Healthcare Equality and Accountability Act - States that the purpose of this Act is to improve minority health and healthcare and to eliminate racial and ethnic disparities in health and healthcare.
FamilyCare Act of 2003 - Amends the Social Security Act respecting: (1) family care; (2) Medicaid coverage for all residents with poverty level incomes; and (3) funding for the territories.
Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to provide for optional coverage of legal immigrants under Medicaid and SCHIP (State children's health insurance program).
Amends the Indian Health Care Improvement Act to revise provisions respecting program operations and funding.
Directs the Secretary of Health and Human Services (HHS) to establish a demonstration project to strengthen Medicaid and SCHIP coverage for migrant workers and farmworkers.
Establishes the National Commission for Expanded Access to Health Care.
Amends the Public Service Health Act to improve limited English speakers' access to health care. Directs the Secretary to establish a Center for Cultural and Linguistic Competence in Healthcare.
Provides for health workforce diversity, including provisions respecting: (1) career training and support; (2) data collection; (3) cultural training; (4) Hispanic-serving health professions schools; (5) student assistance, including online degree programs; (6) the Louis Stokes public health scholars program; (7) the Patsy Mink health and gender research fellowship program; (8) the Paul David Wellstone international health fellowship program; and (9) the Edward R. Roybal Healthcare scholar program.
Environmental Justice Act of 2003 - Establishes: (1) the Interagency Working Group on Environmental Justice which shall provide guidance to Federal agencies for identifying disproportionately high and adverse health and environmental effects on minority, low-income, and Native American populations; and (2) the Federal Environmental Justice Advisory Committee which shall advise the Environmental Protection Agency (EPA) and the Working Group on areas environmental justice.
Border Health Security Act of 2003 - Directs the Secretary, through the United States members of the United States-Mexico Border Health Commission, to award grants to eligible entities 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.
Amends the United States-Mexico Border Health Commission Act to make permanent authorizations of appropriations for activities under such Act.
Patient Navigator, Outreach, and Chronic Disease Prevention Act of 2003 - Authorizes the Secretary to make grants to public and nonprofit private health centers (including Indian Health Service Centers, tribal governments, urban Indian organizations, tribal organizations, clinics serving Asian Americans and Pacific Islanders and Alaska Natives, and rural health clinics) for model programs that provide health disparity populations with: (1) cancer and chronic disease prevention and treatment; (2) patient navigators to manage the care of individuals within such groups; and (3) outreach services. Authorizes similar grant programs through: (1) the National Cancer Institute; and (2) the Indian Health Service.
Community Health Workers Act of 2003 - Authorizes the Secretary to make grants to States or local or tribal units to promote positive health behaviors for women in target populations, especially racial and ethnic minority women in medically underserved communities.
Extends funding for breast and cervical cancer preventive health measures.
Authorizes the Secretary to make grants to qualifying health centers, nonprofit organizations, and public institutions for cancer treatment and prevention programs for underserved minority and other populations, with consideration given to such population's language and cultural context.
Provides for grants and activities respecting: (1) health empowerment zone programs in health disparity communities; (2) the Minority HIV/AIDS Initiative; (3) infant mortality and sudden infant death syndrome rates in minority communities; (4) fetal alcohol syndrome treatment and diagnosis; (5) diabetes prevention and treatment activities with Indian tribes, Pacific Islanders, and Native Hawaiians; (6) diabetes programs, including youth and children's programs; (7) heart disease; (8) a national stroke education campaign; and (9) obesity treatment and prevention in underserved minority populations; (10) tuberculosis control and prevention; (11) asthma; (12) sickle cell disease; (13) autoimmune disease in minority populations; (14) sexually transmitted diseases; (15) children's dental disease coverage under Medicaid or SCHIP, and dental health services in underserved areas; (16) demonstration projects to reduce violence; (17) uterine fibroid research and education; (18) disease screening; (19) community outreach; (20) immunizations; (21) chronic disease management; and (22) racial and ethnic approaches to community health.
Requires HHS funded or operated programs to collect race, ethnicity, and language data to detect ethnic and racial health care disparities. Authorizes demonstration program grants for health plan, health center, and hospital data collection. Amends the Social Security Act to require the Social Security Administration to collect similar data.
Directs the Secretary to fund epidemiology centers in Indian health areas lacking such centers.
Extends funding for the National Center for Health Statistics.
Minority Health and Genomics Act of 2003 - Establishes the Minority Health and Genomics Commission, which shall conduct a study of, and develop recommendations on, issues relating to genomic research as applied to minority groups.
Directs the Secretary to establish: (1) civil rights compliance offices within each HHS agency that administers a health program; and (2) an Office of Minority Health within the Centers for Medicare and Medicaid Services.
Establishes the Indian Health Service as an agency of the Public Health Service.
Amends the Federal Food, Drug, and Cosmetic Act to establish an Office of Minority Affairs within the Office of the Commissioner of the Food and Drug Administration (FDA).
Amends the Public Health Service Act to direct the Secretary to make grants for demonstration programs to improve minority healthcare access and quality.
Directs the Secretary to: (1) designate centers of excellence at hospitals and other health systems serving large numbers of minority patients; (2) provide financial assistance to designated healthcare providers and community health centers for facility and service improvements in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii; and (3) provide grants and loan guarantees from the Health Safety Net Infrastructure Trust Fund (established by this Act) for capital financing assistance to eligible healthcare facilities.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1833 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 1833
To improve the health of minority individuals.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 6, 2003
Mr. Daschle (for himself, Mr. Kennedy, Mr. Bingaman, Mr. Akaka, Mrs.
Clinton, Mr. Corzine, Mr. Dodd, Mr. Durbin, Mr. Edwards, Mr. Inouye,
Mr. Kerry, Mr. Lautenberg, Mr. Lieberman, Ms. Mikulski, Mrs. Murray,
and Mr. Schumer) 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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Healthcare
Equality and Accountability Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purpose.
TITLE I--COVERAGE OF THE UNINSURED
Subtitle A--FamilyCare
Sec. 101. Short title.
Sec. 102. Renaming of title XXI program.
Sec. 103. Familycare coverage of parents under the medicaid program and
title XXI.
Sec. 104. Automatic enrollment of children born to title XXI parents.
Sec. 105. Optional coverage of children through age 20 under the
medicaid program and title XXI.
Sec. 106. Allowing States to simplify rules for families.
Sec. 107. Demonstration programs to improve medicaid and CHIP outreach
to homeless individuals and families.
Sec. 108. Additional CHIP revisions.
Sec. 109. Coordination of title XXI with the maternal and child health
program.
Subtitle B--State Option To Provide Coverage for All Residents With
Income At or Below the Poverty Line
Sec. 121. State option to provide coverage for all residents with
income at or below the poverty line.
Subtitle C--Optional Coverage of Legal Immigrants under the Medicaid
Program and Title XXI
Sec. 131. Equal access to health coverage for legal immigrants.
Subtitle D--Indian Healthcare Funding
Chapter 1--Guaranteed Funding
Sec. 141. Guaranteed adequate funding for Indian healthcare.
Chapter 2--Indian Healthcare Programs
Sec. 145. Programs operated by Indian tribes and tribal organizations.
Sec. 146. Licensing.
Sec. 147. Authorization for emergency contract health services.
Sec. 148. Prompt action on payment of claims.
Sec. 149. Liability for payment.
Sec. 150. Health services for ineligible persons.
Sec. 151. Definitions.
Sec. 152. Authorization of appropriations.
Subtitle E--Territories
Sec. 161. Funding for territories.
Subtitle F--Migrant Workers and Farmworkers Health
Sec. 171. Demonstration project regarding continuity of coverage of
migrant workers and farmworkers under
medicaid and CHIP.
Subtitle G--Expanded Access to Health Care
Sec. 181. National Commission for Expanded Access to Health Care.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTHCARE
Sec. 201. Amendment to the Public Health Service Act.
``TITLE XXIX--MINORITY HEALTH
``Sec. 2900. Definitions.
``Subtitle A--Culturally and Linguistically Appropriate Healthcare
``Sec. 2901. Improving access to services for individuals with
Limited English Proficiency.
``Sec. 2902. National standards for culturally and
linguistically appropriate services in
healthcare.
``Sec. 2903. Center for Cultural and Linguistic Competence in
Healthcare.
``Sec. 2904. Innovations in language access grants.
``Sec. 2905. Research on language access.
``Sec. 2906. Toll-free telephone number.
Sec. 203. Standards for language access services.
Sec. 204. Federal reimbursement for culturally and linguistically
appropriate services under the medicare,
medicaid and State Children's Health
Insurance Program.
Sec. 205. Increasing understanding of health literacy.
Sec. 206. Report on Federal efforts to provide culturally and
linguistically appropriate healthcare
services.
Sec. 207. General Accounting Office report on impact of language access
services.
TITLE III--HEALTH WORKFORCE DIVERSITY
Sec. 301. Amendment to the Public Health Service Act.
``Subtitle B--Workforce Diversity
``Sec. 2911. Report on workforce diversity.
``Sec. 2912. National working group on workforce diversity.
``Sec. 2913. Technical clearinghouse for health workforce
diversity.
``Sec. 2914. Evaluation of workforce diversity initiatives.
``Sec. 2915. Data collection and reporting by health
professional schools.
``Sec. 2916. Support for institutions committed to workforce
diversity.
``Sec. 2917. Career development for scientists and researchers.
``Sec. 2918. Career support for non-research health
professionals.
``Sec. 2919. Research on the effect of workforce diversity on
quality.
``Sec. 2920. Health disparities education program.
``Sec. 2920A. Cultural competence training for healthcare
professionals.
Sec. 302. Health careers opportunity program.
Sec. 303. Program of excellence in health professions education for
underrepresented minorities.
Sec. 304. Hispanic-serving health professions schools.
Sec. 305. Health professions student loan fund; authorizations of
appropriations regarding students from
disadvantaged backgrounds.
Sec. 306. National Health Service Corps; recruitment and fellowships
for individuals from disadvantaged
backgrounds.
Sec. 307. Loan repayment program of Centers for Disease Control and
Prevention.
Sec. 308. Cooperative agreements for online degree programs at schools
of public health and schools of allied
health.
Sec. 309. Mid-career health professions scholarship program.
Sec. 310. National report on the preparedness of health professionals
to care for diverse populations.
Sec. 311. Scholarship and fellowship programs.
``Sec. 2920B. David Satcher Public Health and Health Services
Corps.
``Sec. 2920C. Louis Stokes Public Health Scholars Program.
``Sec. 2920D. Patsy Mink Health and Gender Research Fellowship
Program.
``Sec. 2920E. Paul David Wellstone International Health
Fellowship Program.
``Sec. 2920F. Edward R. Roybal Healthcare Scholar Program.
TITLE IV--REDUCING DISEASE AND DISEASE-RELATED COMPLICATIONS
Subtitle A--Eliminating Disparities in Prevention, Detection, and
Treatment of Disease
Chapter 1--General Provisions
Sec. 401. Guidelines for disease screening for minority patients.
Sec. 402. Preventive health services block grants, use of allotments.
Sec. 403. Program for increasing immunization rates for adults and
adolescents; collection of additional
immunization data.
Sec. 404. Innovative chronic disease management programs.
Sec. 405. Grants for racial and ethnic approaches to community health.
Sec. 406. IOM study request.
Sec. 407. Strategic plan.
Chapter 2--Environmental Justice
Sec. 410. Short title; purposes.
Sec. 411. Definitions.
Sec. 412. Environmental justice responsibilities of Federal agencies.
Sec. 413. Interagency environmental justice working group.
Sec. 414. Federal agency strategies.
Sec. 415. Federal Environmental Justice Advisory Committee.
Sec. 416. Human health and environmental research, data collection and
analysis.
Chapter 3--Border Health
Sec. 421. Short title.
Sec. 422. Definitions.
Sec. 423. Border health grants.
Sec. 424. United States-Mexico Border Health Commission Act Amendments.
``Sec. 9. Authorization of appropriations.
Chapter 4--Patient Navigator, Outreach, and Chronic Disease Prevention
Sec. 425. Short title.
Sec. 426. HRSA grants for model community cancer and chronic disease
care and prevention; HRSA grants for
patient navigators.
Sec. 427. NCI grants for model community cancer and chronic disease
care and prevention; NCI grants for patient
navigators.
Sec. 428. IHS grants for model community cancer and chronic disease
care and prevention; IHS grants for patient
navigators.
Chapter 5--Community Health Workers
Sec. 431. Short title.
Sec. 432. Grants to promote positive health behaviors in women.
Chapter 6--Health Empowerment Zones
Sec. 440. Health empowerment zones.
Subtitle B--Targeting Diseases and Conditions with Particularly
Disparate Impact
Chapter 1--Cancer Reduction
Sec. 441. Cancer reduction.
Chapter 2--HIV/AIDS Reduction
Sec. 442. HIV/AIDS reduction.
Chapter 3--Infant Mortality Reduction
Sec. 443. Infant mortality reduction.
Chapter 4--Fetal Alcohol Syndrome Treatment and Diagnosis
Sec. 444. Fetal alcohol syndrome.
Chapter 5--Diabetes Prevention and Treatment
Sec. 445. Monitoring the quality of and disparities in diabetes care.
Sec. 446. Diabetes prevention, treatment, and control.
Sec. 447. Genetics of diabetes.
Sec. 448. Research and training on diabetes in underserved and minority
populations.
Sec. 449. Authorization of appropriations.
Sec. 450. Model community diabetes and chronic disease care and
prevention among Pacific Islanders and
Native Hawaiians.
Sec. 451. Programs of Centers for Disease Control and Prevention.
Chapter 6--Stroke and Heart Disease Prevention and Treatment
Sec. 455. Systems for heart disease and stroke.
``Subtitle D--Systems for Heart Disease and Stroke
``Chapter 1--Heart Disease
``Sec. 2941. Heart disease.
``Chapter 2--Stroke Education Campaign
``Sec. 2945. Stroke education campaign.
Chapter 7--Obesity and Overweight Reduction
Sec. 461. Overweight and obesity prevention and treatment.
Chapter 8--Tuberculosis Control, Prevention, and Treatment
Sec. 465. Advisory council for the elimination of tuberculosis.
Sec. 466. National program for tuberculosis elimination.
Sec. 467. Inclusion of inpatient hospital services for the treatment of
TB-infected individuals.
Chapter 9--Asthma
Sec. 471. Provisions regarding national asthma education and prevention
program of National Heart, Lung, and Blood
Institute.
Sec. 472. Asthma-related activities of Centers for Disease Control and
Prevention.
Sec. 473. Grants for community outreach regarding asthma information,
education, and services.
Sec. 474. Action plans of local educational agencies regarding asthma.
Chapter 10--Sickle Cell Disease
Sec. 481. Demonstration program for the development and establishment
of systemic mechanisms for the prevention
and treatment of sickle cell disease.
Chapter 11--Autoimmune Disease in Minority Populations
Sec. 482. Research funding for autoimmune disease in minority
populations.
Chapter 12--Prevention And Control of Sexually Transmitted Diseases
Sec. 485. Prevention and control of sexually transmitted diseases.
Chapter 13--Dental Disease
Sec. 486. Grants to improve the provision of dental services under
medicaid and SCHIP.
Sec. 487. State option to provide wrap-around SCHIP coverage to
children who have other health coverage.
Sec. 488. Grants to improve the provision of dental health services
through community health centers and public
health departments.
Chapter 14--Prevention And Control of Injuries
Sec. 491. Prevention and control of injuries.
Chapter 15--Uterine Fibroid Research and Education
Sec. 495. Research with respect to uterine fibroids.
Sec. 496. Information and education with respect to uterine fibroids.
TITLE V--DATA COLLECTION AND REPORTING
Subtitle A--General Provisions
Sec. 501. Amendment to the Public Health Service Act.
``Subtitle E--Data Collection and Reporting
``Sec. 2951. Data on race, ethnicity and primary language.
``Sec. 2952. Provisions relating to Native Americans.
Sec. 502. Collection of race and ethnicity data by the Social Security
Administration.
Sec. 503. Revision of HIPAA claims standards.
Sec. 504. National Center for Health Statistics.
Subtitle B--Minority Health and Genomics Commission
Sec. 511. Short title.
Sec. 512. Minority Health and Genomics Commission.
Sec. 513. Report.
Sec. 514. Membership.
Sec. 515. Powers of Commission.
Sec. 516. Termination.
TITLE VI--ACCOUNTABILITY
Sec. 601. Report on workforce diversity.
Sec. 602. Federal agency plan to eliminate disparities and improve the
health of minority populations.
Sec. 603. Accountability within the Department of Health and Human
Services.
``Subtitle F--Accountability
``Sec. 2961. Elevation of the Office of Civil Rights.
``Sec. 2962. Establishment of Health Program Offices for Civil
Rights within Federal health and human
services agencies.
Sec. 604. Office of Minority Health.
Sec. 605. Establishment of the Indian Health Service as an agency of
the Public Health Service.
Sec. 606. Office of Minority Health at the Centers for Medicare and
Medicaid Services.
Sec. 607. Office of Minority Affairs at the Food and Drug
Administration.
Sec. 608. Safety and effectiveness of drugs with respect to racial and
ethnic background.
Sec. 609. United States Commission on Civil Rights.
Sec. 610. Sense of Congress concerning full funding of activities to
eliminate racial and ethnic health
disparities.
TITLE VII--STRENGTHENING HEALTH INSTITUTIONS THAT PROVIDE HEALTHCARE TO
MINORITY POPULATIONS
Sec. 701. Amendment to the Public Health Service Act.
``Subtitle G--Strengthening Health Institutions that Provide Healthcare
to Minority Populations
``Chapter 1--General Programs
``Sec. 2971. Grant support for quality improvement initiatives.
``Sec. 2971A. Centers of excellence.
``Sec. 2971B. Consultation, construction and renovation of
American Indian and Alaska Native
facilities; reports.
``Sec. 2971C. Reconstruction and improvement grants for public
health care facilities serving Pacific
Islanders and the insular areas.
``Chapter ``subchapter a--general provisionsastructure
``Sec. 2972. Payments to healthcare facilities.
``Sec. 2972A. Application for assistance.
``Sec. 2972B. Public service responsibilities.
``Sec. 2972C. Health Safety Net Infrastructure Trust Fund.
``Sec. 2972D``subchapter b--loan guarantees
``Sec. 2973. Provision of loan guarantees to safety net
healthcare facilities.
``Sec. 2973A. Eligible loans.
``Sec. 2973B. Guarantee allotments.
``Sec. 2973C. Terms and conditions of loan guarantees.
``Sec. 2973D. Premiums for loan guarantees.
``Se``subchapter c--grants for urgent capital needslt.
``Sec. 2976. Provision of grants.
``Sec. 2976B. Eligible projects.
TITLE VIII--MISCELLANEOUS PROVISIONS
Sec. 801. Definitions.
Sec. 802. Davis-Bacon Act.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress makes the following findings:
(1) Despite significant advances in public health and
health care, the health status of racial and ethnic minority
populations continues to lag behind that of the white
population.
(2) The United States is becoming increasingly diverse.
According to the 2000 United States Census, African Americans,
American Indians and Alaska Natives, Asians, Hispanics, and
Native Hawaiians and other Pacific Islanders comprise 30
percent of the United States population. Racial and ethnic
minorities are expected to comprise 40 percent of the United
States population by 2030.
(3) To improve the health care of racial and ethnic
minorities and to reduce and eliminate disparities in health
care and health outcomes, the following issues must be
addressed:
(A) Need for insurance coverage.--
(i) Disparities in health status can be
attributed largely to underlying differences in
socioeconomic status and insurance coverage.
Minorities are at a greater risk of being
uninsured than their white counterparts. Lack
of health insurance has consistently been
associated with worse health outcomes.
(ii) Even after adjusting for differences
in socioeconomic and insurance status, however,
racial and ethnic health and health care
disparities remain.
(iii) Through treaties and Federal
statutes, the Federal Government has
established a trust responsibility to provide
health care to American Indians and Alaska
Natives. In the Indian Health Amendments of
1992, Congress specifically pledged to ``assure
the highest possible health status for Indians
and urban Indians and to provide all resources
necessary to effect that policy.'' Despite
those commitments, the unmet health needs of
American Indians and Alaska Natives remain
alarmingly severe and their health status is
far below the health status of the general
population of the United States. The critical
shortfall of funding for the Indian Health
Service is a major source of this problem.
(B) Need for culturally and linguistically
appropriate care.--
(i) Limited English proficiency adversely
affects the care of many racial and ethnic
minority patients. The lack of available
interpretation and translation services or
bilingual providers contributes to racial and
ethnic disparities in health and health care.
The Federal Government provides and funds an
array of services that should be made
accessible to eligible persons who are not
proficient in the English language.
(ii) Title VI of the Civil Rights Act of
1964 (42 U.S.C. 2000d et seq.) prohibits
discrimination on the basis of race, color, and
national origin in programs and activities
receiving Federal financial assistance.
Discrimination on the basis of primary language
has consistently been interpreted as
discrimination on the basis of national origin.
(iii) The provision of effective language
services has been shown to improve care for
limited English proficient (referred to in this
section as ``LEP'') patients by increasing
patient satisfaction, access to care,
compliance with recommended medical advice, and
appropriate utilization.
(iv) A 2002 study by the Office of
Management and Budget found that language
assistance services can substantially improve
the health and quality of life of LEP
individuals and their families, increase the
efficiency of distribution of government
services to LEP individuals, and measurably
increase the effectiveness of public health and
safety programs.
(v) The same study estimated that language
translation services would only increase the
cost of the average health care visit by less
than one percent.
(C) Need for health workforce diversity.--
(i) Research has demonstrated that minority
health professionals dramatically increase
access to care for minority patients and
improve the quality of care that they receive.
African Americans, American Indians and Alaska
Natives, Hispanics, Native Hawaiians and other
Pacific Islanders, and Southeast Asians are
significantly underrepresented in the health
professions, exacerbating health disparities.
(ii) Minority physicians are more likely
than white physicians to serve minority
populations. Nearly 40 percent of all minority
medical school graduates will practice medicine
in underserved areas, compared to 10 percent of
their white colleagues.
(iii) Minorities often report experiences
with discrimination when seeking health care.
(iv) There is substantial evidence to
demonstrate that race concordance between
physicians and patients increases patient
satisfaction and participation in health
decisionmaking.
(v) Minority health care providers can
bridge linguistic, cultural, and other barriers
that hamper access to care.
(vi) African Americans, Hispanics, and
American Indians remain severely
underrepresented in health professions schools.
African Americans and Hispanics constitute 20
percent and 16 percent, respectively, of the
students in public health and baccalaureate
nursing programs, and less than 15 percent of
students in all other health professions.
(vi) The number of minorities enrolling in
health professional schools has remained
stagnant. For example, in 1994, 1,307 African
American and 1,090 Hispanic students enrolled
in American medical colleges. In 2000, the
figures were essentially unchanged at 1,307
African American and 1,033 Hispanic students.
(D) Need for reduction of disease occurrence and
disease-related complications among minorities.--
(i) Despite notable progress in the overall
health of the Nation, there are continuing
disparities in the burden of illness and death
experienced by minorities compared to the
United States population as a whole. Minority
populations are disproportionately impacted by
acute and chronic diseases.
(ii) Despite suffering a greater burden of
acute and chronic disease, minorities are less
likely to receive needed health care. Numerous
studies have documented that minorities receive
less preventive care, medical therapy, and
surgical interventions.
(E) Need for minority health data collection and
reporting.--
(i) Efforts to study disparities in health
and health care for minorities have been
hampered by the lack of available data on race,
ethnicity, and primary language.
(ii) Data collection, analysis, and
reporting by race, ethnicity, and primary
language is permissible under the law and
necessary to assure equity and
nondiscrimination in the quality of health care
services. Collection, analysis, and reporting
of such data is authorized under Title VI of
the Civil Rights Act of 1964 (42 U.S.C. 2000d
et seq.). Such collection, analysis, and
reporting should be conducted with appropriate
privacy protections in place.
(F) Need for greater accountability in government
institutions.--A number of studies have shown that
differences in health care quality contribute to health
disparities among minority populations. These
differences may result from bias, stereotyping, and
discrimination. Government institutions must be held
accountable for the quality of healthcare delivered to
all patient populations and resultant health outcomes.
(G) Need for strengthening health institutions that
provide care to minority populations.--
(i) A small segment of health care
institutions provide a disproportionate amount
of health care to minority populations.
(ii) Safety net institutions, including
public hospitals, community health centers and
community clinics, provide a disproportionate
share of health care to minority and
underserved populations.
(iii) Financial stress, negative operating
margins, and the overall burden of caring for
the uninsured and delivering high-cost
specialty care to the entire community place
undue pressure on core safety net providers.
These providers are increasingly challenged in
their ability to meet the day-to-day needs of
their patients.
(b) Purposes.--It is the purpose of this Act to improve the health
and healthcare of minority populations and to eliminate racial and
ethnic disparities in health and healthcare by--
(1) increasing access to health care for all populations;
(2) expanding culturally and linguistically appropriate
health services for all populations;
(3) promoting health workforce diversity;
(4) supporting and expanding programs and activities that
will improve the prevention, diagnosis, and management of
disease in minority populations;
(5) enhancing racial, ethnic, and primary language health
data collection at the local, State, and Federal level;
(6) ensuring accountability for the quality of health care
and health outcomes for minority populations; and
(7) strengthening the technical and financial resources of
the safety net institutions of the United States.
TITLE I--COVERAGE OF THE UNINSURED
Subtitle A--FamilyCare
SEC 101. SHORT TITLE.
This subtitle may be cited as the ``FamilyCare Act of 2003''.
SEC. 102. RENAMING OF TITLE XXI PROGRAM.
(a) In General.--The heading of title XXI of the Social Security
Act (42 U.S.C. 1397aa et seq.) is amended to read as follows:
``TITLE XXI--FAMILYCARE PROGRAM''.
(b) Program References.--Any reference in any provision of Federal
law or regulation to ``SCHIP'' or ``State children's health insurance
program'' under title XXI of the Social Security Act shall be deemed a
reference to the FamilyCare program under such title.
SEC. 103. FAMILYCARE COVERAGE OF PARENTS UNDER THE MEDICAID PROGRAM AND
TITLE XXI.
(a) Incentives To Implement FamilyCare Coverage.--
(1) Under medicaid.--
(A) Establishment of new optional eligibility
category.--Section 1902(a)(10) (A)(ii) of the Social
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is
amended--
(i) by striking ``or'' at the end of
subclause (XVII);
(ii) by adding ``or'' at the end of
subclause (XVIII); and
(iii) by adding at the end the following:
``(XIX) who are individuals
described in subsection (k)(1)
(relating to parents of categorically
eligible children);''.
(B) Parents described.--Section 1902 of the Social
Security Act is further amended by inserting after
subsection (j) the following:
``(k)(1)(A) Individuals described in this paragraph are
individuals--
``(i) who are the parents of an individual who is under 19
years of age (or such higher age as the State may have elected
under section 1902(l)(1)(D)) and who is eligible for medical
assistance under subsection (a)(10)(A);
``(ii) who are not otherwise eligible for medical
assistance under such subsection or under a waiver approved
under section 1115 or otherwise (except under section 1931 or
under subsection (a)(10)(A)(ii)(XIX)); and
``(iii) whose family income or resources exceeds the
effective income level or resource level applicable under the
State plan under part A of title IV as in effect as of July 16,
1996, but does not exceed the highest effective income or
resource level (if any) applicable to a child in the family
under this title.
``(B) In establishing an income eligibility level for individuals
described in this paragraph, a State may vary such level consistent
with the various income levels established under subsection (l)(2) in
order to ensure, to the maximum extent possible, that such individuals
shall be enrolled in the same program as their children.
``(C) An individual may not be treated as being described in this
paragraph unless, at the time of the individual's enrollment under this
title, the child referred to in subparagraph (A)(i) of the individual
is also enrolled under this title or otherwise insured.
``(D) In this subsection, the term `parent' includes an individual
treated as a caretaker for purposes of carrying out section 1931.
``(E) In this subsection, the term `effective income level' means
the income level expressed as a percent of the poverty line and
considering applicable income disregards.
``(2) The State shall provide for coverage of a parent described in
paragraph (1) or section 2111 of a child who is covered under this
title or title XXI under the same title as the title as such child is
covered. In the case of a parent described in paragraph (1) who is also
the parent of a child who is eligible for child health assistance under
title XXI, the State may elect (on a uniform basis) to cover all such
parents under section 2111 or under this title.''.
(C) Enhanced matching funds available if certain
conditions met.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(i) in the fourth sentence of subsection
(b), by striking ``or subsection (u)(3)'' and
inserting ``, (u)(3), or (u)(4)''; and
(ii) in subsection (u)--
(I) by redesignating paragraph (4)
as paragraph (6), and
(II) by inserting after paragraph
(3) the following:
``(4) For purposes of subsection (b) and section 2105(a)(1):
``(A) FamilyCare parents.--The expenditures described in
this subparagraph are the expenditures described in the
following clauses (i) and (ii):
``(i) Parents.--If the conditions described in
clauses (iii) and (iv) are met, expenditures for
medical assistance for parents described in section
1902(k)(1) and for parents who would be described in
such section but for the fact that they are eligible
for medical assistance under section 1931 or under a
waiver approved under section 1115.
``(ii) Certain pregnant women.--If the conditions
described in clause (v) are met, expenditures for
medical assistance for pregnant women described in
subsection (n) or under section 1902(l)(1)(A) in a
family the income of which exceeds the effective income
level applicable under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 to a family of the size
involved as of January 1, 2004.
``(iii) Conditions relating to ensuring children's
coverage for enhanced match for parents.--The
conditions described in this clause are the following:
``(I) The State has a State child health
plan under title XXI which (whether implemented
under such title or under this title) has an
effective income level for children that is at
least 200 percent of the poverty line.
``(II) Such State child health plan does
not limit the acceptance of applications, does
not use a waiting list for children who meet
eligibility standards to qualify for
assistance, and provides benefits to all
children in the State who apply for and meet
eligibility standards.
``(III) Effective for determinations of
eligibility made on or after the date that is 1
year after the date of the enactment of this
clause, the application and renewal procedures
for individuals under 19 years of age (or such
higher age as the State has elected under
section 1902(l)(1)(D)) for medical assistance
under section 1902(a)(10)(A) are not be more
restrictive or burdensome than such procedures
used for children with higher income under the
State child health plan under title XXI.
``(iv) Conditions relating to minimum coverage for
parents for enhanced match for parents.--The conditions
described in this clause are the following:
``(I) The State does not apply an income
level for parents that is lower than the
effective income level (expressed as a percent
of the poverty line) that has been specified
under the State plan under title XIX (including
under a waiver authorized by the Secretary or
under section 1902(r)(2)), as of January 1,
2004, to be eligible for medical assistance as
a parent under this title.
``(II) The State plans under this title and
title XXI do not provide coverage for parents
with higher family income without covering
parents with a lower family income.
``(v) Conditions for enhanced match for certain
pregnant women.--The conditions described in this
clause are the following:
``(I) The State has established an
effective income eligibility level for pregnant
women under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 that is at least 185
percent of the poverty line.
``(II) The State plans under this title and
title XXI do not provide coverage for pregnant
women described in subparagraph (A)(ii) with
higher family income without covering such
pregnant women with a lower family income.
``(III) The State does not apply an income
level for pregnant women that is lower than the
effective income level that has been specified
under the State plan under subsection
(a)(10)(A)(i)(III) or (l)(2)(A) of section
1902, as of January 1, 2004, to be eligible for
medical assistance as a pregnant woman.
``(IV) The State satisfies the conditions
described in subclauses (I) and (II) of clause
(iii).
``(vi) Definitions.--For purposes of this
subsection:
``(I) The term `parent' has the meaning
given such term for purposes of section
1902(k)(1).
``(II) The term `poverty line' has the
meaning given such term in section
2110(c)(5).''.
(D) Appropriation from title xxi allotment for
certain medicaid expansion costs.--Section 2105(a) of
the Social Security Act (42 U.S.C. 1397ee(a)) is
amended--
(i) in paragraph (1), by redesignating
subparagraphs (B) through (D) as subparagraphs
(C) through (E), respectively, and by inserting
after subparagraph (A) the following new
subparagraph:
``(B) for medical assistance that is attributable
to expenditures described in section 1905(u)(4)(A);'';
and
(ii) in paragraph (2), by adding at the end
the following new subparagraph:
``(E) Fifth, for expenditures for items described
in paragraph (1)(E).''.
(2) Under title xxi.--
(A) FamilyCare coverage.--Title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.) is amended by
adding at the end the following:
``SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-
INCOME CHILDREN.
``(a) Optional Coverage.--Notwithstanding any other provision of
this title, a State may provide for coverage, through an amendment to
its State child health plan under section 2102, of parent health
assistance for targeted low-income parents, health care assistance for
targeted low-income pregnant women, or both, in accordance with this
section, but only if--
``(1) with respect to the provision of parent health
assistance, the State meets the conditions described in clause
(iii) of section 1905(u)(4)(A);
``(2) with respect to the provision of health care
assistance for pregnant women, the State meets the conditions
described in clause (iv) of section 1905(u)(4)(A); and
``(3) in the case of parent health assistance for targeted
low-income parents, the State elects to provide medical
assistance under section 1902(a)(10)(A)(ii)(XIX), under section
1931, or under a waiver under section 1115 to individuals
described in section 1902(k)(1)(A)(i) and elects an effective
income level that, consistent with paragraphs (1)(B) and (2) of
section 1902(k), ensures to the maximum extent possible, that
such individuals shall be enrolled in the same program as their
children if their children are eligible for coverage under
title XIX (including under a waiver authorized by the Secretary
or under section 1902(r)(2)).
``(b) Definitions.--For purposes of this title:
``(1) Parent health assistance.--The term `parent health
assistance' has the meaning given the term child health
assistance in section 2110(a) as if any reference to targeted
low-income children were a reference to targeted low-income
parents.
``(2) Parent.--The term `parent' has the meaning given the
term `caretaker relative' for purposes of carrying out section
1931.
``(3) Health care assistance for pregnant women.--The term
`health care assistance for pregnant women' has the meaning
given the term child health assistance in section 2110(a) as if
any reference to targeted low-income children were a reference
to targeted low-income pregnant women.
``(4) Targeted low-income parent.--The term `targeted low-
income parent' has the meaning given the term targeted low-
income child in section 2110(b) as if the reference to a child
were deemed a reference to a parent (as defined in paragraph
(3)) of the child; except that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2004, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2004, shall be
substituted for March 31, 1997.
``(5) Targeted low-income pregnant woman.--The term
`targeted low-income pregnant woman' has the meaning given the
term targeted low-income child in section 2110(b) as if any
reference to a child were a reference to a woman during
pregnancy and through the end of the month in which the 60-day
period beginning on the last day of her pregnancy ends; except
that in applying such section--
``(A) there shall be substituted for the income
level described in paragraph (1)(B)(ii)(I) the
applicable income level in effect for a targeted low-
income child;
``(B) in paragraph (3), January 1, 2004, shall be
substituted for July 1, 1997; and
``(C) in paragraph (4), January 1, 2004, shall be
substituted for March 31, 1997.
``(c) References to Terms and Special Rules.--In the case of, and
with respect to, a State providing for coverage of parent health
assistance to targeted low-income parents or health care assistance to
targeted low-income pregnant women under subsection (a), the following
special rules apply:
``(1) Any reference in this title (other than in subsection
(b)) to a targeted low-income child is deemed to include a
reference to a targeted low-income parent or a targeted low-
income pregnant woman (as applicable).
``(2) Any such reference to child health assistance--
``(A) with respect to such parents is deemed a
reference to parent health assistance; and
``(B) with respect to such pregnant women, is
deemed a reference to health care assistance for
pregnant women.
``(3) In applying section 2103(e)(3)(B) in the case of a
family (consisting of a parent and one or more children)
provided coverage under this section or a pregnant woman
provided coverage under this section without covering other
family members, the limitation on total annual aggregate cost-
sharing shall be applied to such entire family or such pregnant
woman, respectively.
``(4) In applying section 2110(b)(4), any reference to
`section 1902(l)(2) or 1905(n)(2) (as selected by a State)' is
deemed a reference to the effective income level applicable to
parents under section 1931 or under a waiver approved under
section 1115, or, in the case of a pregnant woman, the income
level established under section 1902(l)(2)(A).
``(5) In applying section 2102(b)(3)(B), any reference to
children found through screening to be eligible for medical
assistance under the State medicaid plan under title XIX is
deemed a reference to parents and pregnant women.''.
(B) Additional allotment for states providing
familycare.--
(i) In general.--Section 2104 of the Social
Security Act (42 U.S.C. 1397dd) is amended by
inserting after subsection (c) the following:
``(d) Additional Allotments for State Providing FamilyCare.--
``(1) Appropriation; total allotment.--For the purpose of
providing additional allotments to States to provide FamilyCare
coverage under section 2111, there is appropriated, out of any
money in the Treasury not otherwise appropriated--
``(A) for fiscal year 2004, $2,000,000,000;
``(B) for fiscal year 2005, $2,000,000,000;
``(C) for fiscal year 2006, $3,000,000,000; and
``(D) for fiscal year 2007, $3,000,000,000.
``(2) State and territorial allotments.--
``(A) In general.--In addition to the allotments
provided under subsections (b) and (c), subject to
paragraphs (3) and (4), of the amount available for the
additional allotments under paragraph (1) for a fiscal
year, the Secretary shall allot to each State with a
State child health plan approved under this title--
``(i) in the case of such a State other
than a commonwealth or territory described in
clause (ii), the same proportion as the
proportion of the State's allotment under
subsection (b) (determined without regard to
subsection (f)) to 98.95 percent of the total
amount of the allotments under such section for
such States eligible for an allotment under
this subparagraph for such fiscal year; and
``(ii) in the case of a commonwealth or
territory described in subsection (c)(3), the
same proportion as the proportion of the
commonwealth's or territory's allotment under
subsection (c) (determined without regard to
subsection (f)) to 1.05 percent of the total
amount of the allotments under such section for
commonwealths and territories eligible for an
allotment under this subparagraph for such
fiscal year.
``(B) Availability and redistribution of unused
allotments.--In applying subsections (e) and (f) with
respect to additional allotments made available under
this subsection, the procedures established under such
subsections shall ensure such additional allotments are
only made available to States which have elected to
provide coverage under section 2111.
``(3) Use of additional allotment.--Additional allotments
provided under this subsection are not available for amounts
expended before October 1, 2003. Such amounts are available for
amounts expended on or after such date for child health
assistance for targeted low-income children, as well as for
parent health assistance for targeted low-income parents, and
health care assistance for targeted low-income pregnant women.
``(4) Requiring election to provide coverage.--No payments
may be made to a State under this title from an allotment
provided under this subsection unless the State has made an
election to provide parent health assistance for targeted low-
income parents, or health care assistance for targeted low-
income pregnant women.''.
(ii) Conforming amendments.--Section 2104
of the Social Security Act (42 U.S.C. 1397dd)
is amended--
(I) in subsection (a), by inserting
``subject to subsection (d),'' after
``under this section,'';
(II) in subsection (b)(1), by
inserting ``and subsection (d)'' after
``Subject to paragraph (4)''; and
(III) in subsection (c)(1), by
inserting ``subject to subsection
(d),'' after ``for a fiscal year,''.
(C) No cost-sharing for pregnancy-related
benefits.--Section 2103(e)(2) of the Social Security
Act (42 U.S.C. 1397cc(e)(2)) is amended--
(i) in the heading, by inserting ``and
pregnancy-related services'' after ``preventive
services''; and
(ii) by inserting before the period at the
end the following: ``and for pregnancy-related
services''.
(3) Effective date.--The amendments made by this subsection
apply to items and services furnished on or after October 1,
2003, whether or not regulations implementing such amendments
have been issued.
(b) Rules for Implementation Beginning With Fiscal Year 2005.--
(1) Expansion of availability of enhanced match under
medicaid for pre-chip expansions.--Paragraph (4) of section
1905(u) of the Social Security Act (42 U.S.C. 1396d(u)), as
inserted by subsection (a)(1)(C), is amended--
(A) by amending clause (ii) of subparagraph (A) to
read as follows:
``(ii) Certain pregnant women.--Expenditures for
medical assistance for pregnant women under section
1902(l)(1)(A) in a family the income of which exceeds
the 133 percent of the income official poverty line,
but only if the income level established under section
1902(l)(2) (or under a Statewide waiver under section
1115) for pregnant women is 185 percent of the income
official poverty line.''; and
(B) by adding at the end the following:
``(B) Children in families with income above medicaid
mandatory level not previously described.--The expenditures
described in this subparagraph are expenditures (other than
expenditures described in paragraph (2) or (3)) for medical
assistance made available to any child who is eligible for
assistance under section 1902(a)(10)(A) (other than under
clause (i)) and the income of whose family exceeds the minimum
income level required under subsection 1902(l)(2) (or, if
higher, the minimum level required under section 1931 for that
State) for a child of the age involved (treating any child who
is 19 or 20 years of age as being 18 years of age).''.
(2) Offset of additional expenditures for enhanced match
for pre-chip expansion.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(A) in the fourth sentence of subsection (b), by
inserting ``(except in the case of expenditures
described in subsection (u)(5))'' after ``do not
exceed'';
(B) in subsection (u), by inserting after paragraph
(4) (as inserted by subparagraph (C)), the following:
``(5) For purposes of the fourth sentence of subsection (b) and
section 2105(a), the following payments under this title do not count
against a State's allotment under section 2104:
``(A) Regular fmap for expenditures for pregnant women with
income above 133 percent of poverty.--The portion of the
payments made for expenditures described in paragraph
(4)(A)(ii) that represents the amount that would have been paid
if the enhanced FMAP had not been substituted for the Federal
medical assistance percentage.
``(B) FamilyCare parents.--Payments for expenditures
described in paragraph (4)(A)(i).
``(C) Regular fmap for expenditures for certain children in
families with income above medicaid mandatory level.--The
portion of the payments made for expenditures described in
paragraph (4)(B) that represents the amount that would have
been paid if the enhanced FMAP had not been substituted for the
Federal medical assistance percentage.''.
(B) Conforming amendments.--Subparagraph (B) of
section 2105(a)(1) of the Social Security Act, as
amended by subsection (a)(1)(D), is amended to read as
follows:
``(B) Certain familycare parents and others.--
Expenditures for medical assistance that is
attributable to expenditures described in section
1905(u)(4), except as provided in section
1905(u)(5).''.
(3) Effective date.--The amendments made by this subsection
apply as of October 1, 2004, to fiscal years beginning on or
after such date and to expenditures under the State plan on and
after such date, whether or not regulations implementing such
amendments have been issued.
(c) GAO Study.--
(1) Study.--The Comptroller General of the United States
shall conduct a study regarding funding under title XXI of the
Social Security Act that examines--
(A) the adequacy of overall funding under such
title;
(B) the formula for determining allotments and for
redistribution of unspent funds under such title; and
(C) the effect of waiting lists and caps on
enrollment under such title.
(2) Report.--Not later than July 1, 2005, the Comptroller
General shall submit a report on the study conducted under
paragraph (1). Such report shall include recommendations
regarding a better mechanism for determining State allotments
and redistribution of unspent funds under such title in order
to ensure all eligible families in need can access coverage
through such title.
(d) Conforming Amendments.--
(1) Eligibility categories.--Section 1905(a) of the Social
Security Act (42 U.S.C. 1396d(a)) is amended, in the matter
before paragraph (1)--
(A) by striking ``or'' at the end of clause (xii);
(B) by inserting ``or'' at the end of clause
(xiii); and
(C) by inserting after clause (xiii) the following:
``(xiv) who are parents described (or treated as if
described) in section 1902(k)(1),''.
(2) Income limitations.--Section 1903(f)(4) of the Social
Security Act (42 U.S.C. 1396b(f)(4)) is amended by inserting
``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(3) Conforming amendment relating to no waiting period for
pregnant women.--Section 2102(b)(1)(B) of the Social Security
Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
(A) by striking ``, and'' at the end of clause (i)
and inserting a semicolon;
(B) by striking the period at the end of clause
(ii) and inserting ``; and''; and
(C) by adding at the end the following:
``(iii) may not apply a waiting period
(including a waiting period to carry out
paragraph (3)(C)) in the case of a targeted
low-income parent who is pregnant.''.
SEC. 104. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.
Section 2102(b)(1) of the Social Security Act (42 U.S.C.
1397bb(b)(1)) is amended by adding at the end the following:
``(C) Automatic eligibility of children born to a
parent being provided familycare.--Such eligibility
standards shall provide for automatic coverage of a
child born to an individual who is provided assistance
under this title in the same manner as medical
assistance would be provided under section 1902(e)(4)
to a child described in such section.''.
SEC. 105. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE
MEDICAID PROGRAM AND TITLE XXI.
(a) Medicaid.--
(1) In general.--Section 1902(l)(1)(D) of the Social
Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by inserting
``(or, at the election of a State, 20 or 21 years of age)''
after ``19 years of age''.
(2) Conforming amendments.--
(A) Section 1902(e)(3)(A) of the Social Security
Act (42 U.S.C. 1396a(e)(3)(A)) is amended by inserting
``(or 1 year less than the age the State has elected
under subsection (l)(1)(D))'' after ``18 years of
age''.
(B) Section 1902(e)(12) of the Social Security Act
(42 U.S.C. 1396a(e)(12)) is amended by inserting ``or
such higher age as the State has elected under
subsection (l)(1)(D)'' after ``19 years of age''.
(C) Section 1920A(b)(1) of the Social Security Act
(42 U.S.C. 1396r-1a(b)(1)) is amended by inserting ``or
such higher age as the State has elected under section
1902(l)(1)(D)'' after ``19 years of age''.
(D) Section 1928(h)(1) of the Social Security Act
(42 U.S.C. 1396s(h)(1)) is amended by inserting ``or 1
year less than the age the State has elected under
section 1902(l)(1)(D)'' before the period at the end.
(E) Section 1932(a)(2)(A) of the Social Security
Act (42 U.S.C. 1396u-2(a)(2)(A)) is amended by
inserting ``(or such higher age as the State has
elected under section 1902(l)(1)(D))'' after ``19 years
of age''.
(b) Title XXI.--Section 2110(c)(1) of the Social Security Act (42
U.S.C. 1397jj(c)(1)) is amended by inserting ``(or such higher age as
the State has elected under section 1902(l)(1)(D))''.
(c) Effective Date.--The amendments made by this section take
effect on January 1, 2004, and apply to medical assistance and child
health assistance provided on or after such date, whether or not
regulations implementing such amendments have been issued.
SEC. 106. ALLOWING STATES TO SIMPLIFY RULES FOR FAMILIES.
(a) Presumptive Eligibility.--
(1) Application to presumptive eligibility for pregnant
women under medicaid.--Section 1920(b) of the Social Security
Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end
after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined
in section 1920A(b)(3).''.
(2) Optional application of presumptive eligibility
provisions to parents.--Section 1920A of the Social Security
Act (42 U.S.C. 1396r-1a) is amended by adding at the end the
following:
``(e) A State may elect to apply the previous provisions of this
section to provide for a period of presumptive eligibility for medical
assistance for a parent of a child with respect to whom such a period
is provided under this section.''.
(3) Application under title xxi.--Section 2107(e)(1)(D) of
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to
read as follows:
``(D) Sections 1920 and 1920A (relating to
presumptive eligibility).''.
(b) 12-Months Continuous Eligibility.--
(1) Medicaid.--Section 1902(e)(12) of the Social Security
Act (42 U.S.C. 1396a(e)(12)) is amended--
(A) by striking ``At the option of the State, the
plan may'' and inserting ``The plan shall'';
(B) by striking ``an age specified by the State
(not to exceed 19 years of age)'' and inserting ``19
years of age (or such higher age as the State has
elected under subsection (l)(1)(D)) or, at the option
of the State, who is eligible for medical assistance as
the parent of such a child''; and
(C) in subparagraph (A), by striking ``a period
(not to exceed 12 months) '' and inserting ``the 12-
month period beginning on the date''.
(2) Title xxi.--Section 2102(b)(2) of such Act (42 U.S.C.
1397bb(b)(2)) is amended by adding at the end the following:
``Such methods shall provide continuous eligibility for
children under this title in a manner that is no less generous
than the 12-months continuous eligibility provided under
section 1902(e)(12) for children described in such section
under title XIX. If a State has elected to apply section
1902(e)(12) to parents, such methods may provide continuous
eligibility for parents under this title in a manner that is no
less generous than the 12-months continuous eligibility
provided under such section for parents described in such
section under title XIX.''.
(3) Effective date.--The amendments made by this subsection
shall take effect on July 1, 2004 (or, if later, 60 days after
the date of the enactment of this Act), whether or not
regulations implementing such amendments have been issued.
(c) Provision of Medicaid and CHIP Applications and Information
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B.
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is
amended--
(1) by striking ``(B) Applications'' and inserting ``(B)(i)
Applications''; and
(2) by adding at the end the following:
``(ii)(I) Applications for free and reduced price lunches that are
distributed pursuant to clause (i) to parents or guardians of children
in attendance at schools participating in the school lunch program
under this Act shall also contain information on the availability of
medical assistance under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) and of child health and FamilyCare assistance
under title XXI of such Act, including information on how to obtain an
application for assistance under such programs.
``(II) Information on the programs referred to in subclause (I)
shall be provided on a form separate from the application form for free
and reduced price lunches under clause (i).''.
SEC. 107. DEMONSTRATION PROGRAMS TO IMPROVE MEDICAID AND CHIP OUTREACH
TO HOMELESS INDIVIDUALS AND FAMILIES.
(a) Authority.--The Secretary of Health and Human Services may
award demonstration grants to not more than 7 States (or other
qualified entities) to conduct innovative programs that are designed to
improve outreach to homeless individuals and families under the
programs described in subsection (b) with respect to enrollment of such
individuals and families under such programs and the provision of
services (and coordinating the provision of such services) under such
programs.
(b) Programs for Homeless Described.--The programs described in
this subsection are as follows:
(1) Medicaid.--The program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(2) CHIP.--The program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.).
(3) TANF.--The program under part of A of title IV of the
Social Security Act (42 U.S.C. 601 et seq.).
(4) SAMHSA block grants.--The program of grants under part
B of title XIX of the Public Health Service Act (42 U.S.C.
300x-1 et seq.).
(5) Food stamp program.--The program under the Food Stamp
Act of 1977 (7 U.S.C. 2011 et seq.).
(6) Workforce investment act.--The program under the
Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
(7) Welfare-to-work.--The welfare-to-work program under
section 403(a)(5) of the Social Security Act (42 U.S.C.
603(a)(5)).
(8) Other programs.--Other public and private benefit
programs that serve low-income individuals.
(c) Appropriations.--For the purposes of carrying out this section,
there is appropriated for fiscal year 2004, out of any funds in the
Treasury not otherwise appropriated, $10,000,000, to remain available
until expended.
SEC. 108. ADDITIONAL CHIP REVISIONS.
(a) Limiting Cost-Sharing to 2.5 Percent for Families With Income
Below 150 Percent of Poverty.--Section 2103(e)(3)(A) of the Social
Security Act (42 U.S.C. 1397cc(e)(3)(A)) is amended--
(1) by striking ``and'' at the end of clause (i);
(2) by striking the period at the end of clause (ii) and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) total annual aggregate cost-sharing
described in clauses (i) and (ii) with respect
to all such targeted low-income children in a
family under this title that exceeds 2.5
percent of such family's income for the year
involved.''.
(b) Employer Coverage Waiver Changes.--Section 2105(c)(3) of such
Act (42 U.S.C. 1397ee(c)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii) and indenting appropriately;
(2) by designating the matter beginning with ``Payment may
be made'' as a subparagraph (A) with the heading ``In general''
and indenting appropriately; and
(3) by adding at the end the following new subparagraph:
``(B) Application of requirements.--In carrying out
subparagraph (A)--
``(i) in determining cost-effectiveness,
the Secretary shall measure against family
coverage costs to the extent that a State has
expanded coverage to parents pursuant to
section 2111;
``(ii) subject to clause (iii), the State
shall provide satisfactory assurances that the
minimum benefits and cost-sharing protections
established under this title are provided,
either through the coverage under subparagraph
(A) or as a supplement to such coverage; and
``(iii) coverage under such subparagraph
shall not be considered to violate clause (ii)
because it does not comply with requirements
relating to reviews of health service decisions
if the enrollee involved is provided the option
of being provided benefits directly under this
title.''.
(c) Effective Date.--The amendments made by this section apply as
of January 1, 2004, whether or not regulations implementing such
amendments have been issued.
SEC. 109. COORDINATION OF TITLE XXI WITH THE MATERNAL AND CHILD HEALTH
PROGRAM.
(a) In General.--Section 2102(b)(3) of the Social Security Act (42
U.S.C. 1397bb(b)(3)) is amended--
(1) in subparagraph (D), by striking ``and'' at the end;
(2) in subparagraph (E), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(F) that operations and activities under this
title are developed and implemented in consultation and
coordination with the program operated by the State
under title V in areas including outreach and
enrollment, benefits and services, service delivery
standards, public health and social service agency
relationships, and quality assurance and data
reporting.''.
(b) Conforming Medicaid Amendment.--Section 1902(a)(11) of such Act
(42 U.S.C. 1396a(a)(11)) is amended--
(1) by striking ``and'' before ``(C)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (D) provide that operations and activities
under this title are developed and implemented in consultation
and coordination with the program operated by the State under
title V in areas including outreach and enrollment, benefits
and services, service delivery standards, public health and
social service agency relationships, and quality assurance and
data reporting''.
(c) Effective Date.--The amendments made by this section take
effect on January 1, 2004.
Subtitle B--State Option To Provide Coverage for All Residents With
Income At or Below the Poverty Line
SEC. 121. STATE OPTION TO PROVIDE COVERAGE FOR ALL RESIDENTS WITH
INCOME AT OR BELOW THE POVERTY LINE.
(a) In General.--Section 1902(a)(10)(A)(ii) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
(1) by striking ``or'' at the end of subclause (XVII);
(2) by adding ``or'' at the end of subclause (XVIII); and
(3) by adding at the end the following new subclause:
``(XIX) any individual whose family
income does not exceed 100 percent of
the income official poverty line (as
defined by the Office of Management and
Budget, and revised annually in
accordance with section 673(2) of the
Omnibus Budget Reconciliation Act of
1981) applicable to a family of the
size involved and who is not otherwise
eligible for medical assistance under
this title;''.
(b) Conforming Amendments.--
(1) Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is
amended, in the matter before paragraph (1)--
(A) by striking ``or'' at the end of clause (xii);
(B) by adding ``or'' at the end of clause (xiii);
and
(C) by inserting after clause (xiii) the following
new clause:
``(xii) individuals described in section
1902(a)(10)(A)(ii)(XIX),''.
(2) Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4))
is amended by inserting ``1902(a)(10)(A)(ii)(XIX),'' after
``1902(a)(10)(A)(ii)(XVIII),''.
(c) Effective Date.--The amendments made by this section shall take
effect on October 1, 2004.
Subtitle C--Optional Coverage of Legal Immigrants under the Medicaid
Program and Title XXI
SEC. 131. EQUAL ACCESS TO HEALTH COVERAGE FOR LEGAL IMMIGRANTS.
(a) In General.--Section 401(b)(1) of the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(b)(1))
is amended--
(1) by striking subparagraph (A) and inserting the
following:
``(A) Medical assistance under title XIX of the
Social Security Act.''; and
(2) by adding at the end the following:
``(F) Child health assistance under title XXI of
the Social Security Act.''.
(b) Conforming Amendments.--
(1) Section 402(b) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)) is
amended--
(A) in paragraph (2)--
(i) in subparagraph (A)--
(I) by striking clause (i);
(II) by redesignating clause (ii)
as subparagraph (A) and realigning the
margins accordingly; and
(III) by redesignating subclauses
(I) through (V) of subparagraph (A), as
so redesignated, as clauses (i) through
(v), respectively and realigning the
margins accordingly; and
(ii) by striking subparagraphs (E) and (F);
and
(B) in paragraph (3), by striking subparagraph (C).
(2) Section 403 of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C. 1613)) is
amended--
(A) in subsection (c), by adding at the end the
following:
``(M) Child health assistance provided under title
XXI of the Social Security Act.''; and
(B) in subsection (d)(1), by striking ``programs
specified in subsections (a)(3) and (b)(3)(C)'' and
inserting ``program specified in subsection (a)(3)''.
(3) Section 421 of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631)) is
amended by adding at the end the following:
``(g) Exceptions.--This section shall not apply to--
``(1) medical assistance provided under a State plan
approved under title XIX of the Social Security Act; and
``(2) child health assistance provided under title XXI of
the Social Security Act.''.
(4) Section 423(d) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 is amended by adding at
the end the following:
``(12) Child health assistance provided under title XXI of
the Social Security Act.''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section take effect on the date of
enactment of this Act and apply to medical assistance provided
under title XIX of the Social Security Act and child health
assistance provided under title XXI of the Social Security Act
on or after that date.
(2) Requirements for sponsor's affidavit of support.--
Section 423(d) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 shall be applied as if
the amendments made by this Act were enacted on December 1,
2002.
Subtitle D--Indian Healthcare Funding
CHAPTER 1--GUARANTEED FUNDING
SEC. 141. GUARANTEED ADEQUATE FUNDING FOR INDIAN HEALTHCARE.
Section 825 of the Indian Health Care Improvement Act (25 U.S.C.
1680o) is amended to read as follows:
``SEC. 825. FUNDING.
``(a) In General.--Notwithstanding any other provision of law, not
later than 30 days after the date of enactment of this section, on
October 1, 2003, and on each October 1 thereafter, out of any funds in
the Treasury not otherwise appropriated, the Secretary of the Treasury
shall transfer to the Secretary to carry out this title the amount
determined under subsection (d).
``(b) Use and Availability.--
``(1) In general.--An amount transferred under subsection
(a)--
``(A) shall remain available until expended; and
``(B) shall be used to carry out any programs,
functions, and activities relating to clinical services
(as defined in paragraph (2)) of the Service and
Service units.
``(2) Clinical services defined.--For purposes of paragraph
(1)(B), the term `clinical services' includes all programs of
the Indian Health Service which are funded directly or under
the authority of the Indian Self-Determination and Education
Assistance Act, for the purposes of--
``(A) clinical care, including inpatient care,
outpatient care (including audiology, clinical eye and
vision care), primary care, secondary and tertiary
care, and long term care;
``(B) preventive health, including mammography and
other cancer screening;
``(C) dental care;
``(D) mental health, including community mental
health services, inpatient mental health services,
dormitory mental health services, therapeutic and
residential treatment centers;
``(E) emergency medical services;
``(F) treatment and control of, and rehabilitative
care related to, alcoholism and drug abuse (including
fetal alcohol syndrome) among Indians;
``(G) accident prevention programs;
``(H) home healthcare;
``(I) community health representatives;
``(J) maintenance and repair; and
``(K) traditional healthcare practices and training
of traditional healthcare practitioners.
``(c) Receipt and Acceptance.--The Secretary shall be entitled to
receive, shall accept, and shall use to carry out this title the funds
transferred under subsection (a), without further appropriation.
``(d) Amount.--The amount referred to in subsection (a) is--
``(1) for fiscal year 2004, the amount equal to 390 percent
of the amount obligated by the Service during fiscal year 2002
for the purposes described in subsection (b)(2); and
``(2) for fiscal year 2005 and each fiscal year thereafter,
the amount equal to the product obtained by multiplying--
``(A) the number of Indians served by the Service
as of September 30 of the preceding the fiscal year;
and
``(B) the per capita baseline amount, as determined
under subsection (e).
``(e) Per Capita Baseline Amount.--
``(1) In general.--For the purpose of subsection (d)(2)(B),
the per capita baseline amount shall be equal to the sum of--
``(A) the quotient obtained by dividing--
``(i) the amount specified in subsection
(d)(1); by
``(ii) the number of Indians served by the
Service as of September 30, 2002; and
``(B) any applicable increase under paragraph (2).
``(2) Increase.--For each fiscal year, the Secretary shall
provide a percentage increase (rounded to the nearest dollar)
in the per capita baseline amount equal to the percentage by
which--
``(A) the Consumer Price Index for all Urban
Consumers published by the Department of Labor
(relating to the United States city average for medical
care and not seasonally adjusted) for the 1-year period
ending on the June 30 of the fiscal year preceding the
fiscal year for which the increase is made; exceeds
``(B) that Consumer Price Index for the 1-year
period preceding the 1-year period described in
subparagraph (A).''.
CHAPTER 2--INDIAN HEALTHCARE PROGRAMS
SEC. 145. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS.
The Service shall provide funds for healthcare programs and
facilities operated by Indian tribes and tribal organizations under
funding agreements with the Service entered into under the Indian Self-
Determination and Education Assistance Act on the same basis as such
funds are provided to programs and facilities operated directly by the
Service.
SEC. 146. LICENSING.
Healthcare professionals employed by Indian tribes and tribal
organizations to carry out agreements under the Indian Self-
Determination and Education Assistance Act, shall, if licensed in any
State, be exempt from the licensing requirements of the State in which
the agreement is performed.
SEC. 147. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH SERVICES.
With respect to an elderly Indian or an Indian with a disability
receiving emergency medical care or services from a non-Service
provider or in a non-Service facility under the authority of the Indian
Health Care Improvement Act, the time limitation (as a condition of
payment) for notifying the Service of such treatment or admission shall
be 30 days.
SEC. 148. PROMPT ACTION ON PAYMENT OF CLAIMS.
(a) Requirement.--The Service shall respond to a notification of a
claim by a provider of a contract care service with either an
individual purchase order or a denial of the claim within 5 working
days after the receipt of such notification.
(b) Failure To Respond.--If the Service fails to respond to a
notification of a claim in accordance with subsection (a), the Service
shall accept as valid the claim submitted by the provider of a contract
care service.
(c) Payment.--The Service shall pay a valid contract care service
claim within 30 days after the completion of the claim.
SEC. 149. LIABILITY FOR PAYMENT.
(a) No Liability.--A patient who receives contract healthcare
services that are authorized by the Service shall not be liable for the
payment of any charges or costs associated with the provision of such
services.
(b) Notification.--The Secretary shall notify a contract care
provider and any patient who receives contract healthcare services
authorized by the Service that such patient is not liable for the
payment of any charges or costs associated with the provision of such
services.
(c) Limitation.--Following receipt of the notice provided under
subsection (b), or, if a claim has been deemed accepted under section
154(b), the provider shall have no further recourse against the patient
who received the services involved.
SEC. 150. HEALTH SERVICES FOR INELIGIBLE PERSONS.
(a) Ineligible Persons.--
(1) In general.--Any individual who--
(A) has not attained 19 years of age;
(B) is the natural or adopted child, step-child,
foster-child, legal ward, or orphan of an eligible
Indian; and
(C) is not otherwise eligible for the health
services provided by the Service,
shall be eligible for all health services provided by the
Service on the same basis and subject to the same rules that
apply to eligible Indians until such individual attains 19
years of age. The existing and potential health needs of all
such individuals shall be taken into consideration by the
Service in determining the need for, or the allocation of, the
health resources of the Service. If such an individual has been
determined to be legally incompetent prior to attaining 19
years of age, such individual shall remain eligible for such
services until one year after the date such disability has been
removed.
(2) Spouses.--Any spouse of an eligible Indian who is not
an Indian, or who is of Indian descent but not otherwise
eligible for the health services provided by the Service, shall
be eligible for such health services if all of such spouses or
spouses who are married to members of the Indian tribe being
served are made eligible, as a class, by an appropriate
resolution of the governing body of the Indian tribe or tribal
organization providing such services. The health needs of
persons made eligible under this paragraph shall not be taken
into consideration by the Service in determining the need for,
or allocation of, its health resources.
(b) Programs and Services.--
(1) Programs.--
(A) In general.--The Secretary may provide health
services under this subsection through health programs
operated directly by the Service to individuals who
reside within the service area of a service unit and
who are not eligible for such health services under any
other subsection of this section or under any other
provision of law if--
(i) the Indian tribe (or, in the case of a
multi-tribal service area, all the Indian
tribes) served by such service unit requests
such provision of health services to such
individuals; and
(ii) the Secretary and the Indian tribe or
tribes have jointly determined that--
(I) the provision of such health
services will not result in a denial or
diminution of health services to
eligible Indians; and
(II) there is no reasonable
alternative health program or services,
within or without the service area of
such service unit, available to meet
the health needs of such individuals.
(B) Funding agreements.--In the case of health
programs operated under a funding agreement entered
into under the Indian Self-Determination and
Educational Assistance Act, the governing body of the
Indian tribe or tribal organization providing health
services under such funding agreement is authorized to
determine whether health services should be provided
under such funding agreement to individuals who are not
eligible for such health services under any other
subsection of this section or under any other provision
of law. In making such determinations, the governing
body of the Indian tribe or tribal organization shall
take into account the considerations described in
subparagraph (A)(ii).
(2) Liability for payment.--
(A) In general.--Persons receiving health services
provided by the Service by reason of this subsection
shall be liable for payment of such health services
under a schedule of charges prescribed by the Secretary
which, in the judgment of the Secretary, results in
reimbursement in an amount not less than the actual
cost of providing the health services. Notwithstanding
section 1880 of the Social Security Act or any other
provision of law, amounts collected under this
subsection, including medicare or medicaid
reimbursements under titles XVIII and XIX of the Social
Security Act, shall be credited to the account of the
program providing the service and shall be used solely
for the provision of health services within that
program. Amounts collected under this subsection shall
be available for expenditure within such program for
not to exceed 1 fiscal year after the fiscal year in
which collected.
(B) Services for indigent persons.--Health services
may be provided by the Secretary through the Service
under this subsection to an indigent person who would
not be eligible for such health services but for the
provisions of paragraph (1) only if an agreement has
been entered into with a State or local government
under which the State or local government agrees to
reimburse the Service for the expenses incurred by the
Service in providing such health services to such
indigent person.
(3) Service areas.--
(A) Service to only one tribe.--In the case of a
service area which serves only one Indian tribe, the
authority of the Secretary to provide health services
under paragraph (1)(A) shall terminate at the end of
the fiscal year succeeding the fiscal year in which the
governing body of the Indian tribe revokes its
concurrence to the provision of such health services.
(B) Multi-tribal areas.--In the case of a multi-
tribal service area, the authority of the Secretary to
provide health services under paragraph (1)(A) shall
terminate at the end of the fiscal year succeeding the
fiscal year in which at least 51 percent of the number
of Indian tribes in the service area revoke their
concurrence to the provision of such health services.
(c) Purpose for Providing Services.--The Service may provide health
services under this subsection to individuals who are not eligible for
health services provided by the Service under any other subsection of
this section or under any other provision of law in order to--
(1) achieve stability in a medical emergency;
(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard;
(3) provide care to non-Indian women pregnant with an
eligible Indian's child for the duration of the pregnancy
through post partum; or
(4) provide care to immediate family members of an eligible
person if such care is directly related to the treatment of the
eligible person.
(d) Hospital Privileges.--Hospital privileges in health facilities
operated and maintained by the Service or operated under a contract
entered into under the Indian Self-Determination Education Assistance
Act may be extended to non-Service healthcare practitioners who provide
services to persons described in subsection (a) or (b). Such non-
Service healthcare practitioners may be regarded as employees of the
Federal Government for purposes of section 1346(b) and chapter 171 of
title 28, United States Code (relating to Federal tort claims) only
with respect to acts or omissions which occur in the course of
providing services to eligible persons as a part of the conditions
under which such hospital privileges are extended.
(e) Definition.--In this section, the term ``eligible Indian''
means any Indian who is eligible for health services provided by the
Service without regard to the provisions of this section.
SEC. 151. DEFINITIONS.
For purposes of this chapter, the definitions contained in section
4 of the Indian Health Care Improvement Act shall apply.
SEC. 152. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2015 to carry out
this chapter.
Subtitle E--Territories
SEC. 161. FUNDING FOR TERRITORIES.
(a) Temporary Elimination of Spending Cap.--Section 1108 of the
Social Security Act (42 U.S.C. 1308) is amended--
(1) in subsection (f), by striking ``subsection (g)'' and
inserting ``subsections (g) and (h)''; and
(2) by adding at the end the following:
``(h) Temporary Elimination of Caps.--With respect to each of
fiscal years 2004 through 2007, the Secretary shall make payments under
title XIX to Puerto Rico, the Virgin Islands, Guam, the Northern
Mariana Islands, and American Samoa without regard to the limitations
on the amount of such payments imposed under subsections (f) and
(g).''.
(b) Temporary Increase in FMAP.--The first sentence of section
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by
inserting ``(except that, only with respect to fiscal years 2004
through 2007 and only for purposes of expenditures under this title,
such percentage shall be 77 percent)'' after ``50 per centum''.
Subtitle F--Migrant Workers and Farmworkers Health
SEC. 171. DEMONSTRATION PROJECT REGARDING CONTINUITY OF COVERAGE OF
MIGRANT WORKERS AND FARMWORKERS UNDER MEDICAID AND CHIP.
(a) Authority To Conduct Demonstration Project.--
(1) In general.--The Secretary of Health and Human Services
shall conduct a demonstration project for the purpose of
evaluating methods for strengthening the health coverage of,
and continuity of coverage of, migrant workers and farmworkers
under the medicaid and State children's health insurance
programs (42 U.S.C. 1396 et seq., 1397aa et seq.).
(2) Waiver authority.--The Secretary of Health and Human
Services shall waive compliance with the requirements of titles
XI, XIX, and XXI of the Social Security Act (42 U.S.C. 1301 et
seq, 1396 et seq., 1397aa et seq.) to such extent and for such
period as the Secretary determines is necessary to conduct the
demonstration project under this section.
(b) Requirements.--The demonstration project conducted under this
section shall provide for--
(1) uniform eligibility criteria under the medicaid and
State children's health insurance programs with respect to
migrant workers and farmworkers; and
(2) the portability of coverage of such workers under those
programs between participating States.
(c) Report.--Not later than March 31, 2005, the Secretary of Health
and Human Services shall submit a report to Congress on the
demonstration project conducted under this section that contains such
recommendations for legislative action as the Secretary determines is
appropriate.
Subtitle G--Expanded Access to Health Care
SEC. 181. NATIONAL COMMISSION FOR EXPANDED ACCESS TO HEALTH CARE.
(a) Establishment.--There is established a commission to be known
as the National Commission for Expanded Access to Health Care (referred
to in this section as the ``Commission'').
(b) Appointment of Members.--
(1) In general.--Not later than 45 days after the date of
enactment of this Act--
(A) the majority and minority leaders of the Senate
and the Speaker and minority leader of the House of
Representatives shall each appoint 7 members of the
Commission; and
(B) the Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall
appoint 1 member of the Commission.
(2) Criteria.--Members of the Commission shall include
representatives of the following:
(A) Consumers of health insurance.
(B) Health care professionals.
(C) State and territorial officials.
(D) Health economists.
(E) Health care providers.
(F) Experts on health insurance.
(G) Experts on expanding health care to individuals
who are uninsured.
(H) Experts on the elimination of racial and ethnic
health disparities.
(I) Experts on health care in the United States
territories.
(3) Chairperson.--At the first meeting of the Commission,
the Commission shall select a Chairperson from among its
members.
(c) Meetings.--
(1) In general.--After the initial meeting of the
Commission, which shall be called by the Secretary, the
Commission shall meet at the call of the Chairperson.
(2) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(3) Supermajority voting requirement.--To approve a report
required under paragraph (1), (2), or (3) of subsection (e), at
least 60 percent of the membership of the Commission must vote
in favor of such a report.
(d) Duties.--The Commission shall--
(1) assess the effectiveness of programs designed to expand
health care coverage or make health care coverage affordable to
uninsured individuals by identifying the accomplishments and
needed improvements of each program;
(2) make recommendations regarding the benefits and cost-
sharing that should be included in health care coverage for
various groups, taking into account--
(A) the special health care needs of children and
individuals with disabilities;
(B) the different ability of various populations to
pay out-of-pocket costs for services;
(C) incentives for efficiency and cost-containment;
(D) racial and ethnic disparities in health status
and health care;
(E) incremental changes to the United States health
care delivery system and changes to achieve fundamental
restructuring of the system;
(F) populations who are traditionally more
difficult to cover, including immigrants and homeless
persons;
(G) preventive care, diagnostic services, disease
management services, and other factors;
(H) quality improvement initiatives among health
institutions serving disadvantaged patient populations;
and
(I) the feasibility of and barriers to the
development of a comprehensive system of health care;
(3) recommend mechanisms to expand health care coverage to
uninsured individuals;
(4) recommend automatic enrollment and retention procedures
and other measures to increase health care coverage among those
eligible for assistance; and
(5) analyze the size, effectiveness, and efficiency of
current tax and other subsidies for health care coverage and
recommend improvements.
(e) Reports.--
(1) Annual reports.--The Commission shall submit annual
reports to the President and the appropriate committees of
Congress addressing the matters identified in subsection (d).
(2) Biennial report.--The Commission shall submit biennial
reports to the President and the appropriate committees of
Congress containing--
(A) recommendations concerning essential benefits
and maximum out-of-pocket cost-sharing for--
(i) the general population; and
(ii) individuals with limited ability to
pay; and
(B) proposed legislative language to implement such
recommendations.
(3) Commission report.--Not later than January 15, 2007,
the Commission shall submit a report to the President and the
appropriate committees of Congress, which shall include--
(A) recommendations on policies to provide health
care coverage to uninsured individuals;
(B) recommendations on changes to policies enacted
under this Act; and
(C) proposed legislative language to implement such
recommendations.
(f) Administration.--
(1) Powers.--
(A) Hearings.--The Commission may hold such
hearings, sit and act at such times and places, take
such testimony, and receive such evidence as the
Commission considers advisable to carry out this
section.
(B) Information from federal agencies.--The
Commission may secure directly from any Federal
department or agency such information as the Commission
considers necessary to carry out this section. Upon
request of the Chairperson of the Commission, the head
of such department or agency shall furnish such
information to the Commission.
(C) Postal services.--The Commission may use the
United States mails in the same manner and under the
same conditions as other departments and agencies of
the Federal Government.
(D) Gifts.--The Commission may accept, use, and
dispose of donations of services or property.
(2) Compensation.--
(A) In general.--Each member of the Commission who
is not an officer or employee of the Federal Government
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 duties of the Commission.
All members of the Commission who are officers or
employees of the United States shall serve without
compensation in addition to that received for their
services as officers or employees of the United States.
(B) Travel expenses.--The members of the Commission
shall be allowed travel expenses, as authorized by the
Chairperson of the Commission, 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 Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission
may appoint an executive director such other staff as
may be necessary to enable the Commission to perform
its duties. The employment of an executive director
shall be subject to confirmation by the Commission.
(B) Staff compensation.--The Chairperson of the
Commission may fix the compensation of personnel
without regard to chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating to
classification of positions and General Schedule pay
rates, except that the rate of pay for personnel may
not exceed the rate payable for level V of the
Executive Schedule under section 5316 of such title.
(C) Detail of government employees.--Any Federal
Government employee may be detailed to the Commission
without reimbursement, and such detail shall be without
interruption or loss of civil service status or
privilege.
(D) Procurement of temporary and intermittent
services.--The Chairperson of the Commission 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.
(g) Termination.--Except with respect to activities in connection
with the ongoing biennial report required under subsection (e)(2), the
Commission shall terminate 90 days after the date on which the
Commission submits the report required under subsection (e)(3).
(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for fiscal year 2005 and each subsequent fiscal year.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTHCARE
SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXIX--MINORITY HEALTH
``SEC. 2900. DEFINITIONS.
``In this title, the definitions contained in section 801 of the
Healthcare Equality and Accountability Act shall apply.
``Subtitle A--Culturally and Linguistically Appropriate Healthcare
``SEC. 2901. 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 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 enjoy
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 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 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 healthcare 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 Act, each Federal agency that carries out
health care-related activities shall prepare a plan to improve
access to the federally conducted health care-related programs
and activities of the agency by limited English proficient
individuals.
``(2) Plan requirement.--Each plan under paragraph (1)
shall be consistent with the standards set forth in section 204
of the Healthcare Equality and Accountability Act, and shall
include the steps the agency will take to ensure that limited
English proficient individuals have access to the agency's
health care-related programs and activities. Each agency shall
send a copy of such plan to the Department of Justice, which
shall serve as the central repository of the agencies' plans.
``(c) Federally Assisted Programs and Activities.--
``(1) In general.--Not later than 120 days after the date
of enactment of this Act, 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 and
is consistent with the standards described in section 204 of
the Healthcare Equality and Accountability Act. Each agency
shall send a copy of such guidance to the Department of Justice
which shall serve as the central repository of the agencies'
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--
``(A) detail how the general standards established
under section 204 of the Healthcare Equality and
Accountability Act will be applied to the agency's
recipients; and
``(B) 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 that the Department of Justice determines is
consistent with the standards described in section 204 of the
Healthcare Equality and Accountability Act 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-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 and comparable
opportunity to provide input with respect to the actions of the
agency.
``(2) Evaluation of needs.--Each Federal agency described
in paragraph (1) shall evaluate the particular needs of the
limited English proficient individuals served by the agency,
and by a recipient of assistance provided by the agency, and
the burdens of compliance with the agency guidance and its
recipients of the requirements of this section.
``SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES IN HEALTHCARE.
``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 healthcare 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 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 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 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 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 self-
assessments of culturally and linguistically appropriate
services-related activities and integrate cultural and
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, and primary language 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) 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. 2903. CENTER FOR CULTURAL AND LINGUISTIC COMPETENCE IN
HEALTHCARE.
``(a) Establishment.--The Secretary, acting through the Director of
the Office of Minority Health, shall establish and support a center to
be known as the `Center for Cultural and Linguistic Competence in
Healthcare' (referred to in this section as the `Center') to carry out
the following activities:
``(1) Remote medical interpretation.--The Center shall
provide remote medical interpretation, directly or through
contract, at no cost to healthcare providers. Methods of
interpretation may include remote, simultaneous or consecutive
interpreting through telephonic systems, video conferencing,
and other methods determined appropriate by the Secretary for
patients with limited English proficiency. The quality of such
interpretation shall be monitored and reported publicly.
Nothing in this paragraph shall be construed to limit the
ability of healthcare providers or organizations to provide
medical interpretation services directly and obtain
reimbursement for such services as provided for under the
medicare, medicaid or SCHIP programs under titles XVIII, XIX,
or XXI of the Social Security Act.
``(2) Translation of written material.--The Center shall
provide, directly or through contract, for the translation of
written materials for healthcare providers and healthcare
organizations (as defined in section 2902(b)) at no cost to
such providers and organizations. Materials may be submitted
for translation into non-English languages. Translation
services shall be provided in a timely and reasonable manner.
The quality of such translation shall be monitored and reported
publicly.
``(3) Model language assistance programs.--The Center shall
provide for the collection and dissemination of information on
current model language assistance programs and strategies to
improve language access to healthcare for individuals with
limited English proficiency, including case studies using de-
identified patient information, program summaries, and program
evaluations.
``(4) Medical interpretation guidelines.--
``(A) In general.--The Center shall convene a
working group to develop quality guidelines and
standards for the training of medical interpreters and
translators. Such group shall include--
``(i) representatives from the Office of
Minority Health, the National Center on
Minority Health and Health Disparities, the
Agency for Healthcare Research and Quality, the
Centers for Medicare and Medicaid Services, the
Office for Civil Rights of the Department of
Health and Human Services, and other Federal
agencies determined appropriate by the
Secretary; and
``(ii) representatives of communities with
a significant proportion of limited English
proficient individuals, professional
interpreter associations, medical
interpretation service providers, and other
public or private organizations determined
appropriate by the Secretary.
``(B) Publication.--Not later than 18 months after
the date of enactment of this Act, the Center shall
publish guidelines and standards developed under this
paragraph in the Federal Register.
``(5) Internet health clearinghouse.--The Center shall
develop and maintain an Internet clearinghouse to reduce
medical errors and healthcare costs caused by communication
with individuals with limited English proficiency or low
functional health literacy and reduce or eliminate the
duplication of effort to translate materials by--
``(A) developing and making available templates for
standard documents that are necessary for patients and
consumers to access and make educated decisions about
their healthcare, including--
``(i) administrative and legal documents
such as 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; and
``(iii) patient education and outreach
materials such as immunization notices, health
warnings, or screening notices;
``(B) ensuring that the documents are posted in
English and non-English languages and are culturally
appropriate;
``(C) allowing public review of the documents
before dissemination in order to ensure that the
documents are understandable and culturally appropriate
for the target populations;
``(D) allowing healthcare providers to customize
the documents for their use;
``(E) facilitating access to these documents;
``(F) providing technical assistance with respect
to the access and use of such information; and
``(G) carrying out any other activities the
Secretary determines to be useful to fulfill the
purposes of the Clearinghouse.
``(6) Provision of information.--The Center shall provide
information relating to culturally and linguistically competent
healthcare for minority populations residing in the United
States to all healthcare providers and healthcare organizations
at no cost. Such information shall include--
``(A) tenets of culturally and linguistically
competent care;
``(B) cultural and linguistic competence self-
assessment tools;
``(C) cultural and linguistic competence training
tools;
``(D) strategic plans to increase cultural and
linguistic competence in different types of healthcare
organizations; and
``(E) resources for cultural competence information
for educators, practitioners and researchers.
``(b) Director.--The Center shall be headed by a Director to be
appointed by the Director of the Office of Minority Health who shall
report to the Director of the Office of Minority Health.
``(c) Availability of Language Access.--The Director shall
collaborate with the Administrator of the Centers for Medicare and
Medicaid Services and the Administrator of the Health Resources and
Services Administration, to notify healthcare providers and healthcare
organizations about the availability of language access services by the
Center.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2904. INNOVATIONS IN LANGUAGE ACCESS GRANTS.
``(a) In General.--The Secretary, acting through the Administrator
of the Centers for Medicare and Medicaid Services, the Administrator of
the Health Resources and Services Administration, and the Director of
the Office of Minority Health, shall award grants to eligible entities
to enable such entities to design, implement, and evaluate innovative,
cost-effective programs to improve linguistic access to healthcare for
individuals with limited English proficiency.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) be a city, county, Indian tribe, State, territory,
community-based nonprofit organization, health center or
community clinic, university, college, or 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
real-time interpretation services through in-person
interpretation, communications, and computer technology,
including the Internet, teleconferencing, or video
conferencing;
``(2) develop short-term medical interpretation training
courses and incentives for bilingual healthcare staff who are
asked to interpret in the workplace;
``(3) develop formal training programs for individuals
interested in becoming dedicated healthcare interpreters;
``(4) provide language training courses for healthcare
staff;
``(5) provide basic healthcare-related English language
instruction for limited English proficient individuals; and
``(6) develop other language assistance services as
determined appropriate by the Secretary.
``(d) Priority.--In awarding grants under this section, the
Secretary shall give priority to entities that have developed
partnerships with organizations or agencies with experience in language
access services.
``(e) Evaluation.--An entity that receives a grant under this
section shall submit to the Secretary an evaluation that describes the
activities carried out with funds received under the grant, and how
such activities improved access to healthcare services and the quality
of healthcare for individuals with limited English proficiency. Such
evaluation shall be collected and disseminated through the Center for
Linguistic and Cultural Competence in Healthcare established under
section 2903.
``(f) Grantee Convention.--The Secretary, acting through the
Director of the Center for Linguistic and Cultural Competence in
Healthcare, shall at the end of the grant cycle convene grantees under
this section to share findings and develop and disseminate model
programs and practices.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2905. RESEARCH ON LANGUAGE ACCESS.
``(a) In General.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall expand research
concerning--
``(1) the barriers to healthcare services that are faced by
limited English proficient individuals;
``(2) the impact of language barriers on the quality of
healthcare and the health status of limited English proficient
individuals and populations;
``(3) healthcare provider attitudes, knowledge, and
awareness of the barriers described in paragraphs (1) and (2);
and
``(4) the means by which oral or written language
interpretation services are provided to limited English
proficient individuals and whether such services are effective
in improving the quality of care.
``(b) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2906. TOLL-FREE TELEPHONE NUMBER.
``The Secretary shall provide, through a toll-free number, for a
means by which limited English proficient individuals who are seeking
information about, or assistance with, Federal healthcare programs who
phone such toll-free number are transferred (without charge) to
appropriate translators for the provision of such information or
assistance.''.
SEC. 203. STANDARDS FOR LANGUAGE ACCESS SERVICES.
Not later than 120 days after the date of enactment of this Act,
the head of each Federal agency that carries out health care-related
activities shall develop and adopt a guidance on language services for
those with limited English proficiency who attempt to have access to or
participate in such activities that provides at the minimum the factors
and principles set forth in the Department of Justice guidance
published on June 12, 2002.
SEC. 204. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES UNDER THE MEDICARE, MEDICAID AND
STATE CHILDREN'S HEALTH INSURANCE PROGRAM.
(a) Demonstration Project Promoting Access for Medicare
Beneficiaries With Limited English Proficiency.--
(1) In General.--The Secretary shall conduct a
demonstration project (in this section referred to as the
`project') to demonstrate the impact on costs and health
outcomes of providing reimbursement for interpreter services to
certain medicare beneficiaries who are limited English
proficient in urban and rural areas.
(2) Scope.--The Secretary shall carry out the project in
not less than 30 States through contracts with up to--
(A) ten health plans (under part C of title XVIII
of the Social Security Act);
(B) ten small providers; and
(C) ten hospitals.
(3) Duration.--Each contract entered into under the project
shall extend over a period of not longer than 2 years.
(4) Report.--Upon completion of the project, the Secretary
shall submit a report to Congress on the project which shall
include recommendations regarding the extension of such project
to the entire medicare program.
(5) Evaluation.--The Director of the Agency for Healthcare
Research and Quality shall award grants to public and private
nonprofit entities for the evaluation of the project. Such
evaluations shall focus on access, utilization, efficiency,
cost-effectiveness, patient satisfaction, and select health
outcomes.
(b) Medicaid.--Section 1903(a)(3) of the Social Security Act (42
U.S.C. 1396b(a)(3)) is amended--
(1) in subparagraph (D), by striking ``plus'' at the end
and inserting ``and''; and
(2) by adding at the end the following:
``(E) 90 percent of the sums expended with respect
to costs incurred during such quarter as are
attributable to the provision of culturally and
linguistically appropriate services, including oral
interpretation, translations of written materials, and
other cultural and linguistic services for individuals
with limited English proficiency and disabilities who
apply for, or receive, medical assistance under the
State plan (including any waiver granted to the State
plan); plus''.
(c) SCHIP.--Section 2105(a)(1) of the Social Security Act (42
U.S.C.1397ee(a)), as amended by section 515, is amended--
(1) in the matter preceding subparagraph (A), by inserting
``or, in the case of expenditures described in subparagraph
(D)(iv), 90 percent'' after ``enhanced FMAP''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the
end;
(B) by redesignating clause (iv) as clause (v); and
(C) by inserting after clause (iii) the following:
``(iv) for expenditures attributable to the
provision of culturally and linguistically
appropriate services, including oral
interpretation, translations of written
materials, and other language services for
individuals with limited English proficiency
and disabilities who apply for, or receive,
child health assistance under the plan; and''.
(d) Effective Date.--The amendments made by this section take
effect on October 1, 2005.
SEC. 205. INCREASING UNDERSTANDING OF 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, shall award grants to
eligible entities to improve healthcare 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; 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 healthcare;
(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 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.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY AND
LINGUISTICALLY APPROPRIATE HEALTHCARE 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 have meaningful access to culturally and
linguistically appropriate healthcare services. Such report shall
include--
(1) a description and evaluation of the activities carried
out under this title; and
(2) a description of best practices, model programs,
guidelines, and other effective strategies for providing access
to culturally and linguistically appropriate healthcare
services.
SEC. 207. GENERAL ACCOUNTING OFFICE REPORT ON IMPACT OF LANGUAGE ACCESS
SERVICES.
Not later than 3 years after the date of enactment of this Act, the
Comptroller General of the United States shall examine, and prepare and
publish a report on, the impact of language access services on the
health and healthcare of limited English proficient populations. Such
report shall include--
(1) recommendations on the development and implementation
of policies and practices by healthcare organizations and
providers for limited English proficient patient populations;
(2) a description of the effect of providing language
access services on quality of healthcare and access to care;
and
(3) a description of the costs associated with or savings
related to provision of language access services.
TITLE III--HEALTH WORKFORCE DIVERSITY
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXIX of the Public Health Service Act, as added by section
202, is amended by adding at the end the following:
``Subtitle B--Workforce Diversity
``SEC. 2911. REPORT ON WORKFORCE DIVERSITY.
``(a) In General.--Not later than July 1, 2006, 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. 2912. 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), the grantee shall ensure that the group has
representation from the following entities:
``(1) The Health Resources and Services Administration.
``(2) The Department of Health and Human Services Data
Council.
``(3) The Bureau of Labor Statistics of the Department of
Labor.
``(4) The Public Health Practice Program Office--Office of
Workforce Policy and Planning.
``(5) The National Center on Minority Health and Health
Disparities.
``(6) The Agency for Healthcare Research and Quality.
``(7) The Institute of Medicine Study Committee for the
2004 workforce diversity report.
``(8) The Indian Health Service.
``(9) Academic institutions.
``(10) Consumer organizations.
``(11) Health professional associations, including those
that represent underrepresented minority populations.
``(12) Researchers in the area of health workforce.
``(13) Health workforce accreditation entities.
``(14) Private foundations that have sponsored workforce
diversity initiatives.
``(15) 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.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2913. TECHNICAL CLEARINGHOUSE FOR HEALTH WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Office of
Minority Health, and in collaboration with the Bureau of Health
Professions within the Health Resources and Services Administration,
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.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2914. EVALUATION OF WORKFORCE DIVERSITY INITIATIVES.
``(a) In General.--The Secretary, acting through the Bureau of
Health Professions within the Health Resources and Services
Administration, shall award grants to eligible entities for the conduct
of an evaluation of current health workforce diversity initiatives
funded by the Department of Health and Human Services.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) be a city, county, Indian tribe, State, territory,
community-based nonprofit organization, health center,
university, college, or other entity determined appropriate by
the Secretary;
``(2) with respect to an entity that is not an academic
medical center, university, or private research institution,
carry out activities under the grant in partnership with an
academic medical center, university, or private research
institution; and
``(3) 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 awarded under a grant under subsection
(a) shall be used to support the following evaluation activities:
``(1) Determinations of measures of health workforce
diversity success.
``(2) The short- and long-term tracking of participants in
health workforce diversity pipeline programs funded by the
Department of Health and Human Services.
``(3) Assessments of partnerships formed through activities
to increase health workforce diversity.
``(4) Assessments of barriers to health workforce
diversity.
``(5) Assessments of policy changes at the Federal, State,
and local levels.
``(6) Assessments of coordination within and between
Federal agencies and other institutions.
``(7) Other activities determined appropriate by the
Secretary and the Working Group established under section 2912.
``(d) Report.--Not later than 1 year after the date of enactment of
this title, the Bureau of Health Professions within the Health
Resources and Services Administration shall prepare and make available
for public comment a report that summarizes the findings made by
entities under grants under this section.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2915. DATA COLLECTION AND REPORTING BY HEALTH PROFESSIONAL
SCHOOLS.
``(a) In General.--The Secretary, acting through the Bureau of
Health Professions of the Health Resources and Services Administration
and the Office of Minority Health, shall establish an aggregated
database on health professional students.
``(b) Requirement To Collect Data.--Each health professional school
(including medical, dental, and nursing schools) and allied health
profession school and program that receives Federal funds shall collect
race, ethnicity, and language proficiency data concerning those
students enrolled at such schools or in such programs. In collecting
such data, a school or program shall--
``(1) at a minimum, use the categories for race and
ethnicity described in the 1997 Office of Management and Budget
Standards for Maintaining, Collecting, and Presenting Federal
Data on Race and Ethnicity and available language standards;
and
``(2) if practicable, collect data on additional population
groups if such data can be aggregated into the minimum race and
ethnicity data categories.
``(c) Use of Data.--Data on race, ethnicity, and primary language
collected under this section shall be reported to the database
established under subsection (a) on an annual basis. Such data shall be
available for public use.
``(d) Privacy.--The Secretary shall ensure that all data collected
under this section is protected from inappropriate internal and
external use by any entity that collects, stores, or receives the data
and that such data is collected without personally identifiable
information.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2916. SUPPORT FOR INSTITUTIONS COMMITTED TO WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, 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 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. 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) post-baccalaureate 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 and
Pacific Islander-serving institutions' means institutions--
``(1) that are eligible institutions under section 312(b)
of the Higher Education Act of 1965; and
``(2) that, at the time of their application, have an
enrollment of undergraduate students that is made up of at
least 10 percent Asian American and Pacific Islander students.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2917. 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 the Food and Drug
Administration, 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 minority health
issues or minority 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 minority health issues or
minority 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.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2918. 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 healthcare.
``(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;
and
``(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.
``(d) Definition.--In this section, the term `career in non-
research-related healthcare' means employment or intended employment in
the field of public health, health policy, health management, health
administration, medicine, nursing, pharmacy, allied health, community
health, or other fields determined appropriate by the Secretary, other
than in a position that involves research.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2919. 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 Director of the Office
of Minority Health and the Director of the National Center on Minority
Health and Health Disparities, shall award grants to eligible entities
to expand research on the link between health workforce diversity and
quality healthcare.
``(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; or
``(12) 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.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2920. HEALTH DISPARITIES EDUCATION PROGRAM.
``(a) Establishment.--The Secretary, acting through the National
Center on Minority Health and Health Disparities and in collaboration
with the Office of Minority Health, the Office for Civil Rights, the
Centers for Disease Control and Prevention, the Centers for Medicare
and Medicaid Services, the Health Resources and Services
Administration, and other appropriate public and private entities,
shall establish and coordinate a health and healthcare disparities
education program to support, develop, and implement educational
initiatives and outreach strategies that inform healthcare
professionals and the public about the existence of and methods to
reduce racial and ethnic disparities in health and healthcare.
``(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 healthcare,
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, Unequal Treatment;
``(2) disseminate new research findings to healthcare
providers and patients to assist them in understanding,
reducing, and eliminating health and healthcare disparities;
``(3) disseminate information about the impact of
linguistic and cultural barriers on healthcare 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, 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;
``(6) assess the impact of the programs established under
this section in raising awareness of health and healthcare
disparities and providing information on available resources.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2920A. CULTURAL COMPETENCE TRAINING FOR HEALTHCARE
PROFESSIONALS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, the Director of
the Office of Minority Health, and the Director of the National Center
for Minority Health and Health Disparities, shall award grants to
eligible entities to test, implement, and evaluate models of cultural
competence training for healthcare providers in coordination with the
initiative under section 2920A(a).
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be an academic medical center, a health center or
clinic, a hospital, a health plan, or a health system;
``(2) partner with a minority serving institution, minority
professional association, or community-based organization
representing minority populations, in addition to a research
institution to carry out activities under this grant; and
``(3) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
SEC. 302. HEALTH CAREERS OPPORTUNITY PROGRAM.
(a) Purpose.--It is the purpose of this section to diversify the
healthcare workforce by increasing the number of individuals from
disadvantaged backgrounds in the health and allied health professions
by enhancing the academic skills of students from disadvantaged
backgrounds and supporting them in successfully competing, entering,
and graduating from health professions training programs.
(b) Authorization of Appropriations.--Section 740(c) of the Public
Health Service Act (42 U.S.C. 293d(c)) is amended by striking
``$29,400,000'' and all that follows through ``2002'' and inserting
``$50,000,000 for fiscal year 2005, and such sums as may be necessary
for each of fiscal years 2006 through 2010''.
SEC. 303. PROGRAM OF EXCELLENCE IN HEALTH PROFESSIONS EDUCATION FOR
UNDERREPRESENTED MINORITIES.
(a) Purpose.--It is the purpose of this section to diversify the
healthcare workforce by supporting programs of excellence in designated
health professions schools that demonstrate a commitment to
underrepresented minority populations with a focus on minority health
issues, cultural and linguistic competence, and eliminating health
disparities.
(b) Authorization of Appropriation.--Section 737(h)(1) of the
Public Health Service Act (42 U.S.C. 293(h)(1)) is amended to read as
follows:
``(1) Authorization of appropriations.--For the purpose of
making grants under subsection (a), there are authorized to be
appropriated $50,000,000 for fiscal year 2005, and such sums as
may be necessary for each of the fiscal years 2006 through
2010.''.
SEC. 304. 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; and
``(5) has a significant number of graduates who are
providing health services to medically underserved populations
or to individuals in health professional shortage areas.''.
SEC. 305. HEALTH PROFESSIONS STUDENT LOAN FUND; AUTHORIZATIONS OF
APPROPRIATIONS REGARDING STUDENTS FROM DISADVANTAGED
BACKGROUNDS.
Section 724(f)(1) of the Public Health Service Act (42 U.S.C.
292t(f)(1)) is amended by striking ``$8,000,000'' and all that follows
and inserting ``$35,000,000 for fiscal year 2005, and such sums as may
be necessary for each of the fiscal years 2006 through 2010.''.
SEC. 306. NATIONAL HEALTH SERVICE CORPS; RECRUITMENT AND FELLOWSHIPS
FOR INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.
(a) In General.--Section 331(b) of the Public Health Service Act
(42 U.S.C. 254d(b)) is amended by adding at the end the following:
``(3) The Secretary shall ensure that the individuals with respect
to whom activities under paragraphs (1) and (2) are carried out include
individuals from disadvantaged backgrounds, including activities
carried out to provide health professions students with information on
the Scholarship and Repayment Programs.''.
(b) Assignment of Corps Personnel.--Section 333(a) of the Public
Health Service Act (42 U.S.C. 254f(a)) is amended by adding at the end
the following:
``(4) In assigning Corps personnel under this section, the
Secretary shall give preference to applicants who request assignment to
a federally qualified health center (as defined in section
1905(l)(2)(B) of the Social Security Act) or to a provider organization
that has a majority of patients who are minorities or individuals from
low-income families (families with a family income that is less than
200 percent of the Official Poverty Line).''.
SEC. 307. 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 2005, and such sums as may be
necessary for each of the fiscal years 2006 through 2010.''.
SEC. 308. 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 304, 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 Director of the Office of 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 is located in a medically
underserved community.
``(c) Requirements.--Awardees must design and implement an online
degree program, that meet the following restrictions:
``(1) Enrollment of individuals who have obtained a
secondary school diploma or its recognized equivalent.
``(2) Maintaining a significant enrollment of
underrepresented minority or disadvantaged students.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
SEC. 309. MID-CAREER HEALTH PROFESSIONS SCHOLARSHIP PROGRAM.
Part B of title VII of the Public Health Service Act (as amended by
section 308) is further amended by adding at the end the following:
``SEC. 744. MID-CAREER HEALTH PROFESSIONS SCHOLARSHIP PROGRAM.
``(a) In General.--The Secretary may make grants to eligible
schools for awarding scholarships to eligible individuals to attend the
school involved, for the purpose of enabling the individuals to make a
career change from a non-health profession to a health profession.
``(b) Expenses.--Amounts awarded as a scholarship under this
section may be expended only for tuition expenses, other reasonable
educational expenses, and reasonable living expenses incurred in the
attendance of the school involved.
``(c) Definitions.--In this section:
``(1) Eligible school.--The term `eligible school' means a
school of medicine, osteopathic medicine, dentistry, nursing
(as defined in section 801), pharmacy, podiatric medicine,
optometry, veterinary medicine, public health, chiropractic, or
allied health, a school offering a graduate program in
behavioral and mental health practice, or an entity providing
programs for the training of physician assistants.
``(2) Eligible individual.--The term `eligible individual'
means an individual who has obtained a secondary school diploma
or its recognized equivalent.
``(d) Priority.--In providing scholarships to eligible individuals,
eligible schools shall give to individuals from disadvantaged
backgrounds.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
SEC. 310. NATIONAL REPORT ON THE PREPAREDNESS OF HEALTH PROFESSIONALS
TO CARE FOR DIVERSE POPULATIONS.
The Secretary of Health and Human Services shall include in the
report prepared under section 1707(c) of the Public Health Service Act
(as added by section 603 of this Act), information relating to the
preparedness of health professionals to care for racially and
ethnically diverse populations. Such information, which shall be
collected by the Bureau of Health Professions, shall include--
(1) with respect to health professions education, the
number and percentage of hours of classroom discussion relating
to minority health issues, including cultural competence;
(2) a description of the coursework involved in such
education;
(3) a description of the results of an evaluation of the
preparedness of students in such education;
(4) a description of the types of exposure that students
have during their education to minority patient populations;
and
(5) a description of model programs and practices.
SEC. 311. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.
Subtitle B of title XXIX of the Public Health Service Act, as
amended by section 301, is further amended by adding at the end the
following:
``SEC. 2920B. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.
``(a) In General.--The Administrator of the Health Resources and
Services Administration and Director of the Centers for Disease Control
and Prevention, in collaboration with the Director of the Office of
Minority Health, shall award grants to eligible entities to increase
awareness among post-primary and post-secondary 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 non-profit 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) 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 post-secondary level.
``(f) 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).
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2920C. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, in collaboration with the Director of the Office of
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).
``(f) Requirements.--To be eligible to receive assistance under
this section an individual shall--
``(1) have at minimum a grade point average of 2.75 at the
time of entry to an entity described in subsection (d)(2) and
maintain such 2.75 average or above throughout their tenure at
such institutions;
``(2) receive academic instruction that prepares the
individual to enter the field of public health;
``(3) gain experience in public health through working at
non-profit, community-based health facilities or at Federal,
State, or local governmental healthcare institutions; and
``(4) meet at minimum twice a month with the identified
health professions mentor.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2920D. 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 Director of the Office of
Minority Health, the Administrator of the Substance Abuse and Mental
Health Services Administration, and the Director of the Indian Health
Services, 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).
``(f) Requirements.--To be eligible to receive assistance under
this section, an individual shall--
``(1) maintain a minimum a grade point average of 2.75 at
the time of entry to an entity described in subsection (b)(5)
and maintain a grade point average of 3.25 or above throughout
their tenure at such institution;
``(2) undergo academic instruction to assist in completion
of the health professions or graduate degree; and
``(3) attend twice-monthly meetings with an academic
advisor throughout the tenure of the fellowship.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2920E. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP
PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, in collaboration with the Director of the Office
of 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 healthcare 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
healthcare 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).
``(f) Requirements.--To be eligible to receive assistance under
this section, an individual shall--
``(1) maintain a minimum grade point average of 2.75 at the
time of application; and
``(2) undergo academic instruction in global health, and
issues relating to access and quality of healthcare;
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2920F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, the Director of the Centers for Medicaid and
Medicare, and the Administrator for Health Resources and Services
Administration, in collaboration with the Director of the Office of
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 non-profit 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) healthcare and pharmaceutical policy;
``(3) healthcare 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 post-secondary 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).
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
TITLE IV--REDUCING DISEASE AND DISEASE-RELATED COMPLICATIONS
Subtitle A--Eliminating Disparities in Prevention, Detection, and
Treatment of Disease
CHAPTER 1--GENERAL PROVISIONS
SEC. 401. 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) healthcare researchers and providers, including those
with expertise in minority health;
(4) Federal health agencies, including the Office of
Minority Health 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 under subsection (a) for--
(1) hypertension;
(2) hypercholesterolemia;
(3) diabetes;
(4) cardiovascular disease;
(5) prostate cancer;
(6) breast cancer;
(7) colon cancer;
(8) kidney disease;
(9) glaucoma; and
(10) 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
healthcare provider organizations the guidelines developed under
subsection (a).
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, sums as may be necessary for
each of fiscal years 2005 through 2010.
SEC. 402. PREVENTIVE HEALTH SERVICES BLOCK GRANTS, USE OF ALLOTMENTS.
Section 1904(a)(1) of the Public Health Service Act (42 U.S.C.
300w-3(a)(1)) is amended--
(1) in subparagraph (G)--
(A) by striking ``through (F)'' and inserting
``through (G)''; and
(B) by redesignating such subparagraph as
subparagraph (H); and
(2) by inserting after subparagraph (F), the following:
``(G) Community outreach and education programs and other
activities designed to address and prevent minority health
conditions (as defined in section 485E(c)(2)).''.
SEC. 403. PROGRAM FOR INCREASING IMMUNIZATION RATES FOR ADULTS AND
ADOLESCENTS; COLLECTION OF ADDITIONAL IMMUNIZATION DATA.
(a) Activities of Centers for Disease Control and Prevention.--
Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j)) is
amended by adding at the end the following paragraphs:
``(3)(A) For the purpose of carrying out activities toward
increasing immunization rates for adults and adolescents through the
immunization program under this subsection, and for the purpose of
carrying out subsection (k)(2), there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2004 through
2010. Such authorization is in addition to amounts available under
paragraphs (1) and (2) for such purposes.
``(B) In expending amounts appropriated under subparagraph (A), the
Secretary shall give priority to adults and adolescents who are
medically underserved and are at risk for vaccine-preventable diseases,
including as appropriate populations identified through projects under
subsection (k)(2)(E).
``(C) The purposes for which amounts appropriated under
subparagraph (A) are available include (with respect to immunizations
for adults and adolescents) payment of the costs of storing vaccines,
outreach activities to inform individuals of the availability of the
immunizations, and other program expenses necessary for the
establishment or operation of immunization programs carried out or
supported by States or other public entities pursuant to this
subsection.
``(4) The Secretary shall annually submit to the Congress a report
that--
``(A) evaluates the extent to which the immunization system
in the United States has been effective in providing for
adequate immunization rates for adults and adolescents, taking
into account the applicable year 2010 health objectives
established by the Secretary regarding the health status of the
people of the United States; and
``(B) describes any issues identified by the Secretary that
may affect such rates.
``(5) In carrying out this subsection and paragraphs (1) and (2) of
subsection (k), the Secretary shall consider recommendations regarding
immunizations that are made in reports issued by the Institute of
Medicine.''.
(b) Research, Demonstrations, and Education.--Section 317(k) of the
Public Health Service Act (42 U.S.C. 247b(k)) is amended--
(1) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(2) by inserting after paragraph (1) the following
paragraph:
``(2) The Secretary, directly and through grants under
paragraph (1), shall provide for a program of research,
demonstration projects, and education in accordance with the
following:
``(A) The Secretary shall coordinate with public
and private entities (including nonprofit private
entities), and develop and disseminate guidelines,
toward the goal of ensuring that immunizations are
routinely offered to adults and adolescents by public
and private health care providers.
``(B) The Secretary shall cooperate with public and
private entities to obtain information for the annual
evaluations required in subsection (j)(4)(A).
``(C) The Secretary shall (relative to fiscal year
2001) increase the extent to which the Secretary
collects data on the incidence, prevalence, and
circumstances of diseases and adverse events that are
experienced by adults and adolescents and may be
associated with immunizations, including collecting
data in cooperation with commercial laboratories.
``(D) The Secretary shall ensure that the entities
with which the Secretary cooperates for purposes of
subparagraphs (A) through (C) include managed care
organizations, community based organizations that
provide health services, and other health care
providers.
``(E) The Secretary shall provide for projects to
identify racial and ethnic minority groups and other
health disparity populations for which immunization
rates for adults and adolescents are below such rates
for the general population, and to determine the
factors underlying such disparities.''.
SEC. 404. INNOVATIVE CHRONIC DISEASE MANAGEMENT PROGRAMS.
(a) In General.--The Secretary, acting in coordination with the
Administrator of the Centers for Medicare and Medicaid Services, the
Administrator of the Health Resources and Services Administration, the
Director of the National Institutes of Health, the Director of the
Centers for Disease Control and Prevention, and the Director of the
Office of Minority Health, shall award grants to eligible entities for
the identification, implementation, and evaluation of programs for
patients with chronic disease.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
(1) be a health center or clinic, public health department,
health plan, hospital, health system, community-based or non-
profit organization, or other health entity determined
appropriate by the Secretary; 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.--An entity shall use amounts received under a
grant under subsection (a) to identify, implement, and evaluate chronic
disease management programs that are tailored for racially and
ethnically diverse populations. In carrying out such activities, an
entity shall focus on--
(1) self-management training;
(2) patient empowerment;
(3) group visits;
(4) community health workers;
(5) case management;
(6) work- and school-based interventions;
(7) home visitation; or
(8) other activities determined appropriate by the
Secretary.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2004 through 2010.
SEC. 405. 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 healthcare experienced by
racial and ethnic minority individuals.
(b) Authority To Award Grants.--The Secretary, acting through the
Centers for Disease Control and Prevention and the Office of Minority
Health, shall award planning, implementation, and evaluation grants to
eligible entities to assist in designing, implementing, and evaluating
culturally and linguistically appropriate, science-based, and
community-driven strategies to eliminate racial and ethnic health and
healthcare 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 healthcare disparity in a targeted racial or ethnic
minority group in the community served by the
coalition; and
(B) that includes--
(i) at least 3 members selected from
among--
(I) public health departments;
(II) community-based organizations;
(III) university and/or research
organizations;
(IV) Indian tribal organizations or
national Indian organizations;
(V) Papa Ola Lokahi; and
(VI) interested public or private
sector healthcare providers or
organizations;
(ii) at least 1 member that is from a
community-based organization that represents
the targeted racial or ethnic minority group;
and
(iii) at least 1 member that is a National
Center for Minority Health and Health
Disparities Center of Excellence (unless such a
Center does not exist within the community
involved, declines or refuses to participate,
or the coalition demonstrates to the Secretary
that such participation would not further the
goals of the program or would be unduly
burdensome); and
(2) submit to the Secretary an application, at such time,
in such manner, and containing such information as the
Secretary may require, including--
(A) a description of the targeted racial or ethnic
population 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
population; and
(C) a demonstration of the proven record of
accomplishment of the coalition members in serving and
working with the targeted community.
(d) Planning Grants.--
(1) In general.--The Secretary shall award grants to
eligible entities described in subsection (c) to support the
planning and development of culturally and linguistically
appropriate programs that utilize science-based and community-
driven strategies to reduce or eliminate a health or healthcare
disparity in the targeted population. Such grants may be used
to--
(A) expand the coalition that is represented by the
entity through the identification of additional
partners, particularly among the targeted community,
and establish linkages with national and State public
and private partners;
(B) establish community working groups;
(C) conduct a needs assessment for the targeted
population in the area of the health disparity using
input from the targeted community;
(D) participate in workshops sponsored by the
Office of Minority Health or the Centers for Disease
Control and Prevention for technical assistance,
planning, evaluation, and other programmatic issues;
(E) identify promising intervention strategies; and
(F) develop a plan with the input of the targeted
community that includes strategies for--
(i) implementing intervention strategies
that have the most promising potential for
reducing the health disparity in the target
population;
(ii) identifying other sources of revenue
and integrating current and proposed funding
sources to ensure long-term sustainability of
the program; and
(iii) evaluating the program, including
collecting data and measuring progress toward
reducing or eliminating the health disparity in
the targeted population that takes into account
the evaluation model developed by the Centers
for Disease Control and Prevention in
collaboration with the Office of Minority
Health.
(2) Duration.--The period during which payments may be made
under a grant under paragraph (1) shall not exceed 1 year,
except where the Secretary determines that extraordinary
circumstances exist as described in section 340(c)(3) of the
Public Health Service Act.
(e) Implementation Grants.--
(1) In general.--The Secretary shall award grants to
eligible entities that have received a planning grant under
subsection (d) to enable such entity to--
(A) implement a plan to address the selected health
disparity for the target population, in an effective
and timely manner;
(B) collect data appropriate for monitoring and
evaluating the program carried out under the grant;
(C) analyze and interpret data, or collaborate with
academic or other appropriate institutions, for such
analysis and collection;
(D) participate in conferences and workshops for
the purpose of informing and educating others regarding
the experiences and lessons learned from the project;
(E) collaborate with appropriate partners to
publish the results of the project for the benefit of
the public health community;
(F) establish mechanisms with other public or
private groups to maintain financial support for the
program after the grant terminates; and
(G) maintain relationships with local partners and
continue to develop new relationships with State and
national partners.
(2) Duration.--The period during which payments may be made
under a grant under paragraph (1) shall not exceed 4 years.
Such payments shall be subject to annual approval by the
Secretary and to the availability of appropriations for the
fiscal year involved.
(f) Evaluation Grants.--
(1) In general.--The Secretary shall award grants to
eligible entities that have received an implementation grant
under subsection (e) that require additional assistance for the
purpose of rigorous data analysis, program evaluation
(including process and outcome measures), or dissemination of
findings.
(2) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to--
(A) entities that in previous funding cycles--
(i) have received a planning grant under
subsection (d); and
(ii) implemented activities of the type
described in subsection (e)(1);
(B) entities that fulfilled the goals of their
planning grant under subsection (d) in an especially
timely manner;
(C) entities that incorporate best practices or
build on successful models in their action plan,
including the use of community health workers; and
(D) entities that would enable the Secretary to
provide for an equitable distribution of such grants
among the 5 categories for race and ethnicity described
in the 1997 Office of Management and Budget Standards
for Maintaining, Collecting, and Presenting Federal
Data on Race and Ethnicity.
(g) Maintenance of Effort.--The Secretary may not award a grant to
an eligible entity under this section unless 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.
(h) 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.
(i) Administrative Burdens.--The Secretary shall make every effort
to minimize duplicative or unnecessary administrative burdens on
grantees in the process of applying for grants under subsection (d),
(e), or (f).
(j) Report.--Not later than September 30, 2007, the Secretary shall
publish a report that describes the extent to which the activities
funded under this section have been successful in reducing and
eliminating disparities in health and healthcare in targeted
populations, and provides examples of best practices or model programs
funded under this section.
(k) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out this section
for each of fiscal years 2005 through 2010.
SEC. 406. IOM STUDY REQUEST.
(a) In General.--The Secretary of Health and Human Services shall
request that the Institute of Medicine conduct, or contract with
another entity to conduct, a study to investigate promising strategies
for improving minority health and reducing and eliminating racial and
ethnic disparities in health and healthcare.
(b) Content.--The study under subsection (a) shall--
(1) identify key stakeholders for intervention in the
public and private sector;
(2) identify the barriers to eliminating racial and ethnic
disparities in health and healthcare;
(3) explore approaches for addressing disparities in health
and healthcare using a quality improvement framework;
(4) suggest an evaluation and research agenda that will
advance effective strategies for reducing and eliminating
racial and ethnic disparities in health and healthcare; and
(5) assess the capacity of the Department of Health and
Human Services, as currently structured, to implement and
evaluate promising strategies to improve minority health and
reduce and eliminate racial and ethnic disparities in health
and healthcare.
(c) Agenda.--The agenda described in subsection (b)(4) shall
include a focus on the following:
(1) Observational studies of race-discordant and race-
concordant physician-patient clinical encounters.
(2) Studies of the behaviors and expressed attitudes toward
race and ethnicity during education and training of health
professionals.
(3) Expansion of prospective studies of disparities in
care, combining clinical data with qualitative interviews with
patients and providers.
(4) Studies of the natural history of social categorization
in medical education and practice.
(5) Studies of the effectiveness of standard clinical
guidelines in reducing disparities across disease categories.
(6) Exploration of health system characteristics that may
contribute to or mitigate disparities in health care.
(7) Evaluation of cultural competency programs and their
impact on the attitudes, knowledge, skills, and behaviors of
healthcare providers.
(8) Expansion of community-participatory research with a
focus on such topics as increasing trust and patient
empowerment.
(9) Studies on appropriate indicators of socio-economic
status, and methods for incorporating such indicators in
patient records.
(10) Interventional studies designed to eliminate
disparities.
(d) Report.--Not later than 24 months after the date of enactment
of this Act, the Secretary of Health and Human Services shall submit to
the appropriate committees of Congress a report containing the results
of the study conducted under subsection (a).
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 and 2006.
SEC. 407. STRATEGIC PLAN.
(a) In General.--The Secretary, acting through the Administrator of
the Substance Abuse and Mental Health Services Administration, shall
formulate a strategic plan for implementing the 2001 report by the
Surgeon General of the Public Health Service entitled `Mental Health:
Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report
of the Surgeon General' and the 2003 report by the President's New
Freedom Commission on Mental Health entitled `Achieving the Promise:
Transforming Mental Health Care in America'.
(b) Submission.--Not later than 6 months after the date of the
enactment of this title, the Secretary shall submit to the Congress the
strategic plan formulated under this section.
CHAPTER 2--ENVIRONMENTAL JUSTICE
SEC. 410. SHORT TITLE; PURPOSES.
(a) Short Title.--This chapter may be cited as the ``Environmental
Justice Act of 2003''.
(b) Purposes.--The purposes of this chapter are--
(1) to ensure that all Federal health agencies develop
practices that promote environmental justice;
(2) to provide minority, low-income, and Native American
communities greater access to public information and
opportunity for participation in decisionmaking affecting human
health and the environment; and
(3) to mitigate the inequitable distribution of the burdens
and benefits of Federal programs having significant impact on
human health and the environment.
SEC. 411. DEFINITIONS.
For purposes of this chapter:
(1) Environmental justice.--
(A) In general.--The term ``environmental justice''
means the fair treatment of people of all races,
cultures, and socioeconomic groups with respect to the
development, adoption, implementation, and enforcement
of laws, regulations, and policies affecting the
environment.
(B) Fair treatment.--The term ``fair treatment''
means policies and practices that will minimize the
likelihood that a minority, low-income, or Native
American community will bear a disproportionate share
of the adverse environmental consequences, or be denied
reasonable access to the environmental benefits,
resulting from implementation of a Federal program or
policy.
(2) Federal agency.--The term ``Federal agency'' means--
(A) each Federal entity represented on the Working
Group;
(B) any other entity that conducts any Federal
program or activity that substantially affects human
health or the environment; and
(C) each Federal agency that implements any
program, policy, or activity applicable to Native
Americans.
(3) Working group.--The term ``Working Group'' means the
interagency working group established by section 413.
(4) Advisory committee.--The term ``the Advisory
Committee'' means the advisory committee established by section
415.
SEC. 412. ENVIRONMENTAL JUSTICE RESPONSIBILITIES OF FEDERAL AGENCIES.
(a) Environmental Justice Mission.--To the greatest extent
practicable, the head of each Federal agency shall make achieving
environmental justice part of its mission by identifying and
addressing, as appropriate, disproportionately high and adverse human
health or environmental effects of its programs, policies, and
activities on minority and low-income populations in the United States
and its territories and possessions, including the District of
Columbia, the Commonwealth of Puerto Rico, Virgin Islands, Guam, and
the Commonwealth of the Mariana Islands.
(b) Nondiscrimination.--Each Federal agency shall conduct its
programs, policies, and activities in a manner that ensures that such
programs, policies, and activities do not have the effect of excluding
any person or group from participation in, denying any person or group
the benefits of, or subjecting any person or group to discrimination
under, such programs, policies, and activities, because of race, color,
national origin, or income.
SEC. 413. INTERAGENCY ENVIRONMENTAL JUSTICE WORKING GROUP.
(a) Creation and Composition.--There is hereby established the
Interagency Working Group on Environmental Justice, comprising the
heads of the following executive agencies and offices, or their
designees:
(1) The Department of Defense.
(2) The Department of Health and Human Services.
(3) The Department of Housing and Urban Development.
(4) The Department of Homeland Security.
(5) The Department of Labor.
(6) The Department of Agriculture.
(7) The Department of Transportation.
(8) The Department of Justice;
(9) The Department of the Interior.
(10) The Department of Commerce.
(11) The Department of Energy.
(12) The Environmental Protection Agency.
(13) The Office of Management and Budget.
(14) Any other official of the United States that the
President may designate.
(b) Functions.--The Working Group shall--
(1) provide guidance to Federal agencies on criteria for
identifying disproportionately high and adverse human health or
environmental effects on minority, low-income, and Native
American populations;
(2) coordinate with, provide guidance to, and serve as a
clearinghouse for, each Federal agency as it develops or
revises an environmental justice strategy as required by this
chapter, in order to ensure that the administration,
interpretation and enforcement of programs, activities, and
policies are undertaken in a consistent manner;
(3) assist in coordinating research by, and stimulating
cooperation among, the Environmental Protection Agency, the
Department of Health and Human Services, the Department of
Housing and Urban Development, and other Federal agencies
conducting research or other activities in accordance with
section 7;
(4) assist in coordinating data collection, maintenance,
and analysis required by this chapter;
(5) examine existing data and studies on environmental
justice;
(6) hold public meetings and otherwise solicit public
participation and consider complaints as required under
subsection (c);
(7) develop interagency model projects on environmental
justice that evidence cooperation among Federal agencies; and
(8) in coordination with the Department of the Interior and
after consultation with tribal leaders, coordinate steps to be
taken pursuant to this chapter that affect or involve
federally-recognized Indian Tribes.
(c) Public Participation.--The Working Group shall--
(1) hold public meetings and otherwise solicit public
participation, as appropriate, for the purpose of fact-finding
with regard to implementation of this chapter, and prepare for
public review a summary of the comments and recommendations
provided; and
(2) receive, consider, and in appropriate instances conduct
inquiries concerning complaints regarding environmental justice
and the implementation of this chapter by Federal agencies.
(d) Annual Reports.--
(1) In general.--Each fiscal year following enactment of
this Act, the Working Group shall submit to the President,
through the Office of the Deputy Assistant to the President for
Environmental Policy and the Office of the Assistant to the
President for Domestic Policy, a report that describes the
implementation of this chapter, including, but not limited to,
a report of the final environmental justice strategies
described in section 6 of this chapter and annual progress made
in implementing those strategies.
(2) Copy of report.--The President shall transmit to the
Speaker of the House of Representatives and the President of
the Senate a copy of each report submitted to the President
pursuant to paragraph (1).
(e) Conforming Change.--The Interagency Working Group on
Environmental Justice established under Executive Order No. 12898,
dated February 11, 1994, is abolished.
SEC. 414. FEDERAL AGENCY STRATEGIES.
(a) Agency-Wide Strategies.--Each Federal agency shall develop an
agency-wide environmental justice strategy that identifies and
addresses disproportionally high and adverse human health or
environmental effects or disproportionally low benefits of its
programs, policies, and activities with respect to minority, low-
income, and Native American populations.
(b) Revisions.--Each strategy developed pursuant to subsection (a)
shall identify programs, policies, planning, and public participation
processes, rulemaking, and enforcement activities related to human
health or the environment that should be revised to--
(1) promote enforcement of all health and environmental
statutes in areas with minority, low-income, or Native American
populations;
(2) ensure greater public participation;
(3) improve research and data collection relating to the
health of and environment of minority, low-income, and Native
American populations; and
(4) identify differential patterns of use of natural
resources among minority, low-income, and Native American
populations.
(c) Timetables.--Each strategy developed pursuant to subsection (a)
shall include, where appropriate, a timetable for undertaking revisions
identified pursuant to subsection (b).
SEC. 415. FEDERAL ENVIRONMENTAL JUSTICE ADVISORY COMMITTEE.
(a) Establishment.--There is established a committee to be known as
the ``Federal Environmental Justice Advisory Committee''.
(b) Duties.--The Advisory Committee shall provide independent
advice and recommendations to the Environmental Protection Agency and
the Working Group on areas relating to environmental justice, which may
include any of the following:
(1) Advice on Federal agencies' framework development for
integrating socioeconomic programs into strategic planning,
annual planning, and management accountability for achieving
environmental justice results agency-wide.
(2) Advice on measuring and evaluating agencies' progress,
quality, and adequacy in planning, developing, and implementing
environmental justice strategies, projects, and programs.
(3) Advice on agencies' existing and future information
management systems, technologies, and data collection, and the
conduct of analyses that support and strengthen environmental
justice programs in administrative and scientific areas.
(4) Advice to help develop, facilitate, and conduct reviews
of the direction, criteria, scope, and adequacy of the Federal
agencies' scientific research and demonstration projects
relating to environmental justice.
(5) Advice for improving how the Environmental Protection
Agency and others participate, cooperate, and communicate
within that agency and between other Federal agencies, State or
local governments, federally recognized Tribes, environmental
justice leaders, interest groups, and the public.
(6) Advice regarding the Environmental Protection Agency's
administration of grant programs relating to environmental
justice assistance (not to include the review or
recommendations of individual grant proposals or awards).
(7) Advice regarding agencies' awareness, education,
training, and other outreach activities involving environmental
justice.
(c) Advisory Committee.--The Advisory Committee shall be considered
an advisory committee within the meaning of the Federal Advisory
Committee Act (5 U.S.C. App.).
(d) Membership.--
(1) In general.--The Advisory Committee shall be composed
of 21 members to be appointed in accordance with paragraph (2).
Members shall include representatives of--
(A) community-based groups;
(B) industry and business;
(C) academic and educational institutions;
(D) minority health organizations;
(E) State and local governments, federally
recognized tribes, and indigenous groups; and
(F) nongovernmental and environmental groups.
(2) Appointments.--Of the members of the Advisory
Committee--
(A) five members shall be appointed by the majority
leader of the Senate;
(B) five members shall be appointed by the minority
leader of the Senate;
(C) five members shall be appointed by the Speaker
of the House of Representatives;
(D) five members shall be appointed by the minority
leader of the House of Representatives; and
(E) one member to be appointed by the President.
(e) Meetings.--The Advisory Committee shall meet at least twice
annually. Meetings shall occur as needed and approved by the Director
of the Office of Environmental Justice of the Environmental Protection
Agency, who shall serve as the officer required to be appointed under
section 10(e) of the Federal Advisory Committee Act (5 U.S.C. App.)
with respect to the Committee (in this subsection referred to as the
``Designated Federal Officer''). The Administrator of the Environmental
Protection Agency may pay travel and per diem expenses of members of
the Advisory Committee when determined necessary and appropriate. The
Designated Federal Officer or a designee of such Officer shall be
present at all meetings, and each meeting will be conducted in
accordance with an agenda approved in advance by such Officer. The
Designated Federal Officer may adjourn any meeting when the Designated
Federal Officer determines it is in the public interest to do so. As
required by the Federal Advisory Committee Act, meetings of the
Advisory Committee shall be open to the public unless the President
determines that a meeting or a portion of a meeting may be closed to
the public in accordance with subsection (c) of section 552b of title
5, United States Code. Unless a meeting or portion thereof is closed to
the public, the Designated Federal Officer shall provide an opportunity
for interested persons to file comments before or after such meeting or
to make statements to the extent that time permits.
(f) Duration.--The Advisory Committee shall remain in existence
until otherwise provided by law.
SEC. 416. HUMAN HEALTH AND ENVIRONMENTAL RESEARCH, DATA COLLECTION AND
ANALYSIS.
(a) Disproportionate Impact.--To the extent permitted by other
applicable law, including section 552a of title 5, United States Code,
popularly known as the Privacy Act of 1974, the Administrator of the
Environmental Protection Agency, or the head of such other Federal
agency as the President may direct, shall collect, maintain, and
analyze information assessing and comparing environmental and human
health risks borne by populations identified by race, national origin,
or income. To the extent practical and appropriate, Federal agencies
shall use this information to determine whether their programs,
policies, and activities have disproportionally high and adverse human
health or environmental effects on, or disproportionally low benefits
for, minority, low-income, and Native American populations.
(b) Information Related to Non-Federal Facilities.--In connection
with the development and implementation of agency strategies in section
4, the Administrator of the Environmental Protection Agency, or the
head of such other Federal agency as the President may direct, shall
collect, maintain, and analyze information on the race, national
origin, and income level, and other readily accessible and appropriate
information, for areas surrounding facilities or sites expected to have
a substantial environmental, human health, or economic effect on the
surrounding populations, if such facilities or sites become the subject
of a substantial Federal environmental administrative or judicial
action.
(c) Impact From Federal Facilities.--The Administrator of the
Environmental Protection Agency, or the head of such other Federal
agency as the President may direct, shall collect, maintain, and
analyze information on the race, national origin, and income level, and
other readily accessible and appropriate information, for areas
surrounding Federal facilities that are--
(1) subject to the reporting requirements under the
Emergency Planning and Community Right-to-Know Act (42 U.S.C.
11001 et seq.) as mandated in Executive Order No. 12856; and
(2) expected to have a substantial environmental, human
health, or economic effect on surrounding populations.
(d) Information Sharing.--
(1) In general.--In carrying out the responsibilities in
this section, each Federal agency, to the extent practicable
and appropriate, shall share information and eliminate
unnecessary duplication of efforts through the use of existing
data systems and cooperative agreements among Federal agencies
and with State, local, and tribal governments.
(2) Public availability.--Except as prohibited by other
applicable law, information collected or maintained pursuant to
this section shall be made available to the public.
(e) Public Comment.--Federal agencies shall provide minority, low-
income, and Native American populations the opportunity to participate
in the development, design, and conduct of activities undertaken
pursuant to this section.
CHAPTER 3--BORDER HEALTH
SEC. 421. SHORT TITLE.
This chapter may be cited as the ``Border Health Security Act of
2003''.
SEC. 422. DEFINITIONS.
In this chapter:
(1) Border area.--The term ``border area'' has the meaning
given the term ``United States-Mexico Border Area'' in section
8 of the United States-Mexico Border Health Commission Act (22
U.S.C. 290n-6).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
SEC. 423. 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.--From funds appropriated under subsection (f),
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) behavioral and mental 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) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $200,000,000 for fiscal year
2005, and such sums as may be necessary for each succeeding fiscal
year.
SEC. 424. UNITED STATES-MEXICO BORDER HEALTH COMMISSION ACT AMENDMENTS.
The United States-Mexico Border Health Commission Act (22 U.S.C.
290n et seq.) is amended by adding at the end the following:
``SEC. 9. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated to carry out this Act
$10,000,000 for fiscal year 2005 and such sums as may be necessary for
each succeeding fiscal year.''.
CHAPTER 4--PATIENT NAVIGATOR, OUTREACH, AND CHRONIC DISEASE PREVENTION
SEC. 425. SHORT TITLE.
This chapter may be cited as the ``Patient Navigator, Outreach, and
Chronic Disease Prevention Act of 2003''.
SEC. 426. HRSA GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE
CARE AND PREVENTION; HRSA GRANTS FOR PATIENT NAVIGATORS.
Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by adding at the end the following:
``SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE AND
PREVENTION; PATIENT NAVIGATORS.
``(a) Model Community Cancer and Chronic Disease Care and
Prevention.--
``(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may make grants to public and nonprofit private
health centers (including health centers under section 330,
Indian Health Service Centers, tribal governments, urban Indian
organizations, tribal organizations, clinics serving Asian
Americans and Pacific Islanders and Alaska Natives, and rural
health clinics and qualified nonprofit entities that partner
with one or more centers providing healthcare to provide
navigation services, which demonstrate the ability to perform
all of the functions outlined in this subsection and
subsections (b) and (c)) for the development and operation of
model programs that--
``(A) provide to individuals of health disparity
populations prevention, early detection, treatment, and
appropriate follow-up care services for cancer and
chronic diseases;
``(B) ensure that the health services are provided
to such individuals in a culturally competent manner;
``(C) assign patient navigators, in accordance with
applicable criteria of the Secretary, for managing the
care of individuals of health disparity populations
to--
``(i) accomplish, to the extent possible,
the follow-up and diagnosis of an abnormal
finding and the treatment and appropriate
follow-up care of cancer or other chronic
disease; and
``(ii) facilitate access to appropriate
healthcare services within the healthcare
system to ensure optimal patient utilization of
such services, including aid in coordinating
and scheduling appointments and referrals,
community outreach, assistance with
transportation arrangements, and assistance
with insurance issues and other barriers to
care and providing information about clinical
trials;
``(D) require training for patient navigators
employed through such model programs to ensure the
ability of navigators to perform all of the duties
required in this subsection and in subsection (b),
including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(E) ensure that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the program is serving,
about the services of the model program under the grant. Such
activities shall include facilitating access to appropriate
healthcare services and patient navigators within the
healthcare system to ensure optimal patient utilization of
these services.
``(3) Data collection and report.--In order to allow for
effective program evaluation, the grantee shall collect
specific patient data recording services provided to each
patient served by the program and shall establish and implement
procedures and protocols, consistent with applicable Federal
and State laws (including 45 C.F.R. 160 and 164) to ensure the
confidentiality of all information shared by a participant in
the program, or their personal representative and their
healthcare providers, group health plans, or health insurance
insurers with the program. The program may, consistent with
applicable Federal and State confidentiality laws, collect, use
or disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Application for grant.--A grant may be made under
paragraph (1) 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.
``(5) Evaluations.--
``(A) In general.--The Secretary, acting through
the Administrator of the Health Resources and Services
Administration, shall, directly or through grants or
contracts, provide for evaluations to determine which
outreach activities under paragraph (2) were most
effective in informing the public and the specific
community that the program is serving, about the model
program services and to determine the extent to which
such programs were effective in providing culturally
competent services to the health disparity population
served by the programs.
``(B) Dissemination of findings.--The Secretary
shall as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
``(6) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (b), with the program under section
417D, and to the extent practicable, with programs for
prevention centers that are carried out by the Director of the
Centers for Disease Control and Prevention.
``(b) Program for Patient Navigators.--
``(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may make grants to public and nonprofit private
health centers (including health centers under section 330,
Indian Health Service Centers, tribal governments, urban Indian
organizations, tribal organizations, clinics serving Asian
Americans and Pacific Islanders and Alaska Natives, and rural
health clinics and qualified nonprofit entities that partner
with one or more centers providing healthcare to provide
navigation services, which demonstrate the ability to perform
all of the functions outlined in this subsection and
subsections (a) and (c)) for the development and operation of
programs to pay the costs of such health centers in--
``(A) assigning patient navigators, in accordance
with applicable criteria of the Secretary, for managing
the care of individuals of health disparity populations
for the duration of receiving health services from the
health centers, including aid in coordinating and
scheduling appointments and referrals, community
outreach, assistance with transportation arrangements,
and assistance with insurance issues and other barriers
to care and providing information about clinical
trials;
``(B) ensuring that the services provided by the
patient navigators to such individuals include case
management and psychosocial assessment and care or
information and referral to such services;
``(C) ensuring that patient navigators with direct
knowledge of the communities they serve provide
services to such individuals in a culturally competent
manner;
``(D) developing model practices for patient
navigators, including with respect to--
``(i) coordination of health services,
including psychosocial assessment and care;
``(ii) appropriate follow-up care,
including psychosocial assessment and care;
``(iii) determining coverage under health
insurance and health plans for all services;
``(iv) ensuring the initiation,
continuation and/or sustained access to care
prescribed by the patients' healthcare
providers; and
``(v) aiding patients with health insurance
coverage issues;
``(E) requiring training for patient navigators to
ensure the ability of navigators to perform all of the
duties required in this subsection and in subsection
(a), including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(F) ensuring that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the patient navigator is
serving of the services of the model program under the grant.
``(3) Data collection and report.--In order to allow for
effective patient navigator program evaluation, the grantee
shall collect specific patient data recording navigation
services provided to each patient served by the program and
shall establish and implement procedures and protocols,
consistent with applicable Federal and State laws (including 45
C.F.R. 160 and 164) to ensure the confidentiality of all
information shared by a participant in the program, or their
personal representative and their healthcare providers, group
health plans, or health insurance insurers with the program.
The patient navigator program may, consistent with applicable
Federal and State confidentiality laws, collect, use or
disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Application for grant.--A grant may be made under
paragraph (1) 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.
``(5) Evaluations.--
``(A) In general.--The Secretary, acting through
the Administrator of the Health Resources and Services
Administration, shall, directly or through grants or
contracts, provide for evaluations to determine the
effects of the services of patient navigators on the
individuals of health disparity populations for whom
the services were provided, taking into account the
matters referred to in paragraph (1)(C).
``(B) Dissemination of findings.--The Secretary
shall as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
``(6) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (a) and with the program under section
417D.
``(c) Requirements Regarding Fees.--
``(1) In general.--A condition for the receipt of a grant
under subsection (a)(1) or (b)(1) is that the program for which
the grant is made have in effect--
``(A) a schedule of fees or payments for the
provision of its healthcare services related to the
prevention and treatment of disease that is consistent
with locally prevailing rates or charges and is
designed to cover its reasonable costs of operation;
and
``(B) a corresponding schedule of discounts to be
applied to the payment of such fees or payments, which
discounts are adjusted on the basis of the ability of
the patient to pay.
``(2) Rule of construction.--Nothing in this section shall
be construed to require payment for navigation services or to
require payment for healthcare services in cases where care is
provided free of charge, including the case of services
provided through programs of the Indian Health Service.
``(d) Model.--Not later than five years after the date of the
enactment of this section, the Secretary shall develop a peer-reviewed
model of systems for the services provided by this section. The
Secretary shall update such model as may be necessary to ensure that
the best practices are being utilized.
``(e) Duration of Grant.--The period during which payments are made
to an entity from a grant under subsection (a)(1) or (b)(1) may not
exceed five years. The provision of such payments are subject to annual
approval by the Secretary of the payments and subject to the
availability of appropriations for the fiscal year involved to make the
payments. This subsection may not be construed as establishing a
limitation on the number of grants under such subsection that may be
made to an entity.
``(f) Definitions.--For purposes of this section:
``(1) The term `culturally competent', with respect to
providing health-related services, means services that, in
accordance with standards and measures of the Secretary, are
designed to effectively and efficiently respond to the cultural
and linguistic needs of patients.
``(2) The term `appropriate follow-up care' includes
palliative and end-of-life care.
``(3) The term `health disparity population' means a
population in which there exists a significant disparity in the
overall rate of disease incidence, morbidity, mortality, or
survival rates in the population as compared to the health
status of the general population. Such term includes--
``(A) racial and ethnic minority groups as defined
in section 1707; and
``(B) medically underserved groups, such as rural
and low-income individuals and individuals with low
levels of literacy.
``(4)(A) The term `patient navigator' means an individual
whose functions include--
``(i) assisting and guiding patients with a symptom
or an abnormal finding or diagnosis of cancer or other
chronic disease within the healthcare system to
accomplish the follow-up and diagnosis of an abnormal
finding as well as the treatment and appropriate
follow-up care of cancer or other chronic disease
including providing information about clinical trials;
and
``(ii) identifying, anticipating, and helping
patients overcome barriers within the healthcare system
to ensure prompt diagnostic and treatment resolution of
an abnormal finding of cancer or other chronic disease.
``(B) Such term includes representatives of the target
health disparity population, such as nurses, social workers,
cancer survivors, and patient advocates.
``(g) Authorization of Appropriations.--
``(1) In general.--
``(A) Model programs.--For the purpose of carrying
out subsection (a) (other than the purpose described in
paragraph (2)(A)), there are authorized to be
appropriated such sums as may be necessary for each of
the fiscal years 2005 through 2010.
``(B) Patient navigators.--For the purpose of
carrying out subsection (b) (other than the purpose
described in paragraph (2)(B)), there are authorized to
be appropriated such sums as may be necessary for each
of the fiscal years 2005 through 2010.
``(C) Bureau of primary healthcare.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Bureau of Primary Health Care.
``(2) Programs in rural areas.--
``(A) Model programs.--For the purpose of carrying
out subsection (a) by making grants under such
subsection for model programs in rural areas, there are
authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2005 through
2010.
``(B) Patient navigators.--For the purpose of
carrying out subsection (b) by making grants under such
subsection for programs in rural areas, there are
authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2005 through
2010.
``(C) Office of rural health policy.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Office of Rural Health Policy.
``(3) Relation to other authorizations.--Authorizations of
appropriations under paragraphs (1) and (2) are in addition to
other authorizations of appropriations that are available for
the purposes described in such paragraphs.''.
SEC. 427. NCI GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE
CARE AND PREVENTION; NCI GRANTS FOR PATIENT NAVIGATORS.
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
section:
``SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE AND
PREVENTION; PATIENT NAVIGATORS.
``(a) Model Community Cancer and Chronic Disease Care and
Prevention.--
``(1) In general.--The Director of the Institute may make
grants to eligible entities for the development and operation
of model programs that--
``(A) provide to individuals of health disparity
populations prevention, early detection, treatment, and
appropriate follow-up care services for cancer and
chronic diseases;
``(B) ensure that the health services are provided
to such individuals in a culturally competent manner;
``(C) assign patient navigators, in accordance with
applicable criteria of the Secretary, for managing the
care of individuals of health disparity populations
to--
``(i) accomplish, to the extent possible,
the follow-up and diagnosis of an abnormal
finding and the treatment and appropriate
follow-up care of cancer or other chronic
disease; and
``(ii) facilitate access to appropriate
healthcare services within the healthcare
system to ensure optimal patient utilization of
such services, including aid in coordinating
and scheduling appointments and referrals,
community outreach, assistance with
transportation arrangements, and assistance
with insurance issues and other barriers to
care and providing information about clinical
trials;
``(D) require training for patient navigators
employed through such model programs to ensure the
ability of navigators to perform all of the duties
required in this subsection and in subsection (b),
including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(E) ensure that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Eligible entities.--For purposes of this section, an
eligible entity is a designated cancer center of the Institute,
an academic institution, Indian Health Service Clinics, tribal
governments, urban Indian organizations, tribal organizations,
a hospital, a qualified nonprofit entity that partners with one
or more centers providing healthcare to provide navigation
services, which demonstrates the ability to perform all of the
functions outlined in this subsection and subsections (b) and
(c), or any other public or private entity determined to be
appropriate by the Director of the Institute, that provides
services described in paragraph (1)(A) for cancer and chronic
diseases.
``(3) Data collection and report.--In order to allow for
effective program evaluation, the grantee shall collect
specific patient data recording services provided to each
patient served by the program and shall establish and implement
procedures and protocols, consistent with applicable Federal
and State laws (including 45 C.F.R. 160 and 164) to ensure the
confidentiality of all information shared by a participant in
the program, or their personal representative and their
healthcare providers, group health plans, or health insurance
insurers with the program. The program may, consistent with
applicable Federal and State confidentiality laws, collect, use
or disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the program is serving
of the services of the model program under the grant. Such
activities shall include facilitating access to appropriate
healthcare services and patient navigators within the
healthcare system to ensure optimal patient utilization of
these services.
``(5) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Director of the Institute and the application is in such
form, is made in such manner, and contains such agreements,
assurances, and information as the Director determines to be
necessary to carry out this section.
``(6) Evaluations.--
``(A) In general.--The Director of the Institute,
directly or through grants or contracts, shall provide
for evaluations to determine which outreach activities
under paragraph (3) were most effective in informing
the public and the specific community that the program
is serving of the model program services and to
determine the extent to which such programs were
effective in providing culturally competent services to
the health disparity population served by the programs.
``(B) Dissemination of findings.--The Director of
the Institute shall as appropriate disseminate to
public and private entities the findings made in
evaluations under subparagraph (A).
``(7) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (b), with the program under section
330I, and to the extent practicable, with programs for
prevention centers that are carried out by the Director of the
Centers for Disease Control and Prevention.
``(b) Program for Patient Navigators.--
``(1) In general.--The Director of the Institute may make
grants to eligible entities for the development and operation
of programs to pay the costs of such entities in--
``(A) assigning patient navigators, in accordance
with applicable criteria of the Secretary, for managing
the care of individuals of health disparity populations
for the duration of receiving health services from the
health centers, including aid in coordinating and
scheduling appointments and referrals, community
outreach, assistance with transportation arrangements,
and assistance with insurance issues and other barriers
to care and providing information about clinical
trials;
``(B) ensuring that the services provided by the
patient navigators to such individuals include case
management and psychosocial assessment and care or
information and referral to such services;
``(C) ensuring that the patient navigators with
direct knowledge of the communities they serve provide
services to such individuals in a culturally competent
manner;
``(D) developing model practices for patient
navigators, including with respect to--
``(i) coordination of health services,
including psychosocial assessment and care;
``(ii) follow-up services, including
psychosocial assessment and care;
``(iii) determining coverage under health
insurance and health plans for all services;
``(iv) ensuring the initiation,
continuation and/or sustained access to care
prescribed by the patients' healthcare
providers; and
``(v) aiding patients with health insurance
coverage issues;
``(E) requiring training for patient navigators to
ensure the ability of navigators to perform all of the
duties required in this subsection and in subsection
(a), including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
``(F) ensuring that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
``(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the patient navigator is
serving of the services of the model program under the grant.
``(3) Data collection and report.--In order to allow for
effective patient navigator program evaluation, the grantee
shall collect specific patient data recording navigation
services provided to each patient served by the program and
shall establish and implement procedures and protocols,
consistent with applicable Federal and State laws (including 45
C.F.R. 160 and 164) to ensure the confidentiality of all
information shared by a participant in the program, or their
personal representative and their healthcare providers, group
health plans, or health insurance insurers with the program.
The patient navigator program may, consistent with applicable
Federal and State confidentiality laws, collect, use or
disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
``(4) Application for grant.--A grant may be made under
paragraph (1) only if an application for the grant is submitted
to the Director of the Institute and the application is in such
form, is made in such manner, and contains such agreements,
assurances, and information as the Director determines to be
necessary to carry out this section.
``(5) Evaluations.--
``(A) In general.--The Director of the Institute,
directly or through grants or contracts, shall provide
for evaluations to determine the effects of the
services of patient navigators on the health disparity
population for whom the services were provided, taking
into account the matters referred to in paragraph
(1)(C).
``(B) Dissemination of findings.--The Director of
the Institute shall as appropriate disseminate to
public and private entities the findings made in
evaluations under subparagraph (A).
``(6) Coordination with other programs.--The Secretary
shall coordinate the program under this subsection with the
program under subsection (a) and with the program under section
330I.
``(c) Requirements Regarding Fees.--
``(1) In general.--A condition for the receipt of a grant
under subsection (a)(1) or (b)(1) is that the program for which
the grant is made have in effect--
``(A) a schedule of fees or payments for the
provision of its healthcare services related to the
prevention and treatment of disease that is consistent
with locally prevailing rates or charges and is
designed to cover its reasonable costs of operation;
and
``(B) a corresponding schedule of discounts to be
applied to the payment of such fees or payments, which
discounts are adjusted on the basis of the ability of
the patient to pay.
``(2) Rule of construction.--Nothing in this section shall
be construed to require payment for navigation services or to
require payment for healthcare services in cases where care is
provided free of charge, including the case of services
provided through programs of the Indian Health Service.
``(d) Model.--Not later than five years after the date of the
enactment of this section, the Director of the Institute shall develop
a peer-reviewed model of systems for the services provided by this
section. The Director shall update such model as may be necessary to
ensure that the best practices are being utilized.
``(e) Duration of Grant.--The period during which payments are made
to an entity from a grant under subsection (a)(1) or (b)(1) may not
exceed five years. The provision of such payments are subject to annual
approval by the Director of the Institute of the payments and subject
to the availability of appropriations for the fiscal year involved to
make the payments. This subsection may not be construed as establishing
a limitation on the number of grants under such subsection that may be
made to an entity.
``(f) Definitions.--For purposes of this section:
``(1) The term `culturally competent', with respect to
providing health-related services, means services that, in
accordance with standards and measures of the Secretary, are
designed to effectively and efficiently respond to the cultural
and linguistic needs of patients.
``(2) the term `appropriate follow-up care' includes
palliative and end-of-life care.
``(3) the term `health disparity population' means a
population where there exists a significant disparity in the
overall rate of disease incidence, morbidity, mortality, or
survival rates in the population as compared to the health
status of the general population. Such term includes--
``(A) racial and ethnic minority groups as defined
in section 1707; and
``(B) medically underserved groups, such as rural
and low-income individuals and individuals with low
levels of literacy.
``(4)(A) the term `patient navigator' means an individual
whose functions include--
``(i) assisting and guiding patients with a symptom
or an abnormal finding or diagnosis of cancer or other
chronic disease within the healthcare system to
accomplish the follow-up and diagnosis of an abnormal
finding as well as the treatment and appropriate
follow-up care of cancer or other chronic disease,
including providing information about clinical trials;
and
``(ii) identifying, anticipating, and helping
patients overcome barriers within the healthcare system
to ensure prompt diagnostic and treatment resolution of
an abnormal finding of cancer or other chronic disease.
``(B) Such term includes representatives of the target
health disparity population, such as nurses, social workers,
cancer survivors, and patient advocates.
``(g) Authorization of Appropriations.--
``(1) Model programs.--For the purpose of carrying out
subsection (a), there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years 2005
through 2010.
``(2) Patient navigators.--For the purpose of carrying out
subsection (b), there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years 2005
through 2010.
``(3) Relation to other authorizations.--Authorizations of
appropriations under paragraphs (1) and (2) are in addition to
other authorizations of appropriations that are available for
the purposes described in such paragraphs.''.
SEC. 428. IHS GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE
CARE AND PREVENTION; IHS GRANTS FOR PATIENT NAVIGATORS.
(a) Model Community Cancer and Chronic Disease Care and
Prevention.--
(1) In general.--The Director of the Indian Health Service
may make grants to Indian Health Service Centers, tribal
governments, urban Indian organizations, tribal organizations,
and qualified nonprofit entities demonstrating the ability to
perform all of the functions outlined in this subsection and
subsections (b) and (c) that partner with providers or centers
providing healthcare serving Native American populations to
provide navigation services, for the development and operation
of model programs that--
(A) provide to individuals of health disparity
populations prevention, early detection, treatment, and
appropriate follow-up care services for cancer and
chronic diseases;
(B) ensure that the health services are provided to
such individuals in a culturally competent manner;
(C) assign patient navigators, in accordance with
applicable criteria of the Secretary, for managing the
care of individuals of health disparity populations
to--
(i) accomplish, to the extent possible, the
follow-up and diagnosis of an abnormal finding
and the treatment and appropriate follow-up
care of cancer or other chronic disease; and
(ii) facilitate access to appropriate
healthcare services within the healthcare
system to ensure optimal patient utilization of
such services, including aid in coordinating
and scheduling appointments and referrals,
community outreach, assistance with
transportation arrangements, and assistance
with insurance issues and other barriers to
care and providing information about clinical
trials;
(D) require training for patient navigators
employed through such model programs to ensure the
ability of navigators to perform all of the duties
required in this subsection and in subsection (b),
including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
(E) ensure that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the program is serving
of the services of the model program under the grant. Such
activities shall include facilitating access to appropriate
healthcare services and patient navigators within the
healthcare system to ensure optimal patient utilization of
these services.
(3) Data collection and report.--In order to allow for
effective program evaluation, the grantee shall collect
specific patient data recording services provided to each
patient served by the program and shall establish and implement
procedures and protocols, consistent with applicable Federal
and State laws (including 45 C.F.R. 160 and 164) to ensure the
confidentiality of all information shared by a participant in
the program, or their personal representative and their
healthcare providers, group health plans, or health insurance
insurers with the program. The program may, consistent with
applicable Federal and State confidentiality laws, collect, use
or disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
(4) Application for grant.--A grant may be made under
paragraph (1) 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.
(5) Evaluations.--
(A) In general.--The Secretary, acting through the
Director of the Indian Health Service, shall, directly
or through grants or contracts, provide for evaluations
to determine which outreach activities under paragraph
(2) were most effective in informing the public and the
specific community that the program is serving of the
model program services and to determine the extent to
which such programs were effective in providing
culturally competent services to the health disparity
population served by the programs.
(B) Dissemination of findings.--The Secretary shall
as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
(6) Coordination with other programs.--The Secretary shall
coordinate the program under this subsection with the program
under subsection (b), with the program under section 417D, and
to the extent practicable, with programs for prevention centers
that are carried out by the Director of the Centers for Disease
Control and Prevention.
(b) Program for Patient Navigators.--
(1) In general.--The Secretary, acting through the Director
of the Indian Health Service, may make grants to Indian Health
Service Centers, tribal governments, urban Indian
organizations, tribal organizations, and qualified nonprofit
entities demonstrating the ability to perform all of the
functions outlined in this subsection and subsections (a) and
(c) that partner with providers or centers providing healthcare
serving Native American populations to provide navigation
services, for the development and operation of model programs
to pay the costs of such organizations in--
(A) assigning patient navigators, in accordance
with applicable criteria of the Secretary, for
individuals of health disparity populations for the
duration of receiving health services from the health
centers, including aid in coordinating and scheduling
appointments and referrals, community outreach,
assistance with transportation arrangements, and
assistance with insurance issues and other barriers to
care and providing information about clinical trials;
(B) ensuring that the services provided by the
patient navigators to such individuals include case
management and psychosocial assessment and care or
information and referral to such services;
(C) ensuring that patient navigators with direct
knowledge of the communities they serve provide
services to such individuals in a culturally competent
manner;
(D) developing model practices for patient
navigators, including with respect to--
(i) coordination of health services,
including psychosocial assessment and care;
(ii) appropriate follow-up care, including
psychosocial assessment and care;
(iii) determining coverage under health
insurance and health plans for all services;
(iv) ensuring the initiation, continuation
and/or sustained access to care prescribed by
the patients' healthcare providers; and
(v) aiding patients with health insurance
coverage issues;
(E) requiring training for patient navigators to
ensure the ability of navigators to perform all of the
duties required in this subsection and in subsection
(a), including training to ensure that navigators are
informed about health insurance systems and are able to
aid patients in resolving access issues; and
(F) ensuring that consumers have direct access to
patient navigators during regularly scheduled hours of
business operation.
(2) Outreach services.--A condition for the receipt of a
grant under paragraph (1) is that the applicant involved agree
to provide ongoing outreach activities while receiving the
grant, in a manner that is culturally competent for the health
disparity population served by the program, to inform the
public and the specific community that the patient navigator is
serving of the services of the model program under the grant.
(3) Data collection and report.--In order to allow for
effective patient navigator program evaluation, the grantee
shall collect specific patient data recording navigation
services provided to each patient served by the program and
shall establish and implement procedures and protocols,
consistent with applicable Federal and State laws (including 45
C.F.R. 160 and 164) to ensure the confidentiality of all
information shared by a participant in the program, or their
personal representative and their healthcare providers, group
health plans, or health insurance insurers with the program.
The patient navigator program may, consistent with applicable
Federal and State confidentiality laws, collect, use or
disclose aggregate information that is not individually
identifiable (as defined in 45 C.F.R. 160 and 164). With this
data, the grantee shall submit an annual report to the
Secretary that summarizes and analyzes these data, provides
information on needs for navigation services, types of access
difficulties resolved, sources of repeated resolution and flaws
in the system of access, including insurance barriers.
(4) Application for grant.--A grant may be made under
paragraph (1) 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.
(5) Evaluations.--
(A) In general.--The Secretary, acting through the
Director of the Indian Health Service, shall, directly
or through grants or contracts, provide for evaluations
to determine the effects of the services of patient
navigators on the individuals of health disparity
populations for whom the services were provided, taking
into account the matters referred to in paragraph
(1)(C).
(B) Dissemination of findings.--The Secretary shall
as appropriate disseminate to public and private
entities the findings made in evaluations under
subparagraph (A).
(6) Coordination with other programs.--The Secretary shall
coordinate the program under this subsection with the program
under subsection (a) and with the program under section 417D.
(c) Requirements Regarding Fees.--
(1) In general.--A condition for the receipt of a grant
under subsection (a)(1) or (b)(1) is that the program for which
the grant is made have in effect--
(A) a schedule of fees or payments for the
provision of its healthcare services related to the
prevention and treatment of disease that is consistent
with locally prevailing rates or charges and is
designed to cover its reasonable costs of operation;
and
(B) a corresponding schedule of discounts to be
applied to the payment of such fees or payments, which
discounts are adjusted on the basis of the ability of
the patient to pay.
(2) Rule of construction.--Nothing in this section shall be
construed to require payment for navigation services or to
require payment for healthcare services in cases, such as with
the Indian Health Service, where care is provided free of
charge.
(d) Model.--Not later than five years after the date of the
enactment of this section, the Secretary shall develop a peer-reviewed
model of systems for the services provided by this section. The
Secretary shall update such model as may be necessary to ensure that
the best practices are being utilized.
(e) Duration of Grant.--The period during which payments are made
to an entity from a grant under subsection (a)(1) or (b)(1) may not
exceed five years. The provision of such payments are subject to annual
approval by the Secretary of the payments and subject to the
availability of appropriations for the fiscal year involved to make the
payments. This subsection may not be construed as establishing a
limitation on the number of grants under such subsection that may be
made to an entity.
(f) Definitions.--For purposes of this section:
(1) The term ``culturally competent'', with respect to
providing health-related services, means services that, in
accordance with standards and measures of the Secretary, are
designed to effectively and efficiently respond to the cultural
and linguistic needs of patients.
(2) The term ``appropriate follow-up care'' includes
palliative and end-of-life care.
(3) The term ``health disparity population'' means a
population where there exists a significant disparity in the
overall rate of disease incidence, morbidity, mortality, or
survival rates in the population as compared to the health
status of the general population. Such term includes--
(A) racial and ethnic minority groups as defined in
section 1707; and
(B) medically underserved groups, such as rural and
low-income individuals and individuals with low levels
of literacy.
(4)(A) The term ``patient navigator'' means an individual
whose functions include--
(i) assisting and guiding patients with a symptom
or an abnormal finding or diagnosis of cancer or other
chronic disease within the healthcare system to
accomplish the follow-up and diagnosis of an abnormal
finding as well as the treatment and appropriate
follow-up care of cancer or other chronic disease,
including providing information about clinical trials;
and
(ii) identifying, anticipating, and helping
patients overcome barriers within the healthcare system
to ensure prompt diagnostic and treatment resolution of
an abnormal finding of cancer or other chronic disease.
(B) Such term includes representatives of the target health
disparity population, such as nurses, social workers, cancer
survivors, and patient advocates.
(g) Authorization of Appropriations.--
(1) In general.--
(A) Model programs.--For the purpose of carrying
out subsection (a) (other than the purpose described in
paragraph (2)(A)), there are authorized to be
appropriated such sums as may be necessary for each of
the fiscal years 2005 through 2010.
(B) Patient navigators.--For the purpose of
carrying out subsection (b) (other than the purpose
described in paragraph (2)(B)), there are authorized to
be appropriated such sums as may be necessary for each
of the fiscal years 2005 through 2010.
(C) Bureau of primary health 13 care.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Bureau of Primary Health Care.
(2) Programs in rural areas.--
(A) Model programs.--For the purpose of carrying
out subsection (a) by making grants under such
subsection for model programs in rural areas, there are
authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2005 through
2010.
(B) Patient navigators.--For the purpose of
carrying out subsection (b) by making grants under such
subsection for programs in rural areas, there are
authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2005 through
2010.
(C) Office of rural health policy.--Amounts
appropriated under subparagraph (A) or (B) shall be
administered through the Office of Rural Health Policy.
(3) Relation to other authorizations.--Authorizations of
appropriations under paragraphs (1) and (2) are in addition to
other authorizations of appropriations that are available for
the purposes described in such paragraphs.
CHAPTER 5--COMMUNITY HEALTH WORKERS
SEC. 431. SHORT TITLE.
This chapter may be cited as the ``Community Health Workers Act of
2003''.
SEC. 432. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN.
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. 399O. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN.
``(a) Grants Authorized.--The Secretary, in collaboration with the
Director of the Centers for Disease Control and Prevention and other
Federal officials determined appropriate by the Secretary, is
authorized to award grants to States or local or tribal units, to
promote positive health behaviors for women in target populations,
especially racial and ethnic minority women in medically underserved
communities.
``(b) Use of Funds.--Grants awarded pursuant to subsection (a) may
be used to support community health workers--
``(1) to educate, guide, and provide outreach in a
community setting regarding health problems prevalent among
women and especially among racial and ethnic minority women;
``(2) to educate, guide, and provide experiential learning
opportunities that target behavioral risk factors;
``(3) to educate and guide regarding effective strategies
to promote positive health behaviors within the family;
``(4) 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;
``(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 State or local or tribal unit
(including federally recognized tribes and Alaska native
villages) 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;
``(B) with a high percentage of families for whom
English is not their primary language; and
``(C) that encompass the United States-Mexico
border region;
``(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. 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 (e).
``(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--
``(A) by serving as a liaison between communities
and health care agencies;
``(B) by providing guidance and social assistance
to community residents;
``(C) by enhancing community residents' ability to
effectively communicate with health care providers;
``(D) by providing culturally and linguistically
appropriate health or nutrition education;
``(E) by advocating for individual and community
health or nutrition needs; and
``(F) by providing referral and followup services.
``(2) Community setting.--The term `community setting'
means a home or a community organization located in the
neighborhood in which a participant resides.
``(3) Medically underserved community.--The term `medically
underserved community' means a community identified by a
State--
``(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.
``(4) 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.
``(5) Target population.--The term `target population'
means women of reproductive age, regardless of their current
childbearing status.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
CHAPTER 6--HEALTH EMPOWERMENT ZONES
SEC. 440. HEALTH EMPOWERMENT ZONES.
(a) Health Empowerment Zone Programs.--
(1) Grants.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and the Director of the Office of Minority
Health, and in cooperation with the Director of the Office of
Community Services and the Director of the National Center for
Minority Health and Health Disparities, shall make grants to
partnerships of private and public entities to establish health
empowerment zone programs in communities that
disproportionately experience disparities in health status and
healthcare for the purpose described in paragraph (2).
(2) Use of funds.--
(A) In general.--Subject to subparagraph (B), the
purpose of a health empowerment zone program under this
section shall be to assist individuals, businesses,
schools, minority health associations, non-profit
organizations, community-based organizations,
hospitals, healthcare clinics, foundations, and other
entities in communities that disproportionately
experience disparities in health status and healthcare
which are seeking--
(i) to improve the health or environment of
minority individuals in the community and to
reduce disparities in health status and
healthcare by assisting individuals in
accessing Federal programs; and
(ii) to coordinate the efforts of
governmental and private entities regarding the
elimination of racial and ethnic disparities in
health status and healthcare.
(B) Medicare and medicaid.--A health empowerment
zone program under this section shall not provide any
assistance (other than referral and follow-up services)
that is duplicative of programs under title XVIII or
XIX of the Social Security Act (42 U.S.C. 1395 and 1396
et seq.).
(3) Distribution.--The Secretary shall make at least 1
grant under this section to a partnership for a health
empowerment zone program in communities that disproportionately
experience disparities in health status and healthcare that is
located in a territory or possession of the United States.
(4) Application.--To obtain a grant under this section, a
partnership shall submit to the Secretary an application in
such form and in such manner as the Secretary may require. An
application under this paragraph shall--
(A) demonstrate that the communities to be served
by the health empowerment zone program are those that
disproportionately experience disparities in health
status and healthcare;
(B) set forth a strategic plan for accomplishing
the purpose described in paragraph (2), by--
(i) describing the coordinated health,
economic, human, community, and physical
development plan and related activities
proposed for the community;
(ii) describing the extent to which local
institutions and organizations have contributed
and will contribute to the planning process and
implementation;
(iii) identifying the projected amount of
Federal, State, local, and private resources
that will be available in the area and the
private and public partnerships to be used
(including any participation by or cooperation
with universities, colleges, foundations, non-
profit organizations, medical centers,
hospitals, health clinics, school districts, or
other private and public entities);
(iv) identifying the funding requested
under any Federal program in support of the
proposed activities;
(v) identifying benchmarks for measuring
the success of carrying out the strategic plan;
(vi) demonstrating the ability to reach and
service the targeted underserved minority
community populations in a culturally
appropriate and linguistically responsive
manner; and
(vii) demonstrating a capacity and
infrastructure to provide long-term community
response that is culturally appropriate and
linguistically responsive to communities that
disproportionately experience disparities in
health and healthcare; and
(C) include such other information as the Secretary
may require.
(5) Preference.--In awarding grants under this subsection,
the Secretary shall give preference to proposals from
indigenous community entities that have an expertise in
providing culturally appropriate and linguistically responsive
services to communities that disproportionately experience
disparities in health and health care.
(b) Federal Assistance for Health Empowerment Zone Grant
Programs.--The Secretary, the Administrator of the Small Business
Administration, the Secretary of Agriculture, the Secretary of
Education, the Secretary of Labor, and the Secretary of Housing and
Urban Development shall each--
(1) where appropriate, provide entity-specific technical
assistance and evidence-based strategies to communities that
disproportionately experience disparities in health status and
healthcare to further the purposes served by a health
empowerment zone program established with a grant under
subsection (a);
(2) identify all programs administered by the Department of
Health and Human Services, Small Business Administration,
Department of Agriculture, Department of Education, Department
of Labor, and the Department of Housing and Urban Development,
respectively, that may be used to further the purpose of a
health empowerment zone program established with a grant under
subsection (a); and
(3) in administering any program identified under paragraph
(2), consider the appropriateness of giving priority to any
individual or entity located in communities that
disproportionately experience disparities in health status and
healthcare served by a health empowerment zone program
established with a grant under subsection (a), if such priority
would further the purpose of the health empowerment zone
program.
(c) Health Empowerment Zone Coordinating Committee.--
(1) Establishment.--For each health empowerment zone
program established with a grant under subsection (a), the
Secretary acting through the Director of Office of Minority
Health and the Administrator of the Health Resources and
Services Administration shall establish a health empowerment
zone coordinating committee.
(2) Duties.--Each coordinating committee established, in
coordination with the Director of the Office of Minority Health
and the Administrator of the Health Resources and Services
Administration, shall provide technical assistance and
evidence-based strategies to the grant recipient involved,
including providing guidance on research, strategies, health
outcomes, program goals, management, implementation,
monitoring, assessment, and evaluation processes.
(3) Membership.--
(A) Appointment.--The Director of the Office of
Minority Health and the Administrator of the Health
Resources and Services Administration, in consultation
with the respective grant recipient shall appoint the
members of each coordinating committee.
(B) Composition.--The Director of the Office of
Minority Health, and the Administrator of the Health
Resources and Services Administration shall ensure that
each coordinating committee established--
(i) has not more than 20 members;
(ii) includes individuals from communities
that disproportionately experience disparities
in health status and healthcare;
(iii) includes community leaders and
leaders of community-based organizations;
(iv) includes representatives of academia
and lay and professional organizations and
associations including those having expertise
in medicine, technical, social and behavioral
science, health policy, advocacy, cultural and
linguistic competency, research management, and
organization; and
(v) represents a reasonable cross-section
of knowledge, views, and application of
expertise on societal, ethical, behavioral,
educational, policy, legal, cultural,
linguistic, and workforce issues related to
eliminating disparities in health and
healthcare.
(C) Individual qualifications.--The Director of the
Office of Minority Health and the Administrator of the
Health Resources and Services Administration may not
appoint an individual to serve on a coordinating
committee unless the individual meets the following
qualifications:
(i) The individual is not employed by the
Federal Government.
(ii) The individual has appropriate
experience, including experience in the areas
of community development, cultural and
linguistic competency, reducing and eliminating
racial and ethnic disparities in health and
health care, or minority health.
(D) Selection.--In selecting individuals to serve
on a coordinating committee, the Director of Office of
Minority Health and the Administrator Health Resources
and Services Administration shall give due
consideration to the recommendations of the Congress,
industry leaders, the scientific community (including
the Institute of Medicine), academia, community based
non-profit organizations, minority health and related
organizations, the education community, State and local
governments, and other appropriate organizations.
(E) Chairperson.--The Director of the Office of
Minority Health and the Administrator of the Health
Resources and Services Administration, in consultation
with the members of the coordinating committee
involved, shall designate a chairperson of the
coordinating committee, who shall serve for a term of 3
years and who may be reappointed at the expiration of
each such term.
(F) Terms.--Each member of a coordinating committee
shall be appointed for a term of 1 to 3 years in
overlapping staggered terms, as determined by the
Director of the Office of Minority Health and the
Administrator of the Health Resources and Services
Administration at the time of appointment, and may be
reappointed at the expiration of each such term.
(G) Vacancies.--A vacancy on a coordinating
committee shall be filled in the same manner in which
the original appointment was made.
(H) Compensation.--Each member of a coordinating
committee shall be compensated at a rate equal to the
daily equivalent of the annual rate of basic pay for
level IV of the Executive Schedule for each day
(including travel time) during which such member is
engaged in the performance of the duties of the
coordinating committee.
(I) Travel expenses.--Each member of a coordinating
committee shall receive travel expenses, including per
diem in lieu of subsistence, in accordance with
applicable provisions under subchapter I of chapter 57
of title 5, United States Code.
(4) Meetings.--A coordinating committee shall meet 3 to 5
times each year, at the call of the coordinating committee's
chairperson and in consultation with the Director of Office of
Minority Health and the Administrator Health Resources and
Services Administration.
(5) Report.--Each coordinating committee shall transmit to
the Congress an annual report that, with respect to the health
empowerment zone program involved, includes the following:
(A) A review of the program's effectiveness in
achieving stated goals and outcomes.
(B) A review of the program's management and the
coordination of the entities involved.
(C) A review of the activities in the program's
portfolio and components.
(D) An identification of policy issues raised by
the program.
(E) An assessment of the program's capacity,
infrastructure, and number of underserved minority
communities reached.
(F) Recommendations for new program goals, research
areas, enhanced approaches, partnerships, coordination
and management mechanisms, and projects to be
established to achieve the program's stated goals, to
improve outcomes, monitoring, and evaluation.
(G) A review of the degree of minority entity
participation in the program, and an identification of
a strategy to increase such participation.
(H) Any other reviews or recommendations determined
to be appropriate by the coordinating committee.
(d) Report.--The Director of the Office of Minority Health and the
Administrator of the Health Resources and Services Administration shall
submit a joint annual report to the appropriate committees of Congress
on the results of the implementation of programs under this section.
(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
Subtitle B--Targeting Diseases and Conditions with Particularly
Disparate Impact
CHAPTER 1--CANCER REDUCTION
SEC. 441. CANCER REDUCTION.
(a) Preventive Health Measures With Respect to Breast and Cervical
Cancer.--
(1) In general.--Section 1510(a) of the Public Health
Service Act (42 U.S.C. 300n-5(a)) is amended by striking
``2003'' and inserting ``2008''.
(2) Supplemental grants for additional preventive health
services.--Section 1509(d)(1) of the Public Health Service Act
(42 U.S.C. 300n-4a(d)(1)) is amended by striking ``2003'' and
inserting ``2008''.
(b) Treatment and Prevention.--Title XXIX of the Public Health
Service Act, as amended by section 302, is further amended by adding at
the end the following:
``Subtitle C--Reducing Disease and Disease-Related Complications
``CHAPTER 1--CANCER REDUCTION
``SEC. 2921. CANCER PREVENTION AND TREATMENT FOR UNDERSERVED MINORITY
OR OTHER POPULATIONS.
``(a) Grants.--The Secretary may make grants to qualifying health
centers, non-profit organizations, and public institutions for the
development, expansion, or operation of programs that, for individuals
otherwise served by such centers, provide--
``(1) information and education on cancer prevention;
``(2) screenings for cancer;
``(3) counseling on cancer, including counseling upon a
diagnosis of cancer; and
``(4) treatment for cancer.
``(b) Qualifying Health Centers and Public Institutions.--For
purposes of this section:
``(1) Qualifying health centers.--The term `qualifying
health center' includes community health centers, migrant
health centers, health centers for the homeless, health centers
for residents of public housing, and community clinics.
``(2) Qualifying public institutions.--The term `qualifying
public institutions' means an entity that meets the
requirements of section 2971(b)(1).
``(c) Preference in Making Grants.--In making grants under
subsection (a), the Secretary shall give preference to applicants
that--
``(1) have service populations that include a significant
number of low-income minority individuals who are at-risk for
cancer;
``(2) will, through programs under subsection (b)--
``(A) emphasize early detection of and
comprehensive treatment for cancer;
``(B) provide comprehensive treatment services for
cancer in its earliest stages; and
``(C) carry out subparagraphs (A) and (B) for two
or more types of cancer; and
``(3) in order to provide treatment for cancer, have
established or will establish referral arrangements with
entities that provide screenings for low-income individuals.
``(d) Appropriate Cultural Context.--As a condition for the receipt
of a grant under subsection (a), the applicant shall agree 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
background of, the individuals for whom the services are provided.
``(e) Outreach Services.--As a condition for the receipt of a grant
under subsection (a), the applicant shall agree to provide outreach
activities to inform the public of the services of the program, and to
provide information on cancer; and
``(f) 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.
``(g) Designation of Type of Cancer.--In making a grant under
subsection (a), the Secretary shall designate the type or types of
cancer with respect to which the grant is being made.
``(h) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2005 through 2010.''.
CHAPTER 2--HIV/AIDS REDUCTION
SEC. 442. HIV/AIDS REDUCTION.
Subtitle C of title XXIX of the Public Health Service Act, as added
by section 441, is amended by adding at the end the following:
``CHAPTER 2--HIV/AIDS REDUCTION
``SEC. 2922. HIV/AIDS REDUCTION IN THE MINORITY COMMUNITY.
``(a) Expanded Funding.--The Secretary, in collaboration with the
Director of the Office of 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 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 HIV/AIDS Initiative, to
support the following activities:
``(1) The provision of technical assistance and
infrastructure support to reduce HIV/AIDS in minority
populations.
``(2) To increase minority populations' access to HIV/AIDS
prevention and care services.
``(3) To build stronger community programs and partnerships
to address HIV prevention and the healthcare needs of specific
minority racial and ethnic populations.
``(c) Priority Interventions.--Within the minority populations
referred to in subsection (b), priority in conducting intervention
services shall be given to--
``(1) women;
``(2) youth;
``(3) men who engage in homosexual activity;
``(4) persons who engage in intravenous drug abuse;
``(5) homeless individuals; and
``(6) individuals incarcerated or in the penal system.
``(d) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $610,000,000
for fiscal year 2005, and such sums as may be necessary for each of the
fiscal years 2006 through 2010.''.
CHAPTER 3--INFANT MORTALITY REDUCTION
SEC. 443. INFANT MORTALITY REDUCTION.
Subtitle C of title XXIX of the Public Health Service Act, as
amended by section 442, is further amended by adding at the end the
following:
``CHAPTER 3--INFANT MORTALITY REDUCTION
``SEC. 2923. INFANT MORTALITY REDUCTION.
``(a) Back to Sleep Campaign.--
``(1) In general.--The Secretary shall support
collaborations through the National Institute of Child Health
and Human Development.
``(2) Use of funds.--Collaborations funded under paragraph
(1) shall be directed towards the goal of reducing the
incidence of Sudden Infant Death Syndrome in minority
communities, particularly the African American and American
Indian and Native Alaskan communities, through increased
education on the importance of back sleeping for infants. Such
increased education shall include child care centers and other
secondary child caregivers.
``(b) Guidelines for Child Care Licensure.--
``(1) In general.--The Secretary, acting through the
Director of the National Institute of Child Health and Human
Development, shall convene a working group to develop health
guidelines relating to infant mortality reduction for use by
child care licensing entities, including State, territorial,
tribal, and local governments.
``(2) Focus.--The guidelines developed under paragraph (1)
shall focus specifically on appropriate actions to reduce the
incidence of Sudden Infant Death Syndrome in child care
settings.
``(3) Report.--Not later than 1 year after the date of
enactment of this title, the Secretary shall submit to the
appropriate committees of Congress and the States a report that
describes the guidelines developed under this subsection.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
CHAPTER 4--FETAL ALCOHOL SYNDROME TREATMENT AND DIAGNOSIS
SEC. 444. FETAL ALCOHOL SYNDROME.
Subtitle C of title XXIX of the Public Health Service Act, as
amended added by section 443, is further amended by adding at the end
the following:
``CHAPTER 4--FETAL ALCOHOL SYNDROME TREATMENT AND DIAGNOSIS
``SEC. 2924. FETAL ALCOHOL SYNDROME.
``(a) Surveillance and Identification Research.--The Secretary
shall direct the National Center for Birth Defects and Developmental
Disabilities (referred to in this section as the `Center') to--
``(1) develop a uniform surveillance case definition for
Fetal Alcohol Syndrome (referred to in this section as `FAS')
and a uniform surveillance definition for Alcohol Related
Neurodevelopmental Disorder (referred to in this section as
`ARND');
``(2) develop a comprehensive screening process for FAS and
ARND to include all age groups; and
``(3) disseminate the screening process developed under
paragraph (2) to--
``(A) hospitals, outpatient programs, and other
healthcare providers;
``(B) incarceration and detainment facilities;
``(C) primary and secondary schools;
``(D) social work and child welfare offices;
``(E) State offices and others providing services
to individuals with disabilities; and
``(F) others determined appropriate by the
Secretary.
``(b) Clinical Characterization of FAS and Related Diseases.--The
Secretary shall direct the National Institute of Alcohol Abuse and
Alcoholism to--
``(1) research methods to quantify the central nervous
system impairments associated with fetal alcohol exposure and
to develop clinical diagnostic tools for the intellectual and
behavioral problems associated with FAS and related diseases;
``(2) develop a neurocognitive phenotype for FAS and ARND;
and
``(3) include all relevant scientific and clinical
characterizations of FAS and related diseases in relevant
diagnostic codes.
``(c) Community-Based and Support Services Coordination Grants.--
The Secretary shall award grants to States, Indian tribes and tribal
organizations, and nongovernmental organizations for the establishment
of--
``(1) pilot projects to identify and implement best
practices for--
``(A) educating children with fetal alcohol
spectrum disorders, including--
``(i) activities and programs designed
specifically for the identification, treatment,
and education of such children; and
``(ii) curricula development and
credentialing of teachers, administrators, and
social workers who implement such programs;
``(B) educating judges, attorneys, child advocates,
law enforcement officers, prison wardens, alternative
incarceration administrators, and incarceration
officials on how to treat and support individuals
suffering from a fetal alcohol spectrum disorder within
the criminal justice system, including--
``(i) programs designed specifically for
the identification, treatment, and education of
those with a fetal alcohol spectrum disorder;
and
``(ii) curricula development and
credentialing within justice system for
individuals who implement such programs; and
``(C) educating adoption or foster care agency
officials about available and necessary services for
children with fetal alcohol spectrum disorders,
including--
``(i) programs designed specifically for
the identification, treatment, and education of
those with a fetal alcohol spectrum disorder;
and
``(ii) education and training for potential
parents of an adopted child with a fetal
alcohol spectrum disorder;
``(2) nationally coordinated systems that integrate
transitional services for those affected by prenatal alcohol
exposure such as housing assistance, vocational training and
placement, and medication monitoring by--
``(A) providing training and support to family
services programs, children's mental health programs,
and other local efforts;
``(B) recruiting and training mentors for teenagers
with a fetal alcohol spectrum disorder; and
``(C) maintaining a clearinghouse including all
relevant neurobehavioral information needed for
supporting individuals with a fetal alcohol spectrum
disorder; and
``(3) programs to disseminate and coordinate fetal alcohol
spectrum disorder awareness and identification efforts by
community health centers, including--
``(A) education of health professionals regarding
available support services; and
``(B) implementation of a tracking system targeting
the rates of fetal alcohol spectrum disorders among
individuals from certain racial, ethnic, and economic
backgrounds.
``(d) Application.--To be eligible to receive a grant under
subsection (d), an entity shall submit to the Secretary an application
in such form, in such manner, and containing such agreements,
assurances, and information as the Secretary determines to be necessary
to carry out this section.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
CHAPTER 5--DIABETES PREVENTION AND TREATMENT
SEC 445. MONITORING THE QUALITY OF AND DISPARITIES IN DIABETES CARE.
Part A of title IX of the Public Health Service Act (42 U.S.C. 299
et seq.) is amended by adding at the end the following:
``SEC. 904. AREAS OF SPECIAL EMPHASIS.
``The Secretary, acting through the Director, shall incorporate
within the annual quality report required under section 913(b)(2) and
the annual disparities report required under section 903(a)(6),
scientific evidence and information appropriate for monitoring the
quality and safety of diabetes care and identifying, understanding, and
reducing disparities in care.''.
SEC. 446. DIABETES PREVENTION, TREATMENT, AND CONTROL.
(a) Determination.--The Secretary, in consultation with Indian
tribes and tribal organizations, shall determine--
(1) by tribe, tribal organization, and service unit of the
Service, the prevalence of, and the types of complications
resulting from, diabetes among Indians; and
(2) based on paragraph (1), the measures (including patient
education) each service unit should take to reduce the
prevalence of, and prevent, treat, and control the
complications resulting from, diabetes among Indian tribes
within that service unit.
(b) Screening.--The Secretary shall screen each Indian who receives
services from the Service for diabetes and for conditions which
indicate a high risk that the individual will become diabetic. Such
screening may be done by an Indian tribe or tribal organization
operating healthcare programs or facilities with funds from the Service
under the Indian Self-Determination and Education Assistance Act.
(c) Continued Funding.--The Secretary shall continue to fund,
through fiscal year 2015, each effective model diabetes project in
existence on the date of the enactment of this Act and such other
diabetes programs operated by the Secretary or by Indian tribes and
tribal organizations and any additional programs added to meet existing
diabetes needs. Indian tribes and tribal organizations shall receive
recurring funding for the diabetes programs which they operate pursuant
to this section. Model diabetes projects shall consult, on a regular
basis, with tribes and tribal organizations in their regions regarding
diabetes needs and provide technical expertise as needed.
(d) Dialysis Programs.--The Secretary shall provide funding through
the Service, Indian tribes and tribal organizations to establish
dialysis programs, including funds to purchase dialysis equipment and
provide necessary staffing.
(e) Other Activities.--The Secretary shall, to the extent funding
is available--
(1) in each area office of the Service, consult with Indian
tribes and tribal organizations regarding programs for the
prevention, treatment, and control of diabetes;
(2) establish in each area office of the Service a registry
of patients with diabetes to track the prevalence of diabetes
and the complications from diabetes in that area; and
(3) ensure that data collected in each area office
regarding diabetes and related complications among Indians is
disseminated to tribes, tribal organizations, and all other
area offices.
(f) Definitions.--For purposes of this section, the definitions
contained in section 4 of the Indian Health Care Improvement Act shall
apply.
SEC. 447. GENETICS OF DIABETES.
Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.)
is amended by inserting after section 430 the following:
``SEC. 430A. GENETICS OF DIABETES.
``The Diabetes Mellitus Interagency Coordinating Committee, in
collaboration with the Directors of the National Human Genome Research
Institute, the National Institute of Diabetes and Digestive and Kidney
Diseases, and the National Institute of Environmental Health Sciences,
and other voluntary organizations and interested parties, shall--
``(1) coordinate and assist efforts of the Type 1 Diabetes
Genetics Consortium, which will collect and share valuable DNA
information from type 1 diabetes patients from studies around
the world; and
``(2) provide continued coordination and support for the
consortia of laboratories investigating the genomics of
diabetes.''.
SEC. 448. RESEARCH AND TRAINING ON DIABETES IN UNDERSERVED AND MINORITY
POPULATIONS.
(a) Research.--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:
``SEC. 434B. RESEARCH ON DIABETES IN UNDERSERVED AND MINORITY
POPULATIONS.
``(a) In General.--The Director of the Institute, in coordination
with the Director of the National Center on Minority Health and Health
Disparities, the Director of the Office of Minority Health, and other
appropriate institutes and centers, shall expand, intensify, and
coordinate research programs on pre-diabetes, type 1 diabetes and type
2 diabetes in underserved populations and minority groups.
``(b) Research.--The research described in subsection (a) shall
include research on--
``(1) behavior, including diet and physical activity and
other aspects of behavior;
``(2) environmental factors related to type 2 diabetes that
are unique to, more serious, or more prevalent, among
underserved or high-risk populations;
``(3) research on the prevention of complications, which
are unique to, more serious, or more prevalent among
minorities, as well as research on how to effectively translate
the findings of clinical trials and research to improve methods
for self-management and health-care delivery; and
``(4) genetic studies of diabetes, consistent with research
conducted under section 430A.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated for purposes of carrying out this section, such sums as
may be necessary for each of fiscal years 2005 through 2010.''.
(b) Division Directors.--Section 428(b)(1) of the Public Health
Service Act (42 U.S.C. 285c-2(b)(1)) is amended by inserting
``(including research training of members of minority populations in
order to facilitate their conduct of diabetes-related research in
underserved populations and minority groups)'' after ``research
programs''.
SEC. 449. AUTHORIZATION OF APPROPRIATIONS.
Subpart 3 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285c et seq.) (as amended by section 448(a)) is amended by
adding at the end the following:
``SEC. 434C. AUTHORIZATION OF APPROPRIATIONS.
``For the purpose of carrying out this subpart with respect to the
programs of the National Institute of Diabetes and Digestive and Kidney
Diseases, other than section 434B, there are authorized to be
appropriated such sums as may be necessary for each of fiscal years
2005 through 2010.''.
SEC. 450. MODEL COMMUNITY DIABETES AND CHRONIC DISEASE CARE AND
PREVENTION AMONG PACIFIC ISLANDERS AND NATIVE HAWAIIANS.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.), as amended by section 432, is further amended by adding
at the end the following:
``SEC. 399P. MODEL COMMUNITY DIABETES AND CHRONIC DISEASE CARE AND
PREVENTION AMONG PACIFIC ISLANDERS AND NATIVE HAWAIIANS.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, may award grants and
enter into cooperative agreements and contracts with eligible entities
to establish a model community demonstration project to provide
training and support for community-based prevention and control
programs targeting diabetes, hypertension, cardiovascular disease, and
other related health problems in American Samoa, the Commonwealth of
the Northern Mariana Islands, Guam, the Federated States of Micronesia,
Hawaii, the Republic of the Marshall Islands, and the Republic of
Palau.
``(b) Eligible Entity Defined.--In this section the term `eligible
entity' means any organization described in section 501(c)(3) of the
Internal Revenue Code of 1986 and exempt from tax under section 501(a)
of such Code.
``(c) Priority.--The Secretary shall give priority for grants,
agreements, and contracts under this section to eligible entities that
have previously administered culturally appropriate Centers for Disease
Control and Prevention programs intended to prevent and control
diabetes in the areas described in subsection (a).
``(d) Regulations.--The Secretary is authorized to promulgate such
regulations as may be necessary to carry out this section.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for fiscal years 2005 through 2010.''.
SEC. 451. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by striking section 317H and inserting the
following:
``SEC. 317H. DIABETES IN CHILDREN AND YOUTH.
``(a) Surveillance on Type 1 Diabetes.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention
and in consultation with the Director of the National Institutes of
Health, shall develop a sentinel system to collect data on type 1
diabetes, including the incidence and prevalence of type 1 diabetes and
shall establish a national database for such data.
``(b) Type 2 Diabetes in Youth.--The Secretary shall implement a
national public health effort to address type 2 diabetes in youth,
including--
``(1) enhancing surveillance systems and expanding research
to better assess the prevalence and incidence of type 2
diabetes in youth and determine the extent to which type 2
diabetes is incorrectly diagnosed as type 1 diabetes among
children;
``(2) standardizing and improving methods to assist in
diagnosis, treatment, and prevention of diabetes including
developing less invasive ways to monitor blood glucose to
prevent hypoglycemia such as nonmydriatic retinal imaging and
improving existing glucometers that measure blood glucose; and
``(3) developing methods to identify obstacles facing
children in traditionally underserved populations to obtain
care to prevent or treat type 2 diabetes.
``(c) Long-Term Epidemiological Studies on Diabetes in Children.--
The Secretary, acting through the Director of the Centers for Disease
Control and Prevention and the Director of the National Institute of
Diabetes and Digestive and Kidney Diseases, shall conduct or support
long-term epidemiology studies in children with diabetes or at risk for
diabetes. Such studies shall investigate the causes and characteristics
of the disease and its complications.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
CHAPTER 6--HEART DISEASE AND STROKE PREVENTION AND TREATMENT
SEC. 455. SYSTEMS FOR HEART DISEASE AND STROKE.
Title XXIX of the Public Health Service Act, as amended by section
443, is further amended by adding at the end the following:
``Subtitle D--Systems for Heart Disease and Stroke
``CHAPTER 1--HEART DISEASE
``SEC. 2941. HEART DISEASE.
``(a) In General.--The Secretary, acting through the National
Heart, Lung and Blood Institute and the Centers for Disease Control,
shall award competitive grants to eligible entities to provide for
community-based interventions to encourage healthy lifestyles to reduce
morbidity and mortality from heart disease.
``(b) Eligible Entities.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be a community-based or non-profit organization,
academic medical institution, hospital, health center, health
plan, health department, or other health-related entity
determined appropriate by the Secretary; 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.--An entity shall use amounts received under a
grant under this section to--
``(1) carry out interventions that address primary
prevention of heart disease in the minority community,
including educational outreach efforts concerning risk factors
for, and the prevention of, heart disease;
``(2) carry out activities to facilitate healthy lifestyles
in minority populations through--
``(A) behavioral change interventions to increase
physical activity and improve nutrition;
``(B) the increased use of community facilities and
public spaces for exercise;
``(C) school, after-school, or intramural physical
activity or sports programs for children and youth;
``(D) employment-based interventions to increase
physical activity or nutrition; or
``(3) expand or evaluate existing programs of the type
described in paragraphs (1) and (2).
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``CHAPTER 2--STROKE EDUCATION CAMPAIGN
``SEC. 2945. STROKE EDUCATION CAMPAIGN.
``(a) In General.--The Secretary shall carry out a national
education and information campaign to promote stroke prevention and
increase the number of stroke patients who seek immediate treatment. In
implementing such education and information campaign, the Secretary
shall avoid duplicating existing stroke education efforts by other
Federal Government agencies and may consult with national and local
associations that are dedicated to increasing the public awareness of
stroke, consumers of stroke awareness products, and providers of stroke
care.
``(b) Use of Funds.--The Secretary may use amounts appropriated to
carry out the campaign described in subsection (a)--
``(1) to make public service announcements about the
warning signs of stroke and the importance of treating stroke
as a medical emergency;
``(2) to provide education regarding ways to prevent stroke
and the effectiveness of stroke treatment;
``(3) to purchase media time and space;
``(4) to pay for advertising production costs;
``(5) to test and evaluate advertising and educational
materials for effectiveness, especially among groups at high
risk for stroke, including women, older adults, and African-
Americans;
``(6) to develop alternative campaigns that are targeted to
unique communities, including rural and urban communities, and
States with a particularly high incidence of stroke;
``(7) to measure public awareness prior to the start of the
campaign on a national level and in targeted communities to
provide baseline data that will be used to evaluate the
effectiveness of the public awareness efforts; and
``(8) to carry out other activities that the Secretary
determines will promote prevention practices among the general
public and increase the number of stroke patients who seek
immediate care.
``(c) Consultations.--In carrying out this section, the Secretary
shall consult with medical, surgical, rehabilitation, and nursing
specialty groups, hospital associations, voluntary health
organizations, emergency medical services, State directors, and
associations, experts in the use of telecommunication technology to
provide stroke care, national disability, minority health professional
organizations and consumer organizations representing individuals with
disabilities and chronic illnesses, concerned advocates, and other
interested parties.
``(d) Stroke.--In this section, the term `stroke' means a `brain
attack' in which blood flow to the brain is interrupted or in which a
blood vessel or aneurysm in the brain breaks or ruptures.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out subsection (b), such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
CHAPTER 7--OBESITY AND OVERWEIGHT REDUCTION
SEC. 461. OVERWEIGHT AND OBESITY PREVENTION AND TREATMENT.
(a) In General.--The Secretary, in collaboration with the Director
of the Centers for Disease Control and Prevention, the Administrator of
the National Center for Minority Health and Health Disparities, and the
Administrator of the Health Resources and Services Administration,
shall establish grant programs for the purpose of preventing and
treating overweight and obesity in underserved minority populations.
(b) Definitions.--In this section, with respect to an individual:
(1) Obesity.--The term ``obesity'' means a Body Mass Index
greater than or equal to 30.0 kg/m<SUP>2</SUP>.
(2) Overweight.--The term ``overweight'' means a Body Mass
Index of 25 to 29.9 kg/m<SUP>2</SUP>.
(c) Centers for Disease Control and Prevention.--The Director of
the Centers for Disease Control and Prevention shall expand overweight
and obesity reduction activities that include the following:
(1) Surveillance in minority racial and ethnic populations.
(2) Communication strategies, including the use of social
marketing for minority populations, about the dangers of
obesity.
(3) Creation of partnerships with State health departments
in developing obesity prevention and treatment interventions.
(4) Development of work-based wellness programs to
encourage adoption of healthy lifestyles by employees.
(d) National Center for Minority Health and Health Disparities.--
The Director of the Centers for Disease Control and Prevention shall
establish and implement a grant program to support research in the
following areas:
(1) Behavioral and environmental causes of overweight and
obesity in minority populations.
(2) Prevention and treatment interventions for overweight
and obesity, tailored for minority populations.
(3) Disparities in the prevalence of overweight and obesity
among racial and ethnic minority groups.
(4) Development and dissemination of best practice
guidelines for treatment of overweight and obesity, tailored
for gender and age groups within minority populations.
(5) Data collection and reporting relating to overweight
and obesity in minority populations.
(e) Health Resources and Services Administration.--The
Administrator of the Health Resources and Services Administration, in
collaboration with the Director of the Office of Minority Health, the
Secretary of Education, and the Secretary of Agriculture, shall
establish and implement a school-based obesity prevention and treatment
program that may include the following activities:
(1) Projects to change the perception of overweight and
obesity of children from racially and ethnically diverse
backgrounds at all ages.
(2) Culturally appropriate student education about healthy
eating habits, based on the Dietary Guidelines for Americans.
(3) Student programs to increase knowledge, attitudes,
skills, behaviors, and confidence needed to be physically
active for life.
(4) Student peer advisor programs to increase awareness and
model healthy lifestyles among fellow students.
(5) Teacher education using scientifically evaluated
physical education and nutrition curricula tailored to minority
populations.
(6) Family-focused initiatives to encourage the adoption of
strategies relating to healthy lifestyles for parents (or
guardians) and children.
(7) The creation of partnerships with community, fitness,
or health organizations that will promote healthy eating and
physical activity among children.
(8) Incentive programs to ensure the provision of healthful
foods and beverages on school campuses and at school events.
(f) Evaluation.--A grantee under this section shall submit to the
Secretary an evaluation, in collaboration with an academic health
center or other qualified entity, that describes activities carried out
with funds received under the grant and the effectiveness of such
activities in preventing or treating overweight and obesity.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
CHAPTER 8--TUBERCULOSIS CONTROL, PREVENTION, AND TREATMENT
SEC. 465. ADVISORY COUNCIL FOR THE ELIMINATION OF TUBERCULOSIS.
Section 317E(f) of the Public Health Service Act (42 U.S.C. 247b-
6(f)) is amended--
(1) by redesignating paragraph (5) as paragraph (6); and
(2) by striking paragraphs (2) through (4), and inserting
the following:
``(2) Duties.--For the purpose of making progress toward
the goal of eliminating tuberculosis from the United States,
the Council shall provide to the Secretary and other
appropriate Federal officials advice on coordinating the
activities of the Public Health Service and other Federal
agencies that relate to such disease and on efficiently
utilizing the Federal resources involved.
``(3) National plan.--In carrying out paragraph (2), the
Council, in consultation with appropriate public and private
entities, shall make recommendations on the development,
revision, and implementation of a national plan to eliminate
tuberculosis in the United States. In carrying out this
paragraph, the Council shall--
``(A) consider the recommendations of the Institute
of Medicine regarding the elimination of tuberculosis;
``(B) address the development and application of
new technologies; and
``(C) review the extent to which progress has been
made toward eliminating tuberculosis.
``(4) Global activities.--In carrying out paragraph (2),
the Council, in consultation with appropriate public and
private entities, shall make recommendations for the
development and implementation of a plan to guide the
involvement of the United States in global and cross border
tuberculosis-control activities, including recommendations
regarding policies, strategies, objectives, and priorities.
Such recommendations for the plan shall have a focus on
countries where a high incidence of tuberculosis directly
affects the United States, such as Mexico, and on access to a
comprehensive package of tuberculosis control measures, as
defined by the World Health Organization directly observed
treatment, short course strategy (commonly known as DOTS).
``(5) Composition.--The Council shall be composed of--
``(A) representatives from the Centers for Disease
Control and Prevention, the National Institutes of
Health, the Agency for Healthcare Research and Quality,
the Health Resources and Services Administration, the
U.S.-Mexico Border Health Commission, and other Federal
departments and agencies that carry out significant
activities relating to tuberculosis; and
``(B) members appointed from among individuals who
are not officers or employees of the Federal
Government.''.
SEC. 466. NATIONAL PROGRAM FOR TUBERCULOSIS ELIMINATION.
Section 317E of the Public Health Service Act (42 U.S.C. 247b-6) is
amended--
(1) by striking the heading for the section and inserting
the following:
``national program for tuberculosis elimination'';
(2) by amending subsection (b) to read as follows:
``(b) Research, Demonstration Projects, Education, and Training.--
With respect to the prevention, control, and elimination of
tuberculosis, the Secretary may, directly or through grants to public
or nonprofit private entities, carry out the following:
``(1) Research, with priority given to research
concerning--
``(A) diagnosis and treatment of latent infection
of tuberculosis;
``(B) strains of tuberculosis resistant to drugs;
``(C) cases of tuberculosis that affect certain
high-risk populations; and
``(D) clinical trials, including those conducted
through the Tuberculosis Trials Consortium.
``(2) Demonstration projects, including for--
``(A) the development of regional capabilities for
the prevention, control, and elimination of
tuberculosis particularly in low-incidence regions; and
``(B) collaboration with the Immigration and
Naturalization Service to identify and treat immigrants
with active or latent tuberculosis infection.
``(3) Public information and education programs.
``(4) Education, training and clinical skills improvement
activities for health professionals, including allied health
personnel.
``(5) Support of model centers to carry out activities
under paragraphs (2) through (4).
``(6) Collaboration with international organizations and
foreign countries, including Mexico, in coordination with the
United States Agency for International Development, in carrying
out such activities, including coordinating activities through
the Advisory Council for the Elimination of Tuberculosis.
``(7) Capacity support to States and large cities for
strengthening tuberculosis programs.''; and
(3) by striking subsection (g) and inserting the following:
``(g) Reports.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention and in consultation with the
Advisory Council for the Elimination of Tuberculosis, shall biennially
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 the activities carried out under
this section. Each report shall include the opinion of the Council on
the extent to which its recommendations under section 317E(f)(3)
regarding tuberculosis have been implemented.
``(h) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2005 through 2010.''.
SEC. 467. INCLUSION OF INPATIENT HOSPITAL SERVICES FOR THE TREATMENT OF
TB-INFECTED INDIVIDUALS.
(a) In General.--Section 1902(z)(2) of the Social Security Act (42
U.S.C. 1396a(z)(2)) is amended by adding at the end the following:
``(G) Inpatient hospital services.''.
(b) Effective Date.--The amendment made by subsection (a) takes
effect on October 1, 2004.
CHAPTER 9--ASTHMA
SEC. 471. PROVISIONS REGARDING NATIONAL ASTHMA EDUCATION AND PREVENTION
PROGRAM OF NATIONAL HEART, LUNG, AND BLOOD INSTITUTE.
In addition to any other authorization of appropriations that is
available to the National Heart, Lung, and Blood Institute for the
purpose of carrying out the National Asthma Education and Prevention
Program, there is authorized to be appropriated to such Institute for
such purpose such sums as may be necessary for each of fiscal years
2005 through 2010. Amounts appropriated under the preceding sentence
shall be expended to expand such Program.
SEC. 472. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR DISEASE CONTROL AND
PREVENTION.
(a) Expansion of Public Health Surveillance Activities; Program for
Providing Information and Education to Public.--The Secretary of Health
and Human Services, acting through the Director of the Centers for
Disease Control and Prevention, shall collaborate with the States to
expand the scope of--
(1) activities that are carried out to determine the
incidence and prevalence of asthma; and
(2) activities that are carried out to prevent the health
consequences of asthma, including through the provision of
information and education to the public regarding asthma, which
may include the use of public service announcements through the
media and such other means as such Director determines to be
appropriate.
(b) Compilation of Data.--The Secretary of Health and Human
Services, acting through the Director of the Centers for Disease
Control and Prevention and in consultation with the National Asthma
Education Prevention Program Coordinating Committee, shall--
(1) conduct local asthma surveillance activities to collect
data on the prevalence and severity of asthma and the quality
of asthma management, including--
(A) telephone surveys to collect sample household
data on the local burden of asthma; and
(B) health care facility specific surveillance to
collect asthma data on the prevalence and severity of
asthma, and on the quality of asthma care; and
(2) compile and annually publish data on--
(A) the prevalence of children suffering from
asthma in each State; and
(B) the childhood mortality rate associated with
asthma nationally and in each State.
(c) Additional Funding.--In addition to any other authorization of
appropriations that is available to the Centers for Disease Control and
Prevention for the purpose of carrying out this section, there is
authorized to be appropriated to such Centers for such purpose such
sums as may be necessary for each of fiscal years 2005 through 2010.
SEC. 473. GRANTS FOR COMMUNITY OUTREACH REGARDING ASTHMA INFORMATION,
EDUCATION, AND SERVICES.
(a) In General.--The Secretary may make grants to nonprofit private
entities for projects to carry out, in communities identified by
entities applying for the grants, outreach activities to provide for
residents of the communities the following:
(1) Information and education on asthma.
(2) Referrals to health programs of public and nonprofit
private entities that provide asthma-related services,
including such services for low-income individuals. The grant
may be expended to make arrangements to coordinate the
activities of such entities in order to establish and operate
networks or consortia regarding such referrals.
(b) Preferences in Making Grants.--In making grants under
subsection (a), the Secretary shall give preference to applicants that
will carry out projects under such subsection in communities that are
disproportionately affected by asthma or underserved with respect to
the activities described in such subsection and in which a significant
number of low-income individuals reside.
(c) Evaluations.--A condition for a grant under subsection (a) is
that the applicant for the grant agree to provide for the evaluation of
the projects carried out under such subsection by the applicant to
determine the extent to which the projects have been effective in
carrying out the activities referred to in such subsection.
(d) Funding.--For the purpose of carrying out this section, there
is authorized to be appropriated such sums as may be necessary for each
of fiscal years 2005 through 2010.
SEC. 474. ACTION PLANS OF LOCAL EDUCATIONAL AGENCIES REGARDING ASTHMA.
(a) In General.--
(1) School-based asthma activities.--The Secretary of
Education (in this section referred to as the ``Secretary''),
in consultation with the Director of the Centers for Disease
Control and Prevention and the Director of the National
Institutes of Health, may make grants to local educational
agencies for programs to carry out at elementary and secondary
schools specified in paragraph (2) asthma-related activities
for children who attend such schools.
(2) Eligible schools.--The elementary and secondary schools
referred to in paragraph (1) are such schools that are located
in communities with a significant number of low-income or
underserved individuals (as defined by the Secretary).
(b) Development of Programs.--Programs under subsection (a) shall
include grants under which local education agencies and State public
health officials collaborate to develop programs to improve the
management of asthma in school settings.
(c) Certain Guidelines.--Programs under subsection (a) shall be
carried out in accordance with applicable guidelines or other
recommendations of the National Institutes of Health (including the
National Heart, Lung, and Blood Institute) and the Environmental
Protection Agency.
(d) Certain Activities.--Activities that may be carried out in
programs under subsection (a) include the following:
(1) Identifying and working directly with local hospitals,
community clinics, advocacy organizations, parent-teacher
associations, minority health organizations, and asthma
coalitions.
(2) Identifying asthmatic children and training them and
their families in asthma self-management.
(3) Purchasing asthma equipment.
(4) Hiring school nurses.
(5) Training teachers, nurses, coaches, and other school
personnel in asthma-symptom recognition and emergency
responses.
(6) Simplifying procedures to improve students' safe access
to their asthma medications.
(7) Such other asthma-related activities as the Secretary
determines to be appropriate.
(e) Definitions.--For purposes of this section, the terms
``elementary school'', ``local educational agency'', and ``secondary
school'' have the meanings given such terms in the Elementary and
Secondary Education Act of 1965.
(f) Funding.--For the purpose of carrying out this section, there
is authorized to be appropriated such sums as may be necessary for each
of fiscal years 2005 through 2010.
CHAPTER 10--SICKLE CELL DISEASE
SEC. 481. DEMONSTRATION PROGRAM FOR THE DEVELOPMENT AND ESTABLISHMENT
OF SYSTEMIC MECHANISMS FOR THE PREVENTION AND TREATMENT
OF SICKLE CELL DISEASE.
(a) Authority To Conduct Demonstration Program.--
(1) In general.--The Administrator, through the Bureau of
Primary Health Care and the Maternal and Child Health Bureau,
shall conduct a demonstration program by making grants to up to
40 eligible entities for each fiscal year in which the program
is conducted under this section for the purpose of developing
and establishing systemic mechanisms to improve the prevention
and treatment of Sickle Cell Disease, including through--
(A) the coordination of service delivery for
individuals with Sickle Cell Disease;
(B) genetic counseling and testing;
(C) bundling of technical services related to the
prevention and treatment of Sickle Cell Disease;
(D) training of health professionals; and
(E) identifying and establishing other efforts
related to the expansion and coordination of education,
treatment, pain management, and continuity of care
programs for individuals with Sickle Cell Disease.
(2) Grant award requirements.--
(A) Geographic diversity.--The Administrator shall,
to the extent practicable, award grants under this
section to eligible entities located in different
regions of the United States.
(B) Priority.--In awarding grants under this
section, the Administrator shall give priority to
awarding grants to eligible entities that are--
(i) Federally-qualified health centers that
have a partnership or other arrangement with a
comprehensive Sickle Cell Disease treatment
center that does not receive funds from the
National Institutes of Health; or
(ii) Federally-qualified health centers
that intend to develop a partnership or other
arrangement with a comprehensive Sickle Cell
Disease treatment center that does not receive
funds from the National Institutes of Health.
(b) Additional Requirements.--An eligible entity awarded a grant
under this section shall use funds made available under the grant to
carry out, in addition to the activities described in subsection
(a)(1), the following activities:
(1) To facilitate and coordinate the delivery of education,
treatment, and continuity of care for individuals with Sickle
Cell Disease under--
(A) the entity's collaborative agreement with a
community-based Sickle Cell Disease organization or a
nonprofit entity that works with individuals who have
Sickle Cell Disease;
(B) the Sickle Cell Disease newborn screening
program for the State in which the entity is located;
and
(C) the maternal and child health program under
title V of the Social Security Act (42 U.S.C. 701 et
seq.) for the State in which the entity is located.
(2) To train nursing and other health staff who specialize
in pediatrics, obstetrics, internal medicine, or family
practice to provide healthcare and genetic counseling for
individuals with the sickle cell trait.
(3) To enter into a partnership with adult or pediatric
hematologists in the region and other regional experts in
Sickle Cell Disease at tertiary and academic health centers and
State and county health offices.
(c) National Coordinating Center.--
(1) Establishment.--The Administrator shall enter into a
contract with an entity to serve as the National Coordinating
Center for the demonstration program conducted under this
section.
(2) Activities described.--The National Coordinating Center
shall--
(A) collect, coordinate, monitor, and distribute
data, best practices, and findings regarding the
activities funded under grants made to eligible
entities under the demonstration program;
(B) develop a model protocol for eligible entities
with respect to the prevention and treatment of Sickle
Cell Disease;
(C) develop educational materials regarding the
prevention and treatment of Sickle Cell Disease; and
(D) prepare and submit to Congress a final report
that includes recommendations regarding the
effectiveness of the demonstration program conducted
under this section and such direct outcome measures
as--
(i) the number and type of healthcare
resources utilized (such as emergency room
visits, hospital visits, length of stay, and
physician visits for individuals with Sickle
Cell Disease); and
(ii) the number of individuals that were
tested and subsequently received genetic
counseling for the sickle cell trait.
(d) Application.--An eligible entity desiring a grant under this
section shall submit an application to the Administrator at such time,
in such manner, and containing such information as the Administrator
may require.
(e) Definitions.--In this section:
(1) Administrator.--The term ``Administrator'' means the
Administrator of the Health Resources and Services
Administration.
(2) Eligible entity.--The term ``eligible entity'' means a
Federally-qualified health center, a nonprofit hospital or
clinic, or a university health center that provides primary
healthcare, that--
(A) has a collaborative agreement with a community-
based Sickle Cell Disease organization or a nonprofit
entity with experience in working with individuals who
have Sickle Cell Disease; and
(B) demonstrates to the Administrator that either
the Federally-qualified health center, the nonprofit
hospital or clinic, the university health center, the
organization or entity described in subparagraph (A),
or the experts described in subsection (b)(3), has at
least 5 years of experience in working with individuals
who have Sickle Cell Disease.
(3) Federally-qualified health center.--The term
``Federally-qualified health center'' has the meaning given
that term in section 1905(l)(2)(B) of the Social Security Act
(42 U.S.C. 1396d(l)(2)(B)).
(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
CHAPTER 11--AUTOIMMUNE DISEASE IN MINORITY POPULATIONS
SEC. 482. RESEARCH FUNDING FOR AUTOIMMUNE DISEASE IN MINORITY
POPULATIONS.
Part B of title IV of the Public Health Service Act is amended by
inserting after section 409E (42 U.S.C. 284i) the following:
``SEC. 490E-1. RESEARCH FUNDING FOR AUTOIMMUNE DISEASE IN MINORITY
POPULATIONS.
``(a) Expansion and Intensification of Activities Regarding
Autoimmune Diseases on Minorities.--With respect to the plan under
section 409E(c)(1), the Coordinating Committee shall ensure that
provisions of the plan developed under paragraph (2) of such subsection
include provisions for the following:
``(1)(A) Basic research, epidemiological research, and
other appropriate research concerning the etiology and causes
of autoimmune diseases in all minorities, including genetic,
hormonal, and environmental factors.
``(B)(i) Giving priority under subparagraph (A) to research
regarding environmental factors.
``(ii) The coordination of (to the extent practicable and
appropriate), and providing additional support for, research
described in clause (i) that is conducted by public or
nonprofit private entities.
``(2)(A) The development of information and education
programs for patients, healthcare providers, and others as
appropriate on genetic, hormonal, and environmental risk
factors associated with autoimmune diseases in minorities, and
on the importance of the prevention or control of such risk
factors and timely referral with appropriate diagnosis and
treatment.
``(B) The inclusion in programs under subparagraph (A) of
information and education on the prevalence and nature of
autoimmune diseases, on risk factors, and on health-related
behaviors that can improve health status in minority
populations.
``(3) Outreach programs for purposes of paragraphs (1) and
(2) that--
``(A) are directed toward minority individuals,
particularly those who are at-risk for autoimmune
diseases; and
``(B) are carried out through community health
centers, community clinics, or other health centers
under section 330, through State, territory, or local
health departments, Indian tribes, or through primary
care physicians.
``(b) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
CHAPTER 12--PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED DISEASES
SEC. 485. PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED DISEASES.
(a) In General.--Section 318(e)(1) of the Public Health Service Act
(42 U.S.C. 247c(e)(1)) is amended by striking ``1998'' and inserting
``2008''.
(b) Preventable Cases of Infertility.--Section 318A of the Public
Health Service Act (42 U.S.C. 247c-1) is amended--
(1) in subsection (q), by striking ``1998'' and inserting
``2010''; and
(2) in subsection (r)(2), by striking ``1998'' and
inserting ``2010''.
CHAPTER 13--DENTAL DISEASE
SEC. 486. GRANTS TO IMPROVE THE PROVISION OF DENTAL SERVICES UNDER
MEDICAID AND SCHIP.
Title V of the Social Security Act (42 U.S.C. 701 et seq.) is
amended by adding at the end the following:
``SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DENTAL SERVICES UNDER
MEDICAID AND SCHIP.
``(a) Authority To Make Grants.--In addition to any other payments
made under this title to a State, the Secretary shall award grants to
States that satisfy the requirements of subsection (b) to improve the
provision of dental services to children who are enrolled in a State
plan under title XIX or a State child health plan under title XXI (in
this section, collectively referred to as the `State plans').
``(b) Requirements.--In order to be eligible for a grant under this
section, a State shall provide the Secretary with the following
assurances:
``(1) Improved service delivery.--The State shall have a
plan to improve the delivery of dental services to children,
including children with special health care needs, who are
enrolled in the State plans, including providing outreach and
administrative case management, improving collection and
reporting of claims data, and providing incentives, in addition
to raising reimbursement rates, to increase provider
participation.
``(2) Adequate payment rates.--The State has provided for
payment under the State plans for dental services for children
at levels consistent with the market-based rates and sufficient
enough to enlist providers to treat children in need of dental
services.
``(3) Ensured access.--The State shall ensure it will make
dental services available to children enrolled in the State
plans to the same extent as such services are available to the
general population of the State.
``(c) Use of Funds.--
``(1) In general.--Funds provided under this section may be
used to provide administrative resources (such as program
development, provider training, data collection and analysis,
and research-related tasks) to assist States in providing and
assessing services that include preventive and therapeutic
dental care regimens.
``(2) Limitation.--Funds provided under this section may
not be used for payment of direct dental, medical, or other
services or to obtain Federal matching funds under any Federal
program.
``(d) Application.--A State shall submit an application to the
Secretary for a grant under this section in such form and manner and
containing such information as the Secretary may require.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to make grants under this section, such sums as may be
necessary for fiscal year 2005 and each fiscal year thereafter.
``(f) Application of Other Provisions of Title.--
``(1) In general.--Except as provided in paragraph (2), the
other provisions of this title shall not apply to a grant made
under this section.
``(2) Exceptions.--The following provisions of this title
shall apply to a grant made under subsection (a) to the same
extent and in the same manner as such provisions apply to
allotments made under section 502(c):
``(A) Section 504(b)(6) (relating to prohibition on
payments to excluded individuals and entities).
``(B) Section 504(c) (relating to the use of funds
for the purchase of technical assistance).
``(C) Section 504(d) (relating to a limitation on
administrative expenditures).
``(D) Section 506 (relating to reports and audits),
but only to the extent determined by the Secretary to
be appropriate for grants made under this section.
``(E) Section 507 (relating to penalties for false
statements).
``(F) Section 508 (relating to nondiscrimination).
``(G) Section 509 (relating to the administration
of the grant program).''.
SEC. 487. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE TO
CHILDREN WHO HAVE OTHER HEALTH COVERAGE.
(a) In General.--
(1) SCHIP.--
(A) State option to provide wrap-around coverage.--
Section 2110(b) of the Social Security Act (42 U.S.C.
1397jj(b)) is amended--
(i) in paragraph (1)(C), by inserting ``,
subject to paragraph (5),'' after ``under title
XIX or''; and
(ii) by adding at the end the following:
``(5) State option to provide wrap-around coverage.--A
State may waive the requirement of paragraph (1)(C) that a
targeted low-income child may not be covered under a group
health plan or under health insurance coverage, if the State
satisfies the conditions described in subsection (c)(8). The
State may waive such requirement in order to provide--
``(A) dental services;
``(B) cost-sharing protection; or
``(C) all services.
In waiving such requirement, a State may limit the application
of the waiver to children whose family income does not exceed a
level specified by the State, so long as the level so specified
does not exceed the maximum income level otherwise established
for other children under the State child health plan.''.
(B) Conditions described.--Section 2105(c) of the
Social Security Act (42 U.S.C. 1397ee(c)) is amended by
adding at the end the following:
``(8) Conditions for provision of wrap-around coverage.--
For purposes of section 2110(b)(5), the conditions described in
this paragraph are the following:
``(A) Income eligibility.--The State child health
plan (whether implemented under title XIX or this
XXI)--
``(i) has the highest income eligibility
standard permitted under this title as of
January 1, 2002;
``(ii) subject to subparagraph (B), does
not limit the acceptance of applications for
children; and
``(iii) provides benefits to all children
in the State who apply for and meet eligibility
standards.
``(B) No waiting list imposed.--With respect to
children whose family income is at or below 200 percent
of the poverty line, the State does not impose any
numerical limitation, waiting list, or similar
limitation on the eligibility of such children for
child health assistance under such State plan.
``(C) No more favorable treatment.--The State child
health plan may not provide more favorable coverage of
dental services to the children covered under section
2110(b)(5) than to children otherwise covered under
this title.''.
(C) State option to waive waiting period.--Section
2102(b)(1)(B) of the Social Security Act (42 U.S.C.
1397bb(b)(1)(B)) is amended--
(i) in clause (i), by striking ``and'' at
the end;
(ii) in clause (ii), by striking the period
and inserting ``; and''; and
(iii) by adding at the end the following:
``(iii) at State option, may not apply a
waiting period in the case of a child described
in section 2110(b)(5), if the State satisfies
the requirements of section 2105(c)(8).''.
(2) Application of enhanced match under medicaid.--Section
1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
(A) in subsection (b), in the fourth sentence, by
striking ``or subsection (u)(3)'' and inserting
``(u)(3), or (u)(4)''; and
(B) in subsection (u)--
(i) by redesignating paragraph (4) as
paragraph (5); and
(ii) by inserting after paragraph (3) the
following:
``(4) For purposes of subsection (b), the expenditures
described in this paragraph are expenditures for items and
services for children described in section 2110(b)(5), but only
in the case of a State that satisfies the requirements of
section 2105(c)(8).''.
(3) Application of secondary payor provisions.--Section
2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1))
is amended--
(A) by redesignating subparagraphs (B) through (D)
as subparagraphs (C) through (E), respectively; and
(B) by inserting after subparagraph (A) the
following:
``(B) Section 1902(a)(25) (relating to coordination
of benefits and secondary payor provisions) with
respect to children covered under a waiver described in
section 2110(b)(5).''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on January 1, 2004, and shall apply to child health
assistance and medical assistance provided on or after that date.
SEC. 488. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH SERVICES
THROUGH COMMUNITY HEALTH CENTERS AND PUBLIC HEALTH
DEPARTMENTS.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by insert before section 330, the following:
``SEC. 329. GRANT PROGRAM TO EXPAND THE AVAILABILITY OF SERVICES.
``(a) In General.--The Secretary, acting through the Health
Resources and Services Administration, shall establish a program under
which the Secretary may award grants to eligible entities and eligible
individuals to expand the availability of primary dental care services
in dental health professional shortage areas or medically underserved
areas.
``(b) Eligibility.--
``(1) Entities.--To be eligible to receive a grant under
this section an entity--
``(A) shall be--
``(i) a health center receiving funds under
section 330 or designated as a Federally
qualified health center;
``(ii) a county or local public health
department, if located in a federally-
designated dental health professional shortage
area;
``(iii) an Indian tribe or tribal
organization (as defined in section 4 of the
Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b));
``(iv) a dental education program
accredited by the Commission on Dental
Accreditation; or
``(v) a community-based program whose child
service population is made up of at least 33
percent of children who are eligible children,
including at least 25 percent of such children
being children with mental retardation or
related developmental disabilities, unless
specific documentation of a lack of need for
access by this sub-population is established;
and
``(B) shall prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require, including information concerning dental
provider capacity to serve individuals with
developmental disabilities.
``(2) Individuals.--To be eligible to receive a grant under
this section an individual shall--
``(A) be a dental health professional licensed or
certified in accordance with the laws of State in which
such individual provides dental services;
``(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require; and
``(C) provide assurances that--
``(i) the individual will practice in a
federally-designated dental health professional
shortage area; or
``(ii) not less than 25 percent of the
patients of such individual are--
``(I) receiving assistance under a
State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et
seq.);
``(II) receiving assistance under a
State plan under title XXI of the
Social Security Act (42 U.S.C. 1397aa
et seq.); or
``(III) uninsured.
``(c) Use of Funds.--
``(1) Entities.--An entity shall use amounts received under
a grant under this section to provide for the increased
availability of primary dental services in the areas described
in subsection (a). Such amounts may be used to supplement the
salaries offered for individuals accepting employment as
dentists in such areas.
``(2) Individuals.--A grant to an individual under
subsection (a) shall be in the form of a $1,000 bonus payment
for each month in which such individual is in compliance with
the eligibility requirements of subsection (b)(2)(C).
``(d) Authorization of Appropriations.--
``(1) In general.--Notwithstanding any other amounts
appropriated under section 330 for health centers, there is
authorized to be appropriated such sums as may be necessary for
each of fiscal years 2005 through 2010 to hire and retain
dental healthcare providers under this section.
``(2) Use of funds.--Of the amount appropriated for a
fiscal year under paragraph (1), the Secretary shall use--
``(A) not less than 65 percent of such amount to
make grants to eligible entities; and
``(B) not more than 35 percent of such amount to
make grants to eligible individuals.''.
CHAPTER 14--PREVENTION AND CONTROL OF INJURIES
SEC. 491. PREVENTION AND CONTROL OF INJURIES.
(a) In General.--Section 394A of the Public Health Service Act (42
U.S.C. 280b-3) is amended--
(1) by striking ``and'' after ``1994,'';
(2) by striking ``and'' after ``1998,''; and
(3) by striking ``through 2005'' and all that follows and
inserting the following: ``through 2004, $300,000,000 for
fiscal year 2005, and such sums as may be necessary for each of
the fiscal years 2006 through 2010.''.
(b) Demonstration Projects in Urban Areas.--Section 394A of the
Public Health Service Act (42 U.S.C. 280b-3) is amended by adding at
the end the following sentence: ``For the purpose of carrying out
section 393(a)(6) in urban areas, there are authorized to be
appropriated such sums as may be necessary for each of the fiscal years
2005 through 2010, in addition to amounts available for such purpose
pursuant to the preceding sentence.''.
(c) Demonstration Projects Regarding Violence.--Section 393 of the
Public Health Service Act (42 U.S.C. 280b-1a) is amended--
(1) by redesignating subsection (b) as subsection (c); and
(2) by inserting after subsection (a) the following
subsection:
``(b) Grants under subsection (a)(6) shall include grants to public
or nonprofit private trauma centers for demonstration projects to
reduce violence.''.
CHAPTER 15--UTERINE FIBROID RESEARCH AND EDUCATION
SEC. 495. RESEARCH WITH RESPECT TO UTERINE FIBROIDS.
(a) In General.--The Director of the National Institutes of Health
(in this section referred to as the ``Director of NIH'') shall expand,
intensify, and coordinate programs for the conduct and support of
research with respect to uterine fibroids.
(b) Administration.--
(1) In general.--The Director of NIH shall carry out this
section through the appropriate institutes, offices, and
centers, including the National Institute of Child Health and
Human Development, the National Institute of Environmental
Health Sciences, the Office of Research on Women's Health, the
National Center on Minority Health and Health Disparities, and
any other agencies that the Director of NIH determines to be
appropriate.
(2) Coordination of activities.--The Office of Research on
Women's Health shall coordinate activities under paragraph (1)
among the institutes, offices, and centers of the National
Institutes of Health.
(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2005 through 2010.
SEC. 496. INFORMATION AND EDUCATION WITH RESPECT TO UTERINE FIBROIDS.
(a) Uterine Fibroids Public Education Program.--
(1) In general.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary''), acting
through the Director of the Centers for Disease Control and
Prevention, shall develop and disseminate to the public
information regarding uterine fibroids, including information
on--
(A) the incidence and prevalence of uterine
fibroids;
(B) the elevated risk for minority women; and
(C) the availability, as medically appropriate, of
a range of treatment options for symptomatic uterine
fibroids.
(2) Dissemination.--The Secretary may disseminate
information under paragraph (1) directly, or through
arrangements with nonprofit organizations, consumer groups,
institutions of higher education (as defined in section 101 of
the Higher Education Act of 1965 (20 U.S.C. 1001)), Federal,
State, or local agencies, or the media.
(3) Authorization of appropriations.--For the purpose of
carrying out this subsection, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2005 through 2010.
(b) Uterine Fibroids Information Program for Health Care
Providers.--
(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall develop and disseminate to health care
providers information on uterine fibroids, including
information on the elevated risk for minority women and the
range of available options for the treatment of symptomatic
uterine fibroids.
(2) Authorization of appropriations.--For the purpose of
carrying out this subsection, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2005 through 2010.
(c) Definition.--For purposes of this section, the term
``minority'', with respect to women, means women who are members of
racial or ethnic minority groups within the meaning of section 1707 of
the Public Health Service Act (42 U.S.C. 300u-6).
TITLE V--DATA COLLECTION AND REPORTING.
Subtitle A--General Provisions
SEC. 501. 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, and primary
language among federally supported health programs.
(b) Amendment.--Title XXIX of the Public Health Service Act, as
amended by section 463, is further amended by adding at the end the
following:
``Subtitle E--Data Collection and Reporting
``SEC. 2951. DATA ON RACE, ETHNICITY AND PRIMARY LANGUAGE.
``(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, and
primary language of each applicant for and recipient of
health-related assistance under such program--
``(i) using, at a minimum, the categories
for race and ethnicity described in the 1997
Office of Management and Budget Standards for
Maintaining, Collecting, and Presenting Federal
Data on Race and Ethnicity;
``(ii) using the standards developed under
subsection (e) for the collection of language
data;
``(iii) where practicable, collecting data
for additional population groups if such groups
can be aggregated into the minimum race and
ethnicity categories; and
``(iv) where practicable, through self-
report;
``(B) with respect to the collection of the data
described in subparagraph (A) for applicants and
recipients who are minors or 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 preferred 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 in health and
healthcare and when appropriate, for men and women
separately, and report the results of such analysis to
the Secretary, the Director of the Office for Civil
Rights, 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,
and primary language 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) require 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) is 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 improve the collection,
analysis, and reporting of racial, ethnic, and primary language data at
the Federal, State, territorial, Tribal, and local levels, including
data to be collected under subsection (a). 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, 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, and
primary language is legal and necessary to assure equity and
non-discrimination in the quality of healthcare services;
``(3) ensure that future patient record systems have data
code sets for racial, ethnic, and primary language identifiers
and that such identifiers can be retrieved from clinical
records, including records transmitted electronically;
``(4) improve health and healthcare 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, and primary language 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) Language Collection Standards.--Not later than 1 year after
the date of enactment of this title, the Director of the Office of
Minority Health, in consultation with the Office for Civil Rights of
the Department of Health and Human Services, shall develop and
disseminate Standards for the Classification of Federal Data on
Preferred Written and Spoken Language.
``(f) 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 healthcare 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, and primary language
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, and
preferred language are legal and essential for
eliminating health and healthcare disparities.
``(g) Analysis of Racial and Ethnic 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
and Medicaid Services, shall provide technical assistance to agencies
of the Department of Health and Human Services in meeting Federal
standards for race, ethnicity, and primary language data collection and
analysis of racial and ethnic disparities in health and healthcare 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 in health and healthcare;
``(4) identifying the level at which data analysis should
be conducted; and
``(5) sharing data with external organizations for research
and quality improvement purposes.
``(h) National Conference.--
``(1) In general.--The Secretary shall sponsor a biennial
national conference on racial, ethnic, and primary language
data collection to enhance coordination, build partnerships,
and share best practices in racial, ethnic, and primary
language data collection, analysis, and reporting.
``(2) Reports.--Not later than 6 months after the date on
which a national conference has convened under paragraph (1),
the Secretary shall publish in the Federal Register and submit
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 a report concerning the proceedings
and findings of the conference.
``(i) Report.--Not later than 2 years after the date of enactment
of this title, and biennially thereafter, the Secretary shall submit to
the appropriate committees of Congress a report on the effectiveness of
data collection, analysis, and reporting on race, ethnicity, and
primary language under the programs and activities of the Department of
Health and Human Services and under other Federal data collection
systems with which the Department interacts to collect relevant data on
race and ethnicity. The report shall evaluate the progress made in the
Department with respect to the national plan under subsection (c) or
subsequent revisions thereto.
``(j) Grants for Data Collection by Health Plans, Health Centers,
and Hospitals.--
``(1) In general.--The Secretary, in consultation with the
Administrator of the Centers for Medicare and Medicaid
Services, is authorized to award grants for the conduct of 20
demonstration programs by health plans, health centers, or
hospitals to enhance their ability to collect, analyze, and
report the data required under subsection (a).
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1), a health plan or hospital shall--
``(A) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require, including a plan to eliminate racial, ethnic,
and primary language disparities in health and
healthcare through one or more of the activities
described in paragraph (3); and
``(B) provide assurances that the health plan or
hospital will use, at a minimum, the racial and ethnic
categories and the standards for collection described
in the 1997 Office of Management and Budget Standards
for Maintaining, Collecting, and Presenting Federal
Data on Race and Ethnicity and available standards for
language.
``(3) Activities.--A grantee shall use amounts received
under a grant under paragraph (1) to--
``(A) collect, analyze, and report data by race,
ethnicity, and primary language for patients served by
the hospital (including emergency room patients and
patients served on an outpatient basis) or health
center, or, in the case of a private health plan, such
data for enrollees;
``(B) enhance or upgrade computer technology that
will facilitate racial, ethnic, and primary language
data collection and analysis;
``(C) provide analyses of racial and ethnic
disparities in health and healthcare, including
specific disease conditions, diagnostic and therapeutic
procedures, or outcomes;
``(D) improve health data collection and analysis
for additional population groups beyond the Office of
Management and Budget categories if such groups can be
aggregated into the minimum race and ethnicity
categories;
``(E) develop mechanisms for sharing collected data
subject to privacy and confidentiality regulations;
``(F) develop educational programs to inform health
insurance issuers, health plans, health providers,
health-related agencies, patients, enrollees, and the
general public that data collection, analysis, and
reporting by race, ethnicity, and preferred language
are legal and essential for eliminating disparities in
health and healthcare; and
``(G) develop quality assurance systems designed to
track disparities and quality improvement systems
designed to eliminate disparities.
``(l) 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 pay for healthcare and services; and
``(2) under this Act that provide Federal financial
assistance for healthcare, biomedical research, health services
research, and programs designed to improve the public's health.
``(m) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2952. PROVISIONS RELATING TO NATIVE AMERICANS.
``(a) Epidemiology Centers.--
``(1) Establishment.--
``(A) In general.--In addition to those centers
operating 1 day prior to the date of enactment of this
title, (including those centers for which funding is
currently being provided through funding agreements
under the Indian Self-Determination and Education
Assistance Act), the Secretary shall, not later than
180 days after such date of enactment, establish and
fund an epidemiology center in each service area which
does not have such a center to carry out the functions
described in subparagraph (B). Any centers established
under the preceding sentence may be operated by Indian
tribes or tribal organizations pursuant to funding
agreements under the Indian Self-Determination and
Education Assistance Act, but funding under such
agreements may not be divisible.
``(B) Functions.--In consultation with and upon the
request of Indian tribes, tribal organizations and
urban Indian organizations, each area epidemiology
center established under this subsection shall, with
respect to such area shall--
``(i) collect data related to the health
status objective described in section 3(b) of
the Indian Health Care Improvement Act, and
monitor the progress that the Service, Indian
tribes, tribal organizations, and urban Indian
organizations have made in meeting such health
status objective;
``(ii) evaluate existing delivery systems,
data systems, and other systems that impact the
improvement of Indian health;
``(iii) 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;
``(iv) make recommendations for the
targeting of services needed by tribal, urban,
and other Indian communities;
``(v) make recommendations to improve
healthcare delivery systems for Indians and
urban Indians;
``(vi) provide requested technical
assistance to Indian tribes 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
``(vii) 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.
``(2) Funding.--The Secretary may make funding available to
Indian tribes, tribal organizations, and eligible intertribal
consortia or urban Indian organizations to conduct
epidemiological studies of Indian communities.
``(b) Definitions.--For purposes of this section, the definitions
contained in section 4 of the Indian Health Care Improvement Act shall
apply.''.
SEC. 502. 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. 1150A. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL
SECURITY ADMINISTRATION.
``(a) Requirement.--The Commissioner of the Social Security
Administration in consultation with the Administrator of the Centers
for Medicare and Medicaid Services shall--
``(1) require the collection of data on the race,
ethnicity, and primary language of all applicants for social
security numbers, social security income, social security
disability, and medicare--
``(A) using, at a minimum, the categories for race
and ethnicity described in the 1997 Office of
Management and Budget Standards for Maintaining,
Collecting, and Presenting Federal Data on Race and
Ethnicity and available language standards; and
``(B) where practicable, collecting data for
additional population groups if such groups can be
aggregated into the minimum race and ethnicity
categories;
``(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 and
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, and
primary language data.
``(b) Protection of Data.--The Commissioner of Social Security
shall ensure (through the promulgation of regulations or otherwise)
that all data collected pursuant subsection (a) is 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 Education Program.--Not later than 18 months after
the date of enactment of this section, the Secretary, acting through
the Director of the Office of Minority Health and in collaboration with
the Commissioner of the Social Security Administration, shall develop
and implement a program to educate all populations about the purpose
and uses of racial, ethnic, and primary language health data
collection.
``(d) 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.
``(e) 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.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.''.
SEC. 503. 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.), as added by the Health
Insurance Portability and Accountability Act of 1996 (Public Law 104-
191), 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 categories for race and
ethnicity described in the 1997 Office of Management and Budget
Standards for Maintaining, Collecting, and Presenting Federal
Data on Race and Ethnicity;
(2) the establishment of a new data code set for primary
language; and
(3) the designation of the racial, ethnic, and primary
language 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. 504. 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
``2010'';
(2) in paragraph (2), in the first sentence, by striking
``2003'' and inserting ``2010''; and
(3) in paragraph (3), by striking ``2002'' and inserting
``2010''.
Subtitle B--Minority Health and Genomics Commission
SEC. 511. SHORT TITLE.
This subtitle may be cited as the ``Minority Health and Genomics
Act of 2003''.
SEC. 512. MINORITY HEALTH AND GENOMICS COMMISSION.
(a) Establishment.--There is established a commission to be known
as the Minority Health and Genomics Commission (in this subtitle
referred to as the ``Commission'').
(b) Duties.--
(1) Study.--The Commission shall conduct a thorough study
of, and develop recommendations on, issues relating to genomic
research as applied to minority groups and, under section 516,
submit a report to the appropriate committees of Congress that
recommends policies that the Commission finds will ultimately
improve healthcare and promote the elimination of health
disparities.
(2) Issues.--The study under paragraph (1) shall address
specific issues and the needs of each minority group described
in subparagraph (A) in addition to issues involving genomic
research that affect the groups as a whole. In conducting such
study the Commission shall carry out the following:
(A) Establish standards in genomic research and
services that will promote the improvement of health
and health-related services for the following groups:
American Indians and Alaska Natives, African Americans,
Asian Americans, Hispanics, and Native Hawaiians and
other Pacific Islanders.
(B) Recommend minimum requirements and standards
for the equitable use of genetics research in patient
care and public health services for racial and ethnic
minority patients.
(C) Examine the accessibility, effectiveness,
availability, and cost efficiency of genomic research,
genetic testing, genetic counseling, and genetic
screening to minority populations.
(D) Determine and recommend procedures and policies
to address the need for cultural, linguistic, and
religious sensitivity training for genetic counselors
and researchers who work with minority groups.
(E) Evaluate whether minority persons are provided
with informed consent that is culturally and
linguistically appropriate to allow a fully informed
decision about their healthcare, availability of
treatments or options, or participation in any clinical
trial involving the collection of genetic material.
(F) Recommend how population sampling studies of
genetic information can be improved to aid in the
elimination of health disparities and improve
healthcare for minority communities.
(G) Examine how genetic material or information
derived from individual minorities is used the help
minority groups with the use of highly specific drug
therapies.
(H) Identify the accessibility, effectiveness,
availability, privacy, and benefit of genetic databases
and depositories to minority communities.
(I) Identify the accessibility, effectiveness, and
affordability of reproductive technologies to minority
groups.
(J) Recommend an incentives program for genomic
researchers that will encourage the study of disease
and genetic ailments that disproportionately affect
minority communities.
SEC. 513. REPORT.
Not later than 2 years after the date of the enactment of this Act,
the Commission shall prepare and submit to the appropriate committees
of Congress, the President, and the general public a report containing
a detailed statement of the findings and conclusions of the Commission
with respect to matters described in section 512(b)(2), together with
such recommendations as the Commission considers appropriate that may
be specific to each minority group.
SEC. 514. MEMBERSHIP.
(a) Number and Appointment.--The Commission shall be composed of 17
members to be appointed as follows:
(1) Four members shall be appointed by the Speaker of the
House of Representatives.
(2) Four members shall be appointed by the minority leader
of the House of Representatives.
(3) Four members shall be appointed by the majority leader
of the Senate.
(4) Four members shall be appointed by the minority leader
of the Senate.
(5) One member shall be appointed by the President.
(b) Persons Eligible.--
(1) In general.--The members of the Commission shall be
individuals who have knowledge or expertise, whether by
experience or training, in matters to be studied by the
Commission. The members may be from the public or private
sector, and may include employees of the Federal Government or
of State, territory, tribal, or local governments, members of
academia, legal scholars and practitioners, tribal leaders,
representatives of nonprofit organizations, or other interested
individuals who demonstrate a dedication to the use of genomics
to improve minority healthcare and the elimination of health
disparities among minorities.
(2) Diversity.--It is the intent of Congress that
individuals appointed to the Commission represent diverse
interests, ethnicities, various professional backgrounds, and
are from different regions of the United States.
(c) Consultation and Appointment.--
(1) In general.--The President, Speaker of the House of
Representatives, minority leader of the House of
Representatives, majority leader of the Senate, and minority
leader of the Senate shall consult among themselves before
appointing the members of the Commission in order to achieve,
to the maximum extent practicable, fair and equitable
representation of various points of view with respect to
matters studied by the Commission.
(2) Date of appointment.--The appointments of the members
of the Commission shall be made not later than 90 days after
the date of enactment of this Act.
(d) Terms.--
(1) In general.--Each member of the Commission shall be
appointed for the life of the Commission.
(2) Vacancies.--A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
(e) Basic Pay.--Members of the Commission shall serve without pay.
(f) Travel Expenses.--Each member of the Commission shall receive
travel expenses, including per diem in lieu of subsistence, in
accordance with applicable provisions under subchapter I of chapter 57
of title 5, United States Code.
(g) Chairperson and Vice Chairperson.--The members of the
Commission shall elect a Chairperson and Vice Chairperson of the
Commission from among the members.
(h) Meetings.--
(1) In general.--The Commission shall meet at the call of
the Chairperson or a majority of its members.
(2) Initial meeting.--Not later than 30 days after the date
on which all members of the Commission have been appointed, the
Commission shall hold its first meeting.
SEC. 515. POWERS OF COMMISSION.
(a) Hearings and Sessions.--The Commission may, for the purpose of
carrying out this subtitle, hold hearings, sit and act at times and
places, take testimony, and receive evidence as the Commission
considers appropriate to carry out this subtitle.
(b) Powers of Members and Agents.--Any member or agent of the
Commission may, if authorized by the Commission, take any action that
the Commission is authorized to take by this section.
(c) Obtaining Official Data.--Notwithstanding sections 552 and 552a
of title 5, United States Code, the Commission may secure directly from
any department or agency of the United States information necessary to
enable it to carry out this subtitle. Upon request of the Commission,
the head of that department or agency shall furnish that information to
the Commission.
(d) Postal Services.--The Commission may use the United States
mails in the same manner and under the same conditions as other
departments and agencies of the United States.
(e) Website.--For purposes of conducting the study under section
512(b)(1), the Commission shall establish and maintain a website to
facilitate public comment and participation.
(f) Staff of Federal Agencies.--Upon request of the Commission, the
head of any Federal department or agency may detail, on a
nonreimbursable basis, any of the personnel of that department or
agency to the Commission to assist it in carrying out its duties under
this subtitle.
(g) Administrative Support Services.--Upon the request of the
Commission, the Administrator of General Services may provide to the
Commission, on a nonreimbursable basis, the administrative support
services necessary for the Commission to carry out its responsibilities
under this subtitle.
SEC. 516. TERMINATION.
The Commission shall terminate 1 year after submitting its final
report pursuant to section 513.
TITLE VI--ACCOUNTABILITY
SEC. 601. REPORT ON WORKFORCE DIVERSITY.
(a) In General.--Not later than July 1, 2005, and annually
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 healthcare workforce diversity.
(b) Requirement.--The report under subsection (a) shall contain the
following information:
(1) The response of the entity involved to the upcoming
2004 Institute of Medicine report on workforce diversity, the
2002 Institute of Medicine report entitled The Future of the
Public Health in the 21st Century, and the Healthy People 2010
initiative.
(2) A description of the personnel in each such entity who
are responsible for overseeing workforce diversity initiatives.
(3) The level of workforce diversity achieved within each
such entity, including absolute numbers and percentages of
minority employees as well as the rank of such employees.
(4) A description of any grant support that is provided by
each entity for workforce diversity initiatives, including the
amount of the grants and the percentage of grant funds as
compared to overall entity funding;
(c) Public Availability.--The report under subsection (a) shall be
made available for public review and comment.
SEC. 602. FEDERAL AGENCY PLAN TO ELIMINATE DISPARITIES AND IMPROVE THE
HEALTH OF MINORITY POPULATIONS.
(a) In General.--Not later than September 1, 2005, each Federal
health agency shall develop and implement a national strategic action
plan to eliminate disparities on the basis of race, ethnicity, and
primary language and improve the health and healthcare of minority
populations, through programs relevant to the mission of the agency.
(b) Publication.--Each action plan described in paragraph (1)
shall--
(1) be publicly reported in draft form for public review
and comment;
(2) include a response to the review and comment described
in paragraph (1) in the final plan;
(3) include the agency response to the 2002 Institute of
Medicine report, Unequal Treatment--Confronting Racial and
Ethnic Disparities in Healthcare;
(4) demonstrate progress in meeting the Healthy People 2010
objectives; and
(5) be updated, including progress reports, for inclusion
in an annual report to Congress.
SEC. 603. ACCOUNTABILITY WITHIN THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES.
Title XXIX of the Public Health Service Act, as amended by section
502(b), is further amended by adding at the end the following:
``Subtitle F--Accountability
``SEC. 2961. 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 healthcare 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). 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
healthcare 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 2962.
``(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; and
``(E) civil rights.
``(d) Report.--Not later than December 31, 2005, and annually
thereafter, the Secretary, in collaboration with the Director of the
Office for Civil Rights, 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; and
``(4) the staffing levels of the office including staff
credentials.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2962. 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, or disability; and
``(2) promotes the reduction and elimination of disparities
in health and healthcare based on race, national origin,
language, ethnicity, sex, age, and disability.
``(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 healthcare related to race, national
origin, language, ethnicity, sex, age, and disability.
``(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 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 healthcare 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 healthcare and services; and
``(2) under this Act that provide Federal financial
assistance for healthcare, biomedical research, health services
research, and programs designed to improve the public's
health.''.
SEC. 604. OFFICE OF MINORITY HEALTH.
Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is
amended--
(1) by striking the section heading and inserting the
following:
``office of minority health and racial, ethnic, and primary language
health disparity elimination'';
(2) by striking ``Office of Minority Health'' each place
that such appears and inserting ``Office of Minority Health and
Racial, Ethnic, and Primary Language Health Disparities
Elimination'';
(3) by striking subsection (b) and inserting the following:
``(b) Duties.--With respect to improving the health of racial and
ethnic minority groups, the Secretary, acting through the Deputy
Assistant Secretary for Minority Health and Racial, Ethnic, and Primary
Language Health Disparities Elimination (in this section referred to as
the `Deputy Assistant Secretary'), shall carry out the following:
``(1) Establish, implement, monitor, and evaluate short-
range and long-range goals and objectives and oversee all other
activities within the Public Health Service that relate to
disease prevention, health promotion, service delivery, and
research concerning minority groups. The heads of each of the
agencies of the Service shall consult with the Deputy Assistant
Secretary to ensure the coordination of such activities.
``(2) Oversee all activities within the Department of
Health and Human Services that relate to reducing or
eliminating disparities in health and healthcare in racial and
ethnic minority populations, including coordinating--
``(A) the design of programs, support for programs,
and the evaluation of programs;
``(B) the monitoring of trends in health and
healthcare;
``(C) research efforts;
``(D) the training of health providers; and
``(E) information and education programs and
campaigns.
``(3) Enter into interagency and intra-agency agreements
with other agencies of the Public Health Service.
``(4) Ensure that the Federal health agencies and the
National Center for Health Statistics collect data on the
health status and healthcare of each minority group, using at a
minimum the categories specified in the 1997 OMB Standards for
Maintaining, Collecting, and Presenting Federal Data on Race
and Ethnicity as required under subtitle B and available
language standards.
``(5) Provide technical assistance to States, local
agencies, territories, Indian tribes, and entities for
activities relating to the elimination of racial and ethnic
disparities in health and healthcare.
``(6) Support a national minority health resource center to
carry out the following:
``(A) Facilitate the exchange of information
regarding matters relating to health information,
health promotion and wellness, preventive health
services, and education in the appropriate use of
health services.
``(B) Facilitate timely access to culturally and
linguistically appropriate information.
``(C) Assist in the analysis of such information.
``(D) Provide technical assistance with respect to
the exchange of such information (including
facilitating the development of materials for such
technical assistance).
``(7) Carry out programs to improve access to healthcare
services for individuals with limited English proficiency,
including developing and carrying out programs to provide
bilingual or interpretive services through the development and
support of a National Center for Cultural and Linguistic
Competence in Healthcare as provided for in section 2903.
``(8) Carry out programs to improve access to healthcare
services and to improve the quality of healthcare services for
individuals with low functional health literacy. As used in the
preceding sentence, the term `functional health literacy' means
the ability to obtain, process, and understand basic health
information and services needed to make appropriate health
decisions.
``(9) Advise in matters related to the development,
implementation, and evaluation of health professions education
on decreasing disparities in healthcare outcomes, with focus on
cultural competency as a method of eliminating disparities in
health and healthcare in racial and ethnic minority
populations.
``(10) Assist healthcare professionals, community and
advocacy organizations, academic centers and public health
departments in the design and implementation of programs that
will improve the quality of health outcomes by strengthening
the provider-patient relationship.''.
(2) by redesignating subsections (c) through (f) and
subsections (g) and (h) as subsections (d) through (g) and
subsections (j) and (k), respectively;
(3) by inserting after subsection (b), the following:
``(c) National Plan To Eliminate Racial and Ethnic Health and
Healthcare Disparities.--
``(1) In general.--The Secretary, acting through the Deputy
Assistant Secretary, shall--
``(A) not later than 1 year after the date of
enactment of the Healthcare Equality and Accountability
Act, establish and implement a comprehensive plan to
achieve the goal of Healthy People 2010 to eliminate
health disparities in the United States;
``(B) establish the plan referred to in
subparagraph (A) in consultation with--
``(i) the Director of the Centers for
Disease Control and Prevention;
``(ii) the Director of the National
Institutes of Health;
``(iii) the Director of the National Center
on Minority Health and Health Disparities;
``(iv) the Director of the Agency for
Healthcare Research and Quality;
``(v) the Administrator of the Health
Resources and Services Administration;
``(vi) the Administrator of the Centers for
Medicare and Medicaid Services;
``(vii) the Director of the Office for
Civil Rights;
``(viii) the Administrator of the Substance
Abuse and Mental Health Services
Administration;
``(ix) the Commissioner of the Food and
Drug Administration; and
``(x) the heads of other appropriate public
and private entities;
``(C) ensure that the plan includes measurable
objectives, describes the means for achieving such
objectives, and designates a date by which such
objectives are expected to be achieved;
``(D) ensure that all amounts appropriated for such
activities are expended in accordance with the plan;
``(E) review the plan on at least an annual basis
and revise the plan as appropriate;
``(F) ensure that the plan will serve as a binding
statement of policy with respect to the agencies'
activities related to disparities in health and
healthcare; and
``(G) not later than March 1 of each year, submit
the plan (or any revisions to the plan), to the
Committee on Health, Education, Labor, and Pensions of
the Senate and the Committee on Energy and Commerce of
the House of Representatives.
``(2) Components of the plan.--The Deputy Assistant
Secretary shall ensure that the comprehensive plan established
under paragraph (1) addresses--
``(A) the recommendations of the 2002 Institute of
Medicine report (Unequal Treatment) with respect to
racial and ethnic disparities in healthcare;
``(B) health and disease prevention education for
racial, ethnic, and primary language health disparity
populations;
``(C) research to identify sources of health and
healthcare disparities in minority groups;
``(D) the implementation and assessment of
promising intervention strategies;
``(E) data collection and the monitoring of the
healthcare and health status of health disparity
populations;
``(F) care of individuals who lack proficiency with
the English language;
``(G) care of individuals with low functional
health literacy;
``(H) the training, recruitment, and retention of
minority health professionals;
``(I) programs to expand and facilitate access to
healthcare services, including the use of telemedicine,
National Health Service Scholars, community health
workers, and case managers;
``(J) public and health provider awareness of
racial and ethnic disparities in healthcare;
``(K) methods to evaluate and measure progress
toward the goal of eliminating disparities in health
and healthcare in racial and ethnic minority
populations;
``(L) the promotion of interagency and intra-agency
coordination and collaboration and public-private and
community partnerships; and
``(M) the preparedness of health professionals to
care for racially, ethnically, and linguistically
diverse populations and low functional health literacy
populations including evaluations as required under
section 606 of the Healthcare Equality and
Accountability Act.'';
(4) in subsection (d) (as so redesignated)--
(A) in paragraph (1), by inserting ``and Racial,
Ethnic, and Primary Language Health Disparities
Elimination'' after ``Minority Health''; and
(B) in paragraph (2)--
(i) by striking ``Deputy Assistant''; and
(ii) by striking ``(10) of subsection (b)''
and inserting ``(9) of subsection (c)'';
(5) in subsection (e)(1) (as so redesignated)--
(A) in subparagraph (A), by striking ``subsection
(b)(9)'' and inserting ``subsection (b)(7)''; and
(B) in subparagraph (B), by striking ``subsection
(b)(10)'' and inserting ``subsection (b)(8)'';
(6) in subsection (f)(3) (as so redesignated), by striking
``subsection (f)'' and inserting ``subsection (g)'';
(7) in subsection (g)(1) (as so redesignated)--
(A) by striking ``1999 and each second'' and
inserting ``2004 and each'';
(B) by striking ``Labor and Human Resources'' and
inserting ``Health, Education, Labor, and Pensions'';
(C) by striking ``2 fiscal years'' and inserting
``fiscal year''; and
(D) by inserting after ``improving the health of
racial and ethnic minority groups'' the following:
``reducing and eliminating disparities in health and
healthcare in racial and ethnic minority populations,
in accordance with the national plan specified under
subsection (c) and the goals of Healthy People 2010'';
(8) by inserting after subsection (g) (as so redesignated)
the following:
``(h) Federal Partnership With Accreditation Entities.--
``(1) In general.--Not later than 1 year after the date of
enactment of the Healthcare Equality and Accountability Act,
the Secretary, in collaboration with the Director of the Agency
for Healthcare Research and Quality, the Administrator of the
Centers for Medicare and Medicaid Services, the Director of the
Office for Minority Health, and the heads of appropriate State
agencies, shall convene a working group with members of
accreditation organizations and other quality standard setting
organizations to develop guidelines to evaluate and report on
the health and healthcare of minority populations served by
health centers, health plans, hospitals, and other federally
funded health entities.
``(2) Report.--Not later than 6 months after the convening
of the working group under paragraph (1), the working group
shall submit a report to the Secretary at such time, in such
manner, and containing such information as the Secretary may
require, including guidelines and recommendations on how each
accreditation body will work with constituent members to ensure
the adoption of such guidelines.
``(3) Demonstration projects.--The Secretary, acting
through the Administrator of the Centers for Medicare and
Medicaid Services, shall award grants for the establishment of
demonstration projects to assess the impact of providing
financial incentives for the reporting and analysis of the
quality of minority healthcare by hospitals, health plans,
health centers, and other healthcare entities.
``(4) Authorization of appropriations.--There are
authorized to be appropriated to carry out this subsection,
such sums as may be necessary for each of fiscal years 2005
through 2010.
``(i) Preparation of Health Professionals To Provide Healthcare to
Minority Populations.--The Secretary, in collaboration with the
Director of the Bureau of Health Professions and the Director of the
Office of Minority Health, shall require that health professional
schools that receive Federal funds train future health professionals to
provide culturally and linguistically appropriate healthcare to diverse
populations.''; and
(9) by striking subsection (k) (as so redesignated) and
inserting the following:
``(k) Authorization of Appropriations.--For the purpose of carrying
out this section (other than subsection (h)), there is authorized to be
appropriated $100,000,000 for fiscal year 2004, and such sums as may be
necessary for each of fiscal years 2005 through 2010.''.
SEC. 605. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF
THE PUBLIC HEALTH SERVICE.
(a) Establishment.--
(1) In general.--In order to more effectively and
efficiently carry out the responsibilities, authorities, and
functions of the United States to provide healthcare services
to Indians and Indian tribes, as are or may be hereafter
provided by Federal statute or treaties, there is established
within the Public Health Service of the Department of Health
and Human Services the Indian Health Service.
(2) Assistant secretary of indian health.--The Service
shall be administered by an Assistant Secretary of Indian
Health, who shall be appointed by the President, by and with
the advice and consent of the Senate. The Assistant Secretary
shall report to the Secretary. Effective with respect to an
individual appointed by the President, by and with the advice
and consent of the Senate the term of service of the Assistant
Secretary shall be 4 years. An Assistant Secretary may serve
more than 1 term.
(b) Agency.--The Service shall be an agency within the Public
Health Service of the Department, and shall not be an office,
component, or unit of any other agency of the Department.
(c) Functions and Duties.--The Secretary shall carry out through
the Assistant Secretary of the Service--
(1) all functions which were, on the day before the date of
enactment of the Indian Health Care Amendments of 1988, carried
out by or under the direction of the individual serving as
Director of the Service on such day;
(2) all functions of the Secretary relating to the
maintenance and operation of hospital and health facilities for
Indians and the planning for, and provision and utilization of,
health services for Indians;
(3) all health programs under which healthcare is provided
to Indians based upon their status as Indians which are
administered by the Secretary, including programs under--
(A) the Indian Health Care Improvement Act;
(B) the Act of November 2, 1921 (25 U.S.C. 13);
(C) the Act of August 5, 1954 (42 U.S.C. 2001, et
seq.);
(D) the Act of August 16, 1957 (42 U.S.C. 2005 et
seq.);
(E) the Indian Self-Determination Act (25 U.S.C.
450f, et seq.); and
(F) title XXIX of the Public Health Service Act;
and
(4) all scholarship and loan functions carried out under
title I of the Indian Health Care Improvement Act.
(d) Authority.--
(1) In general.--The Secretary, acting through the
Assistant Secretary, shall have the authority--
(A) except to the extent provided for in paragraph
(2), to appoint and compensate employees for the
Service in accordance with title 5, United States Code;
(B) to enter into contracts for the procurement of
goods and services to carry out the functions of the
Service; and
(C) to manage, expend, and obligate all funds
appropriated for the Service.
(2) Personnel actions.--Notwithstanding any other provision
of law, the provisions of section 12 of the Act of June 18,
1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all
personnel actions taken with respect to new positions created
within the Service as a result of its establishment under
subsection (a).
(e) Rate of Pay.--
(1) Positions at level iv.--Section 5315 of title 5, United
States Code, is amended by striking the following: ``Assistant
Secretaries of Health and Human Services (6).'' and inserting
``Assistant Secretaries of Health and Human Services (7).''.
(2) Positions at level v.--Section 5316 of such title is
amended by striking the following: ``Director, Indian Health
Service, Department of Health and Human Services.''.
(f) Duties of Assistant Secretary for Indian Health.--Section 601
of the Indian Health Care Improvement Act (25 U.S.C. 1661) is amended
in subsection (a)--
(1) by inserting ``(1)'' after ``(a)'';
(2) in the second sentence of paragraph (1), as so
designated, by striking ``a Director,'' and inserting ``the
Assistant Secretary for Indian Health,'';
(3) by striking the third sentence of paragraph (1), as so
designated, and all that follows through the end of the
subsection (a) of such section and inserting the following:
``The Assistant Secretary for Indian Health shall carry out the
duties specified in paragraph (2).''; and
(4) by adding after paragraph (1) the following:
``(2) The Assistant Secretary for Indian Health shall--
``(A) report directly to the secretary concerning
all policy and budget-related matters affecting Indian
health;
``(B) collaborate with the Assistant Secretary for
Health concerning appropriate matters of Indian health
that affect the agencies of the Public Health Service;
``(C) advise each Assistant Secretary of the
Department of Health and Human Services concerning
matters of Indian health with respect to which that
Assistant Secretary has authority and responsibility;
``(D) advise the heads of other agencies and
programs of the Department of Health and Human Services
concerning matters of Indian health with respect to
which those heads have authority and responsibility;
and
``(E) coordinate the activities of the Department
of Health and Human Services concerning matters of
Indian health.''.
(g) Continued Service by Incumbent.--The individual serving in the
position of Director of the Indian Health Service on the date preceding
the date of enactment of this Act may serve as Assistant Secretary for
Indian Health, at the pleasure of the President after the date of
enactment of this Act.
(h) Conforming Amendments.--
(1) Amendments to indian health care improvement act.--The
Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) is
amended--
(A) in section 601--
(i) in subsection (c), by striking
``Director of the Indian Health Service'' both
places it appears and inserting ``Assistant
Secretary for Indian Health''; and
(ii) in subsection (d), by striking
``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian
Health''; and
(B) in section 816(c)(1), by striking ``Director of
the Indian Health Service'' and inserting ``Assistant
Secretary for Indian Health''.
(2) Amendments to other provisions of law.--The following
provisions are each amended by striking ``Director of the
Indian Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health'':
(A) Section 203(a)(1) of the Rehabilitation Act of
1973 (29 U.S.C. 761b(a)(1)).
(B) Subsections (b) and (e) of section 518 of the
Federal Water Pollution Control Act (33 U.S.C. 1377 (b)
and (e)).
(C) Section 803B(d)(1) of the Native American
Programs Act of 1974 (42 U.S.C. 2991b-2(d)(1)).
(i) References.--Reference in any other Federal law, Executive
order, rule, regulation, or delegation of authority, or any document of
or relating to the Director of the Indian Health Service shall be
deemed to refer to the Assistant Secretary for Indian Health.
(j) Definitions.--For purposes of this section, the definitions
contained in section 4 of the Indian Health Care Improvement Act shall
apply.
SEC. 606. OFFICE OF MINORITY HEALTH AT THE CENTERS FOR MEDICARE AND
MEDICAID SERVICES.
(a) In General.--Not later than 60 days after the date of enactment
of this Act, the Secretary of Health and Human Services shall establish
within the Centers for Medicare and Medicaid Services an Office of
Minority Health (referred to in this section as the ``Office'').
(b) Duties.--The Office shall be responsible for the coordination
and facilitation of activities of the Centers for Medicare and Medicaid
Services to improve minority health and healthcare and to reduce racial
and ethnic disparities in health and healthcare, which shall include--
(1) creating a strategic plan, which shall be made
available for public review, to improve the health and
healthcare of Medicare, Medicaid, and SCHIP beneficiaries;
(2) promoting agency-wide policies relating to healthcare
delivery and financing that could have a beneficial impact on
the health and healthcare of minority populations;
(3) assisting health plans, hospitals, and other health
entities in providing culturally and linguistically appropriate
healthcare services;
(4) increasing awareness and outreach activities for
minority healthcare consumers and providers about the causes
and remedies for health and healthcare disparities;
(5) developing grant programs and demonstration projects to
identify, implement and evaluate innovative approaches to
improving the health and healthcare of minority beneficiaries
in the Medicare, Medicaid, and SCHIP programs;
(6) considering incentive programs relating to
reimbursement that would reward health entities for providing
quality healthcare for minority populations using established
benchmarks for quality of care;
(7) collaborating with the compliance office to ensure
compliance with the anti-discrimination provisions under title
VI of the Civil Rights Act of 1964;
(8) identifying barriers to enrollment in public programs
under the jurisdiction of the Centers for Medicare and Medicaid
Services;
(9) monitoring and evaluating on a regular basis the
success of minority health programs and initiatives;
(10) publishing an annual report about the activities of
the Centers for Medicare and Medicaid Services relating to
minority health improvement; and
(11) other activities determined appropriate by the
Secretary of Health and Human Services.
(c) Staff.--The staff at the Office shall include--
(1) one or more individuals with expertise in minority
health and racial and ethnic health disparities; and
(2) one or more individuals with expertise in healthcare
financing and delivery in underserved communities.
(d) Coordination.--In carrying out its duties under this section,
the Office shall coordinate with--
(1) the Office of Minority Health in the Office of the
Secretary of Health and Human Services;
(2) the National Centers for Minority Health and Health
Disparities in the National Institutes of Health; and
(3) the Office of Minority Health in the Centers for
Disease Control and Prevention.
(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $10,000,000
for fiscal year 2004, and such sums may be necessary for each of fiscal
years 2005 through 2010.
SEC. 607. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND DRUG
ADMINISTRATION.
Chapter IX of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
391 et seq.) is amended by adding at the end the following:
``SEC. 908. OFFICE OF MINORITY AFFAIRS.
``(a) In General.--Not later than 60 days after the date of
enactment of this section, the Secretary shall establish within the
Office of the Commissioner of the Food and Drug Administration an
Office of Minority Affairs (referred to in this section as the
`Office').
``(b) Duties.--The Office shall be responsible for the coordination
and facilitation of activities of the Food and Drug Administration to
improve minority health and healthcare and to reduce racial and ethnic
disparities in health and healthcare, which shall include--
``(1) promoting policies in the development and review of
medical products that reduce racial and ethnic disparities in
health and healthcare;
``(2) encouraging appropriate data collection, analysis,
and dissemination of racial and ethnic differences using, at a
minimum, the categories described in the 1997 Office of
Management and Budget standards, in response to different
therapies in both adult and pediatric populations;
``(3) providing, in coordination with other appropriate
government agencies, education, training, and support to
increase participation of minority patients and physicians in
clinical trials;
``(4) collecting and analyzing data using, at a minimum,
the categories described in the 1997 Office of Management and
Budget standards, on the number of participants from minority
racial and ethnic backgrounds in clinical trials used to
support medical product approvals;
``(5) the identification of methods to reduce language and
literacy barriers; and
``(6) publishing an annual report about the activities of
the Food and Drug Administration pertaining to minority health.
``(c) Staff.--The staff of the Office shall include--
``(1) one or more individuals with expertise in the design
and conduct of clinical trials of drugs, biological products,
and medical devices; and
``(2) one or more individuals with expertise in therapeutic
classes or disease states for which medical evidence suggests a
difference based on race or ethnicity.
``(d) Coordination.--In carrying out its duties under this section,
the Office shall coordinate with--
``(1) the Office of Minority Health in the Office of the
Secretary of Health and Human Services;
``(2) the National Center for Minority Health and Health
Disparities in the National Institutes of Health; and
``(3) the Office of Minority Health in the Centers for
Disease Control and Prevention.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2005 through 2010.''.
SEC. 608. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL AND
ETHNIC BACKGROUND.
(a) In General.--Chapter V of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 351 et seq.) is amended by adding after section 505B the
following:
``SEC. 505C. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL
AND ETHNIC BACKGROUND.
``(a) Pre-Approval Studies.--If there is evidence that there may be
a disparity on the basis of racial or ethnic background as to the
safety or effectiveness of a drug, then--
``(1)(A) the investigations required under section
505(b)(1)(A) shall include adequate and well-controlled
investigations of the disparity; or
``(B) the evidence required under section 351(a) of the
Public Health Service Act for approval of a biologics license
application for the drug shall include adequate and well-
controlled investigations of the disparity; and
``(2) if the investigations confirm that there is a
disparity, the labeling of the drug shall include appropriate
information about the disparity.
``(b) Post-Market Studies.--
``(1) In general.--If there is evidence that there may be a
disparity on the basis of racial or ethnic background as to the
safety or effectiveness of a drug for which there is an
approved application under section 505 or a license under
section 351 of the Public Health Service Act, the Secretary may
by order require the holder of the approved application or
license to conduct, by a date specified by the Secretary, post-
marketing studies to investigate the disparity.
``(2) Labeling.--If the Secretary determines that the post-
market studies confirm that there is a disparity described in
paragraph (1), the labeling of the drug shall include
appropriate information about the disparity.
``(3) Study design.--The Secretary may specify all aspects
of study design, including the number of studies and study
participants, in the order requiring post-market studies of the
drug.
``(4) Modifications of study design.--The Secretary may by
order modify any aspect of the study design as necessary after
issuing an order under paragraph (1).
``(5) Study results.--The results from studies required
under paragraph (1) shall be submitted to the Secretary as
supplements to the drug application or biological license
application.
``(c) Disparity.--The term `evidence that there may be a disparity
on the basis of racial or ethnic background for adult and pediatric
populations as to the safety or effectiveness of a drug' includes--
``(1) evidence that there is a disparity on the basis of
racial or ethnic background as to safety or effectiveness of a
drug in the same chemical class as the drug;
``(2) evidence that there is a disparity on the basis of
racial or ethnic background in the way the drug is metabolized;
and
``(3) other evidence as the Secretary may determine.
``(d) Applications Under Section 505(b)(2) and 505(j).--
``(1) In general.--A drug for which an application has been
submitted or approved under section 505(j) shall not be
considered ineligible for approval under that section or
misbranded under section 502 on the basis that the labeling of
the drug omits information relating to a disparity on the basis
of racial or ethnic background as to the safety or
effectiveness of the drug, whether derived from investigations
or studies required under this section or derived from other
sources, when the omitted information is protected by patent or
by exclusivity under clause (iii) or (iv) of section
505(j)(5)(D).
``(2) Labeling.--Notwithstanding clauses (iii) and (iv) of
section 505(j)(5)(D), the Secretary may require that the
labeling of a drug approved under section 505(j) that omits
information relating to a disparity on the basis of racial or
ethnic background as to the safety or effectiveness of the drug
include a statement of any appropriate contraindications,
warnings, or precautions related to the disparity that the
Secretary considers necessary.''.
(b) Enforcement.--Section 502 of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 352) is amended by adding at the end the
following:
``(w)(1) If it is a drug and the holder of the approved application
under section 505 or license under section 351 of the Public Health
Service Act for the drug has failed to complete the investigations or
studies, or comply with any other requirement, of section 505C.''.
(c) Drug Fees.--Section 736(a)(1)(A)(ii) of the Federal Food, Drug,
and Cosmetic Act (21 U.S.C. 379h) is amended by adding after
``required'' the following: ``, including supplements required under
section 505C of the Act''.
SEC. 609. UNITED STATES COMMISSION ON CIVIL RIGHTS.
(a) Coordination Within Department of Justice of Activities
Regarding Health Disparities.--Section 3 of the Civil Rights Commission
Act of 1983 (42 U.S.C. 1975a) is amended--
(1) in paragraph (1)(B), by striking ``and'' at the end;
(2) in paragraph (2), in the matter after and below
subparagraph (D), by striking the period and inserting ``;
and''; and
(3) by adding at the end the following:
``(3) shall, with respect to activities carried out in
healthcare 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).''.
(b) Authorization of Appropriations.--Section 5 of the Civil Rights
Commission Act of 1983 (42 U.S.C. 1975c) is amended by striking the
first sentence and inserting the following: ``For the purpose of
carrying out this Act, there are authorized to be appropriated
$30,000,000 for fiscal year 2005, and such sums as may be necessary for
each of the fiscal years 2006 through 2010.''.
SEC. 610. 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) Within the spectrum of declining health, racial and
ethnic minority populations tend to be in the poorest of health
and face substantial cultural, social, and economic barriers to
obtaining quality healthcare.
(3) The problems affecting minority health have been
exacerbated by the fact that adequate resources (funding,
staffing, stewardship, and accountability) have not been
devoted to initiatives designed to examine and eliminate racial
and ethnic disparities in health.
(b) Sense of Congress.--It is the sense of Congress that--
(1) funding should be doubled by fiscal year 2005 for the
National Center 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 2005, and subsequent
funding increases, should be provided for health professions
training programs, the Racial and Ethnic Approaches to
Community Health (REACH) at the Center 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) 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 2005; and
(4) stewardship and accountability should be provided by
Congress and the President for health disparity elimination.
TITLE VII--STRENGTHENING HEALTH INSTITUTIONS THAT PROVIDE HEALTHCARE TO
MINORITY POPULATIONS
SEC. 701. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXIX of the Public Health Service Act, as amended by section
602, is further amended by adding at the end the following:
``Subtitle G--Strengthening Health Institutions That Provide Healthcare
to Minority Populations
``CHAPTER 1--GENERAL PROGRAMS
``SEC. 2971. 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 and Medicaid Services, shall
award grants to eligible entities for the conduct of demonstration
projects to improve the quality of and access to healthcare.
``(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
healthcare 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 healthcare 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 healthcare quality improvement activities or minority health and
healthcare disparity reduction activities that include--
``(1) with respect to healthcare systems, activities
relating to improving--
``(A) patient safety;
``(B) timeliness of care;
``(C) effectiveness of care;
``(D) efficiency of care; and
``(E) patient centeredness; 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.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2971A. 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 2971(b)(1);
``(2) demonstrate excellence in providing care to minority
populations; and
``(3) demonstrate excellence in reducing disparities in
health and healthcare.
``(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 healthcare 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.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2005 through 2010.
``SEC. 2971B. CONSULTATION, CONSTRUCTION AND RENOVATION OF AMERICAN
INDIAN AND ALASKA NATIVE FACILITIES; REPORTS.
``(a) Consultation.--Prior to the expenditure of, or the making of
any firm commitment to expend, any funds appropriated for the planning,
design, construction, or renovation of facilities pursuant to the Act
of November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act),
the Secretary, acting through the Service, shall--
``(1) consult with any Indian tribe that would be
significantly affected by such expenditure for the purpose of
determining and, whenever practicable, honoring tribal
preferences concerning size, location, type, and other
characteristics of any facility on which such expenditure is to
be made; and
``(2) ensure, whenever practicable, that such facility
meets the construction standards of any nationally recognized
accrediting body by not later than 1 year after the date on
which the construction or renovation of such facility is
completed.
``(b) Closure of Facilities.--
``(1) In general.--Notwithstanding any provision of law
other than this subsection, no Service hospital or outpatient
healthcare facility or any inpatient service or special care
facility operated by the Service, may be closed if the
Secretary has not submitted to the Congress at least 1 year
prior to the date such proposed closure an evaluation of the
impact of such proposed closure which specifies, in addition to
other considerations--
``(A) the accessibility of alternative healthcare
resources for the population served by such hospital or
facility;
``(B) the cost effectiveness of such closure;
``(C) the quality of healthcare to be provided to
the population served by such hospital or facility
after such closure;
``(D) the availability of contract healthcare funds
to maintain existing levels of service;
``(E) the views of the Indian tribes served by such
hospital or facility concerning such closure;
``(F) the level of utilization of such hospital or
facility by all eligible Indians; and
``(G) the distance between such hospital or
facility and the nearest operating Service hospital.
``(2) Temporary closure.--Paragraph (1) shall not apply to
any temporary closure of a facility or of any portion of a
facility if such closure is necessary for medical,
environmental, or safety reasons.
``(c) Priority System.--
``(1) Establishment.--The Secretary shall establish a
healthcare facility priority system, that shall--
``(A) be developed with Indian tribes and tribal
organizations through negotiated rulemaking;
``(B) give the needs of Indian tribes the highest
priority, with additional priority being given to those
service areas where the health status of Indians within
the area, as measured by life expectancy based upon the
most recent data available, is significantly lower than
the average health status for Indians in all service
areas; and
``(C) at a minimum, include the lists required in
paragraph (2)(B) and the methodology required in
paragraph (2)(E);
except that the priority of any project established under the
construction priority system in effect on the date of this Act
shall not be affected by any change in the construction
priority system taking place thereafter if the project was
identified as one of the top 10 priority inpatient projects or
one of the top 10 outpatient projects in the Indian Health
Service budget justification for fiscal year 2004, or if the
project had completed both Phase I and Phase II of the
construction priority system in effect on the date of this
title.
``(2) Report.--The Secretary shall submit to the President
and Congress a report that includes--
``(A) a description of the healthcare facility
priority system of the Service, as established under
paragraph (1);
``(B) healthcare facility lists, including--
``(i) the total healthcare facility
planning, design, construction and renovation
needs for Indians;
``(ii) the 10 top-priority inpatient care
facilities;
``(iii) the 10 top-priority outpatient care
facilities;
``(iv) the 10 top-priority specialized care
facilities (such as long-term care and alcohol
and drug abuse treatment); and
``(v) any staff quarters associated with
such prioritized facilities;
``(C) the justification for the order of priority
among facilities;
``(D) the projected cost of the projects involved;
and
``(E) the methodology adopted by the Service in
establishing priorities under its healthcare facility
priority system.
``(3) Consultation.--In preparing each report required
under paragraph (2) (other than the initial report) the
Secretary shall annually--
``(A) consult with, and obtain information on all
healthcare facilities needs from, Indian tribes and
tribal organizations including those tribes or tribal
organizations operating health programs or facilities
under any funding agreement entered into with the
Service under the Indian Self-Determination and
Education Assistance Act; and
``(B) review the total unmet needs of all tribes
and tribal organizations for healthcare facilities
(including staff quarters), including needs for
renovation and expansion of existing facilities.
``(4) Criteria.--For purposes of this subsection, the
Secretary shall, in evaluating the needs of facilities operated
under any funding agreement entered into with the Service under
the Indian Self-Determination and Education Assistance Act, use
the same criteria that the Secretary uses in evaluating the
needs of facilities operated directly by the Service.
``(5) Equitable integration.--The Secretary shall ensure
that the planning, design, construction, and renovation needs
of Service and non-Service facilities, operated under funding
agreements in accordance with the Indian Self-Determination and
Education Assistance Act are fully and equitably integrated
into the healthcare facility priority system.
``(d) Review of Need for Facilities.--
``(1) Report.--Beginning in 2005, the Secretary shall
annually submit to the President and Congress a report which
sets forth the needs of the Service and all Indian tribes and
tribal organizations, including urban Indian organizations, for
inpatient, outpatient and specialized care facilities,
including the needs for renovation and expansion of existing
facilities.
``(2) Consultation.--In preparing each report required
under paragraph (1) (other than the initial report), the
Secretary shall consult with Indian tribes and tribal
organizations including those tribes or tribal organizations
operating health programs or facilities under any funding
agreement entered into with the Service under the Indian Self-
Determination and Education Assistance Act, and with urban
Indian organizations.
``(3) Criteria.--For purposes of this subsection, the
Secretary shall, in evaluating the needs of facilities operated
under any funding agreement entered into with the Service under
the Indian Self-Determination and Education Assistance Act, use
the same criteria that the Secretary uses in evaluating the
needs of facilities operated directly by the Service.
``(4) Equitable integration.--The Secretary shall ensure
that the planning, design, construction, and renovation needs
of facilities operated under funding agreements, in accordance
with the Indian Self-Determination and Education Assistance
Act, are fully and equitably integrated into the development of
the health facility priority system.
``(5) Annual nominations.--Each year the Secretary shall
provide an opportunity for the nomination of planning, design,
and construction projects by the Service and all Indian tribes
and tribal organizations for consideration under the healthcare
facility priority system.
``(e) Inclusion of Certain Programs.--All funds appropriated under
the Act of November 2, 1921 (25 U.S.C. 13), for the planning, design,
construction, or renovation of health facilities for the benefit of an
Indian tribe or tribes shall be subject to the provisions of section
102 of the Indian Self-Determination and Education Assistance Act.
``(f) Innovative Approaches.--The Secretary shall consult and
cooperate with Indian tribes, tribal organizations and urban Indian
organizations in developing innovative approaches to address all or
part of the total unmet need for construction of health facilities,
including those provided for in other sections of this title and other
approaches.
``(g) Location of Facilities.--
``(1) Priority.--The Bureau of Indian Affairs and the
Service shall, in all matters involving the reorganization or
development of Service facilities, or in the establishment of
related employment projects to address unemployment conditions
in economically depressed areas, give priority to locating such
facilities and projects on Indian lands if requested by the
Indian owner and the Indian tribe with jurisdiction over such
lands or other lands owned or leased by the Indian tribe or
tribal organization so long as priority is given to Indian land
owned by an Indian tribe or tribes.
``(2) Definition.--In this subsection, the term `Indian
lands' means--
``(A) all lands within the exterior boundaries of
any Indian reservation;
``(B) any lands title to which is held in trust by
the United States for the benefit of any Indian tribe
or individual Indian, or held by any Indian tribe or
individual Indian subject to restriction by the United
States against alienation and over which an Indian
tribe exercises governmental power; and
``(C) all lands in Alaska owned by any Alaska
Native village, or any village or regional corporation
under the Alaska Native Claims Settlement Act, or any
land allotted to any Alaska Native.
``(h) Definitions.--For purposes of this section, the definitions
contained in section 4 of the Indian Health Care Improvement Act shall
apply.
``SEC. 2971C. 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 healthcare 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, or
the Commonwealth of the Northern Mariana Islands, the United States
Virgin Islands, Puerto Rico, and Hawaii that--
``(1) is owned or operated by--
``(A) the government of American Samoa, Guam, or
the Commonwealth of the Northern Mariana Islands, the
United States Virgin Islands, Puerto Rico, and 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, and 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 healthcare
facilities needs from the entities described in subsection (b);
and
``(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
healthcare 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.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated such sums as necessary to carry out this section.
``CHAPTER 2--NATIONAL HEALTH SAFETY NET INFRASTRUCTURE.
``Subchapter A--General Provisions
``SEC. 2972. PAYMENTS TO HEALTHCARE FACILITIES.
``(a) In General.--The Secretary, with the approval of the Health
Safety Net Infrastructure Trust Fund Board of Trustees described in
section 2972C(d) (hereafter in this subtitle referred to as the `Trust
Fund Board'), shall make payments, from amounts in the Health Safety
Net Infrastructure Trust Fund established under section 2972C(a)
(hereafter in this subtitle referred to as the `Trust Fund'), for
capital financing assistance to eligible healthcare facilities whose
applications for assistance have been approved under this subtitle.
``(b) General Eligibility Requirements for Assistance.--
``(1) Eligible healthcare facilities described.--
``(A) In general.--A healthcare facility shall be
generally eligible for capital financing assistance
under this subtitle if the healthcare facility--
``(i) receives an additional payment under
section 1886(d)(5)(F) of the Social Security
Act and is described in clause (i)(II) or
clause (vii)(I) of such section, or is deemed a
disproportionate share hospital under a State
plan for medical assistance under title XIX of
the Social Security Act on the basis described
in section 1923(b)(1) of such Act;
``(ii) is a hospital which meets the
criteria for designation by the Secretary as an
essential access community hospital under
section 1820(i)(1) of such Act or a rural
primary care hospital under section 1820(i)(2)
of such Act (whether or not such hospital is
actually designated under such section);
``(iii) is a Federally qualified health
center (as defined in section 1905(l)(2)(B) of
such Act);
``(iv) is a hospital which--
``(I) is a sole community provider;
or
``(II) has closed within the
preceding 12 months;
``(v) is a facility which--
``(I) provides service to ill or
injured individuals prior to the
transportation of such individuals to a
hospital or provides inpatient care to
individuals needing such care for a
period not longer than 96 hours;
``(II) is located in a county (or
equivalent unit of local government)
with fewer than 6 residents per square
mile or is located more than 35 road
miles from the nearest hospital;
``(III) permits a physician
assistant or nurse practitioner to
admit and treat patients under the
supervision of a physician not present
in such facility; and
``(IV) has obtained a waiver from
the Secretary permitting the facility
to participate in the medicare program
under title XVIII of the Social
Security Act; or
``(vi) is a hospital that the Secretary
otherwise determines to be an appropriate
recipient of assistance under this subtitle on
the basis of the existence of a patient care
operating deficit, a demonstrated inability to
secure or repay financing for a qualifying
project on reasonable terms, or such other
criteria as the Secretary considers
appropriate.
``(B) Development of criteria.--For purposes of
subparagraph (A)(vi), with respect to rural hospitals
which are at risk or critical to healthcare access, the
Prospective Payment Review Commission, not later than
January 1, 1994, shall develop criteria to assist the
Secretary in deciding if such hospitals deserve
assistance, after considering, at a minimum, the
following factors:
``(i) At-risk rural hospitals.--In the case
of rural hospitals the closure of which within
the next year is imminent or the continued
operation of which over a 2- to 5-year period
is questionable, such factors as the level of
health resources available in a community as
measured by physician supply, the population
base of the area served by the hospital and
utilization of services by such population as
measured by service area population, and
financial indicators predictive of closure.
``(ii) Rural hospitals critical to
healthcare access.--In the case of rural
hospitals which provide access to essential
health services within a service area where no
other provider of such essential services
exists, such factors as the market share of the
hospital for an area or population, the number
of outpatient visits, the proximity of the next
closest provider of such services, and the
degree to which the area population is
medically underserved.
``(2) Ownership requirements.--In order to be eligible for
assistance under this subtitle, a healthcare facility (other
than a healthcare facility described in clauses (ii) and (v) of
paragraph (1)) must--
``(A) be owned or operated by a unit of State or
local government;
``(B) be a quasi-public corporation, defined as a
private, nonprofit corporation or public benefit
corporation which is formally granted one or more
governmental powers by legislative action through (or
is otherwise partially funded by) the State
legislature, city or county council;
``(C) be a private nonprofit healthcare facility
which has contracted with, or is otherwise funded by, a
governmental agency to provide healthcare services to
low income individuals not eligible for assistance
under title XVIII or title XIX of the Social Security
Act, where revenue from such contracts constitute at
least 10 percent of the facility's operating revenues
over the prior 3 fiscal years; or
``(D) be a nonprofit small rural healthcare
facility (as determined by the Secretary).
``(3) Priority.--In making payments under this section, the
Secretary shall give priority to eligible healthcare entities
that are federally qualified health centers (as defined in
section 1905(l)(2)(B) of the Social Security Act), or other
similar entities at least 50 percent of the patients of which
are minority or low-income individuals.
``(c) Meeting Additional Specific Criteria.--Healthcare facilities
that are generally eligible for assistance under this subtitle under
subsection (b) may apply for the specific programs described in this
subtitle and must meet any additional criteria for participation in
such programs.
``(d) Assistance Available.--Capital financing assistance available
under this subtitle shall include loan guarantees, interest rate
subsidies, matching loans and direct grants. Healthcare facilities
determined to be generally eligible for assistance under this subtitle
may apply for and receive more than one type of assistance under this
subtitle.
``SEC. 2972A. APPLICATION FOR ASSISTANCE.
``(a) In General.--No healthcare facilities may receive assistance
for a qualifying project under this subtitle unless the healthcare
facility--
``(1) has filed with the Secretary, in a form and manner
specified by the Secretary, with the advice and approval of the
Trust Fund Board (as described in section 2972C(d)), an
application for assistance under this subtitle;
``(2) establishes in its application (for its most recent
cost reporting period) that it meets the criteria for general
eligibility under this subtitle;
``(3) includes a description of the project, including the
community in which it is located, and describes utilization and
services characteristics of the project and the healthcare
facility, and the patient population that is to be served;
``(4) describes the extent to which the project will
include the financial participation of State and local
governments if assistance is granted under this subtitle, and
all other sources of financing sought for the project; and
``(5) establishes, to the satisfaction of the Secretary and
the Trust Fund Board, that the project meets the additional
criteria for each type of capital financing assistance for
which it is applying.
``(b) Criteria for Approval.--The Secretary, with the approval of
the Trust Fund Board, shall determine for each application for
assistance under this subtitle--
``(1) whether the healthcare facility meets the general
eligibility criteria under section 2972(b);
``(2) whether the healthcare facility meets the specific
eligibility criteria of each type of assistance for which it
has applied, including whether the healthcare facility meets
any criteria for priority consideration for the type of
assistance for which it has applied;
``(3) whether the capital project for which assistance is
being requested is a qualifying project under this subtitle;
and
``(4) whether funds are available, pursuant to the
limitations of each program, to fully fund the request for
assistance.
``(c) Priority of Applications.--In addition to meeting the
criteria otherwise described in this subtitle, at the discretion of the
Trust Fund Board, the Secretary shall give preference to those
applications for qualifying projects that--
``(1)(A) are necessary to bring existing safety net
healthcare facilities into compliance with accreditation
standards of fire and life safety, seismic, or other related
Federal, State or local regulatory standards;
``(B) improve the provision of essential services such as
emergency medical and trauma services, AIDS and infectious
disease, perinatal, burn, primary care, and other services
which the Trust Fund Board may designate; or
``(C) provide access to otherwise unavailable essential
health services to the indigent and other needy persons within
the healthcare facility's territorial area;
``(2) include specific State or local governmental or other
non-Federal assurances of financial support if assistance for a
qualifying project is granted under this subtitle; and
``(3) are unlikely to be financed without assistance
granted under this subtitle.
``(d) Submission of Applications.--Applications under this subtitle
shall be submitted to the Secretary through the Trust Fund Board. If
two or more healthcare facilities join in the project, the application
shall be submitted by all participating healthcare facilities jointly.
Such applications shall set forth all of the descriptions, plans,
specifications, and assurances as required by this subtitle and contain
other such information as the Trust Fund Board shall require.
``(e) Opportunity for Appeal.--The Trust Fund Board shall afford a
healthcare facility applying for a loan guarantee under this section an
opportunity for a hearing if the guarantee is denied.
``(f) Applications for Amendments.--Amendment of an approved
application shall be subject to approval in the same manner as an
original application.
``SEC. 2972B. PUBLIC SERVICE RESPONSIBILITIES.
``(a) In General.--Any healthcare facility accepting capital
financing assistance under this subtitle shall agree--
``(1) to make the services of the facility or portion
thereof to be constructed, acquired, or modernized available to
all persons; and
``(2) to provide a significant volume of services to
persons unable to pay therefore, consistent with other
provisions of this Act and the amount of assistance received
under this subtitle.
``(b) Enforcement.--The Director of the Office for Civil Rights of
the Department of Health and Human Services shall be given the power to
enforce the public service responsibilities described in this section.
``SEC. 2972C. HEALTH SAFETY NET INFRASTRUCTURE TRUST FUND.
``(a) Creation of Trust Fund.--There is established in the Treasury
of the United States a trust fund to be known as the Health Safety Net
Infrastructure Trust Fund, consisting of such amounts as may be
transferred, appropriated, or credited to such Trust Fund as provided
in this subtitle.
``(b) Authorization of Appropriations to Trust Fund.--There are
authorized to be appropriated to the Trust Fund such sums as may be
necessary to carry out the purposes of this subtitle.
``(c) Expenditures From Trust Fund.--Amounts in the Trust Fund
shall be available, pursuant to appropriations Acts, only for making
expenditures to carry out the purposes of this subtitle.
``(d) Board of Trustees; Composition; Meetings; Duties.--
``(1) In general.--There shall be created a Health Safety
Net Infrastructure Trust Fund Board of Trustees composed of the
Secretary of Health and Human Services, the Secretary of the
Treasury, the Assistant Secretary for Health, the Director of
the Office of Minority Health, and the Administrator of the
Centers for Medicare and Medicaid Services (all serving in
their ex officio capacities), and 5 public members who shall be
appointed for 4 year terms by the President, from the following
categories--
``(A) one chief health officer from a State;
``(B) one chief executive officer of a healthcare
facility that meets the general eligibility criteria of
this subtitle;
``(C) one representative of the financial
community; and
``(D) two additional public or consumer
representatives.
``(2) Duties.--The Board of Trustees shall meet no less
than quarterly and shall have the responsibility to approve
implementing regulations, to establish criteria, and to
recommend and approve expenditures by the Secretary under the
programs set forth in this subtitle.
``(3) Managing trustee.--The Secretary of the Treasury
shall serve as the Managing Trustee of the Trust Fund, and
shall be responsible for the investment of funds. The
provisions of subsections (b) through (e) of section 1817 of
the Social Security Act shall apply to the Trust Fund and the
Managing Trustee of the Trust Fund in the same manner as they
apply to the Federal Hospital Insurance Trust Fund and the
Managing Trustee of that Trust Fund.
``SEC. 2972D. ADMINISTRATION.
``(a) In General.--The Administrator of the Centers for Medicare
and Medicaid Services shall serve as Secretary of the Board of Trustees
and shall administer the programs under this subtitle.
``(b) Limitation on Administrative Expenses.--Not more than 5
percent of the funds annually appropriated to the Trust Fund may be
available for administration of the Trust Fund or programs under this
subtitle.
``Subchapter B--Loan Guarantees
``SEC. 2973. PROVISION OF LOAN GUARANTEES TO SAFETY NET HEALTHCARE
FACILITIES.
``(a) In General.--The Safety Net Infrastructure Trust Fund will
provide a Federal guarantee of loan repayment, including guarantees of
repayment of refinancing loans, to non-Federal lenders making loans to
eligible healthcare facilities for healthcare facility replacement
(either by construction or acquisition), modernization and renovation
projects, and capital equipment acquisition.
``(b) Purposes.--The loan guarantee program shall be designed by
the Trust Fund Board with the goal of rebuilding and maintaining the
essential health services of healthcare facilities eligible for
assistance under this subtitle.
``SEC. 2973A. ELIGIBLE LOANS.
``(a) In General.--Loan guarantees under this chapter are available
for loans made to eligible healthcare facilities for replacement
facilities (either newly constructed or acquired), modernization and
renovation of existing facilities, and for capital equipment
acquisition.
``(b) Loan Guarantee Must Be Essential to Bond Financing.--Eligible
healthcare facilities must demonstrate that a Federal loan guarantee is
essential to obtaining bond financing from non-Federal lenders at a
reasonably affordable rate of interest.
``(c) Additional Eligibility Criteria for Loan Guarantees.--In
order to be eligible for assistance under this chapter, a healthcare
facility must demonstrate that the following criteria are met:
``(1) The healthcare facility has evidence of an ability to
meet debt service.
``(2) The assistance, when considered with other resources
available to the project, is necessary and will restore,
improve, or maintain the financial or physical soundness of the
healthcare facility.
``(3) The applicant agrees to assume the public service
responsibilities described in section 2972B.
``(4) The project is being, or will be, operated and
managed in accordance with a management-improvement-and-
operating plan which is designed to reduce the operating costs
of the project, which has been approved by the Trust Fund
Board, and which includes--
``(A) a detailed maintenance schedule;
``(B) a schedule for correcting past deficiencies
in maintenance, repairs, and replacements;
``(C) a plan to upgrade the project to meet cost-
effective energy efficiency standards prescribed by the
Trust Fund Board;
``(D) a plan to improve financial and management
control systems;
``(E) a detailed annual operating budget taking
into account such standards for operating costs in the
area as may be determined by the Trust Fund Board; and
``(F) such other requirements as the Trust Fund
Board may determine.
``(5) The application includes stringent provisions for
continued State or local support of the program, both with
respect to operating and financial capital.
``(6) The terms, conditions, maturity, security (if any),
and schedule and amount of repayments with respect to the loan
are sufficient to protect the financial interests of the United
States and are otherwise reasonable and in accord with
regulation, including a determination that the rate of interest
does not exceed such annual percentage on the principal
obligation outstanding as the Trust Fund Board determines to be
reasonable, taking into account the range of interest rates
prevailing in the private market for similar loans and the
risks assumed by the United States.
``(7) The healthcare facility must meet such other
additional criteria as the Secretary may impose.
``(e) State or Local Participation.--Projects in which State or
local governmental entities participate in the form of first guarantees
of part or all of the total loan value shall be given a preference for
loan guarantees under this chapter.
``SEC. 2973B. GUARANTEE ALLOTMENTS.
``(a) In General.--$150,000,000 shall be annually allocated within
the Trust Fund to the loan guarantee program established by this
chapter in order to create a cumulative reserve in support of loan
guarantees.
``(b) Loan Guarantees for Rural Healthcare Facilities.--At least 20
percent of the dollar value of loan guarantees made under this program
during any given year shall be allocated for eligible rural healthcare
facilities, to the extent a sufficient number of applications are made
by such healthcare facilities.
``(c) Guarantees for Small Loans.--At least $200,000,000 of the
annual dollar value of loan guarantees made under the program shall be
reserved for loans of under $50,000,000, if there are a sufficient
number of applicants for loans of that size.
``(d) Special Rule for Refinancing Loans.--Not more than 20 percent
of the amount allocated each year to the loan guarantee program
established by this chapter may be allocated to guarantee refinancing
loans during the year.
``SEC. 2973C. TERMS AND CONDITIONS OF LOAN GUARANTEES.
``(a) In General.--The principal amount of the guaranteed loan,
when added to any Federal grant assistance made under this subtitle,
may not exceed 95 percent of the total value of the project, including
land.
``(b) Guarantees Provided May Not Supplant Other Funds.--Guarantees
provided under this chapter may not be used to supplant other forms of
State or local support.
``(c) Right To Recover Funds.--The United States shall be entitled
to recover from any applicant healthcare facility the amount of
payments made pursuant to any loan guarantee under this chapter, unless
the Trust Fund Board for good cause waives its right of recovery, and
the United States shall, upon making any such payment pursuant to any
such loan guarantee be subrogated to all of the rights of the
recipients of the payments.
``(d) Modification of Terms.--Loan guarantees made under this
chapter shall be subject to further terms and conditions as the Trust
Fund Board determines to be necessary to assure that the purposes of
this Act will be achieved, and any such terms and conditions may be
modified by the Trust Fund Board to the extent that it determines such
modifications to be consistent with the financial interest of the
United States.
``(e) Terms Are Incontestable Absent Fraud or Misrepresentation.--
Any loan guarantee made by the Trust Fund Board pursuant to this
chapter shall be incontestable in the hands of an applicant on whose
behalf such guarantee is made, and as to any person who makes or
contracts to make a loan to such applicant in reliance thereon, except
for fraud or misrepresentation on the part of such applicant or other
person.
``SEC. 2973D. PREMIUMS FOR LOAN GUARANTEES.
``(a) In General.--The Trust Fund Board shall determine a
reasonable loan insurance premium which shall be charged for loan
guarantees under this chapter, taking into account the availability of
the reserves created under section 2973B. Premium charges shall be
payable in cash to the Trust Fund Board, either in full upon issuance,
or annually in advance. In addition to the premium charge herein
provided for, the Trust Fund Board is authorized to charge and collect
such amount as it may deem reasonable for the appraisal of a property
or project offered for insurance and for the inspection of such
property or project.
``(b) Payment in Advance.--In the event that the principal
obligation of any loan accepted for insurance under this chapter is
paid in full prior to the maturity date, the Trust Fund Board is
authorized in its discretion to require the payment by the borrower of
an adjusted premium charge in such amount as the Board determines to be
equitable, but not in excess of the aggregate amount of the premium
charges that the healthcare facility would otherwise have been required
to pay if the loan had continued to be insured until maturity date.
``(c) Trust Fund Board May Waive Premiums.--The Trust Fund Board
may in its discretion partially or totally waive premiums charged for
loan insurance under this section for financially distressed healthcare
facilities (as described by the Secretary).
``SEC. 2973E. PROCEDURES IN THE EVENT OF LOAN DEFAULT.
``(a) In General.--Failure of the borrower to make payments due
under or provided by the terms of a loan accepted for insurance under
this chapter shall constitute a default.
``(b) Assignment of Defaulted Loans.--If a default continues for 30
days, then, upon the lender's transfer to the Trust Fund Board of all
its rights and interests arising under the defaulted loan or in
connection with the loan transaction, the lender shall be entitled to
debentures which, together with a certificate of claim, are equal in
value to the amount the lender would have received if, on the date of
transfer, the borrower had repaid the loan in full, together with the
amount of necessary expenses incurred by the lender in connection with
the default.
``(c) Foreclosure by Lender.--Subject to the approval of the Trust
Fund Board, or as provided in regulations, the lender may foreclose on
the property securing the defaulted loan.
``(d) Foreclosure by Trust Fund Board.--The Trust Fund Board is
authorized to--
``(1) acquire possession of and title to any property
securing a defaulted loan by voluntary conveyance in
extinguishment of the indebtedness, or
``(2) institute proceedings for foreclosure on the property
securing any such defaulted loan and prosecute such proceedings
to conclusion.
``(e) Handling and Disposal of Property; Settlement of Claims.--
``(1) Payment for certain expenses.--Notwithstanding any
other provision of law relating to the acquisition, handling,
or disposal of real and other property by the United States,
the Trust Fund Board shall also have power, for the protection
of the interests of the Trust Fund, to pay out of the Trust
Fund all expenses or charges in connection with, and to deal
with, complete, reconstruct, rent, renovate, modernize, insure,
make contracts for the management of, or establish suitable
agencies for the management of, or sell for cash or credit or
lease in its discretion, any property acquired by the Trust
Fund under this section.
``(2) Settlement of claims.--Notwithstanding any other
provision of law, the Trust Fund Board shall also have the
power to pursue to final collection by way of compromise or
otherwise all claims assigned and transferred to the Trust Fund
in connection with the assignment, transfer, and delivery
provided for in this section, and at any time, upon default, to
foreclose or refrain from foreclosing on any property secured
by any defaulted loan assigned and transferred to or held by
the Trust Fund.
``(3) Limitations on authority.--Subsections (a) and (b)
shall not be construed to apply to any contract for hazard
insurance, or to any purchase or contract for services or
supplies on account of such property if the amount thereof does
not exceed $1,000.
``(f) Regulations.--The Trust Fund Board shall propose and the
Secretary shall promulgate regulations governing procedures in the
event of a default on a loan accepted for insurance under this chapter.
``Subchapter C--Grants for Urgent Capital Needs
``SEC. 2976. PROVISION OF GRANTS.
``(a) In General.--The Trust Fund Board shall make available
$400,000,000 in direct grants annually. The Secretary, with the
approval of the Trust Fund Board, shall make direct grants to eligible
healthcare facilities with urgent capital needs.
``(b) Purposes.--Direct grants shall be available to eligible
healthcare facilities for 3 types of projects:
``(1) Emergency certification and licensure grants would be
available to eligible healthcare facilities that are threatened
with closure or loss of accreditation or certification of a
facility or of essential services as a result of life or safety
code violations or similar facility or equipment failures. Such
grants would provide limited funding for repair and renovation
where failure to fund would disrupt the provision of essential
public health services such as emergency care.
``(2) Emergency grants would be available for capital
renovation, expansion, or replacement necessary to the
maintenance or expansion of essential safety and health
services such as obstetrics, perinatal, emergency and trauma,
primary care and preventive health services.
``(3) Planning grants would be available to eligible
healthcare facilities who require pre-approval assistance to
meet regulatory requirements related to management and finance
in order to apply for loans, loan guarantees, and interest
subsidies under this subtitle.
``(c) Priority to Financially Distressed Healthcare Facilities.--
Priority for direct grants under this section would be given to
financially distressed healthcare facilities (as described by the
Secretary).
``(d) Application Process.--The Secretary, with the approval of the
Trust Fund Board, shall create an expedited application process for
direct grants.
``SEC. 2976B. ELIGIBLE PROJECTS.
``(a) Matching Grants.--
``(1) Limitation on amount.--Grants for capital
expenditures by eligible healthcare facilities will be limited
to $25,000,000.
``(2) Matching requirement.--At least half of the projects
funded in a year must receive at least 50 percent of their
funding from State or local sources. The remaining projects
funded during the year could be financed up to 90 percent with
a combination of Federal grants and loans.
``(3) Reservation for rural healthcare facilities.--No less
than 20 percent of the grant funds in any given year would be
reserved for rural healthcare facilities, provided that a
sufficient number of applications are approved.
``(b) Planning Grants.--Applicants who can demonstrate general
qualification for the direct matching loan, loan guarantee, or interest
subsidy programs under this subtitle or eligibility for mortgage
insurance under section 242 of the National Housing Act will be
eligible for a grant of up to $500,000 to assist in implementation of
key budgetary and financial systems as well as management and
governance restructuring.''.
TITLE VIII--MISCELLANEOUS PROVISIONS
SEC. 801. DEFINITIONS.
For purposes of this Act (including the amendments made by this Act
other than the amendments made by subtitles A through G of title I):
(1) Appropriate healthcare services.--The term
``appropriate healthcare services'' includes services or
treatments to address physical, mental, and behavioral
diseases, conditions, or syndromes. The definition contained in
this paragraph shall not apply for purposes of sections 206 and
606.
(2) Hispanic.--The term ``Hispanic'' means individuals
whose origin is Mexican, Puerto Rican, Cuban, Central or South
American, or any other Spanish-speaking country.
(3) Indian.--The term ``Indian'', unless otherwise
designated, means any person who is a member of an Indian tribe
(4) 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.
(5) Limited english proficient.--The term ``limited English
proficient'' with respect to an individual means an individual
who cannot speak, read, write, or understand the English
language at a level that permits them to interact effectively
with clinical or nonclinical staff at a healthcare
organization.
(6) 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.
(7) Minority group.--The term ``minority group'' has the
meaning given the term ``racial and ethnic minority group''.
(8) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' means American Indians and Alaska
Natives, African Americans (including Blacks), Asian Americans,
Hispanics (including Latinos), and Native Hawaiians and other
Pacific Islanders.
(9) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(10) State.--The term ``State'' means each of the several
states, the District of Columbia, the Commonwealth of Puerto
Rico, the Indian tribes, the Virgin Islands, Guam, American
Samoa, and the Commonwealth of the Northern Mariana Islands.
(11) Tribal organization.--The term ``tribal organization''
means the elected governing body of any Indian tribe or any
legally established organization of Indians which is controlled
by one or more such bodies or by a board of directors elected
or selected by one or more such bodies (or elected by the
Indian population to be served by such organization) and which
includes the maximum participation of Indians in all phases of
its activities.
(12) Underrepresented minority.--The terms
``underrepresented minority'' and ``underrepresented
minorities'' refer to individuals who are members of racial or
ethnic minority groups that are underrepresented in the health
professions relative to their numbers in the general
population.
(13) Underserved populations.--The term ``underserved
population'' means the population of an urban or rural area
designated by the Secretary as an area with a shortage of
personal health services or a population group designated by
the Secretary as having a shortage of such services.
SEC. 802. DAVIS-BACON ACT.
All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work financed in
whole or in part with assistance under this Act (or an amendment made
by this Act), including capital financing assistance, or grants or loan
guarantees from the Safety Net Infrastructure Trust Fund (established
under section 2972C of the Public Health Service Act), shall be paid
wages at rates not less than those prevailing on similar work in the
locality involved as determined by the Secretary of Labor in accordance
with subchapter IV of chapter 31 of title 40, United States Code
(commonly referred to as the Davis-Bacon Act). The Secretary of Labor
shall have, with respect to such labor standards, the authority and
functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R.
3176; 64 Stat 1267) and section 3145 of title 40, United States Code.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Sponsor introductory remarks on measure. (CR S3967-3968)
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