals. In making such appointments, the
Secretary shall ensure a fair balance between the health
professions, that at least 75 percent of the members of the
Advisory Committee are health professionals, a broad geographic
representation of members and a balance between urban and rural
members. Members shall be appointed based on their competence,
interest, and knowledge of the mission of the profession
involved.
(3) Minority representation.--In appointing the members of
the Advisory Committee under paragraph (2), the Secretary shall
ensure the adequate representation of women and minorities.
(c) Terms.--
(1) In general.--A member of the Advisory Committee shall
be appointed for a term of 3 years, except that of the members
first appointed--
(A) \1/3\ of such members shall serve for a term of
1 year;
(B) \1/3\ of such members shall serve for a term of
2 years; and
(C) \1/3\ of such members shall serve for a term of
3 years.
(2) Vacancies.--
(A) In general.--A vacancy on the Advisory
Committee shall be filled in the manner in which the
original appointment was made and shall be subject to
any conditions which applied with respect to the
original appointment.
(B) Filling unexpired term.--An individual chosen
to fill a vacancy shall be appointed for the unexpired
term of the member replaced.
(d) Duties.--
(1) In general.--The Advisory Committee shall--
(A) provide advice and recommendations to the
Secretary concerning policy and program development and
other matters of significance concerning activities
under this part; and
(B) not later than 2 years after the date of
enactment of this section, and annually thereafter,
prepare and submit to the Secretary, and the Committee
on Health, Education, Labor, and Pensions of the
Senate, and the Committee on Energy and Commerce of the
House of Representatives, a report describing the
activities of the Committee.
(2) Consultation with students.--In carrying out duties
under paragraph (1), the Advisory Committee shall consult with
individuals who are attending health professions schools with
which this part is concerned.
(e) Meetings and Documents.--
(1) Meetings.--The Advisory Committee shall meet not less
than 2 times each year. Such meetings shall be held jointly
with other related entities established under this title where
appropriate.
(2) Documents.--Not later than 14 days prior to the
convening of a meeting under paragraph (1), the Advisory
Committee shall prepare and make available an agenda of the
matters to be considered by the Advisory Committee at such
meeting. At any such meeting, the Advisory Committee shall
distribute materials with respect to the issues to be addressed
at the meeting. Not later than 30 days after the adjourning of
such a meeting, the Advisory Committee shall prepare and make
available a summary of the meeting and any actions taken by the
Committee based upon the meeting.
(f) Compensation and Expenses.--
(1) Compensation.--Each member of the Advisory Committee
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Committee.
(2) Expenses.--The members of the Advisory Committee shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Committee.
(g) FACA.--The Federal Advisory Committee Act shall apply to the
Advisory Committee under this section only to the extent that the
provisions of such Act do not conflict with the requirements of this
section.
SEC. 308. MCNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM.
Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a-
15) is amended by striking subsection (g) and inserting the following:
``(g) Collaboration in Health Profession Diversity Training
Programs.--The Secretary shall coordinate with the Secretary of Health
and Human Services to ensure that there is collaboration between the
goals of the program under this section and programs of the Health
Resources and Services Administration that promote health workforce
diversity. The Secretary of Education shall take such measures as may
be necessary to encourage participants in programs under this section
to consider health profession careers.''.
SEC. 309. RULES FOR DETERMINATION OF FULL-TIME EQUIVALENT RESIDENTS FOR
COST REPORTING PERIODS.
(a) DGME Determinations.--Section 1886(h)(4) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(B)) is amended--
(1) in subparagraph (E), by striking ``Subject to
subparagraphs (J) and (K), such rules'' and inserting ``Subject
to subparagraphs (J), (K), and (L), such rules'';
(2) in subparagraph (J), by striking ``Such rules'' and
inserting ``Subject to subparagraph (L), such rules'';
(3) in subparagraph (K), by striking ``In determining'' and
inserting ``Subject to subparagraph (L), in determining''; and
(4) by adding at the end the following new subparagraph:
``(L) For purposes of cost-reporting periods
beginning on or after the date of enactment of the
Health Equity and Accountability Act of 2012, in
determining the hospital's number of full-time
equivalent residents for purposes of this subparagraph,
all the time spent by an intern or resident in an
approved medical residency training program shall be
counted toward the determination of full-time
equivalency if the hospital--
``(i) is recognized as a subsection (d)
hospital;
``(ii) is recognized as a subsection (d)
Puerto Rico hospital;
``(iii) is reimbursed under a reimbursement
system authorized under section 1814(b)(3); or
``(iv) is a provider-based hospital
outpatient department.''.
(b) IME Determinations.--Section 1886(d)(5)(B) of such Act (42
U.S.C. 1395ww(d)(5)(B)) is amended--
(1) by redesignating clause (x), as added by section
5505(b) of Public Law 111-148, as clause (xi); and
(2) in clause (xi), as redesignated by paragraph (1)--
(A) in subclause (II), by striking ``In
determining'' and inserting ``Subject to subclause
(IV), in determining'';
(B) in subclause (III), by striking ``In
determining'' and inserting ``Subject to subclause
(IV), in determining''; and
(C) by adding at the end the following new
subclause:
``(IV) The provisions of
subparagraph (L) of subsection (h)(4)
shall apply under this subparagraph in
the same manner as they apply under
such subsection.''.
SEC. 310. DEVELOPING AND IMPLEMENTING STRATEGIES FOR LOCAL HEALTH
EQUITY.
(a) Grants.--The Secretaries of Health and Human Services,
Education, and Labor, acting jointly, shall make grants to academic
institutions for the purposes of--
(1) in accordance with subsection (b), developing
capacity--
(A) to build an evidence base for successful
strategies for increasing local health equity; and
(B) to serve as national models of driving local
health equity;
(2) in accordance with subsection (c), developing a
strategic partnership with the community in which the academic
institution is located; and
(3) collecting data on, and periodically evaluating, the
effectiveness of the institution's programs funded through this
section to enable the institution to adapt accordingly for
maximum efficiency and success.
(b) Developing Capacity for Increasing Local Health Equity.--As a
condition on receipt of a grant under subsection (a), an academic
institution shall agree to use the grant to build an evidence base for
successful strategies for increasing local health equity, and to serve
as a national model of driving local health equity, by supporting--
(1) resources to strengthen institutional metrics and
capacity to execute institutionwide health workforce goals that
can serve as models for increasing health equity in communities
across the country ;
(2) collaborations among a cohort of institutions in
implementing systemic change, partnership development, and
programmatic efforts supportive of health equity goals across
disciplines and populations; and
(3) enhanced or newly developed data systems and research
infrastructure capable of informing current and future
workforce efforts and building a foundation for a broader
research agenda targeting urban health disparities.
(c) Strategic Partnerships.--As a condition on receipt of a grant
under subsection (a), an academic institution shall agree to use the
grant to develop a strategic partnership with the community in which
the institution is located for the purposes of--
(1) strengthening connections between the institution and
the community--
(A) to improve evaluation of and address the
community's health and health workforce needs; and
(B) to engage the community in health workforce
development;
(2) developing, enhancing, or accelerating innovative
undergraduate and graduate programs in the biomedical sciences
and health professions; and
(3) strengthening the ``birth to career'' pipeline in the
biomedical sciences and health professions, including by
developing partnerships between institutions of higher
education and elementary and secondary schools to recruit the
next generation of health professionals earlier in the pipeline
to a health care career.
SEC. 311. LOAN FORGIVENESS FOR MENTAL AND BEHAVIORAL HEALTH SOCIAL
WORKERS.
Section 455 of the Higher Education Act of 1965 (20 U.S.C. 1087e)
is amended by adding at the end the following new subsection:
``(q) Repayment Plan for Mental and Behavioral Health Social
Workers.--
``(1) In general.--The Secretary shall cancel the balance
of interest and principal due on any eligible Federal Direct
Loan not in default for a borrower who--
``(A) has made 120 monthly payments on the eligible
Federal Direct Loan after October 1, 2012, pursuant to
any one or a combination of the following--
``(i) payments under an income-based
repayment plan under section 493C;
``(ii) payments under a standard repayment
plan under subsection (d)(1)(A), based on a 10-
year repayment period;
``(iii) monthly payments under a repayment
plan under subsection (d)(1) or (g) of not less
than the monthly amount calculated under
subsection (d)(1)(A), based on a 10-year
repayment period; or
``(iv) payments under an income contingent
repayment plan under subsection (d)(1)(D); and
``(B)(i) is employed as a mental health or
behavioral health social worker, as defined by the
Secretary by regulation, at the time of such
forgiveness; and
``(ii) has been employed as such a mental health or
behavioral health social worker during the period in
which the borrower makes each of the 120 payments as
described in subparagraph (A).
``(2) Loan cancellation amount.--After the conclusion of
the employment period described in paragraph (1), the Secretary
shall cancel the obligation to repay the balance of principal
and interest due as of the time of such cancellation, on the
eligible Federal Direct Loans made to the borrower under this
part.
``(3) Definition of eligible federal direct loan.--In this
subsection, the term `eligible Federal Direct Loan' means a
Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal
Direct Unsubsidized Stafford Loan, or a Federal Direct
Consolidation Loan.''.
TITLE IV--IMPROVEMENT OF HEALTH CARE SERVICES
Subtitle A--Health Empowerment Zones
SEC. 401. SHORT TITLE.
This subtitle may be cited as the ``Health Empowerment Zone Act of
2012''.
SEC. 402. FINDINGS.
The Congress finds the following:
(1) Numerous studies and reports, including the National
Healthcare Disparities Report and Unequal Treatment, the 2002
Institute of Medicine Report, document the extensiveness to
which health disparities exist across the country.
(2) These studies have found that, on average, racial and
ethnic minorities are disproportionately afflicted with chronic
and acute conditions--such as cancer, diabetes, and
hypertension--and suffer worse health outcomes, worse health
status, and higher mortality rates than their White
counterparts.
(3) Several recent studies also show that health
disparities are a function of not only access to health care,
but also the social determinants of health--including the
environment, the physical structure of communities, nutrition
and food options, educational attainment, employment, race,
ethnicity, geography, and language preference--that directly
and indirectly affect the health, health care, and wellness of
individuals and communities.
(4) Integrally involving and fully supporting the
communities most affected by health inequities in the
assessment, planning, launch, and evaluation of health
disparity elimination efforts is among the leading
recommendations made to adequately address and ultimately
reduce health disparities.
(5) Recommendations also include supporting the efforts of
community stakeholders from a broad cross section--including,
but not limited to local businesses, local departments of
commerce, education, labor, urban planning, and transportation,
and community-based and other nonprofit organizations--to find
areas of common ground around health disparity elimination and
collaborate to improve the overall health and wellness of a
community and its residents.
SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT ZONES.
(a) In General.--At the request of an eligible community
partnership, the Secretary may designate an eligible area as a health
empowerment zone.
(b) Eligibility Criteria.--
(1) Eligible community partnership.--A community
partnership is eligible to submit a request under this section
if the partnership--
(A) demonstrates widespread public support from key
individuals and entities in the eligible area,
including State and local governments, nonprofit
organizations, and community and industry leaders, for
designation of the eligible area as a health
empowerment zone; and
(B) includes representatives of--
(i) a broad cross section of stakeholders
and residents from communities in the eligible
area experiencing disproportionate disparities
in health status and health care; and
(ii) organizations, facilities, and
institutions that have a history of working
within and serving such communities.
(2) Eligible area.--An area is eligible to be designated as
a health empowerment zone under this section if one or more
communities in the area experience disproportionate disparities
in health status and health care. In determining whether a
community experiences such disparities, the Secretary shall
consider the data collected by the Department of Health and
Human Services focusing on the following areas:
(A) Access to affordable high-quality health
services.
(B) Arthritis, osteoporosis, and chronic back
conditions.
(C) Cancer.
(D) Chronic kidney disease.
(E) Diabetes.
(F) Injury and violence prevention.
(G) Maternal, infant, and child health.
(H) Medical product safety.
(I) Mental health and mental disorders.
(J) Nutrition and overweight.
(K) Disability and secondary conditions.
(L) Educational and community-based health
programs.
(M) Environmental health.
(N) Family planning.
(O) Food safety.
(P) Health communication.
(Q) Health disease and stroke.
(R) HIV/AIDS.
(S) Immunization and infectious diseases.
(T) Occupational safety and health.
(U) Oral health.
(V) Physical activity and fitness.
(W) Public health infrastructure.
(X) Respiratory diseases.
(Y) Sexually transmitted diseases.
(Z) Substance abuse.
(AA) Tobacco use.
(BB) Vision and hearing.
(CC) The degree to which those who have
disabilities have access to health services, including
physical activity and fitness, including the ability to
physically access the locations where such services are
provided.
(c) Procedure.--
(1) Request.--A request under subsection (a) shall--
(A) describe the bounds of the area to be
designated as a health empowerment zone and the process
used to select those bounds;
(B) demonstrate that the partnership submitting the
request is an eligible community partnership described
in subsection (b)(1);
(C) demonstrate that the area is an eligible area
described in subsection (b)(2);
(D) include a comprehensive assessment of
disparities in health status and health care experience
by one or more communities in the area;
(E) set forth--
(i) a vision and a set of values for the
area; and
(ii) a comprehensive and holistic set of
goals to be achieved in the area through
designation as a health empowerment zone; and
(F) include a strategic plan for achieving the
goals described in subparagraph (E)(ii).
(2) Approval.--Not later than 60 days after the receipt of
a request for designation of an area as a health empowerment
zone under this section, the Secretary shall approve or
disapprove the request.
(d) Minimum Number.--The Secretary--
(1) shall designate not more than 110 health empowerment
zones under this section; and
(2) shall designate at least one health empowerment zone in
each of the several States, the District of Columbia, and each
territory or possession of the United States.
SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION.
At the request of any organization or entity seeking to submit a
request under section 403(a), the Secretary shall provide technical
assistance, and may award a grant, to assist such organization or
entity--
(1) to form an eligible community partnership described in
section 403(b)(1);
(2) to complete a health assessment, including an
assessment of health disparities under section 403(c)(1)(D); or
(3) to prepare and submit a request, including a strategic
plan, in accordance with section 403.
SEC. 405. BENEFITS OF DESIGNATION.
(a) Priority.--In awarding any competitive grant, a Federal
official shall give priority to any applicant that--
(1) meets the eligibility criteria for the grant;
(2) proposes to use the grant for activities in a health
empowerment zone; and
(3) demonstrates that such activities will directly and
significantly further the goals of the strategic plan approved
for such zone under section 403.
(b) Grants for Initial Implementation of Strategic Plan.--
(1) In general.--Upon designating an eligible area as a
health empowerment zone at the request of an eligible community
partnership, the Secretary shall, subject to the availability
of appropriations, make a grant to the community partnership
for implementation of the strategic plan for such zone.
(2) Grant period.--A grant under paragraph (1) for a health
empowerment zone shall be for a period of 2 years and may be
renewed, except that the total period of grants under paragraph
(1) for such zone may not exceed 10 years.
(3) Limitation.--In awarding grants under this subsection,
the Secretary shall not give less priority to an applicant or
reduce the amount of a grant because the Secretary rendered
technical assistance or made a grant to the same applicant
under section 404.
(4) Reporting.--The Secretary shall require each recipient
of a grant under this subsection to report to the Secretary not
less than every 6 months on the progress in implementing the
strategic plan for the health empowerment zone.
SEC. 406. DEFINITION.
In this subtitle, the term ``Secretary'' means the Secretary of
Health and Human Services, acting through the Administrator of the
Health Resources and Services Administration and the Deputy Assistant
Secretary for Minority Health, and in cooperation with the Director of
the Office of Community Services and the Director of the National
Institute for Minority Health and Health Disparities.
Subtitle B--Other Improvements of Health Care Services
CHAPTER 1--EXPANSION OF COVERAGE
SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as amended by titles
I, II, III, and IX of this Act, is further amended by inserting after
subtitle C the following:
``Subtitle D--Reconstruction and Improvement Grants for Public Health
Care Facilities Serving Pacific Islanders and the Insular Areas
``SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT INITIATIVES.
``(a) In General.--The Secretary, in collaboration with the
Administrator of the Health Resources and Services Administration, the
Director of the Agency for Healthcare Research and Quality, and the
Administrator of the Centers for Medicare & Medicaid Services, shall
award grants to eligible entities for the conduct of demonstration
projects to improve the quality of and access to health care.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be a health center, hospital, health plan, health
system, community clinic. or other health entity determined
appropriate by the Secretary--
``(A) that, by legal mandate or explicitly adopted
mission, provides patients with access to services
regardless of their ability to pay;
``(B) that provides care or treatment for a
substantial number of patients who are uninsured, are
receiving assistance under a State program under title
XIX of the Social Security Act, or are members of
vulnerable populations, as determined by the Secretary;
and
``(C)(i) with respect to which, not less than 50
percent of the entity's patient population is made up
of racial and ethnic minorities; or
``(ii) that--
``(I) serves a disproportionate percentage
of local, minority racial and ethnic patients,
or that has a patient population, at least 50
percent of which is limited-English proficient;
and
``(II) provides an assurance that amounts
received under the grant will be used only to
support quality improvement activities in the
racial and ethnic population served; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
``(c) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to applicants under subsection (b)(2)
that--
``(1) demonstrate an intent to operate as part of a health
care partnership, network, collaborative, coalition, or
alliance where each member entity contributes to the design,
implementation, and evaluation of the proposed intervention; or
``(2) intend to use funds to carry out systemwide changes
with respect to health care quality improvement, including--
``(A) improved systems for data collection and
reporting;
``(B) innovative collaborative or similar
processes;
``(C) group programs with behavioral or self-
management interventions;
``(D) case management services;
``(E) physician or patient reminder systems;
``(F) educational interventions; or
``(G) other activities determined appropriate by
the Secretary.
``(d) Use of Funds.--An entity shall use amounts received under a
grant under subsection (a) to support the implementation and evaluation
of health care quality improvement activities or minority health and
health care disparity reduction activities that include--
``(1) with respect to health care systems, activities
relating to improving--
``(A) patient safety;
``(B) timeliness of care;
``(C) effectiveness of care;
``(D) efficiency of care;
``(E) patient centeredness; and
``(F) health information technology; and
``(2) with respect to patients, activities relating to--
``(A) staying healthy;
``(B) getting well;
``(C) living with illness or disability; and
``(D) coping with end-of-life issues.
``(e) Common Data Systems.--The Secretary shall provide financial
and other technical assistance to grantees under this section for the
development of common data systems.
``SEC. 3452. CENTERS OF EXCELLENCE.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall designate
centers of excellence at public hospitals, and other health systems
serving large numbers of minority patients, that--
``(1) meet the requirements of section 3451(b)(1);
``(2) demonstrate excellence in providing care to minority
populations; and
``(3) demonstrate excellence in reducing disparities in
health and health care.
``(b) Requirements.--A hospital or health system that serves as a
Center of Excellence under subsection (a) shall--
``(1) design, implement, and evaluate programs and policies
relating to the delivery of care in racially, ethnically, and
linguistically diverse populations;
``(2) provide training and technical assistance to other
hospitals and health systems relating to the provision of
quality health care to minority populations; and
``(3) develop activities for graduate or continuing medical
education that institutionalize a focus on cultural competence
training for health care providers.
``SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS FOR PUBLIC HEALTH
CARE FACILITIES SERVING PACIFIC ISLANDERS AND THE INSULAR
AREAS.
``(a) In General.--The Secretary shall provide direct financial
assistance to designated health care providers and community health
centers in American Samoa, Guam, the Commonwealth of the Northern
Mariana Islands, the United States Virgin Islands, Puerto Rico, and
Hawaii for the purposes of reconstructing and improving health care
facilities and services.
``(b) Eligibility.--To be eligible to receive direct financial
assistance under subsection (a), an entity shall be a public health
facility or community health center located in American Samoa, Guam,
the Commonwealth of the Northern Mariana Islands, the United States
Virgin Islands, Puerto Rico, or Hawaii that--
``(1) is owned or operated by--
``(A) the Government of American Samoa, Guam, the
Commonwealth of the Northern Mariana Islands, the
United States Virgin Islands, Puerto Rico, or Hawaii or
a unit of local government; or
``(B) a nonprofit organization; and
``(2)(A) provides care or treatment for a substantial
number of patients who are uninsured, receiving assistance
under a State program under a title XVIII of the Social
Security Act, or a State program under title XIX of such Act,
or who are members of a vulnerable population, as determined by
the Secretary; or
``(B) serves a disproportionate percentage of local,
minority racial and ethnic patients.
``(c) Report.--Not later than 180 days after the date of enactment
of this title and annually thereafter, the Secretary shall submit to
the Congress and the President a report that includes an assessment of
health resources and facilities serving populations in American Samoa,
Guam, the Commonwealth of the Northern Mariana Islands, the United
States Virgin Islands, Puerto Rico, and Hawaii. In preparing such
report, the Secretary shall--
``(1) consult with and obtain information on all health
care facilities needs from the entities described in subsection
(b);
``(2) include all amounts of Federal assistance received by
each entity in the preceding fiscal year;
``(3) review the total unmet needs of each jurisdiction for
health care facilities, including needs for renovation and
expansion of existing facilities; and
``(4) include a strategic plan for addressing the needs of
each jurisdiction identified in the report.''.
SEC. 412. REMOVING BARRIERS TO UNSUBSIDIZED PURCHASE OF PRIVATE
INSURANCE IN AMERICAN HEALTH BENEFIT EXCHANGES.
(a) In General.--Section 1312(f) of the Patient Protection and
Affordable Care Act (42 U.S.C.18032(f)) is amended--
(1) in the subsection heading, by striking the semicolon
and all that follows through ``Residents''; and
(2) by striking paragraph (3).
(b) Conforming Amendment.--Section 1411(a)(1) of such Act (42
U.S.C. 18081(a)(1)) is amended by striking ``1312(f)(3),''.
SEC. 413. STUDY ON THE UNINSURED.
(a) In General.--The Secretary of Health and Human Services shall--
(1) conduct a study on the demographic characteristics of
the population of individuals who do not have health insurance
coverage; and
(2) predict, based on such study, the demographic
characteristics of the population of individuals who will not
have health insurance coverage after January 1, 2014.
(b) Reporting Requirements.--
(1) In general.--Not later than 12 months after the date of
the enactment of this Act, the Secretary shall submit to the
Congress the results of the study under subsection (a)(1) and
the prediction made under subsection (a)(2).
(2) Reporting of demographic characteristics.--The
Secretary shall report the demographic characteristics under
paragraphs (1) and (2) of subsection (a) on the basis of racial
and ethnic group, and shall stratify the reporting on each
racial and ethnic group by other demographic characteristics
that can impact access to health insurance coverage, such as
sexual orientation, gender identity, primary language,
disability status, sex, socioeconomic status, and citizenship
and immigration status, in a manner consistent with title I of
this Act.
SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRITORIES.
(a) Elimination of Funding Limitations for Puerto Rico, the United
States Virgin Islands, Guam, the Commonwealth of the Northern Mariana
Islands, and American Samoa.--
(1) In general.--Section 1108 of the Social Security Act
(42 U.S.C. 1308) is amended--
(A) in subsection (f), in the matter before
paragraph (1), by striking ``subsection (g)'' and
inserting ``subsections (g) and (h)'';
(B) in subsection (g)(2), in the matter before
subparagraph (A), by inserting ``and subsection (h) of
this Act'' after ``paragraphs (3) and (5)''; and
(C) by adding at the end the following new
subsection:
``(h) Sunset of Funding Limitations for Puerto Rico, the United
States Virgin Islands, Guam, the Commonwealth of the Northern Mariana
Islands, and American Samoa.--Subsections (f) and (g) shall not apply
to Puerto Rico, the United States Virgin Islands, Guam, the
Commonwealth of the Northern Mariana Islands, and American Samoa for
any fiscal year after fiscal year 2011.''.
(2) Conforming amendment.--Section 1903(u) of such Act (42
U.S.C. 1396c(u)) is amended by striking paragraph (4).
(3) Effective date.--The amendments made by this subsection
shall apply beginning with fiscal year 2012.
(b) Parity in FMAP.--
(1) In general.--The first sentence of section 1905(b) of
such Act (42 U.S.C. 1396d(b)) is amended by inserting after
``shall be 50 per centum'' the following: ``(except that,
beginning with fiscal year 2014, the Federal medical assistance
percentage for Puerto Rico, the United States Virgin Islands,
Guam, the Commonwealth of the Northern Mariana Islands, and
American Samoa shall be the Federal medical assistance
percentage determined by the Secretary in consultation (for the
United States Virgin Islands, Guam, the Commonwealth of the
Northern Mariana Islands, and American Samoa) with the
Secretary of the Interior)''.
(2) 2-fiscal-year transition.--Notwithstanding any other
provision of law, during fiscal years 2012 and 2013, the
Federal medical assistance percentage established under section
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) for
Puerto Rico, the United States Virgin Islands, Guam, the
Commonwealth of the Northern Mariana Islands, and American
Samoa shall be the highest such Federal medical assistance
percentage applicable to any of the 50 States or the District
of Columbia for the fiscal year involved, taking into account
the application of subsections (a) and (b)(1) of 5001 of
division B of the American Recovery and Reinvestment Act of
2009 (Public Law 111-5) to such States and District of Columbia
for calendar quarters during such fiscal years for which such
subsections apply respectively.
(3) Per capita income data.--
(A) Report to congress.--Not later than October 1,
2012, the Secretary of Health and Human Services shall
submit to Congress a report that describes the per
capita income data used to promulgate the Federal
medical assistance percentage in the territories and
how such data differ from the per capita income data
used to promulgate Federal medical assistance
percentages for the 50 States and the District of
Columbia. The report should include recommendations on
how the Federal medical assistance percentages can be
calculated for the territories to ensure parity with
the 50 States and the District of Columbia.
(B) Application.--Section 1101(a)(8)(B) of the
Social Security Act (42 U.S.C. 1308(a)(8)(B)) is
amended--
(i) by striking ``(other than Puerto Rico,
the United States Virgin Islands, and Guam)''
and inserting ``(including Puerto Rico, the
United States Virgin Islands, Guam, the
Commonwealth of the Northern Mariana Islands,
and American Samoa)''; and
(ii) by inserting ``(or, if such
satisfactory data are not available in the case
of the Virgin Islands, Guam, the Northern
Mariana Islands, or American Samoa,
satisfactory data available from the Department
of the Interior for the same period, or if such
satisfactory data are not available in the case
of Puerto Rico, satisfactory data available
from the government of the Commonwealth of
Puerto Rico for the same period)'' after
``Department of Commerce''.
(4) Relation to american recovery and reinvestment act of
2009.--For any period and territory in which the provisions of
this subsection apply to a territory, the provisions of section
5001(b)(2) of division B of the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5) shall not apply
(except as otherwise specifically provided in paragraph (2)).
SEC. 415. MEDICAID ELIGIBILITY FOR CITIZENS OF FREELY ASSOCIATED
STATES.
(a) In General.--Section 402(b)(2) of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2))
is amended by adding at the end the following:
``(G) Medicaid exception for citizens of freely
associated states.--With respect to eligibility for
benefits for the program defined in paragraph (3)(C)
(relating to Medicaid), paragraph (1) shall not apply
to any individual who lawfully resides in the United
States (including territories and possessions of the
United States) in accordance with--
``(i) section 141 of the Compact of Free
Association between the Government of the
United States and the Government of the
Federated States of Micronesia, approved by
Congress in the Compact of Free Association
Amendments Act of 2003;
``(ii) section 141 of the Compact of Free
Association between the Government of the
United States and the Government of the
Republic of the Marshall Islands, approved by
Congress in the Compact of Free Association
Amendments Act of 2003; or
``(iii) section 141 of the Compact of Free
Association between the Government of the
United States and the Government of Palau,
approved by Congress in Public Law 99-658 (100
Stat. 3672).''.
(b) Exception to 5-Year Limited Eligibility.--Section 403(d) of
such Act (8 U.S.C. 1613(d)) is amended--
(1) in paragraph (1), by striking ``or'' at the end;
(2) in paragraph (2), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(3) an individual described in section 402(b)(2)(G), but
only with respect to the designated Federal program defined in
section 402(b)(3)(C).''.
(c) Definition of Qualified Alien.--Section 431(b) of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (8
U.S.C. 1641(b)) is amended--
(1) in paragraph (6), by striking ``or'' at the end;
(2) in paragraph (7), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following:
``(8) an individual who lawfully resides in the United
States (including territories and possessions of the United
States) in accordance with a Compact of Free Association
referred to in section 402(b)(2)(G).''.
(d) Conforming Amendments.--Section 1108 of the Social Security Act
(42 U.S.C. 1308) is amended--
(1) in subsection (f), in the matter preceding paragraph
(1), by striking ``subsection (g)'' and inserting ``subsections
(g) and (h)''; and
(2) by adding at the end the following:
``(h) The limitations of subsections (f) and (g) shall not apply
with respect to medical assistance provided to an individual described
in section 431(b)(8) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996.''.
(e) Effective Date.--The amendments made by this section take
effect on the date of enactment of this Act and apply to benefits for
items and services furnished on or after that date.
SEC. 416. EXTENSION OF MEDICARE SECONDARY PAYER.
(a) In General.--Section 1862(b)(1)(C) of the Social Security Act
(42 U.S.C. 1395y(b)(1)(C)) is amended--
(1) in the last sentence, by inserting ``, and before
January 1, 2013'' after ``prior to such date)''; and
(2) by adding at the end the following new sentence:
``Effective for items and services furnished on or after
January 1, 2013 (with respect to periods beginning on or after
the date that is 42 months prior to such date), clauses (i) and
(ii) shall be applied by substituting `42-month' for `12-month'
each place it appears in the first sentence.''.
(b) Effective Date.--The amendments made by this subsection shall
take effect on the date of enactment of this Act. For purposes of
determining an individual's status under section 1862(b)(1)(C) of the
Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by paragraph
(1), an individual who is within the coordinating period as of the date
of enactment of this Act shall have that period extended to the full 42
months described in the last sentence of such section, as added by the
amendment made by paragraph (1)(B).
SEC. 417. BORDER HEALTH GRANTS.
(a) Eligible Entity Defined.--In this section, the term ``eligible
entity'' means a State, public institution of higher education, local
government, tribal government, nonprofit health organization, community
health center, or community clinic receiving assistance under section
330 of the Public Health Service Act (42 U.S.C. 254b), that is located
in the border area.
(b) Authorization.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary''), acting through the
United States members of the United States-Mexico Border Health
Commission, shall award grants to eligible entities to address
priorities and recommendations to improve the health of border area
residents that are established by--
(1) the United States members of the United States-Mexico
Border Health Commission;
(2) the State border health offices; and
(3) the Secretary.
(c) Application.--An eligible entity that desires a grant under
subsection (b) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may require.
(d) Use of Funds.--An eligible entity that receives a grant under
subsection (b) shall use the grant funds for--
(1) programs relating to--
(A) maternal and child health;
(B) primary care and preventative health;
(C) public health and public health infrastructure;
(D) health education and promotion;
(E) oral health;
(F) mental and behavioral health;
(G) substance abuse;
(H) health conditions that have a high prevalence
in the border area;
(I) medical and health services research;
(J) workforce training and development;
(K) community health workers or promotoras;
(L) health care infrastructure problems in the
border area (including planning and construction
grants);
(M) health disparities in the border area;
(N) environmental health; and
(O) outreach and enrollment services with respect
to Federal programs (including programs authorized
under titles XIX and XXI of the Social Security Act (42
U.S.C. 1396 and 1397aa)); and
(2) other programs determined appropriate by the Secretary.
(e) Supplement, Not Supplant.--Amounts provided to an eligible
entity awarded a grant under subsection (b) shall be used to supplement
and not supplant other funds available to the eligible entity to carry
out the activities described in subsection (d).
(f) Primary Care Definition.--In this Act, the term ``primary
care'' includes obstetrical and gynecological care and psychiatric and
mental health care.
SEC. 418. REMOVING MEDICARE BARRIERS TO HEALTH CARE.
(a) Part A.--Section 1818(a)(3) of the Social Security Act (42
U.S.C. 1395i-2(a)(3)) is amended by striking ``(B) an alien'' and all
that follows through the comma and inserting ``(B) an individual who is
lawfully present in the United States,''.
(b) Part B.--Section 1836(2) of the Social Security Act (42 U.S.C.
1395o(2)) is amended by striking ``(B) an alien'' and all that follows
through the comma and inserting ``(B) an individual who is lawfully
present in the United States,''.
SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED BY URBAN
INDIAN HEALTH CENTERS.
(a) In General.--Section 1905(b) of the Social Security Act (42
U.S.C. 1396(b)), as amended by section 414(b)(1), is amended by
striking ``or by an Indian tribe or tribal organization (as defined in
section 4 of the Indian Health Care Improvement Act)'' and inserting
``, by an Indian tribe or tribal organization (as defined in section 4
of the Indian Health Care Improvement Act), or are received through a
program operated by an urban Indian organization through a grant or
contract under section 502 of the Indian Health Care Improvement Act''.
(b) Effective Date.--The amendment made by this section shall apply
to medical assistance provided on or after the date of enactment of
this Act.
SEC. 420. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED TO A NATIVE
HAWAIIAN THROUGH A FEDERALLY QUALIFIED HEALTH CENTER OR A
NATIVE HAWAIIAN HEALTH CARE SYSTEM UNDER THE MEDICAID
PROGRAM.
(a) In General.--The third sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), as amended by section 419, is
amended by inserting ``; and, with respect to medical assistance
provided to a Native Hawaiian (as defined in section 12(2) of the
Native Hawaiian Health Care Improvement Act) through a federally
qualified health center or a Native Hawaiian health care system (as
defined in section 12(6) of such Act), whether directly, by referral,
or under contract or other arrangement between such federally qualified
health center or Native Hawaiian health care system and another health
care provider'' before the period.
(b) Effective Date.--The amendment made by this section shall apply
to medical assistance provided on or after the date of enactment of
this Act.
CHAPTER 2--EXPANSION OF ACCESS
SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH.
(a) Purpose.--It is the purpose of this section to provide for the
awarding of grants to assist communities in mobilizing and organizing
resources in support of effective and sustainable programs that will
reduce or eliminate disparities in health and health care experienced
by racial and ethnic minority individuals.
(b) Authority To Award Grants.--The Secretary, acting through the
Centers for Disease Control and Prevention, shall award grants to
eligible entities to assist in designing, implementing, and evaluating
culturally and linguistically appropriate, science-based, and
community-driven sustainable strategies to eliminate racial and ethnic
health and health care disparities.
(c) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall--
(1) represent a coalition--
(A) whose principal purpose is to develop and
implement interventions to reduce or eliminate a health
or health care disparity in a targeted racial or ethnic
minority group in the community served by the
coalition; and
(B) that includes--
(i) members selected from among--
(I) public health departments;
(II) community-based organizations;
(III) university and research
organizations;
(IV) American Indian tribal
organizations, national American Indian
organizations, Indian Health Service,
or organizations serving Alaska
Natives; and
(V) interested public or private
health care providers or organizations
as deemed appropriate by the Secretary;
and
(ii) at least 1 member from a community-
based organization that represents the targeted
racial or ethnic minority group; and
(2) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary
may require, which shall include--
(A) a description of the targeted racial or ethnic
populations in the community to be served under the
grant;
(B) a description of at least 1 health disparity
that exists in the racial or ethnic targeted
populations, including health issues such as infant
mortality, breast and cervical cancer screening and
management, cardiovascular disease, diabetes, child and
adult immunization levels, or other health priority
areas as designated by the Secretary; and
(C) a demonstration of a proven record of
accomplishment of the coalition members in serving and
working with the targeted community.
(d) Sustainability.--The Secretary shall give priority to an
eligible entity under this section if the entity agrees that, with
respect to the costs to be incurred by the entity in carrying out the
activities for which the grant was awarded, the entity (and each of the
participating partners in the coalition represented by the entity) will
maintain its expenditures of non-Federal funds for such activities at a
level that is not less than the level of such expenditures during the
fiscal year immediately preceding the first fiscal year for which the
grant is awarded.
(e) Nonduplication.--Funds provided through this grant program
should supplement, not supplant, existing Federal funding, and the
funds should not be used to duplicate the activities of the other
health disparity grant programs in this Act.
(f) Technical Assistance.--The Secretary may, either directly or by
grant or contract, provide any entity that receives a grant under this
section with technical and other nonfinancial assistance necessary to
meet the requirements of this section.
(g) Dissemination.--The Secretary shall encourage and enable
grantees to share best practices, evaluation results, and reports with
communities not affiliated with grantees using the Internet,
conferences, and other pertinent information regarding the projects
funded by this section, including the outreach efforts of the Office of
Minority Health and Health Disparity Elimination and the Centers for
Disease Control and Prevention.
(h) Administrative Burdens.--The Secretary shall make every effort
to minimize duplicative or unnecessary administrative burdens on
grantees.
SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS.
(a) Elimination of Isolation Test for Cost-based Ambulance
Reimbursement.--
(1) In general.--Section 1834(l)(8) of the Social Security
Act (42 U.S.C. 1395m(l)(8)) is amended--
(A) in subparagraph (B)--
(i) by striking ``owned and''; and
(ii) by inserting ``(including when such
services are provided by the entity under an
arrangement with the hospital)'' after
``hospital''; and
(B) by striking the comma at the end of
subparagraph (B) and all that follows and inserting a
period.
(2) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after January 1, 2013.
(b) Provision of a More Flexible Alternative to the CAH Designation
25 Inpatient Bed Limit Requirement.--
(1) In general.--Section 1820(c)(2) of the Social Security
Act (42 U.S.C. 1395i-4(c)(2)) is amended--
(A) in subparagraph (B)(iii), by striking
``provides not more than'' and inserting ``subject to
subparagraph (F), provides not more than''; and
(B) by adding at the end the following new
subparagraph:
``(F) Alternative to 25 inpatient bed limit
requirement.--
``(i) In general.--A State may elect to
treat a facility, with respect to the
designation of the facility for a cost
reporting period, as satisfying the requirement
of subparagraph (B)(iii) relating to a maximum
number of acute care inpatient beds if the
facility elects, in accordance with a method
specified by the Secretary and before the
beginning of the cost reporting period, to meet
the requirement under clause (ii).
``(ii) Alternate requirement.--The
requirement under this clause, with respect to
a facility and a cost reporting period, is that
the total number of inpatient bed days
described in subparagraph (B)(iii) during such
period will not exceed 7,300. For purposes of
this subparagraph, an individual who is an
inpatient in a bed in the facility for a single
day shall be counted as one inpatient bed day.
``(iii) Withdrawal of election.--The option
described in clause (i) shall not apply to a
facility for a cost reporting period if the
facility (for any two consecutive cost-
reporting periods during the previous 5 cost-
reporting periods) was treated under such
option and had a total number of inpatient bed
days for each of such two cost-reporting
periods that exceeded the number specified in
such clause.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to cost-reporting periods beginning on or after the
date of the enactment of this Act.
SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL (RCH) PROGRAM.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x), as amended by section 203(b)(1)(A), is amended by adding at the
end of the following new subsection:
``Rural Community Hospital; Rural Community Hospital Services
``(jjj)(1) The term `rural community hospital' means a hospital (as
defined in subsection (e)) that--
``(A) is located in a rural area (as defined in section
1886(d)(2)(D)) or treated as being so located pursuant to
section 1886(d)(8)(E);
``(B) subject to paragraph (2), has less than 51 acute care
inpatient beds, as reported in its most recent cost report;
``(C) makes available 24-hour emergency care services;
``(D) subject to paragraph (3), has a provider agreement in
effect with the Secretary and is open to the public as of
January 1, 2010; and
``(E) applies to the Secretary for such designation.
``(2) For purposes of paragraph (1)(B), beds in a psychiatric or
rehabilitation unit of the hospital which is a distinct part of the
hospital shall not be counted.
``(3) Paragraph (1)(D) shall not be construed to prohibit any of
the following from qualifying as a rural community hospital:
``(A) A replacement facility (as defined by the Secretary
in regulations in effect on January 1, 2012) with the same
service area (as defined by the Secretary in regulations in
effect on such date).
``(B) A facility obtaining a new provider number pursuant
to a change of ownership.
``(C) A facility which has a binding written agreement with
an outside, unrelated party for the construction,
reconstruction, lease, rental, or financing of a building as of
January 1, 2012.
``(4) Nothing in this subsection shall be construed as prohibiting
a critical access hospital from qualifying as a rural community
hospital if the critical access hospital meets the conditions otherwise
applicable to hospitals under subsection (e) and section 1866.
``(5) Nothing in this subsection shall be construed as prohibiting
a rural community hospital participating in the demonstration program
under section 410A of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2313) from
qualifying as a rural community hospital if the rural community
hospital meets the conditions otherwise applicable to hospitals under
subsection (e) and section 1866.''.
(b) Payment.--
(1) Inpatient hospital services.--Section 1814 of the
Social Security Act (42 U.S.C. 1395f) is amended by adding at
the end the following new subsection:
``Payment for Inpatient Services Furnished in Rural Community Hospitals
``(m) The amount of payment under this part for inpatient hospital
services furnished in a rural community hospital, other than such
services furnished in a psychiatric or rehabilitation unit of the
hospital which is a distinct part, is, at the election of the hospital
in the application referred to in section 1861(jjj)(1)(E)--
``(1) 101 percent of the reasonable costs of providing such
services, without regard to the amount of the customary or
other charge, or
``(2) the amount of payment provided for under the
prospective payment system for inpatient hospital services
under section 1886(d).''.
(2) Outpatient services.--Section 1834 of such Act (42
U.S.C. 1395m) is amended by adding at the end the following new
subsection:
``(p) Payment for Outpatient Services Furnished in Rural Community
Hospitals.--The amount of payment under this part for outpatient
services furnished in a rural community hospital is, at the election of
the hospital in the application referred to in section
1861(jjj)(1)(E)--
``(1) 101 percent of the reasonable costs of providing such
services, without regard to the amount of the customary or
other charge and any limitation under section 1861(v)(1)(U), or
``(2) the amount of payment provided for under the
prospective payment system for covered OPD services under
section 1833(t).''.
(3) Exemption from reduction in reimbursement for bad
debt.--Section 1861(v)(1) of such Act (42 U.S.C. 1395x(v)(1))
is amended--
(A) in subparagraph (T), in the matter preceding
clause (i), by inserting ``(other than for a rural
community hospital)'' after ``In determining such
reasonable costs for hospitals''; and
(B) in subparagraph (W)(ii), as added by section
3201(c) of the Middle Class Tax Relief and Job Creation
Act of 2012 (Public Law 112-96), by inserting ``(other
than a rural community hospital)'' after ``(V)''.
(c) Beneficiary Copayment for Outpatient Services.--Section 1834(p)
of such Act (as added by subsection (b)(2)) is amended--
(1) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively;
(2) by inserting ``(1)'' after ``(p)''; and
(3) by adding at the end the following:
``(2) The amounts of beneficiary cost sharing for outpatient
services furnished in a rural community hospital under this part shall
be as follows:
``(A) For items and services that would have been paid
under section 1833(t) if provided by a hospital, the amount of
copayment determined under paragraph (8) of such section.
``(B) For items and services that would have been paid
under section 1833(h) if furnished by a provider or supplier,
no copayment shall apply.
``(C) For all other items and services, the amount of
copayment that would apply to the item or service under the
methodology that would be used to determine payment for such
item or service if provided by a physician, provider, or
supplier, as the case may be.''.
(d) Conforming Amendments.--
(1) Part a payment.--Section 1814(b) of such Act (42 U.S.C.
1395f(b)) is amended in the matter preceding paragraph (1) by
inserting ``other than inpatient hospital services furnished by
a rural community hospital,'' after ``critical access hospital
services,''.
(2) Part b payment.--Section 1833(a) of such Act (42 U.S.C.
1395l(a)), as amended by section 203(b)(2), is amended--
(A) in paragraph (2), in the matter before
subparagraph (A), by striking ``and (I)'' and inserting
``(I), and (K)'';
(B) by striking ``and'' at the end of paragraph
(9);
(C) by striking the period at the end of paragraph
(10) and inserting ``; and''; and
(D) by adding at the end the following:
``(11) in the case of outpatient services furnished by a
rural community hospital, the amounts described in section
1834(p).''.
(3) Technical amendments.--
(A) Consultation with state agencies.--Section 1863
of such Act (42 U.S.C. 1395z) is amended by striking
``and (dd)(2)'' and inserting ``(dd)(2), (mm)(1), and
(jjj)(1)''.
(B) Provider agreements.--Section 1866(a)(2)(A) of
such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by
inserting ``section 1834(p)(2),'' after ``section
1833(b),''.
(e) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after October 1, 2012.
SEC. 424. MEDICARE REMOTE MONITORING PILOT PROJECTS.
(a) Pilot Projects.--
(1) In general.--Not later than 9 months after the date of
enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall conduct pilot projects under title XVIII of the Social
Security Act for the purpose of providing incentives to home
health agencies to utilize home monitoring and communications
technologies that--
(A) enhance health outcomes for Medicare
beneficiaries; and
(B) reduce expenditures under such title.
(2) Site requirements.--
(A) Urban and rural.--The Secretary shall conduct
the pilot projects under this section in both urban and
rural areas.
(B) Site in a small state.--The Secretary shall
conduct at least 3 of the pilot projects in a State
with a population of less than 1,000,000.
(3) Definition of home health agency.--In this section, the
term ``home health agency'' has the meaning given that term in
section 1861(o) of the Social Security Act (42 U.S.C.
1395x(o)).
(b) Medicare Beneficiaries Within the Scope of Projects.--The
Secretary shall specify the criteria for identifying those Medicare
beneficiaries who shall be considered within the scope of the pilot
projects under this section for purposes of the application of
subsection (c) and for the assessment of the effectiveness of the home
health agency in achieving the objectives of this section. Such
criteria may provide for the inclusion in the projects of Medicare
beneficiaries who begin receiving home health services under title
XVIII of the Social Security Act after the date of the implementation
of the projects.
(c) Incentives.--
(1) Performance targets.--The Secretary shall establish for
each home health agency participating in a pilot project under
this section a performance target using one of the following
methodologies, as determined appropriate by the Secretary:
(A) Adjusted historical performance target.--The
Secretary shall establish for the agency--
(i) a base expenditure amount equal to the
average total payments made to the agency under
parts A and B of title XVIII of the Social
Security Act for Medicare beneficiaries
determined to be within the scope of the pilot
project in a base period determined by the
Secretary; and
(ii) an annual per capita expenditure
target for such beneficiaries, reflecting the
base expenditure amount adjusted for risk and
adjusted growth rates.
(B) Comparative performance target.--The Secretary
shall establish for the agency a comparative
performance target equal to the average total payments
under such parts A and B during the pilot project for
comparable individuals in the same geographic area that
are not determined to be within the scope of the pilot
project.
(2) Incentive.--Subject to paragraph (3), the Secretary
shall pay to each participating home care agency an incentive
payment for each year under the pilot project equal to a
portion of the Medicare savings realized for such year relative
to the performance target under paragraph (1).
(3) Limitation on expenditures.--The Secretary shall limit
incentive payments under this section in order to ensure that
the aggregate expenditures under title XVIII of the Social
Security Act (including incentive payments under this
subsection) do not exceed the amount that the Secretary
estimates would have been expended if the pilot projects under
this section had not been implemented.
(d) Waiver Authority.--The Secretary may waive such provisions of
titles XI and XVIII of the Social Security Act as the Secretary
determines to be appropriate for the conduct of the pilot projects
under this section.
(e) Report to Congress.--Not later than 5 years after the date that
the first pilot project under this section is implemented, the
Secretary shall submit to Congress a report on the pilot projects. Such
report shall contain a detailed description of issues related to the
expansion of the projects under subsection (f) and recommendations for
such legislation and administrative actions as the Secretary considers
appropriate.
(f) Expansion.--If the Secretary determines that any of the pilot
projects under this section enhance health outcomes for Medicare
beneficiaries and reduce expenditures under title XVIII of the Social
Security Act, the Secretary may initiate comparable projects in
additional areas.
(g) Incentive Payments Have No Effect on Other Medicare Payments to
Agencies.--An incentive payment under this section--
(1) shall be in addition to the payments that a home health
agency would otherwise receive under title XVIII of the Social
Security Act for the provision of home health services; and
(2) shall have no effect on the amount of such payments.
SEC. 425. RURAL HEALTH QUALITY ADVISORY COMMISSION AND DEMONSTRATION
PROJECTS.
(a) Rural Health Quality Advisory Commission.--
(1) Establishment.--Not later than 6 months after the date
of the enactment of this section, the Secretary of Health and
Human Services (in this section referred to as the
``Secretary'') shall establish a commission to be known as the
Rural Health Quality Advisory Commission (in this section
referred to as the ``Commission'').
(2) Duties of commission.--
(A) National plan.--The Commission shall develop,
coordinate, and facilitate implementation of a national
plan for rural health quality improvement. The national
plan shall--
(i) identify objectives for rural health
quality improvement;
(ii) identify strategies to eliminate known
gaps in rural health system capacity and
improve rural health quality; and
(iii) provide for Federal programs to
identify opportunities for strengthening and
aligning policies and programs to improve rural
health quality.
(B) Demonstration projects.--The Commission shall
design demonstration projects to test alternative
models for rural health quality improvement, including
with respect to both personal and population health.
(C) Monitoring.--The Commission shall monitor
progress toward the objectives identified pursuant to
paragraph (1)(A).
(3) Membership.--
(A) Number.--The Commission shall be composed of 11
members appointed by the Secretary.
(B) Selection.--The Secretary shall select the
members of the Commission from among individuals with
significant rural health care and health care quality
expertise, including expertise in clinical health care,
health care quality research, population or public
health, or purchaser organizations.
(4) Contracting authority.--Subject to the availability of
funds, the Commission may enter into contracts and make other
arrangements, as may be necessary to carry out the duties
described in paragraph (2).
(5) Staff.--Upon the request of the Commission, the
Secretary may detail, on a reimbursable basis, any of the
personnel of the Office of Rural Health Policy of the Health
Resources and Services Administration, the Agency for Health
care Quality and Research, or the Centers for Medicare &
Medicaid Services to the Commission to assist in carrying out
this subsection.
(6) Reports to congress.--Not later than 1 year after the
establishment of the Commission, and annually thereafter, the
Commission shall submit a report to the Congress on rural
health quality. Each such report shall include the following:
(A) An inventory of relevant programs and
recommendations for improved coordination and
integration of policy and programs.
(B) An assessment of achievement of the objectives
identified in the national plan developed under
paragraph (2) and recommendations for realizing such
objectives.
(C) Recommendations on Federal legislation,
regulations, or administrative policies to enhance
rural health quality and outcomes.
(b) Rural Health Quality Demonstration Projects.--
(1) In general.--Not later than 270 days after the date of
the enactment of this section, the Secretary, in consultation
with the Rural Health Quality Advisory Commission, the Office
of Rural Health Policy of the Health Resources and Services
Administration, the Agency for Healthcare Research and Quality,
and the Centers for Medicare & Medicaid Services, shall make
grants to eligible entities for 5 demonstration projects to
implement and evaluate methods for improving the quality of
health care in rural communities. Each such demonstration
project shall include--
(A) alternative community models that--
(i) will achieve greater integration of
personal and population health services; and
(ii) address safety, effectiveness,
patient- or community-centeredness, timeliness,
efficiency, and equity (the 6 aims identified
by the Institute of Medicine of the National
Academies in its report entitled ``Crossing the
Quality Chasm: A New Health System for the 21st
Century'' released on March 1, 2001);
(B) innovative approaches to the financing and
delivery of health services to achieve rural health
quality goals; and
(C) development of quality improvement support
structures to assist rural health systems and
professionals (such as workforce support structures,
quality monitoring and reporting, clinical care
protocols, and information technology applications).
(2) Eligible entities.--In this subsection, the term
``eligible entity'' means a consortium that--
(A) shall include--
(i) at least one health care provider or
health care delivery system located in a rural
area; and
(ii) at least one organization representing
multiple community stakeholders; and
(B) may include other partners such as rural
research centers.
(3) Consultation.--In developing the program for awarding
grants under this subsection, the Secretary shall consult with
the Administrator of the Agency for Healthcare Research and
Quality, rural health care providers, rural health care
researchers, and private and nonprofit groups (including
national associations) which are undertaking similar efforts.
(4) Expedited waivers.--The Secretary shall expedite the
processing of any waiver that--
(A) is authorized under title XVIII or XIX of the
Social Security Act (42 U.S.C. 1395 et seq.); and
(B) is necessary to carry out a demonstration
project under this subsection.
(5) Demonstration project sites.--The Secretary shall
ensure that the 5 demonstration projects funded under this
subsection are conducted at a variety of sites representing the
diversity of rural communities in the Nation.
(6) Duration.--Each demonstration project under this
subsection shall be for a period of 4 years.
(7) Independent evaluation.--The Secretary shall enter into
an arrangement with an entity that has experience working
directly with rural health systems for the conduct of an
independent evaluation of the program carried out under this
subsection.
(8) Report.--Not later than 1 year after the conclusion of
all of the demonstration projects funded under this subsection,
the Secretary shall submit a report to the Congress on the
results of such projects. The report shall include--
(A) an evaluation of patient access to care,
patient outcomes, and an analysis of the cost
effectiveness of each such project; and
(B) recommendations on Federal legislation,
regulations, or administrative policies to enhance
rural health quality and outcomes.
SEC. 426. RURAL HEALTH CARE SERVICES.
Section 330A of the Public Health Service Act (42 U.S.C. 254c) is
amended to read as follows:
``SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK
DEVELOPMENT, DELTA RURAL DISPARITIES AND HEALTH SYSTEMS
DEVELOPMENT, AND SMALL RURAL HEALTH CARE PROVIDER QUALITY
IMPROVEMENT GRANT PROGRAMS.
``(a) Purpose.--The purpose of this section is to provide for
grants--
``(1) under subsection (b), to promote rural health care
services outreach;
``(2) under subsection (c), to provide for the planning and
implementation of integrated health care networks in rural
areas;
``(3) under subsection (d), to assist rural communities in
the Delta Region to reduce health disparities and to promote
and enhance health system development; and
``(4) under subsection (e), to provide for the planning and
implementation of small rural health care provider quality
improvement activities.
``(b) Rural Health Care Services Outreach Grants.--
``(1) Grants.--The Director of the Office of Rural Health
Policy of the Health Resources and Services Administration may
award grants to eligible entities to promote rural health care
services outreach by expanding the delivery of health care
services to include new and enhanced services in rural areas.
The Director may award the grants for periods of not more than
3 years.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection for a project, an entity--
``(A) shall be a rural public or rural nonprofit
private entity, a facility that qualifies as a rural
health clinic under title XVIII of the Social Security
Act, a public or nonprofit entity existing exclusively
to provide services to migrant and seasonal farm
workers in rural areas, or a tribal government whose
grant-funded activities will be conducted within
federally recognized tribal areas;
``(B) shall represent a consortium composed of
members--
``(i) that include 3 or more independently
owned health care entities; and
``(ii) that may be nonprofit or for-profit
entities; and
``(C) shall not previously have received a grant
under this subsection for the same or a similar
project, unless the entity is proposing to expand the
scope of the project or the area that will be served
through the project.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity shall prepare and
submit to the Director an application at such time, in such
manner, and containing such information as the Director may
require, including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) a description of the manner in which the
project funded under the grant will meet the health
care needs of rural populations in the local community
or region to be served;
``(C) a plan for quantifying how health care needs
will be met through identification of the target
population and benchmarks of service delivery or health
status, such as--
``(i) quantifiable measurements of health
status improvement for projects focusing on
health promotion; or
``(ii) benchmarks of increased access to
primary care (which includes obstetrical and
gynecological care and psychiatric and mental
health care), including tracking factors such
as the number and type of primary care visits,
identification of a medical home, or other
general measures of such access;
``(D) a description of how the local community or
region to be served will be involved in the development
and ongoing operations of the project;
``(E) a plan for sustaining the project after
Federal support for the project has ended;
``(F) a description of how the project will be
evaluated;
``(G) the administrative capacity to submit annual
performance data electronically as specified by the
Director; and
``(H) other such information as the Director
determines to be appropriate.
``(c) Rural Health Network Development Grants.--
``(1) Grants.--
``(A) In general.--The Director may award rural
health network development grants to eligible entities
to promote, through planning and implementation, the
development of integrated health care networks that
have combined the functions of the entities
participating in the networks in order to--
``(i) achieve efficiencies and economies of
scale;
``(ii) expand access to, coordinate, and
improve the quality of the health care delivery
system through development of organizational
efficiencies;
``(iii) implement health information
technology to achieve efficiencies, reduce
medical errors, and improve quality;
``(iv) coordinate care and manage chronic
illness; and
``(v) strengthen the rural health care
system as a whole in such a manner as to show a
quantifiable return on investment to the
participants in the network.
``(B) Grant periods.--The Director may award such a
rural health network development grant--
``(i) for a period of 3 years for
implementation activities; or
``(ii) for a period of 1 year for planning
activities to assist in the initial development
of an integrated health care network, if the
proposed participants in the network do not
have a history of collaborative efforts and a
3-year grant would be inappropriate.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection, an entity--
``(A) shall be a rural public or rural nonprofit
private entity, a facility that qualifies as a rural
health clinic under title XVIII of the Social Security
Act, a public or nonprofit entity existing exclusively
to provide services to migrant and seasonal farm
workers in rural areas, or a tribal government whose
grant-funded activities will be conducted within
federally recognized tribal areas;
``(B) shall represent a network composed of
participants--
``(i) that include 3 or more independently
owned health care entities; and
``(ii) that may be nonprofit or for-profit
entities; and
``(C) shall not previously have received a grant
under this subsection (other than a 1-year grant for
planning activities) for the same or a similar project.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity, in consultation with
the appropriate State office of rural health or another
appropriate State entity, shall prepare and submit to the
Director an application at such time, in such manner, and
containing such information as the Director may require,
including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of--
``(i) the history of collaborative
activities carried out by the participants in
the network;
``(ii) the degree to which the participants
are ready to integrate their functions; and
``(iii) how the local community or region
to be served will benefit from and be involved
in the activities carried out by the network;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services across the continuum of
care as a result of the integration activities carried
out by the network, including a description of--
``(i) return on investment for the
community and the network members; and
``(ii) other quantifiable performance
measures that show the benefit of the network
activities;
``(E) a plan for sustaining the project after
Federal support for the project has ended;
``(F) a description of how the project will be
evaluated;
``(G) the administrative capacity to submit annual
performance data electronically as specified by the
Director; and
``(H) other such information as the Director
determines to be appropriate.
``(d) Delta Rural Disparities and Health Systems Development
Grants.--
``(1) Grants.--The Director may award grants to eligible
entities to support reduction of health disparities, improve
access to health care, and enhance rural health system
development in the Delta Region.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection, an entity shall be a rural public or rural
nonprofit private entity, a facility that qualifies as a rural
health clinic under title XVIII of the Social Security Act, a
public or nonprofit entity existing exclusively to provide
services to migrant and seasonal farm workers in rural areas,
or a tribal government whose grant-funded activities will be
conducted within federally recognized tribal areas.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity shall prepare and
submit to the Director an application at such time, in such
manner, and containing such information as the Director may
require, including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of the manner in which the
project funded under the grant will meet the health
care needs of the Delta Region;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services as a result of the
activities carried out by the entity;
``(E) a description of how health disparities will
be reduced or the health system will be improved;
``(F) a plan for sustaining the project after
Federal support for the project has ended;
``(G) a description of how the project will be
evaluated including process and outcome measures
related to the quality of care provided or how the
health care system improves its performance;
``(H) a description of how the grantee will develop
an advisory group made up of representatives of the
communities to be served to provide guidance to the
grantee to best meet community need; and
``(I) other such information as the Director
determines to be appropriate.
``(e) Small Rural Health Care Provider Quality Improvement
Grants.--
``(1) Grants.--The Director may award grants to provide for
the planning and implementation of small rural health care
provider quality improvement activities. The Director may award
the grants for periods of 1 to 3 years.
``(2) Eligibility.--To be eligible for a grant under this
subsection, an entity--
``(A) shall be--
``(i) a rural public or rural nonprofit
private health care provider or provider of
health care services, such as a rural health
clinic; or
``(ii) another rural provider or network of
small rural providers identified by the
Director as a key source of local care; and
``(B) shall not previously have received a grant
under this subsection for the same or a similar
project.
``(3) Preference.--In awarding grants under this
subsection, the Director shall give preference to facilities
that qualify as rural health clinics under title XVIII of the
Social Security Act.
``(4) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity shall prepare and
submit to the Director an application at such time, in such
manner, and containing such information as the Director may
require, including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of the manner in which the
project funded under the grant will assure continuous
quality improvement in the provision of services by the
entity;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services as a result of the
activities carried out by the entity;
``(E) a plan for sustaining the project after
Federal support for the project has ended;
``(F) a description of how the project will be
evaluated including process and outcome measures
related to the quality of care provided; and
``(G) other such information as the Director
determines to be appropriate.
``(f) General Requirements.--
``(1) Prohibited uses of funds.--An entity that receives a
grant under this section may not use funds provided through the
grant--
``(A) to build or acquire real property; or
``(B) for construction.
``(2) Coordination with other agencies.--The Director shall
coordinate activities carried out under grant programs
described in this section, to the extent practicable, with
Federal and State agencies and nonprofit organizations that are
operating similar grant programs, to maximize the effect of
public dollars in funding meritorious proposals.
``(g) Report.--Not later than September 30, 2014, the Secretary
shall prepare and submit to the appropriate committees of Congress a
report on the progress and accomplishments of the grant programs
described in subsections (b), (c), (d), and (e).
``(h) Definitions.--In this section:
``(1) The term `Delta Region' has the meaning given to the
term `region' in section 382A of the Consolidated Farm and
Rural Development Act (7 U.S.C. 2009aa).
``(2) The term `Director' means the Director of the Office
of Rural Health Policy of the Health Resources and Services
Administration.''.
SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE ACCESS EXPANSION.
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is
amended by adding at the end the following:
``(t) Miscellaneous Provisions.--
``(1) Rule of construction with respect to rural health
clinics.--
``(A) In general.--Nothing in this section shall be
construed to prevent a community health center from
contracting with a federally certified rural health
clinic (as defined by section 1861(aa)(2) of the Social
Security Act) for the delivery of primary health care
services that are available at the rural health clinic
to individuals who would otherwise be eligible for free
or reduced cost care if that individual were able to
obtain that care at the community health center. Such
services may be limited in scope to those primary
health care services available in that rural health
clinic.
``(B) Assurances.--In order for a rural health
clinic to receive funds under this section through a
contract with a community health center under paragraph
(1), such rural health clinic shall establish policies
to ensure--
``(i) nondiscrimination based upon the
ability of a patient to pay; and
``(ii) the establishment of a sliding fee
scale for low-income patients.''.
SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS
STATE LINES.
(a) In General.--For purposes of expediting the provision of
telehealth services, for which payment is made under the Medicare
program, across State lines, the Secretary of Health and Human Services
shall, in consultation with representatives of States, physicians,
health care practitioners, and patient advocates, encourage and
facilitate the adoption of provisions allowing for multistate
practitioner practice across State lines.
(b) Definitions.--In subsection (a):
(1) Telehealth service.--The term ``telehealth service''
has the meaning given that term in subparagraph (F) of section
1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
(2) Physician, practitioner.--The terms ``physician'' and
``practitioner'' have the meaning given those terms in
subparagraphs (D) and (E), respectively, of such section.
(3) Medicare program.--The term ``Medicare program'' means
the program of health insurance administered by the Secretary
of Health and Human Services under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS.
Section 202 of the Congressional Budget and Impoundment Control Act
of 1974 (2 U.S.C. 602) is amended by adding at the end the following
new subsection:
``(h) Scoring of Preventive Health Savings.--
``(1) Determination by the director.--Upon a request by the
chairman or ranking minority member of the Committee on the
Budget of the Senate, or by the chairman or ranking minority
member of the Committee on the Budget of the House of
Representatives, the Director shall determine if a proposed
measure would result in reductions in budget outlays in
budgetary outyears through the use of preventive health and
preventive health services.
``(2) Projections.--If the Director determines that a
measure would result in substantial reductions in budget
outlays as described in paragraph (1), the Director--
``(A) shall include, in any projection prepared by
the Director, a description and estimate of the
reductions in budget outlays in the budgetary outyears
and a description of the basis for such conclusions;
and
``(B) may prepare a budget projection that includes
some or all of the budgetary outyears, notwithstanding
the time periods for projections described in
subsection (e) and sections 308, 402, and 424.
``(3) Definitions.--As used in this subsection--
``(A) the term `preventive health' means an action
that focuses on the health of the public, individuals,
and defined populations in order to protect, promote,
and maintain health, wellness, and functional ability,
and prevent disease, disability, and premature death
that is demonstrated by credible and publicly available
epidemiological projection models, incorporating
clinical trials or observational studies in humans, to
avoid future health care costs; and
``(B) the term `budgetary outyears' means the 2
consecutive 10-year periods beginning with the first
fiscal year that is 10 years after the budget year
provided for in the most recently agreed to concurrent
resolution on the budget.''.
SEC. 430. SENSE OF CONGRESS.
It is the sense of the Congress that--
(1) the maintenance of effort (MOE) provisions added to
sections 1902 and 2105(d) of the Social Security Act by
sections 2001(b) and 2101(b) of the Patient Protection and
Affordable Care Act were written to maintain the eligibility
standards for the Medicaid program and Children's Health
Insurance Program until the American Health Benefit Exchanges
in the States are fully operational;
(2) it is imperative that the MOE provisions are enforced
to the strict standard intended by the Congress;
(3) waiving the MOE provisions should not be permitted,
except in the case of a request for a waiver that meets the
explicit nonapplication requirements;
(4) the MOE provisions ensure the continued success of the
Medicaid program and CHIP and were written deliberately to
specifically protect vulnerable and disabled individuals,
children, and senior citizens, many of whom are also members of
communities of color; and
(5) the MOE provisions must be strictly enforced and
proposals to weaken the MOE provisions must not be considered
in this time of recession.
SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTATION EVIDENCING
CITIZENSHIP OR NATIONALITY UNDER THE MEDICAID PROGRAM.
(a) Repeal.--Subsections (i)(22) and (x) of section 1903 of the
Social Security Act (42 U.S.C. 1396b), as added by section 6036 of the
Deficit Reduction Act of 2005, are each repealed.
(b) Conforming Amendments.--
(1) Section 1902(a)(46)(B) of the Social Security Act (42
U.S.C. 1396a(a)(46)(B)) is amended by striking ``requirements
of'' and all that follows through ``subsection (ee);'' and
inserting ``requirements of subsection (ee);''.
(2) Subsection (c) of section 6036 of the Deficit Reduction
Act of 2005 is repealed.
(c) Effective Date.--The repeals and amendments made by this
section shall take effect as if included in the enactment of the
Deficit Reduction Act of 2005.
SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS HEALTH ADMINISTRATION
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Establishment and Functions.--Subchapter I of chapter 73 of
title 38, United States Code, is amended by adding at the end the
following new section:
``Sec. 7309. Office of Minority Health
``(a) Establishment.--There is established in the Department within
the Office of the Under Secretary for Health an office to be known as
the `Office of Minority Health' (in this section referred to as the
`Office').
``(b) Head.--The Director of the Office of Minority Health shall be
the head of the Office. The Director of the Office of Minority Health
shall be appointed by the Under Secretary of Health from among
individuals qualified to perform the duties of the position.
``(c) Functions.--The functions of the Office are as follows:
``(1) To establish short-range and long-range goals and
objectives and coordinate all other activities within the
Veterans Health Administration that relate to disease
prevention, health promotion, health care services delivery,
and health care research concerning veterans who are members of
a racial or ethnic minority group.
``(2) To support research, demonstrations, and evaluations
to test new and innovative models for the discharge of
activities described in paragraph (1).
``(3) To increase knowledge and understanding of health
risk factors for veterans who are members of a racial or ethnic
minority group.
``(4) To develop mechanisms that support better health care
information dissemination, education, prevention, and services
delivery to veterans from disadvantaged backgrounds, including
veterans who are members of a racial or ethnic minority group.
``(5) To enter into contracts or agreements with
appropriate public and nonprofit private entities to develop
and carry out programs to provide bilingual or interpretive
services to assist veterans who are members of a racial or
ethnic minority group and who lack proficiency in speaking the
English language in accessing and receiving health care
services through the Veterans Health Administration.
``(6) To carry out programs to improve access to health
care services through the Veterans Health Administration for
veterans with limited proficiency in speaking the English
language, including the development and evaluation of
demonstration and pilot projects for that purpose.
``(7) To advise the Under Secretary of Health on matters
relating to the development, implementation, and evaluation of
health professions education in decreasing disparities in
health care outcomes between veterans who are members of a
racial or ethnic minority group and other veterans, including
cultural competency as a method of eliminating such health
disparities.
``(8) To perform such other functions and duties as the
Secretary or the Under Secretary for Health considers
appropriate.
``(d) Definitions.--In this section:
``(1) The term `racial or ethnic minority group' means the
following:
``(A) American Indians (including Alaska Natives,
Eskimos, and Aleuts).
``(B) Asian Americans.
``(C) Native Hawaiians and other Pacific Islanders.
``(D) Blacks.
``(E) Hispanics.
``(2) The term `Hispanic' means individuals whose origin is
Mexican, Puerto Rican, Cuban, Central or South American, or any
other Spanish-speaking country.''.
SEC. 433. ACCESS FOR NATIVE AMERICANS UNDER PPACA.
(a) In General.--Title I of the Patient Protection and Affordable
Care Act is amended--
(1) in section 1311(c)(6)(D), by striking ``(as defined in
section 4 of the Indian Health Care Improvement Act)'' and
inserting ``(as defined in section 447.50(b)(1) of title 42 of
the Code of Federal Regulations, as in effect on July 1,
2010)''; and
(2) in section 1402(d)(1), by striking ``(as defined in
section 4(d) of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b(d)))'' and inserting (f) ``(as
defined in section 447.50(b)(1) of title 42 of the Code of
Federal Regulations, as in effect on July 1, 2010)''.
(b) Individual Mandate.--In section 5000A(e)(3) of the Internal
Revenue Code of 1986, by striking ``(as defined in section 45A(c)(6))''
and inserting ``(as defined in section 447.50(b)(1) of title 42 of the
Code of Federal Regulations, as in effect on July 1, 2010)''.
SEC. 434. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL ACCESS FOR LOW-
INCOME PATIENTS.
(a) In General.--Not later than January 1, 2016, the Comptroller
General of the United States shall--
(1) evaluate and examine the continued need for payments to
disproportionate share hospitals under section 1886(d)(5)(F) of
the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section
1923 of such Act (42 U.S.C. 1396r-4) to ensure timely access to
health care services for low-income patients after the
expansion of coverage under the Medicaid program pursuant to
the Patient Protection and Affordable Care Act (Public Law 111-
148) in 2014, as well as how such funding should be allocated
among such hospitals; and
(2) provide recommendations--
(A) to the Secretary of Health and Human Services
for purposes of assisting in development of the
methodology for reduction of payments to
disproportionate share hospitals, as required pursuant
to sections 2551 and 3133 of the Patient Protection and
Affordable Care Act; and
(B) to Congress for any legislative changes to the
payment levels provided for disproportionate share
hospitals that are needed to ensure access to health
services for low-income patients, as based on the
number of individuals without health insurance, the
amount of uncompensated care provided by such
hospitals, and the impact of reduced payments levels on
low-income communities.
(b) Additional Considerations.--For purposes of the study and
recommendations described in subsection (a), the Comptroller General
shall take into account--
(1) the impact of the expansion of coverage under the
Medicaid program pursuant to the Patient Protection and
Affordable Care Act on--
(A) the number of individuals in the United States
who are without health insurance, as well as the
distribution of such individuals in relation to areas
primarily served by disproportionate share hospitals;
and
(B) the low-income utilization rate of such
hospitals and their resulting fiscal sustainability;
(2) the role played by disproportionate share hospitals in
providing critical access to emergency, inpatient, and
outpatient health services, as well as their location in
relation to medically underserved areas;
(3) the appropriate level and distribution of payments to
disproportionate share hospitals in order to--
(A) sufficiently account for the level of
uncompensated care provided by such hospitals to low-
income patients; and
(B) provide timely access to health services for
individuals in medically underserved areas;
(4) the extent to which disproportionate share hospitals
satisfy the requirements established for charitable hospital
organizations under section 501(r) of the Internal Revenue Code
of 1986 in regard to community health needs assessments,
financial assistance policy requirements, limitations on
charges, and billing and collection requirements; and
(5) any reports submitted by the Secretary of the Treasury,
in consultation with the Secretary of Health and Human
Services, to Congressional committees in regard to the costs
incurred by charitable hospital organizations for charity care,
bad debt, and non-reimbursed expenses for services provided to
individuals under the Medicare and Medicaid programs, as well
as any community benefit activities provided by such
organizations.
TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES
SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN AND
CHILDREN.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-6. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN AND
CHILDREN.
``(a) Grants Authorized.--The Secretary, in collaboration with the
Administrator of the Health Resources and Services Administration and
other Federal officials determined appropriate by the Secretary, is
authorized to award grants to eligible entities to promote positive
health behaviors for women and children in target populations,
especially racial and ethnic minority women and children in medically
underserved communities and in underserved rural communities.
``(b) Use of Funds.--Grants awarded pursuant to subsection (a) may
be used to support the activities of community health workers,
including those activities--
``(1) to educate and provide outreach regarding enrollment
in health insurance including the State Children's Health
Insurance Program under title XXI of the Social Security Act,
Medicare under title XVIII of such Act, and Medicaid under
title XIX of such Act;
``(2) to educate, guide, and provide outreach in a
community setting regarding health problems prevalent among
women and children and especially among racial and ethnic
minority women and children;
``(3) to educate, guide, and provide experiential learning
opportunities that target behavioral risk factors including--
``(A) poor nutrition;
``(B) physical inactivity;
``(C) being overweight or obese;
``(D) tobacco use;
``(E) alcohol and substance use;
``(F) injury and violence;
``(G) risky sexual behavior;
``(H) mental health problems;
``(I) musculoskeletal health;
``(J) dental and oral health problems; and
``(K) understanding informed consent;
``(4) to educate and guide regarding effective strategies
to promote positive health behaviors within the family;
``(5) to promote community wellness and awareness; and
``(6) to educate and refer target populations to
appropriate health care agencies and community-based programs
and organizations in order to increase access to quality health
care services, including preventive health services.
``(c) Application.--
``(1) In general.--Each eligible entity that desires to
receive a grant under subsection (a) shall submit an
application to the Secretary, at such time, in such manner, and
accompanied by such additional information as the Secretary may
require.
``(2) Contents.--Each application submitted pursuant to
paragraph (1) shall--
``(A) describe the activities for which assistance
under this section is sought;
``(B) contain an assurance that with respect to
each community health worker program receiving funds
under the grant awarded, such program provides training
and supervision to community health workers to enable
such workers to provide authorized program services;
``(C) contain an assurance that the applicant will
evaluate the effectiveness of community health worker
programs receiving funds under the grant;
``(D) contain an assurance that each community
health worker program receiving funds under the grant
will provide services in the cultural context most
appropriate for the individuals served by the program;
``(E) contain a plan to document and disseminate
project description and results to other States and
organizations as identified by the Secretary; and
``(F) describe plans to enhance the capacity of
individuals to utilize health services and health-
related social services under Federal, State, and local
programs by--
``(i) assisting individuals in establishing
eligibility under the programs and in receiving
the services or other benefits of the programs;
and
``(ii) providing other services as the
Secretary determines to be appropriate, that
may include transportation and translation
services.
``(d) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to those applicants--
``(1) who propose to target geographic areas--
``(A) with a high percentage of residents who are
eligible for health insurance but are uninsured or
underinsured; and
``(B) with a high percentage of families for whom
English is not their primary language;
``(2) with experience in providing health or health-related
social services to individuals who are underserved with respect
to such services; and
``(3) with documented community activity and experience
with community health workers.
``(e) Collaboration With Academic Institutions.--The Secretary
shall encourage community health worker programs receiving funds under
this section to collaborate with academic institutions, including
minority-serving institutions. Nothing in this section shall be
construed to require such collaboration.
``(f) Quality Assurance and Cost Effectiveness.--The Secretary
shall establish guidelines for assuring the quality of the training and
supervision of community health workers under the programs funded under
this section and for assuring the cost effectiveness of such programs.
``(g) Monitoring.--The Secretary shall monitor community health
worker programs identified in approved applications and shall determine
whether such programs are in compliance with the guidelines established
under subsection (f).
``(h) Technical Assistance.--The Secretary may provide technical
assistance to community health worker programs identified in approved
applications with respect to planning, developing, and operating
programs under the grant.
``(i) Report to Congress.--
``(1) In general.--Not later than 4 years after the date on
which the Secretary first awards grants under subsection (a),
the Secretary shall submit to Congress a report regarding the
grant project.
``(2) Contents.--The report required under paragraph (1)
shall include the following:
``(A) A description of the programs for which grant
funds were used.
``(B) The number of individuals served.
``(C) An evaluation of--
``(i) the effectiveness of these programs;
``(ii) the cost of these programs; and
``(iii) the impact of the project on the
health outcomes of the community residents.
``(D) Recommendations for sustaining the community
health worker programs developed or assisted under this
section.
``(E) Recommendations regarding training to enhance
career opportunities for community health workers.
``(j) Definitions.--In this section:
``(1) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides, including
by--
``(A) serving as a liaison between communities and
health care agencies;
``(B) providing guidance and social assistance to
community residents;
``(C) enhancing community residents' ability to
effectively communicate with health care providers;
``(D) providing culturally and linguistically
appropriate health or nutrition education;
``(E) advocating for individual and community
health, including dental, oral, mental, and
environmental health, or nutrition needs; and
``(F) providing referral and followup services.
``(2) Community setting.--The term `community setting'
means a home or a community organization that serves a
population.
``(3) Eligible entity.--The term `eligible entity' means--
``(A) a unit of State, territorial, local, or
tribal government (including a federally recognized
tribe or Alaska Native village); or
``(B) a community-based organization.
``(4) Medically underserved community.--The term `medically
underserved community' means a community--
``(A) that has a substantial number of individuals
who are members of a medically underserved population,
as defined by section 330(b)(3); and
``(B) a significant portion of which is a health
professional shortage area as designated under section
332.
``(5) Support.--The term `support' means the provision of
training, supervision, and materials needed to effectively
deliver the services described in subsection (b), reimbursement
for services, and other benefits.
``(6) Target population.--The term `target population'
means women of reproductive age, regardless of their current
childbearing status and children under 21 years of age.''.
SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NUTRITION ASSISTANCE FOR
CHILDREN, PREGNANT WOMEN, AND LAWFULLY PRESENT
INDIVIDUALS.
(a) Medicaid.--Paragraph (4) of section 1903(v) of the Social
Security Act (42 U.S.C. 1396b(v)) is amended to read as follows:
``(4)(A) Notwithstanding sections 401(a), 402(b), 403, and
421 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, payment shall be made under this
section for care and services that are furnished to aliens,
including those described in paragraph (1), if they otherwise
meet the eligibility requirements for medical assistance under
the State plan approved under this subchapter (other than the
requirement of the receipt of aid or assistance under title IV,
supplemental security income benefits under title XVI, or a
State supplementary payment), and are--
``(i) lawfully present in the United
States;
``(ii) children under 21 years of age,
including any optional targeted low-income
child (as such term is defined in section
1905(u)(2)(B)); or
``(iii) pregnant women during pregnancy and
during the 60-day period beginning on the last
day of the pregnancy.
``(B) No debt shall accrue under an affidavit of support
against any sponsor of such an alien on the basis of provision
of assistance to such alien under this paragraph and the cost
of such assistance shall not be considered as an unreimbursed
cost.''.
(b) SCHIP.--Section 2107(e)(1) of the Social Security Act (42
U.S.C. 1397gg(e)(1)) is amended by amending subparagraph (J) to read as
follows:
``(J) Paragraph (4) of section 1903(v) (relating to
individuals who, but for sections 401(a), 403, and 421
of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, would be eligible for
medical assistance under title XXI).''.
(c) Supplemental Nutrition Assistance.--Notwithstanding sections
401(a), 402(a), and 403(a) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(a); 1612(a);
1613(a)) and section 6(f) of the Food and Nutrition Act of 2008 (7
U.S.C. 2015(f)), persons who are lawfully present in the United States
shall be not be ineligible for benefits under the supplemental
nutrition assistance program on the basis of their immigration status
or date of entry into the United States.
(d) Eligibility for Families With Children.--Section of the
421(d)(3) of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1631(d)(3)) is amended by striking
``to the extent that a qualified alien is eligible under section
402(a)(2)(J)'' and inserting, ``to the extent that a child is a member
of a household under the supplemental nutrition assistance program''.
(e) Ensuring Proper Screening.--Section 11(e)(2)(B) of the Food and
Nutrition Act of 2008 (7 U.S.C. 2020(e)(2)(B)) is amended--
(1) by redesignating clauses (vi) and (vii) as clauses
(vii) and (viii); and
(2) by inserting after clause (v) the following:
``(vi) shall provide a method for
implementing section 421 of the Personal
Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1631) that
does not require any unnecessary information
from persons who may be exempt from that
provision;''.
SEC. 503. REPEAL OF DENIAL OF BENEFITS.
Section 115 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (21 U.S.C. 862a) is amended--
(1) in subsection (a) by striking paragraph (2);
(2) in subsection (b) by striking paragraph (2); and
(3) in subsection (e) by striking paragraph (2).
SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, AND AWARENESS.
(a) In General.--The Secretary shall establish and implement a
birth defects prevention and public awareness program, consisting of
the activities described in subsections (c) and (d).
(b) Definitions.--In this section:
(1) The term ``pregnancy and breastfeeding information
services'' includes only--
(A) information services to provide accurate,
evidence-based, clinical information regarding maternal
exposures during pregnancy that may be associated with
birth defects or other health risks, such as exposures
to medications, chemicals, infections, foodborne
pathogens, illnesses, nutrition, or lifestyle factors;
(B) information services to provide accurate,
evidence-based, clinical information regarding maternal
exposures during breastfeeding that may be associated
with health risks to a breast-fed infant, such as
exposures to medications, chemicals, infections,
foodborne pathogens, illnesses, nutrition, or lifestyle
factors;
(C) the provision of accurate, evidence-based
information weighing risks of exposures during
breastfeeding against the benefits of breastfeeding;
and
(D) the provision of information described in
subparagraph (A), (B), or (C) through counselors, Web
sites, fact sheets, telephonic or electronic
communication, community outreach efforts, or other
appropriate means.
(2) The term ``Secretary'' means the Secretary of Health
and Human Services, acting through the Director of the Centers
for Disease Control and Prevention.
(c) Nationwide Media Campaign.--In carrying out subsection (a), the
Secretary shall conduct or support a nationwide media campaign to
increase awareness among health care providers and at-risk populations
about pregnancy and breastfeeding information services.
(d) Grants for Pregnancy and Breastfeeding Information Services.--
(1) In general.--In carrying out subsection (a), the
Secretary shall award grants to State or regional agencies or
organizations for any of the following:
(A) Information services.--The provision of, or
campaigns to increase awareness about, pregnancy and
breastfeeding information services.
(B) Surveillance and research.--The conduct or
support of--
(i) surveillance of or research on--
(I) maternal exposures and maternal
health conditions that may influence
the risk of birth defects, prematurity,
or other adverse pregnancy outcomes;
and
(II) maternal exposures that may
influence health risks to a breastfed
infant; or
(ii) networking to facilitate surveillance
or research described in this subparagraph.
(2) Preference for certain states.--The Secretary, in
making any grant under this subsection, shall give preference
to States, otherwise equally qualified, that have or had a
pregnancy and breastfeeding information service in place on or
after January 1, 2006.
(3) Matching funds.--The Secretary may only award a grant
under this subsection to a State or regional agency or
organization that agrees, with respect to the costs to be
incurred in carrying out the grant activities, to make
available (directly or through donations from public or private
entities) non-Federal funds toward such costs in an amount
equal to not less than 25 percent of the amount of the grant.
(4) Coordination.--The Secretary shall ensure that
activities funded through a grant under this subsection are
coordinated, to the maximum extent practicable, with other
birth defects prevention and environmental health activities of
the Federal Government, including with respect to pediatric
environmental health specialty units and children's
environmental health centers.
(e) Evaluation.--In furtherance of the program under subsection
(a), the Secretary shall provide for an evaluation of pregnancy and
breastfeeding information services to identify efficient and effective
models of--
(1) providing information;
(2) raising awareness and increasing knowledge about birth
defects prevention measures;
(3) modifying risk behaviors; or
(4) other outcome measures as determined appropriate by the
Secretary.
SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW COMMITTEES ON
PREGNANCY-RELATED DEATHS.
(a) Condition of Receipt of Payments From Allotment Under Maternal
and Child Health Service Block Grant.--Title V of the Social Security
Act (42 U.S.C. 701 et seq.) is amended by adding at the end the
following new section:
``SEC. 514. UNIFORM STATE MATERNAL MORTALITY REVIEW COMMITTEES ON
PREGNANCY-RELATED DEATHS.
``(a) Grants.--
``(1) In general.--Notwithstanding any other provision of
this title, for each of fiscal years 2012 through 2018, in
addition to payments from allotments for States under section
502 for such year, the Secretary shall, subject to paragraph
(3) and in accordance with the criteria established under
paragraph (2), award grants to States to--
``(A) carry out the activities described in
subsection (b)(1);
``(B) establish a State maternal mortality review
committee, in accordance with subsection (b)(2), to
carry out the activities described in subsection
(b)(2)(A), and to establish the processes described in
subsection (b)(1);
``(C) ensure the State department of health carries
out the applicable activities described in subsection
(b)(3), with respect to pregnancy-related deaths
occurring within the State during such fiscal year;
``(D) implement and use the comprehensive case
abstraction form developed under subsection (c), in
accordance with such subsection; and
``(E) provide for public disclosure of information,
in accordance with subsection (e).
``(2) Criteria.--The Secretary shall establish criteria for
determining eligibility for and the amount of a grant awarded
to a State under paragraph (1). Such criteria shall provide
that in the case of a State that receives such a grant for a
fiscal year and is determined by the Secretary to have not used
such grant in accordance with this section, such State shall
not be eligible for such a grant for any subsequent fiscal
year.
``(b) Pregnancy-Related Death Review.--
``(1) Review of pregnancy-related death and pregnancy-
associated death cases.--For purposes of subsection (a), with
respect to a State that receives a grant under subsection (a),
the following shall apply:
``(A) Mandatory reporting of pregnancy-related
deaths.--
``(i) In general.--The State shall, through
the State maternal mortality review committee,
develop a process, separate from any reporting
process established by the State department of
health prior to the date of the enactment of
this section, that provides for mandatory and
confidential case reporting by individuals and
entities described in clause (ii) of pregnancy-
related deaths to the State department of
health.
``(ii) Individuals and entities
described.--Individuals and entities described
in this clause include each of the following:
``(I) Health care providers.
``(II) Medical examiners.
``(III) Medical coroners.
``(IV) Hospitals.
``(V) Free-standing birth centers.
``(VI) Other health care
facilities.
``(VII) Any other individuals
responsible for completing death
certificates.
``(VIII) Any other appropriate
individuals or entities specified by
the Secretary.
``(B) Voluntary reporting of pregnancy-related and
pregnancy-associated deaths.--
``(i) The State shall, through the State
maternal mortality review committee, develop a
process for and encourage, separate from any
reporting process established by the State
department of health prior to the date of the
enactment of this section, voluntary and
confidential case reporting by individuals
described in clause (ii) of pregnancy-
associated deaths to the State department of
health.
``(ii) The State shall, through the State
maternal mortality review committee, develop a
process for voluntary and confidential
reporting by family members of the deceased and
by other individuals on possible pregnancy-
related and pregnancy-associated deaths to the
State department of health. Such process shall
include--
``(I) making publicly available on
the Internet Web site of the State
department of health a telephone
number, Internet Web link, and email
address for such reporting; and
``(II) publicizing to local
professional organizations, community
organizations, and social services
agencies the availability of the
telephone number, Internet Web link,
and email address made available under
subclause (I).
``(C) Development of case-finding.--The State,
through the vital statistics unit of the State, shall
annually identify pregnancy-related and pregnancy-
associated deaths occurring in such State during the
year involved by--
``(i) matching all death records, with
respect to such year, for women of childbearing
age to live birth certificates and infant death
certificates to identify deaths of women that
occurred during pregnancy and within one year
after the end of a pregnancy;
``(ii) identifying deaths reported during
such year as having an underlying or
contributing cause of death related to
pregnancy, regardless of the time that has
passed between the end of the pregnancy and the
death;
``(iii) collecting data from medical
examiner and coroner reports; and
``(iv) any other methods the States may
devise to identify maternal deaths, such as
through review of a random sample of reported
deaths of women of childbearing age to
ascertain cases of pregnancy-related and
pregnancy-associated deaths that are not
discernable from a review of death certificates
alone.
When feasible and for purposes of effectively
collecting and obtaining data on pregnancy-related and
pregnancy-associated deaths, the State shall adopt the
most recent standardized birth and death certificates,
as issued by the National Center for Vital Health
Statistics, including the recommended checkbox section
for pregnancy on the death certificates.
``(D) Case investigation and development of case
summaries.--Following receipt of reports by the State
department of health pursuant to subparagraph (A) or
(B) and collection by the vital statistics unit of the
State of possible cases of pregnancy-related and
pregnancy-associated deaths pursuant to subparagraph
(C), the State, through the State maternal mortality
review committee established under subsection (a),
shall investigate each case, utilizing the case
abstraction form described in subsection (c), and
prepare de-identified case summaries, which shall be
reviewed by the committee and included in applicable
reports. For purposes of subsection (a), under the
processes established under subparagraphs (A), (B), and
(C), a State department of health or vital statistics
unit of a State shall provide to the State maternal
mortality review committee access to information
collected pursuant to such subparagraphs as necessary
to carry out this subparagraph. Data and information
collected for the case summary and review are for
purposes of public health activities, in accordance
with HIPAA privacy and security law (as defined in
section 3009(a)(2) of the Public Health Service Act).
Such case investigations shall include data and
information obtained through--
``(i) medical examiner and autopsy reports
of the woman involved;
``(ii) medical records of the woman,
including such records related to health care
prior to pregnancy, prenatal and postnatal
care, labor and delivery care, emergency room
care, hospital discharge records, and any care
delivered up until the time of death of the
woman for purposes of public health activities,
in accordance with HIPAA privacy and security
law (as defined in section 3009(a)(2) of the
Public Health Service Act);
``(iii) oral and written interviews of
individuals directly involved in the maternal
care of the woman during and immediately
following the pregnancy of the woman, including
health care, mental health, and social service
providers, as applicable;
``(iv) optional oral or written interviews
of the family of the woman;
``(v) socioeconomic and other relevant
background information about the woman;
``(vi) information collected in
subparagraph (C)(i); and
``(vii) other information on the cause of
death of the woman, such as social services and
child welfare reports.
``(2) State maternal mortality review committees.--
``(A) Duties.--
``(i) Required committee activities.--For
purposes of subsection (a), a maternal
mortality review committee established by a
State pursuant to a grant under such subsection
shall carry out the following pregnancy-related
death and pregnancy-associated death review
activities and shall include all information
relevant to the death involved on the case
abstraction form developed under subsection
(d):
``(I) With respect to a case of
pregnancy-related or pregnancy-
associated death of a woman, review the
case summaries prepared under
subparagraphs (A), (B), (C), and (D) of
paragraph (1).
``(II) Review aggregate statistical
reports developed by the vital
statistics unit of the State under
paragraph (1)(C) regarding pregnancy-
related and pregnancy-associated deaths
to identify trends, patterns, and
disparities in adverse outcomes and
address medical, non-medical, and
system-related factors that may have
contributed to such pregnancy-related
and pregnancy-associated deaths and
disparities.
``(III) Develop recommendations,
based on the review of the case
summaries under paragraph (1)(D) and
aggregate statistical reports under
subclause (II), to improve maternal
care, social and health services, and
public health policy and institutions,
including with respect to improving
access to maternal care, improving the
availability of social services, and
eliminating disparities in maternal
care and outcomes.
``(ii) Optional committee activities.--For
purposes of subsection (a), a maternal
mortality review committee established by a
State under such subsection may present
findings and recommendations regarding a
specific case or set of circumstances directly
to a health care facility or its local or State
professional organization for the purpose of
instituting policy changes, educational
activities, or otherwise improving the quality
of care provided by the facilities.
``(B) Composition of maternal mortality review
committees.--
``(i) In general.--Each State maternal
mortality review committee established pursuant
to a grant under subsection (a) shall be multi-
disciplinary, consisting of health care and
social service providers, public health
officials, other persons with professional
expertise on maternal health and mortality, and
patient and community advocates who represent
those communities within such State that are
the most affected by maternal mortality.
Membership on such a committee of a State shall
be reviewed annually by the State department of
health to ensure that membership representation
requirements are being fulfilled in accordance
with this paragraph.
``(ii) Required membership.--Each such
review committee shall include--
``(I) representatives from medical
specialities providing care to pregnant
and postpartum patients, including
obstetricians (including generalists
and maternal fetal medicine
specialists), and family practice
physicians;
``(II) certified nurse midwives,
certified midwives, and advanced
practice nurses;
``(III) hospital-based nurses;
``(IV) representatives of the State
department of health maternal and child
health department;
``(V) social service providers or
social workers;
``(VI) the chief medical examiners
or designees;
``(VII) facility representatives,
such as from hospitals or free-standing
birth centers; and
``(VIII) community or patient
advocates who represent those
communities within the State that are
the most affected by maternal
mortality.
``(iii) Additional members.--Each such
review committee may also include
representatives from other relevant academic,
health, social service, or policy professions,
or community organizations, on an ongoing
basis, or as needed, as determined beneficial
by the review committee, including--
``(I) anesthesiologists;
``(II) emergency physicians;
``(III) pathologists;
``(IV) epidemiologists or
biostatisticians;
``(V) intensivists;
``(VI) vital statistics officers;
``(VII) nutritionists;
``(VIII) mental health
professionals;
``(IX) substance abuse treatment
specialists;
``(X) representatives of relevant
advocacy groups;
``(XI) academics;
``(XII) representatives of
beneficiaries of the State plan under
the Medicaid program under title XIX;
``(XIII) paramedics;
``(XIV) lawyers;
``(XV) risk management specialists;
``(XVI) representatives of the
departments of health or public health
of major cities in the State involved;
and
``(XVII) policy makers.
``(iv) Diverse community membership.--The
composition of such a committee, with respect
to a State, shall include--
``(I) representatives from diverse
communities, particularly those
communities within such State most
severely affected by pregnancy-related
deaths or pregnancy-associated deaths
and by a lack of access to relevant
maternal care services, from community
maternal child health organizations,
and from minority advocacy groups;
``(II) members, including health
care providers, from different
geographic regions in the State,
including any rural, urban, and tribal
areas; and
``(III) health care and social
service providers who work in
communities that are diverse with
regard to race, ethnicity, immigration
status, Indigenous status, and English
proficiency.
``(v) Maternal mortality review staff.--
Staff of each such review committee shall
include--
``(I) vital health statisticians,
maternal child health statisticians, or
epidemiologists;
``(II) a coordinator of the State
maternal mortality review committee, to
be designated by the State; and
``(III) administrative staff.
``(C) Option for states to form regional maternal
mortality reviews.--States with a low rate of
occurrence of pregnancy-associated or pregnancy-related
deaths may choose to partner with one or more
neighboring States to fulfill the activities described
in paragraph (1)(C). In such a case, with respect to
States in such a partnership, any requirement under
this section relating to the reporting of information
related to such activities shall be deemed to be
fulfilled by each such State if a single such report is
submitted for the partnership.
``(3) State department of health activities.--For purposes
of subsection (a), a State department of health of a State
receiving a grant under such subsection shall--
``(A) in consultation with the maternal mortality
review committee of the State and in conjunction with
relevant professional organizations, develop a plan for
ongoing health care provider education, based on the
findings and recommendations of the committee, in order
to improve the quality of maternal care; and
``(B) take steps to widely disseminate the findings
and recommendations of the State maternal mortality
review committees of the State and to implement the
recommendations of such committee.
``(c) Case Abstraction Form.--
``(1) Development.--The Director of the Centers for Disease
Control and Prevention shall develop a uniform, comprehensive
case abstraction form and make such form available to States
for State maternal mortality review committees for use by such
committees in order to--
``(A) ensure that the cases and information
collected and reviewed by such committees can be pooled
for review by the Department of Health and Human
Services and its agencies; and
``(B) preserve the uniformity of the information
and its use for Federal public health purposes.
``(2) Permissible state modification.--Each State may
modify the form developed under paragraph (1) for
implementation and use by such State or by the State maternal
mortality review committee of such State by including on such
form additional information to be collected, but may not alter
the standard questions on such form, in order to ensure that
the information can be collected and reviewed centrally at the
Federal level.
``(d) Treatment as Public Health Authority for Purposes of HIPAA.--
For purposes of applying HIPAA privacy and security law (as defined in
section 3009(a)(2) of the Public Health Service Act), a State maternal
mortality review committee of a State established pursuant to this
section to carry out activities described in subsection (b)(2)(A) shall
be deemed to be a public health authority described in section 164.501
(and referenced in section 164.512(b)(1)(i)) of title 45, Code of
Federal Regulations (or any successor regulation), carrying out public
health activities and purposes described in such section
164.512(b)(1)(i) (or any such successor regulation).
``(e) Public Disclosure of Information.--
``(1) In general.--For fiscal year 2012 or a subsequent
fiscal year, each State receiving a grant under this section
for such year shall, subject to paragraph (3), provide for the
public disclosure, and submission to the information
clearinghouse established under paragraph (2), of the
information included in the report of the State under section
506(a)(2)(F) for such year (relating to the findings for such
year of the State maternal mortality review committee
established by the State under this section).
``(2) Information clearinghouse.--The Secretary of Health
and Human Services shall establish an information
clearinghouse, that shall be administered by the Director of
the Centers for Disease Control and Prevention, that will
maintain findings and recommendations submitted pursuant to
paragraph (1) and provide such findings and recommendations for
public review and research purposes by State health
departments, maternal mortality review committees, and health
providers and institutions.
``(3) Confidentiality of information.--In no case shall any
individually identifiable health information be provided to the
public, or submitted to the information clearinghouse, under
paragraph (1).
``(f) Confidentiality of Review Committee Proceedings.--
``(1) In general.--All proceedings and activities of a
State maternal mortality review committee under this section,
opinions of members of such a committee formed as a result of
such proceedings and activities, and records obtained, created,
or maintained pursuant to this section, including records of
interviews, written reports, and statements procured by the
Department of Health and Human Services or by any other person,
agency, or organization acting jointly with the Department, in
connection with morbidity and mortality reviews under this
section, shall be confidential, and not subject to discovery,
subpoena, or introduction into evidence in any civil, criminal,
legislative, or other proceeding. Such records shall not be
open to public inspection.
``(2) Testimony of members of committee.--
``(A) In general.--Members of a State maternal
mortality review committee under this section may not
be questioned in any civil, criminal, legislative, or
other proceeding regarding information presented in, or
opinions formed as a result of, a meeting or
communication of the committee.
``(B) Clarification.--Nothing in this subsection
shall be construed to prevent a member of such a
committee from testifying regarding information that
was obtained independent of such member's participation
on the committee, or that is public information.
``(3) Availability of information for research purposes.--
Nothing in this subsection shall prohibit the publishing by
such a committee or the Department of Health and Human Services
of statistical compilations and research reports that--
``(A) are based on confidential information,
relating to morbidity and mortality review; and
``(B) do not contain identifying information or any
other information that could be used to ultimately
identify the individuals concerned.
``(g) Definitions.--For purposes of this section:
``(1) The term `pregnancy-associated death' means the death
of a woman while pregnant or during the one-year period
following the date of the end of pregnancy, irrespective of the
cause of such death.
``(2) The term `pregnancy-related death' means the death of
a woman while pregnant or during the one-year period following
the date of the end of pregnancy, irrespective of the duration
or site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management, but not from any
accidental or incidental cause.
``(3) The term `woman of childbearing age' means a woman
who is at least 10 years of age and not more than 54 years of
age.''.
(b) Inclusion of Findings of Review Committees in Required
Reports.--
(1) State triennial reports.--Paragraph (2) of section
506(a) of such Act (42 U.S.C. 706(a)) is amended by inserting
after subparagraph (E) the following new subparagraph:
``(F) In the case of a State receiving a grant
under section 514, beginning for the first fiscal year
beginning after 3 years after the date of establishment
of the State maternal mortality review committee
established by the State pursuant to such grant and
once every 3 years thereafter, information containing
the findings and recommendations of such committee and
information on the implementation of such
recommendations during the period involved.''.
(2) Annual reports to congress.--Paragraph (3) of such
section is amended--
(A) in subparagraph (D), at the end, by striking
``and'';
(B) in subparagraph (E), at the end, by striking
the period and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(F) For fiscal year 2012 and each subsequent
fiscal year, taking into account the findings,
recommendations, and implementation information
submitted by States pursuant to paragraph (2)(F), on
the status of pregnancy-related deaths and pregnancy-
associated deaths in the United States and including
recommendations on methods to prevent such deaths in
the United States.''.
SEC. 506. ELIMINATING DISPARITIES IN MATERNITY HEALTH OUTCOMES.
Part B of title III of the Public Health Service Act is amended by
inserting after section 317V, as added, the following new section:
``SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY HEALTH OUTCOMES.
``(a) In General.--The Secretary shall, in consultation with
relevant national stakeholder organizations, such as national medical
specialty organizations, national maternal child health organizations,
and national health disparity organizations, carry out the following
activities to eliminate disparities in maternal health outcomes:
``(1) Conduct research into the determinants and the
distribution of disparities in maternal care, health risks, and
health outcomes, and improve the capacity of the performance
measurement infrastructure to measure such disparities.
``(2) Expand access to services that have been demonstrated
to improve the quality and outcomes of maternity care for
vulnerable populations.
``(3) Establish a demonstration project to compare the
effectiveness of interventions to reduce disparities in
maternity services and outcomes, and implement and assess
effective interventions.
``(b) Scope and Selection of States for Demonstration Project.--The
demonstration project under subsection (a)(3) shall be conducted in no
more than 8 States, which shall be selected by the Secretary based on--
``(1) applications submitted by States, which specify which
regions and populations the State involved will serve under the
demonstration project;
``(2) criteria designed by the Secretary to ensure that, as
a whole, the demonstration project is, to the greatest extent
possible, representative of the demographic and geographic
composition of communities most affected by disparities;
``(3) criteria designed by the Secretary to ensure that a
variety of type of models are tested through the demonstration
project and that such models include interventions that have an
existing evidence base for effectiveness; and
``(4) criteria designed by the Secretary to assure that the
demonstration projects and models will be carried out in
consultation with local and regional provider organizations,
such as community health centers, hospital systems, and medical
societies representing providers of maternity services.
``(c) Duration of Demonstration Project.--The demonstration project
under subsection (a)(3) shall begin on January 1, 2012, and end on
December 31, 2016.
``(d) Grants for Evaluation and Monitoring.--The Secretary may make
grants to States and health care providers participating in the
demonstration project under subsection (a)(3) for the purpose of
collecting data necessary for the evaluation and monitoring of such
project.
``(e) Reports.--
``(1) State reports.--Each State that participates in the
demonstration project under subsection (a)(3) shall report to
the Secretary, in a time, form, and manner specified by the
Secretary, the data necessary to--
``(A) monitor the--
``(i) outcomes of the project;
``(ii) costs of the project; and
``(iii) quality of maternity care provided
under the project; and
``(B) evaluate the rationale for the selection of
the items and services included in any bundled payment
made by the State under the project.
``(2) Final report.--Not later than December 31, 2017, the
Secretary shall submit to Congress a report on the results of
the demonstration project under subsection (a)(3).''.
SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN UNEXPECTED INFANT
DEATH AND SUDDEN UNEXPLAINED DEATH IN CHILDHOOD.
(a) Establishment.--The Secretary of Health and Human Services
acting through the Administrator of the Health Resources and Services
Administration and in consultation with the Director of the Centers for
Disease Control and Prevention and the Director of the National
Institutes of Health (in this section referred to as the ``Secretary'')
shall establish and implement a culturally competent public health
awareness and education campaign to provide information that is focused
on decreasing the risk factors for sudden unexpected infant death and
sudden unexplained death in childhood, including educating individuals
about safe sleep environments, sleep positions, and reducing exposure
to smoking during pregnancy and after birth.
(b) Targeted Populations.--The campaign under subsection (a) shall
be designed to reduce health disparities through the targeting of
populations with high rates of sudden unexpected infant death and
sudden unexplained death in childhood.
(c) Consultation.--In establishing and implementing the campaign
under subsection (a), the Secretary shall consult with national
organizations representing health care providers, including nurses and
physicians, parents, child care providers, children's advocacy and
safety organizations, maternal and child health programs and women's,
infants, and children nutrition professionals, and other individuals
and groups determined necessary by the Secretary for such establishment
and implementation.
(d) Grants.--
(1) In general.--In carrying out the campaign under
subsection (a), the Secretary shall award grants to national
organizations, State and local health departments, and
community-based organizations for the conduct of education and
outreach programs for nurses, parents, child care providers,
public health agencies, and community organizations.
(2) Application.--To be eligible to receive a grant under
paragraph (1), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
SEC. 508. REDUCING TEENAGE PREGNANCIES.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following new part:
``PART W--YOUTH PREGNANCY PREVENTION PROGRAMS
``SEC. 399OO. PURPOSE.
``It is the purpose of this part to develop and carry out research
and demonstration projects on new and existing program interventions to
provide youth in racial or ethnic minority or immigrant communities the
information and skills needed to reduce teenage pregnancies, build
healthy relationships, and improve overall health and well-being.
``SEC. 399OO-1. DEMONSTRATION GRANTS TO REDUCE TEENAGE PREGNANCIES.
``(a) In General.--The Secretary shall award competitive grants to
eligible entities for establishing or expanding programs to provide
youth in racial or ethnic minority or immigrant communities the
information and skills needed to avoid teenage pregnancy and develop
healthy relationships.
``(b) Priority.--In awarding grants under this section, the
Secretary shall give priority to applicants--
``(1) proposing to carry out projects in racial or ethnic
minority or immigrant communities;
``(2) that have a demonstrated history of effectively
working with such targeted communities; or
``(3) that have a demonstrated history of engaging in a
meaningful and significant partnership with such targeted
communities.
``(c) Program Settings.--Programs funded through a grant under
subsection (a) shall be provided--
``(1) through classroom-based settings, such as school
health education, humanities, language arts, or family and
consumer science education; after-school programs; community-
based programs; workforce development programs; and health care
settings; or
``(2) in collaboration with systems that serve large
numbers of at-risk youth such as juvenile justice or foster
care systems.
``(d) Project Requirements.--As a condition of receipt of a grant
under this section, an entity shall agree that, with respect to
information and skills provided through the grant--
``(1) such information and skills will be--
``(A) age-appropriate;
``(B) evidence-based or evidence-informed;
``(C) provided in accordance with section 399OO-
5(b); and
``(D) culturally sensitive and relevant to the
target populations; and
``(2) any information provided about contraceptives shall
include the health benefits and side effects of all
contraceptives and barrier methods.
``(e) Evaluation.--Of the total amount made available to carry out
this section for a fiscal year, the Secretary, acting through the
Director of the Centers for Disease Control and Prevention and other
agencies as appropriate, shall allot up to 10 percent of such amount to
carry out a rigorous, independent evaluation to determine the extent
and the effectiveness of activities funded through this section during
such fiscal year in changing attitudes and behavior of teenagers with
respect to healthy relationships and childbearing.
``(f) Grants for Indian Tribes or Tribal Organizations.--Of the
total amount made available to carry out this section for a fiscal
year, the Secretary shall reserve 5 percent of such amount to award
grants under this section to Indian tribes and tribal organizations in
such manner, and subject to such requirements, as the Secretary, in
consultation with Indian tribes and tribal organizations, determines
appropriate.
``(g) Eligible Entity Defined.--
``(1) In general.--In this section, the term `eligible
entity' means a State, local, or tribal agency; a school or
postsecondary institution; an after-school program; a nonprofit
organization; or a community or faith-based organization.
``(2) Preventing exclusion of smaller community-based
organizations.--In carrying out this section, the Secretary
shall ensure that the amounts and requirements of grants
provided under this section do not preclude receipt of such
grants by community-based organizations with a demonstrated
history of effectively working with adolescents in racial or
ethnic minority or immigrant communities or engaged in
meaningful and significant partnership with such communities.
``SEC. 399OO-2. MULTIMEDIA CAMPAIGNS TO REDUCE TEENAGE PREGNANCIES.
``(a) In General.--The Secretary shall award competitive grants to
public and private entities to carry out multimedia campaigns to
provide public education and increase public awareness regarding
teenage pregnancy and related social and emotional issues, such as
violence prevention.
``(b) Priority.--In awarding grants under this section, the
Secretary shall give priority to applicants proposing to carry out
campaigns developed for racial or ethnic minority or immigrant
communities.
``(c) Information To Be Provided.--As a condition of receipt of a
grant under this section, an entity shall agree to use the grant to
carry out multimedia campaigns described in subsection (a) that--
``(1) at a minimum, shall provide information on--
``(A) the prevention of teenage pregnancy; and
``(B) healthy relationship development; and
``(2) may provide information on the prevention of dating
violence.
``SEC. 399OO-3. RESEARCH ON REDUCING TEENAGE PREGNANCIES AND TEENAGE
DATING VIOLENCE AND IMPROVING HEALTHY RELATIONSHIPS.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall make grants to
public and private entities to conduct, support, or coordinate research
on teenage pregnancy, dating violence, and healthy relationships among
racial or ethnic minority or immigrant communities that--
``(1) improves data collection on--
``(A) sexual and reproductive health, including
teenage pregnancies and births, among all minority
communities and subpopulations in which such data are
not collected, including American Indian and Alaska
Native youth;
``(B) sexual behavior, reproductive and sexual
coercion, and teenage contraceptive use patterns at the
State level, as appropriate; and
``(C) teenage pregnancies among youth in and aging
out of foster care or juvenile justice systems and the
underlying factors that lead to teenage pregnancy among
youth in foster care or juvenile justice systems;
``(2) investigates--
``(A) the variance in the rates of teenage
pregnancy by--
``(i) racial and ethnic group (such as
Hispanic, Asian-American, African-American,
Pacific Islander, American Indian, and Alaska
Native); and
``(ii) socioeconomic status, including as
based on the income of the family and education
attainment;
``(B) factors affecting the risk for youth of
teenage pregnancy or dating abuse, including the
physical and social environment, level of
acculturation, access to health care, aspirations for
the future, and history of physical or sexual violence
or abuse;
``(C) the role that violence and abuse play in
teenage sex, pregnancy, and childbearing;
``(D) strategies to address the disproportionate
rates of teenage pregnancies and dating violence in
racial or ethnic minority or immigrant communities;
``(E) how effective interventions can be replicated
or adapted in other settings to serve racial or ethnic
minority or immigrant communities; and
``(F) the effectiveness of media campaigns in
addressing healthy relationship development, dating
violence prevention, and teenage pregnancy; and
``(3) tests research-based strategies for addressing high
rates of unintended teenage pregnancy through programs that
emphasize healthy relationships and violence prevention.
``(b) Priority.--In carrying out this section, the Secretary shall
give priority to research that incorporates--
``(1) interdisciplinary approaches;
``(2) a strong emphasis on community-based participatory
research; or
``(3) translational research.
``SEC. 399OO-4. HHS ADOLESCENT HEALTH WORK GROUP.
``(a) Purpose.--Not later than 30 days after the date of the
enactment of this part, the Secretary shall direct the interagency
adolescent health workgroup within the Office of Adolescent Health of
the Department of Health and Human Services to--
``(1) include in the work of the group strategies for
teenage dating violence prevention and healthy teenage
relationships with a particular focus among racial or ethnic
minority or immigrant communities; and
``(2) with respect to including such strategies, consult,
to the greatest extent possible, with the Federal Interagency
Workgroup on Teen Dating Violence formed under the leadership
of the National Institute of Justice of the Department of
Justice.
``(b) Report Requirement.--The Secretary, through the Office of
Adolescent Health, shall periodically submit to Congress a report
that--
``(1) includes a review of the evidence-based programs on
preventing teenage pregnancy, which are carried out and
identified by the Office; and
``(2) identifies the programs of the Department of Health
and Human Services that include teenage dating violence
prevention and the promotion of healthy teenage relationships
as part of a strategy to prevent teenage pregnancy.
``SEC. 399OO-5. GENERAL GRANT PROVISIONS.
``(a) Applications.--To seek a grant under this part, an entity
shall submit an application to the Secretary in such form, in such
manner, and containing such agreements, assurances, and information as
the Secretary may require.
``(b) Additional Requirements.--A grant may be made under this part
only if the applicant involved agrees that information, activities, and
services provided under the grant--
``(1) will be evidence-based or evidence informed;
``(2) will be factually and medically accurate and
complete; and
``(3) if directed to a particular population group, will be
provided in an appropriate language and cultural context.
``(c) Training and Technical Assistance.--
``(1) In general.--Of the total amount made available to
carry out this part for a fiscal year, the Secretary shall use
10 percent to provide, directly or through a competitive grant
process, training and technical assistance to the grant
recipients under this part, including by disseminating research
and information regarding effective and promising practices,
providing consultation and resources on a broad array of
teenage and unintended pregnancy and violence prevention
strategies, and developing resources and materials.
``(2) Collaboration.--In carrying out this subsection, the
Secretary shall collaborate with entities that have expertise
in the prevention of teenage pregnancy, healthy relationship
development, minority health and health disparities, and
violence prevention.
``SEC. 399OO-6. DEFINITIONS.
``In this part:
``(1) Medically accurate and complete.--The term `medically
accurate and complete' means, with respect to information,
activities, or services, verified or supported by the weight of
research conducted in compliance with accepted scientific
methods and--
``(A) published in peer-reviewed journals, where
applicable; or
``(B) comprising information that leading
professional organizations and agencies with relevant
expertise in the field recognize as accurate,
objective, and complete.
``(2) Racial or ethnic minority or immigrant communities.--
The term `racial or ethnic minority or immigrant communities'
means communities with a substantial number of residents who
are members of racial or ethnic minority groups or who are
immigrants.
``(3) Reproductive and sexual coercion.--The term
`reproductive and sexual coercion'--
``(A) means, with respect to a person, coercive
behavior that interferes with the ability of such
person to control the reproductive decisionmaking of
such person, such as intentionally exposing such person
to sexually transmitted infections; in the case such
person is a female, attempting to impregnate such
person against her will; intentionally interfering with
the person's birth control; or threatening or acting
violent if the person does not comply with the
perpetrator's wishes regarding contraception or the
decision whether to terminate or continue a pregnancy;
and
``(B) includes a range of behaviors that a partner
may use related to sexual decisionmaking to pressure or
coerce a person to have sex without using physical
force, such as repeatedly pressuring a partner to have
sex when he or she does not want to; threatening to end
a relationship if a person does not have sex; and
threatening retaliation if notified of a positive
sexually transmitted disease test result.
``(4) Youth.--The term `youth' means individuals who are 11
to 19 years of age.
``SEC. 399OO-7. REPORTS.
``(a) Report on Use of Funds.--Not later than 1 year after the date
of the enactment of this part, the Secretary shall submit to Congress a
report on the use of funds provided pursuant to this part.
``(b) Report on Impact of Programs.--Not later than March 1, 2016,
the Secretary shall submit to Congress a report on the impact that the
programs under this part had on reducing teenage pregnancies.''.
SEC. 509. GESTATIONAL DIABETES.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by adding after section 317H the following:
``SEC. 317H-1. GESTATIONAL DIABETES.
``(a) Understanding and Monitoring Gestational Diabetes.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, in
consultation with the Diabetes Mellitus Interagency
Coordinating Committee established under section 429 and
representatives of appropriate national health organizations,
shall develop a multisite gestational diabetes research project
within the diabetes program of the Centers for Disease Control
and Prevention to expand and enhance surveillance data and
public health research on gestational diabetes.
``(2) Areas to be addressed.--The research project
developed under paragraph (1) shall address--
``(A) procedures to establish accurate and
efficient systems for the collection of gestational
diabetes data within each State and commonwealth,
territory, or possession of the United States;
``(B) the progress of collaborative activities with
the National Vital Statistics System, the National
Center for Health Statistics, and State health
departments with respect to the standard birth
certificate, in order to improve surveillance of
gestational diabetes;
``(C) postpartum methods of tracking women with
gestational diabetes after delivery as well as targeted
interventions proven to lower the incidence of type 2
diabetes in that population;
``(D) variations in the distribution of diagnosed
and undiagnosed gestational diabetes, and of impaired
fasting glucose tolerance and impaired fasting glucose,
within and among groups of women; and
``(E) factors and culturally sensitive
interventions that influence risks and reduce the
incidence of gestational diabetes and related
complications during childbirth, including cultural,
behavioral, racial, ethnic, geographic, demographic,
socioeconomic, and genetic factors.
``(3) Report.--Not later than 2 years after the date of the
enactment of this section, and annually thereafter, the
Secretary shall generate a report on the findings and
recommendations of the research project including prevalence of
gestational diabetes in the multisite area and disseminate the
report to the appropriate Federal and non-Federal agencies.
``(b) Expansion of Gestational Diabetes Research.--The Secretary
shall expand and intensify public health research regarding gestational
diabetes. Such research may include--
``(1) developing and testing novel approaches for improving
postpartum diabetes testing or screening and for preventing
type 2 diabetes in women with a history of gestational
diabetes; and
``(2) conducting public health research to further
understanding of the epidemiologic, socioenvironmental,
behavioral, translation, and biomedical factors and health
systems that influence the risk of gestational diabetes and the
development of type 2 diabetes in women with a history of
gestational diabetes.
``(c) Demonstration Grants To Lower the Rate of Gestational
Diabetes.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall award grants, on a competitive basis, to eligible
entities for demonstration projects that implement evidence-
based interventions to reduce the incidence of gestational
diabetes, the recurrence of gestational diabetes in subsequent
pregnancies, and the development of type 2 diabetes in women
with a history of gestational diabetes.
``(2) Priority.--In making grants under this subsection,
the Secretary shall give priority to projects focusing on--
``(A) helping women who have 1 or more risk factors
for developing gestational diabetes;
``(B) working with women with a history of
gestational diabetes during a previous pregnancy;
``(C) providing postpartum care for women with
gestational diabetes;
``(D) tracking cases where women with a history of
gestational diabetes developed type 2 diabetes;
``(E) educating mothers with a history of
gestational diabetes about the increased risk of their
child developing diabetes;
``(F) working to prevent gestational diabetes and
prevent or delay the development of type 2 diabetes in
women with a history of gestational diabetes; and
``(G) achieving outcomes designed to assess the
efficacy and cost-effectiveness of interventions that
can inform decisions on long-term sustainability,
including third-party reimbursement.
``(3) Application.--An eligible entity desiring to receive
a grant under this subsection shall submit to the Secretary--
``(A) an application at such time, in such manner,
and containing such information as the Secretary may
require; and
``(B) a plan to--
``(i) lower the rate of gestational
diabetes during pregnancy; or
``(ii) develop methods of tracking women
with a history of gestational diabetes and
develop effective interventions to lower the
incidence of the recurrence of gestational
diabetes in subsequent pregnancies and the
development of type 2 diabetes.
``(4) Uses of funds.--An eligible entity receiving a grant
under this subsection shall use the grant funds to carry out
demonstration projects described in paragraph (1), including--
``(A) expanding community-based health promotion
education, activities, and incentives focused on the
prevention of gestational diabetes and development of
type 2 diabetes in women with a history of gestational
diabetes;
``(B) aiding State- and tribal-based diabetes
prevention and control programs to collect, analyze,
disseminate, and report surveillance data on women
with, and at risk for, gestational diabetes, the
recurrence of gestational diabetes in subsequent
pregnancies, and, for women with a history of
gestational diabetes, the development of type 2
diabetes; and
``(C) training and encouraging health care
providers--
``(i) to promote risk assessment, high-
quality care, and self-management for
gestational diabetes and the recurrence of
gestational diabetes in subsequent pregnancies;
and
``(ii) to prevent the development of type 2
diabetes in women with a history of gestational
diabetes, and its complications in the practice
settings of the health care providers.
``(5) Report.--Not later than 4 years after the date of the
enactment of this section, the Secretary shall prepare and
submit to the Congress a report concerning the results of the
demonstration projects conducted through the grants awarded
under this subsection.
``(6) Definition of eligible entity.--In this subsection,
the term `eligible entity' means a nonprofit organization (such
as a nonprofit academic center or community health center) or a
State, tribal, or local health agency.
``(d) Postpartum Follow-Up Regarding Gestational Diabetes.--The
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, shall work with the State- and tribal-based
diabetes prevention and control programs assisted by the Centers to
encourage postpartum follow-up after gestational diabetes, as medically
appropriate, for the purpose of reducing the incidence of gestational
diabetes, the recurrence of gestational diabetes in subsequent
pregnancies, the development of type 2 diabetes in women with a history
of gestational diabetes, and related complications.''.
SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.
(a) Emergency Contraception Public Education Program.--
(1) In general.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall
develop and disseminate to the public information on emergency
contraception.
(2) Dissemination.--The Secretary may disseminate
information under paragraph (1) directly or through
arrangements with nonprofit organizations, consumer groups,
institutions of higher education, clinics, the media, and
Federal, State, and local agencies.
(3) Information.--The information disseminated under
paragraph (1) shall include, at a minimum, a description of
emergency contraception and an explanation of the use, safety,
efficacy, and availability of such contraception.
(b) Emergency Contraception Information Program for Health Care
Providers.--
(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in consultation with major medical and
public health organizations, shall develop and disseminate to
health care providers information on emergency contraception.
(2) Information.--The information disseminated under
paragraph (1) shall include, at a minimum--
(A) information describing the use, safety,
efficacy, and availability of emergency contraception;
(B) a recommendation regarding the use of such
contraception in appropriate cases; and
(C) information explaining how to obtain copies of
the information developed under subsection (a) for
distribution to the patients of the providers.
(c) Definitions.--In this section:
(1) Emergency contraception.--The term ``emergency
contraception'' means a drug or device (as the terms are
defined in section 201 of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 321)) or a drug regimen that--
(A) is used postcoitally;
(B) prevents pregnancy primarily by preventing or
delaying ovulation, and does not terminate an
established pregnancy; and
(C) is approved by the Food and Drug
Administration.
(2) Health care provider.--The term ``health care
provider'' means an individual who is licensed or certified
under State law to provide health care services and who is
operating within the scope of such license. Such term shall
include a pharmacist.
(3) Institution of higher education.--The term
``institution of higher education'' has the same meaning given
such term in section 101(a) of the Higher Education Act of 1965
(20 U.S.C. 1001(a)).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOPMENT.
(a) In General.--The Secretary may award a grant to each eligible
State to conduct programs of sex education described in subsection (b),
including education on both abstinence and contraception for the
prevention of teenage pregnancy and sexually transmitted diseases,
including HIV/AIDS.
(b) Requirements for Sex Education Programs.--A program of sex
education described in this subsection is a program that--
(1) is age appropriate and medically accurate;
(2) stresses the value of abstinence while not ignoring
those young people who have been or are sexually active;
(3) provides information about the health benefits and side
effects of contraceptive and barrier methods used--
(A) as a means to prevent pregnancy; and
(B) to reduce the risk of contracting sexually
transmitted disease, including HIV/AIDS;
(4) encourages family communication between parent and
child about sexuality;
(5) cultivates a respectful dialogue about sexuality,
including sexual orientation and gender identity, and embraces
the principles of nondiscrimination based on sexual orientation
and gender identity;
(6) counters the perpetuation of narrow gender roles,
including the sexualization of female children, adolescents,
and adults;
(7) teaches young people the skills to make responsible
decisions about sexuality, including how to avoid unwanted
verbal, physical, and sexual advances and how to avoid making
verbal, physical, and sexual advances that are not wanted by
the other party;
(8) develops healthy relationships, including the
prevention of dating and sexual violence;
(9) teaches young people how alcohol and drug use can
affect responsible decisionmaking; and
(10) does not teach or promote religion.
(c) Additional Activities.--In carrying out a program of sex
education, a State may expend grant funds awarded under subsection (a)
to carry out educational and motivational activities that help young
people--
(1) gain knowledge about the physical, emotional,
biological, and hormonal changes of adolescence and subsequent
stages of human maturation;
(2) develop the knowledge and skills necessary to ensure
and protect their sexual and reproductive health from
unintended pregnancy and sexually transmitted disease,
including HIV/AIDS, throughout their lifespan;
(3) gain knowledge about the specific involvement and
responsibility of each individual in sexual decisionmaking;
(4) develop healthy attitudes and values about adolescent
growth and development, body image, gender roles, racial and
ethnic diversity, sexual orientation and gender identity, and
other subjects;
(5) develop and practice healthy life skills including
goal-setting, decisionmaking, negotiation, communication, and
stress management; and
(6) promote self-esteem and positive interpersonal skills
focusing on relationship dynamics, including friendships,
dating, romantic involvement, marriage, and family
interactions.
(d) Matching Funds.--The Secretary may not make payments to a State
under this section in an amount exceeding Federal medical assistance
percentage for such State (as such term is defined in section 1905(b)
of the Social Security Act (42 U.S.C. 1396d(b))) of the costs of the
programs conducted by the State under this section.
(e) Evaluation of Programs.--
(1) In general.--For the purpose of evaluating the
effectiveness of programs of sex education carried out with a
grant under this section, evaluations shall be carried out in
accordance with paragraphs (2) and (3).
(2) National evaluation.--
(A) Method.--The Secretary shall provide for a
national evaluation of a representative sample of
programs of sex education carried out with grants under
this section to determine--
(i) the effectiveness of such programs in
helping to delay the initiation of sexual
intercourse and other high-risk behaviors;
(ii) the effectiveness of such programs in
preventing adolescent pregnancy;
(iii) the effectiveness of such programs in
preventing sexually transmitted disease,
including HIV/AIDS;
(iv) the effectiveness of such programs in
increasing contraceptive knowledge and
contraceptive behaviors when sexual intercourse
occurs; and
(v) a list of best practices based upon
essential programmatic components of evaluated
programs that have led to success described in
clauses (i) through (iv).
(B) Grant condition.--A condition for the receipt
of a grant to a State under this section is that the
State cooperate with the evaluation under subparagraph
(A).
(C) Report.--The Secretary shall submit to the
Congress--
(i) not later than the end of each fiscal
year during the 5-year period beginning with
fiscal year 2012, an interim report on the
national evaluation under subparagraph (A); and
(ii) not later than March 31, 2017, a final
report providing the results of such national
evaluation.
(3) Individual state evaluations.--A condition for the
receipt of a grant under this section is that the State
evaluate of the programs of sex education funded through such
grant in accordance with the following requirements:
(A) The evaluation will be conducted by an
external, independent entity.
(B) The purposes of the evaluation will be the
determination of--
(i) the effectiveness of such programs in
helping to delay the initiation of sexual
intercourse and other high-risk behaviors;
(ii) the effectiveness of such programs in
preventing adolescent pregnancy;
(iii) the effectiveness of such programs in
preventing sexually transmitted disease,
including HIV/AIDS; and
(iv) the effectiveness of such programs in
increasing contraceptive and barrier method
knowledge and contraceptive behaviors when
sexual intercourse occurs.
(f) Limitations on Use of Funds.--
(1) Limitations on secretary.--Of the amounts appropriated
for a fiscal year for purposes of this section, the Secretary
may not use more than--
(A) 7 percent of such amounts for administrative
expenses related to carrying out this section for that
fiscal year; and
(B) 10 percent of such amounts for the national
evaluation under subsection (e)(2).
(2) Limitations to states.--Of amounts provided to an
eligible State under this subsection, the State may not use
more than 10 percent of the grant to conduct any evaluation
under subsection (e)(3).
(g) Nondiscrimination Required.--Programs funded under this section
shall not discriminate on the basis of sex, race, ethnicity, national
origin, disability, religion, marital status, familial status, sexual
orientation, or gender identity. Nothing in this section shall be
construed to invalidate or limit rights, remedies, procedures, or legal
standards available to victims of discrimination under any other
Federal law or any law of a State or a political subdivision of a
State, including title VI of the Civil Rights Act of 1964 (42 U.S.C.
2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C.
1681 et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C.
794), and the Americans with Disabilities Act of 1990 (42 U.S.C. 12101
et seq.).
(h) Definitions.--For purposes of this section:
(1) The term ``age appropriate'' means, with respect to
topics, messages, and teaching methods, those suitable to
particular ages or age groups of children, adolescents, and
adults, based on developing cognitive, emotional, and
behavioral capacity typical for the age or age group.
(2) The term ``eligible State'' means a State that submits
to the Secretary an application for a grant under this section
that is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary
determines to be necessary to carry out this section.
(3) The term ``HIV/AIDS'' means the human immunodeficiency
virus, and includes acquired immune deficiency syndrome.
(4) The term ``medically accurate'', with respect to
information, means information that is supported by research,
recognized as accurate and objective by leading medical,
psychological, psychiatric, and public health organizations and
agencies, and, published in journals that are peer reviewed.
(5) The term ``State'' means the 50 States, the District of
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of
the Northern Mariana Islands, American Samoa, Guam, the United
States Virgin Islands, and any other territory or possession of
the United States.
TITLE VI--MENTAL HEALTH
SEC. 601. COMMUNITY MENTAL HEALTH AND ADDICTION SAFETY NET EQUITY ACT.
(a) Federally Qualified Behavioral Health Centers.--Section 1913 of
the Public Health Service Act (42 U.S.C. 300x-3) is amended--
(1) in subsection (a)(2)(A), by striking ``community mental
health services'' and inserting ``behavioral health services
(of the type offered by federally qualified behavioral health
centers consistent with subsection (c)(3))'';
(2) in subsection (b)--
(A) by striking paragraph (1) and inserting the
following:
``(1) services under the plan will be provided only through
appropriate, qualified community programs (which may include
federally qualified behavioral health centers, child mental
health programs, psychosocial rehabilitation programs, mental
health peer-support programs, and mental health primary
consumer-directed programs); and''; and
(B) in paragraph (2), by striking ``community
mental health centers'' and inserting ``federally
qualified behavioral health centers''; and
(3) by striking subsection (c) and inserting the following:
``(c) Criteria for Federally Qualified Behavioral Health Centers.--
``(1) In general.--The Administrator shall certify, and
recertify at least every 5 years, federally qualified
behavioral health centers as meeting the criteria specified in
this subsection.
``(2) Regulations.--Not later than 18 months after the date
of the enactment of this section, the Administrator shall issue
final regulations for certifying nonprofit or local government
centers as centers under paragraph (1).
``(3) Criteria.--The criteria referred to in subsection
(b)(2) are that the center performs each of the following:
``(A) Provide services in locations that ensure
services will be promptly available, be physically
accessible, provide reasonable policy modifications,
and be provided in a manner which preserves human
dignity and assures continuity of care.
``(B) Provide services in a mode of service
delivery appropriate for the target population.
``(C) Provide individuals with a choice of service
options where there is more than one efficacious
treatment.
``(D) Employ a core staff of clinical staff that is
multidisciplinary and culturally and linguistically
competent.
``(E) Provide services, within the limits of the
capacities of the center, to any individual residing or
employed in the service area of the center, regardless
of the ability of the individual to pay.
``(F) Provide, directly or through contract, to the
extent covered for adults in the State Medicaid plan
under title XIX of the Social Security Act and for
children in accordance with section 1905(r) of such Act
regarding early and periodic screening, diagnosis, and
treatment, each of the following services:
``(i) Screening, assessment, and diagnosis,
including risk assessment.
``(ii) Person-centered treatment planning
or similar processes, including risk assessment
and crisis planning.
``(iii) Outpatient clinic mental health
services, including screening, assessment,
diagnosis, psychotherapy, substance abuse
counseling, medication management, and
integrated treatment for mental illness and
substance abuse which shall be evidence-based
(including cognitive behavioral therapy and
other such therapies which are evidence-based).
``(iv) Outpatient clinic primary care
services (which includes obstetrical and
gynecological care and psychiatric and mental
health care), including screening and
monitoring of key health indicators and health
risk (including screening for diabetes,
hypertension, and cardiovascular disease and
monitoring of weight, height, body mass index
(BMI), blood pressure, blood glucose or HbA1C,
and lipid profile).
``(v) Crisis mental health services,
including 24-hour mobile crisis teams,
emergency crisis intervention services, and
crisis stabilization.
``(vi) Targeted case management (services
to assist individuals gaining access to needed
medical, social, educational, and other home-
and community-based services and applying for
income security and other benefits to which
they may be entitled).
``(vii) Psychiatric rehabilitation services
including skills training, assertive community
treatment, family psychoeducation, disability
self-management, supported employment,
supported housing services, therapeutic foster
care services, and such other evidence-based
practices as the Secretary may require.
``(viii) Peer support and counselor
services and family supports.
``(G) Maintain linkages, and where possible enter
into formal contracts with the following:
``(i) Inpatient psychiatric facilities and
substance abuse detoxification and residential
programs.
``(ii) Adult and youth peer support and
counselor services.
``(iii) Family support services for
families of children with serious mental
disorders.
``(iv) Other home- and community-based or
regional services, supports, and providers,
including schools, child welfare agencies,
juvenile and criminal justice agencies and
facilities, housing agencies and programs,
employers, and other social services.
``(v) Onsite or offsite access to primary
care services (which includes obstetrical and
gynecological care and psychiatric and mental
health care).
``(vi) Enabling services, including
outreach, transportation, and translation.
``(vii) Health and wellness services,
including services for tobacco cessation.''.
(b) Medicaid Coverage and Payment for Federally Qualified
Behavioral Health Center Services.--
(1) Payment for services provided by federally qualified
behavioral health centers.--Section 1902(bb) of the Social
Security Act (42 U.S.C. 1396a(bb)) is amended--
(A) in the heading, by striking ``and Rural Health
Clinics'' and inserting ``, Federally Qualified
Behavioral Health Centers, and Rural Health Clinics'';
(B) in paragraph (1), by inserting ``(and beginning
with fiscal year 2012 with respect to services
furnished on or after January 1, 2012, and each
succeeding fiscal year, for services described in
section 1905(a)(2)(D) furnished by a federally
qualified behavioral health center)'' after ``by a
rural health clinic'';
(C) in paragraph (2)--
(i) by striking the heading and inserting
``Initial fiscal year'';
(ii) by inserting ``(or, in the case of
services described in section 1905(a)(2)(D)
furnished by a federally qualified behavioral
health center, for services furnished on and
after January 1, 2012, during fiscal year
2012)'' after ``January 1, 2001, during fiscal
year 2001'';
(iii) by inserting ``(or, in the case of
services described in section 1905(a)(2)(D)
furnished by a federally qualified behavioral
health center, during fiscal years 2010 and
2011)'' after ``1999 and 2000''; and
(iv) by inserting ``(or, in the case of
services described in section 1905(a)(2)(D)
furnished by a federally qualified behavioral
health center, during fiscal year 2012)''
before the period;
(D) in paragraph (3)--
(i) in the heading, by striking ``Fiscal
year 2002 and succeeding'' and inserting
``Succeeding''; and
(ii) by inserting ``(or, in the case of
services described in section 1905(a)(2)(D)
furnished by a federally qualified behavioral
health center, for services furnished during
fiscal year 2013 or a succeeding fiscal year)''
after ``2002 or a succeeding fiscal year'';
(E) in paragraph (4)--
(i) by inserting ``(or as a federally
qualified behavioral health center after fiscal
year 2011)'' after ``or rural health clinic
after fiscal year 2000'';
(ii) by striking ``furnished by the center
or'' and inserting ``furnished by the federally
qualified health center, services described in
section 1905(a)(2)(D) furnished by the
federally qualified behavioral health center,
or'';
(iii) in the second sentence, by striking
``or rural health clinic'' and inserting ``,
federally qualified behavioral health center,
or rural health clinic'';
(F) in paragraph (5), in each of subparagraphs (A)
and (B), by striking ``or rural health clinic'' and
inserting ``, federally qualified behavioral health
center, or rural health clinic''; and
(G) in paragraph (6), by striking ``or to a rural
health clinic'' and inserting ``, to a federally
qualified behavioral health center for services
described in section 1905(a)(2)(D), or to a rural
health clinic''.
(2) Inclusion of federally qualified behavioral health
center services in the term medical assistance.--Section
1905(a)(2) of the Social Security Act (42 U.S.C. 1396d(a)(2))
is amended--
(A) by striking ``and'' before ``(C)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (D) federally qualified
behavioral health center services (as defined in
subsection (l)(4))''.
(3) Definition of federally qualified behavioral health
center services.--Section 1905(l) of the Social Security Act
(42 U.S.C. 1396d(l)) is amended by adding at the end the
following paragraph:
``(4)(A) The term `federally qualified behavioral health
center services' means services furnished to an individual at a
federally qualified behavioral health center (as defined by
subparagraph (B)).
``(B) The term `federally qualified behavioral health
center' means an entity that is certified under section 1913(c)
of the Public Health Service Act as meeting the criteria
described in paragraph (3) of such section.''.
(c) Mental Health and Addiction Safety Net Studies.--
(1) Paperwork reduction study.--
(A) In general.--Not later than 12 months after the
date of the enactment of this Act, the Institute of
Medicine shall submit to the appropriate committees of
Congress a report that evaluates the combined paperwork
burden of federally qualified behavioral health centers
certified section 1913(c) of the Public Health Service
Act, as inserted by subsection (a).
(B) Scope.--In preparing the report under
subparagraph (A), the Institute of Medicine shall
examine licensing, certification, service definitions,
claims payment, billing codes, and financial auditing
requirements utilized by the Office of Management and
Budget, the Centers for Medicare & Medicaid Services,
the Health Resources and Services Administration, the
Substance Abuse and Mental Health Services
Administration, the Office of the Inspector General,
State Medicaid agencies, State departments of health,
State departments of education, and State and local
juvenile justice and social services agencies to--
(i) establish an estimate of the combined
nationwide cost of complying with the
requirements described in this subparagraph, in
terms of both administrative funding and staff
time;
(ii) establish an estimate of the per
capita cost to each federally qualified
behavioral health center certified under
section 1913(c) of the Public Health Service
Act to comply with the requirements described
in this subparagraph, in terms of both
administrative funding and staff time; and
(iii) make administrative and statutory
recommendations to Congress, which may include
a uniform methodology, to reduce the paperwork
burden experienced by such federally qualified
behavioral health centers.
(2) Wage study.--
(A) In general.--Not later than 12 months after the
date of the enactment of this Act, the Institute of
Medicine shall conduct a nationwide analysis, and
submit a report to the appropriate committees of
Congress, concerning the compensation structure of
professional and paraprofessional personnel employed by
federally qualified behavioral health centers certified
under section 1913(c) of the Public Health Service Act,
as inserted by subsection (a), as compared with the
compensation structure of comparable health safety net
providers and relevant private sector health care
employers.
(B) Scope.--In preparing the report under
subparagraph (A), the Institute of Medicine shall
examine compensation disparities, if such disparities
are determined to exist, by type of personnel, type of
provider or private sector employer, and by geographic
region.
SEC. 602. MINORITY FELLOWSHIP PROGRAM.
Title V of the Public Health Service Act is amended by inserting
after section 506B of such Act (42 U.S.C. 290aa-5b) the following:
``SEC. 506C. MINORITY FELLOWSHIP PROGRAM.
``(a) Fellowships.--The Administrator shall maintain a program, to
be known as the Minority Fellowship Program, under which the
Administrator awards grants or contracts to national associations or
other appropriate entities for the financial support of graduate
students, postdoctoral fellows, and residents in the professions of
psychology, psychiatry, social work, psychiatric advance-practice
nursing, and marriage and family therapy to students who demonstrate a
commitment to clinical or research careers focused on racial and ethnic
minority populations.
``(b) Term of Financial Support.--Financial support provided to an
individual pursuant to subsection (a) shall be for a term of not more
than 12 months and may be renewed thereafter.''.
SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION PROGRAM.
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
et seq.) is amended by adding at the end the following:
``SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR PROVISION OF
BEHAVIORAL HEALTH CARE IN PRIMARY CARE SETTINGS.
``(a) Grants.--The Secretary, acting through the Director of the
Office of Minority Health of the Administration, shall award grants to
eligible entities for the purpose of providing technical assistance and
training regarding the effective development and implementation of
integrated interprofessional health care teams that provide behavioral
health care.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be a federally qualified health center
(as defined in section 1861(aa) of the Social Security Act) serving a
high proportion of individuals from racial and ethnic minority groups
(as defined in section 1707(g)).''.
SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY MENTAL HEALTH
DISPARITIES RESEARCH GAPS.
Not later than 6 months after the date of the enactment of this
Act, the Director of the National Institute on Minority Health and
Health Disparities shall enter into an arrangement with the Institute
of Medicine (or, if the Institute declines to enter into such an
arrangement, another appropriate entity)--
(1) to conduct a study with respect to mental and
behavioral health disparities in racial and ethnic minority
groups (as defined in section 1707(g) of the Public Health
Service Act (42 U.S.C. 300u-6(g)); and
(2) to submit to the Congress a report on the results of
such study, including--
(A) a compilation of information on the dynamics of
mental disorders in such racial and ethnic minority
groups;
(B) an identification of gaps in knowledge and
research needs; and
(C) recommendations for an interprofessional
research agenda at the National Institutes of Health
aimed at reducing and ultimately eliminating mental and
behavioral health disparities in such racial and ethnic
minority groups.
TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES
Subtitle A--Cancer
SEC. 701. LUNG CANCER MORTALITY REDUCTION.
(a) Short Title.--This section may be cited as the ``Lung Cancer
Mortality Reduction Act of 2012''.
(b) Findings.--Congress makes the following findings:
(1) Lung cancer is the leading cause of cancer death for
both men and women, accounting for 28 percent of all cancer
deaths.
(2) Lung cancer kills more people annually than breast
cancer, prostate cancer, colon cancer, liver cancer, melanoma,
and kidney cancer combined.
(3) Since the National Cancer Act of 1971 (Public Law 92-
218; 85 Stat. 778), coordinated and comprehensive research has
raised the 5-year survival rates for breast cancer to 88
percent, for prostate cancer to 99 percent, and for colon
cancer to 64 percent.
(4) However, the 5-year survival rate for lung cancer is
still only 15 percent and a similar coordinated and
comprehensive research effort is required to achieve increases
in lung cancer survivability rates.
(5) Sixty percent of lung cancer cases are now diagnosed
nonsmokers or former smokers.
(6) Two-thirds of nonsmokers diagnosed with lung cancer are
women.
(7) Certain minority populations, such as African-American
males, have disproportionately high rates of lung cancer
incidence and mortality, notwithstanding their similar smoking
rate.
(8) Members of the baby boomer generation are entering
their sixties, the most common age at which people develop lung
cancer.
(9) Tobacco addiction and exposure to other lung cancer
carcinogens such as Agent Orange and other herbicides and
battlefield emissions are serious problems among military
personnel and war veterans.
(10) Significant and rapid improvements in lung cancer
mortality can be expected through greater use and access to
lung cancer screening tests for at-risk individuals.
(11) Additional strategies are necessary to further enhance
the existing tests and therapies available to diagnose and
treat lung cancer in the future.
(12) The August 2001 Report of the Lung Cancer Progress
Review Group of the National Cancer Institute stated that
funding for lung cancer research was ``far below the levels
characterized for other common malignancies and far out of
proportion to its massive health impact''.
(13) The Report of the Lung Cancer Progress Review Group
identified as its ``highest priority'' the creation of
integrated, multidisciplinary, multi-institutional research
consortia organized around the problem of lung cancer rather
than around specific research disciplines.
(14) The United States must enhance its response to the
issues raised in the Report of the Lung Cancer Progress Review
Group, and this can be accomplished through the establishment
of a coordinated effort designed to reduce the lung cancer
mortality rate by 50 percent by 2015 and targeted funding to
support this coordinated effort.
(c) Sense of Congress Concerning Investment in Lung Cancer
Research.--It is the sense of the Congress that--
(1) lung cancer mortality reduction should be made a
national public health priority; and
(2) a comprehensive mortality reduction program coordinated
by the Secretary of Health and Human Services is justified and
necessary to adequately address and reduce lung cancer
mortality.
(d) Lung Cancer Mortality Reduction Program.--
(1) In general.--Subpart 1 of part C of title IV of the
Public Health Service Act (42 U.S.C. 285 et seq.) is amended by
adding at the end the following:
``SEC. 417G. LUNG CANCER MORTALITY REDUCTION PROGRAM.
``(a) In General.--Not later than 6 months after the date of the
enactment of this section, the Secretary, in consultation with the
Secretary of Defense, the Secretary of Veterans Affairs, the Director
of the National Institutes of Health, the Director of the Centers for
Disease Control and Prevention, the Commissioner of Food and Drugs, the
Administrator of the Centers for Medicare & Medicaid Services, the
Director of the National Institute on Minority Health and Health
Disparities, and other members of the Lung Cancer Advisory Board
established under section 546 of the Lung Cancer Mortality Reduction
Act of 2012, shall implement a comprehensive program, to be known as
the Lung Cancer Mortality Reduction Program, to achieve a reduction of
at least 25 percent in the mortality rate of lung cancer by 2017.
``(b) Requirements.--The Program shall include at least the
following:
``(1) With respect to the National Institutes of Health--
``(A) a strategic review and prioritization by the
National Cancer Institute of research grants to achieve
the goal of the Lung Cancer Mortality Reduction Program
in reducing lung cancer mortality;
``(B) the provision of funds to enable the Airway
Biology and Disease Branch of the National Heart, Lung,
and Blood Institute to expand its research programs to
include predispositions to lung cancer, the
interrelationship between lung cancer and other
pulmonary and cardiac disease, and the diagnosis and
treatment of these interrelationships;
``(C) the provision of funds to enable the National
Institute of Biomedical Imaging and Bioengineering to
expedite the development of computer assisted
diagnostic, surgical, treatment, and drug-testing
innovations to reduce lung cancer mortality, such as
through expansion of the Institute's Quantum Grant
Program and Image-Guided Interventions programs; and
``(D) the provision of funds to enable the National
Institute of Environmental Health Sciences to implement
research programs relative to the lung cancer
incidence.
``(2) With respect to the Food and Drug Administration--
``(A) activities under section 529 of the Federal
Food, Drug, and Cosmetic Act; and
``(B) activities under section 561 of the Federal
Food, Drug, and Cosmetic Act to expand access to
investigational drugs and devices for the diagnosis,
monitoring, or treatment of lung cancer.
``(3) With respect to the Centers for Disease Control and
Prevention, the establishment of an early disease research and
management program under section 1511.
``(4) With respect to the Agency for Healthcare Research
and Quality, the conduct of a biannual review of lung cancer
screening, diagnostic, and treatment protocols, including
consideration of how lung cancer screening and treatment affect
men and women differently, and the issuance of updated
guidelines.
``(5) The cooperation and coordination of all minority and
health disparity programs within the Department of Health and
Human Services to ensure that all aspects of the Lung Cancer
Mortality Reduction Program under this section adequately
address the burden of lung cancer on minority and rural
populations.
``(6) The cooperation and coordination of all tobacco
control and cessation programs within agencies of the
Department of Health and Human Services to achieve the goals of
the Lung Cancer Mortality Reduction Program under this section
with particular emphasis on the coordination of drug and other
cessation treatments with early detection protocols.''.
(2) Federal food, drug, and cosmetic act.--Subchapter B of
chapter V of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 360aaa et seq.) is amended by adding at the end the
following:
``drugs relating to lung cancer
``Sec. 529. (a) In General.--The provisions of this subchapter
shall apply to a drug described in subsection (b) to the same extent
and in the same manner as such provisions apply to a drug for a rare
disease or condition.
``(b) Qualified Drugs.--A drug described in this subsection is--
``(1) a chemoprevention drug for precancerous conditions of
the lung;
``(2) a drug for targeted therapeutic treatments, including
any vaccine, for lung cancer; and
``(3) a drug to curtail or prevent nicotine addiction.
``(c) Board.--The Board established under the Lung Cancer Mortality
Reduction Act of 2012 shall monitor the program implemented under this
section.''.
(3) Access to unapproved therapies.--Section 561(e) of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb(e)) is
amended by inserting before the period the following: ``and
shall include expanding access to drugs under section 529, with
substantial consideration being given to whether the totality
of information available to the Secretary regarding the safety
and effectiveness of an investigational drug, as compared to
the risk of morbidity and death from the disease, indicates
that a patient may obtain more benefit than risk if treated
with the drug''.
(4) CDC.--Title XV of the Public Health Service Act (42
U.S.C. 300k et seq.) is amended by adding at the end the
following:
``SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT PROGRAM.
``The Secretary shall establish and implement an early disease
research and management program targeted at the high incidence and
mortality rates of lung cancer among minority and low-income
populations.''.
(e) Department of Defense and the Department of Veterans Affairs.--
The Secretary of Defense and the Secretary of Veterans Affairs shall
coordinate with the Secretary of Health and Human Services--
(1) in the development of the Lung Cancer Mortality
Reduction Program under section 417H;
(2) in the implementation within the Department of Defense
and the Department of Veterans Affairs of an early detection
and disease management research program for military personnel
and veterans whose smoking history and exposure to carcinogens
during active duty service has increased their risk for lung
cancer; and
(3) in the implementation of coordinated care programs for
military personnel and veterans diagnosed with lung cancer.
(f) Lung Cancer Advisory Board.--
(1) In general.--The Secretary of Health and Human Services
shall convene a Lung Cancer Advisory Board (referred to in this
section as the ``Board'')--
(A) to monitor the programs established under this
section (and the amendments made by this section); and
(B) to provide annual reports to the Congress
concerning benchmarks, expenditures, lung cancer
statistics, and the public health impact of such
programs.
(2) Composition.--The Board shall be composed of--
(A) the Secretary of Health and Human Services;
(B) the Secretary of Defense;
(C) the Secretary of Veterans Affairs; and
(D) two representatives each from the fields of
clinical medicine focused on lung cancer, lung cancer
research, imaging, drug development, and lung cancer
advocacy, to be appointed by the Secretary of Health
and Human Services.
SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUTREACH, SCREENING,
TESTING, ACCESS, AND TREATMENT EFFECTIVENESS.
(a) Short Title.--This section may be cited as the ``Prostate
Research, Outreach, Screening, Testing, Access, and Treatment
Effectiveness Act of 2012'' or the ``PROSTATE Act''.
(b) Findings.--Congress makes the following findings:
(1) Prostate cancer is the second leading cause of cancer
death among men.
(2) In 2010, more than 217,730 new patients were diagnosed
with prostate cancer and more than 32,000 men died from this
disease.
(3) Roughly 2,000,000 Americans are living with a diagnosis
of prostate cancer and its consequences.
(4) While prostate cancer generally affects older
individuals, younger men are also at risk for the disease, and
when prostate cancer appears in early middle age it frequently
takes on a more aggressive form.
(5) There are significant racial and ethnic disparities
that demand attention, namely African-Americans have prostate
cancer mortality rates that are more than double those in the
White population.
(6) Underserved rural populations have higher rates of
mortality compared to their urban counterparts, and innovative
and cost-efficient methods to improve rural access to high
quality care should take advantage of advances in telehealth to
diagnose and treat prostate cancer when appropriate.
(7) Certain veterans populations may have nearly twice the
incidence of prostate cancer as the general population of the
United States.
(8) Urologists may constitute the specialists who diagnose
and treat the vast majority of prostate cancer patients.
(9) Although much basic and translational research has been
completed and much is currently known, there are still many
unanswered questions. For example, it is not fully understood
how much of known disparities are attributable to disease
etiology, access to care, or education and awareness in the
community.
(10) Causes of prostate cancer are not known. There is not
good information regarding how to differentiate accurately,
early on, between aggressive and indolent forms of the disease.
As a result, there is significant overtreatment in prostate
cancer. There are no treatments that can durably arrest growth
or cure prostate cancer once it has metastasized.
(11) A significant proportion (roughly 23 to 54 percent) of
cases may be clinically indolent and ``overdiagnosed'',
resulting in significant overtreatment. More accurate tests
will allow men and their families to face less physical,
psychological, financial, and emotional trauma and billions of
dollars could be saved in private and public health care
systems in an area that has been identified by the Medicare
program as one of eight high-volume, high-cost areas in the
Resource Utilization Report program authorized by Congress
under the Medicare Improvements for Patients and Providers Act
of 2008.
(12) Prostate cancer research and health care programs
across Federal agencies should be coordinated to improve
accountability and actively encourage the translation of
research into practice, to identify and implement best
practices, in order to foster an integrated and consistent
focus on effective prevention, diagnosis, and treatment of this
disease.
(c) Prostate Cancer Coordination and Education.--
(1) Interagency prostate cancer coordination and education
task force.--Not later than 180 days after the date of the
enactment of this section, the Secretary of Veterans Affairs,
in cooperation with the Secretary of Defense and the Secretary
of Health and Human Services, shall establish an Interagency
Prostate Cancer Coordination and Education Task Force (in this
section referred to as the ``Prostate Cancer Task Force'').
(2) Duties.--The Prostate Cancer Task Force shall--
(A) develop a summary of advances in prostate
cancer research supported or conducted by Federal
agencies relevant to the diagnosis, prevention, and
treatment of prostate cancer, including psychosocial
impairments related to prostate cancer treatment, and
compile a list of best practices that warrant broader
adoption in health care programs;
(B) consider establishing, and advocating for, a
guidance to enable physicians to allow screening of men
who are over age 74, on a case-by-case basis, taking
into account quality of life and family history of
prostate cancer;
(C) share and coordinate information on Federal
research and health care program activities, including
activities related to--
(i) determining how to improve research and
health care programs, including psychosocial
impairments related to prostate cancer
treatment;
(ii) identifying any gaps in the overall
research inventory and in health care programs;
(iii) identifying opportunities to promote
translation of research into practice; and
(iv) maximizing the effects of Federal
efforts by identifying opportunities for
collaboration and leveraging of resources in
research and health care programs that serve
those susceptible to or diagnosed with prostate
cancer;
(D) develop a comprehensive interagency strategy
and advise relevant Federal agencies in the
solicitation of proposals for collaborative,
multidisciplinary research and health care programs,
including proposals to evaluate factors that may be
related to the etiology of prostate cancer, that
would--
(i) result in innovative approaches to
study emerging scientific opportunities or
eliminate knowledge gaps in research to improve
the prostate cancer research portfolio of the
Federal Government;
(ii) outline key research questions,
methodologies, and knowledge gaps; and
(iii) ensure consistent action, as outlined
by section 402(b) of the Public Health Service
Act;
(E) develop a coordinated message related to
screening and treatment for prostate cancer to be
reflected in educational and beneficiary materials for
Federal health programs as such documents are updated;
and
(F) not later than 2 years after the date of the
establishment of the Prostate Cancer Task Force, submit
to the Expert Advisory Panel to be reviewed and
returned within 30 days, and then within 90 days
submitted to Congress recommendations--
(i) regarding any appropriate changes to
research and health care programs, including
recommendations to improve the research
portfolio of the Department of Veterans
Affairs, Department of Defense, National
Institutes of Health, and other Federal
agencies to ensure that scientifically based
strategic planning is implemented in support of
research and health care program priorities;
(ii) designed to ensure that the research
and health care programs and activities of the
Department of Veterans Affairs, the Department
of Defense, the Department of Health and Human
Services, and other Federal agencies are free
of unnecessary duplication;
(iii) regarding public participation in
decisions relating to prostate cancer research
and health care programs to increase the
involvement of patient advocates, community
organizations, and medical associations
representing a broad geographical area;
(iv) on how to best disseminate information
on prostate cancer research and progress
achieved by health care programs;
(v) about how to expand partnerships
between public entities, including Federal
agencies, and private entities to encourage
collaborative, cross-cutting research and
health care delivery;
(vi) assessing any cost savings and
efficiencies realized through the efforts
identified and supported in this section and
recommending expansion of those efforts that
have proved most promising while also ensuring
against any conflicts in directives from other
congressional or statutory mandates or enabling
statutes;
(vii) identifying key priority action items
from among the recommendations; and
(viii) with respect to the level of funding
needed by each agency to implement the
recommendations contained in the report.
(3) Members of the prostate cancer task force.--The
Prostate Cancer Task Force described in subsection (a) shall be
composed of representatives from such Federal agencies, as each
Secretary determines necessary, to coordinate a uniform message
relating to prostate cancer screening and treatment where
appropriate, including representatives of the following:
(A) The Department of Veterans Affairs, including
representatives of each relevant program areas of the
Department of Veterans Affairs.
(B) The Prostate Cancer Research Program of the
Congressionally Directed Medical Research Program of
the Department of Defense.
(C) The Department of Health and Human Services,
including at a minimum representatives of the
following:
(i) The National Institutes of Health.
(ii) National research institutes and
centers, including the National Cancer
Institute, the National Institute of Allergy
and Infectious Diseases, and the Office of
Minority Health.
(iii) The Centers for Medicare & Medicaid
Services.
(iv) The Food and Drug Administration.
(v) The Centers for Disease Control and
Prevention.
(vi) The Agency for Healthcare Research and
Quality.
(vii) The Health Resources and Services
Administration.
(4) Appointing expert advisory panels.--The Prostate Cancer
Task Force shall appoint expert advisory panels, as determined
appropriate, to provide input and concurrence from individuals
and organizations from the medical, prostate cancer patient and
advocate, research, and delivery communities with expertise in
prostate cancer diagnosis, treatment, and research, including
practicing urologists, primary care providers, and others and
individuals with expertise in education and outreach to
underserved populations affected by prostate cancer.
(5) Meetings.--The Prostate Cancer Task Force shall convene
not less than twice a year, or more frequently as the Secretary
determines to be appropriate.
(6) Submission of recommendations to congress.--The
Secretary of Veterans Affairs shall submit to Congress any
recommendations submitted to the Secretary under paragraph
(2)(E).
(7) Federal advisory committee act.--
(A) In general.--Except as provided in subparagraph
(B), the Federal Advisory Committee Act (5 U.S.C. App.)
shall apply to the Prostate Cancer Task Force.
(B) Exception.--Section 14(a)(2)(B) of such Act
(relating to the termination of advisory committees)
shall not apply to the Prostate Cancer Task Force.
(8) Sunset date.--The Prostate Cancer Task Force shall
terminate at the end of fiscal year 2016.
(d) Prostate Cancer Research.--
(1) Research coordination.--The Secretary of Veterans
Affairs, in coordination with the Secretaries of Defense and of
Health and Human Services, shall establish and carry out a
program to coordinate and intensify prostate cancer research as
needed. Specifically, such research program shall--
(A) develop advances in diagnostic and prognostic
methods and tests, including biomarkers and an improved
prostate cancer screening blood test, including
improvements or alternatives to the prostate specific
antigen test and additional tests to distinguish
indolent from aggressive disease;
(B) better understand the etiology of the disease
(including an analysis of lifestyle factors proven to
be involved in higher rates of prostate cancer, such as
obesity and diet, and in different ethnic, racial, and
socioeconomic groups, such as the African-American,
Latino, and American Indian populations and men with a
family history of prostate cancer) to improve
prevention efforts;
(C) expand basic research into prostate cancer,
including studies of fundamental molecular and cellular
mechanisms;
(D) identify and provide clinical testing of novel
agents for the prevention and treatment of prostate
cancer;
(E) establish clinical registries for prostate
cancer;
(F) use the National Institute of Biomedical
Imaging and Bioengineering and the National Cancer
Institute for assessment of appropriate imaging
modalities; and
(G) address such other matters relating to prostate
cancer research as may be identified by the Federal
agencies participating in the program under this
section.
(2) Prostate cancer advisory board.--There is established
in the Office of the Chief Scientist of the Food and Drug
Administration a Prostate Cancer Scientific Advisory Board.
Such board shall be responsible for accelerating real-time
sharing of the latest research data and accelerating movement
of new medicines to patients.
(3) Underserved minority grant program.--In carrying out
such program, the Secretary shall--
(A) award grants to eligible entities to carry out
components of the research outlined in paragraph (1);
(B) integrate and build upon existing knowledge
gained from comparative effectiveness research; and
(C) recognize and address--
(i) the racial and ethnic disparities in
the incidence and mortality rates of prostate
cancer and men with a family history of
prostate cancer;
(ii) any barriers in access to care and
participation in clinical trials that are
specific to racial, ethnic, and other
underserved minorities and men with a family
history of prostate cancer;
(iii) needed outreach and educational
efforts to raise awareness in these
communities; and
(iv) appropriate access and utilization of
imaging modalities.
(e) Telehealth and Rural Access Pilot Project.--
(1) In general.--The Secretary of Veterans Affairs, the
Secretary of Defense, and the Secretary of Health and Human
Services (in this section referred to as the ``Secretaries'')
shall establish 4-year telehealth pilot projects for the
purpose of analyzing the clinical outcomes and cost
effectiveness associated with telehealth services in a variety
of geographic areas that contain high proportions of medically
underserved populations, including African-Americans, Latinos,
American Indians, and those in rural areas. Such projects shall
promote efficient use of specialist care through better
coordination of primary care and physician extender teams in
underserved areas and more effectively employ tumor boards to
better counsel patients.
(2) Eligible entities.--
(A) In general.--The Secretaries shall select
eligible entities to participate in the pilot projects
under this section.
(B) Priority.--In selecting eligible entities to
participate in the pilot projects under this section,
the Secretaries shall give priority to such entities
located in medically underserved areas, particularly
those that include African-Americans, Latinos, and
facilities of the Indian Health Service, and those in
rural areas.
(3) Evaluation.--The Secretaries shall, through the pilot
projects, evaluate--
(A) the effective and economic delivery of care in
diagnosing and treating prostate cancer with the use of
telehealth services in medically underserved and tribal
areas including collaborative uses of health
professionals and integration of the range of
telehealth and other technologies;
(B) the effectiveness of improving the capacity of
nonmedical providers and nonspecialized medical
providers to provide health services for prostate
cancer in medically underserved and tribal areas,
including the exploration of innovative medical home
models with collaboration between urologists, other
relevant medical specialists, including oncologists,
radiologists, and primary care teams and coordination
of care through the efficient use of primary care teams
and physician extenders; and
(C) the effectiveness of using telehealth services
to provide prostate cancer treatment in medically
underserved areas, including the use of tumor boards to
facilitate better patient counseling.
(4) Report.--Not later than 12 months after the completion
of the pilot projects under this subsection, the Secretaries
shall submit to Congress a report describing the outcomes of
such pilot projects, including any cost savings and
efficiencies realized, and providing recommendations, if any,
for expanding the use of telehealth services.
(f) Education and Awareness.--
(1) In general.--The Secretary of Veterans Affairs shall
develop a national education campaign for prostate cancer. Such
campaign shall involve the use of written educational materials
and public service announcements consistent with the findings
of the Prostate Cancer Task Force under subsection (c), that
are intended to encourage men to seek prostate cancer screening
when appropriate.
(2) Racial disparities and the population of men with a
family history of prostate cancer.--In developing the national
campaign under paragraph (1), the Secretary shall ensure that
such educational materials and public service announcements are
more readily available in communities experiencing racial
disparities in the incidence and mortality rates of prostate
cancer and by men of any race classification with a family
history of prostate cancer.
(3) Grants.--In carrying out the national campaign under
this section, the Secretary shall award grants to nonprofit
private entities to enable such entities to test alternative
outreach and education strategies.
SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN BREAST AND CERVICAL
CANCER PATIENTS IN THE TERRITORIES.
(a) Elimination of Funding Limitations.--
(1) In general.--Section 1108(g)(4) of the Social Security
Act (42 U.S.C. 1308(g)(4)) is amended by adding at the end the
following: ``With respect to fiscal years beginning with fiscal
year 2012, payment for medical assistance for individuals who
are eligible for such assistance only on the basis of section
1902(a)(10)(A)(ii)(XVIII) shall not be taken into account in
applying subsection (f) (as increased in accordance with
paragraphs (1), (2), and (3) of this subsection) to such
commonwealth or territory for such fiscal year.''.
(2) Technical amendment.--Section 1108(g)(4) of such Act is
further amended by striking ``(3), and (4)'' and inserting
``and (3)''.
(b) Application of Enhanced FMAP for Highest State.--Section
1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding at the
end the following: ``Notwithstanding the first sentence of this
subsection, with respect to medical assistance described in clause (4)
of such sentence that is furnished in Puerto Rico, the United States
Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands,
or American Samoa in a fiscal year, the Federal medical assistance
percentage is equal to the highest such percentage applied under such
clause for such fiscal year for any of the 50 States or the District of
Columbia that provides such medical assistance for any portion of such
fiscal year.''
(c) Effective Date.--The amendments made by this section shall
apply to payment for medical assistance for items and services
furnished on or after October 1, 2011.
SEC. 704. CANCER PREVENTION AND TREATMENT DEMONSTRATION FOR ETHNIC AND
RACIAL MINORITIES.
(a) Demonstration.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
conduct demonstration projects (in this section referred to as
``demonstration projects'') for the purpose of developing
models and evaluating methods that--
(A) improve the quality of items and services
provided to target individuals in order to facilitate
reduced disparities in early detection and treatment of
cancer;
(B) improve clinical outcomes, satisfaction,
quality of life, and appropriate use of Medicare-
covered services and referral patterns among those
target individuals with cancer;
(C) eliminate disparities in the rate of preventive
cancer screening measures, such as Pap smears, prostate
cancer screenings, and CT scans for lung cancer among
target individuals;
(D) promote collaboration with community-based
organizations to ensure cultural competency of health
care professionals and linguistic access for persons
with limited-English proficiency; and
(E) encourage the incorporation of community health
workers to increase the efficiency and appropriateness
of cancer screening programs.
(2) Community health worker defined.--In this section, the
term ``community health worker'' includes a community health
advocate, a lay health worker, a community health
representative, a peer health promoter, a community health
outreach workers, and promotores de salud, who promotes health
or nutrition within the community in which the individual
resides.
(3) Target individual defined.--In this section, the term
``target individual'' means an individual of a racial and
ethnic minority group, as defined in section 1707(g)(1) of the
Public Health Service Act (42 U.S.C. 300u-6(g)(1)), who is
entitled to benefits under part A, and enrolled under part B,
of title XVIII of the Social Security Act.
(b) Program Design.--
(1) Initial design.--Not later than 1 year after the date
of the enactment of this Act, the Secretary shall evaluate best
practices in the private sector, community programs, and
academic research of methods that reduce disparities among
individuals of racial and ethnic minority groups in the
prevention and treatment of cancer and shall design the
demonstration projects based on such evaluation.
(2) Number and project areas.--Not later than 2 years after
the date of the enactment of this Act, the Secretary shall
implement at least nine demonstration projects, including the
following:
(A) Two projects for each of the four following
major racial and ethnic minority groups:
(i) American Indians and Alaska Natives,
Eskimos and Aleuts.
(ii) Asian-Americans.
(iii) Blacks/African-Americans.
(iv) Hispanic/Latinos.
(v) Native Hawaiians and other Pacific
Islanders.
The two projects must target different ethnic
subpopulations.
(B) One project within the Pacific Islands or
United States insular areas.
(C) At least one project each in a rural area and
inner-city area.
(3) Expansion of projects; implementation of demonstration
project results.--If the initial report under subsection (c)
contains an evaluation that demonstration projects--
(A) reduce expenditures under the Medicare program
under title XVIII of the Social Security Act; or
(B) do not increase expenditures under the Medicare
program and reduce racial and ethnic health disparities
in the quality of health care services provided to
target individuals and increase satisfaction of
beneficiaries and health care providers;
the Secretary shall continue the existing demonstration
projects and may expand the number of demonstration projects.
(c) Report to Congress.--
(1) In general.--Not later than 2 years after the date the
Secretary implements the initial demonstration projects, and
biannually thereafter, the Secretary shall submit to Congress a
report regarding the demonstration projects.
(2) Contents of report.--Each report under paragraph (1)
shall include the following:
(A) A description of the demonstration projects.
(B) An evaluation of--
(i) the cost effectiveness of the
demonstration projects;
(ii) the quality of the health care
services provided to target individuals under
the demonstration projects; and
(iii) beneficiary and health care provider
satisfaction under the demonstration projects.
(C) Any other information regarding the
demonstration projects that the Secretary determines to
be appropriate.
(d) Waiver Authority.--The Secretary shall waive compliance with
the requirements of title XVIII of the Social Security Act to such
extent and for such period as the Secretary determines is necessary to
conduct demonstration projects.
SEC. 705. REDUCING CANCER TREATMENT DISPARITIES WITHIN MEDICARE.
(a) Development of Measures of Disparities in Quality of Cancer
Care.--
(1) Development of measures.--
(A) In general.--The Secretary of Health and Human
Services (in this section referred to as the
``Secretary'') shall enter into an agreement with an
entity that specializes in developing quality measures
for cancer care under which the entity shall--
(i) develop a uniform set of measures to
evaluate disparities in the quality of cancer
care; and
(ii) annually update such set of measures.
(B) Measures to be included.--Such set of measures
shall include, with respect to the treatment of cancer,
measures of patient outcomes, the process for
delivering medical care related to such treatment,
patient counseling and engagement in decisionmaking,
patient experience of care, resource use, and practice
capabilities, such as care coordination.
(2) Endorsement of measures.--Any measure included in the
set of measures developed pursuant to this subsection must have
been endorsed by the entity with a contract under section
1890(a) of the Social Security Act (42 U.S.C. 1395aaa(a)).
(b) Establishment of Reporting Process.--
(1) In general.--The Secretary shall establish a reporting
process that provides for a method for health care providers
specified under paragraph (2) to submit to the Secretary and
make public data on the performance of such providers during
each reporting period through use of the measures developed
pursuant to subsection (a). Such data shall be submitted in a
form and manner and at a time specified by the Secretary.
(2) Specification of providers to report on measures.--The
Secretary shall specify the classes of Medicare providers of
services and suppliers, including hospitals, cancer centers,
physicians, primary care providers, and specialty providers,
that will be required under such process to publicly report on
the measures developed pursuant to subsection (a).
(3) Assessment of changes.--Within this reporting process,
the Secretary shall also establish a format that assesses
changes in both the absolute and relative disparities over
time. These measures shall be presented in an easily
comprehensible format, such as those presented in the final
publications relating to Healthy People 2010 or the National
Healthcare Disparities Report.
(4) Initial implementation.--The Secretary shall implement
the reporting process under this subsection for reporting
periods beginning not later than 6 months after the date that
measures are first developed pursuant to subsection (a).
Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention
SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL AND PREVENTION.
(a) Short Title.--This subtitle may be cited as the ``Viral
Hepatitis and Liver Cancer Control and Prevention Act of 2012''.
(b) Findings.--Congress finds the following:
(1) Approximately 5,300,000 Americans are chronically
infected with the hepatitis B virus (referred to in this
section as ``HBV''), the hepatitis C virus (referred to in this
section as ``HCV''), or both.
(2) In the United States, chronic HBV and HCV are the most
common cause of liver cancer, one of the most lethal and
fastest growing cancers in this country. It is the most common
cause of chronic liver disease, liver cirrhosis, and the most
common indication for liver transplantation. It is also a
leading cause of death in Americans living with HIV/AIDS, many
of whom are coinfected with chronic HBV, chronic HCV, or both.
At least 15,000 deaths per year in the United States can be
attributed to chronic HBV and HCV.
(3) According to the Centers for Disease Control and
Prevention (referred to in this section as the ``CDC''),
approximately 2 percent of the population of the United States
is living with chronic HBV, chronic HCV, or both. The CDC has
recognized HCV as the Nation's most common chronic bloodborne
virus infection and HBV as the deadliest vaccine-preventable
disease.
(4) HBV is easily transmitted and is 100 times more
infectious than HIV. According to the CDC, HBV is transmitted
through percutaneous (i.e., puncture through the skin) or
mucosal contact with infectious blood or body fluids. HCV is
transmitted by percutaneous exposures to infectious blood.
(5) The CDC conservatively estimates that in 2008
approximately 18,000 Americans were newly infected with HCV and
more than 38,000 Americans were newly infected with HBV.
(6) There were 6 outbreaks reported to CDC for
investigation in 2008 related to health care acquired infection
of HBV and HCV, potentially exposing more than 52,000 Americans
to the viruses, in 2009-2010 there were 15 outbreaks in which
more than 30,000 people were potentially exposed.
(7) Chronic HBV and chronic HCV usually do not cause
symptoms early in the course of the disease, but after many
years of a clinically ``silent'' phase, more than 50 percent of
infected individuals will develop cirrhosis, end-stage liver
disease, or liver cancer. Since most of those with chronic HBV
and HCV are unaware of their infection, they do not know to
take precautions to prevent the spread of their infection and
can unknowingly exacerbate their own disease progression.
(8) HBV and HCV disproportionately affect certain
populations in the United States. Although representing only 5
percent of the population, Asian-Americans and Pacific
Islanders account for over half of the 1,400,000 domestic
chronic HBV cases. Baby boomers (those born between 1946 and
1964) account for more than half of domestic chronic hepatitis
C cases. In addition, African-Americans, Latinos, and American
Indian/Alaskan Natives are among the groups which have
disproportionately high rates of HBV and/or HCV infections in
the United States.
(9) For both chronic HBV and chronic HCV, behavioral
changes can slow disease progression if diagnosis is made
early. Early diagnosis, which is determined through simple
blood tests, can reduce the risk of transmission and disease
progression through education and vaccination of household
members and other susceptible persons at risk.
(10) For those chronically infected with HBV or HCV,
regular monitoring can lead to the early detection of liver
cancer at a stage where cure is still possible. Liver cancer is
the third deadliest cancer in the United States however, liver
cancer has received little funding for research, prevention, or
treatment.
(11) Treatment for chronic HCV can eradicate the disease in
approximately 75 percent of those currently treated. The
treatment of chronic HBV can effectively suppress viral
replication in the overwhelming majority (>80%) of those
treated thereby reducing the risk of transmission and
progression to liver scarring or liver cancer even though a
complete cure is much less common than for HCV.
(12) To combat the HBV and HCV epidemics in the United
States, in May 2011, the Department of Health and Human
Services released Combating the Silent Epidemic of Viral
Hepatitis: Action Plan for the Prevention, Care & Treatment of
Viral Hepatitis (hereafter referred to as the HHS Action Plan).
The Institute of Medicine (IOM) of the National Academies 2010
reported on the Federal response to HBV and HCV titled:
Hepatitis and Liver Cancer: A National Strategy for Prevention
and Control of Hepatitis B and C. These recommendations and
guidelines provide a framework for HBV and HCV prevention,
education, control, research, and medical management programs.
(13) The annual health care costs attributable to HBV and
HCV in the United States are significant. For HBV, it is
estimated to be approximately $1,000,000,000 to 2,000,000,000
($1,000 to $2,000 per infected person). More than
$1,000,000,000 is spent each year for HBV-related
hospitalizations. The indirect costs of chronic HBV infection
are harder to measure, but include reduced physical and
emotional quality of life, reduced economic productivity, long-
term disability, and premature death. For HCV, medical costs
for patients are expected to increase from $30,000,000,000 in
2009 to over $85,000,000,000 in 2024. Avoiding these costs by
screening and diagnosing individuals earlier--and connecting
them to appropriate treatment and care will save lives and
critical health care dollars. Currently, without a
comprehensive screening, testing and diagnosis program, most
patients are diagnosed too late when they need a liver
transplant costing at least $314,000 for uncomplicated cases or
when they have liver cancer or end stage liver disease which
costs $30,980 to $110,576 per hospital admission. As health
care costs continue to grow, it is critical that the Federal
Government invests in effective mechanisms to avoid documented
cost drivers.
(14) According to the IOM report in 2010, chronic HBV and
HCV infections cause substantial morbidity and mortality
despite being preventable and treatable. Deficiencies in the
implementation of established guidelines for the prevention,
diagnosis, and medical management of chronic HBV and HCV
infections perpetuate personal and economic burdens. Existing
grants are not sufficient for the scale of the health burden
presented by HBV and HCV.
(15) Screening and testing for HBV and HCV is aligned with
the Healthy People 2020 goal; Increase immunization rates and
reduce preventable infectious diseases. Awareness of disease
and access to prevention and treatment remain essential
components for reducing infectious disease transmission.
(16) Federal support is necessary to increase knowledge and
awareness of HBV and HCV and to assist State and local
prevention and control efforts in reducing the morbidity and
mortality of these epidemics.
(c) Biennial Assessment of HHS Hepatitis B and Hepatitis C
Prevention, Education, Research, and Medical Management Plan.--Title
III of the Public Health Service Act (42 U.S.C. 241 et seq.) is
amended--
(1) by striking section 317N (42 U.S.C. 247b-15); and
(2) by adding at the end the following:
``PART X--BIENNIAL ASSESSMENT OF HHS HEPATITIS B AND HEPATITIS C
PREVENTION, EDUCATION, RESEARCH, AND MEDICAL MANAGEMENT PLAN
``SEC. 399NN. BIENNIAL UPDATE OF THE PLAN.
``(a) In General.--The Secretary shall conduct a biennial
assessment of the Secretary's plan for the prevention, control, and
medical management of, and education and research relating to,
hepatitis B and hepatitis C, for the purposes of--
``(1) incorporating into such plan new knowledge or
observations relating to hepatitis B and hepatitis C (such as
knowledge and observations that may be derived from clinical,
laboratory, and epidemiological research and disease detection,
prevention, and surveillance outcomes);
``(2) addressing gaps in the coverage or effectiveness of
the plan; and
``(3) evaluating and, if appropriate, updating
recommendations, guidelines, or educational materials of the
Centers for Disease Control and Prevention or the National
Institutes of Health for health care providers or the public on
viral hepatitis in order to be consistent with the plan.
``(b) Publication of Notice of Assessments.--Not later than October
1 of the first even-numbered year beginning after the date of the
enactment of this part, and October 1 of each even-numbered year
thereafter, the Secretary shall publish in the Federal Register a
notice of the results of the assessments conducted under paragraph (1).
Such notice shall include--
``(1) a description of any revisions to the plan referred
to in subsection (a) as a result of the assessment;
``(2) an explanation of the basis for any such revisions,
including the ways in which such revisions can reasonably be
expected to further promote the original goals and objectives
of the plan; and
``(3) in the case of a determination by the Secretary that
the plan does not need revision, an explanation of the basis
for such determination.
``SEC. 399NN-1. ELEMENTS OF PROGRAM.
``(a) Education and Awareness Programs.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
the Administrator of the Health Resources and Services Administration,
and the Administrator of the Substance Abuse and Mental Health Services
Administration, and in accordance with the plan referred to in section
399NN(a), shall implement programs to increase awareness and enhance
knowledge and understanding of hepatitis B and hepatitis C. Such
programs shall include--
``(1) the conduct of culturally and language appropriate
health education in primary and secondary schools, college
campuses, public awareness campaigns, and community outreach
activities (especially to the ethnic communities with high
rates of chronic hepatitis B and chronic hepatitis C and other
high-risk groups) to promote public awareness and knowledge
about the value of hepatitis A and hepatitis B immunization,
risk factors, the transmission and prevention of hepatitis B
and hepatitis C, the value of screening for the early detection
of hepatitis B and hepatitis C, and options available for the
treatment of chronic hepatitis B and chronic hepatitis C;
``(2) the promotion of immunization programs that increase
awareness and access to hepatitis A and hepatitis B vaccines
for susceptible adults and children;
``(3) the training of health care professionals regarding
the importance of vaccinating individuals infected with
hepatitis C and individuals who are at risk for hepatitis C
infection against hepatitis A and hepatitis B;
``(4) the training of health care professionals regarding
the importance of vaccinating individuals chronically infected
with hepatitis B and individuals who are at risk for chronic
hepatitis B infection against the hepatitis A virus;
``(5) the training of health care professionals and health
educators to make them aware of the high rates of chronic
hepatitis B and chronic hepatitis C in certain adult ethnic
populations, and the importance of prevention, detection, and
medical management of hepatitis B and hepatitis C and of liver
cancer screening;
``(6) the development and distribution of health education
curricula (including information relating to the special needs
of individuals infected with hepatitis B and hepatitis C, such
as the importance of prevention and early intervention, regular
monitoring, the recognition of psychosocial needs, appropriate
treatment, and liver cancer screening) for individuals
providing hepatitis B and hepatitis C counseling; and
``(7) support for the implementation curricula described in
paragraph (6) by State and local public health agencies.
``(b) Immunization, Prevention, and Control Programs.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall support the integration of activities described in
paragraph (2) into existing clinical and public health programs
at State, local, territorial, and tribal levels (including
community health clinics, programs for the prevention and
treatment of HIV/AIDS, sexually transmitted diseases, and
substance abuse, and programs for individuals in correctional
settings).
``(2) Activities.--
``(A) Voluntary testing programs.--
``(i) In general.--The Secretary shall
establish a mechanism by which to support and
promote the development of State, local,
territorial, and tribal voluntary hepatitis B
and hepatitis C testing programs to screen the
high-prevalence populations to aid in the early
identification of chronically infected
individuals.
``(ii) Confidentiality of the test
results.--The Secretary shall prohibit the use
of the results of a hepatitis B or hepatitis C
test conducted by a testing program developed
or supported under this subparagraph for any of
the following:
``(I) Issues relating to health
insurance.
``(II) To screen or determine
suitability for employment.
``(III) To discharge a person from
employment.
``(B) Counseling regarding viral hepatitis.--The
Secretary shall support State, local, territorial, and
tribal programs in a wide variety of settings,
including those providing primary and specialty health
care services in nonprofit private and public sectors,
to--
``(i) provide individuals with ongoing risk
factors for hepatitis B and hepatitis C
infection with client-centered education and
counseling which concentrates on--
``(I) promoting testing of
individuals that have been exposed to
their blood, family members, and their
sexual partners; and
``(II) changing behaviors that
place individuals at risk for
infection;
``(ii) provide individuals chronically
infected with hepatitis B or hepatitis C with
education, health information, and counseling
to reduce their risk of--
``(I) dying from end-stage liver
disease and liver cancer; and
``(II) transmitting viral hepatitis
to others; and
``(iii) provide women chronically infected
with hepatitis B or hepatitis C who are
pregnant or of childbearing age with culturally
and language appropriate health information,
such as how to prevent hepatitis B perinatal
infection, and to alleviate fears associated
with pregnancy or raising a family.
``(C) Immunization.--The Secretary shall support
State, local, territorial, and tribal efforts to expand
the current vaccination programs to protect every child
in the country and all susceptible adults, particularly
those infected with hepatitis C and high-prevalence
ethnic populations and other high-risk groups, from the
risks of acute and chronic hepatitis B infection by--
``(i) ensuring continued funding for
hepatitis B vaccination for all children 19
years of age or younger through the Vaccines
for Children Program;
``(ii) ensuring that the recommendations of
the Advisory Committee on Immunization
Practices are followed regarding the birth dose
of hepatitis B vaccinations for newborns;
``(iii) requiring proof of hepatitis B
vaccination for entry into public or private
daycare, preschool, elementary school,
secondary school, and institutions of higher
education;
``(iv) expanding the availability of
hepatitis B vaccination for all susceptible
adults to protect them from becoming acutely or
chronically infected, including ethnic and
other populations with high prevalence rates of
chronic hepatitis B infection;
``(v) expanding the availability of
hepatitis B vaccination for all susceptible
adults, particularly those in their
reproductive age (women and men less than 45
years of age), to protect them from the risk of
hepatitis B infection;
``(vi) ensuring the vaccination of
individuals infected, or at risk for infection,
with hepatitis C against hepatitis A, hepatitis
B, and other infectious diseases, as
appropriate, for which such individuals may be
at increased risk; and
``(vii) ensuring the vaccination of
individuals infected, or at risk for infection,
with hepatitis B against hepatitis A virus and
other infectious diseases, as appropriate, for
which such individuals may be at increased
risk.
``(D) Medical referral.--The Secretary shall
support State, local, territorial, and tribal programs
that support--
``(i) referral of persons chronically
infected with hepatitis B or hepatitis C--
``(I) for medical evaluation to
determine the appropriateness for
antiviral treatment to reduce the risk
of progression to cirrhosis and liver
cancer; and
``(II) for ongoing medical
management including regular monitoring
of liver function and screening for
liver cancer; and
``(ii) referral of persons infected with
acute or chronic hepatitis B infection or acute
or chronic hepatitis C infection for drug and
alcohol abuse treatment where appropriate.
``(3) Increased support for adult viral hepatitis
coordinators.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall provide
increased support to Adult Viral Hepatitis Coordinators in
State, local, territorial, and tribal health departments in
order to enhance the additional management, networking, and
technical expertise needed to ensure successful integration of
hepatitis B and hepatitis C prevention and control activities
into existing public health programs.
``(c) Epidemiological Surveillance.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall support the establishment and maintenance of a national
chronic and acute hepatitis B and hepatitis C surveillance
program, in order to identify--
``(A) trends in the incidence of acute and chronic
hepatitis B and acute and chronic hepatitis C;
``(B) trends in the prevalence of acute and chronic
hepatitis B and acute and chronic hepatitis C infection
among groups that may be disproportionately affected;
and
``(C) trends in liver cancer and end-stage liver
disease incidence and deaths, caused by chronic
hepatitis B and chronic hepatitis C in the high-risk
ethnic populations.
``(2) Seroprevalence and liver cancer studies.--The
Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall prepare a report
outlining the population-based seroprevalence studies currently
underway, future planned studies, the criteria involved in
determining which seroprevalence studies to conduct, defer, or
suspend, and the scope of those studies, the economic and
clinical impact of hepatitis B and hepatitis C, and the impact
of chronic hepatitis B and chronic hepatitis C infections on
the quality of life. Not later than one year after the date of
the enactment of this part, the Secretary shall submit the
report to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate.
``(3) Confidentiality.--The Secretary shall not disclose
any individually identifiable information identified under
paragraph (1) or derived through studies under paragraph (2).
``(d) Research.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, the Director of the
National Cancer Institute, and the Director of the National Institutes
of Health, shall--
``(1) conduct epidemiologic and community-based research to
develop, implement, and evaluate best practices for hepatitis B
and hepatitis C prevention especially in the ethnic populations
with high rates of chronic hepatitis B and chronic hepatitis C
and other high-risk groups;
``(2) conduct research on hepatitis B and hepatitis C
natural history, pathophysiology, improved treatments and
prevention (such as the hepatitis C vaccine), and noninvasive
tests that help to predict the risk of progression to liver
cirrhosis and liver cancer;
``(3) conduct research that will lead to better noninvasive
or blood tests to screen for liver cancer, and more effective
treatments of liver cancer caused by chronic hepatitis B and
chronic hepatitis C; and
``(4) conduct research comparing the effectiveness of
screening, diagnostic, management, and treatment approaches for
chronic hepatitis B, chronic hepatitis C, and liver cancer in
the affected communities.
``(e) Underserved and Disproportionately Affected Populations.--In
carrying out this section, the Secretary shall provide expanded support
for individuals with limited access to health education, testing, and
health care services and groups that may be disproportionately affected
by hepatitis B and hepatitis C.
``(f) Evaluation of Program.--The Secretary shall develop
benchmarks for evaluating the effectiveness of the programs and
activities conducted under this section and make determinations as to
whether such benchmarks have been achieved.
``SEC. 399NN-2. GRANTS.
``(a) In General.--The Secretary may award grants to, or enter into
contracts or cooperative agreements with, States, political
subdivisions of States, territories, Indian tribes, or nonprofit
entities that have special expertise relating to hepatitis B, hepatitis
C, or both, to carry out activities under this part.
``(b) Application.--To be eligible for a grant, contract, or
cooperative agreement under subsection (a), an entity shall prepare and
submit to the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require.''.
(d) Enhancing SAMHSA's Role in Hepatitis Activities.--Paragraph (6)
of section 501(d) of the Public Health Service Act (42 U.S.C. 290aa(d))
is amended by striking ``HIV or tuberculosis'' and inserting ``HIV,
tuberculosis, or hepatitis''.
Subtitle C--Acquired Bone Marrow Failure Diseases
SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES.
(a) Short Title.--This subtitle may be cited as the ``Bone Marrow
Failure Disease Research and Treatment Act of 2012''.
(b) Findings.--The Congress finds the following:
(1) Between 20,000 and 30,000 Americans are diagnosed each
year with myelodysplastic syndromes, aplastic anemia,
paroxysmal nocturnal hemoglobinuria, and other acquired bone
marrow failure diseases.
(2) Acquired bone marrow failure diseases have a
debilitating and often fatal impact on those diagnosed with
these diseases.
(3) While some treatments for acquired bone marrow failure
diseases can prolong and improve the quality of patients'
lives, there is no single cure for these diseases.
(4) The prevalence of acquired bone marrow failure diseases
in the United States will continue to grow as the general
public ages.
(5) Evidence exists suggesting that acquired bone marrow
failure diseases occur more often in minority populations,
particularly in Asian-American and Hispanic/Latino populations.
(6) The National Heart, Lung, and Blood Institute and the
National Cancer Institute have conducted important research
into the causes of and treatments for acquired bone marrow
failure diseases.
(7) The National Marrow Donor Program Registry has made
significant contributions to the fight against bone marrow
failure diseases by connecting millions of potential marrow
donors with individuals and families suffering from these
conditions.
(8) Despite these advances, a more comprehensive Federal
strategic effort among numerous Federal agencies is needed to
discover a cure for acquired bone marrow failure disorders.
(9) Greater Federal surveillance of acquired bone marrow
failure diseases is needed to gain a better understanding of
the causes of acquired bone marrow failure diseases.
(10) The Federal Government should increase its research
support for and engage with public and private organizations in
developing a comprehensive approach to combat and cure acquired
bone marrow failure diseases.
(c) National Acquired Bone Marrow Failure Disease Registry.--Part B
of the Public Health Service Act (42 U.S.C. 311 et seq.) is amended by
inserting after section 317W, as added, the following:
``SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE DISEASE REGISTRY.
``(a) Establishment of Registry.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Director of the Centers for Disease Control and Prevention,
shall--
``(A) develop a system to collect data on acquired
bone marrow failure diseases; and
``(B) establish and maintain a national and
publicly available registry, to be known as the
National Acquired Bone Marrow Failure Disease Registry,
in accordance with paragraph (3).
``(2) Recommendations of advisory committee.--In carrying
out this subsection, the Secretary shall take into
consideration the recommendations of the Advisory Committee on
Acquired Bone Marrow Failure Diseases established under
subsection (b).
``(3) Purposes of registry.--The National Acquired Bone
Marrow Failure Disease Registry--
``(A) shall identify the incidence and prevalence
of acquired bone marrow failure diseases in the United
States;
``(B) shall be used to collect and store data on
acquired bone marrow failure diseases, including data
concerning--
``(i) the age, race or ethnicity, general
geographic location, sex, and family history of
individuals who are diagnosed with acquired
bone marrow failure diseases, and any other
characteristics of such individuals determined
appropriate by the Secretary;
``(ii) the genetic and environmental
factors that may be associated with developing
acquired bone marrow failure diseases;
``(iii) treatment approaches for dealing
with acquired bone marrow failure diseases;
``(iv) outcomes for individuals treated for
acquired bone marrow failure diseases,
including outcomes for recipients of stem cell
therapeutic products as contained in the
database established pursuant to section 379A;
and
``(v) any other factors pertaining to
acquired bone marrow failure diseases
determined appropriate by the Secretary; and
``(C) shall be made available--
``(i) to the general public; and
``(ii) to researchers to facilitate further
research into the causes of, and treatments
for, acquired bone marrow failure diseases in
accordance with standard practices of the
Centers for Disease Control and Preventions.
``(b) Advisory Committee.--
``(1) Establishment.--Not later than 6 months after the
date of the enactment of this section, the Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, shall establish an advisory committee, to be known
as the Advisory Committee on Acquired Bone Marrow Failure
Diseases.
``(2) Members.--The members of the Advisory Committee on
Acquired Bone Marrow Failure Diseases shall be appointed by the
Secretary, acting through the Director of the Centers for
Disease Control and Prevention, and shall include at least one
representative from each of the following:
``(A) A national patient advocacy organization with
experience advocating on behalf of patients suffering
from acquired bone marrow failure diseases.
``(B) The National Institutes of Health, including
at least one representative from each of--
``(i) the National Cancer Institute;
``(ii) the National Heart, Lung, and Blood
Institute; and
``(iii) the Office of Rare Diseases.
``(C) The Centers for Disease Control and
Prevention.
``(D) Clinicians with experience in--
``(i) diagnosing or treating acquired bone
marrow failure diseases; and
``(ii) medical data registries.
``(E) Epidemiologists who have experience with data
registries.
``(F) Publicly or privately funded researchers who
have experience researching acquired bone marrow
failure diseases.
``(G) The entity operating the C.W. Bill Young Cell
Transplantation Program established pursuant to section
379 and the entity operating the C.W. Bill Young Cell
Transplantation Program Outcomes Database.
``(3) Responsibilities.--The Advisory Committee on Acquired
Bone Marrow Failure Diseases shall provide recommendations to
the Secretary on the establishment and maintenance of the
National Acquired Bone Marrow Failure Disease Registry,
including recommendations on the collection, maintenance, and
dissemination of data.
``(4) Public availability.--The Secretary shall make the
recommendations of the Advisory Committee on Acquired Bone
Marrow Failure Disease publicly available.
``(c) Grants.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, may award grants to, and
enter into contracts and cooperative agreements with, public or private
nonprofit entities for the management of, as well as the collection,
analysis, and reporting of data to be included in, the National
Acquired Bone Marrow Failure Disease Registry.
``(d) Definition.--In this section, the term `acquired bone marrow
failure disease' means--
``(1) myelodysplastic syndromes (MDS);
``(2) aplastic anemia;
``(3) paroxysmal nocturnal hemoglobinuria (PNH);
``(4) pure red cell aplasia;
``(5) acute myeloid leukemia that has progressed from
myelodysplastic syndromes; or
``(6) large granular lymphocytic leukemia.''.
(d) Pilot Studies Through the Agency for Toxic Substances and
Disease Registry.--
(1) Pilot studies.--The Secretary of Health and Human
Services, acting through the Administrator of the Agency for
Toxic Substances and Disease Registry, shall conduct pilot
studies to determine which environmental factors, including
exposure to toxins, may cause acquired bone marrow failure
diseases.
(2) Collaboration with the radiation injury treatment
network.--In carrying out the directives of this section, the
Secretary may collaborate with the Radiation Injury Treatment
Network of the C.W. Bill Young Cell Transplantation Program
established pursuant to section 379 of the Public Health
Service Act (42 U.S.C. 274j) to--
(A) augment data for the pilot studies authorized
by this section;
(B) access technical assistance that may be
provided by the Radiation Injury Treatment Network; or
(C) perform joint research projects.
(e) Minority-Focused Programs on Acquired Bone Marrow Failure
Diseases.--Title XVII of the Public Health Service Act (42 U.S.C. 300u
et seq.) is amended by inserting after section 1707A the following:
``minority-focused programs on acquired bone marrow failure diseases
``Sec. 1707B. (a) Information and Referral Services.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Deputy Assistant Secretary for Minority Health, shall
establish and coordinate outreach and informational programs
targeted to minority populations affected by acquired bone
marrow failure diseases.
``(2) Program requirements.--Minority-focused outreach and
informational programs authorized by this section--
``(A) shall make information about treatment
options and clinical trials for acquired bone marrow
failure diseases publicly available, and
``(B) shall provide referral services for treatment
options and clinical trials,
at the national minority health resource center supported under
section 1707(b)(8) (including by means of the center's Web
site, through appropriate locations such as the center's
knowledge center, and through appropriate programs such as the
center's resource persons network) and through minority health
consultants located at each Department of Health and Human
Services regional office.
``(b) Hispanic and Asian-American and Pacific Islander Outreach.--
``(1) In general.--The Secretary, acting through the Deputy
Assistant Secretary for Minority Health, shall undertake a
coordinated outreach effort to connect Hispanic, Asian-
American, and Pacific Islander communities with comprehensive
services focused on treatment of, and information about,
acquired bone marrow failure diseases.
``(2) Collaboration.--In carrying out this subsection, the
Secretary may collaborate with public health agencies,
nonprofit organizations, community groups, and online entities
to disseminate information about treatment options and clinical
trials for acquired bone marrow failure diseases.
``(c) Grants and Cooperative Agreements.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Deputy Assistant Secretary for Minority Health, shall award
grants to, or enter into cooperative agreements with, entities
to perform research on acquired bone marrow failure diseases.
``(2) Requirement.--Grants and cooperative agreements
authorized by this subsection shall be awarded or entered into
on a competitive, peer-reviewed basis.
``(3) Scope of research.--Research funded under this
section shall examine factors affecting the incidence of
acquired bone marrow failure diseases in minority populations.
``(d) Definition.--In this section, the term `acquired bone marrow
failure disease' has the meaning given to such term in section
317X(d).''.
(f) Diagnosis and Quality of Care for Acquired Bone Marrow Failure
Diseases.--The Secretary of Health and Human Services, acting through
the Director of the Agency for Healthcare Research and Quality, shall
award grants to entities to improve diagnostic practices and quality of
care with respect to patients with acquired bone marrow failure
diseases.
(g) Definition.--In this section, the term ``acquired bone marrow
failure disease'' means--
(1) myelodysplastic syndromes (MDS);
(2) aplastic anemia;
(3) paroxysmal nocturnal hemoglobinuria (PNH);
(4) pure red cell aplasia;
(5) acute myeloid leukemia that progressed from
myelodysplastic syndromes; or
(6) large granular lymphocytic leukemia.
Subtitle D--Cardiovascular Disease, Chronic Disease, and Other Disease
Issues
SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MINORITY PATIENTS.
(a) In General.--The Secretary, acting through the Director of the
Agency for Healthcare Research and Quality, shall convene a series of
meetings to develop guidelines for disease screening for minority
patient populations which have a higher than average risk for many
chronic diseases and cancers.
(b) Participants.--In convening meetings under subsection (a), the
Secretary shall ensure that meeting participants include
representatives of--
(1) professional societies and associations;
(2) minority health organizations;
(3) health care researchers and providers, including those
with expertise in minority health;
(4) Federal health agencies, including the Office of
Minority Health, the National Institute on Minority Health and
Health Disparities, and the National Institutes of Health; and
(5) other experts determined appropriate by the Secretary.
(c) Diseases.--Screening guidelines for minority populations shall
be developed as appropriate under subsection (a) for--
(1) hypertension;
(2) hypercholesterolemia;
(3) diabetes;
(4) cardiovascular disease;
(5) cancers, including breast, prostate, colon, cervical,
and lung cancer;
(6) asthma;
(7) diabetes;
(8) kidney diseases;
(9) eye diseases and disorders, including glaucoma;
(10) HIV/AIDS and sexually transmitted diseases;
(11) uterine fibroids;
(12) autoimmune disease;
(13) mental health conditions;
(14) dental health conditions and oral diseases;
(15) environmental and related health illnesses and
conditions;
(16) Sickle cell disease;
(17) violence and injury prevention and control;
(18) genetic and related conditions;
(19) heart disease and stroke;
(20) tuberculosis;
(21) chronic obstructive pulmonary disease; and
(22) other diseases determined appropriate by the
Secretary.
(d) Dissemination.--Not later than 24 months after the date of
enactment of this title, the Secretary shall publish and disseminate to
health care provider organizations the guidelines developed under
subsection (a).
SEC. 732. COVERAGE OF THE SHINGLES VACCINE UNDER THE MEDICARE PROGRAM.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended--
(1) in subsection (s)(10)(A), by inserting ``, shingles
vaccine and its administration,'' before ``and, subject to'';
and
(2) in subsection (ww)(2)(A), by inserting ``shingles,''
after ``Pneumococcal,''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to shingles vaccine furnished on or after January 1 of the first
calendar year beginning more than 60 days after the date of the
enactment of this Act.
SEC. 733. CDC WISEWOMAN SCREENING PROGRAM.
Section 1509 of the Public Health Service Act (42 U.S.C. 300n-4a)
is amended--
(1) in subsection (a)--
(A) by striking the heading and inserting ``In
General.--''; and
(B) in the matter preceding paragraph (1), by
striking ``may make grants'' and all that follows
through ``purpose'' and inserting the following: ``may
make grants to such States for the purpose''; and
(2) in subsection (d)(1), by striking ``there are
authorized'' and all that follows through the period and
inserting ``there are authorized to be appropriated $23,000,000
for fiscal year 2012, $25,300,000 for fiscal year 2013,
$27,800,000 for fiscal year 2014, $30,800,000 for fiscal year
2015, and $34,000,000 for fiscal year 2016.''.
SEC. 734. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-7. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.
``Not later than September 30, 2014, and annually thereafter, the
Secretary shall prepare and submit to the Congress a report on the
quality of and access to care for women and minorities with heart
disease, stroke, and other cardiovascular diseases. The report shall
contain recommendations for eliminating disparities in, and improving
the treatment of, heart disease, stroke, and other cardiovascular
diseases in women, racial and ethnic minorities, those for whom English
is not their primary language, and individuals with disabilities.''.
SEC. 735. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES IN
MEDICAID.
(a) Requiring Coverage of Counseling and Pharmacotherapy for
Cessation of Tobacco Use.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended--
(1) in subsection (a)(4), by striking ``by pregnant
women''; and
(2) in subsection (bb)--
(A) by striking ``by pregnant women'' each place it
appears;
(B) in paragraph (1), in the matter before
subparagraph (A), by inserting ``by individuals''
before ``who use tobacco''; and
(C) in paragraph (2)(A), by striking ``with respect
to pregnant women''.
(b) Exception From Optional Restriction Under Medicaid Prescription
Drug Coverage.--Section 1927(d)(2)(F) of the Social Security Act (42
U.S.C. 1396r-8(d)(2)(F)) is amended by striking ``in the case of
pregnant women''.
(c) Removal of Cost Sharing for Counseling and Pharmacotherapy for
Cessation of Tobacco Use.--
(1) General cost sharing limitations.--Section 1916 of the
Social Security Act (42 U.S.C. 1396o) is amended--
(A) in subsections (a)(2)(B) and (b)(2)(B), by
striking ``, and counseling and pharmacotherapy for
cessation of tobacco use by pregnant women (as defined
in section 1905(bb)) and covered outpatient drugs (as
defined in subsection (k)(2) of section 1927 and
including nonprescription drugs described in subsection
(d)(2) of such section) that are prescribed for
purposes of promoting, and when used to promote,
tobacco cessation by pregnant women in accordance with
the Guideline referred to in section 1905(bb)(2)(A)''
each place it appears; and
(B) in each of subsections (a)(2)(D) and (b)(2)(D)
by inserting ``and counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1905(bb)) and covered outpatient drugs (as defined in
subsection (k)(2) of section 1927 and including
nonprescription drugs described in subsection (d)(2) of
such section) that are prescribed for purposes of
promoting, and when used to promote, tobacco cessation
in accordance with the Guideline referred to in section
1905(bb)(2)(A),'' after ``section 1905(a)(4)(C),''.
(2) Application to alternative cost-sharing.--Section
1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-1(b)(3)(B)) is
amended--
(A) in clause (iii), by striking ``, and counseling
and pharmacotherapy for cessation of tobacco use by
pregnant women (as defined in section 1905(bb))''; and
(B) by adding at the end the following:
``(xi) Counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1905(bb)) and covered outpatient drugs (as
defined in subsection (k)(2) of section 1927
and including nonprescription drugs described
in subsection (d)(2) of such section) that are
prescribed for purposes of promoting, and when
used to promote, tobacco cessation in
accordance with the Guideline referred to in
section 1905(bb)(2)(A).''.
(d) Effective Date.--The amendments made by this section shall take
effect on October 1, 2012.
SEC. 736. CLINICAL RESEARCH FUNDING FOR ORAL HEALTH.
(a) In General.--The Secretary of Health and Human Services shall
expand and intensify the conduct and support of the research activities
of the National Institutes of Health and the National Institute of
Dental and Craniofacial Research to improve the oral health of the
population through the prevention and management of oral diseases and
conditions.
(b) Included Research Activities.--Research activities under
subsection (a) shall include--
(1) comparative effectiveness research and clinical disease
management research addressing early childhood caries and oral
cancer; and
(2) awarding of grants and contracts to support the
training and development of health services researchers,
comparative effectiveness researchers, and clinical researchers
whose research improves the oral health of the population.
SEC. 737. PARTICIPATION BY MEDICAID BENEFICIARIES IN APPROVED CLINICAL
TRIALS.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by inserting after section 1943 the following
new section:
``participation in an approved clinical trial
``Sec. 1944. (a) Coverage of Routine Patient Costs Associated With
Approved Clinical Trials.--
``(1) Inclusion.--Subject to paragraph (2), routine patient
costs shall include all items and services consistent with the
medical assistance provided under the State plan that would
otherwise be provided to the individual under such State plan
if such individual was not enrolled in the approved clinical
trial, including any items or services related to the
prevention, detection, and treatment of any medical
complications that arise as a result of participation in the
approved clinical trial.
``(2) Exclusion.--For purposes of paragraph (1), routine
patient costs does not include--
``(A) the investigational item, device, or service
itself;
``(B) items and services that are provided solely
to satisfy data collection and analysis needs and that
are not used in the direct clinical management of the
patient; or
``(C) a service that is clearly inconsistent with
widely accepted and established standards of care for a
particular diagnosis.
``(3) Information concerning clinical trials.--
``(A) In general.--Subject to subparagraph (B), the
Secretary, in consultation with relevant stakeholders,
shall develop a single standardized electronic form for
use by the individual or the referring health care
provider to submit to the State agency administering
the State plan in order to verify that the clinical
trial meets the conditions established for an approved
clinical trial (as defined in subsection (c)).
``(B) Excluded information.--For purposes of
subparagraph (A) or any such request by the State
agency for information regarding a clinical trial, an
individual or referring health care provider shall not
be required to submit--
``(i) the clinical protocol document for
the clinical trial; or
``(ii) subject to subparagraph (C), any
additional information other than such
information as is required pursuant to the form
described in subparagraph (A).
``(C) Optional information.--For purposes of
subparagraphs (A) and (B)(ii), the form may include a
requirement that the referring health care provider
attest that the individual is eligible to participate
in the clinical trial pursuant to the trial protocol
and that their participation in such trial would be
appropriate.
``(D) Review of information.--
``(i) In general.--A State plan under this
title shall establish a process for timely
review by the State agency of the form and
information submitted pursuant to subparagraph
(A) and, not later than 48 hours after receipt
of such form, confirmation that the information
provided in such form satisfies the
requirements established under such
subparagraph, with such process to include
establishment and operation of a 24-hour toll-
free telephone number and e-mail address to
provide for expedited communication.
``(ii) Failure to respond.--If an
individual or the referring health care
provider does not receive a response or request
for additional information from the State
agency following the 48-hour period described
in clause (i), the information provided in the
form may be presumed to satisfy the
requirements established under this paragraph.
``(b) Encouragement of Participation in Approved Clinical Trials.--
``(1) Reasonably accessible provider.--For purposes of
participation in an approved clinical trial by an individual
eligible for medical assistance under this title, the State
agency administering the State plan shall make reasonable
efforts to ensure that the individual is provided with access
to a provider who is--
``(A) participating in the approved clinical trial;
``(B) located not more than 25 miles from the
residence of the individual (or, if no such provider is
available, as close as possible to the residence of the
individual); and
``(C) a participating provider under the State plan
or has been deemed to be a participating provider under
the State plan for purposes of providing medical
assistance to the individual during their participation
in the approved clinical trial.
``(2) Informational materials.--The State agency
administering the plan approved under this title shall develop
informational materials and programs to encourage participating
providers to make appropriate referrals to physicians and other
appropriate health care professionals who can provide
individuals with access to approved clinical trials.
``(c) Definition of Approved Clinical Trial.--The term `approved
clinical trial' has the same meaning as provided under section 2709(d)
of the Public Health Service Act.''.
(b) Conforming Amendments.--Section 1902(a) of such Act (42 U.S.C.
1396a(a)) is amended--
(1) in paragraph (82)(C), by striking ``and'' at the end;
(2) in paragraph (83), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (83) the following:
``(84) provide that participation in an approved clinical
trial and coverage of routine patient costs associated with
such trial for an individual eligible for medical assistance
under this title is conducted in accordance with the
requirements under section 1944.''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to calendar
quarters beginning on or after October 1, 2012.
(2) Delay permitted for state plan amendment.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
Subtitle E--HIV/AIDS
SEC. 741. FINDINGS.
The Congress finds the following:
(1) Over one million people are estimated to be living with
HIV in the United States according to the Centers for Disease
Control and Prevention.
(2) Annually there are over 17,000 deaths in people with an
HIV diagnoses in 40 States and 5 dependent areas of the United
States.
(3) The Centers for Disease Control and Prevention
estimates that in 2009 there were approximately 48,100 people
newly infected with HIV. Though this number seems to be staying
relatively stable, the number of new infections is rapidly
increasing among certain populations especially among young
African-American men who have sex with men who had an overall
48 percent increase in new infections from 2006 to 2009.
(4) HIV disproportionately affects certain populations in
the United States. Though African-Americans represent less than
13 percent of the population, African-Americans account for
almost half (46 percent) of all people living with HIV in the
United States. Men who have sex with men (MSM) make up
approximately 2 percent of the population, but account for over
half (53 percent) of individuals living with HIV and are the
only risk group in which HIV infections continue to increase.
(5) Disparities exist among Latinos; they make up 15
percent of US population and 17 percent of new infections
(2006).
(6) Though American Indians/Alaska Natives represent less
than 1 percent of the total number of HIV/AIDS cases, American
Indians and Alaska Natives rank third in rates of HIV/AIDS
diagnosis, after African-Americans and Latinos.
(7) While Asian-Americans, Native Hawaiians, and Pacific
Islanders HIV/AIDS cases account for approximately 1 percent of
cases nationally, Asian Americans and Pacific Islanders were
the only racial/ethnic groups with a statistically significant
increase in new HIV diagnoses between 2001 and 2008.
(8) The limited data available on transgender individuals
point to a disproportionate burden of HIV infection.
(9) Stigma and discrimination contribute to these
disparities.
(10) For HIV, early detection and treatment can have huge
effects. New research suggests that treatment of individuals
not only slows disease progression, but can also greatly reduce
the risk of transmission to other individuals.
(11) To combat the HIV epidemic in the United States, the
National HIV/AIDS Strategy (NHAS) from the White House Office
of National AIDS Policy provides a framework of increasing
access to care, reducing new infections, and eliminating HIV-
related health disparities. The vision of NHAS is ``The United
States will become a place where new HIV infections are rare
and when they do occur, every person, regardless of age,
gender, race/ethnicity, sexual orientation, gender identity, or
socio-economic circumstance, will have unfettered access to
high quality, life extending care, free from stigma and
discrimination.''.
(12) Although the cost of education, treatment and care,
and research are not inconsequential, they are substantially
less than the annual health care cost attributable to HIV in
the United States. The lifetime cost of HIV care and treatment
in 2004 was estimated to be $405,000 to $648,000 dollars
annually. Preventing 40,000 new infections in the United States
each year would save $12.8 billion annually.
SEC. 742. ADDRESSING HIV/AIDS IN COMMUNITIES OF COLOR.
(a) National Observance Days.--It is the sense of the Congress that
national observance days highlighting the impact of HIV/AIDS on
communities of color include the following:
(1) National Black HIV/AIDS Awareness Day.
(2) National Latino AIDS Awareness Day.
(3) National Asian and Pacific Islander HIV/AIDS Awareness
Day.
(4) National Native HIV/AIDS Awareness Day.
(5) Caribbean American HIV/AIDS Awareness Day.
(b) Call to Action.--It is the sense of the Congress that the
President should call on members of communities of color--
(1) to become involved at the local community level in HIV/
AIDS testing, policy, and advocacy;
(2) to become aware, engaged, and empowered on the HIV/AIDS
epidemic within their communities; and
(3) to urge members of their communities to reduce risk
factors, practice safe sex and other preventive measures, be
tested for HIV/AIDS, and seek care when appropriate.
SEC. 743. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MINORITY COMMUNITIES.
(a) Expanded Funding.--The Secretary, in collaboration with the
Deputy Assistant Secretary for Minority Health, the Director of the
Centers for Disease Control and Prevention, the Administrator of the
Health Resources and Services Administration, and the Administrator of
the Substance Abuse and Mental Health Services Administration, shall
provide funds and carry out activities to expand the Minority HIV/AIDS
Initiative.
(b) Use of Funds.--The additional funds made available under this
section may be used, through the Minority AIDS Initiative, to support
the following activities:
(1) Providing technical assistance and infrastructure
support to reduce HIV/AIDS in minority populations.
(2) Increasing minority populations' access to HIV/AIDS
prevention and care services.
(3) Building strong community programs and partnerships to
address HIV prevention and the health care needs of specific
racial and ethnic minority populations.
(c) Priority Interventions.--Within the racial and ethnic minority
populations referred to in subsection (b), priority in conducting
intervention services shall be given to--
(1) women;
(2) youth;
(3) men who have sex with men;
(4) persons who engage in intravenous drug abuse;
(5) homeless individuals; and
(6) individuals incarcerated or in the penal system.
SEC. 744. REPEALING INEFFECTIVE AND INCOMPLETE ABSTINENCE-ONLY
EDUCATION PROGRAM.
(a) In General.--Title V of the Social Security Act (42 U.S.C. 701
et seq.) is amended by striking section 510.
(b) Rescission.--Amounts appropriated for each of fiscal years 2010
and 2011 under section 510(d) of the Social Security Act (42 U.S.C.
710(d)) (as in effect on the day before the date of enactment of this
Act) that are unobligated as of the date of enactment of this Act are
rescinded.
(c) Reprogram of Eliminated Abstinence-Only Funds for the Personal
Responsibility Education Program (prep).--Section 513(f) of the Social
Security Act (42 U.S.C. 713(f)) is amended by striking ``for each of
fiscal years 2010 through 2014'' and inserting ``for fiscal year 2010,
$75,000,000 increased by an amount equal to the unobligated portion of
funds appropriated for each of fiscal years 2010 and 2011 under section
510(d) that are rescinded under subsection (b), and $125,000,000 for
each of fiscal years 2012 through 2014''.
SEC. 745. DENTAL EDUCATION LOAN REPAYMENT PROGRAM.
(a) In General.--The Secretary of Health and Human Services may
enter into an agreement with any dentist under which--
(1) the dentist agrees to serve as a dentist for a period
of not less than 2 years at a facility with a critical shortage
of dentists (as determined by the Secretary) in an area with a
high incidence of HIV/AIDS; and
(2) the Secretary agrees to make payments in accordance
with subsection (b) on the dental education loans of the
dentist.
(b) Manner of Payments.--The payments described in subsection (a)
shall be made by the Secretary as follows:
(1) Upon completion by the dentist for whom the payments
are to be made of the first year of the service specified in
the agreement entered into with the Secretary under subsection
(a), the Secretary shall pay 30 percent of the principal of and
the interest on the dental education loans of the dentist.
(2) Upon completion by the dentist of the second year of
such service, the Secretary shall pay another 30 percent of the
principal of and the interest on such loans.
(3) Upon completion by that individual of a third year of
such service, the Secretary shall pay another 25 percent of the
principal of and the interest on such loans.
(c) Applicability of Certain Provisions.--The provisions of subpart
III of part D of title III of the Public Health Service Act (42 U.S.C.
254l et seq.) shall, except as inconsistent with this section, apply to
the program carried out under this section in the same manner and to
the same extent as such provisions apply to the National Health Service
Corps Loan Repayment Program.
(d) Reports.--Not later than 18 months after the date of the
enactment of this Act, and annually thereafter, the Secretary shall
prepare and submit to the Congress a report describing the program
carried out under this section, including statements regarding the
following:
(1) The number of dentists enrolled in the program.
(2) The number and amount of loan repayments.
(3) The placement location of loan repayment recipients at
facilities described in subsection (a)(1).
(4) The default rate and actions required.
(5) The amount of outstanding default funds.
(6) To the extent that it can be determined, the reason for
the default.
(7) The demographics of individuals participating in the
program.
(8) An evaluation of the overall costs and benefits of the
program.
(e) Definitions.--In this section:
(1) The term ``dental education loan''--
(A) means a loan that is incurred for the cost of
attendance (including tuition, other reasonable
educational expenses, and reasonable living costs) at a
school of dentistry; and
(B) includes only the portion of the loan that is
outstanding on the date the dentist involved begins the
service specified in the agreement under subsection
(a).
(2) The term ``dentist'' means a graduate of a school of
dentistry who has completed postgraduate training in general or
pediatric dentistry.
(3) The term ``HIV/AIDS'' means human immunodeficiency
virus and acquired immune deficiency syndrome.
(4) The term ``school of dentistry'' has the meaning given
to that term in section 799B of the Public Health Service Act
(42 U.S.C. 295p).
(5) The term ``Secretary'' means the Secretary of Health
and Human Services.
SEC. 746. REPORT ON THE IMPLEMENTATION OF THE NATIONAL HIV/AIDS
STRATEGY.
(a) Report Required.--Not later than 6 months after the date of the
enactment of this Act, the President, in consultation with the heads of
all relevant agencies including the Department of Education, the
Department of Health and Human Services, the Department of Housing and
Urban Development, the Department of Justice, the Department of Labor,
the Department of Veterans Affairs, and the Social Security
Administration, shall transmit to the Congress and make publicly
available a report on the status of the implementation of the National
HIV/AIDS Strategy.
(b) Contents.--The report required by subsection (a) shall include
a description, analysis, and evaluation of--
(1) key steps taken by the Federal Government towards the
achievement of the goals of the National HIV/AIDS Strategy,
including the goals of--
(A) reducing the number of people who become
infected with HIV;
(B) increasing access to care and optimizing health
outcomes for people living with HIV; and
(C) reducing HIV-related health disparities;
(2) the extent to which the National HIV/AIDS Strategy has
improved coordination of efforts to maximize the effective
delivery of HIV/AIDS prevention, care, and treatment services
at the community level, including coordination--
(A) within and among Federal agencies and
departments;
(B) between the Federal Government and State and
local governments and health departments;
(C) between the Federal Government and nonprofit
foundations and civil society organizations, including
community- and faith-based organizations focused on
addressing the issue of HIV/AIDS; and
(D) between the Federal Government and private
businesses;
(3) efforts by the Federal Government to educate, involve,
and establish and strengthen partnerships with civil society
organizations, including community- and faith-based
organizations, in order to implement the National HIV/AIDS
Strategy and achieve its goals;
(4) how Federal resources are being deployed to implement
the Strategy, including--
(A) the amount of funding used to date, by each
Federal agency and department, to implement the
National HIV/AIDS Strategy;
(B) a brief summary for each Federal agency and
department of the number and function of all Federal
employees assisting in implementing the Strategy; and
(C) an estimate of the amount of funding necessary
to implement the National HIV/AIDS Strategy, by each
Federal agency and department, for the next fiscal
year; and
(5) what additional steps, if any, are necessary to fully
implement the National HIV/AIDS Strategy, including--
(A) whether any existing statutory laws, policies,
or regulations are impeding the implementation of the
National HIV/AIDS Strategy, at the Federal, State, or
local level, and whether any changes to such laws,
policies, or regulations are necessary or recommended;
and
(B) whether any Federal agencies or departments
require additional statutory authority to effectively
carry out their duties as part of the National HIV/AIDS
Strategy.
(c) Use of Previously Appropriated Funds.--Funding for the report
required under subsection (a) shall derive from discretionary funds of
the departments and agencies specified in such subsection.
SEC. 747. ADDRESSING HIV/AIDS IN THE AFRICAN-AMERICAN COMMUNITY.
(a) Sense of Congress on National Black Clergy HIV/AIDS Awareness
Sunday.--It is the sense of Congress that--
(1) there should be established a National Black Clergy
HIV/AIDS Awareness Sunday on which the Congress and the
President call on members of the Black clergy--
(A) to become involved at the local community level
in HIV/AIDS testing, policy, and advocacy;
(B) to discuss the HIV/AIDS epidemic with their
congregations and the community at-large; and
(C) to urge members of their congregations to
reduce risk factors, practice safe sex and other
preventive measures, be tested for HIV/AIDS, and seek
care when appropriate; and
(2) an appropriate Sunday should be selected for this
occasion.
(b) Sense of Congress on Federal Agencies With Responsibility for
Preventing, Testing for, and Treating HIV/AIDS.--It is the sense of
Congress that all Federal agencies with a responsibility for
preventing, testing for, and treating HIV/AIDS should--
(1) adopt policies for prevention, testing, and treatment
that are consistent with the guidelines issued in 2006 by the
Centers for Disease Control and Prevention, entitled ``Revised
Recommendations for HIV Testing of Adults, Adolescents, and
Pregnant Women in Health-Care Settings''; and
(2) begin a systemic, aggressive approach to implementing
voluntary, routine testing as part of all health exams,
including in emergency rooms, clinics, and private physician
offices.
(c) Sense of Congress on Federal Bureau of Prisons Procedures for
Inmates With HIV.--It is the sense of Congress that the Federal Bureau
of Prisons should implement procedures for--
(1) voluntary HIV testing as a routine component of inmate
care; and
(2) referral to care as a routine component of release
planning for inmates with HIV/AIDS, including referral to
community-based care and faith-based institutions.
SEC. 748. NATIONAL BLACK CLERGY FOR THE ELIMINATION OF HIV/AIDS.
(a) Short Title.--This section may be cited as the ``National Black
Clergy for the Elimination of HIV/AIDS Act of 2012''.
(b) Findings.--Congress finds the following:
(1) It has been estimated that more than 1,200,000 people
in the United States are living with HIV/AIDS, and
approximately 500,000 of them are Black. Blacks are 8 times
more likely to have AIDS than their White counterparts. Within
the Black community, the subpopulation most disproportionately
impacted by HIV/AIDS is Black men who have sex with men (MSM)
with prevalence rates twice those of White MSM. Black women
account for the majority of new AIDS cases among women and are
23 times more likely to be living with AIDS than White women
and 4 times more likely than Latinas.
(2) On October 7-8, 2007, 186 Black clergy, consisting of
Baptist, COGIC, Methodist, Protestant, AME, and Pentecostal,
together with, medical, policy, and AIDS leaders, were brought
together by the National Black Leadership Commission on AIDS
(NBLCA), the oldest and largest Black AIDS organization of its
kind in America, hosted by Time Warner, Inc., with other
foundation support, to participate in the National Black Clergy
Conclave On HIV/AIDS Policy.
(3) The attendees included faith leaders across
traditional, mega, and activist churches representing millions
of congregants: the National Medical Association (NMA)
representing 30,000 African-American physicians; the National
Conference of Black Mayors; the National Caucus of Black State
Legislators; and the Health Brain Trust of the Congressional
Black Caucus and key African-American HIV/AIDS advocates from
across the United States. This group developed a plan of action
that has become the National Black Clergy for the Elimination
of HIV/AIDS Act of 2012 to respond to the ``on the ground''
emergency in prevention, care, and treatment for AIDS in Black
America.
(4) In August 2007, the NMA, the oldest and largest
organization representing 30,000 African-American physicians,
released a consensus report entitled ``Addressing The HIV/AIDS
Crisis In The African American Community: Fact, Fiction and
Policy''; and specifically called on the next President of the
United States to declare HIV/AIDS in African-American
communities a public health emergency and worked with NBLCA to
organize clergy to advocate for the specific needs of Black
physicians, their patients, and those at risk in African-
American communities; and have pledged to advocate and work
with clergy to develop, execute, and implement these
initiatives as a part of their rightful role of leadership in
African-American communities and culture.
(5) The National Conference of Black Mayors has pledged to
work with clergy, medical, and community leaders to develop and
support these initiatives on a local level and to help them to
continue to develop a policy agenda leading to the elimination
of HIV/AIDS.
(6) The National Caucus of Black State Legislators pledged
to take the initiatives herein to their body and develop plans
of action for Black State Legislators to work with local
clergy, health departments, and CBOs to adopt and implement
these initiatives on a national level.
(7) At their April 2008 annual meeting, the National Policy
Alliance (NPA), consisting of the Joint Center For Political
and Economic Studies (secretariat) and the National Black
Caucus of School Board Members, National Black Caucus of Local
Elected Officials; the Judicial Council of the National Bar
Association; the National Association of Black County
Officials; Blacks in Government and the CBC; NCBM; WCM, voted
unanimously to support, endorse, and encourage the passage of
the National Black Clergy for the Elimination of HIV/AIDS Act
of 2012 and to organize their respective members to endorse and
support the passage of this bill.
(8) The World Conference of Black Mayors has ratified its
support of these initiatives and legislation, and pledged to
assist the clergy to take them internationally.
(9) The National Black Leadership Commission on AIDS, the
Balm in Gilead, and the Black AIDS Institute have been
recognized by the clergy for their tradition and history of
service and will work with clergy to conduct community and
policy development, linkages to local departments of health and
other services, infrastructure development, education media,
and fund development activities.
(10) Bishop T.D. Jakes of the Potters House in Dallas,
Texas, and Rev. Calvin O. Butts of the Abyssinian Baptist
Church in Harlem, New York, and chairman of the National Black
Leadership Commission on AIDS have been recognized as the
organizers of this group and will help guide and lead the
development efforts of fellow clergy through this process.
(11) The National Conclave on HIV/AIDS for Black Clergy
calls upon the President, Congress, and corporate America to
declare the HIV/AIDS crisis in the African-American community a
``public health emergency''.
(12) The Black clergy will aggressively seek to have every
person under the sphere of their influence tested for HIV in
order to know the person's status.
(13) The Black clergy will promote HIV/AIDS awareness to
ensure that all Black clergy serving in their denominations and
other congregations are equipped to address issues related to
this disease in a factual and scientifically sound manner.
(14) The Black clergy will use the ABC/D model as a
behavioral guideline for prevention initiatives:
(A) A-Abstain.
(B) B-Be Faithful.
(C) C-Use Condoms.
(D) D-Don't Engage in Risky Behaviors.
(c) Definitions Applicable Throughout Section.--In this section--
(1) the terms ``HIV'' and ``HIV/AIDS'' have the meanings
given to such terms in section 2689 of the Public Health
Service Act (42 U.S.C. 300ff-88); and
(2) the term ``Secretary'' means the Secretary of Health
and Human Services.
(d) Services To Reduce HIV/AIDS in the African-American
Community.--For the purpose of reducing HIV/AIDS in the African-
American community, the Secretary, acting through the Deputy Assistant
Secretary for Minority Health, may make grants to public health
agencies and faith-based organizations to conduct--
(1) outreach activities related to HIV/AIDS prevention and
testing activities;
(2) HIV/AIDS prevention activities; and
(3) HIV/AIDS testing activities.
(e) Grants for Substance Abuse and Mental Health Services to Public
Health Agencies and Faith-Based Organizations.--The Secretary, acting
through the Administrator of the Substance Abuse and Mental Health
Services Administration, may make grants to public health agencies and
faith-based organizations to--
(1) conduct HIV/AIDS and sexually transmitted disease
outreach, prevention, and testing activities that are targeted
to the African-American community; and
(2) in connection with such activities, provide substance
abuse testing and mental health services to members of such
community.
(f) Services for HIV/AIDS Affected Youth Who Are Separated From
Their Families.--The Secretary, acting through the Administrator of the
Substance Abuse and Mental Health Services Administration, may make
grants to faith- and community-based organizations to provide family
reunification services, mental health counseling, HIV/AIDS and sexually
transmitted disease testing, and substance abuse testing and treatment
to youth who--
(1)(A) have run away from home;
(B) are homeless; or
(C) reside in a detention center or foster care; and
(2) are HIV positive or at risk for HIV/AIDS, including
young men who have sex with men.
(g) Public Health Intervention and Prevention Activities.--
(1) In general.--For the purpose of reducing HIV/AIDS,
sexually transmitted diseases, tuberculosis, and viral
hepatitis in African-American communities, the Secretary,
acting through the Director of the Centers for Disease Control
and Prevention, may make grants to faith-based organizations
for public health intervention and prevention activities,
including the use of rapid testing in traditional and
nontraditional settings to increase the number of individuals
who know their status at the point of care and are put into
treatment.
(2) Partnerships.--In carrying out this subsection, the
Secretary shall encourage grantees to enter into partnerships
with public health agencies.
(h) HIV/AIDS Prevention and Education.--
(1) Prevention activities.--The Secretary, acting through
the Director of the Centers for Disease Control and Prevention,
shall expand and intensify HIV/AIDS prevention activities in
African-American communities. Such activities--
(A) shall be targeted to specific populations;
(B) shall be comprehensive and accurately based on
science and research; and
(C) shall include information on abstinence, the
proper use of condoms, risks associated with
unprotected sex, and the value of sexual delay
particularly among young adolescents and teenagers.
(2) Education.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall expand
and intensify HIV/AIDS educational activities targeting Black
women, youth, and men who have sex with men.
(3) Coordination.--The Secretary shall carry out this
subsection in coordination with public schools of all levels,
Black organizations, historically Black colleges and
universities, and faith-based organizations and institutions.
(i) Building Capacity of Communities.--
(1) In general.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall expand
funding to eligible entities to build the capacity of African-
American communities to respond to HIV/AIDS.
(2) Emphasis.--In carrying out this subsection, the
Secretary shall emphasize the provision of funding for policy
development, education, technical assistance, and training--
(A) to national and local faith-based
organizations; and
(B) to organizations with a significant history of
working within the African-American community on HIV/
AIDS issues, an interdenominational center of
seminaries specializing in the training of African-
American clergy, and historically Black colleges and
universities.
(3) Definition.--In this subsection, the term ``eligible
entity'' means a national or community-based organization with
a history and tradition of service to African-American
communities.
(j) National Media Outreach Campaign.--
(1) In general.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall
implement a national media outreach campaign that urges all
sexually active individuals to be tested for and know their
HIV/AIDS status.
(2) Requirements.--The national media outreach campaign
under this subsection shall--
(A) be science-driven and targeted to African-
American men, women, and youth; and
(B) give special emphasis to Black women and men
who have sex with men.
(3) Coordination; consultation.--The Secretary shall carry
out this subsection--
(A) in coordination with Black media outlets for
print, electronic, and Web-based media and Black media
associations, including the National Association of
Black Owned Broadcasters and the National Newspaper
Publishers Association; and
(B) in consultation with an advisory board
including representatives of the National Medical
Association, faith leaders, elected and appointed
officials, social marketing experts, and business and
community stakeholders.
(k) Research To Develop Behavioral Strategies To Reduce
Transmission of HIV/AIDS.--
(1) In general.--The Secretary, acting through the Director
of the National Institutes of Health, may conduct or support
culturally competent research to develop evidence-based
behavioral strategies to reduce the transmission of HIV/AIDS
within the African-American community.
(2) Priority.--In carrying out this subsection, the
Secretary shall prioritize research that focuses on populations
within the African-American community that are at increased
risk for HIV/AIDS, including--
(A) men who have sex with men; and
(B) women.
(l) Study of Biological and Behavioral Factors.--The Secretary,
acting through the Director of the National Institute on Minority
Health and Health Disparities, may make grants for--
(1) the study of biological and behavioral factors that
lead to increased HIV/AIDS prevalence in the African-American
community, to be conducted by researchers with a history and
tradition of service to Black communities; and
(2) behavioral and structural network research and
interventions, in collaboration with other institutes and
centers of the National Institutes of Health, indigenous faith
and national and community-based organizations with a history
and tradition of conducting such research for Black
communities, with a special emphasis on Black women and Black
men who have sex with men.
(m) Health Care Professionals Treating Individuals With HIV/AIDS.--
Part E of title VII of the Public Health Service Act (42 U.S.C. 294n et
seq.) is amended by adding at the end the following:
``Subpart 4--Health Care Professionals Treating Individuals With HIV/
AIDS
``SEC. 781. BETTER CARE FOR INDIVIDUALS WITH HIV/AIDS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration and in consultation
with the African-American church community, may award grants for any of
the following:
``(1) Development of curricula for training primary care
providers in HIV/AIDS prevention and care.
``(2) Training health care professionals with expertise in
HIV/AIDS to provide care to individuals with HIV/AIDS.
``(3) Development by grant recipients under title XXVI and
other persons of policies for providing culturally relevant and
sensitive treatment to individuals with HIV/AIDS, with
particular emphasis on treatment to African-Americans and
children with HIV/AIDS.
``(4) Development and implementation of programs to
increase the use of telemedicine to respond to HIV/AIDS-
specific health care needs in rural and minority communities,
with particular emphasis given to medically underserved
communities and the southern States.
``(5) Creation of faith- and community-based certification
programs for providers in HIV/AIDS care and support services.
``(6) Establishment of comfort care centers that provide
mental, emotional, and psychosocial counseling for people with
HIV/AIDS and implement additional protocols to be carried out
in the centers that address the needs of children and young
adults who are infected with the disease and are transitioning
from childhood to adulthood.
``(7) Incentive payments to health care providers supported
by the Health Resources and Services Administration to
implement HIV/AIDS testing consistent with the guidelines
issued in 2006 by the Centers for Disease Control and
Prevention entitled `Revised Recommendations for HIV Testing of
Adults, Adolescents, and Pregnant Women in Health-Care
Settings'.
``(b) Definitions.--In this section--
``(1) the term `HIV/AIDS' has the meaning given to such
term in section 2689; and
``(2) the term `primary care' includes obstetrical and
gynecological care and psychiatric and mental health care.''.
(n) Report on Impact of HIV/AIDS in the African-American
Community.--
(1) In general.--The Secretary shall submit to Congress and
the President an annual report on the impact of HIV/AIDS in the
African-American community.
(2) Contents.--The report under subsection (a) shall
include information on the--
(A) progress that has been made in reducing the
impact of HIV/AIDS in such community;
(B) opportunities that exist to make additional
progress in reducing the impact of HIV/AIDS in such
community;
(C) challenges that may impede such additional
progress; and
(D) Federal funding necessary to achieve
substantial reductions in HIV/AIDS in the African-
American community.
SEC. 749. REDUCING THE SPREAD OF SEXUALLY TRANSMITTED INFECTIONS IN
CORRECTIONAL FACILITIES.
(a) Short Title.--This section may be cited as the ``Justice for
the Unprotected Against Sexually Transmitted Infections among the
Confined and Exposed Act'' or the ``JUSTICE Act''.
(b) Findings.--The Congress makes the following findings:
(1) According to the Bureau of Justice Statistics (BJS),
2,292,133 persons were incarcerated in the United States as of
the end of 2009. Between 1998 and 2008, the number of persons
incarcerated in Federal or State correctional facilities
increased by an average of 2.4 percent per year. One in every
32 United States residents was on probation, in jail or prison,
or on parole at the end of 2009.
(2) As of 2009, 66.8 percent of incarcerated persons were
racial or ethnic minorities. Based on current incarceration
rates, BJS estimates that African-American males are 6 times
more likely to be held in custody than White males, while
Hispanic males are a little more than 2 times more likely to be
held in custody. Across all age categories, African-American
males were incarcerated at higher rates than Hispanic or White
males.
(3) There is a disproportionately high rate of HIV/AIDS
among incarcerated persons, especially among minorities.
Approximately 25 percent of the HIV-positive population of the
United States passes through correctional facilities each year.
BJS has determined that the rate of confirmed AIDS cases is 2.4
times higher among incarcerated persons than in the general
population. Minorities account for the majority of AIDS-related
deaths among incarcerated persons, with African-American
incarcerated persons 2.8 times more likely than White
incarcerated persons and 1.4 times more likely than Hispanic
incarcerated persons to die from AIDS-related causes. Nearly
two-thirds of AIDS-related deaths are among Black, non-Hispanic
males.
(4) Studies suggest that other sexually transmitted
infections (STIs), such as gonorrhea, chlamydia, syphilis,
genital herpes, viral hepatitis, and human papillomavirus, also
exist at a higher rate among incarcerated persons than in the
general population. For instance, researchers have estimated
that the rate of hepatitis C (HCV) infection among incarcerated
persons is somewhere between 8 and 20 times higher than that of
the general population.
(5) Correctional facilities lack a uniform system of STI
testing and reporting. Establishing a uniform data collection
system would assist in developing and targeting counseling and
treatment programs for incarcerated persons. Better developed
and targeted programs may reduce the spread of STIs.
(6) Although Congress has acted to reduce the spread of
sexual violence in correctional facilities by enacting the
National Prison Rape Elimination Act (PREA) of 2003, BJS
reported that approximately 4.4 percent of incarcerated persons
in prisons and 3.1 percent of persons in jail reported
experiencing one or more incidents of sexual victimization by
another incarcerated person or correctional facility staff in
the previous year.
(7) Approximately 95 percent of all incarcerated persons
eventually return to society. According to one study, every
year approximately 100,000 persons infected with both HIV and
HCV are released from correctional facilities. These
individuals comprise approximately 50 percent of all persons
with both infections in the United States.
(8) According to the Centers for Disease Control and
Prevention (CDC), latex condoms, when used consistently and
correctly, are highly effective in preventing the transmission
of HIV. Latex condoms also reduce the risk of other STIs.
Despite the effectiveness of condoms in reducing the spread of
STIs, the Bureau of Prisons does not recommend their use in
correctional facilities.
(9) The distribution of condoms in correctional facilities
is currently legal in certain parts of the United States and
the world. The States of Vermont and Mississippi and the
District of Columbia allow condom distribution programs in
their correctional facilities. The cities of New York, San
Francisco, Los Angeles, Washington DC, and Philadelphia also
allow condom distribution in their correctional facilities.
However, these States and cities operate fewer than 1 percent
of all correctional facilities.
(10) A 2007 report by the Massachusetts General Hospital
Division of Infectious Diseases and the University of
California, San Francisco, found that the proportion of
European prison systems allowing condoms rose from 53 percent
in 1989 to 81 percent in 1997. The same report also found that
no prison system allowing the distribution of condoms had
reversed their decision, and no prison system reported an
increase in sexual activity among incarcerated persons as a
result of a decision to allow condom distribution.
(11) In 2000 and 2001, researchers surveyed 300
incarcerated persons and 100 correctional officers at the
Central Detention Facility, a correctional facility operated by
the District of Columbia at which condoms are available.
Researchers found that both incarcerated persons and
correctional officers generally supported the condom
distribution program and considered it to be important.
Furthermore, the researchers determined that the program had
not caused any major security infractions. In Canada, the
Expert Committee on AIDS and Prisons surveyed more than 400
correctional officers in the Federal prison system of Canada in
1995 and reported that 82 percent of those responding indicated
that the availability of condoms had created no problems at
their facility.
(12) The American Public Health Association, the United
Nations Joint Program on HIV/AIDS, and the World Health
Organization have endorsed the effectiveness of condom
distribution programs in correctional facilities.
(13) Many correctional facilities in the United States do
not provide comprehensive testing and treatment programs to
reduce the spread of STIs. According to BJS surveys from 2005,
only 996 of the 1,821 Federal and State correctional facilities
(i.e. 54.7 percent) provided HIV/AIDS counseling programs.
(14) Individuals who are enrolled in Medicaid prior to
incarceration face a suspension of their benefits upon
incarceration, and in some States a termination of their
Medicaid eligibility. The Federal Government encourages States
to automatically re-enroll incarcerated persons on Medicaid
upon their release from a correctional facility, unless the
State reaches a determination that the individual is no longer
eligible for reasons other than their prior incarceration.
(15) Formerly incarcerated individuals who are newly
released from correctional facilities often face delays in the
resumption of their Medicaid benefits which may exacerbate any
health issues which they face.
(16) Incarcerated individuals living with HIV/AIDS who are
eligible for Medicaid would benefit from prompt and automatic
enrollment upon their release in order to ensure their
continued ability to access health services, including
antiretroviral treatment.
(c) Authority To Allow Community Organizations To Provide STI
Counseling, STI Prevention Education, and Sexual Barrier Protection
Devices in Federal Correctional Facilities.--
(1) Directive to attorney general.--Not later than 30 days
after the date of enactment of this Act, the Attorney General
shall direct the Bureau of Prisons to allow community
organizations to distribute sexual barrier protection devices
and to engage in STI counseling and STI prevention education in
Federal correctional facilities. These activities shall be
subject to all relevant Federal laws and regulations which
govern visitation in correctional facilities.
(2) Information requirement.--Any community organization
permitted to distribute sexual barrier protection devices under
paragraph (1) must ensure that the persons to whom the devices
are distributed are informed about the proper use and disposal
of sexual barrier protection devices in accordance with
established public health practices. Any community organization
conducting STI counseling or STI prevention education under
paragraph (1) must offer comprehensive sexuality education.
(3) Possession of device protected.--No Federal
correctional facility may, because of the possession or use of
a sexual barrier protection device--
(A) take adverse action against an incarcerated
person; or
(B) consider possession or use as evidence of
prohibited activity for the purpose of any Federal
correctional facility administrative proceeding.
(4) Implementation.--The Attorney General and Bureau of
Prisons shall implement this section according to established
public health practices in a manner that protects the health,
safety, and privacy of incarcerated persons and of correctional
facility staff.
(d) Sense of Congress Regarding Distribution of Sexual Barrier
Protection Devices in State Prison Systems.--It is the sense of
Congress that States should allow for the legal distribution of sexual
barrier protection devices in State correctional facilities to reduce
the prevalence and spread of STIs in those facilities.
(e) Automatic Reinstatement of Medicaid Benefits.--
(1) In general.--Section 1902(e) of the Social Security Act
(42 U.S.C. 1396a(e)) is amended by adding at the end the
following:
``(15) Enrollment of ex-offenders.--
``(A) Automatic enrollment or reinstatement.--
``(i) In general.--The State plan shall
provide for the automatic enrollment or
reinstatement of enrollment of an eligible
individual if--
``(I) such individual is scheduled
to be released from a public
institution due to the completion of
sentence, not less than 30 days prior
to the scheduled date of the release;
and
``(II) such individual is to be
released from a public institution on
parole or on probation, as soon as
possible after the date on which the
determination to release such
individual was made, and before the
date such individual is released.
``(ii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date by
which the individual would be enrolled
under clause (i), such clause shall not
apply to such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(B) Relationship of enrollment to payment for
services.--
``(i) In general.--Subject to subparagraph
(A)(ii), an eligible individual who is
enrolled, or whose enrollment is reinstated
under subparagraph (A), shall be eligible for
medical assistance that is provided after the
date that the eligible individual is released
from the public institution
``(ii) Relationship to payment prohibition
for inmates.--No provision of this paragraph
may be construed to permit payment for care or
services for which payment is excluded under
the subparagraph (A), following paragraph (29),
of section 1905(a).
``(C) Treatment of continuous eligibility.--
``(i) Suspension for inmates.--Any period
of continuous eligibility under this title
shall be suspended on the date an individual
enrolled under this title becomes an inmate of
a public institution (except as a patient of a
medical institution).
``(ii) Determination of remaining period.--
Notwithstanding any changes to State law
related to continuous eligibility during the
time that an individual is an inmate of a
public institution (except as a patient of a
medical institution), subject to clause (iii),
with respect to an eligible individual who was
subject to a suspension under subclause (I), on
the date that such individual is released from
a public institution the suspension of
continuous eligibility under such subclause
shall be lifted for a period that is equal to
the time remaining in the period of continuous
eligibility for such individual on the date
that such period was suspended under such
subclause.
``(iii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date that
the suspension of continuous
eligibility is lifted under clause
(ii), such clause shall not apply to
such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(D) Automatic enrollment or reinstatement of
enrollment defined.--For purposes of this paragraph,
the term `automatic enrollment or reinstatement of
enrollment' means that the State determines eligibility
for medical assistance under the State plan without a
program application from, or on behalf of, the eligible
individual, but an individual can only be automatically
enrolled in the State Medicaid plan if the individual
affirmatively consents to being enrolled through
affirmation in writing, by telephone, orally, through
electronic signature, or through any other means
specified by the Secretary.
``(E) Eligible individual defined.--For purposes of
this paragraph, the term `eligible individual' means an
individual who is an inmate of a public institution
(except as a patient in a medical institution)--
``(i) who was enrolled under the State plan
for medical assistance immediately before
becoming an inmate of such an institution; or
``(ii) is diagnosed with human
immunodeficiency virus.''.
(2) Supplemental funding for state implementation of
automatic reinstatement of medicaid benefits.--
(A) In general.--Subject to paragraph (6), for each
State for which the Secretary of Health and Human
Services has approved an application under paragraph
(3), the Federal matching payments (including payments
based on the Federal medical assistance percentage)
made to such State under section 1903 of the Social
Security Act (42 U.S.C. 1396b) shall be increased by
5.0 percentage points for payments to the State for the
activities permitted under paragraph (2) for a period
of one year.
(B) Use of funds.--A State may only use increased
matching payments authorized under paragraph (1)--
(i) to strengthen the State's enrollment
and administrative resources for the purpose of
improving processes for enrolling (or
reinstating the enrollment of) eligible
individuals (as such term is defined in section
1902(e)(15)(E) of the Social Security Act); and
(ii) for medical assistance (as such term
is defined in section 1905(a) of the Social
Security Act) provided to such eligible
individuals.
(C) Application and agreement.--The Secretary may
only make payments to a State in the increased amount
if--
(i) the State has amended the State plan
under section 1902 of the Social Security Act
to incorporate the requirements of subsection
(e)(15) of such section;
(ii) the State has submitted an application
to the Secretary that includes a plan for
implementing the requirements of section
1902(e)(15) of the Social Security Act under
the State's amended State plan before the end
of the 90-day period beginning on the date that
the State receives increased matching payments
under paragraph (1);
(iii) the State's application meets the
satisfaction of the Secretary; and
(iv) the State enters an agreement with the
Secretary that states that--
(I) the State will only use the
increased matching funds for the uses
permitted under paragraph (2); and
(II) at the end of the period under
paragraph (1), the State will submit to
the Secretary, and make publicly
available, a report that contains the
information required under paragraph
(4).
(D) Required report information.--The information
that is required in the report under paragraph
(3)(D)(ii) includes--
(i) the results of an evaluation of the
impact of the implementation of the
requirements of section 1902(e)(15) of the
Social Security Act on improving the State's
processes for enrolling of individuals who are
released for public institutions into the
Medicaid program;
(ii) the number of individuals who were
automatically enrolled (or whose enrollment is
reinstated) under such section 1902(e)(15)
during the period under paragraph (1); and
(iii) any other information that is
required by the Secretary.
(E) Increase in cap on medicaid payments to
territories.--Subject to paragraph (6), the amounts
otherwise determined for Puerto Rico, the United States
Virgin Islands, Guam, the Commonwealth of the Northern
Mariana Islands, and American Samoa under subsections
(f) and (g) of section 1108 of the Social Security Act
(42 U.S.C. 1308) shall each be increased by the
necessary amount to allow for the increase in the
Federal matching payments under paragraph (1), but only
for the period under such paragraph for such State. In
the case of such an increase for a territory,
subsection (a)(1) of such section 1108 shall be applied
without regard to any increase in payment made to the
territory under part E of title IV of such Act that is
attributable to the increase in Federal medical
assistance percentage effected under paragraph (1) for
the territory.
(F) Limitations.--
(i) Timing.--With respect to a State, at
the end of the period under paragraph (1), no
increased matching payments may be made to such
State under this subsection.
(ii) Maintenance of eligibility.--
(I) In general.--Subject to clause
(ii), a State is not eligible for an
increase in its Federal matching
payments under paragraph (1), or an
increase in a cap amount under
paragraph (5), if eligibility
standards, methodologies, or procedures
under its State plan under title XIX of
the Social Security Act (including any
waiver under such title or under
section 1115 of such Act (42 U.S.C.
1315)) are more restrictive than the
eligibility standards, methodologies,
or procedures, respectively, under such
plan (or waiver) as in effect on the
date of enactment of this Act.
(II) State reinstatement of
eligibility permitted.--A State that
has restricted eligibility standards,
methodologies, or procedures under its
State plan under title XIX of the
Social Security Act (including any
waiver under such title or under
section 1115 of such Act (42 U.S.C.
1315)) after the date of enactment of
this Act, is no longer ineligible under
clause (i) beginning with the first
calendar quarter in which the State has
reinstated eligibility standards,
methodologies, or procedures that are
no more restrictive than the
eligibility standards, methodologies,
or procedures, respectively, under such
plan (or waiver) as in effect on such
date.
(iii) No waiver authority.--The Secretary
may not waive the application of this
subsection under section 1115 of the Social
Security Act or otherwise.
(iv) Limitation of matching payments to 100
percent.--In no case shall an increase in
Federal matching payments under this subsection
result in Federal matching payments that exceed
100 percent.
(3) Effective date.--
(A) In general.--Except as provided in paragraph
(2), the amendments made by subsection (a) shall take
effect 180 days after the date of the enactment of this
Act and shall apply to services furnished on or after
such date.
(B) Rule for changes requiring state legislation.--
In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the
Secretary of Health and Human Services determines
requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirement imposed by the amendments made
by this subsection, the State plan shall not be
regarded as failing to comply with the requirements of
such title solely on the basis of its failure to meet
this additional requirement before the first day of the
first calendar quarter beginning after the close of the
first regular session of the State legislature that
begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year
of such session shall be deemed to be a separate
regular session of the State legislature.
(f) Survey of and Report on Correctional Facility Programs Aimed
at Reducing the Spread of STIs.--
(1) Survey.--The Attorney General, after consulting with
the Secretary of Health and Human Services, State officials,
and community organizations, shall, to the maximum extent
practicable, conduct a survey of all Federal and State
correctional facilities, no later than 180 days after the date
of enactment of this Act and annually thereafter for 5 years,
to determine the following:
(A) Prevention education offered.--The type of
prevention education, information, or training offered
to incarcerated persons and correctional facility staff
regarding sexual violence and the spread of STIs,
including whether such education, information, or
training--
(i) constitutes comprehensive sexuality
education;
(ii) is compulsory for new incarcerated
persons and for new staff; and
(iii) is offered on an ongoing basis.
(B) Access to sexual barrier protection devices.--
Whether incarcerated persons can--
(i) possess sexual barrier protection
devices;
(ii) purchase sexual barrier protection
devices;
(iii) purchase sexual barrier protection
devices at a reduced cost; and
(iv) obtain sexual barrier protection
devices without cost.
(C) Incidence of sexual violence.--The incidence of
sexual violence and assault committed by incarcerated
persons and by correctional facility staff.
(D) Counseling, treatment, and supportive
services.--Whether the correctional facility requires
incarcerated persons to participate in counseling,
treatment, and supportive services related to STIs, or
whether it offers such programs to incarcerated
persons.
(E) STI testing.--Whether the correctional facility
tests incarcerated persons for STIs or gives them the
option to undergo such testing--
(i) at intake;
(ii) on a regular basis; and
(iii) prior to release.
(F) STI test results.--The number of incarcerated
persons who are tested for STIs and the outcome of such
tests at each correctional facility, disaggregated to
include results for--
(i) the type of sexually transmitted
infection tested for;
(ii) the race and/or ethnicity of
individuals tested;
(iii) the age of individuals tested; and
(iv) the gender of individuals tested.
(G) Pre-release referral policy.--Whether
incarcerated persons are informed prior to release
about STI-related services or other health services in
their communities, including free and low-cost
counseling and treatment options.
(H) Pre-release referrals made.--The number of
referrals to community-based organizations or public
health facilities offering STI-related or other health
services provided to incarcerated persons prior to
release, and the type of counseling or treatment for
which the referral was made.
(I) Reinstatement of medicaid benefits.--Whether
the correctional facility assists incarcerated persons
that were enrolled in the State Medicaid program prior
to their incarceration, in reinstating their enrollment
upon release and whether such individuals receive
referrals as provided by paragraph (8) to entities that
accept the State Medicaid program, including if
applicable--
(i) the number of such individuals,
including those diagnosed with the human
immunodeficiency virus, that have been
reinstated;
(ii) a list of obstacles to reinstating
enrollment or to making determinations of
eligibility for reinstatement, if any; and
(iii) the number of individuals denied
enrollment.
(J) Other actions taken.--Whether the correctional
facility has taken any other action, in conjunction
with community organizations or otherwise, to reduce
the prevalence and spread of STIs in that facility.
(2) Privacy.--In conducting the survey, the Attorney
General shall not request or retain the identity of any person
who has sought or been offered counseling, treatment, testing,
or prevention education information regarding an STI (including
information about sexual barrier protection devices), or who
has tested positive for an STI.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available the results of the survey
required under paragraph (1), both for the Nation as a whole
and disaggregated as to each State and each correctional
facility. To the maximum extent possible, the Attorney General
shall issue the first report no later than 1 year after the
date of enactment of this Act and shall issue reports annually
thereafter for 5 years.
(g) Strategy.--
(1) Directive to attorney general.--The Attorney General,
in consultation with the Secretary of Health and Human
Services, State officials, and community organizations, shall
develop and implement a 5-year strategy to reduce the
prevalence and spread of STIs in Federal and State correctional
facilities. To the maximum extent possible, the strategy shall
be developed, transmitted to Congress, and made publicly
available no later than 180 days after the transmission of the
first report required under subsection (h)(3).
(2) Contents of strategy.--The strategy shall include the
following:
(A) Prevention education.--A plan for improving
prevention education, information, and training offered
to incarcerated persons and correctional facility
staff, including information and training on sexual
violence and the spread of STIs, and comprehensive
sexuality education.
(B) Sexual barrier protection device access.--A
plan for expanding access to sexual barrier protection
devices in correctional facilities.
(C) Sexual violence reduction.--A plan for reducing
the incidence of sexual violence among incarcerated
persons and correctional facility staff, developed in
consultation with the National Prison Rape Elimination
Commission.
(D) Counseling and supportive services.--A plan for
expanding access to counseling and supportive services
related to STIs in correctional facilities.
(E) Testing.--A plan for testing incarcerated
persons for STIs during intake, during regular health
exams, and prior to release, and that--
(i) is conducted in accordance with
guidelines established by the Centers for
Disease Control and Prevention;
(ii) includes pre-test counseling;
(iii) requires that incarcerated persons
are notified of their option to decline testing
at any time;
(iv) requires that incarcerated persons are
confidentially notified of their test results
in a timely manner; and
(v) ensures that incarcerated persons
testing positive for STIs receive post-test
counseling, care, treatment, and supportive
services.
(F) Treatment.--A plan for ensuring that
correctional facilities have the necessary medicine and
equipment to treat and monitor STIs and for ensuring
that incarcerated persons living with or testing
positive for STIs receive and have access to care and
treatment services.
(G) Strategies for demographic groups.--A plan for
developing and implementing culturally appropriate,
sensitive, and specific strategies to reduce the spread
of STIs among demographic groups heavily impacted by
STIs.
(H) Linkages with communities and facilities.--A
plan for establishing and strengthening linkages to
local communities and health facilities that--
(i) provide counseling, testing, care, and
treatment services;
(ii) may receive persons recently released
from incarceration who are living with STIs;
and
(iii) accept payment through the State
Medicaid program.
(I) Enrollment in state medicaid programs.--Plans
to ensure that incarcerated persons who were--
(i) enrolled in their State Medicaid
program prior to incarceration in a
correctional facility are automatically re-
enrolled in such program upon their release;
and
(ii) not enrolled in their State Medicaid
program prior to incarceration, but who are
diagnosed with the human immunodeficiency virus
while incarcerated in a correctional facility,
are automatically enrolled in such program upon
their release.
(J) Other plans.--Any other plans developed by the
Attorney General for reducing the spread of STIs or
improving the quality of health care in correctional
facilities.
(K) Monitoring system.--A monitoring system that
establishes performance goals related to reducing the
prevalence and spread of STIs in correctional
facilities and which, where feasible, expresses such
goals in quantifiable form.
(L) Monitoring system performance indicators.--
Performance indicators that measure or assess the
achievement of the performance goals described in
subparagraph (I).
(M) Cost estimate.--A detailed estimate of the
funding necessary to implement the strategy at the
Federal and State levels for all 5 years, including the
amount of funds required by community organizations to
implement the parts of the strategy in which they take
part.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available an annual progress report
regarding the implementation and effectiveness of the strategy
described in subsection (a). The progress report shall include
an evaluation of the implementation of the strategy using the
monitoring system and performance indicators provided for in
subparagraphs (I) and (J) of paragraph (2).
(h) Definitions.--For the purposes of this section:
(1) Community organization.--The term ``community
organization'' means a public health care facility or a
nonprofit organization which provides health- or STI-related
services according to established public health standards.
(2) Comprehensive sexuality education.--The term
``comprehensive sexuality education'' means sexuality education
that includes information about abstinence and about the proper
use and disposal of sexual barrier protection devices and which
is--
(A) evidence-based;
(B) medically accurate;
(C) age and developmentally appropriate;
(D) gender and identity sensitive;
(E) culturally and linguistically appropriate; and
(F) structured to promote critical thinking, self-
esteem, respect for others, and the development of
healthy attitudes and relationships.
(3) Correctional facility.--The term ``correctional
facility'' means any prison, penitentiary, adult detention
facility, juvenile detention facility, jail, or other facility
to which persons may be sent after conviction of a crime or act
of juvenile delinquency within the United States.
(4) Incarcerated person.--The term ``incarcerated person''
means any person who is serving a sentence in a correctional
facility after conviction of a crime.
(5) Sexually transmitted infection.--The term ``sexually
transmitted infection'' or ``STI'' means any disease or
infection that is commonly transmitted through sexual activity,
including HIV/AIDS, gonorrhea, chlamydia, syphilis, genital
herpes, viral hepatitis, and human papillomavirus.
(6) Sexual barrier protection device.--The term ``sexual
barrier protection device'' means any FDA-approved physical
device which has not been tampered with and which reduces the
probability of STI transmission or infection between sexual
partners, including female condoms, male condoms, and dental
dams.
(7) State.--The term ``State'' includes the District of
Columbia, American Samoa, the Commonwealth of the Northern
Mariana Islands, Guam, Puerto Rico, and the United States
Virgin Islands.
SEC. 750. STOP AIDS IN PRISON.
(a) Short Title.--This section may be cited as the ``Stop AIDS in
Prison Act of 2012''.
(b) Comprehensive HIV/AIDS Policy.--
(1) In general.--The Bureau of Prisons (hereinafter in this
section referred to as the ``Bureau'') shall develop a
comprehensive policy to provide HIV testing, treatment, and
prevention for inmates within the correctional setting and upon
reentry.
(2) Purpose.--The purposes of such policy are the
following:
(A) To stop the spread of HIV/AIDS among inmates.
(B) To protect prison guards and other personnel
from HIV/AIDS infection.
(C) To provide comprehensive medical treatment to
inmates who are living with HIV/AIDS.
(D) To promote HIV/AIDS awareness and prevention
among inmates.
(E) To encourage inmates to take personal
responsibility for their health.
(F) To reduce the risk that inmates will transmit
HIV/AIDS to other persons in the community following
their release from prison.
(3) Consultation.--The Bureau shall consult with
appropriate officials of the Department of Health and Human
Services, the Office of National Drug Control Policy, the
Office of National AIDS Policy, and the Centers for Disease
Control regarding the development of such policy.
(4) Time limit.--The Bureau shall draft appropriate
regulations to implement such policy not later than 1 year
after the date of the enactment of this Act.
(c) Requirements for Policy.--The policy created under subsection
(b) shall provide for the following:
(1) Testing and counseling upon intake.--
(A)(i) Subject to clause (ii), health care
personnel shall provide routine HIV testing to all
inmates as a part of a comprehensive medical
examination immediately following admission to a
facility.
(ii) Health care personnel shall not be required to
provide routine HIV testing to an inmate who is
transferred to a facility from another facility if the
inmate's medical records are transferred with the
inmate and indicate that the inmate has been tested
previously.
(B) To all inmates admitted to a facility prior to
the effective date of this policy, health care
personnel shall provide routine HIV testing within no
more than 6 months. HIV testing for these inmates may
be performed in conjunction with other health services
provided to these inmates by health care personnel.
(C) All HIV tests under this paragraph shall comply
with paragraph (9).
(2) Pre-test and post-test counseling.--Health care
personnel shall provide confidential pre-test and post-test
counseling to all inmates who are tested for HIV. Counseling
may be included with other general health counseling provided
to inmates by health care personnel.
(3) HIV/AIDS prevention education.--
(A) Health care personnel shall improve HIV/AIDS
awareness through frequent educational programs for all
inmates. HIV/AIDS educational programs may be provided
by community based organizations, local health
departments, and inmate peer educators. Such HIV/AIDS
educational programs shall include information on modes
of transmission, including transmission through
tattooing, sexual contact, and intravenous drug use;
prevention methods; treatment; and disease progression.
HIV/AIDS educational programs shall be culturally
sensitive, conducted in a variety of languages, and
present scientifically accurate information in a clear
and understandable manner.
(B) HIV/AIDS educational materials shall be made
available to all inmates at orientation, at health care
clinics, at regular educational programs, and prior to
release. Both written and audio-visual materials shall
be made available to all inmates. These materials shall
be culturally sensitive, written for low literacy
levels, and available in a variety of languages.
(4) HIV testing upon request.--
(A) Health care personnel shall allow inmates to
obtain HIV tests upon request once per year or whenever
an inmate has a reason to believe the inmate may have
been exposed to HIV. Health care personnel shall, both
orally and in writing, inform inmates, during
orientation and periodically throughout incarceration,
of their right to obtain HIV tests.
(B) Health care personnel shall encourage inmates
to request HIV tests if the inmate is sexually active,
has been raped, uses intravenous drugs, receives a
tattoo, or if the inmate is concerned that the inmate
may have been exposed to HIV/AIDS.
(C) An inmate's request for an HIV test shall not
be considered an indication that the inmate has put
himself or herself at risk of infection or committed a
violation of prison rules.
(5) HIV testing of pregnant woman.--
(A) Health care personnel shall provide routine HIV
testing to all inmates who become pregnant.
(B) All HIV tests under this paragraph shall comply
with paragraph (9).
(6) Comprehensive treatment.--
(A) Health care personnel shall provide all inmates
who test positive for HIV--
(i) timely, comprehensive medical
treatment;
(ii) confidential counseling on managing
their medical condition and preventing its
transmission to other persons; and
(iii) voluntary partner notification
services.
(B) Medical care provided under this paragraph
shall be consistent with current Department of Health
and Human Services guidelines and standard medical
practice. Health care personnel shall discuss treatment
options, the importance of adherence to antiretroviral
therapy, and the side effects of medications with
inmates receiving treatment.
(C) Health care personnel and pharmacy personnel
shall ensure that the facility formulary contains all
Food and Drug Administration-approved medications
necessary to provide comprehensive treatment for
inmates living with HIV/AIDS, and that the facility
maintains adequate supplies of such medications to meet
inmates' medical needs. Health care personnel and
pharmacy personnel shall also develop and implement
automatic renewal systems for these medications to
prevent interruptions in care.
(D) Correctional staff, health care personnel, and
pharmacy personnel shall develop and implement
distribution procedures to ensure timely and
confidential access to medications.
(7) Protection of confidentiality.--
(A) Health care personnel shall develop and
implement procedures to ensure the confidentiality of
inmate tests, diagnoses, and treatment. Health care
personnel and correctional staff shall receive regular
training on the implementation of these procedures.
Penalties for violations of inmate confidentiality by
health care personnel or correctional staff shall be
specified and strictly enforced.
(B) HIV testing, counseling, and treatment shall be
provided in a confidential setting where other routine
health services are provided and in a manner that
allows the inmate to request and obtain these services
as routine medical services.
(8) Testing, counseling, and referral prior to reentry.--
(A)(i) Subject to clauses (ii) and (iii), health
care personnel shall provide routine HIV testing to all
inmates no more than 3 months prior to their release
and reentry into the community.
(ii) Inmates who are already known to be infected
shall not be required to be tested again.
(iii) The requirement under clause (i) may be
waived if an inmate's release occurs without sufficient
notice to the Bureau to allow health care personnel to
perform a routine HIV test and notify the inmate of the
results.
(B) All HIV tests under this paragraph shall comply
with paragraph (9).
(C) To all inmates who test positive for HIV and
all inmates who already are known to have HIV/AIDS,
health care personnel shall provide--
(i) confidential prerelease counseling on
managing their medical condition in the
community, accessing appropriate treatment and
services in the community, and preventing the
transmission of their condition to family
members and other persons in the community;
(ii) referrals to appropriate health care
providers and social service agencies in the
community that meet the inmate's individual
needs, including voluntary partner notification
services and prevention counseling services for
people living with HIV/AIDS; and
(iii) a 30-day supply of any medically
necessary medications the inmate is currently
receiving.
(9) Opt-out provision.--Inmates shall have the right to
refuse routine HIV testing. Inmates shall be informed both
orally and in writing of this right. Oral and written
disclosure of this right may be included with other general
health information and counseling provided to inmates by health
care personnel. If an inmate refuses a routine test for HIV,
health care personnel shall make a note of the inmate's refusal
in the inmate's confidential medical records. However, the
inmate's refusal shall not be considered a violation of prison
rules or result in disciplinary action.
(10) Exclusion of tests performed under section 4014(b)
from the definition of routine hiv testing.--HIV testing of an
inmate under section 4014(b) of title 18, United States Code,
is not routine HIV testing for the purposes of paragraph (9).
Health care personnel shall document the reason for testing
under section 4014(b) of title 18, United States Code, in the
inmate's confidential medical records.
(11) Timely notification of test results.--Health care
personnel shall provide timely notification to inmates of the
results of HIV tests.
(d) Changes in Existing Law.--
(1) Screening in general.--Section 4014(a) of title 18,
United States Code, is amended--
(A) by striking ``for a period of 6 months or
more'';
(B) by striking ``, as appropriate,''; and
(C) by striking ``if such individual is determined
to be at risk for infection with such virus in
accordance with the guidelines issued by the Bureau of
Prisons relating to infectious disease management'' and
inserting ``unless the individual declines. The
Attorney General shall also cause such individual to be
so tested before release unless the individual
declines.''.
(2) Inadmissibility of hiv test results in civil and
criminal proceedings.--Section 4014(d) of title 18, United
States Code, is amended by inserting ``or under the Stop AIDS
in Prison Act of 2012'' after ``under this section''.
(3) Screening as part of routine screening.--Section
4014(e) of title 18, United States Code, is amended by adding
at the end the following: ``Such rules shall also provide that
the initial test under this section be performed as part of the
routine health screening conducted at intake.''.
(e) Reporting Requirements.--
(1) Report on hepatitis and other diseases.--Not later than
1 year after the date of the enactment of this Act, the Bureau
shall provide a report to the Congress on Bureau policies and
procedures to provide testing, treatment, and prevention
education programs for hepatitis and other diseases transmitted
through sexual activity and intravenous drug use. The Bureau
shall consult with appropriate officials of the Department of
Health and Human Services, the Office of National Drug Control
Policy, the Office of National AIDS Policy, and the Centers for
Disease Control and Prevention regarding the development of
this report.
(2) Annual reports.--
(A) Generally.--Not later than 2 years after the
date of the enactment of this Act, and then annually
thereafter, the Bureau shall report to Congress on the
incidence among inmates of diseases transmitted through
sexual activity and intravenous drug use.
(B) Matters pertaining to various diseases.--
Reports under subparagraph (A) shall discuss--
(i) the incidence among inmates of HIV/
AIDS, hepatitis, and other diseases transmitted
through sexual activity and intravenous drug
use; and
(ii) updates on Bureau testing, treatment,
and prevention education programs for these
diseases.
(C) Matters pertaining to hiv/aids only.--Reports
under subparagraph (A) shall also include--
(i) the number of inmates who tested
positive for HIV upon intake;
(ii) the number of inmates who tested
positive prior to reentry;
(iii) the number of inmates who were not
tested prior to reentry because they were
released without sufficient notice;
(iv) the number of inmates who opted-out of
taking the test;
(v) the number of inmates who were tested
under section 4014(b) of title 18, United
States Code; and
(vi) the number of inmates under treatment
for HIV/AIDS.
(D) Consultation.--The Bureau shall consult with
appropriate officials of the Department of Health and
Human Services, the Office of National Drug Control
Policy, the Office of National AIDS Policy, and the
Centers for Disease Control and Prevention regarding
the development of reports under subparagraph (A).
SEC. 751. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND ETHNIC MINORITY
COMMUNITIES.
For the purpose of reducing HIV/AIDS in racial and ethnic minority
communities, the Secretary, acting through the Deputy Assistant
Secretary for Minority Health, may make grants to public health
agencies and faith-based organizations to conduct--
(1) outreach activities related to HIV/AIDS prevention and
testing activities;
(2) HIV/AIDS prevention activities; and
(3) HIV/AIDS testing activities.
SEC. 752. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV/AIDS.
Part E of title VII of the Public Health Service Act (42 U.S.C.
294n et seq.) is amended by adding at the end the following:
``Subpart 5--Health Care Professionals Treating Individuals With HIV/
AIDS
``SEC. 785. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV/
AIDS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration and in consultation
with racial and ethnic minority community organizations, may award
grants for any of the following:
``(1) Development of curricula for training primary care
providers in HIV/AIDS prevention and care.
``(2) Training health care professionals with expertise in
HIV/AIDS to provide care to individuals with HIV/AIDS.
``(3) Development by grant recipients under title XXVI and
other persons of policies for providing culturally relevant and
sensitive treatment to individuals with HIV/AIDS, with
particular emphasis on treatment to racial and ethnic
minorities, men who have sex with men, and women and children
with HIV/AIDS.
``(4) Development and implementation of programs to
increase the use of telemedicine to respond to HIV/AIDS-
specific health care needs in rural and minority communities,
with particular emphasis given to medically underserved
communities and insular areas.
``(5) Creation of faith- and community-based certification
programs for providers in HIV/AIDS care and support services.
``(6) Establishment of comfort care centers that provide
mental, emotional, and psychosocial counseling for people with
HIV/AIDS and implement additional protocols to be carried out
in the centers that address the needs of children and young
adults who are infected with the disease and are transitioning
from childhood to adulthood.
``(7) Incentive payments to health care providers supported
by the Health Resources and Services Administration to
implement HIV/AIDS testing consistent with the guidelines
issued in 2006 by the Centers for Disease Control and
Prevention entitled `Revised Recommendations for HIV Testing of
Adults, Adolescents, and Pregnant Women in Health-Care
Settings'.
``(b) Definitions.--In this section--
``(1) the term `HIV/AIDS' has the meaning given to such
term in section 2689; and
``(2) the term `primary care' includes obstetrical and
gynecological care and psychiatric and mental health care.''.
SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN RACIAL AND ETHNIC MINORITY
COMMUNITIES.
(a) In General.--The Secretary shall submit to the Congress and the
President an annual report on the impact of HIV/AIDS in racial and
ethnic minority communities.
(b) Contents.--The report under subsection (a) shall include
information on the--
(1) progress that has been made in reducing the impact of
HIV/AIDS in such communities;
(2) opportunities that exist to make additional progress in
reducing the impact of HIV/AIDS in such communities;
(3) challenges that may impede such additional progress;
and
(4) Federal funding necessary to achieve substantial
reductions in HIV/AIDS in racial and ethnic minority
communities.
SEC. 754. STUDY ON STATUS OF HIV/AIDS EPIDEMIC AMONG AFRICAN-AMERICANS.
The Secretary shall--
(1) seek to enter into an agreement with the Institute of
Medicine to document, in collaboration with an academic
organization which specializes in the identification and
reduction of health disparities within the African-American
community, all aspects of the HIV/AIDS epidemic among African-
Americans, including the role that historical racial or ethnic
barriers play in sustaining the epidemic among African-
Americans;
(2) submit a report to the President, the Director of the
Office of National AIDS Policy Coordination, the Director of
the White House Domestic Policy Council, the Director of White
House Office of Faith-Based and Neighborhood Partnerships, key
Federal agencies, and the relevant committees of the Congress
on the status of the HIV/AIDS epidemic among African-Americans
in the United States; and
(3) include in such report--
(A) specific recommendations on the implementation
of Federal policies to reduce the burden of HIV/AIDS in
the African-American community; and
(B) a special focus on the Black clergy and the
church as a unique resource in the African-American
community.
Subtitle F--Diabetes
SEC. 755. TREATMENT OF DIABETES IN MINORITY COMMUNITIES.
(a) Short Title.--This subtitle may be cited as the ``Minority
Diabetes Initiative Act''.
(b) Grants Regarding Treatment of Diabetes in Minority
Communities.--Part D of title III of the Public Health Service Act (42
U.S.C. 254b et seq.) is amended by inserting after section 330L the
following:
``SEC. 330M. GRANTS REGARDING TREATMENT OF DIABETES IN MINORITY
COMMUNITIES.
``(a) In General.--The Secretary may make grants to public and
nonprofit private health care providers for the purpose of providing
treatment for diabetes in minority communities.
``(b) Recipients of Grants.--The public and nonprofit private
health care providers to whom grants may be made under subsection (a)
include physicians, podiatrists, community-based organizations, health
care organizations, community health centers, and State, local, and
tribal health departments.
``(c) Scope of Treatment Activities.--The Secretary shall ensure
that grants under subsection (a) cover a variety of diabetes-related
health care services, including routine care for diabetic patients,
public education on diabetes prevention and control, eye care, foot
care, and treatment for kidney disease and other complications of
diabetes.
``(d) Appropriate Cultural Context.--A condition for the receipt of
a grant under subsection (a) is that the applicant involved agrees
that, in the program carried out with the grant, services will be
provided in the languages most appropriate for, and with consideration
for the cultural backgrounds of, the individuals for whom the services
are provided.
``(e) Outreach Services.--A condition for the receipt of a grant
under subsection (a) is that the applicant involved agrees to provide
outreach activities to inform the public of the services of the
program, and to provide offsite information on diabetes.
``(f) Reporting of Data.--A condition for the receipt of a grant
under subsection (a) is that the applicant involved agrees--
``(1) to collect and report data, on a time basis
determined appropriate by the Secretary, on race, ethnicity,
sex, gender, primary language, disability status, and
socioeconomic status; and
``(2) to develop research methodologies that ensure
reporting of data stratified as described in paragraph (1).
``(g) Application for Grant.--A grant may be made under subsection
(a) only if an application for the grant is submitted to the Secretary
and the application is in such form, is made in such manner, and
contains such agreements, assurances, and information as the Secretary
determines to be necessary to carry out this section.''.
SEC. 756. ELIMINATING DISPARITIES IN DIABETES PREVENTION ACCESS AND
CARE.
(a) Research, Treatment, and Education.--
(1) In general.--Subpart 3 of part C of title IV of the
Public Health Service Act (42 U.S.C. 285c et seq.) is amended
by adding at the end the following new section:
``SEC. 434B. DIABETES IN MINORITY POPULATIONS.
``(a) In General.--The Director of the National Institutes of
Health shall expand, intensify, and support ongoing research and other
activities with respect to pre-diabetes and diabetes, particularly type
2, in minority populations, including research to identify clinical,
socioeconomic, geographical, cultural, and organizational factors that
contribute to type 2 diabetes in such populations.
``(b) Certain Activities.--Activities under subsection (a)
regarding type 2 diabetes in minority populations shall include the
following:
``(1) Continuing research on behavior and obesity,
including through the obesity research center that is sponsored
by the National Institutes of Health.
``(2) Research on environmental factors that may contribute
to the increase in type 2 diabetes.
``(3) Support for new methods to identify environmental
triggers and genetic interactions that lead to the development
of type 2 diabetes in minority newborns. Such research should
follow the newborns through puberty, an increasingly high-risk
period for developing type 2 diabetes.
``(4) Research to identify genes that predispose
individuals to the onset of developing type 1 and type 2
diabetes and to the development of complications.
``(5) Research to prevent complications in individuals who
have already developed diabetes, such as research that attempts
to identify the genes that predispose individuals with diabetes
to the development of complications.
``(6) Research methods and alternative therapies to control
blood glucose.
``(7) Support of ongoing research efforts examining the
level of glycemia at which adverse outcomes develop during
pregnancy and to address the many clinical issues associated
with minority mothers and fetuses during diabetic and
gestational diabetic pregnancies.
``(c) Education.--The Director of the National Institutes of Health
shall--
``(1) through the National Institute on Minority Health and
Health Disparities and the National Diabetes Education
Program--
``(A) make grants to programs funded under section
485F (relating to centers of excellence) for the
purpose of establishing a mentoring program for health
care professionals to be more involved in weight
counseling, obesity research, and nutrition; and
``(B) provide for the participation of minority
health professionals in diabetes-focused research
programs; and
``(2) make grants for programs to establish a pipeline from
high school to professional school that will increase minority
representation in diabetes-focused health fields by expanding
Minority Access to Research Careers (MARC) program internships
and mentoring opportunities for recruitment.
``(d) Collection and Reporting of Data.--
``(1) In general.--The Secretary shall ensure that research
and other activities undertaken pursuant to this section
include the collection and reporting, on a time basis
determined appropriate by the Secretary, data on race,
ethnicity, sex, gender, primary language, disability status and
socioeconomic status.
``(2) Grants.--To qualify for a grant under this section,
grantees shall develop research methodologies that ensure
annual reporting of data stratified as described in paragraph
(1).
``(e) Definition.--For purposes of this section, the term `minority
population' means a racial and ethnic minority group, as defined in
section 1707(g).''.
(2) Diabetes mellitus interagency coordinating committee.--
Section 429 of the Public Health Service Act (42 U.S.C. 285c-3)
is amended by adding at the end the following new subsection:
``(c)(1) The Diabetes Mellitus Interagency Coordinating Committee
shall submit to the Secretary a biennial report that shall include an
assessment of the Federal activities and programs related to diabetes
in minority populations. Such assessment shall--
``(A) compile the current activities of all current Federal
health programs to allow for the assessment of their adequacy
as a systemic method of addressing the impact of diabetes
mellitus on minority populations;
``(B) develop strategic planning activities to develop an
effective and comprehensive Federal plan to address diabetes
mellitus within minority populations which will involve all
appropriate Federal health programs and shall--
``(i) include steps to address issues including
type 1 and type 2 diabetes in children and the
disproportionate impact of diabetes mellitus on
minority populations; and
``(ii) remain consistent with the programs and
activities identified in section 399O, as well as
remaining consistent with the intent of the Eliminating
Disparities in Diabetes Prevention Access and Care Act
of 2010; and
``(C) assess the implementation of such a plan throughout
Federal health programs.
``(2) For the purposes of this subsection, the term `minority
population' means a racial and ethnic minority group, as defined in
section 1707(g).''.
(b) Research, Education, and Other Activities.--Part B of title III
of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by
inserting after section 317T the following section:
``SEC. 317U. DIABETES IN MINORITY POPULATIONS.
``(a) Research and Other Activities.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall conduct and support research and other activities with
respect to diabetes in minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding diabetes in minority populations shall include the
following:
``(A) Expanding the National Diabetes Laboratory
capacity for translational research and the
identification of genetic and immunological risk
factors associated with diabetes.
``(B) Improving the understanding of diabetes
prevalence among Asian-American, Native Hawaiian and
other Pacific Islanders by enhancing data in the
National Health and Nutrition Examination Survey by
oversampling these populations in appropriate
geographic areas, or by another method determined
appropriate to collect this data.
``(C) Within the Division of Diabetes Translation,
providing for prevention research to better understand
how to influence health care systems changes to improve
quality of care being delivered to such populations,
and within the Division of Diabetes Translation,
carrying out model demonstration projects to design,
implement, and evaluate effective diabetes prevention
and control intervention for such populations.
``(D) Through the Division of Diabetes Translation,
carrying out culturally appropriate community-based
interventions designed to address issues and problems
experienced by such populations.
``(E) Conducting applied research within the
Division of Diabetes Translation to reduce health
disparities within such populations with diabetes.
``(F) Conducting applied research on primary
prevention within the Division of Diabetes Translation
to specifically focus on such populations with pre-
diabetes.
``(b) Education.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall direct the Division of Diabetes Translation to conduct
and support programs to educate the public on the causes and
effects of diabetes in minority populations.
``(2) Certain activities.--Programs under paragraph (1)
regarding education on diabetes in minority populations shall
include carrying out public awareness campaigns directed toward
such populations to aggressively emphasize the importance and
impact of physical activity and diet in regard to diabetes and
diabetes-related complications through the National Diabetes
Education Program.
``(c) Diabetes; Health Promotion, Prevention Activities, and
Access.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall carry out culturally appropriate diabetes health
promotion and prevention programs for minority populations.
``(2) Certain activities.--Activities regarding culturally
appropriate diabetes health promotion and prevention programs
for minority populations shall include the following:
``(A) Expanding the Diabetes Prevention and Control
Program (currently existing in all the States and
territories) and providing funds for education and
community outreach on diabetes.
``(B) Providing funds for an expansion of the
Diabetes Prevention Program Initiative that focuses on
physical inactivity and diet and its relation to type 2
diabetes within such populations.
``(C) Providing funds to strengthen existing
surveillance systems to improve the quality, accuracy,
and timeliness of morbidity and mortality diabetes data
for such populations.
``(d) Collection and Reporting of Data.--The Secretary shall ensure
that research and other activities undertaken pursuant to this section
include the collection and reporting, on a time basis determined
appropriate by the Secretary, data on race, ethnicity, sex, gender,
primary language, disability status and socioeconomic status.
``(e) Definition.--For purposes of this section, the term `minority
population' means a racial and ethnic minority group, as defined in
section 1707(g).''.
(c) Research, Education, and Other Activities.--Part P of title III
of the Public Health Service Act is amended--
(1) by redesignating the section 399R inserted by section 2
of Public Law 110-373 as section 399S;
(2) by redesignating the section 399R inserted by section 3
of Public Law 110-374 as section 399T; and
(3) by adding at the end the following new section:
``SEC. 399V-8. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON THE CAUSES AND
EFFECTS OF DIABETES IN MINORITY POPULATIONS.
``(a) In General.--The Secretary, acting through the Director of
the Health Resources and Services Administration, shall conduct and
support programs described in subsection (b) to educate health
professionals on the causes and effects of diabetes in minority
populations.
``(b) Programs.--Programs described in this subsection, with
respect to education on diabetes in minority populations, shall include
the following:
``(1) Making grants for diabetes-focused education classes
or training programs on cultural sensitivity and patient care
within such populations for health care providers.
``(2) Providing funds to community health centers for
programs that provide diabetes services and screenings.
``(3) Providing additional funds for the Health Careers
Opportunity Program, Centers for Excellence, and the Minority
Faculty Fellowship Program to partner with the Office of
Minority Health under section 1707 and the National Institutes
of Health to strengthen programs for career opportunities
within minority populations focused on diabetes treatment and
care.
``(4) Developing a diabetes focus within, and providing
additional funds for, the National Health Service Corps
Scholarship program to place individuals in areas that are
disproportionately affected by diabetes and to provide health
care services to such areas.
``(5) Establishing a diabetes ambassador program for
recruitment efforts to increase the number of underrepresented
minorities currently serving in student, faculty, or
administrative positions in institutions of higher learning,
hospitals, and community health centers.
``(6) Establishing a loan repayment program that focuses on
diabetes care and prevention in minority populations.
``(c) Collection and Reporting of Data.--
``(1) In general.--The Secretary shall ensure that research
and other activities undertaken pursuant to this section
include the collection and reporting, on a time basis
determined appropriate by the Secretary, data on race,
ethnicity, sex, gender, primary language, disability status and
socioeconomic status.
``(2) Grants.--To qualify for a grant under this section,
grantees shall develop research methodologies that ensure
annual reporting of data stratified as described in paragraph
(1).''.
(d) Research, Education, and Other Activities.--Part P of title III
of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended
by subsection (c), is further amended by adding at the end the
following section:
``SEC. 399V-9. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING
DIABETES IN MINORITY POPULATIONS.
``(a) Research and Other Activities.--
``(1) In general.--In addition to activities under sections
317U and 434B, the Secretary shall conduct and support research
and other activities with respect to diabetes within minority
populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding diabetes in minority populations shall include the
following:
``(A) Through the National Center on Minority
Health and Health Disparities, the Office of Minority
Health under section 1707, the Health Resources and
Services Administration, the Centers for Disease
Control and Prevention, and the Indian Health Service,
establishing partnerships within minority populations
to conduct studies on cultural, familial, and social
factors that may influence health promotion, diabetes
management, and prevention.
``(B) Through the Indian Health Service, in
collaboration with other appropriate Federal agencies,
coordinating the collection of data on ethnic and
culturally appropriate diabetes treatment, care,
prevention, and services by health care professionals
to the American Indian population.
``(3) Programs relating to clinical research.--
``(A) Education regarding clinical trials.--The
Secretary shall carry out education and awareness
programs designed to increase participation of minority
populations in clinical trials.
``(B) Minority researchers.--The Secretary shall
carry out mentorship programs for minority researchers
who are conducting or intend to conduct research on
diabetes in minority populations.
``(C) Supplementing clinical research regarding
children.--The Secretary shall make grants to
supplement clinical research programs to assist such
programs in obtaining the services of health
professionals and other resources to provide
specialized care for children with type 1 and type 2
diabetes.
``(4) Additional programs.--Activities under paragraph (1)
regarding education on diabetes shall include providing funds
for new and existing diabetes-focused education grants and
programs for present and future students and clinicians in the
medical field from minority populations, including for the
following:
``(A) For Federal and State loan repayment programs
for health profession students within communities of
color.
``(B) For the Office of Minority Health under
section 1707 for training health profession students to
focus on diabetes within such populations.
``(b) Collection and Reporting of Data.--
``(1) In general.--The Secretary shall ensure that research
and other activities undertaken pursuant to this section
include the collection and reporting, on a time basis
determined appropriate by the Secretary, data on race,
ethnicity, sex, gender, primary language, disability status and
socioeconomic status.
``(2) Grants.--To qualify for a grant under this section,
grantees shall develop research methodologies that ensure
annual reporting of data stratified as described in paragraph
(1).
``(c) Definition.--For purposes of this section, the term `minority
population' means a racial and ethnic minority group as defined in
section 1707(g).''.
(e) Sense of the Congress.--It is the sense of the Congress that
States and localities are encourage to recognize established times of
diabetes awareness, such as American Diabetes Month (November),
American Diabetes Alert Day (annually on the 4th Tuesday of March), and
World Diabetes Day (November 14th).
Subtitle G--Lung Disease
SEC. 761. EXPANSION OF THE NATIONAL ASTHMA EDUCATION AND PREVENTION
PROGRAM.
(a) In General.--Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
convene a working group comprised of patient groups, nonprofit
organizations, medical societies, and other relevant governmental and
nongovernmental entities, including those that participate in the
National Asthma Education and Prevention Program, to develop a report
to Congress that--
(1) catalogs, with respect to asthma prevention,
management, and surveillance--
(A) the activities of the Federal Government,
including identifying all Federal programs that carry
out asthma-related activities, as well as assessment of
the progress of the Federal Government and States, with
respect to achieving the goals of the Healthy People
2020 initiative; and
(B) the activities of other entities that
participate in the program, including nonprofit
organizations, patient advocacy groups, and medical
societies; and
(2) makes recommendations for the future direction of
asthma activities, in consultation with researchers from the
National Institutes of Health and other member bodies of the
National Asthma Education and Prevention Program who are
qualified to review and analyze data and evaluate
interventions, including--
(A) description of how the Federal Government may
better coordinate and improve its response to asthma
including identifying any barriers that may exist;
(B) description of how the Federal Government may
continue, expand, and improve its private-public
partnerships with respect to asthma including
identifying any barriers that may exist;
(C) identification of steps that may be taken to
reduce the--
(i) morbidity, mortality, and overall
prevalence of asthma;
(ii) financial burden of asthma on society;
(iii) burden of asthma on
disproportionately affected areas, particularly
those in medically underserved populations (as
defined in section 330(b)(3) of the Public
Health Service Act (42 U.S.C. 254b(b)(3)); and
(iv) burden of asthma as a chronic disease;
(D) identification of programs and policies that
have achieved the steps described in subparagraph (C),
and steps that may be taken to expand such programs and
policies to benefit larger populations; and
(E) recommendations for future research and
interventions.
(b) Report to Congress.--At the end of the 5-year period following
the submission of the report under subsection (a), the National Asthma
Education and Prevention Program shall evaluate the analyses and
recommendations under such report and determine whether a new report to
the Congress is necessary, and make appropriate recommendations to the
Congress.
SEC. 762. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL
AND PREVENTION.
Section 317I of the Public Health Service Act (42 U.S.C. 247b-10)
is amended to read as follows:
``SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE
CONTROL AND PREVENTION.
``(a) Program for Providing Information and Education to the
Public.--The Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall collaborate with State and local
health departments to conduct activities, including the provision of
information and education to the public regarding asthma including--
``(1) deterring the harmful consequences of uncontrolled
asthma; and
``(2) disseminating health education and information
regarding prevention of asthma episodes and strategies for
managing asthma.
``(b) Development of State Asthma Plans.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
shall collaborate with State and local health departments to develop
State plans incorporating public health responses to reduce the burden
of asthma, particularly regarding disproportionately affected
populations.
``(c) Compilation of Data.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, shall, in
cooperation with State and local public health officials--
``(1) conduct asthma surveillance activities to collect
data on the prevalence and severity of asthma, the
effectiveness of public health asthma interventions, and the
quality of asthma management, including--
``(A) collection of household data on the local
burden of asthma;
``(B) surveillance of health care facilities; and
``(C) collection of data not containing
individually identifiable information from electronic
health records or other electronic communications;
``(2) compile and annually publish data regarding the
prevalence and incidence of childhood asthma, the child
mortality rate, and the number of hospital admissions and
emergency department visits by children associated with asthma
nationally and in each State and at the county level by age,
sex, race, and ethnicity, as well as lifetime and current
prevalence; and
``(3) compile and annually publish data regarding the
prevalence and incidence of adult asthma, the adult mortality
rate, and the number of hospital admissions and emergency
department visits by adults associated with asthma nationally
and in each State and at the county level by age, sex, race,
ethnicity, industry, and occupation, as well as lifetime and
current prevalence.
``(d) Coordination of Data Collection.--The Director of the Centers
for Disease Control and Prevention, in conjunction with State and local
health departments, shall coordinate data collection activities under
subsection (c)(2) so as to maximize comparability of results.
``(e) Collaboration.--The Centers for Disease Control and
Prevention are encouraged to collaborate with national, State, and
local nonprofit organizations to provide information and education
about asthma, and to strengthen such collaborations when possible.''.
SEC. 763. INFLUENZA AND PNEUMONIA VACCINATION CAMPAIGN.
(a) In General.--The Secretary of Health and Human Services shall--
(1) enhance the annual campaign by the Department of Health
and Human Services to increase the number of people vaccinated
each year for influenza and pneumonia; and
(2) include in such campaign the use of written educational
materials, public service announcements, physician education,
and any other means which the Secretary deems effective.
(b) Materials and Announcements.--In carrying out the annual
campaign described in subsection (a), the Secretary of Health and Human
Services shall ensure that--
(1) educational materials and public service announcements
are readily and widely available in communities experiencing
disparities in the incidence and mortality rates of influenza
and pneumonia; and
(2) the campaign uses targeted, culturally appropriate
messages and messengers to reach underserved communities.
SEC. 764. CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACTION PLAN.
(a) In General.--The Director of the Centers for Disease Control
and Prevention shall conduct, support, and expand public health
strategies, prevention, diagnosis, surveillance, and public and
professional awareness activities regarding chronic obstructive
pulmonary disease.
(b) National Action Plan.--
(1) Development.--Not later than 2 years after the date of
the enactment of this Act, the Director of the National Heart,
Lung, and Blood Institute, in consultation with the Director of
the Centers for Disease Control and Prevention, shall develop a
national action plan to address chronic obstructive pulmonary
disease in the United States with participation from patients,
caregivers, health professionals, patient advocacy
organizations, researchers, providers, public health
professionals, and other stakeholders.
(2) Contents.--At a minimum, such plan shall include
recommendations for--
(A) public health interventions for the purpose of
implementation of the national plan;
(B) biomedical, health services, and public health
research on chronic obstructive pulmonary disease; and
(C) inclusion of chronic obstructive pulmonary
disease in the health data collections of all Federal
agencies.
(3) Consideration.--In developing such plan, the Director
of the National Heart, Lung, and Blood Institute shall consider
the recommendations and findings of the Institute of Medicine
in the report entitled ``A Nationwide Framework for
Surveillance of Cardiovascular and Chronic Lung Diseases''
(July 22, 2011).
(c) Chronic Disease Prevention Programs.--The Director of the
National Heart, Lung, and Blood Institute shall carry out the
following:
(1) Conduct public education and awareness activities with
patient and professional organizations to stimulate earlier
diagnosis and improve patient outcomes from treatment of
chronic obstructive pulmonary disease. To the extent known and
relevant, such public education and awareness activities shall
reflect differences in chronic obstructive pulmonary disease by
cause (tobacco, environmental, occupational, biological, and
genetic) and include a focus on outreach to undiagnosed and, as
appropriate, minority populations.
(2) Supplement and expand upon the activities of the
National Heart, Lung, and Blood Institute by making grants to
nonprofit organizations, State and local jurisdictions, and
Indian tribes for the purpose of reducing the burden of chronic
obstructive pulmonary disease, especially in disproportionately
impacted communities, through public health interventions and
related activities.
(3) Coordinate with the Centers for Disease Control and
Prevention, the Indian Health Service, the Health Resources and
Services Administration, and the Department of Veterans Affairs
to develop pilot programs to demonstrate best practices for the
diagnosis and management of chronic obstructive pulmonary
disease.
(4) Develop improved techniques and identify best
practices, in coordination with the Secretary of Veterans
Affairs, for assisting chronic obstructive pulmonary disease
patients to successfully stop smoking, including identification
of subpopulations with different needs. Initiatives under this
paragraph may include research to determine whether successful
smoking cessation strategies are different for chronic
obstructive pulmonary disease patients compared to such
strategies for patients with other chronic diseases.
(d) Environmental and Occupational Health Programs.--The Director
of the Centers for Disease Control and Prevention shall--
(1) support research into the environmental and
occupational causes and biological mechanisms that contribute
to chronic obstructive pulmonary disease; and
(2) develop and disseminate public health interventions
that will lessen the impact of environmental and occupational
causes of chronic obstructive pulmonary disease.
(e) Data Collection.--Not later than 180 days after the enactment
of this Act, the Director of the National Heart, Lung, and Blood
Institute and the Director of the Centers for Disease Control and
Prevention, acting jointly, shall assess the depth and quality of
information on chronic obstructive pulmonary disease that is collected
in surveys and population studies conducted by the Centers for Disease
Control and Prevention, including whether there are additional
opportunities for information to be collected in the National Health
and Nutrition Examination Survey, the National Health Interview Survey,
and the Behavioral Risk Factors Surveillance System surveys. The
Director of the National Heart, Lung, and Blood Institute shall include
the results of such assessment in the national action plan under
subsection (b).
TITLE VIII--HEALTH INFORMATION TECHNOLOGY
Subtitle A--Reducing Health Disparities Through Health IT
SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR PROMOTION OF HEALTH IT.
The Secretary of Health and Human Services, acting through the
Administrator of the Health Resources and Services Administration,
shall expand and intensify the programs and activities of the
Administration (directly or through grants or contracts) to provide
technical assistance and resources to health centers (as defined in
section 330(a) of the Public Health Service Act (42 U.S.C. 254b(a)) to
adopt and meaningfully use certified EHR technology (as defined in
section 3000(1) of such Act (42 U.S.C. 300jj(1)) for the management of
chronic diseases and health conditions.
SEC. 802. ASSESSMENT OF USE OF HEALTH IT IN RACIAL AND ETHNIC MINORITY
COMMUNITIES.
(a) National Coordinator for Health Information Technology.--
(1) In general.--The National Coordinator for Health
Information Technology shall conduct an evaluation of the level
of use and accessibility of electronic health records in racial
and ethnic minority communities.
(2) Content.--In conducting the evaluation under paragraph
(1), the National Coordinator shall publish the results of a
study regarding the 100,000 providers recruited by the Regional
Extension Center established under section 3012 of the Public
Health Service Act (42 U.S.C. 300jj-32), including the race and
ethnicity of such providers and the populations served by such
providers.
(b) National Center for Health Statistics.--As soon as practicable
after the date of enactment of this Act, the Director of the National
Center for Health Statistics shall provide to Congress a more detailed
analysis of the data presented in the Data Brief 79 published by such
Center in November 2011 (entitled ``Electronic Health Record Systems
and Intent to Apply for Meaningful Use Incentives Among Office-Based
Physician Practices'').
(c) Institute of Medicine.--The Secretary of Health and Human
Services may enter into an agreement with the Institute of Medicine of
the National Academies that provides such Institute will evaluate the
impact of health information technology in racial and ethnic minority
communities and publish a report regarding such evaluation.
Subtitle B--Modifications to Achieve Parity in Existing Programs
SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE HEALTH IT INFRASTRUCTURE
IN RACIAL AND ETHNIC MINORITY COMMUNITIES.
Section 3011 of the Public Health Service Act (42 U.S.C. 300jj-31)
is amended--
(1) in subsection (a), by adding at the end the following
new paragraph:
``(8) Activities described in the previous paragraphs of
this subsection with respect to communities with a high
proportion of individuals from racial and ethnic minority
groups (as defined in section 1707(g)).''; and
(2) by adding at the end the following new subsection:
``(e) Annual Report on Expenditures.--The National Coordinator
shall report annually to the Congress on activities and expenditures
under this section.''.
SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER ASSISTANCE TO RACIAL
AND ETHNIC MINORITY GROUPS.
(a) In General.--Section 3012(c)(4)(C) of the Public Health Service
Act (42 U.S.C. 300jj-32(c)(4)(C)) is amended by inserting ``or
individuals from racial and ethnic minority groups (as defined in
section 1707(g))'' after ``medically underserved individuals''.
(b) Biennial Evaluation.--Section 3012(c)(8) of such Act (42 U.S.C.
300jj-32(c)(8)) is amended--
(1) by inserting: ``Each evaluation panel shall include at
least one consumer advocate from a racial and ethnic minority
community served by the center involved and at least one
representative of a minority-serving institution.'' after
```and of Federal officials.''; and
(2) by inserting ``and shall determine the degree to which
such center provides outreach and assistance to providers
predominantly serving racial and ethnic minority groups (as
defined in section 1707(g))'' after ``specified in paragraph
(3)''.
SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DEVELOPMENT OF LOAN
PROGRAMS TO FACILITATE ADOPTION OF CERTIFIED EHR
TECHNOLOGY BY PROVIDERS SERVING RACIAL AND ETHNIC
MINORITY GROUPS.
Section 3014(e) of the Public Health Service Act (42 U.S.C. 300jj-
34(e)) is amended--
(1) in paragraph (3), by striking at the end ``or'';
(2) in paragraph (4), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(5) carry out any of the activities described in a
previous paragraph of this subsection with respect to
communities with a high proportion of individuals from racial
and ethnic minority groups (as defined in section 1707(g)).''.
Subtitle C--Additional Research and Studies
SEC. 821. DATA COLLECTION AND ASSESSMENTS CONDUCTED IN COORDINATION
WITH MINORITY-SERVING INSTITUTIONS.
Section 3001(c)(6) of the Public Health Service Act (42 U.S.C.
300jj-11(c)(6)) is amended by adding at the end the following new
subparagraph:
``(F) Data collection and assessments conducted in
coordination with minority-serving institutions.--
``(i) In general.--In carrying out
subparagraph (C) with respect to communities
with a high proportion of individuals from
racial and ethnic minority groups (as defined
in section 1707(g)), the National Coordinator
shall, to the greatest extent possible,
coordinate with an entity described in clause
(ii).
``(ii) Minority-serving institutions.--For
purposes of clause (i), an entity described in
this clause is a historically Black college or
university, an Hispanic-serving institution, a
tribal college or university, or an Asian-
American-, Native American-, and Pacific
Islander-serving institution with an accredited
public health, health policy, or health
services research program.''.
SEC. 822. IOM STUDY AND REPORT ON PRIVACY CONCERNS OF CERTAIN MINORITY
POPULATIONS.
(a) In General.--The Secretary of Health and Human Services shall
seek to enter into an agreement with the Institute of Medicine of the
National Academies to--
(1) complete a study--
(A) on the privacy concerns, relating to the
exchange of health information, of individuals
described in subsection (b);
(B) on how such concerns may create barriers for
such individuals to access health care or participate
in the exchange of health information; and
(C) including recommendations for overcoming such
barriers for such individuals; and
(2) not later than 24 months after the date of the
enactment of this Act, submit to Congress a report on the
results of such study.
If such Institute declines to conduct the study and submit the report,
the Secretary shall enter into an agreement with another appropriate
public or nonprofit private entity to conduct the study and submit the
report.
(b) Individuals Described.--For purposes of subsection (a), the
individuals described in this subsection are individuals from racial
and ethnic minority groups (as defined in section 1707(g)), including
such individuals who--
(1) are immigrants, as well as citizens living within
immigrant households (``mixed-status'' households) in the
United States;
(2) are lesbian, gay, bisexual, or transgender; or
(3) have a mental health disability or a record of a mental
health disability or treatment for a mental health disability.
SEC. 823. STUDY OF HEALTH INFORMATION TECHNOLOGY IN MEDICALLY
UNDERSERVED AREAS.
(a) In General.--Not later than 24 months after the date of
enactment of this Act, the Secretary of Health and Human Services
shall--
(1) enter into an agreement with the Institute of Medicine
of the National Academies (or, if the Institute of Medicine
declines, another appropriate public or nonprofit private
entity) to conduct a study on the development, implementation,
and effectiveness of health information technology within
medically underserved areas (as described in subsection (c));
and
(2) submit a report to Congress describing the results of
such study, including any recommendations for legislative or
administrative action.
(b) Study.--The study described in subsection (a)(1) shall--
(1) identify barriers to successful implementation of
health information technology in medically underserved areas;
(2) examine the impact of health information technology on
providing quality care and reducing the cost of care to
individuals in such areas, including the impact of such
technology on improved health outcomes for individuals;
(3) examine the impact of health information technology on
improving health care-related decisions by both patients and
providers in such areas;
(4) identify specific best practices for using health
information technology to foster the consistent provision of
physical accessibility and reasonable policy accommodations in
health care to individuals with disabilities in such areas;
(5) assess the feasibility and costs associated with the
use of health information technology in such areas;
(6) evaluate whether the adoption and use of qualified
electronic health records (as described in section 3000(13) of
the Public Health Service Act (42 U.S.C. 300jj(13)) is
effective in reducing health disparities, including analysis of
clinical quality measures reported by Medicare and Medicaid
providers pursuant to programs to encourage the adoption and
use of certified EHR technology;
(7) identify providers in medically underserved areas that
are not electing to adopt and use electronic health records and
determine what barriers are preventing those providers from
adopting and using such records; and
(8) examine urban and rural community health systems and
determine the impact that health information technology may
have on the capacity of primary health providers in those
systems.
(c) Medically Underserved Area.--The term ``medically underserved
area'' means--
(1) a population that has been designated as a medically
underserved population under section 330(b)(3) of the Public
Health Service Act (42 U.S.C. 254b(b)(3));
(2) an area that has been designated as a health
professional shortage area under section 332 of the Public
Health Service Act (42 U.S.C. 254e);
(3) an area or population that has been designated as a
medically underserved community under section 799B(6) of the
Public Health Service Act (42 U.S.C. 295p(6)); or
(4) an area or population that--
(A) is not described in paragraphs (1) through (3)
of this subsection;
(B) experiences significant barriers to accessing
quality health services; and
(C) has a high prevalence of diseases or conditions
described in title VII of this Act, with such diseases
or conditions having a disproportionate impact on
racial and ethnic minority groups (as defined in
section 1707(g) of the Public Health Service Act (42
U.S.C. 300u-6(g))) or a subgroup of people with
disabilities who have specific functional impairments.
Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs
SEC. 831. APPLICATION OF MEDICARE HITECH PAYMENTS TO HOSPITALS IN
PUERTO RICO.
(a) In General.--Subsection (n)(6)(B) of section 1886 of the Social
Security Act (42 U.S.C. 1395ww) is amended by striking ``subsection (d)
hospital'' and inserting ``hospital that is a subsection (d) hospital
or a subsection (d) Puerto Rico hospital''.
(b) Offsetting Reduction.--Subsection (n)(2) of such section is
amended by adding at the end the following new subparagraph:
``(H) Budget neutrality adjustment.--The Secretary
shall reduce the applicable amounts that would
otherwise be determined under this subsection with
respect to--
``(i) the first fiscal year to which this
subparagraph applies by an amount that the
Secretary estimates would ensure that estimated
aggregate payments under this subsection for
such fiscal year are not increased as a result
of the amendments made by subsection (a) of
section 831 of the Health Equity and
Accountability Act of 2012; or
``(ii) a succeeding fiscal year by an
amount that the Secretary estimates would
ensure that estimated aggregate payments under
this subsection for such fiscal year are not
increased as a result of the amendments made by
subsections (a) and (c) of such section.''.
(c) Conforming Amendments.--(1) Subsection (b)(3)(B)(ix) of such
section is amended--
(A) in subclause (I), by striking ``(n)(6)(A)'' and
inserting ``(n)(6)(B)''; and
(B) in subclause (II), by striking ``subsection (d)
hospital'' and inserting ``an eligible hospital''.
(2) Paragraphs (2) and (4)(A) of section 1853(m) of the Social
Security Act (42 U.S.C. 1395w-23(m)) are each amended by striking
``1886(n)(6)(A)'' and inserting ``1886(n)(6)(B)''.
(d) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by subsections (a), (b) and (c) by program instruction or
otherwise.
(e) Effective Date.--The amendments made by this section shall
apply to payments for payment years for fiscal years beginning after
the date of the enactment of this Act.
SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY FOR MEDICAID
ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS.
(a) In General.--Section 1903(t)(3)(B)(v) of the Social Security
Act (42 U.S.C. 1396b(t)(3)(B)(v)) is amended by striking ``insofar as
the assistant is practicing'' and all that follows through ``so led''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to amounts expended under 1903(a)(3)(F) of the
Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters
beginning on or after the date of the enactment of this Act.
TITLE IX--ACCOUNTABILITY AND EVALUATION
SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL ASSISTED HEALTH CARE
SERVICES AND RESEARCH PROGRAMS ON THE BASIS OF SEX, RACE,
COLOR, NATIONAL ORIGIN, SEXUAL ORIENTATION, GENDER
IDENTITY, OR DISABILITY STATUS.
No person in the United States shall, on the basis of sex, race,
color, national origin, sexual orientation, gender identity, or
disability status, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any health care
service or research program or activity receiving Federal financial
assistance.
SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER TITLE VI OF THE CIVIL
RIGHTS ACT OF 1964.
A payment to a provider of services, physician, or other supplier
under part B, C, or D of title XVIII of the Social Security Act shall
be deemed a grant, and not a contract of insurance or guaranty, for the
purposes of title VI of the Civil Rights Act of 1964.
SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES.
Title XXXIV of the Public Health Service Act, as amended by titles
I, II, and III of this Act, is further amended by inserting after
subtitle B the following:
``Subtitle C--Strengthening Accountability
``SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS.
``(a) In General.--The Secretary shall establish within the Office
for Civil Rights an Office of Health Disparities, which shall be headed
by a director to be appointed by the Secretary.
``(b) Purpose.--The Office of Health Disparities shall ensure that
the health programs, activities, and operations of health entities
which receive Federal financial assistance are in compliance with title
VI of the Civil Rights Act, which prohibits discrimination on the basis
of race, color, or national origin. The activities of the Office shall
include the following:
``(1) The development and implementation of an action plan
to address racial and ethnic health care disparities, which
shall address concerns relating to the Office for Civil Rights
as released by the United States Commission on Civil Rights in
the report entitled `Health Care Challenge: Acknowledging
Disparity, Confronting Discrimination, and Ensuring Equity'
(September 1999) in conjunction with the reports by the
Institute of Medicine entitled `Unequal Treatment: Confronting
Racial and Ethnic Disparities in Health Care', `Crossing the
Quality Chasm: A New Health System for the 21st Century', and
`In the Nation's Compelling Interest: Ensuring Diversity in the
Health Care Workforce', and `The National Partnership for
Action to End Health Disparities', and other related reports by
the Institute of Medicine. This plan shall be publicly
disclosed for review and comment and the final plan shall
address any comments or concerns that are received by the
Office.
``(2) Investigative and enforcement actions against
intentional discrimination and policies and practices that have
a disparate impact on minorities.
``(3) The review of racial, ethnic, and primary language
health data collected by Federal health agencies to assess
health care disparities related to intentional discrimination
and policies and practices that have a disparate impact on
minorities.
``(4) Outreach and education activities relating to
compliance with title VI of the Civil Rights Act.
``(5) The provision of technical assistance for health
entities to facilitate compliance with title VI of the Civil
Rights Act.
``(6) Coordination and oversight of activities of the civil
rights compliance offices established under section 3442.
``(7) Ensuring compliance with the 1997 Office of
Management and Budget Standards for Maintaining, Collecting,
and Presenting Federal Data on Race, Ethnicity and the
available language standards.
``(c) Funding and Staff.--The Secretary shall ensure the
effectiveness of the Office of Health Disparities by ensuring that the
Office is provided with--
``(1) adequate funding to enable the Office to carry out
its duties under this section; and
``(2) staff with expertise in--
``(A) epidemiology;
``(B) statistics;
``(C) health quality assurance;
``(D) minority health and health disparities;
``(E) cultural and linguistic competency; and
``(F) civil rights.
``(d) Report.--Not later than December 31, 2012, and annually
thereafter, the Secretary, in collaboration with the Director of the
Office for Civil Rights and the Deputy Assistant Secretary for Minority
Health, shall submit a report to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on Energy and
Commerce of the House of Representatives that includes--
``(1) the number of cases filed, broken down by category;
``(2) the number of cases investigated and closed by the
office;
``(3) the outcomes of cases investigated;
``(4) the staffing levels of the office including staff
credentials;
``(5) the number of other lingering and emerging cases in
which civil rights inequities can be demonstrated; and
``(6) the number of cases remaining open and an explanation
for their open status.
``SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OFFICES FOR CIVIL RIGHTS
WITHIN FEDERAL HEALTH AND HUMAN SERVICES AGENCIES.
``(a) In General.--The Secretary shall establish civil rights
compliance offices in each agency within the Department of Health and
Human Services that administers health programs.
``(b) Purpose of Offices.--Each office established under subsection
(a) shall ensure that recipients of Federal financial assistance under
Federal health programs administer their programs, services, and
activities in a manner that--
``(1) does not discriminate, either intentionally or in
effect, on the basis of race, national origin, language,
ethnicity, sex, age, disability, sexual orientation, and gender
identity; and
``(2) promotes the reduction and elimination of disparities
in health and health care based on race, national origin,
language, ethnicity, sex, age, disability, sexual orientation,
and gender identity.
``(c) Powers and Duties.--The offices established in subsection (a)
shall have the following powers and duties:
``(1) The establishment of compliance and program
participation standards for recipients of Federal financial
assistance under each program administered by an agency within
the Department of Health and Human Services including the
establishment of disparity reduction standards to encompass
disparities in health and health care related to race, national
origin, language, ethnicity, sex, age, disability, sexual
orientation, and gender identity.
``(2) The development and implementation of program-
specific guidelines that interpret and apply Department of
Health and Human Services guidance under title VI of the Civil
Rights Act of 1964 and section 1557 of the Patient Protection
and Affordable Care Act to each Federal health program
administered by the agency.
``(3) The development of a disparity-reduction impact
analysis methodology that shall be applied to every rule issued
by the agency and published as part of the formal rulemaking
process under sections 555, 556, and 557 of title 5, United
States Code.
``(4) Oversight of data collection, analysis, and
publication requirements for all recipients of Federal
financial assistance under each Federal health program
administered by the agency, and compliance with the 1997 Office
of Management and Budget Standards for Maintaining, Collecting,
and Presenting Federal Data on Race and Ethnicity and the
available language standards.
``(5) The conduct of publicly available studies regarding
discrimination within Federal health programs administered by
the agency as well as disparity reduction initiatives by
recipients of Federal financial assistance under Federal health
programs.
``(6) Annual reports to the Committee on Health, Education,
Labor, and Pensions and the Committee on Finance of the Senate
and the Committee on Energy and Commerce and the Committee on
Ways and Means of the House of Representatives on the progress
in reducing disparities in health and health care through the
Federal programs administered by the agency.
``(d) Relationship to Office for Civil Rights in the Department of
Justice.--
``(1) Department of health and human services.--The Office
for Civil Rights in the Department of Health and Human Services
shall provide standard-setting and compliance review
investigation support services to the Civil Rights Compliance
Office for each agency.
``(2) Department of justice.--The Office for Civil Rights
in the Department of Justice shall continue to maintain the
power to institute formal proceedings when an agency Office for
Civil Rights determines that a recipient of Federal financial
assistance is not in compliance with the disparity reduction
standards of the agency.
``(e) Definition.--In this section, the term `Federal health
programs' mean programs--
``(1) under the Social Security Act (42 U.S.C. 301 et seq.)
that pay for health care and services; and
``(2) under this Act that provide Federal financial
assistance for health care, biomedical research, health
services research, and programs designed to improve the
public's health.''.
SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS.
Section 3 of the Civil Rights Commission Act of 1983 (42 U.S.C.
1975a) is amended--
(1) in paragraph (1), by striking ``and'' at the end;
(2) in paragraph (2), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(3) shall, with respect to activities carried out in
health care and correctional facilities toward the goal of
eliminating health disparities between the general population
and members of racial or ethnic minority groups, coordinate
such activities of--
``(A) the Office for Civil Rights within the
Department of Justice;
``(B) the Office of Justice Programs within the
Department of Justice;
``(C) the Office for Civil Rights within the
Department of Health and Human Services; and
``(D) the Office of Minority Health within the
Department of Health and Human Services (headed by the
Deputy Assistant Secretary for Minority Health).''.
SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUNDING OF ACTIVITIES TO
ELIMINATE RACIAL AND ETHNIC HEALTH DISPARITIES.
(a) Findings.--Congress makes the following findings:
(1) The health status of the American populace is declining
and the United States currently ranks below most industrialized
nations in health status measured by longevity, sickness, and
mortality.
(2) Racial and ethnic minority populations tend have the
poorest health status and face substantial cultural, social,
and economic barriers to obtaining quality health care.
(3) Efforts to improve minority health have been limited by
inadequate resources (funding, staffing, and stewardship) and
accountability.
(b) Sense of Congress.--It is the sense of Congress that--
(1) funding should be doubled by fiscal year 2013 for the
National Institute for Minority Health Disparities, the Office
of Civil Rights in the Department of Health and Human Services,
the National Institute of Nursing Research, and the Office of
Minority Health;
(2) adequate funding by fiscal year 2013, and subsequent
funding increases, should be provided for health professions
training programs, the Racial and Ethnic Approaches to
Community Health (REACH) at the Centers for Disease Control and
Prevention, the Minority HIV/AIDS Initiative, and the
Excellence Centers to Eliminate Ethnic/Racial Disparities
(EXCEED) Program at the Agency for Healthcare Research and
Quality;
(3) funding should be restored to the Racial and Ethnic
Approaches to Community Health (REACH) program at the Centers
for Disease Control and Prevention, which has been a successful
program at the community health level;
(4) current and newly created health disparity elimination
incentives, programs, agencies, and departments under this Act
(and the amendments made by this Act) should receive adequate
staffing and funding by fiscal year 2013; and
(5) stewardship and accountability should be provided to
the Congress and the President for measurable and sustainable
progress toward health disparity elimination.
SEC. 906. GAO AND NIH REPORTS.
(a) GAO Report on NIH Grant Racial and Ethnic Diversity.--
(1) In general.--The Comptroller General of the United
States shall conduct a study on the racial and ethnic diversity
among the following groups:
(A) All applicants for grants, contracts, and
cooperative agreements awarded by the National
Institutes of Health during the period beginning
January 1, 1990, and ending December 31, 2011.
(B) All recipients of such grants, contracts, and
cooperative agreements.
(C) All members of the peer review panels of such
applicants and recipients, respectively.
(2) Report.--Not later than six months after the date of
the enactment of this Act, the Comptroller General shall
complete the study under paragraph (1) and submit to Congress a
report containing the results of such study.
(b) NIH Report on Certain Authority of National Institute on
Minority Health and Health Disparities.--Not later than six months
after the date of the enactment of this Act, and biennially thereafter,
the Director of the National Institutes of Health, in collaboration
with the Director of the National Institute on Minority Health and
Health Disparities, shall submit to Congress a report that details and
evaluates--
(1) the steps taken during the applicable report period by
the Director of the National Institutes of Health to enforce
the expanded planning, coordination, review, and evaluation
authority provided the National Institute on Minority Health
and Health Disparities under section 464z-3(h) of the Public
Health Service Act (42 U.S.C. 285(h)), as added by section
10334(c) of the Patient Protection and Affordable Care Act,
over all minority health and health disparity research that is
conducted or supported by the Institutes and Centers at the
National Institutes of Health; and
(2) the outcomes of such steps.
(c) GAO Report Related to Recipients of PPACA Funding.--Not later
than one year after the date of the enactment of this Act and
biennially thereafter until 2020, the Comptroller General of the United
States shall submit to Congress a report that identifies, with respect
to minority community-based organizations that applied during the
applicable report period for Federal funding provided pursuant to the
provisions of (and amendments made by) the Patient Protection and
Affordable Care Act for purposes of achieving health equity and
eliminating health disparities, the percentage of such organizations
that were awarded such funding.
(d) Annual Report on Activities of National Institute on Minority
Health and Health Disparities.--The Director of the National Institute
on Minority Health and Health Disparities shall prepare an annual
report on the activities carried out or to be carried out by the
Institute, and shall submit each such report to the Committee on
Health, Education, Labor, and Pensions of the Senate, the Committee on
Energy and Commerce of the House of Representatives, the Secretary of
Health and Human Services, and the Director of the National Institutes
of Health. With respect to the fiscal year involved, the report shall--
(1) describe and evaluate the progress made in health
disparities research conducted or supported by institutes and
centers of the National Institutes of Health;
(2) summarize and analyze expenditures made for activities
with respect to health disparities research conducted or
supported by the National Institutes of Health;
(3) include a separate statement applying the requirements
of paragraphs (1) and (2) specifically to minority health
disparities research; and
(4) contain such recommendations as the Director of the
Institute considers appropriate.
TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
JUSTICE
SEC. 1001. CODIFICATION OF EXECUTIVE ORDER 12898.
(a) In General.--The President of the United States is authorized
and directed to execute, administer, and enforce as a matter of Federal
law the provisions of Executive Order 12898, dated February 11, 1994
(``Federal Actions To Address Environmental Justice In Minority
Populations and Low-Income Populations''), with such modifications as
are provided in this section.
(b) Definition of Environmental Justice.--For purposes of carrying
out the provisions of Executive Order 12898, the following definitions
shall apply:
(1) The term ``environmental justice'' means the fair
treatment and meaningful involvement of all people regardless
of race, color, national origin, educational level, or income
with respect to the development, implementation, and
enforcement of environmental laws and regulations in order to
ensure that--
(A) minority and low-income communities have access
to public information relating to human health and
environmental planning, regulations, and enforcement;
and
(B) no minority or low-income population is forced
to shoulder a disproportionate burden of the negative
human health and environmental impacts of pollution or
other environmental hazard.
(2) The term ``fair treatment'' means policies and
practices that ensure that no group of people, including
racial, ethnic, or socioeconomic groups bear disproportionately
high and adverse human health or environmental effects
resulting from Federal agency programs, policies, and
activities.
(c) Judicial Review and Rights of Action.--The provisions of
section 6-609 of Executive Order 12898 shall not apply for purposes of
this Act.
SEC. 1002. IMPLEMENTATION OF RECOMMENDATIONS BY ENVIRONMENTAL
PROTECTION AGENCY.
(a) Inspector General Recommendations.--The Administrator of the
Environmental Protection Agency shall, as promptly as practicable,
carry out each of the following recommendations of the Inspector
General of the agency as set forth in Report No. 2006-P-00034 entitled
``EPA needs to conduct environmental justice reviews of its programs,
policies and activities'':
(1) The recommendation that the Agency's program and
regional offices identify which programs, policies, and
activities need environmental justice reviews and require these
offices to establish a plan to complete the necessary reviews.
(2) The recommendation that the Administrator of the Agency
ensure that these reviews determine whether the programs,
policies, and activities may have a disproportionately high and
adverse health or environmental impact on minority and low-
income populations.
(3) The recommendation that each program and regional
office develop specific environmental justice review guidance
for conducting environmental justice reviews.
(4) The recommendation that the Administrator designate a
responsible office to compile results of environmental justice
reviews and recommend appropriate actions.
(b) GAO Recommendations.--In developing rules under laws
administered by the Environmental Protection Agency, the Administrator
of the Agency shall, as promptly as practicable, carry out each of the
following recommendations of the Comptroller General of the United
States as set forth in GAO Report numbered GAO-05-289 entitled ``EPA
Should Devote More Attention to Environmental Justice when Developing
Clean Air Rules'':
(1) The recommendation that the Administrator ensure that
workgroups involved in developing a rule devote attention to
environmental justice while drafting and finalizing the rule.
(2) The recommendation that the Administrator enhance the
ability of such workgroups to identify potential environmental
justice issues through such steps as providing workgroup
members with guidance and training to helping them identify
potential environmental justice problems and involving
environmental justice coordinators in the workgroups when
appropriate.
(3) The recommendation that the Administrator improve
assessments of potential environmental justice impacts in
economic reviews by identifying the data and developing the
modeling techniques needed to assess such impacts.
(4) The recommendation that the Administrator direct
appropriate Agency officers and employees to respond fully when
feasible to public comments on environmental justice, including
improving the Agency's explanation of the basis for its
conclusions, together with supporting data.
(c) 2004 Inspector General Report.--The Administrator of the
Environmental Protection Agency shall, as promptly as practicable,
carry out each of the following recommendations of the Inspector
General of the Agency as set forth in the report entitled ``EPA Needs
to Consistently Implement the Intent of the Executive Order on
Environmental Justice'' (Report No. 2004-P-00007):
(1) The recommendation that the Agency clearly define the
mission of the Office of Environmental Justice (OEJ) and
provide Agency staff with an understanding of the roles and
responsibilities of the Office.
(2) The recommendation that the Agency establish (through
issuing guidance or a policy statement from the Administrator)
specific time frames for the development of definitions, goals,
and measurements regarding environmental justice and provide
the regions and program offices a standard and consistent
definition for a minority and low-income community, with
instructions on how the Agency will implement and
operationalize environmental justice into the Agency's daily
activities.
(3) The recommendation that the Agency ensure the
comprehensive training program currently under development
includes standard and consistent definitions of the key
environmental justice concepts (such as ``low-income'',
``minority'', and ``disproportionately impacted'') and
instructions for implementation of those concepts.
The Administrator shall submit an initial report to Congress within 6
months after the enactment of this Act regarding the Administrator's
strategy for implementing the recommendations referred to in paragraphs
(1), (2), and (3). Thereafter, the Administrator shall provide
semiannual reports to Congress regarding the Administrator's progress
in implementing such recommendations and modifying the Administrator's
emergency management procedures to incorporate environmental justice in
the Agency's Incident Command Structure (in accordance with the
December 18, 2006, letter from the Deputy Administrator to the Acting
Inspector General of the Agency).
(d) Federal Action Plan for Saving Lives, Protecting People and
Their Families From Radon.--
(1) In general.--Because radon is a naturally occurring
radioactive gas that is recognized as the leading cause of lung
cancer among nonsmokers and is a particular environmental
threat for low-income and minority individuals because of the
lack of information about radon levels in their own homes, the
Administrator of the Environmental Protection Agency shall
within 6 months after the date of the enactment of this Act,
implement the action plan entitled ``Protecting People and
Families from Radon: A Federal Action Plan for Saving Lives''
(June 20, 2011), working with the Secretary of Health and Human
Services acting through the Director of the Centers for Disease
Control and Prevention, and with the other Federal agencies
mentioned in and as set forth in the action plan.
(2) Specific steps.--In carrying out paragraph (1), the
Administrator shall take steps to achieve each of the
following:
(A) The recommendation that the workgroup comprised
of the Federal agencies participating in the
development of the action plan referred to in paragraph
(1) implement specific steps within the current
authority and activities of each Federal agency to
reduce exposure to radon.
(B) The recommendation that such workgroup meet on
the 1-year anniversary of the plan to assess and
recognize achievements of the plan.
(3) Report.--The Administrator shall report to the Congress
on the 1-year assessment of the plan's implementation,
including the challenges remaining and the progress in reducing
radon exposure particularly to low-income and minority
families.
SEC. 1003. GRANT PROGRAM.
(a) Definitions.--In this section:
(1) Director.--The term ``Director'' means the Director of
the Centers for Disease Control and Prevention, acting in
collaboration with the Administrator of the Environmental
Protection Agency and the Director of the National Institute of
Environmental Health Sciences.
(2) Eligible entity.--The term ``eligible entity'' means a
State or local community that--
(A) bears a disproportionate burden of exposure to
environmental health hazards;
(B) has established a coalition--
(i) with not less than 1 community-based
organization; and
(ii) with not less than 1--
(I) public health entity;
(II) health care provider
organization; or
(III) academic institution,
including any minority-serving
institution (including an Hispanic-
serving institution, a historically
Black college or university, and a
tribal college or university);
(C) ensures planned activities and funding streams
are coordinated to improve community health; and
(D) submits an application in accordance with
subsection (c).
(b) Establishment.--The Director shall establish a grant program
under which eligible entities shall receive grants to conduct
environmental health improvement activities.
(c) Application.--To receive a grant under this section, an
eligible entity shall submit an application to the Director at such
time, in such manner, and accompanied by such information as the
Director may require.
(d) Cooperative Agreements.--An eligible entity may use a grant
under this section--
(1) to promote environmental health; and
(2) to address environmental health disparities.
(e) Amount of Cooperative Agreement.--
(1) In general.--The Director shall award grants to
eligible entities at the 2 different funding levels described
in this subsection.
(2) Level 1 cooperative agreements.--
(A) In general.--An eligible entity awarded a grant
under this paragraph shall use the funds to identify
environmental health problems and solutions by--
(i) establishing a planning and
prioritizing council in accordance with
subparagraph (B); and
(ii) conducting an environmental health
assessment in accordance with subparagraph (C).
(B) Planning and prioritizing council.--
(i) In general.--A prioritizing and
planning council established under subparagraph
(A)(i) (referred to in this paragraph as a
``PPC'') shall assist the environmental health
assessment process and environmental health
promotion activities of the eligible entity.
(ii) Membership.--Membership of a PPC shall
consist of representatives from various
organizations within public health, planning,
development, and environmental services and
shall include stakeholders from vulnerable
groups such as children, the elderly, disabled,
and minority ethnic groups that are often not
actively involved in democratic or
decisionmaking processes.
(iii) Duties.--A PPC shall--
(I) identify key stakeholders and
engage and coordinate potential
partners in the planning process;
(II) establish a formal advisory
group to plan for the establishment of
services;
(III) conduct an in-depth review of
the nature and extent of the need for
an environmental health assessment,
including a local epidemiological
profile, an evaluation of the service
provider capacity of the community, and
a profile of any target populations;
and
(IV) define the components of care
and form essential programmatic
linkages with related providers in the
community.
(C) Environmental health assessment.--
(i) In general.--A PPC shall carry out an
environmental health assessment to identify
environmental health concerns.
(ii) Assessment process.--The PPC shall--
(I) define the goals of the
assessment;
(II) generate the environmental
health issue list;
(III) analyze issues with a systems
framework;
(IV) develop appropriate community
environmental health indicators;
(V) rank the environmental health
issues;
(VI) set priorities for action;
(VII) develop an action plan;
(VIII) implement the plan; and
(IX) evaluate progress and planning
for the future.
(D) Evaluation.--Each eligible entity that receives
a grant under this paragraph shall evaluate, report,
and disseminate program findings and outcomes.
(E) Technical assistance.--The Director may provide
such technical and other non-financial assistance to
eligible entities as the Director determines to be
necessary.
(3) Level 2 cooperative agreements.--
(A) Eligibility.--
(i) In general.--The Director shall award
grants under this paragraph to eligible
entities that have already--
(I) established broad-based
collaborative partnerships; and
(II) completed environmental
assessments.
(ii) No level 1 requirement.--To be
eligible to receive a grant under this
paragraph, an eligible entity is not required
to have successfully completed a Level 1
Cooperative Agreement (as described in
paragraph (2)).
(B) Use of grant funds.--An eligible entity awarded
a grant under this paragraph shall use the funds to
further activities to carry out environmental health
improvement activities, including--
(i) addressing community environmental
health priorities in accordance with paragraph
(2)(C)(ii), including--
(I) air quality;
(II) water quality;
(III) solid waste;
(IV) land use;
(V) housing;
(VI) food safety;
(VII) crime;
(VIII) injuries; and
(IX) health care services;
(ii) building partnerships between
planning, public health, and other sectors, to
address how the built environment impacts food
availability and access and physical activity
to promote healthy behaviors and lifestyles and
reduce overweight and obesity, asthma,
respiratory conditions, dental, oral and mental
health conditions, poverty, and related co-
morbidities;
(iii) establishing programs to address--
(I) how environmental and social
conditions of work and living choices
influence physical activity and dietary
intake; or
(II) how those conditions influence
the concerns and needs of people who
have impaired mobility and use
assistance devices, including
wheelchairs and lower limb prostheses;
and
(iv) convening intervention programs that
examine the role of the social environment in
connection with the physical and chemical
environment in--
(I) determining access to
nutritional food; and
(II) improving physical activity to
reduce morbidity and increase quality
of life.
SEC. 1004. ADDITIONAL RESEARCH ON THE RELATIONSHIP BETWEEN THE BUILT
ENVIRONMENT AND THE HEALTH OF COMMUNITY RESIDENTS.
(a) Definition of Eligible Institution.--In this section, the term
``eligible institution'' means a public or private nonprofit
institution that submits to the Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') and the
Administrator of the Environmental Protection Agency (in this section
referred to as the ``Administrator'') an application for a grant under
the grant program authorized under subsection (b)(2) at such time, in
such manner, and containing such agreements, assurances, and
information as the Secretary and Administrator may require.
(b) Research Grant Program.--
(1) Definition of health.--In this section, the term
``health'' includes--
(A) levels of physical activity;
(B) consumption of nutritional foods;
(C) rates of crime;
(D) air, water, and soil quality;
(E) risk of injury;
(F) accessibility to health care services; and
(G) other indicators as determined appropriate by
the Secretary.
(2) Grants.--The Secretary, in collaboration with the
Administrator, shall provide grants to eligible institutions to
conduct and coordinate research on the built environment and
its influence on individual and population-based health.
(3) Research.--The Secretary shall support research that--
(A) investigates and defines the causal links
between all aspects of the built environment and the
health of residents;
(B) examines--
(i) the extent of the impact of the built
environment (including the various
characteristics of the built environment) on
the health of residents;
(ii) the variance in the health of
residents by--
(I) location (such as inner cities,
inner suburbs, and outer suburbs); and
(II) population subgroup (such as
children, the elderly, the
disadvantaged); or
(iii) the importance of the built
environment to the total health of residents,
which is the primary variable of interest from
a public health perspective;
(C) is used to develop--
(i) measures to address health and the
connection of health to the built environment;
and
(ii) efforts to link the measures to travel
and health databases; and
(D) distinguishes carefully between personal
attitudes and choices and external influences on
observed behavior to determine how much an observed
association between the built environment and the
health of residents, versus the lifestyle preferences
of the people that choose to live in the neighborhood,
reflects the physical characteristics of the
neighborhood; and
(E)(i) identifies or develops effective
intervention strategies to promote better health among
residents with a focus on behavioral interventions and
enhancements of the built environment that promote
increased use by residents; and
(ii) in developing the intervention strategies
under clause (i), ensures that the intervention
strategies will reach out to high-risk populations,
including racial and ethnic minorities and low-income
urban and rural communities.
(4) Priority.--In providing assistance under the grant
program authorized under paragraph (2), the Secretary and the
Administrator shall give priority to research that
incorporates--
(A) minority-serving institutions as grantees;
(B) interdisciplinary approaches; or
(C) the expertise of the public health, physical
activity, urban planning, and transportation research
communities in the United States and abroad.
SEC. 1005. ENVIRONMENT AND PUBLIC HEALTH RESTORATION.
(a) Findings.--
(1) General findings.--The Congress finds as follows:
(A) As human beings, we share our environment with
a wide variety of habitats and ecosystems that nurture
and sustain a diversity of species.
(B) The abundance of natural resources in our
environment forms the basis for our economy and has
greatly contributed to human development throughout
history.
(C) The accelerated pace of human development over
the last several hundred years has significantly
impacted our natural environment and its resources, the
health and diversity of plant and animal wildlife, the
availability of critical habitats, the quality of our
air and our water, and our global climate.
(D) The intervention of the Federal Government is
necessary to minimize and mitigate human impact on the
environment for the benefit of public health, to
maintain air quality and water quality, to sustain the
diversity of plants and animals, to combat global
climate change, and to protect the environment.
(E) Laws and regulations in the United States have
been created and promulgated to minimize and mitigate
human impact on the environment for the benefit of
public health, to maintain air quality and water
quality, to sustain wildlife, and to protect the
environment.
(F) Such laws include the Antiquities Act of 1906
(16 U.S.C. 431 et seq.) initiated by President Theodore
Roosevelt to create the national park system, the
National Environmental Policy Act of 1969 (42 U.S.C.
4321 et seq.), the Clean Air Act (42 U.S.C. 7401 et
seq.), the Federal Water Pollution Control Act (33
U.S.C. 1251 et seq.), the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980
(Public Law 96-510), the Endangered Species Act of 1973
(Public Law 93-205), and the National Forest Management
Act of 1976 (Public Law 94-588).
(G) Attempts to repeal or weaken key environmental
safeguards pose dangers to the public health, air
quality, water quality, wildlife, and the environment.
(2) Findings on changes and proposed changes in law.--The
Congress finds that, since 2001, the following changes and
proposed changes to existing law or regulations have negatively
impacted or will negatively impact the environment and public
health:
(A) Clean water.--
(i) On May 9, 2002, the Environmental
Protection Agency (EPA) and the Army Corps of
Engineers put forth a final rule that
reconciled regulations implementing section 404
of the Federal Water Pollution Control Act by
redefining the term ``fill material'' and
amending the definition of the term ``discharge
of fill material'', reversing a 25-year-old
regulation. The new rule fails to restrict the
dumping of hardrock mining waste, construction
debris, and other industrial wastes into
rivers, streams, lakes, and wetlands. The rule
further allows destructive mountaintop removal
coal mining companies to dump waste into
streams and lakes, polluting the surrounding
natural habitat and poisoning plants and
animals that depend on those water sources.
(ii) On February 12, 2003, the
Environmental Protection Agency published the
rule ``National Pollutant Discharge Elimination
System Permit Regulation and Effluent
Limitation Guidelines and Standards for
Concentrated Animal Feeding Operations'', new
livestock waste regulations that aimed to
control factory farm pollution but which would
severely undermine existing protections under
the Federal Water Pollution Control Act. This
regulation allows large-scale animal factories
to foul the Nation's waters with animal waste,
allows livestock owners to draft their own
pollution-management plans and avoid ground
water monitoring, legalizes the discharge of
contaminated runoff water rich in nitrogen,
phosphorus, bacteria, and metals, and ensures
that large factory farms are not held liable
for the environmental damage they cause. In a
2005 Federal court decision (``Waterkeeper
Alliance, et al. v. Environmental Protection
Agency'', 399 F.3d 486 (2nd Cir. 2005)), major
parts of the rule were upheld, others vacated,
and still others remanded back to the EPA. On
November 20, 2008, the Environmental Protection
Agency published a revised final rule which
undermines environmental protection provisions
by removing mandatory permitting requirements
and allowing large animal farms to self-certify
the absence of pollutant discharge activity.
(iii) On March 19, 2003, the Environmental
Protection Agency published a new rule
regarding the Total Maximum Daily Load program
of the Federal Water Pollution Control Act that
regulates the maximum amount of a particular
pollutant that can be present in a body of
water and still meet water quality standards.
The new rule withdrew the existing regulation
put forth on July 13, 2000, and halted momentum
in cleaning up polluted waterways throughout
the Nation. By abandoning the existing rule,
the Environmental Protection Agency is
undermining the effectiveness of clean-up plans
and is allowing States to avoid cleaning
polluted waters entirely by dropping them from
their clean-up lists. Waterways play a crucial
role in the lives of the people of the United
States and are critical to the livelihood of
fish and wildlife. The result of dropping the
July 2000 rule is that the restoration of
polluted rivers, shorelines, and lakes will be
delayed, harming more fish and wildlife and
worsening the quality of drinking water.
(iv) On December 2, 2008, the Environmental
Protection Agency and the Army Corps of
Engineers jointly issued a guidance document in
the form of a legal memorandum, titled ``Clean
Water Act Jurisdiction Following the U.S.
Supreme Court's Decision in Rapanos v. United
States & Carabell v. United States''. This new
guidance dictates enforcement actions under the
Federal Water Pollution Control Act and calls
for a complicated ``case-by-case'' analysis to
determine jurisdiction for waterways that do
not flow all year. Such actions endanger small
streams and wetlands that serve as important
habitats for aquatic life, which play a
fundamental role in safeguarding sources of
clean drinking water and mitigate the risks and
effects of floods and droughts. Further, the
definition provided therein for ``waters of the
United States'' is applicable to the Federal
Water Pollution Control Act as a whole,
potentially affecting programs that control
industrial pollution and sewage levels, prevent
oil spills, and set water quality standards for
all waters in the United States protected under
the Federal Water Pollution Control Act.
(B) Forests and land management.--
(i) On December 3, 2003, the President
signed into law the Healthy Forests Restoration
Act of 2003 (Public Law 108-148; 16 U.S.C. 6501
et seq.). Although the law attempts to reduce
the risk of catastrophic forest fires, it
provides a boon to timber companies by
accelerating the aggressive thinning of
backcountry forests that are far from at-risk
communities. The law allows for increased
logging of large, fire-resistant trees that are
not in close proximity of homes and
communities; it undermines critical protections
for endangered species by exempting Federal
land management agencies from consulting with
the United States Fish and Wildlife Service
before approving any action that could harm
endangered plants or wildlife; and it limits
public participation by reducing the number of
environmental project reviews.
(ii) On April 21, 2008, the Department of
Agriculture issued a Final Planning Rule and
Record of Decision for National Forest System
Land Management Planning. Similar to rules
enacted by the Administration on January 5,
2005, later remanded back to the agency in
Federal district court for violating the
National Environmental Policy Act of 1969, the
Endangered Species Act of 1973, and the
Administrative Procedure Act (``Citizens for
Better Forestry v. United States Department of
Agriculture'', 481 F. Supp. 2d 1059 (N.D. Cal.
2007)), this revised rule eliminates strict
forest planning standards established in 1982,
and opens millions of acres of public lands to
damaging and invasive logging, mining, and
drilling operations. These regulations would
reverse more than 20 years of protection for
wildlife and national forests by removing the
overall goal of ensuring ecological
sustainability in managing the national forest
system, weakening the National Forest
Management Act of 1976, and effectively ending
the review of forest management plans under the
National Environmental Policy Act of 1969.
(iii) On September 20, 2006, the District
Court for the Northern District of California
vacated the Protection of Inventoried Roadless
Areas rule, enacted on May 13, 2005, which gave
State Governors 18 months to petition the
Federal Government to either restore the
previous rule for their States, or submit a new
management and development plan for national
forest areas inventoried under the rule.
Despite the enjoinment of the Administration's
2005 rule, and the subsequent restoration of
the original Roadless Area Conservation Rule,
the U.S. Forest Service has continued to allow
States to petition for a special rule under the
authority of the Administrative Procedure Act,
publishing a final special rule for Idaho on
October 16, 2008. As a result, 58.5 million
acres of wild national forests are still
vulnerable to logging, road building, and other
developments that may fragment natural habitats
and negatively impact fish and wildlife.
(iv) On November 17, 2008, the Department
of the Interior's Bureau of Land Management
(BLM) signed the Record of Decision (ROD)
amending 12 resource management plans in
Colorado, Utah, and Wyoming, opening 2,000,000
acres of public lands to commercial tar sands
and oil shale exploration and development. On
November 18, 2008, the BLM published a final
rule for Oil Shale Management setting the
policies and procedures for a commercial
leasing program for the management of federally
owned oil shale in those three States.
Previously barred by a congressional moratorium
on the commercial leasing regulations for oil
shale until September 30, 2008, the development
of oil shale on public lands poses a serious
threat to land conservation, endangered and
threatened species, and critical habitat.
Domestic shale oil production allowed by these
regulations is highly water and energy
intensive, the impacts of which will intensify
existing water scarcity in the arid Western
Region and potentially degrade air and water
quality for surrounding populations.
(C) Scientific review.--On December 16, 2008, the
United States Fish and Wildlife Service of the
Department of the Interior and the National Oceanic and
Atmospheric Administration of the Department of
Commerce jointly issued a new rule amending regulations
governing interagency cooperation under section 7 of
the Endangered Species Act of 1973 (ESA). This rule
undermines the intention of the ESA to protect species
and the ecosystems upon which they depend by allowing
Federal agencies to carry out, permit, or fund an
action without proper environmental review and expert
third-party consultation from Federal wildlife experts.
Under this new rule, Federal agencies can unilaterally
circumvent the formal review process, eliminating
longstanding and scientifically grounded safeguards
that serve to protect the biodiversity of our Nation's
ecosystems and avert harm to thousands of endangered
and threatened species.
(b) Statement of Policy.--It is the policy of the United States
Government to work in conjunction with States, territories, tribal
governments, international organizations, and foreign governments in
order to act as a steward of the environment for the benefit of public
health, to maintain air quality and water quality, to sustain the
diversity of plant and animal species, to combat global climate change,
and to protect the environment for future generations to enjoy.
(c) Study and Report on Public Health or Environmental Impact of
Revised Rules, Regulations, Laws, or Proposed Laws.--
(1) Study.--Not later than 30 days after the date of
enactment of this Act, the President shall enter into an
arrangement under which the National Academy of Sciences will
conduct a study to determine the impact on public health, air
quality, water quality, wildlife, and the environment of the
following regulations, laws, and proposed laws:
(A) Clean water.--
(i) Final revisions to the Federal Water
Pollution Control Act regulatory definitions of
``fill material'' and ``discharge of fill
material'', finalized and published in the
Federal Register on May 9, 2002 (67 FR 31129),
amending part 232 of title 40, Code of Federal
Regulations.
(ii) Revised National Pollutant Discharge
Elimination System Permit Regulation and
Effluent Limitation Guidelines and Standards
for Concentrated Animal Feeding Operations in
response to the ``Waterkeeper Alliance, et al.
v. Environmental Protection Agency'' decision,
finalized and published in the Federal Register
on November 20, 2008 (73 FR 225), amending
parts 9, 122, and 412 of title 40, Code of
Federal Regulations.
(iii) A March 19, 2003, rule published in
the Federal Register (68 FR 13608) withdrawing
a July 13, 2000, rule revising the Total
Maximum Daily Load program of the Federal Water
Pollution Control Act (65 FR 43586), amending
parts 9, 122, 123, 124, and 130 of title 40,
Code of Federal Regulations.
(iv) Official Guidance Document, ``Clean
Water Act Jurisdiction Following the United
States Supreme Court's Decision in Rapanos v.
United States & Carabell v. United States'',
issued on December 2, 2008, relating to
jurisdiction under section 404 of the Federal
Water Pollution Control Act.
(B) Forests and land management.--
(i) Healthy Forests Restoration Act of
2003, signed into law on December 3, 2003
(Public Law 108-148; 16 U.S.C. 6501 et seq.).
(ii) National Forest System Land Management
Planning Rule, finalized and published in the
Federal Register on April 21, 2008 (73 FR
21468), replacing the 2005 final rule (70 FR
1022, Jan. 5, 2005), as amended March 3, 2006
(71 FR 10837) and the 2000 final rule adopted
on November 9, 2000 (65 FR 67514) as amended on
September 29, 2004 (69 FR 58055), amending
title 36, Code of Federal Regulations, part
219.
(iii) The application of the Administrative
Procedure Act (5 U.S.C. 551 to 559, 701 to 706,
et seq.), such that States may petition for a
special rule for the roadless areas in all or
part of said State.
(iv) Record of Decision, ``Oil Shale and
Tar Sands Resources Resource Management Plan
Amendments'', issued on November 17, 2008,
along with the Final Rule, Oil Shale
Management-General, published in the Federal
Register on November 18, 2008 (73 FR 223),
amending title 43, Code of Federal Regulations,
parts 3900, 3910, 3920, and 3930.
(C) Scientific review.--Final Rule, Interagency
Cooperation Under the Endangered Species Act, published
in the Federal Register on December 16, 2008, amending
title 50, Code of Federal Regulations, part 402.
(2) Method.--In conducting the study under paragraph (1),
the National Academy of Sciences may utilize and compare
existing scientific studies regarding the regulations, laws,
and proposed laws listed in paragraph (1).
(3) Report.--Under the arrangement entered into under
paragraph (1), not later than 270 days after the date on which
such arrangement is entered into, the National Academy of
Sciences shall make publicly available and shall submit to the
Congress and to the head of each department and agency of the
Federal Government that issued, implements, or would implement
a regulation, law, or proposed law listed in paragraph (1), a
report containing--
(A) a description of the impact of all such
regulations, laws, and proposed laws on public health,
air quality, water quality, wildlife, and the
environment, compared to the impact of preexisting
regulations, or laws in effect, including--
(i) any negative impacts to air quality or
water quality;
(ii) any negative impacts to wildlife;
(iii) any delays in hazardous waste cleanup
that are projected to be hazardous to public
health; and
(iv) any other negative impact on public
health or the environment; and
(B) any recommendations that the National Academy
of Sciences considers appropriate to maintain, restore,
or improve in whole or in part protections for public
health, air quality, water quality, wildlife, and the
environment for each of the regulations, laws, and
proposed laws listed in paragraph (1), which may
include recommendations for the adoption of any
regulation or law in place or proposed prior to January
1, 2001.
(d) Department and Agency Revision of Existing Rules, Regulations,
or Laws.--Not later than 180 days after the date on which the report is
submitted pursuant to subsection (c)(3), the head of each department
and agency that has issued or implemented a regulation or law listed in
subsection (c)(1) shall submit to the Congress a plan describing the
steps such department or such agency will take, or has taken, to
restore or improve protections for public health and the environment in
whole or in part that were in existence prior to the issuance of such
regulation or law.
SEC. 1006. HEALTHY FOOD FINANCING INITIATIVE.
(a) In General.--Subtitle D of the Department of Agriculture
Reorganization Act of 1994 (7 U.S.C. 6951) is amended by adding at the
end the following:
``SEC. 242. HEALTHY FOOD FINANCING INITIATIVE.
``(a) Purpose.--The purpose of this section is to establish a
program to improve access to healthy foods in underserved areas, to
create and preserve quality jobs, and to revitalize low-income
communities by providing loans and grants to eligible fresh, healthy
food retailers to overcome the higher costs and initial barriers to
entry in underserved, urban, suburban, and rural areas.
``(b) Definitions.--In this section:
``(1) Community development financial institution.--The
term `community development financial institution' has the
meaning given the term in section 103 of the Community
Development Banking and Financial Institutions Act of 1994 (12
U.S.C. 4702).
``(2) Food access organization.--The term `food access
organization' means a nonprofit organization with expertise in
improving access to healthy food in underserved communities.
``(3) Initiative.--The term `Initiative' means the Healthy
Food Financing Initiative established in the Department by
subsection (c)(1).
``(4) Local funds.--The term `local funds' means the
allocation of national funds and any other forms of financial
assistance (including grants, loans, and equity investments)
that are raised by partnerships to carry out the purposes of
this section.
``(5) National funds.--The term `national funds' means any
Federal appropriation made to carry out this section and any
other forms of financial assistance (including grants, loans,
and equity investments) that are raised by the national fund
manager to carry out the purposes of this section.
``(6) National fund manager.--The term `national fund
manager' means a community development financial institution in
existence as of the date of enactment of this section and
certified by the Community Development Financial Institutions
Fund of the Department of the Treasury that is designated by
the Secretary to manage the Initiative for purposes of--
``(A) raising private capital;
``(B) providing financial and technical assistance
to partnerships; and
``(C) funding eligible projects directly at the
request of partnerships to attract fresh, healthy food
retailers to underserved urban, suburban, and rural
areas, in accordance with this section.
``(7) Partnership.--
``(A) In general.--The term `partnership' means a
regional, State, or local public and private
partnership that is organized to improve access to
fresh, healthy foods by providing financial and
technical assistance to eligible projects.
``(B) Inclusions.--The term `partnership'
includes--
``(i) an unit of State, local, or tribal
government or a quasi-public State or local
government agency;
``(ii) a food access or community health
organization committed to improving access to
healthy foods;
``(iii) a community development financial
institution or other organization that is
capable of administering a loan and grant
program in accordance with this section; and
``(iv) other organizations interested in
improving access to healthy foods in
underserved areas.
``(c) Establishment.--
``(1) In general.--There is established in the Department a
Healthy Food Financing Initiative.
``(2) Management.--Not later than 1 year after the date of
enactment of this section, the Secretary shall select and enter
into a grant agreement with a national fund manager who shall
be responsible for the management of the Initiative nationally.
``(3) Eligible projects.--
``(A) In general.--Subject to the requirements of
this paragraph, the national fund manager shall
establish the eligibility criteria for projects to be
assisted by the Initiative.
``(B) Requirements.--To be eligible to receive
assistance through the Initiative, a project shall--
``(i) include a supermarket, grocery store,
farmers market, or other fresh, healthy food
retailer;
``(ii) consist of a for-profit business
enterprise, a member- or worker-owned
cooperative, or a nonprofit organization;
``(iii) meet the eligibility criteria
established under this section;
``(iv) continue to be a viable business
enterprise with a financial viability plan;
``(v) require an investment of public
funding to move forward and be competitive;
``(vi) operate on a self-service basis;
``(vii) in accordance with subparagraph
(C), expand or preserve the availability of
healthy, fresh, high quality unprepared and
unprocessed foods, particularly fresh fruits
and vegetables, in underserved areas; and
``(viii) agree to accept benefits under the
supplemental nutrition assistance program
established under the Food and Nutrition Act of
2008 (7 U.S.C. 2011 et seq.).
``(C) Requirements.--
``(i) Definitions.--In this subparagraph:
``(I) Perishable food.--
``(aa) In general.--The
term `perishable food' means
food that is fresh,
refrigerated, or frozen.
``(bb) Exclusion.--The term
`perishable food' does not
include packaged or canned
goods.
``(II) Staple food.--
``(aa) In general.--The
term `staple food' means food
that is a basic dietary item,
including bread, flour, fruits,
vegetables, and meat.
``(bb) Exclusions.--The
term `staple food' does not
include snack or accessory food
(such as chips, soda, coffee,
condiments, and spices) or
ready-to-eat, prepared food.
``(III) Variety.--The term
`variety' means an assortment of
different types of food items.
``(ii) In general.--For purposes of
subparagraph (B)(vii), to expand or preserve
the availability of fresh fruits and vegetables
in underserved areas shall mean, with respect
to a project, that the project maintains a
store that--
``(I) carries a full line of fresh
produce, as defined by the national
fund manager to reflect differences in
project size and overall store size;
``(II) sells food for home
preparation and consumption; and
``(III) at a minimum--
``(aa) offers for sale at
least 3 different varieties of
food in each of the 4 staple
food groups (bread and grains,
dairy, fruits and vegetables,
and meat, poultry, and fish),
with perishable food in at
least 2 categories, on a daily
basis; or
``(bb) has a store at which
at least 50 percent of the
total sales of the store
(including food and nonfood
items or services) are from the
sale of eligible staple food.
``(D) Income criteria.--Each eligible project shall
be located in--
``(i) a low- or moderate-income census
tract, as determined by the Bureau of the
Census of the Department of Commerce;
``(ii) a population census tract that is
treated as a low-income community under section
45D(e) of the Internal Revenue Code of 1986; or
``(iii) an area that significantly serves
an adjacent area that meets the criteria
described in clause (i) or (ii), as approved by
the national fund manager.
``(E) Underserved criteria.--
``(i) In general.--Each eligible project
shall be located in an underserved area, as
determined by the partnerships according to
criteria established by the national fund
manager.
``(ii) Factors.--In determining whether an
area is an underserved area, the following
factors shall be taken into consideration:
``(I) Population density.
``(II) Below average supermarket
density or sales.
``(III) Car ownership.
``(IV) Geographical or physical
barriers, such as highways, mountains,
major parks, or bodies of water.
``(iii) Locations.--On an annual basis, the
national fund manager shall collect data and
publish maps that show the location of
underserved areas.
``(4) Priority projects.--
``(A) In general.--Priority shall be given to
projects that--
``(i) are located in severely distressed
low-income communities, as defined by the
Community Development Financial Institutions
Fund of the Department of the Treasury; and
``(ii) include 1 or more of the following
characteristics:
``(I) The project will create or
retain quality jobs in the community,
as determined in accordance with
subparagraph (B).
``(II) The project has community
support in terms of store quality,
affordability, site location, and
coordination with local community plans
or other programs promoting community
and economic development.
``(III) The project supports
regional food systems and locally grown
foods, to the extent available.
``(IV) In major metropolitan areas,
the project is associated with a
transit-oriented development project.
``(V) In areas with public transit,
the project is accessible by public
transit.
``(VI) The project involves the
reuse of a building that is listed in
or eligible for the National Register
of Historic Places.
``(VII) The project involves a
brownfield or grayfield (as those terms
are used in the Comprehensive
Environmental Response, Compensation,
and Liability Act of 1980 (42 U.S.C.
9601 et seq.)).
``(VIII) The estimated energy
consumption of the project, calculated
using building energy software approved
by the Department of Energy, will
qualify the project for designation
under the Energy Star program
established by section 324A of the
Energy Policy and Conservation Act (42
U.S.C. 6294a).
``(IX) The project involves women-
and minority-owned businesses.
``(B) Quality jobs.--For purposes of subparagraph
(A)(ii)(I), a quality job is a job that--
``(i) provides wages that are comparable to
or better than similar positions in existing
businesses of similar size in similar local
economies;
``(ii) offers benefits that are comparable
to or better than what is offered for similar
positions in existing local businesses of
similar size in similar local economies; and
``(iii) is targeted for residents of
neighborhoods with a high proportion of persons
of low income (as that term is defined in
section 102(a) of the Housing and Community
Development Act of 1974 (42 U.S.C. 5302(a)))
through local targeted hiring programs.
``(d) Duties of the Secretary.--
``(1) In general.--The Secretary shall--
``(A) designate a national fund manager to manage
national funds;
``(B) oversee the Initiative nationally;
``(C) work closely with the designated national
fund manager--
``(i) to ensure that funds are used
appropriately and in the most effective manner
practicable; and
``(ii) to develop the program strategy into
a detailed work plan, program, and operating
budget;
``(D) review and approve the operating budget for
the national fund manager to ensure that the
administrative costs are--
``(i) reasonable (not more than 5 percent
of the total budget);
``(ii) connected to the costs of
operations; and
``(iii) reflect efficient operations by the
national fund manager; and
``(E) make available to the public an annual
report, using data obtained from the Department of
Agriculture, the Department of Health and Human
Services, and the Community Development Financial
Institutions, that describes the impacts of the
Initiative, including tracking health and economic
development indicators at the local, State, and
national levels to determine the impacts of individual
projects and the collective impact in local areas and
statewide of funded projects and the Initiative
overall.
``(2) National fund manager.--The Secretary shall--
``(A) select the national fund manager through a
competitive process from among community development
financial institutions that have a proven and recent
track record of success and effectiveness in--
``(i) attracting private capital;
``(ii) developing and managing programs
that provide grants and loans to support
supermarkets and other fresh, healthy food
retail business enterprises in low- and
moderate-income communities, including the
development of grocery stores, farmers markets,
and other fresh, healthy food retail models;
``(iii) making and servicing loans that are
similar to loans proposed in the Initiative or
having a record of otherwise successfully
investing in fresh, healthy food retail
development projects;
``(iv) effectively managing multiple
contracts and subcontractors;
``(v) effectively managing large capital
pools, of at least $100,000,000; and
``(vi) providing or contracting for the
provision of technical assistance; and
``(B) administer the Initiative by approving the
disbursement of funds to the national fund manager in a
manner that facilitates the implementation of the
overall Initiative.
``(3) Coordination.--
``(A) In general.--Not later than 45 days after the
date of receipt of an award, the national fund manager
shall develop, with guidance from and in consultation
with the Secretary, and submit to the Secretary, a
detailed work plan.
``(B) Approval required.--The Secretary shall
review and approve the work plan, program budget, and
administrative costs under subsection (e)(4)(C) prior
to entering into an agreement with the national fund
manager to administer the Initiative.
``(4) Performance targets.--
``(A) In general.--The Secretary shall conduct
financial audits of, and establish performance targets
for, the national fund manager, which shall include, at
a minimum, the requirements described in this
paragraph.
``(B) Geographic spread.--Partnerships funded by
the Initiative shall be geographically diverse and
representative of the underserved areas across the
United States.
``(C) Focus on low-income communities.--A
substantial portion of the projects funded by
partnerships shall serve very low- and low-income
communities, as defined by the Bureau of the Census of
the Department of Commerce.
``(D) Financial effectiveness of the national fund
manager.--The national fund manager and any local
financial institution involved in a partnership shall
demonstrate on-going capacity and timeliness in raising
private capital and disbursing funds as required under
the Initiative.
``(E) Technical assistance effectiveness of the
national fund manager.--The provision of technical
assistance by the national fund manager shall be
evaluated based on--
``(i) the responsiveness of the national
fund manager to requests for assistance; and
``(ii) the ability of the national fund
manager to craft programs that develop needed
new capacities in partnerships.
``(F) Impact.--Performance targets shall address
the allocation of funds by the national fund manager to
partnerships and the tracking and reporting of the
impacts of the funds in improving access to fresh,
healthy foods and in achieving other related impacts.
``(e) Duties of the National Fund Manager.--
``(1) Allocation of funds.--
``(A) In general.--The national fund manager
shall--
``(i) allocate at least 70 percent of any
Federal appropriation made to carry out this
section to partnerships that are selected based
on the criteria described in paragraph (3); and
``(ii) retain not more than 30 percent of
any Federal appropriation made to carry out
this section to undertake financing activities
described in subparagraph (C), including a
reasonable amount for administrative costs (not
to exceed 5 percent) approved by the Secretary
in accordance with paragraph (4)(C).
``(B) Use of the national funds by partnership
programs.--
``(i) In general.--As a condition on the
receipt of funds, each partnership shall use--
``(I) the national funds received
from the national fund manager under
subparagraph (A)(i) to create 1 or more
revolving loan programs or other
revolving pools of capital or other
products to facilitate financing of
local projects as determined by the
agreement between the partnership and
the national fund manager; and
``(II) any remaining funds for
grants, or, as approved, for innovative
financing mechanisms.
``(ii) Limitations.--
``(I) In general.--Use of funds for
administrative costs and other purposes
shall be--
``(aa) limited in
accordance with the terms of
the agreement negotiated
between the national fund
manager and partnerships;
``(bb) based on whether
administrative costs are
reasonable, connected to the
costs of operation, and reflect
efficient operations by the
partnership; and
``(cc) determined using
criteria including geographic
coverage, program duration, and
total funding amount.
``(II) Goal.--The goal of this
clause to limit administrative costs to
the maximum extent practicable, but in
no case may the amount used for
administrative costs exceed 10 percent
of the Federal funds allocated.
``(C) Use of the national funds by the national
fund manager.--The national fund manager shall use
national funds described in subparagraph (A)(ii) to
undertake financing and other activities to enhance and
maximize the effectiveness of the Initiative, as
determined by the agreement with the Secretary,
including--
``(i) attracting other forms of financial
assistance to match or leverage the national
funds;
``(ii) awarding national funds to
partnerships in accordance with paragraph (3);
``(iii) creating and managing pools of
grant or loan capital that blend or leverage
national funds with other forms of financial
assistance, including capital in the form of
tax credits under section 45D of the Internal
Revenue Code of 1986, for the benefit of
partnerships;
``(iv) creating and managing pools of grant
or loan capital that blend or leverage the
national funds with other forms of financial
assistance, including capital in the form of
tax credits under section 45D of the Internal
Revenue Code of 1986, to finance eligible local
projects identified by partnerships or the
national fund manager that have special or
unique characteristics;
``(v) providing loans or grants directly to
eligible local projects as matching funds if
requested by a partnership;
``(vi) providing credit enhancement or
other financial products and instruments for
the benefit of partnerships or eligible local
projects;
``(vii) providing technical assistance; and
``(viii) funding reasonable administrative
costs approved by the Secretary in accordance
with paragraph (4)(C).
``(2) Responsibilities of the national fund manager.--The
designated national fund manager shall--
``(A) raise other forms of financial assistance to
match or leverage the national funds;
``(B) use administrative funds to develop
appropriate training programs and offer technical
assistance services to--
``(i) partnerships;
``(ii) State, local, and tribal
governments;
``(iii) the food retail industry; and
``(iv) food access and health advocacy
organizations to augment local capacities;
``(C) develop financial products such as loans,
grants, and credit enhancement tools that can be used
by partnerships to incentivize and support the
development and retention of supermarkets and other
fresh, healthy food retail in underserved areas;
``(D) award Initiative funds to eligible
partnerships through an annual competitive process in
accordance with paragraph (3);
``(E) contract with a national food access
organization to assist in the review of applications
from partnerships and to provide technical assistance
to local food access organizations in the proposed
partnerships;
``(F) award and disburse funds to partnerships or
eligible local projects in a timely manner;
``(G) create and meet performance benchmarks and
reporting guidelines, as approved by the Secretary,
including for--
``(i) the amount of capital raised and
leveraged from financial institutions,
partnerships, and other resources;
``(ii) the geographic diversity of
partnerships; and
``(iii) the proportion of projects funded
by the partnership that are in severely
distressed low-income communities;
``(H) develop program guidelines and operating
procedures for the Initiative, including--
``(i) maximum grant and loan amounts for
projects;
``(ii) eligible uses of funds;
``(iii) prudent underwriting criteria;
``(iv) performance targets;
``(v) reporting guidelines;
``(vi) limits on administrative costs; and
``(vii) implementation milestones;
``(I) monitor the performance of partnerships; and
``(J) collect data, compile information, and
conduct such research studies as the national fund
manager determines to be relevant to the successful
implementation of the Initiative, including--
``(i) to assess national and local market
conditions;
``(ii) to determine barriers to market
entry; and
``(iii) to identify opportunities for the
development or retention of supermarkets and
other fresh, healthy food retail enterprises in
underserved communities.
``(3) Criteria for awarding national funds to
partnerships.--
``(A) In general.--The national fund manager shall
award national funds to partnerships through a
competitive process on an annual basis.
``(B) First round priority.--In the first round of
funding, the national fund manager shall give priority
to existing partnerships that have demonstrable
capacity to implement fresh food financing programs in
underserved areas quickly.
``(C) Additional rounds.--Additional rounds shall
be designed to promote geographic diversity.
``(D) Criteria.--In awarding national funds to
partnerships, the national fund manager shall
consider--
``(i) the amount of funds and other
resources pledged by a partnership to match or
leverage national funds;
``(ii) the degree of State, local, or
tribal government support of the partnership as
evidenced by matching grant and loan funds or
other types of support, such as allocation of
tax-exempt bonds, loan guarantees, and
coordination of resources from other State or
local economic development programs;
``(iii) the capacity of the partnership to
successfully develop and manage loan and grant
programs;
``(iv) the lack of supermarkets and other
fresh, healthy food retail enterprises in low-
and moderate-income areas that would be served
by the partnership;
``(v) the experience of the food access or
community health organization of the
partnership in outreach about access to healthy
foods and local healthy food access issues;
``(vi) the degree of community engagement
and support in the development and retention of
supermarkets and other fresh, healthy food
retail enterprises; and
``(vii) the contribution of the program of
the partnership to the overall geographic
diversity of the Initiative.
``(4) Administrative costs.--
``(A) In general.--Not later than 45 days after the
date of receipt of an award, the national fund manager
shall submit to the Secretary for approval a 3-year
program and operating budget and detailed work plan
that shall include--
``(i) costs for research and evaluation,
technical assistance, and training; and
``(ii) program and operating costs.
``(B) Earned revenues.--Earned revenues from loan
fees and interest may be expended on program and
operating costs in accordance with the budget approved
by the Secretary.
``(C) Basis of review.--The Secretary shall base
the review under subparagraph (A) on--
``(i) the likelihood of the plan and
expenditures to further the purposes of this
section; and
``(ii) whether the administrative costs are
reasonable, connected to the costs of
operation, and reflect efficient operations by
the national fund manager.
``(f) Partnerships.--
``(1) In general.--Each partnership that receives
assistance through the Initiative shall provide financial and
technical assistance to eligible fresh, healthy food retail
projects in underserved areas within the defined communities of
the partnership.
``(2) Administration.--Each partnership shall designate a
community development financial institution or other
organization that is capable of administering a loan and grant
program--
``(A) to execute grant agreements with the national
fund manager; and
``(B) to serve as the manager of local funds.
``(3) Responsibilities of partnerships.--A partnership
shall--
``(A) raise other forms of financial assistance to
match the national funds received by the partnership;
``(B) provide marketing and outreach to
communities, the supermarket industry, other fresh,
healthy food retailers, State and local government
officials, and civic and public interest
organizations--
``(i) to solicit applications from
underserved areas from across the State or
locality to be served by the partnership; and
``(ii) to inform the communities and other
persons about the availability of grants,
loans, training, and technical assistance;
``(C) review and underwrite projects to determine
whether--
``(i) a proposed project meets the criteria
for eligible projects under subsection (c)(3);
and
``(ii) a proposed project meets the
criteria for priority projects under subsection
(c)(4);
``(D) provide technical assistance services to
eligible fresh, healthy food retail operators and
developers;
``(E) track and report outcomes, including--
``(i) the number of jobs created or
retained;
``(ii) the quantity of fresh, healthy food
retail space created or retained; and
``(iii) such other health and economic
indicators as are required by the national fund
manager;
``(F) monitor and audit funded projects to ensure
compliance with the Initiative, the national fund
manager, and partnership program requirements for a
period of at least 3 years;
``(G) submit an annual report to the national fund
manager that describes--
``(i) the activities of the partnership;
``(ii) the expenditure of local funds; and
``(iii) success in meeting performance
targets and satisfying such other terms and
conditions as are specified in the agreement
between the partnership and the national fund
manager; and
``(H) coordinate with the national fund manager for
the smooth operation of the Initiative.
``(4) Administrative costs.--
``(A) In general.--As a condition on the receipt of
assistance under this section, each partnership shall
submit to the national fund manager for approval a 3-
year budget and plan for all program and operating
costs, including--
``(i) costs for research and evaluation,
technical assistance, and training; and
``(ii) administrative and operating costs.
``(B) Earned revenues.--Earned revenues from loan
fees and interest may be expended on program and
operating costs in accordance with the budget approved
by the national fund manager.
``(C) Basis of review.--The national fund manager
shall base the review under subparagraph (A) on the
likelihood of the budget and plan to further the
purposes of this section.
``(g) Evaluation and Monitoring.--
``(1) In general.--Program evaluation and financial audits
shall occur at all levels of the Initiative to ensure that--
``(A) national and local funds are used properly;
and
``(B) the objectives of the Initiative are met.
``(2) Program evaluation and financial audits.--
``(A) In general.--The Secretary shall--
``(i) conduct periodic program evaluations
and financial audits of the national fund
manager, partnerships, and projects funded by
the Initiative; and
``(ii) share with the national fund manager
the results of the evaluations and audits.
``(B) Funded projects.--The Secretary or the
national fund manager shall evaluate partnerships to
assess the health and economic impacts of projects
funded by the Initiative.
``(C) Other impacts.--
``(i) Secretary of health and human
services.--The Secretary of Health and Human
Services shall conduct research studies and
evaluate the health impacts of the Initiative.
``(ii) Community development financial
institutions.--Representatives of the Community
Development Financial Institutions shall
conduct research studies and evaluate the
economic impacts of the Initiative.
``(D) Partnerships.--
``(i) In general.--Each partnership shall--
``(I) conduct periodic
administrative and financial audits of
projects funded by the Initiative; and
``(II) share with the national fund
manager the results of the audits.
``(ii) Failure of partnership.--In a case
in which a partnership fails, the national fund
manager shall take over the portfolio of the
failed partnership.
``(h) Administrative Provisions.--Not later than 180 days after the
date of enactment of this section, the Secretary shall promulgate such
regulations as may be necessary to carry out this section, including
regulations--
``(1) for the conduct of a performance evaluation at the
end of the initial 5-year period;
``(2) to terminate the contract for cause; and
``(3) to extend the contract for an additional 5-year
period.''.
(b) Conforming Amendment.--Section 296(b) of the Department of
Agriculture Reorganization Act of 1994 (7 U.S.C. 7014(b)) is amended--
(1) in paragraph (6)(C), by striking ``or'' at the end;
(2) in paragraph (7), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following:
``(8) the authority of the Secretary to establish in the
Department the Healthy Food Financing Initiative in accordance
with section 242.''.
SEC. 1007. GAO REPORT ON HEALTH EFFECTS OF DEEPWATER HORIZON OIL RIG
EXPLOSION IN THE GULF COAST.
(a) Study.--The Comptroller General of the United States shall
conduct a study on the type and scope of health care services
administered through the Department of Health and Human Services
addressing the provision of health care to racial and ethnic minorities
(whether residents, clean-up workers, or volunteers) affected by the
explosion of the mobile offshore drilling unit Deepwater Horizon that
occurred on April 20, 2010.
(b) Specific Components; Reporting.--In carrying out subsection
(a), the Comptroller General shall--
(1) assess the type, size, and scope of programs
administered by the Department of Health and Human Services
that focus on provision of health care to communities in the
Gulf Coast;
(2) identify the merits and disadvantages associated with
each the programs;
(3) perform an analysis of the costs and benefits of the
programs;
(4) determine whether there is any duplication of programs;
and
(5) not later than 180 days after the date of the enactment
of this Act, report findings and recommendations for improving
access to health care for racial and ethnic minorities to the
Congress.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S2830-2831)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line