Health Equity and Accountability Act of 2014 - Amends the Public Health Service Act and the Social Security Act to expand the collection and analysis of data in programs of the Department of Health and Human Services (HHS).
Sets forth provisions to improve cultural competence in federal health care programs and services, including by establishing the Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care.
Requires the Secretary of HHS (Secretary) to engage in activities to improve health workforce diversity, including by: (1) establishing a working group and a technical clearinghouse; (2) awarding grants to academic institutions; (3) establishing a health and health care disparities education program; and (4) providing for scholarships, student loan repayment and loan forgiveness, and research fellowships.
Health Empowerment Zone Act of 2014 - Provides for the establishment of health empowerment zones in communities that experience disproportionate disparities in health status and health care.
Requires the Secretary to engage in activities to improve the quality of and access to health care, including by expanding access to health care and health care insurance for immigrants, designating centers of excellence at public hospitals and other health systems serving minority patients, increasing Medicaid payments to territories and to Native Hawaiian health centers, and providing for border health grants.
Sets forth programs to reduce health disparities affecting minorities and rural residents. Establishes an Office of Minority Health in the Department of Veterans Affairs (VA).
Sets forth provisions to improve health for women and children, including by expanding access to federal programs for immigrant women and children, creating public awareness campaigns, engaging in activities to eliminate disparities in maternal health outcomes, and establishing programs to reduce teenage pregnancies, including contraception education and information programs, programs to support healthy adolescent development, maintaining a database of systematic reviews of maternity care, designating maternity care health professional shortage areas, and establishing a research center on optimal maternity outcomes.
Directs the Secretary to develop a multisite gestational diabetes research project within the diabetes program of the Centers for Disease Control and Prevention (CDC).
Requires pharmacies to provide in stock contraceptives to customers without delay.
Expands Medicare coverage of marriage and family therapist services, mental health counselor services, and substance abuse counselor services.
Lung Cancer Mortality Reduction Act of 2014 - Requires the Secretary to implement the Lung Cancer Mortality Reduction Program to achieve a reduction of at least 25% in the mortality rate of lung cancer by 2020.
Prostate Research, Outreach, Screening, Testing, Access, and Treatment Effectiveness Act of 2014 or the PROSTATE Act - Requires the Secretary of Veterans Affairs (VA) to take action to address prostate cancer, including by establishing the Interagency Prostate Cancer Coordination and Education Task Force.
Viral Hepatitis and Liver Cancer Control and Prevention Act of 2014 - Requires the Secretary to implement programs to address hepatitis B and hepatitis C.
Bone Marrow Failure Disease Research and Treatment Act of 2014 - Requires the Director of CDC to establish the National Acquired Bone Marrow Failure Disease Registry.
Requires the Director of the Agency for Healthcare Research and Quality to develop guidelines to screen minority patient populations which have a higher than average risk for many chronic diseases and cancers.
Expands Medicaid to cover a beneficiary's routine medical costs when they are in an approved clinical trial.
Requires the Secretary to expand HIV/AIDS treatment and prevention activities, including: (1) identification of issues that impede disease status awareness and retention in appropriate care, (2) research into treatment adherence strategies, (3) grants to public health agencies and faith-based organizations, (4) the Minority HIV/AIDS Initiative, and (5) health workforce training for culturally competent care.
Directs the Secretary to award grants for comprehensive sex education programs for adolescents. Eliminates a program that supports abstinence education.
Permits community organizations to distribute sexual barrier protection devices (e.g., condoms) and to engage in sexually transmitted infection counseling and prevention education in federal correctional facilities.
Stop AIDS in Prison Act - Requires the Bureau of Prisons to develop a comprehensive policy to provide HIV testing, treatment, and prevention for inmates.
Requires the Secretary to conduct research and other activities with respect to diabetes in minority populations and the prevention of lung disease.
Sleep and Circadian Rhythm Disorders Health Disparities Act - Requires the Director of the National Institutes of Health (NIH) to expand research addressing sleep health disparities. Requires the Director of CDC to expand activities regarding sleep disorders.
Sets forth provisions regarding the use of health information technology to reduce health disparities, particularly in racial and ethnic minority communities.
Prohibits discrimination in federal health care programs or research activities.
Requires the Secretary to establish the Office of Health Disparities in the Office for Civil Rights and to establish civil rights compliance offices in each HHS agency that administers health programs.
Directs the Secretary to establish a program at the National Center for Environmental Health on health impact assessment (the process of determining the potential effects of a policy, program, or project on health).
Directs the Comptroller General (GAO) to study the type and scope of health care services provided to racial and ethnic minorities affected by the explosion of the Deepwater Horizon drilling unit on April 20, 2010.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5294 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 5294
To improve the health of minority individuals, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 30, 2014
Ms. Roybal-Allard (for herself, Ms. Lee of California, Mrs.
Christensen, Ms. Bordallo, Ms. Brown of Florida, Mr. Butterfield, Ms.
Chu, Ms. Clarke of New York, Mr. Cardenas, Mr. Carson of Indiana, Ms.
Castor of Florida, Mr. Conyers, Mr. Crowley, Mr. Cummings, Mr. Danny K.
Davis of Illinois, Ms. DeGette, Ms. DeLauro, Ms. Edwards, Mr. Ellison,
Mr. Faleomavaega, Mr. Farr, Mr. Fattah, Ms. Fudge, Mr. Garcia, Mr.
Grijalva, Ms. Michelle Lujan Grisham of New Mexico, Mr. Gutierrez, Ms.
Hahn, Mr. Hinojosa, Mr. Honda, Ms. Jackson Lee, Ms. Eddie Bernice
Johnson of Texas, Mr. Johnson of Georgia, Mr. Lewis, Ms. Lofgren, Mrs.
Lowey, Mr. Ben Ray Lujan of New Mexico, Ms. Matsui, Ms. McCollum, Mr.
McGovern, Mrs. Negrete McLeod, Mr. Meeks, Ms. Meng, Mrs. Napolitano,
Ms. Norton, Mr. Pastor of Arizona, Mr. Pierluisi, Mr. Rangel, Mr.
Richmond, Mr. Rush, Mr. Sablan, Ms. Linda T. Sanchez of California, Ms.
Loretta Sanchez of California, Ms. Schakowsky, Mr. Schiff, Mr. David
Scott of Georgia, Mr. Scott of Virginia, Mr. Serrano, Mr. Sires, Ms.
Slaughter, Mr. Takano, Mr. Tonko, Mr. Vargas, Mr. Vela, Ms. Velazquez,
and Ms. Waters) introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Committees
on Ways and Means, Agriculture, Education and the Workforce, the
Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural
Resources, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To improve the health of minority individuals, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Equity and Accountability Act
of 2014''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
TITLE I--DATA COLLECTION AND REPORTING
Sec. 101. Amendment to the Public Health Service Act.
Sec. 102. Elimination of prerequisite of direct appropriations for data
collection and analysis.
Sec. 103. Collection of race and ethnicity data by the Social Security
Administration.
Sec. 104. Revision of HIPAA claims standards.
Sec. 105. National Center for Health Statistics.
Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific
Islanders and other underrepresented groups
in Federal health surveys.
Sec. 107. Geo-access study.
Sec. 108. Racial, ethnic, and primary language data collected by the
Federal Government.
Sec. 109. Data collection and analysis grants to minority-serving
institutions.
Sec. 110. Standards for measuring sexual orientation and gender
identity in collection of health data.
Sec. 111. Standards for measuring socioeconomic status in collection of
health data.
Sec. 112. Safety and effectiveness of drugs with respect to racial and
ethnic background.
Sec. 113. Improving health data regarding Native Hawaiians and other
Pacific Islanders.
Sec. 114. Clarification of simplified administrative reporting
requirement.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
Sec. 201. Definitions.
Sec. 202. Amendment to the Public Health Service Act.
Sec. 203. Pilot program for improvement and development of State
medical interpreting services.
Sec. 204. Training tomorrow's doctors for culturally and linguistically
appropriate care: graduate medical
education.
Sec. 205. Federal reimbursement for culturally and linguistically
appropriate services under the Medicare,
Medicaid, and State Children's Health
Insurance Programs.
Sec. 206. Increasing understanding of and improving health literacy.
Sec. 207. Assurances for receiving Federal funds.
Sec. 208. Report on Federal efforts to provide culturally and
linguistically appropriate health care
services.
Sec. 209. English for speakers of other languages.
Sec. 210. Implementation.
Sec. 211. Language access services.
TITLE III--HEALTH WORKFORCE DIVERSITY
Sec. 301. Amendment to the Public Health Service Act.
Sec. 302. Hispanic-serving health professions schools.
Sec. 303. Loan repayment program of Centers for Disease Control and
Prevention.
Sec. 304. Cooperative agreements for online degree programs at schools
of public health and schools of allied
health.
Sec. 305. Sense of Congress on the mission of the National Health Care
Workforce Commission.
Sec. 306. Scholarship and fellowship programs.
Sec. 307. McNair Postbaccalaureate Achievement Program.
Sec. 308. Rules for determination of full-time equivalent residents for
cost-reporting periods.
Sec. 309. Developing and implementing strategies for local health
equity.
Sec. 310. Loan forgiveness for mental and behavioral health social
workers.
Sec. 311. Health Professions Workforce Fund.
Sec. 312. Findings; sense of Congress relating to graduate medical
education.
Sec. 313. Career support for skilled internationally educated health
professionals.
TITLE IV--IMPROVEMENT OF HEALTH CARE SERVICES
Subtitle A--Health Empowerment Zones
Sec. 401. Short title.
Sec. 402. Findings.
Sec. 403. Designation of health empowerment zones.
Sec. 404. Assistance to those seeking designation.
Sec. 405. Benefits of designation.
Sec. 406. Definition.
Sec. 407. Authorization of appropriations.
Subtitle B--Other Improvements of Health Care Services
Chapter 1--Expansion of Coverage
Sec. 411. Amendment to the Public Health Service Act.
Sec. 412. Removing citizenship and immigration barriers to access to
affordable health care under the ACA.
Sec. 413. Study on the uninsured.
Sec. 414. Medicaid payment parity for the territories.
Sec. 415. Extension of Medicare secondary payer.
Sec. 416. Border health grants.
Sec. 417. Removing Medicare barrier to health care.
Sec. 418. 100 percent FMAP for medical assistance provided by urban
Indian health centers.
Sec. 419. 100 percent FMAP for medical assistance provided to a Native
Hawaiian through a federally qualified
health center or a Native Hawaiian health
care system under the Medicaid program.
Chapter 2--Expansion of Access
Sec. 421. Grants for racial and ethnic approaches to community health.
Sec. 422. Critical access hospital improvements.
Sec. 423. Establishment of Rural Community Hospital (RCH) Program.
Sec. 424. Medicare remote monitoring pilot projects.
Sec. 425. Rural health quality advisory commission and demonstration
projects.
Sec. 426. Rural health care services.
Sec. 427. Community health center collaborative access expansion.
Sec. 428. Facilitating the provision of telehealth services across
State lines.
Sec. 429. Scoring of preventive health savings.
Sec. 430. Sense of Congress.
Sec. 431. Repeal of requirement for documentation evidencing
citizenship or nationality under the
Medicaid program.
Sec. 432. Office of Minority Health in Veterans Health Administration
of Department of Veterans Affairs.
Sec. 433. Indian defined in PPACA.
Sec. 434. Study of DSH payments to ensure hospital access for low-
income patients.
Sec. 435. Assistant Secretary of the Indian Health Service.
Sec. 436. Reauthorization of the Native Hawaiian Health Care
Improvement Act.
TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES
Sec. 501. Grants to promote positive health behaviors in women and
children.
Sec. 502. Removing barriers to health care and nutrition assistance for
children, pregnant women, and lawfully
present individuals.
Sec. 503. Repeal of denial of benefits.
Sec. 504. Birth defects prevention, risk reduction, and awareness.
Sec. 505. Uniform State maternal mortality review committees on
pregnancy-related deaths.
Sec. 506. Eliminating disparities in maternity health outcomes.
Sec. 507. Decreasing the risk factors for sudden unexpected infant
death and sudden unexplained death in
childhood.
Sec. 508. Reducing unintended teenage pregnancies.
Sec. 509. Gestational diabetes.
Sec. 510. Emergency contraception education and information programs.
Sec. 511. Supporting healthy adolescent development.
Sec. 512. Compassionate assistance for rape emergencies.
Sec. 513. Access to birth control duties of pharmacies to ensure
provision of FDA-approved contraception.
Sec. 514. Additional focus area for the Office on Women's Health.
Sec. 515. Interagency coordinating committee on the promotion of
optimal maternity outcomes.
Sec. 516. Consumer education campaign.
Sec. 517. Bibliographic database of systematic reviews for care of
childbearing women and newborns.
Sec. 518. Maternity care health professional shortage areas.
Sec. 519. Expansion of CDC prevention research centers program to
include centers on optimal maternity
outcomes.
Sec. 520. Expanding models allowed to be tested by Center for Medicare
and Medicaid Innovation to include
maternity care models.
Sec. 521. Development of interprofessional maternity care educational
models and tools.
Sec. 522. Including within inpatient hospital services under Medicare
services furnished by certain students,
interns, and residents supervised by
certified nurse midwives.
Sec. 523. Grants to professional organizations to increase diversity in
maternity care professionals.
TITLE VI--MENTAL HEALTH
Sec. 601. Coverage of marriage and family therapist services, mental
health counselor services, and substance
abuse counselor services under part B of
the Medicare program.
Sec. 602. Minority Fellowship Program.
Sec. 603. Integrated Health Care Demonstration Program.
Sec. 604. Addressing racial and ethnic minority mental health
disparities research gaps.
Sec. 605. Health professions competencies to address racial and ethnic
minority mental health disparities.
TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES
Subtitle A--Cancer
Sec. 701. Lung cancer mortality reduction.
Sec. 702. Expanding prostate cancer research, outreach, screening,
testing, access, and treatment
effectiveness.
Sec. 703. Improved Medicaid coverage for certain breast and cervical
cancer patients in the territories.
Sec. 704. Cancer prevention and treatment demonstration for ethnic and
racial minorities.
Sec. 705. Reducing cancer disparities within Medicare.
Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention
Sec. 711. Viral hepatitis and liver cancer control and prevention.
Subtitle C--Acquired Bone Marrow Failure Diseases
Sec. 721. Acquired bone marrow failure diseases.
Subtitle D--Cardiovascular Disease, Chronic Disease, and Other Disease
Issues
Sec. 731. Guidelines for disease screening for minority patients.
Sec. 732. CDC Wisewoman Screening Program.
Sec. 733. Report on cardiovascular care for women and minorities.
Sec. 734. Coverage of comprehensive tobacco cessation services in
Medicaid.
Sec. 735. Clinical research funding for oral health.
Sec. 736. Participation by Medicaid beneficiaries in approved clinical
trials.
Subtitle E--HIV/AIDS
Sec. 741. Statement of policy.
Sec. 742. Findings.
Sec. 743. Additional funding for AIDS drug assistance program
treatments.
Sec. 744. Enhancing the national HIV surveillance system.
Sec. 745. Evidence-based strategies for improving linkage to and
retention in appropriate care.
Sec. 746. Improving entry into and retention in care and antiretroviral
adherence for persons with HIV.
Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority
communities.
Sec. 748. Minority AIDS initiative.
Sec. 749. Health care professionals treating individuals with HIV/AIDS.
Sec. 750. HIV/AIDS provider loan repayment program.
Sec. 751. Dental education loan repayment program.
Sec. 752. Reducing new HIV infections among injecting drug users.
Sec. 753. Support for expansion of comprehensive sexual health and
education programs.
Sec. 754. Elimination of abstinence-only education program.
Sec. 755. Report on impact of HIV/AIDS in vulnerable populations.
Sec. 756. National HIV/AIDS observance days.
Sec. 757. Review of all Federal and State laws, policies, and
regulations regarding the criminal
prosecution of individuals for HIV-related
offenses.
Sec. 758. Repeal of limitation against use of funds for education or
information designed to promote or
encourage, directly, homosexual or
heterosexual activity or intravenous
substance abuse.
Sec. 759. Expanding support for condoms in prisons.
Sec. 760. Automatic reinstatement or enrollment in Medicaid for people
who test positive for HIV before reentering
communities.
Sec. 761. Stop AIDS in prison.
Sec. 762. Support data system review and indicators for monitoring HIV
care.
Sec. 763. Transfer of funds for implementation of national HIV/AIDS
strategy.
Sec. 764. HIV integrated services delivery model demonstration.
Sec. 765. Report on the implementation of goal 4 (improved
coordination) of the national HIV/AIDS
strategy.
Subtitle F--Diabetes
Sec. 771. Research, treatment, and education.
Sec. 772. Research, education, and other activities.
Sec. 773. Research, education, and other activities.
Sec. 774. Research, education, and other activities.
Sec. 775. Updated report on health disparities.
Subtitle G--Lung Disease
Sec. 776. Expansion of the National Asthma Education and Prevention
Program.
Sec. 777. Asthma-related activities of the Centers for Disease Control
and Prevention.
Sec. 778. Influenza and pneumonia vaccination campaign.
Sec. 779. Chronic obstructive pulmonary disease action plan.
Subtitle H--Osteoarthritis and Musculoskeletal Diseases
Sec. 781. Findings.
Sec. 782. Osteoarthritis and other musculoskeletal health-related
activities of the Centers for Disease
Control and Prevention.
Subtitle I--Sleep and Circadian Rhythm Disorders
Sec. 791. Short title; findings.
Sec. 792. Sleep and circadian rhythm disorders research activities of
the National Institutes of Health.
Sec. 793. Sleep and circadian rhythm health disparities-related
activities of the Centers for Disease
Control and Prevention.
TITLE VIII--HEALTH INFORMATION TECHNOLOGY
Sec. 800. Definitions.
Subtitle A--Reducing Health Disparities Through Health IT
Sec. 801. HRSA assistance to health centers for promotion of Health IT.
Sec. 802. Assessment of impact of Health IT on racial and ethnic
minority communities; outreach and adoption
of Health IT in such communities.
Subtitle B--Modifications To Achieve Parity in Existing Programs
Sec. 811. Extending funding to strengthen the Health IT infrastructure
in racial and ethnic minority communities.
Sec. 812. Prioritizing regional extension center assistance to racial
and ethnic minority groups.
Sec. 813. Extending competitive grants for the development of loan
programs to facilitate adoption of
certified EHR technology by providers
serving racial and ethnic minority groups.
Sec. 814. Authorization of appropriations.
Subtitle C--Additional Research and Studies
Sec. 831. Data collection and assessments conducted in coordination
with minority-serving institutions.
Sec. 832. Study of health information technology in medically
underserved communities.
Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs
Sec. 841. Application of Medicare HITECH payments to hospitals in
Puerto Rico.
Sec. 842. Extending Medicaid EHR incentive payments to rehabilitation
facilities, long-term care facilities, and
home health agencies.
Sec. 843. Extending physician assistant eligibility for Medicaid
electronic health record incentive
payments.
TITLE IX--ACCOUNTABILITY AND EVALUATION
Sec. 901. Prohibition on discrimination in Federal assisted health care
services and research programs on the basis
of sex, race, color, national origin,
marital status, familial status, sexual
orientation, gender identity, or disability
status.
Sec. 902. Treatment of Medicare payments under title VI of the Civil
Rights Act of 1964.
Sec. 903. Accountability and transparency within the Department of
Health and Human Services.
Sec. 904. United States Commission on Civil Rights.
Sec. 905. Sense of Congress concerning full funding of activities to
eliminate racial and ethnic health
disparities.
Sec. 906. GAO and NIH reports.
TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
JUSTICE
Sec. 1001. Definitions.
Sec. 1002. Findings.
Sec. 1003. Health impact assessments.
Sec. 1004. Implementation of recommendations by Environmental
Protection Agency.
Sec. 1005. Grant program to conduct environmental health improvement
activities and to improve social
determinants of health.
Sec. 1006. Additional research on the relationship between the built
environment and the health of community
residents.
Sec. 1007. Environment and public health restoration.
Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig
explosion in the Gulf Coast.
SEC. 3. FINDINGS.
The Congress finds as follows:
(1) The population of racial and ethnic minorities is
expected to increase over the next few decades, yet racial and
ethnic minorities have the poorest health status and face
substantial cultural, social, and economic barriers to
obtaining quality health care.
(2) Health disparities are a function of not only access to
health care, but also the social determinants of health--
including the environment, the physical structure of
communities, nutrition and food options, educational
attainment, employment, race, ethnicity, sex, geography,
language preference, immigrant or citizenship status, sexual
orientation, gender identity, socioeconomic status, or
disability status--that directly and indirectly affect the
health, health care, and wellness of individuals and
communities.
(3) By 2020, the Nation will face a shortage of health care
providers and allied health workers and this shortage
disproportionately affects health professional shortage areas
where many racial and ethnic minority populations reside.
(4) All efforts to reduce health disparities and barriers
to quality health services require better and more consistent
data.
(5) A full range of culturally and linguistically
appropriate health care and public health services must be
available and accessible in every community.
(6) Racial and ethnic minorities and underserved
populations must be included early and equitably in health
reform innovations.
(7) Efforts to improve minority health have been limited by
inadequate resources in funding, staffing, stewardship, and
accountability. Targeted investments that are focused on
disparities elimination must be made in providing care and
services that are community-based, including prevention and
policies addressing social determinants of health.
(8) In 2011, the Department of Health and Human Services
developed the HHS Action Plan to Reduce Racial and Ethnic
Health Disparities and the National Stakeholder Strategy for
Achieving Health Equity, two strategic plans that represent the
country's first coordinated roadmap to reducing health
disparities. Along with the National Prevention Strategy,
Healthy People 2020, and the National Health Care Quality
Strategy, as well as critical resources such as the 2012
National Healthcare Quality and Disparities Reports, these
comprehensive plans will work to increase the number of
Americans who are healthy at every stage of life.
(9) The Department of Health and Human Services also
developed other strategic planning documents to combat disease
disparities with a high impact on minority populations
including the National HIV/AIDS Strategy, and the Action Plan
for the Prevention, Care and Treatment of Viral Hepatitis.
(10) The Patient Protection and Affordable Care Act, as
amended by the Health Care and Education Reconciliation Act,
represents the biggest advancement for minority health in the
last 40 years.
TITLE I--DATA COLLECTION AND REPORTING
SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
(a) Purpose.--It is the purpose of this section to promote data
collection, analysis, and reporting by race, ethnicity, sex, primary
language, sexual orientation, disability status, gender identity, and
socioeconomic status among federally supported health programs.
(b) Amendment.--Title XXXIV of the Public Health Service Act, as
amended by titles II and III of this Act, is further amended by
inserting after subtitle A the following:
``Subtitle B--Strengthening Data Collection, Improving Data Analysis,
and Expanding Data Reporting
``SEC. 3431. HEALTH DISPARITY DATA.
``(a) Requirements.--
``(1) In general.--Each health-related program operated by
or that receives funding or reimbursement, in whole or in part,
either directly or indirectly from the Department of Health and
Human Services shall--
``(A) require the collection, by the agency or
program involved, of data on the race, ethnicity, sex,
primary language, sexual orientation, disability
status, gender identity, and socioeconomic status of
each applicant for and recipient of health-related
assistance under such program--
``(i) using, at a minimum, the standards
for data collection on race, ethnicity, sex,
primary language, sexual orientation,
disability status, gender identity, and
socioeconomic status developed under section
3101;
``(ii) collecting data for additional
population groups if such groups can be
aggregated into the race and ethnicity
categories outlined by the standards developed
under section 3101;
``(iii) additionally referring, where
practicable, to the standards developed by the
Institute of Medicine in `Race, Ethnicity, and
Language Data: Standardization for Health Care
Quality Improvement'; and
``(iv) where practicable, through self-
reporting;
``(B) with respect to the collection of the data
described in subparagraph (A), for applicants and
recipients who are minors, require communication
assistance in speech or writing, and for applicants and
recipients who are otherwise legally incapacitated,
require that--
``(i) such data be collected from the
parent or legal guardian of such an applicant
or recipient; and
``(ii) the primary language of the parent
or legal guardian of such an applicant or
recipient be collected;
``(C) systematically analyze such data using the
smallest appropriate units of analysis feasible to
detect racial and ethnic disparities, as well as
disparities along the lines of primary language, sex,
disability status, sexual orientation, gender identity,
and socioeconomic status in health and health care, and
report the results of such analysis to the Secretary,
the Director of the Office for Civil Rights, each
agency listed in section 3101(c)(1), the Committee on
Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate, and the Committee
on Energy and Commerce and the Committee on Ways and
Means of the House of Representatives;
``(D) provide such data to the Secretary on at
least an annual basis; and
``(E) ensure that the provision of assistance to an
applicant or recipient of assistance is not denied or
otherwise adversely affected because of the failure of
the applicant or recipient to provide race, ethnicity,
primary language, sex, sexual orientation, disability
status, gender identity, and socioeconomic status data.
``(2) Rules of construction.--Nothing in this subsection
shall be construed to--
``(A) permit the use of information collected under
this subsection in a manner that would adversely affect
any individual providing any such information; or
``(B) diminish existing or future requirements on
health care providers to collect data.
``(3) No compelled disclosure of data.--This title does not
authorize any health care provider, Federal official, or other
entity to compel the disclosure of any data collected under
this title. The disclosure of any such data by an individual
pursuant to this title shall be strictly voluntary.
``(b) Protection of Data.--The Secretary shall ensure (through the
promulgation of regulations or otherwise) that all data collected
pursuant to subsection (a) are protected--
``(1) under the same privacy protections as the Secretary
applies to other health data under the regulations promulgated
under section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033)
relating to the privacy of individually identifiable health
information and other protections; and
``(2) from all inappropriate internal use by any entity
that collects, stores, or receives the data, including use of
such data in determinations of eligibility (or continued
eligibility) in health plans, and from other inappropriate
uses, as defined by the Secretary.
``(c) National Plan of the Data Council.--The Secretary shall
develop and implement a national plan to ensure the collection of data
in a culturally appropriate and competent manner, to improve the
collection, analysis, and reporting of racial, ethnic, sex, primary
language, sexual orientation, disability status, gender identity, and
socioeconomic status data at the Federal, State, territorial, tribal,
and local levels, including data to be collected under subsection (a),
and to ensure that data collection activities carried out under this
section are in compliance with the standards developed under section
3101. The Data Council of the Department of Health and Human Services,
in consultation with the National Committee on Vital Health Statistics,
the Office of Minority Health, Office on Women's Health, and other
appropriate public and private entities, shall make recommendations to
the Secretary concerning the development, implementation, and revision
of the national plan. Such plan shall include recommendations on how
to--
``(1) implement subsection (a) while minimizing the cost
and administrative burdens of data collection and reporting;
``(2) expand awareness among Federal agencies, States,
territories, Indian tribes, health providers, health plans,
health insurance issuers, and the general public that data
collection, analysis, and reporting by race, ethnicity, primary
language, sexual orientation, disability status, gender
identity, and socioeconomic status is legal and necessary to
assure equity and nondiscrimination in the quality of health
care services;
``(3) ensure that future patient record systems have data
code sets for racial, ethnic, primary language, sexual
orientation, disability status, gender identity, and
socioeconomic status identifiers and that such identifiers can
be retrieved from clinical records, including records
transmitted electronically;
``(4) improve health and health care data collection and
analysis for more population groups if such groups can be
aggregated into the minimum race and ethnicity categories,
including exploring the feasibility of enhancing collection
efforts in States for racial and ethnic groups that comprise a
significant proportion of the population of the State;
``(5) provide researchers with greater access to racial,
ethnic, primary language, sexual orientation, disability
status, gender identity, and socioeconomic status data, subject
to privacy and confidentiality regulations; and
``(6) safeguard and prevent the misuse of data collected
under subsection (a).
``(d) Compliance With Standards.--Data collected under subsection
(a) shall be obtained, maintained, and presented (including for
reporting purposes) in accordance with the standards developed under
section 3101.
``(e) Technical Assistance for the Collection and Reporting of
Data.--
``(1) In general.--The Secretary may, either directly or
through grant or contract, provide technical assistance to
enable a health care program or an entity operating under such
program to comply with the requirements of this section.
``(2) Types of assistance.--Assistance provided under this
subsection may include assistance to--
``(A) enhance or upgrade computer technology that
will facilitate racial, ethnic, primary language,
sexual orientation, disability status, gender identity,
and socioeconomic status data collection and analysis;
``(B) improve methods for health data collection
and analysis, including additional population groups if
such groups can be aggregated into the race and
ethnicity categories outlined by the standards
developed under section 3101;
``(C) develop mechanisms for submitting collected
data subject to existing privacy and confidentiality
regulations; and
``(D) develop educational programs to inform health
insurance issuers, health plans, health providers,
health-related agencies, and the general public that
data collection and reporting by race, ethnicity,
primary language, sexual orientation, disability
status, gender identity, and socioeconomic status are
legal and essential for eliminating health and health
care disparities.
``(f) Analysis of Health Disparity Data.--The Secretary, acting
through the Director of the Agency for Healthcare Research and Quality
and in coordination with the Administrator of the Centers for Medicare
& Medicaid Services, shall provide technical assistance to agencies of
the Department of Health and Human Services in meeting Federal
standards for health disparity data collection and for analysis of
racial and ethnic disparities in health and health care in public
programs by--
``(1) identifying appropriate quality assurance mechanisms
to monitor for health disparities;
``(2) specifying the clinical, diagnostic, or therapeutic
measures which should be monitored;
``(3) developing new quality measures relating to racial
and ethnic disparities and their overlap with other disparity
factors in health and health care;
``(4) identifying the level at which data analysis should
be conducted; and
``(5) sharing data with external organizations for research
and quality improvement purposes.
``(g) Primary Language.--References in this section--
``(1) to primary language data, include spoken and written
primary language data; and
``(2) to primary language data collection activities,
include identifying, collecting, storing, tracking, and
analyzing primary language data and information on the methods
used to meet the language access needs of limited-English-
proficient individuals.
``(h) Definition.--In this section, the term `health-related
program' mean a program--
``(1) under the Social Security Act (42 U.S.C. 301 et seq.)
that pays for health care and services; and
``(2) under this Act that provides Federal financial
assistance for health care, biomedical research, or health
services research and or is designed to improve the public's
health.
``(i) 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 2015 through 2020.
``SEC. 3432. PROVISIONS RELATING TO NATIVE AMERICANS.
``(a) Establishment of Epidemiology Centers.--The Secretary shall
establish an epidemiology center in each service area to carry out the
functions described in subsection (b). Any new center established after
the date of the enactment of the Health Equity and Accountability Act
of 2014 may be operated under a grant authorized by subsection (d), but
funding under such a grant shall not be divisible.
``(b) Functions of Centers.--In consultation with and upon the
request of Indian tribes, tribal organizations, and urban Indian
organizations, each service area epidemiology center established under
this subsection shall, with respect to such service area--
``(1) collect data relating to, and monitor progress made
toward meeting, each of the health status objectives of the
service, the Indian tribes, tribal organizations, and urban
Indian organizations in the service area;
``(2) evaluate existing delivery systems, data systems, and
other systems that impact the improvement of Indian health;
``(3) assist Indian tribes, tribal organizations, and urban
Indian organizations in identifying their highest priority
health status objectives and the services needed to achieve
such objectives, based on epidemiological data;
``(4) make recommendations for the targeting of services
needed by the populations served;
``(5) make recommendations to improve health care delivery
systems for Indians and urban Indians;
``(6) provide requested technical assistance to Indian
tribes, tribal organizations, and urban Indian organizations in
the development of local health service priorities and
incidence and prevalence rates of disease and other illness in
the community; and
``(7) provide disease surveillance and assist Indian
tribes, tribal organizations, and urban Indian organizations to
promote public health.
``(c) Technical Assistance.--The Director of the Centers for
Disease Control and Prevention shall provide technical assistance to
the centers in carrying out the requirements of this subsection.
``(d) Grants for Studies.--
``(1) In general.--The Secretary may make grants to Indian
tribes, tribal organizations, urban Indian organizations, and
eligible intertribal consortia to conduct epidemiological
studies of Indian communities.
``(2) Eligible intertribal consortia.--An intertribal
consortium is eligible to receive a grant under this subsection
if--
``(A) the intertribal consortium is incorporated
for the primary purpose of improving Indian health; and
``(B) the intertribal consortium is representative
of the Indian tribes or urban Indian communities in
which the intertribal consortium is located.
``(3) Applications.--An application for a grant under this
subsection shall be submitted in such manner and at such time
as the Secretary shall prescribe.
``(4) Requirements.--An applicant for a grant under this
subsection shall--
``(A) demonstrate the technical, administrative,
and financial expertise necessary to carry out the
functions described in paragraph (5);
``(B) consult and cooperate with providers of
related health and social services in order to avoid
duplication of existing services; and
``(C) demonstrate cooperation from Indian tribes or
urban Indian organizations in the area to be served.
``(5) Use of funds.--A grant awarded under paragraph (1)
may be used--
``(A) to carry out the functions described in
subsection (b);
``(B) to provide information to and consult with
tribal leaders, urban Indian community leaders, and
related health staff on health care and health service
management issues; and
``(C) in collaboration with Indian tribes, tribal
organizations, and urban Indian communities, to provide
the service with information regarding ways to improve
the health status of Indians.
``(e) Access to Information.--An epidemiology center operated by a
grantee pursuant to a grant awarded under subsection (d) shall be
treated as a public health authority for purposes of the Health
Insurance Portability and Accountability Act of 1996 (Public Law 104-
191; 110 Stat. 2033), as such entities are defined in part 164.501 of
title 45, Code of Federal Regulations (or a successor regulation). The
Secretary shall grant such grantees access to and use of data, data
sets, monitoring systems, delivery systems, and other protected health
information in the possession of the Secretary.''.
SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT APPROPRIATIONS FOR DATA
COLLECTION AND ANALYSIS.
Section 3101 of the Public Health Service Act (42 U.S.C. 300kk) is
amended--
(1) by striking subsection (h); and
(2) by redesignating subsection (i) as subsection (h).
SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL SECURITY
ADMINISTRATION.
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et
seq.) is amended by adding at the end the following:
``SEC. 1150C. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL
SECURITY ADMINISTRATION.
``(a) Requirement.--The Commissioner of Social Security, in
consultation with the Administrator of the Centers for Medicare &
Medicaid Services, shall--
``(1) require the collection of data on the race,
ethnicity, primary language, and disability status of all
applicants for Social Security account numbers or benefits
under title II or part A of title XVIII and all individuals
with respect to whom the Commissioner maintains records of
wages and self-employment income in accordance with reports
received by the Commissioner or the Secretary of the Treasury--
``(A) using, at a minimum, the standards for data
collection on race, ethnicity, primary language, and
disability status developed under section 3101 of the
Public Health Service Act;
``(B) where practicable, collecting data for
additional population groups if such groups can be
aggregated into the race and ethnicity categories
outlined by the standards developed under section 3101
of the Public Health Service Act; and
``(C) additionally referring, where practicable, to
the standards developed by the Institute of Medicine in
`Race, Ethnicity, and Language Data: Standardization
for Health Care Quality Improvement' (released August
31, 2009);
``(2) with respect to the collection of the data described
in paragraph (1) for applicants who are under 18 years of age
or otherwise legally incapacitated, require that--
``(A) such data be collected from the parent or
legal guardian of such an applicant; and
``(B) the primary language of the parent or legal
guardian of such an applicant or recipient be used;
``(3) require that such data be uniformly analyzed and
reported at least annually to the Commissioner of Social
Security;
``(4) be responsible for storing the data reported under
paragraph (3);
``(5) ensure transmission to the Centers for Medicare &
Medicaid Services and other Federal health agencies;
``(6) provide such data to the Secretary on at least an
annual basis; and
``(7) ensure that the provision of assistance to an
applicant is not denied or otherwise adversely affected because
of the failure of the applicant to provide race, ethnicity,
primary language, and disability status data.
``(b) Protection of Data.--The Commissioner of Social Security
shall ensure (through the promulgation of regulations or otherwise)
that all data collected pursuant to subsection (a) are protected--
``(1) under the same privacy protections as the Secretary
applies to health data under the regulations promulgated under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033)
relating to the privacy of individually identifiable health
information and other protections; and
``(2) from all inappropriate internal use by any entity
that collects, stores, or receives the data, including use of
such data in determinations of eligibility (or continued
eligibility) in health plans, and from other inappropriate
uses, as defined by the Secretary.
``(c) Rule of Construction.--Nothing in this section shall be
construed to permit the use of information collected under this section
in a manner that would adversely affect any individual providing any
such information.
``(d) Technical Assistance.--The Secretary may, either directly or
by grant or contract, provide technical assistance to enable any health
entity to comply with the requirements of this section.
``(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 2015 through 2020.''.
SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Health and Human Services shall revise
the regulations promulgated under part C of title XI of the Social
Security Act (42 U.S.C. 1320d et seq.), relating to the collection of
data on race, ethnicity, and primary language in a health-related
transaction, to require--
(1) the use, at a minimum, of the standards for data
collection on race, ethnicity, primary language, disability,
and sex developed under section 3101 of the Public Health
Service Act (42 U.S.C. 300kk); and
(2) the designation of the racial, ethnic, primary
language, disability, and sex code sets as required for claims
and enrollment data.
(b) Dissemination.--The Secretary of Health and Human Services
shall disseminate the new standards developed under subsection (a) to
all health entities that are subject to the regulations described in
such subsection and provide technical assistance with respect to the
collection of the data involved.
(c) Compliance.--The Secretary of Health and Human Services shall
require that health entities comply with the new standards developed
under subsection (a) not later than 2 years after the final
promulgation of such standards.
SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n))
is amended--
(1) in paragraph (1), by striking ``2003'' and inserting
``2020'';
(2) in paragraph (2), in the first sentence, by striking
``2003'' and inserting ``2020''; and
(3) in paragraph (3), by striking ``2002'' and inserting
``2020''.
SEC. 106. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE HAWAIIANS, OR PACIFIC
ISLANDERS AND OTHER UNDERREPRESENTED GROUPS IN FEDERAL
HEALTH SURVEYS.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317T the following:
``SEC. 317U. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE HAWAIIANS, OR
PACIFIC ISLANDERS AND OTHER UNDERREPRESENTED GROUPS IN
FEDERAL HEALTH SURVEYS.
``(a) National Strategy.--
``(1) In general.--The Secretary of Health and Human
Services, acting through the Director of the National Center
for Health Statistics (referred to in this section as `NCHS')
of the Centers for Disease Control and Prevention, and other
agencies within the Department of Health and Human Services as
the Secretary determines appropriate, shall develop and
implement an ongoing and sustainable national strategy for
oversampling Asian-Americans, Native Hawaiians, or Pacific
Islanders, and other underrepresented populations as determined
appropriate by the Secretary in Federal health surveys.
``(2) Consultation.--In developing and implementing a
national strategy, as described in paragraph (1), not later
than 180 days after the date of the enactment of the this
section, the Secretary--
``(A) shall consult with representatives of
community groups, nonprofit organizations,
nongovernmental organizations, and government agencies
working with Asian-Americans, Native Hawaiians, or
Pacific Islanders, and other underrepresented
populations; and
``(B) may solicit the participation of
representatives from other Federal departments and
agencies.
``(b) Progress Report.--Not later than 2 years after the date of
the enactment of this section, the Secretary shall submit to the
Congress a progress report, which shall include the national strategy
described in subsection (a)(1).
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2020.''.
SEC. 107. GEO-ACCESS STUDY.
The Administrator of the Substance Abuse and Mental Health Services
Administration shall--
(1) conduct a study to--
(A) determine which geographic areas of the United
States have shortages of specialty mental health
providers; and
(B) assess the preparedness of speciality mental
health providers to deliver culturally and
linguistically appropriate, affordable, and accessible
services; and
(2) submit a report to the Congress on the results of such
study.
SEC. 108. RACIAL, ETHNIC, AND PRIMARY LANGUAGE DATA COLLECTED BY THE
FEDERAL GOVERNMENT.
(a) Collection; Submission.--Not later than 90 days after the date
of the enactment of this Act, and January 31 of each year thereafter,
each department, agency, and office of the Federal Government that has
collected racial, ethnic, or primary language data during the preceding
calendar year shall submit such data to the Secretary of Health and
Human Services.
(b) Analysis; Public Availability; Reporting.--Not later than April
30, 2015, and each April 30 thereafter, the Secretary of Health and
Human Services, acting through the Director of the National Institute
on Minority Health and Health Disparities and the Deputy Assistant
Secretary for Minority Health, shall--
(1) collect and analyze the racial, ethnic, and primary
language data submitted under subsection (a) for the preceding
calendar year;
(2) make publicly available such data and the results of
such analysis; and
(3) submit a report to the Congress on such data and
analysis.
SEC. 109. DATA COLLECTION AND ANALYSIS GRANTS TO MINORITY-SERVING
INSTITUTIONS.
(a) Authority.--The Secretary of Health and Human Services, acting
through the National Institute on Minority Health and Health
Disparities and the Office of Minority Health, may award grants to
access and analyze racial and ethnic, and where possible other health
disparity data, to monitor and report on progress to reduce and
eliminate disparities in health and health care.
(b) Eligible Entity.--In this section, the term ``eligible entity''
means a historically Black college or university, an Hispanic-serving
institution, a tribal college or university, or an Asian-American,
Native American, or Pacific Islander-serving institution with an
accredited public health, health policy, or health services research
program.
SEC. 110. STANDARDS FOR MEASURING SEXUAL ORIENTATION AND GENDER
IDENTITY IN COLLECTION OF HEALTH DATA.
Section 3101(a) of the Public Health Service Act (42 U.S.C.
300kk(a)) is amended--
(1) in paragraph (1)(A), by inserting ``sexual orientation,
gender identity,'' before ``and disability status'';
(2) in paragraph (1)(C), by inserting ``sexual orientation,
gender identity,'' before ``and disability status''; and
(3) in paragraph (2)(B), by inserting ``sexual orientation,
gender identity,'' before ``and disability status''.
SEC. 111. STANDARDS FOR MEASURING SOCIOECONOMIC STATUS IN COLLECTION OF
HEALTH DATA.
Section 3101(a) of the Public Health Service Act (42 U.S.C.
300kk(a)), as amended, is amended--
(1) in paragraph (1)(A), by inserting ``socioeconomic
status,'' before ``and disability status'';
(2) in paragraph (1)(C), by inserting ``socioeconomic
status,'' before ``and disability status''; and
(3) in paragraph (2)(B), by inserting ``socioeconomic
status,'' before ``and disability status''.
SEC. 112. 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 505E the
following:
``SEC. 505F. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL
AND ETHNIC BACKGROUND.
``(a) Preapproval 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) Postmarket 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,
postmarketing studies to investigate the disparity.
``(2) Labeling.--If the Secretary determines that the
postmarket 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, and the other demographic characteristics of
study participants included, in the order requiring postmarket
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 Sections 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)(B).
``(2) Labeling.--Notwithstanding clauses (iii) and (iv) of
section 505(j)(5)(B), 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:
``(cc) 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 505F.''.
(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 ``are
required'' the following: ``, including supplements required under
section 505F''.
SEC. 113. IMPROVING HEALTH DATA REGARDING NATIVE HAWAIIANS AND OTHER
PACIFIC ISLANDERS.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317U, as added, the
following:
``SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER HEALTH DATA.
``(a) Definitions.--In this section:
``(1) Community group.--The term `community group' means a
group of NHOPI who are organized at the community level, and
may include a church group, social service group, national
advocacy organization, or cultural group.
``(2) Nonprofit, nongovernmental organization.--The term
`nonprofit, nongovernmental organization' means a group of
NHOPI with a demonstrated history of addressing NHOPI issues,
including a NHOPI coalition.
``(3) Designated organization.--The term `designated
organization' means an entity established to represent NHOPI
populations and which has statutory responsibilities to
provide, or has community support for providing, health care.
``(4) Government representatives.--The term `government
representatives' means representatives from Hawaii, American
Samoa, the Commonwealth of the Northern Mariana Islands, the
Federated States of Micronesia, Guam, the Republic of Palau,
and the Republic of the Marshall Islands.
``(5) Native hawaiians and other pacific islanders
(nhopi).--The term `Native Hawaiians and Other Pacific
Islanders' or `NHOPI' means people having origins in any of the
original peoples of American Samoa, the Commonwealth of the
Northern Mariana Islands, the Federated States of Micronesia,
Guam, Hawaii, the Republic of the Marshall Islands, the
Republic of Palau, or any other Pacific island.
``(6) Insular area.--The term `insular area' means Guam,
the Commonwealth of Northern Mariana Islands, American Samoa,
the United States Virgin Islands, the Federated States of
Micronesia, the Republic of Palau, or the Republic of the
Marshall Islands.
``(b) National Strategy.--
``(1) In general.--The Secretary, acting through the
Director of the National Center for Health Statistics (referred
to in this section as `NCHS') of the Centers for Disease
Control and Prevention, and other agencies within the
Department of Health and Human Services as the Secretary
determines appropriate, shall develop and implement an ongoing
and sustainable national strategy for identifying and
evaluating the health status and health care needs of NHOPI
populations living in the continental United States, Hawaii,
American Samoa, the Commonwealth of the Northern Mariana
Islands, the Federated States of Micronesia, Guam, the Republic
of Palau, and the Republic of the Marshall Islands.
``(2) Consultation.--In developing and implementing a
national strategy, as described in paragraph (1), not later
than 180 days after the date of enactment of the Health Equity
and Accountability Act of 2014, the Secretary--
``(A) shall consult with representatives of
community groups, designated organizations, and
nonprofit, nongovernmental organizations and with
government representatives of NHOPI populations; and
``(B) may solicit the participation of
representatives from other Federal departments.
``(c) Preliminary Health Survey.--
``(1) In general.--The Secretary, acting through the
Director of NCHS, shall conduct a preliminary health survey in
order to identify the major areas and regions in the
continental United States, Hawaii, American Samoa, the
Commonwealth of the Northern Mariana Islands, the Federated
States of Micronesia, Guam, the Republic of Palau, and the
Republic of the Marshall Islands in which NHOPI people reside.
``(2) Contents.--The health survey described in paragraph
(1) shall include health data and any other data the Secretary
determines to be--
``(A) useful in determining health status and
health care needs; or
``(B) required for developing or implementing a
national strategy.
``(3) Methodology.--Methodology for the health survey
described in paragraph (1), including plans for designing
questions, implementation, sampling, and analysis, shall be
developed in consultation with community groups, designated
organizations, nonprofit, nongovernmental organizations, and
government representatives of NHOPI populations, as determined
by the Secretary.
``(4) Timeframe.--The survey required under this subsection
shall be completed not later than 18 months after the date of
enactment of the Health Equity and Accountability Act of 2014.
``(d) Progress Report.--Not later than 2 years after the date of
enactment of the Health Equity and Accountability Act of 2014, the
Secretary shall submit to Congress a progress report, which shall
include the national strategy described in subsection (b)(1).
``(e) Study and Report by the IOM.--
``(1) In general.--The Secretary shall enter into an
agreement with the Institute of Medicine to conduct a study,
with input from stakeholders in insular areas, on the
following:
``(A) The standards and definitions of health care
applied to health care systems in insular areas and the
appropriateness of such standards and definitions.
``(B) The status and performance of health care
systems in insular areas, evaluated based upon
standards and definitions, as the Secretary determines.
``(C) The effectiveness of donor aid in addressing
health care needs and priorities in insular areas.
``(D) The progress toward implementation of
recommendations of the Committee on Health Care
Services in the United States--Associated Pacific Basin
of the Institute of Medicine that are set forth in the
1998 report, `Pacific Partnerships for Health: Charting
a New Course for the 21st Century'.
``(2) Report.--An agreement described in paragraph (1)
shall require the Institute of Medicine to submit to the
Secretary and to Congress, not later than 2 years after the
date of the enactment of the Health Equity and Accountability
Act of 2014, a report containing a description of the results
of the study conducted under paragraph (1), including the
conclusions and recommendations of the Institute of Medicine
for each of the items described in subparagraphs (A) through
(D) of such paragraph.
``(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2020.''.
SEC. 114. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE REPORTING
REQUIREMENT.
Section 11(a) of the Food and Nutrition Act of 2008 (7 U.S.C.
2020(a)) is amended by adding at the end the following:
``(5) Simplified administrative reporting requirement.--The
administrative notification requirement under section 421(e)(2)
of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1631(e)(2)) shall be
satisfied by the submission by an agency of a report on the
aggregate number of exceptions granted under such section by
such agency in each year.''.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
SEC. 201. DEFINITIONS.
In this title, the definitions contained in section 3400 of the
Public Health Service Act, as added by section 202, shall apply.
SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
(a) Findings.--Congress finds the following:
(1) Effective communication is essential to meaningful
access to quality physical and mental health care.
(2) Research indicates that the lack of appropriate
language services creates language barriers that result in
increased risk of misdiagnosis, ineffective treatment plans and
poor health outcomes for limited-English-proficient individuals
and individuals with communication disabilities such as
hearing, vision, or print impairments.
(3) The number of limited-English-speaking residents in the
United States who speak English less than very well and,
therefore, cannot effectively communicate with health and
social service providers continues to increase significantly.
(4) The responsibility to fund language services in the
provision of health care and health-care-related services to
limited-English-proficient individuals and individuals with
communication disabilities such as hearing, vision, or print
impairments is a societal one that cannot fairly be visited
solely upon the health care, public health, or social services
community.
(5) Title VI of the Civil Rights Act of 1964 prohibits
discrimination based on the grounds of race, color, or national
origin by any entity receiving Federal financial assistance. In
order to avoid discrimination on the grounds of national
origin, all programs or activities administered by the
Department must take adequate steps to ensure that their
policies and procedures do not deny or have the effect of
denying limited-English-proficient individuals with equal
access to benefits and services for which such persons qualify.
(6) Linguistic diversity in the health care and health-
care-related-services workforce is important for providing all
patients the environment most conducive to positive health
outcomes.
(7) All members of the health care and health-care-related-
services community should continue to educate their staff and
constituents about limited-English-proficient and disability
communication issues and help them identify resources to
improve access to quality care for limited-English-proficient
individuals and individuals with communication disabilities
such as hearing, vision, or print impairments.
(8) Access to English as a second language and sign
language instructions is an important mechanism for ensuring
effective communication and eliminating the language barriers
that impede access to health care.
(9) Competent language services in health care settings
should be available as a matter of course.
(b) Amendment.--The Public Health Service Act (42 U.S.C. 201 et
seq.) is amended by adding at the end the following:
``TITLE XXXIV--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
``SEC. 3400. DEFINITIONS.
``In this title:
``(1) Bilingual.--The term `bilingual' with respect to an
individual means a person who has sufficient degree of
proficiency in two languages.
``(2) Community health worker.--The term `community health
worker' includes a community health advocate, a lay health
educator, a community health representative, a peer health
promoter, a community health outreach worker, and in Spanish,
promotores de salud.
``(3) Competent interpreter services.--The term `competent
interpreter services' means a translanguage rendition of a
spoken or signed message in which the interpreter--
``(A) comprehends the source language and can
communicate comprehensively in the target language to
convey the meaning intended in the source language; and
``(B) knows health and health-related terminology
and provides accurate interpretations by choosing
equivalent expressions that convey the best matching
and meaning to the source language and capture, to the
greatest possible extent, all nuances intended in the
source message.
``(4) Competent translation services.--The term `competent
translation services' means a translanguage rendition of a
written document in which the translator--
``(A) comprehends the source language and can write
or sign comprehensively in the target language to
convey the meaning intended in the source language; and
``(B) knows health and health-related terminology
and provides accurate translations by choosing
equivalent expressions that convey the best matching
and meaning to the source language and capture, to the
greatest possible extent, all nuances intended in the
source document.
``(5) Cultural competence.--The term `cultural competence'
means a set of congruent behaviors, attitudes, and policies
that come together in a system, agency, or among professionals
that enables effective work in cross-cultural situations. In
the preceding sentence--
``(A) the term `cultural' refers to integrated
patterns of human behavior that include the language,
thoughts, communications, actions, customs, beliefs,
values, and institutions of racial, ethnic, religious,
or social groups, including lesbian, gay, bisexual,
transgender, and intersex individuals, and individuals
with physical and mental disabilities; and
``(B) the term `competence' implies having the
capacity to function effectively as an individual and
an organization within the context of the cultural
beliefs, behaviors, and needs presented by consumers
and their communities.
``(6) Effective communication.--The term `effective
communication' means an exchange of information between the
provider of health care or health-care-related services and the
recipient of such services who is limited in English
proficiency, or has a communication impairment such as a
hearing, vision, or learning impairment, that enables access,
understanding, and benefit from health care or health-care-
related services, and full participation in the development of
their treatment plan.
``(7) Grievance resolution process.--The term `grievance
resolution process' means all aspects of dispute resolution
including filing complaints, grievance and appeal procedures,
and court action.
``(8) Health care group.--The term `health care group'
means a group of physicians organized, at least in part, for
the purposes of providing physicians' services under the
Medicaid, SCHIP, or Medicare programs and may include a
hospital and any other individual or entity furnishing services
covered under the Medicaid, SCHIP, or Medicare programs that is
affiliated with the health care group.
``(9) Healthcare services.--The term `health care services'
means services that address physical as well as mental health
conditions in all care settings.
``(10) Health-care-related services.--The term `health-
care-related services' means human or social services programs
or activities that provide access, referrals or links to health
care.
``(11) Indian tribe.--The term `Indian tribe' means any
Indian tribe, band, nation, or other organized group or
community, including any Alaska Native village or group or
regional or village corporation as defined in or established
pursuant to the Alaska Native Claims Settlement Act (85 Stat.
688) (43 U.S.C. 1601 et seq.), which is recognized as eligible
for the special programs and services provided by the United
States to Indians because of their status as Indians.
``(12) Integrated health care delivery system.--The term
`integrated health care delivery system' means an
interdisciplinary system that brings together providers from
the primary health, mental health, substance use and related
disciplines to improve the health outcomes of an individual.
Providers may include but are not limited to hospitals, health,
mental health or substance use clinics and providers, home
health agencies, ambulatory surgery centers, skilled nursing
facilities, rehabilitation centers, and employed, independent,
or contracted physicians.
``(13) Interpreting/interpretation.--The terms
`interpreting' and `interpretation' mean the transmission of a
spoken, written, or signed message from one language or format
into another, faithfully, accurately, and objectively.
``(14) Language access.--The term `language access' means
the provision of language services to an LEP individual or
individual with communication disabilities designed to enhance
that individual's access to, understanding of, or benefit from
health care or health-care-related services.
``(15) Language or language access services.--The term
`language or language access services' means provision of
health care services directly in a non-English language,
interpretation, translation, signage, video recording, and
English or non-English alternative formats.
``(16) LEP.--The term `LEP' means limited-English-
proficient.
``(17) Medicare, medicaid, and schip.--The terms
`Medicare', `Medicaid', and `SCHIP' mean the respective
programs under titles XVIII, XIX, and XXI of the Social
Security Act.
``(18) 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.
``(19) Minority group.--The term `minority group' has the
meaning given the term `racial and ethnic minority group'.
``(20) Racial and ethnic minority group.--The term `racial
and ethnic minority group' means American Indians and Alaska
Natives, African-Americans (including Caribbean Blacks,
Africans, and other Blacks), Asian-Americans, Hispanics
(including Latinos), and Native Hawaiians and other Pacific
Islanders.
``(21) Onsite interpretation.--The term `onsite
interpretation' means a method of interpreting or
interpretation for which the interpreter is in the physical
presence of the provider of health care or health-care-related
services and the recipient of such services who is limited in
English proficiency or has a communication impairment such as
hearing, vision, or learning.
``(22) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(23) Sight translation.--The term `sight translation'
means the transmission of a written message in one language
into a spoken or signed message in another language, or an
alternative format in English or another language.
``(24) State.--The term `State' means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Indian tribes, the United States Virgin Islands,
Guam, American Samoa, and the Commonwealth of the Northern
Mariana Islands.
``(25) Telephonic interpretation.--The term `telephonic
interpretation' (also known as over the phone interpretation or
OPI) means a method of interpreting/interpretation for which
the interpreter is not in the physical presence of the provider
of health care or related services and the limited-English-
proficient recipient of such services but is connected via
telephone.
``(26) Translation.--The term `translation' means the
transmission of a written message in one language into a
written or signed message in another language, and includes
translation into another language or alternative format, such
as large print font, Braille, audio recording, or CD.
``(27) Video interpretation.--The term `video
interpretation' means a method of interpreting/interpretation
for which the interpreter is not in the physical presence of
the provider of health care or related services and the
limited-English-proficient recipient of such services but is
connected via a video hook-up that includes both audio and
video transmission.
``(28) Vital document.--The term `vital document' includes
but is not limited to applications for government programs that
provide health care services, medical or financial consent
forms, financial assistance documents, letters containing
important information regarding patient instructions (such as
prescriptions, referrals to other providers, and discharge
plans) and participation in a program (such as a Medicaid
managed care program), notices pertaining to the reduction,
denial, or termination of services or benefits, notices of the
right to appeal such actions, and notices advising limited-
English-proficient individuals and individuals with
communication disabilities of the availability of free language
services, alternative formats, and other outreach materials.
``SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVIDUALS WITH LIMITED
ENGLISH PROFICIENCY.
``(a) Purpose.--As provided in Executive Order 13166, it is the
purpose of this section--
``(1) to improve Federal agency performance regarding
access to federally conducted and federally assisted programs
and activities for individuals who are limited in their English
proficiency;
``(2) to require each Federal agency to examine the
services it provides and develop and implement a system by
which limited-English-proficient individuals can obtain
cultural competence and meaningful access to those services
consistent with, and without substantially burdening, the
fundamental mission of the agency;
``(3) to require each Federal agency to ensure that
recipients of Federal financial assistance provide cultural
competence and meaningful access to their limited-English-
proficient applicants and beneficiaries;
``(4) to ensure that recipients of Federal financial
assistance take reasonable steps, consistent with the
guidelines set forth in the Limited English Proficient Guidance
of the Department of Justice (as issued on June 12, 2002), to
ensure cultural competence and meaningful access to their
programs and activities by limited-English-proficient
individuals; and
``(5) to ensure compliance with title VI of the Civil
Rights Act of 1964 and that health care providers and
organizations do not discriminate in the provision of services.
``(b) Federally Conducted Programs and Activities.--
``(1) In general.--Not later than 120 days after the date
of enactment of this title, each Federal agency that carries
out health-care-related activities shall prepare a plan to
improve access cultural competence to the federally conducted,
health-care-related programs and activities of the agency by
limited-English-proficient individuals. Not later than one year
after the date of enactment of this title, each such Federal
agency shall ensure that such plan is fully implemented.
``(2) Plan requirement.--Each plan under paragraph (1)
shall include--
``(A) the steps the agency will take to ensure that
limited-English-proficient individuals have access to
the agency's federally conducted health care and
health-care-related programs and activities;
``(B) the policies and procedures for identifying,
assessing, and meeting the language needs and cultural
competence needs of its limited-English-proficient
beneficiaries served by federally conducted programs
and activities;
``(C) the steps the agency will take for its
federally conducted programs and activities to improve
cultural competence to provide a range of language
assistance options, notice to limited-English-
proficient individuals of the right to competent
language services, periodic training of staff,
monitoring and quality assessment of the language
services and, in appropriate circumstances, the
translation of written materials;
``(D) the steps the agency will take to ensure that
applications, forms, and other relevant documents for
its federally conducted programs and activities are
competently translated into the primary language of a
limited-English-proficient client where such materials
are needed to improve access to federally conducted and
federally assisted programs and activities for such a
limited-English-proficient individual;
``(E) the resources the agency will provide to
improve cultural competence to assist recipients of
Federal funds to improve access to health care or
health-care-related programs and activities for
limited-English-proficient individuals;
``(F) the resources the agency will provide to
ensure that competent language assistance is provided
to limited-English-proficient patients by interpreters
or trained bilingual staff; and
``(G) the resources the agency will provide to
ensure that family, particularly minor children, and
friends are not used to provide interpretation
services, except--
``(i) in the case of a medical emergency
where delay directly associated with obtaining
a competent interpreter would jeopardize the
health of the patient; or
``(ii) on request of the patient, who has
been informed in his or her preferred language
of the availability of free interpretation
services, if the health care services provider
has determined that the family or friend can
provide competent interpreter services as
defined in section 3400.
``(3) Submission of plan to doj.--Each agency that is
required to prepare a plan under paragraph (1) shall send a
copy of such plan to the Department of Justice, which shall
serve as the central repository of such plans.
``(4) Rule of construction.--Paragraph (2)(G)(i) shall not
be construed to mean that emergency rooms or similar entities
that regularly provide health care services in medical
emergencies are exempt from legal or regulatory requirements
related to competent interpreter services.
``(c) Federally Assisted Programs and Activities.--
``(1) In general.--Not later than 120 days after the date
of enactment of this title, each Federal agency providing
health-care-related Federal financial assistance shall ensure
that the guidance for recipients of Federal financial
assistance developed by the agency to ensure compliance with
title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et
seq.) is specifically tailored to the recipients of such
assistance. Each agency shall send a copy of such guidance to
the Department of Justice which shall serve as the central
repository of the agency's plans. After approval by the
Department of Justice, each agency shall publish its guidance
document in the Federal Register for public comment.
``(2) Requirements.--The agency-specific guidance developed
under paragraph (1) shall take into account the types of health
care services provided by the recipients, the individuals
served by the recipients, and other factors set out in such
standards.
``(3) Existing guidances.--A Federal agency that has
developed a guidance for purposes of title VI of the Civil
Rights Act of 1964 shall examine such existing guidance, as
well as the programs and activities to which such guidance
applies, to determine if modification of such guidance is
necessary to comply with this subsection.
``(4) Consultation.--Each Federal agency shall consult with
the Department of Justice in establishing the guidances under
this subsection.
``(d) Consultations.--
``(1) In general.--In carrying out this section, each
Federal agency that carriers out health care and health-care-
related activities shall ensure that stakeholders, such as
limited-English-proficient individuals and their representative
organizations, recipients of Federal assistance, and other
appropriate individuals or entities, have an adequate
opportunity to provide input with respect to the actions of the
agency.
``(2) Evaluation.--Each Federal agency described in
paragraph (1) shall evaluate the--
``(A) particular needs of the limited-English-
proficient individuals served by the agency;
``(B) particular needs of the limited-English-
proficient individuals served by the agency's
recipients of Federal financial assistance; and
``(C) burdens of compliance with the agency
guidance and this section for the agency and its
recipients.
``SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES IN HEALTH CARE.
``(a) Applicability.--This section applies to any health program or
activity, any part of which is receiving Federal financial assistance,
including credits, subsidies, or contracts of insurance, or any program
or activity that is administered by an executive agency or any entity
established under title I of the Patient Protection and Affordable Care
Act (or amendments made thereby), as such programs, activities,
agencies, and entities are described in section 1557(a) of the Patient
Protection and Affordable Care Act.
``(b) Standards.--The programs, activities, agencies, and entities
described in subsection (a) shall--
``(1) implement strategies to recruit, retain, and promote
individuals at all levels to maintain a diverse staff and
leadership that can provide culturally and linguistically
appropriate health care to patient populations of the service
area of the programs, activities, agencies, and entities;
``(2) educate and train governance, leadership, and
workforce at all levels and across all disciplines of the
programs, activities, agencies, and entities in culturally and
linguistically appropriate policies and practices on an ongoing
basis;
``(3) offer and provide language assistance, including
trained bilingual staff and interpreter services, to
individuals who have limited-English proficiency or other
communication needs, at no cost to them at all points of
contact, and during all hours of operation, to facilitate
timely access to all health care and services;
``(4) notify patients, in a culturally appropriate manner,
of their right to receive language assistance services in their
primary language, verbally and in writing;
``(5) ensure the competence of language assistance provided
to limited-English-proficient patients by interpreters and
bilingual staff, and ensure that family, particularly minor
children, and friends are not used to provide interpretation
services--
``(A) except in case of emergency; or
``(B) except on request of the patient, who has
been informed in his or her preferred language of the
availability of free interpretation services if the
health care services provider has determined that the
family or friend can provide competent interpreter
services as defined in section 3400;
``(6) for each eligible LEP language group that constitutes
5 percent or 500 individuals, whichever is less, of the
population of persons eligible to be served or likely to be
affected or encountered in the service area of the
organization, make available--
``(A) easily understood patient-related materials,
including print and multimedia materials;
``(B) information or notices about termination of
benefits; and
``(C) signage;
``(7) develop and implement clear goals, policies,
operational plans, and management, accountability, and
oversight mechanisms to provide culturally and linguistically
appropriate services and infuse them throughout the
organization's planning and operations;
``(8) conduct initial and ongoing organizational
assessments of culturally and linguistically appropriate
services-related activities and integrate valid linguistic,
competence-related National Standards for Culturally and
Linguistically Appropriate Services (CLAS) measures into the
internal audits, performance improvement programs, patient
satisfaction assessments, continuous quality improvement
activities, and outcomes-based evaluations of the organization
and develop ways to standardize the assessments;
``(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, data on an individual required to be collected
pursuant to section 3101, including the individual's
alternative format preferences and policy modification needs,
are--
``(A) collected in health records;
``(B) integrated into the organization's management
information systems; and
``(C) periodically updated;
``(10) maintain a current demographic, cultural, and
epidemiological profile of the community, conduct regular
assessments of community health assets and needs, and use the
results 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, implementing, and evaluating policies and practices
to ensure culturally and linguistically appropriate service-
related activities;
``(12) ensure that conflict and grievance resolution
processes are culturally and linguistically sensitive and
capable of identifying, preventing, and resolving cross-
cultural conflicts or complaints by patients;
``(13) regularly make available to the public information
about their progress and successful innovations in implementing
the standards under this section and provide public notice in
their communities about the availability of this information;
and
``(14) if requested, regularly make available to the head
of each Federal entity from which Federal funds are received,
information about their progress and successful innovations in
implementing the standards under this section as required by
the head of such entity.
``SEC. 3403. ROBERT T. MATSUI CENTER FOR CULTURAL AND LINGUISTIC
COMPETENCE IN HEALTH CARE.
``(a) Establishment.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall establish and
support a center to be known as the `Robert T. Matsui Center for
Cultural and Linguistic Competence in Health Care' (referred to in this
section as the `Center') to carry out the following activities:
``(1) Interpretation services.--The Center shall provide
resources via the Internet to identify and link health care
providers to competent interpreter and translation services.
``(2) Translation of written material.--
``(A) The Center shall provide, directly or through
contract, vital documents from competent translation
services for providers of health care and health-care-
related services at no cost to such providers.
Materials may be submitted for translation into non-
English languages. Translation services shall be
provided in a timely and reasonable manner. The quality
of such translation services shall be monitored and
reported publicly.
``(B) For each form developed or revised by the
Secretary that will be used by LEP individuals in
health care or health-care-related settings, the Center
shall translate the form, at a minimum, into the top 15
non-English languages in the United States according to
the most recent data from the American Community Survey
or its replacement. The translation must be completed
within 45 days of the Secretary receiving final
approval of the form from the Office of Management and
Budget.
``(3) Toll-free customer service telephone number.--The
Center shall provide, through a toll-free number, a customer
service line for LEP individuals--
``(A) to obtain information about federally
conducted or funded health programs, including
Medicare, Medicaid, and SCHIP;
``(B) to obtain assistance with applying for or
accessing these programs and understanding Federal
notices written in English; and
``(C) to learn how to access language services.
``(4) Health information clearinghouse.--
``(A) In general.--The Center shall develop and
maintain an information clearinghouse to facilitate the
provision of language services by providers of health
care and health-care-related services to reduce medical
errors, improve medical outcomes, to improve cultural
competence, reduce health care costs caused by
miscommunication with individuals with limited-English
proficiency, and reduce or eliminate the duplication of
effort to translate materials. The clearinghouse shall
make such information available on the Internet and in
print. Such information shall include the information
described in the succeeding provisions of this
paragraph.
``(B) Document templates.--The Center shall collect
and evaluate for accuracy, develop, and make available
templates for standard documents that are necessary for
patients and consumers to access and make educated
decisions about their health care, including the
following:
``(i) Administrative and legal documents,
including--
``(I) intake forms;
``(II) Medicare, Medicaid, and
SCHIP forms, including eligibility
information;
``(III) forms informing patient of
HIPAA compliance and consent; and
``(IV) documents concerning
informed consent, advanced directives,
and waivers of rights.
``(ii) Clinical information, such as how to
take medications, how to prevent transmission
of a contagious disease, and other prevention
and treatment instructions.
``(iii) Public health, patient education,
and outreach materials, such as immunization
notices, health warnings, or screening notices.
``(iv) Additional health or health-care-
related materials as determined appropriate by
the Director of the Center.
``(C) Structure of forms.--In operating the
clearinghouse, the Center shall--
``(i) ensure that the documents posted in
English and non-English languages are
culturally appropriate;
``(ii) allow public review of the documents
before dissemination in order to ensure that
the documents are understandable and culturally
appropriate for the target populations;
``(iii) allow health care providers to
customize the documents for their use;
``(iv) facilitate access to these
documents;
``(v) provide technical assistance with
respect to the access and use of such
information; and
``(vi) carry out any other activities the
Secretary determines to be useful to fulfill
the purposes of the clearinghouse.
``(D) Language assistance programs.--The Center
shall provide for the collection and dissemination of
information on current examples of language assistance
programs and strategies to improve language services
for LEP individuals, including case studies using de-
identified patient information, program summaries, and
program evaluations.
``(E) Cultural and linguistic competence
materials.--The Center shall provide information
relating to culturally and linguistically competent
health care for minority populations residing in the
United States to all health care providers and health-
care-related services at no cost. Such information
shall include--
``(i) tenets of culturally and
linguistically competent care;
``(ii) cultural and linguistic competence
self-assessment tools;
``(iii) cultural and linguistic competence
training tools;
``(iv) strategic plans to increase cultural
and linguistic competence in different types of
providers of health care and health-care-
related services, including regional
collaborations among health care organizations;
and
``(v) cultural and linguistic competence
information for educators, practitioners, and
researchers.
``(F) Information about progress.--The Center shall
regularly collect and make publicly available
information about the progress of entities receiving
grants under section 3404 regarding successful
innovations in implementing the obligations under this
subsection and provide public notice in the entities'
communities about the availability of this information.
``(b) Director.--The Center shall be headed by a Director who shall
be appointed by, and who shall report to, the Director of the Agency
for Healthcare Research and Quality.
``(c) Availability of Language Access.--The Director shall
collaborate with the Deputy Assistant Secretary for Minority Health,
the Administrator of the Centers for Medicare & Medicaid Services, and
the Administrator of the Health Resources and Services Administration
to notify health care providers and health care organizations about the
availability of language access services by the Center.
``(d) Education.--The Secretary, directly or through contract,
shall undertake a national education campaign to inform providers, LEP
individuals, health professionals, graduate schools, and community
health centers about--
``(1) Federal and State laws and guidelines governing
access to language services;
``(2) the value of using trained interpreters and the risks
associated with using family members, friends, minors, and
untrained bilingual staff;
``(3) funding sources for developing and implementing
language services; and
``(4) promising practices to effectively provide language
services.
``(e) Authorization of Appropriations.--In addition to the amounts
authorized under subsection (e)(8)(F), there are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2015 through 2019.
``SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC COMPETENCE GRANTS.
``(a) In General.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall award grants to
eligible entities to enable such entities to design, implement, and
evaluate innovative, cost-effective programs to improve cultural
competence and language access in health care for individuals with
limited-English proficiency. The Director of the Agency for Healthcare
Research and Quality shall coordinate with, and ensure the
participation of, other agencies including the Health Resources and
Services Administration, the Center on Minority Health and Health
Disparities at the National Institutes of Health, and the Office of
Minority Health, regarding the design and evaluation of the grants
program.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) be--
``(A) a city, county, Indian tribe, State,
territory, or subdivision thereof;
``(B) an organization described in section
501(c)(3) of the Internal Revenue Code of 1986 and
exempt from tax under section 501(a) of such Code;
``(C) a community health, mental health, or
substance use center or clinic;
``(D) a solo or group physician practice;
``(E) an integrated health care delivery system;
``(F) a public hospital;
``(G) a health care group, university, or college;
or
``(H) other entity designated by the Secretary; and
``(2) prepare and submit to the Secretary an application,
at such time, in such manner, and accompanied by such
additional information as the Secretary may require.
``(c) Use of Funds.--An entity shall use funds received under a
grant under this section to--
``(1) develop, implement, and evaluate models of providing
competent interpretation services through onsite
interpretation, telephonic interpretation, or video
interpretation;
``(2) implement strategies to recruit, retain, and promote
individuals at all levels of the organization to maintain a
diverse staff and leadership that can promote and provide
language services to patient populations of the service area of
the organization;
``(3) develop and maintain a needs assessment that
identifies the current demographic, cultural, and
epidemiological profile of the community to accurately plan for
and implement language services needed in service area of the
organization;
``(4) develop a strategic plan to implement language
services;
``(5) develop participatory, collaborative partnerships
with communities encompassing the LEP patient populations being
served to gain input in designing and implementing language
services;
``(6) develop and implement grievance resolution processes
that are culturally and linguistically sensitive and capable of
identifying, preventing, and resolving complaints by LEP
individuals; or
``(7) develop short-term medical mental health
interpretation training courses and incentives for bilingual
health care staff who are asked to interpret in the workplace;
``(8) develop formal training programs, including continued
professional development and education programs as well as
supervision, for individuals interested in becoming dedicated
health care interpreters and culturally competent providers;
``(9) provide staff language training instruction, which
shall include information on the practical limitations of such
instruction for non-native speakers;
``(10) develop policies that address compensation in salary
for staff who receive training to become either a staff
interpreter or bilingual provider;
``(11) develop other language assistance services as
determined appropriate by the Secretary;
``(12) develop, implement, and evaluate models of improving
cultural competence; and
``(13) ensure that, consistent with the privacy protections
provided for under the regulations promulgated under section
264(c) of the Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d-2 note) and any applicable State
privacy laws, data on the individual patient or recipient's
race, ethnicity, and primary language are collected (and
periodically updated) in health records and integrated into the
organization's information management systems or any similar
system used to store and retrieve data.
``(d) Priority.--In awarding grants under this section, the
Secretary shall give priority to entities that primarily engage in
providing direct care and that have developed partnerships with
community organizations or with agencies with experience in improving
language access.
``(e) Evaluation.--
``(1) By grantees.--An entity that receives a grant under
this section shall submit to the Secretary an evaluation that
describes, in the manner and to the extent required by the
Secretary, the activities carried out with funds received under
the grant, and how such activities improved access to health
and health-care-related services and the quality of health care
for individuals with limited-English proficiency. Such
evaluation shall be collected and disseminated through the
Robert T. Matsui Center for Cultural and Linguistic Competence
in Health Care established under section 3403. The Director of
the Agency for Healthcare Research and Quality shall notify
grantees of the availability of technical assistance for the
evaluation and provide such assistance upon request.
``(2) By secretary.--The Director of the Agency for
Healthcare Research and Quality shall evaluate or arrange with
other individuals or organizations to evaluate projects funded
under this section.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $5,000,000 for each of fiscal
years 2015 through 2019.
``SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COMPETENCE.
``(a) In General.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall expand research
concerning language access in the provision of health care.
``(b) Eligibility.--The Director of the Agency for Healthcare
Research and Quality may conduct the research described in subsection
(a) or enter into contracts with other individuals or organizations to
do so.
``(c) Use of Funds.--Research under this section shall be designed
to do one or more of the following:
``(1) To identify the barriers to mental and behavioral
services that are faced by LEP individuals.
``(2) To identify health care providers' and health
administrators' attitudes, knowledge, and awareness of the
barriers to quality health care services that are faced by LEP
individuals.
``(3) To identify optimal approaches for delivering
language access.
``(4) To identify best practices for data collection,
including--
``(A) the collection by providers of health care
and health-care-related services of data on the race,
ethnicity, and primary language of recipients of such
services, taking into account existing research
conducted by the Government or private sector;
``(B) the development and implementation of data
collection and reporting systems; and
``(C) effective privacy safeguards for collected
data.
``(5) To develop a minimum data collection set for primary
language.
``(6) To evaluate the most effective ways in which the
Department can create or coordinate, and then subsidize or
otherwise fund telephonic interpretation providers for health
care providers, taking into consideration, among other factors,
the flexibility necessary for such a system to accommodate
variations in--
``(A) provider type;
``(B) languages needed and their frequency of use;
``(C) type of encounter;
``(D) time of encounter, including regular business
hours and after hours; and
``(E) location of encounter.
``(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 2015 through 2019.''.
SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DEVELOPMENT OF STATE
MEDICAL INTERPRETING SERVICES.
(a) Grants Authorized.--The Secretary shall award one grant in
accordance with this section to each of three States to assist each
such State in designing, implementing, and evaluating a statewide
program to provide onsite interpreter services under Medicaid.
(b) Grant Period.--A grant awarded under this section is authorized
for a period of three fiscal years beginning on October 1, 2014.
(c) Preference.--In awarding a grant under this section, the
Secretary shall give preference to a State--
(1) that has a high proportion of qualified LEP enrollees,
as determined by the Secretary;
(2) that has a large number of qualified LEP enrollees, as
determined by the Secretary;
(3) that has a high growth rate of the population of LEP
individuals, as determined by the Secretary; and
(4) that has a population of qualified LEP enrollees that
is linguistically diverse, requiring interpreter services in at
least 200 non-English languages.
(d) Use of Funds.--A State receiving a grant under this section
shall use the grant funds to--
(1) ensure that all health care providers in the State
participating in the State plan under Medicaid have access to
onsite interpreter services, for the purpose of enabling
effective communication between such providers and qualified
LEP enrollees during the furnishing of items and services and
administrative interactions;
(2) establish, expand, procure, or contract for--
(A) a statewide health care information technology
system that is designed to achieve efficiencies and
economies of scale with respect to onsite interpreter
services provided to health care providers in the State
participating in the State plan under Medicaid; and
(B) an entity to administer such system, the duties
of which shall include--
(i) procuring and scheduling interpreter
services for qualified LEP enrollees;
(ii) procuring and scheduling interpreter
services for LEP individuals seeking to enroll
in the State plan under Medicaid;
(iii) ensuring that interpreters receive
payment for interpreter services rendered under
the system; and
(iv) consulting regularly with
organizations representing consumers,
interpreters, and health care providers; and
(3) develop mechanisms to establish, improve, and
strengthen the competency of the medical interpretation
workforce that serves qualified LEP enrollees in the State,
including a national certification process that is valid,
credible, and vendor-neutral.
(e) Application.--To receive a grant under this section, a State
shall submit an application at such time and containing such
information as the Secretary may require, which shall include the
following:
(1) A description of the language access needs of
individuals in the State enrolled in the State plan under
Medicaid.
(2) A description of the extent to which the program will--
(A) use the grant funds for the purposes described
in subsection (d);
(B) meet the health care needs of rural populations
of the State; and
(C) collect information that accurately tracks the
language services requested by consumers as compared to
the language services provided by health care providers
in the State participating in the State plan under
Medicaid.
(3) A description of how the program will be evaluated,
including a proposal for collaboration with organizations
representing interpreters, consumers, and LEP individuals.
(f) Definitions.--In this section:
(1) Qualified lep enrollee.--The term ``qualified LEP
enrollee'' means an individual--
(A) who is limited-English-proficient; and
(B) who is enrolled in a State plan under Medicaid.
(2) State.--The term ``State'' has the meaning given the
term in section 1101(a)(1) of the Social Security Act (42
U.S.C. 1301(a)(1)), for purposes of title XIX of such Act.
(3) United states.--The term ``United States'' has the
meaning given the term in section 1101(a)(2) of the Social
Security Act (42 U.S.C. 1301(a)(2)), for purposes of title XIX
of such Act.
(g) Funding.--
(1) Authorization of appropriations.--There is authorized
to be appropriated $5,000,000 to carry out this section.
(2) Availability of funds.--The funds authorized by
paragraph (1) shall be available without fiscal year
limitation.
(3) Increased federal financial participation.--Section
1903(a)(2)(E) of the Social Security Act (42 U.S.C.
1396b(a)(2)(E)), as amended by section 205(d)(1) of this Act,
is further amended by inserting ``(or, in the case of a State
receiving a grant under section 203 of the Health Equity and
Accountability Act of 2014, 100 percent for each quarter
occurring during the grant period)'' after ``90 percent''.
(h) Limitation.--No Federal funds under this section may be used to
provide interpreter services from a location outside the United States.
SEC. 204. TRAINING TOMORROW'S DOCTORS FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE CARE: GRADUATE MEDICAL EDUCATION.
(a) Direct Graduate Medical Education.--Section 1886(h)(4) of the
Social Security Act (42 U.S.C. 1395ww(h)(4)) is amended by adding at
the end the following new subparagraph:
``(L) Treatment of culturally competency
training.--In determining a hospital's number of full-
time equivalent residents for purposes of this
subsection, all the time that is spent by an intern or
resident in an approved medical residency training
program for education and training in cultural
competency and linguistically appropriate service
delivery shall be counted toward the determination of
full-time equivalency.''.
(b) Indirect Medical Education.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at
the end the following new clause:
``(xii) The provisions of subparagraph (L) of
subsection (h)(4) shall apply under this subparagraph
in the same manner as they apply under such
subsection.''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply with respect to payments made to hospitals on or after the
date that is one year after the date of the enactment of this Act.
SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES UNDER THE MEDICARE, MEDICAID, AND
STATE CHILDREN'S HEALTH INSURANCE PROGRAMS.
(a) Language Access Grants for Medicare Providers.--
(1) Establishment.--
(A) In general.--Not later than 6 months after the
date of the enactment of this Act, the Secretary of
Health and Human Services, acting through the Centers
for Medicare & Medicaid Services and in consultation
with the Center for Medicare and Medicaid Innovation,
shall establish a demonstration program under which the
Secretary shall award grants to eligible Medicare
service providers to improve communication between such
providers and limited-English-proficient Medicare
beneficiaries, including beneficiaries who live in
diverse and underserved communities.
(B) Application of innovation rules.--The
demonstration project under subparagraph (A) shall be
conducted in a manner that is consistent with the
applicable provisions of subsections (b), (c), and (d)
of section 1115A of the Social Security Act (42 U.S.C.
1315a).
(C) Number of grants.--To the extent practicable,
the Secretary shall award not less than 24 grants under
this subsection.
(D) Grant period.--Except as provided under
paragraph (2)(D), each grant awarded under this
subsection shall be for a 3-year period.
(2) Eligibility requirements.--To be eligible for a grant
under this subsection, an entity must meet the following
requirements:
(A) Medicare provider.--The entity must be--
(i) a provider of services under part A of
title XVIII of the Social Security Act;
(ii) a provider of services under part B of
such title;
(iii) a Medicare Advantage organization
offering a Medicare Advantage plan under part C
of such title; or
(iv) a PDP sponsor offering a prescription
drug plan under part D of such title.
(B) Underserved communities.--The entity must serve
a community that, with respect to necessary language
services for improving access and utilization of health
care among limited-English-proficient individuals, is
disproportionally underserved.
(C) Application.--The entity must prepare and
submit to the Secretary an application, at such time,
in such manner, and accompanied by such additional
information as the Secretary may require.
(D) Reporting.--In the case of a grantee that
received a grant under this subsection in a previous
year, such grantee is only eligible for continued
payments under a grant under this subsection if the
grantee met the reporting requirements under paragraph
(9) for such year. If a grantee fails to meet the
requirement of such paragraph for the first year of a
grant, the Secretary may terminate the grant and
solicit applications from new grantees to participate
in the demonstration program.
(3) Distribution.--To the extent feasible, the Secretary
shall award--
(A) at least 6 grants to providers of services
described in paragraph (2)(A)(i);
(B) at least 6 grants to service providers
described in paragraph (2)(A)(ii);
(C) at least 6 grants to organizations described in
paragraph (2)(A)(iii); and
(D) at least 6 grants to sponsors described in
paragraph (2)(A)(iv).
(4) Considerations in awarding grants.--
(A) Variation in grantees.--In awarding grants
under this subsection, the Secretary shall select
grantees to ensure the following:
(i) The grantees provide many different
types of language services.
(ii) The grantees serve Medicare
beneficiaries who speak different languages,
and who, as a population, have differing needs
for language services.
(iii) The grantees serve Medicare
beneficiaries in both urban and rural settings.
(iv) The grantees serve Medicare
beneficiaries in at least two geographic
regions, as defined by the Secretary.
(v) The grantees serve Medicare
beneficiaries in at least two large
metropolitan statistical areas with racial,
ethnic, and economically diverse populations.
(B) Priority for partnerships with community
organizations and agencies.--In awarding grants under
this subsection, the Secretary shall give priority to
eligible entities that have a partnership with--
(i) a community organization; or
(ii) a consortia of community
organizations, State agencies, and local
agencies,
that has experience in providing language services.
(5) Use of funds for competent language services.--
(A) In general.--Subject to subparagraph (E), a
grantee may only use grant funds received under this
subsection to pay for the provision of competent
language services to Medicare beneficiaries who are
limited-English-proficient.
(B) Competent language services defined.--For
purposes of this subsection, the term ``competent
language services'' means--
(i) interpreter and translation services
that--
(I) subject to the exceptions under
subparagraph (C)--
(aa) if the grantee
operates in a State that has
statewide health care
interpreter standards, meet the
State standards currently in
effect; or
(bb) if the grantee
operates in a State that does
not have statewide health care
interpreter standards, utilizes
competent interpreters who
follow the National Council on
Interpreting in Health Care's
Code of Ethics and Standards of
Practice; and
(II) that, in the case of
interpreter services, are provided
through--
(aa) onsite interpretation;
(bb) telephonic
interpretation; or
(cc) video interpretation;
and
(ii) the direct provision of health care or
health-care-related services by a competent
bilingual health care provider.
(C) Exceptions.--The requirements of subparagraph
(B)(i)(I) do not apply, with respect to interpreter and
translation services and a grantee--
(i) in the case of a Medicare beneficiary
who is limited-English-proficient if--
(I) such beneficiary has been
informed, in the beneficiary's primary
language, of the availability of free
interpreter and translation services
and the beneficiary instead requests
that a family member, friend, or other
person provide such services; and
(II) the grantee documents such
request in the beneficiary's medical
record; or
(ii) in the case of a medical emergency
where the delay directly associated with
obtaining a competent interpreter or
translation services would jeopardize the
health of the patient.
Subparagraph (C)(ii) shall not be construed to exempt
emergency rooms or similar entities that regularly
provide health care services in medical emergencies to
limited-English-proficient patients from any applicable
legal or regulatory requirements related to providing
competent interpreter and translation services without
undue delay.
(D) Medicare advantage organizations and pdp
sponsors.--If a grantee is a Medicare Advantage
organization offering a Medicare Advantage plan under
part C of title XVIII of the Social Security Act or a
PDP sponsor offering a prescription drug plan under
part D of such title, such entity must provide at least
50 percent of the grant funds that the entity receives
under this subsection directly to the entity's network
providers (including all health providers and
pharmacists) for the purpose of providing support for
such providers to provide competent language services
to Medicare beneficiaries who are limited-English-
proficient.
(E) Administrative and reporting costs.--A grantee
may use up to 10 percent of the grant funds to pay for
administrative costs associated with the provision of
competent language services and for reporting required
under paragraph (9).
(6) Determination of amount of grant payments.--
(A) In general.--Payments to grantees under this
subsection shall be calculated based on the estimated
numbers of limited-English-proficient Medicare
beneficiaries in a grantee's service area utilizing--
(i) data on the numbers of limited-English-
proficient individuals who speak English less
than ``very well'' from the most recently
available data from the Bureau of the Census or
other State-based study the Secretary
determines likely to yield accurate data
regarding the number of such individuals in
such service area; or
(ii) data provided by the grantee, if the
grantee routinely collects data on the primary
language of the Medicare beneficiaries that the
grantee serves and the Secretary determines
that the data is accurate and shows a greater
number of limited-English-proficient
individuals than would be estimated using the
data under clause (i).
(B) Discretion of secretary.--Subject to
subparagraph (C), the amount of payment made to a
grantee under this subsection may be modified annually
at the discretion of the Secretary, based on changes in
the data under subparagraph (A) with respect to the
service area of a grantee for the year.
(C) Limitation on amount.--The amount of a grant
made under this subsection to a grantee may not exceed
$500,000 for the period under paragraph (1)(D).
(7) Assurances.--Grantees under this subsection shall, as a
condition of receiving a grant under this subsection--
(A) ensure that clinical and support staff receive
appropriate ongoing education and training in
linguistically appropriate service delivery;
(B) ensure the linguistic competence of bilingual
providers;
(C) offer and provide appropriate language services
at no additional charge to each patient with limited-
English proficiency for all points of contact between
the patient and the grantee, in a timely manner during
all hours of operation;
(D) notify Medicare beneficiaries of their right to
receive language services in their primary language;
(E) post signage in the primary languages commonly
used by the patient population in the service area of
the organization; and
(F) ensure that--
(i) primary language data are collected for
recipients of language services and such data
are consistent with standards developed under
title XXXIV of the Public Health Service Act,
as added by section 202 of this Act, to the
extent such standards are available upon the
initiation of the demonstration program; and
(ii) consistent with the privacy
protections provided under the regulations
promulgated pursuant to section 264(c) of the
Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d-2 note), if the
recipient of language services is a minor or is
incapacitated, primary language data are
collected on the parent or legal guardian of
such recipient.
(8) No cost-sharing.--Limited-English-proficient Medicare
beneficiaries shall not have to pay cost-sharing or co-payments
for competent language services provided under this
demonstration program.
(9) Reporting requirements for grantees.--Not later than
the end of each calendar year, a grantee that receives funds
under this subsection in such year shall submit to the
Secretary a report that includes the following information:
(A) The number of Medicare beneficiaries to whom
competent language services are provided.
(B) The primary languages of those Medicare
beneficiaries.
(C) The types of language services provided to such
beneficiaries.
(D) Whether such language services were provided by
employees of the grantee or through a contract with
external contractors or agencies.
(E) The types of interpretation services provided
to such beneficiaries, and the approximate length of
time such service is provided to such beneficiaries.
(F) The costs of providing competent language
services.
(G) An account of the training or accreditation of
bilingual staff, interpreters, and translators
providing services funded by the grant under this
subsection.
(10) Evaluation and report to congress.--Not later than 1
year after the completion of a 3-year grant under this
subsection, the Secretary shall conduct an evaluation of the
demonstration program under this subsection and shall submit to
the Congress a report that includes the following:
(A) An analysis of the patient outcomes and the
costs of furnishing care to the limited-English-
proficient Medicare beneficiaries participating in the
project as compared to such outcomes and costs for
limited-English-proficient Medicare beneficiaries not
participating, based on the data provided under
paragraph (9) and any other information available to
the Secretary.
(B) The effect of delivering language services on--
(i) Medicare beneficiary access to care and
utilization of services;
(ii) the efficiency and cost effectiveness
of health care delivery;
(iii) patient satisfaction;
(iv) health outcomes; and
(v) the provision of culturally appropriate
services provided to such beneficiaries.
(C) The extent to which bilingual staff,
interpreters, and translators providing services under
such demonstration were trained or accredited and the
nature of accreditation or training needed by type of
provider, service, or other category as determined by
the Secretary to ensure the provision of high-quality
interpretation, translation, or other language services
to Medicare beneficiaries if such services are expanded
pursuant to subsection (c) of section 1907 of this Act.
(D) Recommendations, if any, regarding the
extension of such project to the entire Medicare
program, subject to the provisions of section 1115A(c)
of the Social Security Act.
(11) Appropriations.--There is appropriated to carry out
this subsection, in equal parts from the Federal Hospital
Insurance Trust Fund under section 1817 of the Social Security
Act (42 U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42 U.S.C.
1395t), $16,000,000 for each fiscal year of the demonstration
program.
(b) Language Services Under the Medicare Program.--
(1) Inclusion as rural health clinic services.--Section
1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (aa)(1)--
(i) in subparagraph (B), by striking the
``and'' at the end;
(ii) in subparagraph (C), by inserting
``and'' after the comma at the end; and
(iii) by inserting after subparagraph (C)
the following:
``(D) language services as defined in subsection
(iii)(1),''; and
(B) by adding at the end the following new
subsection:
``Language Services and Related Terms
``(iii)(1) Language Services Defined.--The term `language services'
has the same meaning given `language or language access services' in
section 3400 of the Public Health Service Act.
``(2) Interpreter Services Defined.--For the purposes of this
subsection, the term `interpreter services' has the meaning given
`competent interpreter services' under section 3400(3) of the Public
Health Service Act.
``(3) Interpreter Defined.--The term `interpreter'--
``(A) means an individual--
``(i) who faithfully, accurately, and objectively
transmits a spoken message from one language into
another language; and
``(ii) who knows health and health-related
terminology in both languages; and
``(B) includes individuals who provide in-person,
telephonic, and video interpretation.
``(4) Translation Defined.--The term `translation' means the
transmission of a written message in one language into a written
message in another language that retains the intended meaning of the
original message.
``(5) Limited-English-Proficient and LEP Defined.--The terms
`limited-English-proficient' and `LEP' have the meaning given the term
`limited english proficient' under section 9101(25) of the Elementary
and Secondary Education Act of 1965, except that subparagraphs (A),
(B), and (D) of such section not apply.''.
(2) Coverage.--Section 1832(a)(2) of such Act (42 U.S.C.
1395k(a)(2)) is amended--
(A) by striking ``and'' at the end of subparagraph
(I);
(B) by striking the period at the end of
subparagraph (J) and inserting ``; and''; and
(C) by adding at the end of subparagraph (J) the
following:
``(K) language services (as defined in paragraph
(1) of section 1861(iii)) furnished by an interpreter
(as defined in paragraph (3) of such section) or
translator.''.
(3) Payment.--Section 1833(a) of the Social Security Act
(42 U.S.C. 1395l(a)) is amended--
(A) by striking ``and'' at the end of paragraph
(8);
(B) by redesignating paragraph (9) as paragraph
(10); and
(C) by inserting after paragraph (8) the following
new paragraph:
``(9) in the case of language services described in section
1861(iii)(1), 100 percent of the reasonable charges for such
services, as determined in consultation with the Medicare
Payment Advisory Commission; and''.
(4) Waiver of budget neutrality.--For the 3-year period
beginning on the date of enactment of this section, the budget
neutrality provision of section 1848(c)(2)(B)(ii) of the Social
Security Act (42 U.S.C. 1395w-4(c)(2)(B)(ii)) shall not apply
with respect to language services (as such term is defined in
section 1861(iii)(1) of such Act).
(c) Medicare Parts C and D.--
(1) In general.--Medicare Advantage plans under part C of
the Social Security Act and prescription drug plans under part
D of such Act shall comply with title VI of the Civil Rights
Act of 1964 and section 1557 of the Patient Protection and
Affordable Care Act to provide effective language services to
enrollees of such plans.
(2) Medicare advantage plans and prescription drug plans
reporting requirement.--Section 1857(e) of the Social Security
Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end the
following new paragraph:
``(5) Reporting requirements relating to effective language
services.--A contract under this part shall require a Medicare
Advantage organization (and, through application of section
1860D-12(b)(3)(D), a contract under section 1860D-12 shall
require a PDP sponsor) to annually submit (for each year of the
contract) a report that contains information on the plan's
internal policies and procedures related to recruitment and
retention efforts directed to workforce diversity and
linguistically and culturally appropriate provision of services
in each of the following contexts:
``(A) The collection of data in a manner that meets
the requirements of title I of the Health Equity and
Accountability Act of 2014, regarding the enrollee
population.
``(B) Education of staff and contractors who have
routine contact with enrollees regarding the various
needs of the diverse enrollee population.
``(C) Evaluation of the health plan's language
services programs and services with respect to the
plan's enrollee population, such as through analysis of
complaints or satisfaction survey results.
``(D) Methods by which the plan provides to the
Secretary information regarding the ethnic diversity of
the plan's enrollee population.
``(E) The periodic provision of educational
information to plan enrollees on the plan's language
services and programs.''.
(d) Improving Language Services in Medicaid and CHIP.--
(1) Payments to states.--Section 1903(a)(2)(E) of the
Social Security Act (42 U.S.C. 1396b(a)(2)(E)) is amended by--
(A) striking ``75'' and inserting ``90'';
(B) striking ``translation or interpretation
services'' and inserting ``language services''; and
(C) striking ``children of families'' and inserting
``individuals''.
(2) State plan requirements.--Section 1902(a)(10)(A) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by
striking ``and (28)'' and inserting ``(28), and (29)''.
(3) Definition of medical assistance.--Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended by--
(A) in paragraph (28), by striking ``and'' at the
end;
(B) by redesignating paragraph (29) as paragraph
(30); and
(C) by inserting after paragraph (28) the following
new paragraph:
``(29) language services, as such term is defined in
section 1861(iii)(1), provided in a timely manner to limited-
English-proficient individuals who need such services; and''.
(4) Use of deductions and cost sharing.--Section 1916(a)(2)
of the Social Security Act (42 U.S.C. 1396o(2)) is amended by--
(A) by striking ``or'' at the end of subparagraph
(D);
(B) by striking ``; and'' at the end of
subparagraph (E) and inserting ``, or''; and
(C) by adding at the end the following new
subparagraph:
``(F) language services described in section
1905(a)(29); and''.
(5) CHIP coverage requirements.--Section 2103 of the Social
Security Act (42 U.S.C. 1397cc) is amended--
(A) in subsection (a), in the matter before
paragraph (1), by striking ``and (7)'' and inserting
``(7), and (9)''; and
(B) in subsection (c), by adding at the end the
following new paragraph:
``(9) Language services.--The child health assistance
provided to a targeted low-income child shall include coverage
of language services, as such term is defined in section
1861(iii)(1), provided in a timely manner to limited-English-
proficient individuals who need such services.''; and
(C) in subsection (e)(2)--
(i) in the heading, by striking
``Preventive'' and inserting ``Certain''; and
(ii) by inserting ``, subsection (c)(9),''
after ``subsection (c)(1)(C)''.
(6) Definition of child health assistance.--Section
2110(a)(27) of the Social Security Act (42 U.S.C. 1397jj) is
amended by striking ``translation'' and inserting ``language
services as described in section 2103(c)(9)''.
(7) State data collection.--Pursuant to the reporting
requirement described in section 2107(b)(1) of the Social
Security Act (42 U.S.C. 1397gg(b)(1)), the Secretary of Health
and Human Services shall require that States collect data on--
(A) the primary language of individuals receiving
child health assistance under title XXI of the Social
Security Act; and
(B) in the case of such individuals who are minors
or incapacitated, the primary language of the
individual's parent or guardian.
(8) CHIP payments to states.--Section 2105 of the Social
Security Act (42 U.S.C. 1397ee(c)) is amended--
(A) in subsection (a)(1) by striking ``75'' and
inserting ``90''; and
(B) in subsection (c)(2)(A), by inserting before
the period ``, except that expenditures pursuant to
clause (iv) of subparagraph (D) of such paragraph shall
not count towards this total''.
(e) Funding Language Services Furnished by Providers of Health Care
and Health-Care-Related Services That Serve High Rates of Uninsured LEP
Individuals.--
(1) Payment of costs.--
(A) In general.--Subject to subparagraph (B), the
Secretary of Health and Human Services shall make
payments (on a quarterly basis) directly to eligible
entities to support the provision of language services
to limited-English-proficient individuals in an amount
equal to an eligible entity's eligible costs for such
services for the quarter.
(B) Funding.--Out of any funds in the Treasury not
otherwise appropriated, there are appropriated to the
Secretary of Health and Human Services such sums as may
be necessary for each of fiscal years 2012 through
2016.
(C) Relation to medicaid dsh.--Payments under this
subsection shall not offset or reduce payments under
section 1923 of the Social Security Act, nor shall
payments under such section be considered when
determining uncompensated costs associated with the
provision of language services.
(2) Methodology for payment of claims.--
(A) In general.--The Secretary shall establish a
methodology to determine the average per person cost of
language services.
(B) Different entities.--In establishing such
methodology, the Secretary may establish different
methodologies for different types of eligible entities.
(C) No individual claims.--The Secretary may not
require eligible entities to submit individual claims
for language services for individual patients as a
requirement for payment under this subsection.
(3) Data collection instrument.--For purposes of this
subsection, the Secretary shall create a standard data
collection instrument that is consistent with any existing
reporting requirements by the Secretary or relevant accrediting
organizations regarding the number of individuals to whom
language access are provided.
(4) Guidelines.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall establish and distribute guidelines concerning
the implementation of this subsection.
(5) Reporting requirements.--
(A) Report to secretary.--Entities receiving
payment under this subsection shall provide the
Secretary with a quarterly report on how the entity
used such funds. Such report shall contain aggregate
(and may not contain individualized) data collected
using the instrument under paragraph (3) and shall
otherwise be in a form and manner determined by the
Secretary.
(B) Report to congress.--Not later than 2 years
after the date of enactment of this Act, and every 2
years thereafter, the Secretary shall submit a report
to Congress concerning the implementation of this
subsection.
(6) Definitions.--In this subsection:
(A) Eligible costs.--The term ``eligible costs''
means, with respect to an eligible entity that provides
language services to limited-English-proficient
individuals, the product of--
(i) the average per person cost of language
services, determined according to the
methodology devised under paragraph (2); and
(ii) the number of limited-English-
proficient individuals who are provided
language services by the entity and for whom no
reimbursement is available for such services
under the amendments made by subsections (a),
(b), (c), or (d) or by private health
insurance.
(B) Eligible entity.--The term ``eligible entity''
means an entity that--
(i) is a Medicaid provider that is--
(I) a physician;
(II) a hospital with a low-income
utilization rate (as defined in section
1923(b)(3) of the Social Security Act
(42 U.S.C. 1396r-4(b)(3))) of greater
than 25 percent; or
(III) a federally qualified health
center (as defined in section
1905(l)(2)(B) of the Social Security
Act (42 U.S.C. 1396d(l)(2)(B)));
(ii) provide language services to at least
8 percent of the entity's total number of
patients, not later than 6 months after the
date of the enactment of the Act; and
(iii) prepare and submit an application to
the Secretary, at such time, in such manner,
and accompanied by such information as the
Secretary may require to ascertain the entity's
eligibility for funding under this subsection.
(C) Language services.--The term ``language
services'' has the meaning given such term in section
1861(iii)(1) of the Social Security Act.
(f) Application of Civil Rights Act of 1964 and Other Laws.--
Nothing in this section shall be construed to limit otherwise existing
obligations of recipients of Federal financial assistance under title
VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et seq.) or other
laws that protect the civil rights of individuals.
(g) Effective Date.--
(1) In general.--Except as otherwise provided and subject
to paragraph (2), the amendments made by this section shall
take effect on January 1, 2013.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
SEC. 206. INCREASING UNDERSTANDING OF AND IMPROVING HEALTH LITERACY.
(a) In General.--The Secretary, acting through the Director of the
Agency for Healthcare Research and Quality and the Administrator of the
Health Resources and Services Administration, in consultation with the
Director of the National Institute on Minority Health and Health
Disparities and the Office of Minority Health, shall award grants to
eligible entities to improve health care for patient populations that
have low functional health literacy.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
(1) be a hospital, health center or clinic, health plan, or
other health entity (including a nonprofit minority health
organization or association); and
(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
(c) Use of Funds.--
(1) Agency for healthcare research and quality.--Grants
awarded under subsection (a) through the Agency for Healthcare
Research and Quality shall be used--
(A) to define and increase the understanding of
health literacy;
(B) to investigate the correlation between low
health literacy and health and health care;
(C) to clarify which aspects of health literacy
have an effect on health outcomes; and
(D) for any other activity determined appropriate
by the Director of the Agency.
(2) Health resources and services administration.--Grants
awarded under subsection (a) through the Health Resources and
Services Administration shall be used to conduct demonstration
projects for interventions for patients with low health
literacy that may include--
(A) the development of new disease management
programs for patients with low health literacy;
(B) the tailoring of existing disease management
programs addressing mental, physical, oral, and
behavioral health conditions for patients with low
health literacy;
(C) the translation of written health materials for
patients with low health literacy;
(D) the identification, implementation, and testing
of low health literacy screening tools;
(E) the conduct of educational campaigns for
patients and providers about low health literacy; and
(F) other activities determined appropriate by the
Administrator of the Health Resources and Services
Administration.
(d) Definitions.--In this section, the term ``low health literacy''
means the inability of an individual to obtain, process, and understand
basic health information and services needed to make appropriate health
decisions.
(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 2015 through 2019.
SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS.
(a) In General.--Any health program or activity, any part of which
is receiving Federal financial assistance, including credits,
subsidies, or contracts of insurance, and any program or activity that
is administered by an executive agency or any entity established under
title I of the Patient Protection and Affordable Care Act (or
amendments made thereby), as such programs, activities, agencies, and
entities are described in section 1557(a) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18116), in order to ensure the right of
LEP individuals to receive access to quality health care, shall--
(1) ensure that appropriate clinical and support staff
receive ongoing education and training in linguistically
appropriate service delivery;
(2) offer and provide appropriate language services at no
additional charge to each patient with limited-English-
proficiency at all points of contact, in a timely manner during
all hours of operation;
(3) notify patients of their right to receive language
services in their primary language; and
(4) utilize only competent interpreter or translation
services, as defined in section 3400 of the Public Health
Service Act.
(b) Exemptions.--The requirements of subsection (a)(4) shall not
apply as follows:
(1) When a patient (who has been informed in his or her
primary language of the availability of free interpreter and
translation services) requests the use of family, friends, or
other persons untrained in interpretation or translation if the
following conditions are met:
(A) The interpreter requested by the patient is
over the age of 18.
(B) The recipient informs the patient that he or
she has the option of having the recipient provide an
interpreter for him or her without charge, or of using
his or her own interpreter.
(C) The recipient informs the patient that the
recipient may not require an LEP person to use a family
member or friend as an interpreter.
(D) The recipient evaluates whether the person the
patient wishes to use as an interpreter is competent.
If the recipient has reason to believe that the
interpreter is not competent, the recipient provides
the recipient's own interpreter to protect the
recipient from liability if the patient's interpreter
is later found not competent.
(E) If the recipient has reason to believe that
there is a conflict of interest between the interpreter
and patient, the recipient may not use the patient's
interpreter.
(F) The recipient has the patient sign a waiver,
witnessed by at least 1 individual not related to the
patient, that includes the information stated in
subparagraphs (A) through (E) and is translated into
the patient's language.
(2) When a medical emergency exists and the delay directly
associated with obtaining competent interpreter or translation
services would jeopardize the health of the patient, but only
until a competent interpreter or translation service is
available.
(c) Rule of Construction.--Subsection (b)(2) shall not be construed
to mean that emergency rooms or similar entities that regularly provide
health care services in medical emergencies are exempt from legal or
regulatory requirements related to competent interpreter services.
SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY AND
LINGUISTICALLY APPROPRIATE HEALTH CARE SERVICES.
(a) Report.--Not later than 1 year after the date of enactment of
this Act and annually thereafter, the Secretary of Health and Human
Services shall enter into a contract with the Institute of Medicine for
the preparation and publication of a report that describes Federal
efforts to ensure that all individuals with limited-English proficiency
have meaningful access culturally competent to health care and health-
care-related services. Such report shall include--
(1) a description and evaluation of the activities carried
out under this Act;
(2) a description and analysis of best practices, model
programs, guidelines, and other effective strategies for
providing access to culturally and linguistically appropriate
health care services;
(3) recommendations on the development and implementation
of policies and practices by providers of health care and
health-care-related services for limited-English-proficient
individuals;
(4) a description of the effect of providing language
services on quality of health care and access to care; and
(5) a description of the costs associated with or savings
related to the provision of language services.
(b) 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 2015 through 2019.
SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES.
(a) Grants Authorized.--The Secretary of Education is authorized to
provide grants to eligible entities for the provision of English as a
second language (hereafter referred to as ``ESL'') instruction and
shall determine, after consultation with appropriate stakeholders, the
mechanism for administering and distributing such grants.
(b) Eligible Entity Defined.--For purposes of this section, the
term ``eligible entity'' means a State or community-based organization
that employs, and serves, minority populations.
(c) Application.--An eligible entity may apply for a grant under
this section by submitting such information as the Secretary may
require and in such form and manner as the Secretary may require.
(d) Use of Grant.--As a condition of receiving a grant under this
section, an eligible entity shall--
(1) develop and implement a plan for assuring the
availability of ESL instruction that effectively integrates
information about the nature of the United States health care
system, how to access care, and any special language skills
that may be required for them to access and regularly negotiate
the system effectively;
(2) develop a plan, including, where appropriate, public-
private partnerships, for making ESL instruction progressively
available to all individuals seeking instruction; and
(3) maintain current ESL instruction efforts by using the
additional funds to supplement rather than supplant any funds
expended for ESL instruction in the State as of January 1,
2015.
(e) Additional Duties of the Secretary.--The Secretary of Education
shall--
(1) collect and publicize annual data on how much Federal,
State, and local governments spend on ESL instruction;
(2) collect data from State and local governments to
identify the unmet needs of English language learners for
appropriate ESL instruction, including--
(A) the preferred written and spoken language of
such English language learners;
(B) the extent of waiting lists including how many
programs maintain waiting lists and, for programs that
do not have waiting lists, the reasons why not;
(C) the availability of programs to geographically
isolated communities;
(D) the impact of course enrollment policies,
including open enrollment, on the availability of ESL
instruction;
(E) the number individuals in the State and each
participating locality;
(F) the effectiveness of the instruction in meeting
the needs of individuals receiving instruction and
those needing instruction;
(G) as assessment of the need for programs that
integrate job training and ESL instruction, to assist
individuals to obtain better jobs; and
(H) the availability of ESL slots by State and
locality;
(3) determine the cost and most appropriate methods of
making ESL instruction available to all English language
learners seeking instruction; and
(4) within 1 year of the date of enactment of this Act,
issue a report to Congress that assesses the information
collected in paragraphs (1), (2), and (3) and makes
recommendations on steps that should be taken to progressively
realize the goal of making ESL instruction available to all
English language learners seeking instruction.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary of Education for each of fiscal years
2015 through 2018 $250,000,000 to carry out this section.
SEC. 210. IMPLEMENTATION.
(a) General Provisions.--
(1) A State shall not be immune under the Eleventh
Amendment of the Constitution of the United States from suit in
Federal court for failing to provide the language access funded
pursuant to this title.
(2) In a suit against a State for a violation of this
title, remedies (including remedies at both at law and in
equity) are available for such a violation to the same extent
as such remedies are available for such a violation in the suit
against any public or private entity other than a State.
(b) Rule of Construction.--Nothing in this title shall be construed
to limit otherwise existing obligations of recipients of Federal
financial assistance under title VI of the Civil Rights Act of 1964 (42
U.S.C. 2000(d) et seq.) or any other statute.
SEC. 211. LANGUAGE ACCESS SERVICES.
(a) Essential Benefits.--Section 1302(b)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended
by adding at the end the following:
``(K) Language access services, including oral
interpretation and written translations.''.
(b) Employer-Sponsored Minimum Essential Coverage.--Section
36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended by adding
at the end the following:
``(v) Coverage must include language access
and services.--Except as provided in clause
(iii), an employee shall not be treated as
eligible for minimum essential coverage if such
coverage consists of an eligible employer-
sponsored plan (as defined in section
5000A(f)(2)) and the plan does not provide
coverage for language access services,
including oral interpretation and written
translations.''.
(c) Quality Reporting.--Section 2717(a)(1) of the Public Health
Service Act (42 U.S.C. 300gg-17(a)(1)) is amended--
(1) by striking ``and'' at the end of subparagraph (C);
(2) by striking the period at the end of subparagraph (D)
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(E) reduce health disparities through the
provision of language access services, including oral
interpretation and written translations.''.
(d) Regulations Regarding Internal Claims and Appeals and External
Review Processes for Health Plans and Health Insurance Issuers.--The
Secretary of the Treasury, the Secretary of Labor, and the Secretary of
Health and Human Services shall amend the regulations in section
54.9815-2719T(e) of title 26, Code of Federal Regulations, section
2590.715- 2719(e) of title 29, Code of Federal Regulations, and section
147.136(e) of title 45, Code of Federal Regulations, respectively, to
require group health plans and health insurance issuers offering group
or individual health insurance coverage to which such sections apply--
(1) to provide oral interpretation services without any
threshold requirements;
(2) to provide in the English versions of all notices a
statement prominently displayed in not less than 15 non-English
languages clearly indicating how to access the language
services provided by the plan or issuer; and
(3) with respect to written translations of notices, to
apply a threshold that 5 percent of the population or at least
500 individuals per service area are literate only in the same
non-English language in lieu of 10 percent or more residing in
a county.
(e) Data Collection and Reporting.--The Secretary of Health and
Human Services shall--
(1) amend the single streamlined application form developed
pursuant to section 1413 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18083) to collect the preferred
spoken and written language for each household member applying
for coverage under a qualified health plan through an Exchange
under title I of the Patient Protection and Affordable Care
Act;
(2) require navigators, certified application counselors,
and other enrollment assisters to collect and report requests
for language assistance; and
(3) require the Federal and State call centers established
pursuant to section 1311(d)(4)(b) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(d)(4)(b)) to submit an
annual report documenting the number of language assistance
requests, the types of languages requested, the range and
average wait time for a consumer to speak with an interpreter,
and any steps the call center and language line have taken to
actively address some of the consumer complaints.
(f) Effective Date.--The amendments made by this section shall
apply to plan years beginning after the date of the enactment of this
Act.
TITLE III--HEALTH WORKFORCE DIVERSITY
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as added by section
202, is amended by adding at the end the following:
``Subtitle A--Diversifying the Health Care Workplace
``SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Bureau of
Health Workforce within the Health Resources and Services
Administration, shall award a grant to an entity determined appropriate
by the Secretary for the establishment of a national working group on
workforce diversity.
``(b) Representation.--In establishing the national working group
under subsection (a):
``(1) The grantee shall ensure that the group has
representatives of the following:
``(A) The Health Resources and Services
Administration.
``(B) The Department of Health and Human Services
Data Council.
``(C) The Office of Minority Health of the
Department of Health and Human Services.
``(D) The Substance Abuse and Mental Health
Services Administration.
``(E) The Bureau of Labor Statistics of the
Department of Labor.
``(F) The Public Health Practice Program Office--
Office of Workforce Policy and Planning.
``(G) The National Institute on Minority Health and
Health Disparities.
``(H) The Agency for Healthcare Research and
Quality.
``(I) The Institute of Medicine Study Committee for
the 2004 workforce diversity report.
``(J) The Indian Health Service.
``(K) Minority-serving academic institutions.
``(L) Consumer organizations.
``(M) Health professional associations, including
those that represent underrepresented minority
populations.
``(N) Researchers in the area of health workforce.
``(O) Health workforce accreditation entities.
``(P) Private foundations that have sponsored
workforce diversity initiatives.
``(Q) Local and State health departments.
``(R) Representatives of community members to be
included on admissions committees for health profession
schools pursuant to subsection (c)(8).
``(S) Other entities determined appropriate by the
Secretary.
``(2) The grantee shall ensure that, in addition to the
representatives under paragraph (1), the group has not less
than 5 health professions students representing various health
profession fields and levels of training.
``(c) Activities.--The working group established under subsection
(a) shall convene at least twice each year to complete the following
activities:
``(1) Review current public and private health workforce
diversity initiatives.
``(2) Identify successful health workforce diversity
programs and practices.
``(3) Examine challenges relating to the development and
implementation of health workforce diversity initiatives.
``(4) Draft a national strategic work plan for health
workforce diversity, including recommendations for public and
private sector initiatives.
``(5) Develop a framework and methods for the evaluation of
current and future health workforce diversity initiatives.
``(6) Develop recommended standards for workforce diversity
that could be applicable to all health professions programs and
programs funded under this Act.
``(7) Develop guidelines to train health professionals to
care for a diverse population.
``(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 2015 through 2020.
``SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Deputy
Assistant Secretary for Minority Health, and in collaboration with the
Bureau of Health Workforce within the Health Resources and Services
Administration, the National Institute on Minority Health and Health
Disparities, shall establish a technical clearinghouse on health
workforce diversity within the Office of Minority Health and coordinate
current and future clearinghouses.
``(b) Information and Services.--The clearinghouse established
under subsection (a) shall offer the following information and
services:
``(1) Information on the importance of health workforce
diversity.
``(2) Statistical information relating to underrepresented
minority representation in health and allied health professions
and occupations.
``(3) Model health workforce diversity practices and
programs, including integrated models of care.
``(4) Admissions policies that promote health workforce
diversity and are in compliance with Federal and State laws.
``(5) Retainment policies that promote completion of health
profession degrees for underserved populations.
``(6) Lists of scholarship, loan repayment, and loan
cancellation grants as well as fellowship information for
underserved populations for health professions schools.
``(7) 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 and minority sections of major 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 2015 through 2020.
``SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration and the Centers for
Disease Control and Prevention, shall award grants to eligible entities
that demonstrate a commitment to health workforce diversity.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be an educational institution or entity that
historically produces or trains meaningful numbers of
underrepresented minority health professionals, including--
``(A) historically Black colleges and universities;
``(B) Hispanic-serving health professions schools;
``(C) Hispanic-serving institutions;
``(D) tribal colleges and universities;
``(E) Asian-American, Native American, and Pacific
Islander-serving institutions;
``(F) institutions that have programs to recruit
and retain underrepresented minority health
professionals, in which a significant number of the
enrolled participants are underrepresented minorities;
``(G) health professional associations, which may
include underrepresented minority health professional
associations; and
``(H) institutions--
``(i) located in communities with
predominantly underrepresented minority
populations;
``(ii) with whom partnerships have been
formed for the purpose of increasing workforce
diversity; and
``(iii) in which at least 20 percent of the
enrolled participants are underrepresented
minorities; and
``(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under a grant under
subsection (a) shall be used to expand existing workforce diversity
programs, implement new workforce diversity programs, or evaluate
existing or new workforce diversity programs, including with respect to
mental health care professions. Such programs shall enhance diversity
by considering minority status as part of an individualized
consideration of qualifications. Possible activities may include--
``(1) educational outreach programs relating to
opportunities in the health professions;
``(2) scholarship, fellowship, grant, loan repayment, and
loan cancellation programs;
``(3) postbaccalaureate programs;
``(4) academic enrichment programs, particularly targeting
those who would not be competitive for health professions
schools;
``(5) kindergarten through 12th grade and other health
pipeline programs;
``(6) mentoring programs;
``(7) internship or rotation programs involving hospitals,
health systems, health plans, and other health entities;
``(8) community partnership development for purposes
relating to workforce diversity; or
``(9) leadership training.
``(d) Reports.--Not later than 1 year after receiving a grant under
this section, and annually for the term of the grant, a grantee shall
submit to the Secretary a report that summarizes and evaluates all
activities conducted under the grant.
``(e) Definition.--In this section, the term `Asian-American,
Native American, and Pacific Islander-serving institutions' has the
same meaning as the term `Asian American and Native American Pacific
Islander-serving institution' as defined in section 371(c) of the
Higher Education Act of 1965 (20 U.S.C. 1067q(c)).
``(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 2015 through 2020.
``SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND RESEARCHERS.
``(a) In General.--The Secretary, acting through the Director of
the National Institutes of Health, the Director of the Centers for
Disease Control and Prevention, the Commissioner of Food and Drugs, the
Director of the Agency for Healthcare Research and Quality, and the
Administrator of the Health Resources and Services Administration,
shall award grants that expand existing opportunities for scientists
and researchers and promote the inclusion of underrepresented
minorities in the health professions.
``(b) Research Funding.--The head of each entity within the
Department of Health and Human Services shall establish or expand
existing programs to provide research funding to scientists and
researchers in training. Under such programs, the head of each such
entity shall give priority in allocating research funding to support
health research in traditionally underserved communities, including
underrepresented minority communities, and research classified as
community or participatory.
``(c) Data Collection.--The head of each entity within the
Department of Health and Human Services shall collect data on the
number (expressed as an absolute number and a percentage) of
underrepresented minority and nonminority applicants who receive and
are denied agency funding at every stage of review. Such data shall be
reported annually to the Secretary and the appropriate committees of
Congress.
``(d) Student Loan Reimbursement.--The Secretary shall establish a
student loan reimbursement program to provide student loan
reimbursement assistance to researchers who focus on racial and ethnic
disparities in health. The Secretary shall promulgate regulations to
define the scope and procedures for the program under this subsection.
``(e) Student Loan Cancellation.--The Secretary shall establish a
student loan cancellation program to provide student loan cancellation
assistance to researchers who focus on racial and ethnic disparities in
health. Students participating in the program shall make a minimum 5-
year commitment to work at an accredited health profession school. The
Secretary shall promulgate additional regulations to define the scope
and procedures for the program under this subsection.
``(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 2015 through 2020.
``SEC. 3415. CAREER SUPPORT FOR NONRESEARCH 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 & Medicaid Services,
shall establish a program to award grants to eligible individuals for
career support in nonresearch-related health and wellness professions.
``(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, an individual working in a health or wellness
profession (including mental and behavioral health), or a
faculty member of such a school; and
``(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--An individual shall use amounts received under
a grant under this section to--
``(1) support the individual's health activities or
projects that involve underserved communities, including racial
and ethnic minority communities;
``(2) support health-related career advancement activities;
``(3) to pay, or as reimbursement for payments of, student
loans or training or credentialing costs for individuals who
are health professionals and are focused on health issues
affecting underserved communities, including racial and ethnic
minority communities; and
``(4) to establish and promote leadership training programs
to decrease health disparities and to increase cultural
competence with the goal of increasing diversity in leadership
positions.
``(d) Definition.--In this section, the term `career in
nonresearch-related health and wellness professions' means employment
or intended employment in the field of public health, health policy,
health management, health administration, medicine, nursing, pharmacy,
psychology, social work, psychiatry, other mental and behavioral
health, allied health, community health, social work, or other fields
determined appropriate by the Secretary, other than in a position that
involves research.
``(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 2015 through 2020.
``SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DIVERSITY ON QUALITY.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, in collaboration with the Deputy Assistant
Secretary for Minority Health and the Director of the National
Institute on Minority Health and Health Disparities, shall award grants
to eligible entities to expand research on the link between health
workforce diversity and quality health care.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be a clinical, public health, or health services
research entity or other entity determined appropriate by the
Director; and
``(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under a grant awarded under
subsection (a) shall be used to support research that investigates the
effect of health workforce diversity on--
``(1) language access;
``(2) cultural competence;
``(3) patient satisfaction;
``(4) timeliness of care;
``(5) safety of care;
``(6) effectiveness of care;
``(7) efficiency of care;
``(8) patient outcomes;
``(9) community engagement;
``(10) resource allocation;
``(11) organizational structure;
``(12) compliance of care; or
``(13) other topics determined appropriate by the Director.
``(d) Priority.--In awarding grants under subsection (a), the
Director shall give individualized consideration to all relevant
aspects of the applicant's background. Consideration of prior research
experience involving the health of underserved communities shall be
such a factor.
``(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 2015 through 2020.
``SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM.
``(a) Establishment.--The Secretary, acting through the National
Institute on Minority Health and Health Disparities and in
collaboration with the Office of Minority Health, the Office for Civil
Rights, the Centers for Disease Control and Prevention, the Centers for
Medicare & Medicaid Services, the Health Resources and Services
Administration, and other appropriate public and private entities,
shall establish and coordinate a health and health care disparities
education program to support, develop, and implement educational
initiatives and outreach strategies that inform health care
professionals and the public about the existence of and methods to
reduce racial and ethnic disparities in health and health care.
``(b) Activities.--The Secretary, through the education program
established under subsection (a), shall, through the use of public
awareness and outreach campaigns targeting the general public and the
medical community at large--
``(1) disseminate scientific evidence for the existence and
extent of racial and ethnic disparities in health care,
including disparities that are not otherwise attributable to
known factors such as access to care, patient preferences, or
appropriateness of intervention, as described in the 2002
Institute of Medicine Report entitled `Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care', as
well as the impact of disparities related to age, disability
status, socioeconomic status, sex, gender identity, and sexual
orientation on racial and ethnic minorities;
``(2) disseminate new research findings to health care
providers and patients to assist them in understanding,
reducing, and eliminating health and health care disparities;
``(3) disseminate information about the impact of
linguistic and cultural barriers on health care quality and the
obligation of health providers who receive Federal financial
assistance to ensure that people with limited-English
proficiency have access to language access services;
``(4) disseminate information about the importance and
legality of racial, ethnic, disability status, socioeconomic
status, sex, gender identity, and sexual orientation, and
primary language data collection, analysis, and reporting;
``(5) design and implement specific educational initiatives
to health care providers relating to health and health care
disparities; and
``(6) assess the impact of the programs established under
this section in raising awareness of health and health care
disparities and providing information on available resources.
``(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 2015 through 2020.''.
SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.
Part B of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.) is amended by adding at the end the following:
``SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award grants
to Hispanic-serving health professions schools for the purpose of
carrying out programs to recruit Hispanic individuals to enroll in and
graduate from such schools, which may include providing scholarships
and other financial assistance as appropriate.
``(b) Eligibility.--In subsection (a), the term `Hispanic-serving
health professions school' means an entity that--
``(1) is a school or program under section 799B;
``(2) has an enrollment of full-time equivalent students
that is made up of at least 9 percent Hispanic students;
``(3) has been effective in carrying out programs to
recruit Hispanic individuals to enroll in and graduate from the
school;
``(4) has been effective in recruiting and retaining
Hispanic faculty members;
``(5) has a significant number of graduates who are
providing health services to medically underserved populations
or to individuals in health professional shortage areas; and
``(6) is a Regional Hispanic Center of Excellence.''.
SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR DISEASE CONTROL AND
PREVENTION.
Section 317F(c) of the Public Health Service Act (42 U.S.C. 247b-
7(c)) is amended--
(1) by striking ``and'' after ``1994,''; and
(2) by inserting before the period at the end the
following: ``$750,000 for fiscal year 2015, and such sums as
may be necessary for each of the fiscal years 2016 through
2020''.
SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS AT SCHOOLS
OF PUBLIC HEALTH AND SCHOOLS OF ALLIED HEALTH.
Part B of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.), as amended by section 302, is further amended by adding at
the end the following:
``SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS.
``(a) Cooperative Agreements.--The Secretary, acting through the
Administrator of the Health Resources and Services Administration, in
consultation with the Director of the Centers for Disease Control and
Prevention, the Director of the Agency for Healthcare Research and
Quality, and the Deputy Assistant Secretary for Minority Health, shall
award cooperative agreements to schools of public health and schools of
allied health to design and implement online degree programs.
``(b) Priority.--In awarding cooperative agreements under this
section, the Secretary shall give priority to any school of public
health or school of allied health that has an established track record
of serving medically underserved communities.
``(c) Requirements.--Recipients of cooperative agreements under
this section shall design and implement an online degree program that
meets 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.
``(3) Achieving a high completion rate of enrolled
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 2015 through 2020.''.
SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE NATIONAL HEALTH CARE
WORKFORCE COMMISSION.
It is the sense of Congress that the National Health Care Workforce
Commission established by section 5101 of the Patient Protection and
Affordable Care Act (42 U.S.C. 294q) should, in carrying out its
assigned duties under that section, give attention to the needs of
racial and ethnic minorities, individuals with lower socioeconomic
status, individuals with mental, developmental, and physical
disabilities, lesbian, gay, bisexual, and transgender populations, and
individuals who are members of multiple minority or special population
groups.
SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.
Subtitle A of title XXXIV of the Public Health Service Act, as
added by section 301, is further amended by inserting after section
3417 the following:
``SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.
``(a) In General.--The Administrator of the Health Resources and
Services Administration and the Director of the Centers for Disease
Control and Prevention, in collaboration with the Deputy Assistant
Secretary for Minority Health, shall award grants to eligible entities
to increase awareness among postprimary and postsecondary students of
career opportunities in the health professions.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be a clinical, public health, or health services
organization, community-based or nonprofit entity, or other
entity determined appropriate by the Director of the Centers
for Disease Control and Prevention;
``(2) serve a health professional shortage area, as
determined by the Secretary;
``(3) work with students, including those from racial and
ethnic minority backgrounds, that have expressed an interest in
the health professions; and
``(4) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Grant awards under subsection (a) shall be
used to support internships that will increase awareness among students
of non-research-based, career opportunities in the following health
professions:
``(1) Medicine.
``(2) Nursing.
``(3) Public Health.
``(4) Pharmacy.
``(5) Health administration and management.
``(6) Health policy.
``(7) Psychology.
``(8) Dentistry.
``(9) International health.
``(10) Social work.
``(11) Allied health.
``(12) Psychiatry.
``(13) Hospice care.
``(14) Other professions deemed appropriate by the Director
of the Centers for Disease Control and Prevention.
``(d) Priority.--In awarding grants under subsection (a), the
Director of the Centers for Disease Control and Prevention shall give
priority to those entities that--
``(1) serve a high proportion of individuals from
disadvantaged backgrounds;
``(2) have experience in health disparity elimination
programs;
``(3) facilitate the entry of disadvantaged individuals
into institutions of higher education; and
``(4) provide counseling or other services designed to
assist disadvantaged individuals in successfully completing
their education at the postsecondary level.
``(e) Stipends.--The Secretary may approve stipends under this
section for individuals for any period of education in student-
enhancement programs (other than regular courses) at health professions
schools, programs, or entities, except that such a stipend may not be
provided to an individual for more than 6 months, and such a stipend
may not exceed $20 per day (notwithstanding any other provision of law
regarding the amount of stipends).
``(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 2015 through 2020.
``SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, in collaboration with the Deputy Assistant Secretary
for Minority Health, shall award scholarships to postsecondary students
who seek a career in public health.
``(b) Eligibility.--To be eligible to receive a scholarship under
subsection (a), an individual shall--
``(1) have interest, knowledge, or skill 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) demonstrate promise for becoming a leader in public
health;
``(4) secure admission to a 4-year institution of higher
education;
``(5) comply with subsection (e); 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 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) 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 2015 through 2020.
``SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH FELLOWSHIP PROGRAM.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, in collaboration with the Deputy Assistant Secretary
for Minority Health, the Administrator of the Substance Abuse and
Mental Health Services Administration, 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) 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 2015 through 2020.
``SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP
PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, in collaboration with the Deputy Assistant
Secretary for Minority Health, shall award research fellowships to
college students or recent graduates to advance their understanding of
international health.
``(b) Eligibility.--To be eligible to receive a fellowship under
subsection (a) an individual shall--
``(1) have educational experience in the field of
international health;
``(2) reside in a health professional shortage area as
determined by the Secretary;
``(3) demonstrate promise for becoming a leader in the
field of international health;
``(4) be a college senior or recent graduate of a four-year
higher education institution;
``(5) comply with subsection (e); and
``(6) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under an award under
subsection (a) shall be used to support opportunities for students to
become health professionals and to advance their knowledge about
international issues relating to health care access and quality.
``(d) Priority.--In awarding grants under subsection (a), the
Director shall give priority to those applicants that--
``(1) are from a disadvantaged background; and
``(2) have identified a mentor at a health professions
school or institution, an academic advisor to assist in the
completion of their graduate or professional degree, and an
advisor from an international health non-governmental
organization, private volunteer organization, or other
international institution or program that focuses on increasing
health care access and quality for residents in developing
countries.
``(e) Fellowships.--The Secretary shall approve fellowships for
college seniors or recent graduates, except that such a fellowship may
not be provided to an individual for more than 6 months, may not be
awarded to a graduate that has not been enrolled in school for more
than 1 year, and may not exceed $4,000 per academic year
(notwithstanding any other provision of law regarding the amount of
fellowship).
``(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 2015 through 2020.
``SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, the Director of the Centers for Medicare and
Medicaid Services, and the Administrator for Health Resources and
Services Administration, in collaboration with the Deputy Assistant
Secretary for Minority Health, shall award grants to eligible entities
to expose entering graduate students to the health professions.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be a clinical, public health, or health services
organization, community-based, academic, or nonprofit entity,
or other entity determined appropriate by the Director of the
Agency for Healthcare Research and Quality;
``(2) serve in a health professional shortage area as
determined by the Secretary;
``(3) work with students obtaining a degree in the health
professions; and
``(4) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(c) Use of Funds.--Amounts received under a grant awarded under
subsection (a) shall be used to support opportunities that expose
students to non-research-based health professions, including--
``(1) public health policy;
``(2) health care and pharmaceutical policy;
``(3) health care administration and management;
``(4) health economics; and
``(5) other professions determined appropriate by the
Director of the Agency for Healthcare Research and Quality, the
Director of the Centers for Medicare and Medicaid Services, and
the Administrator for Health Resources and Services
Administration.
``(d) Priority.--In awarding grants under subsection (a), the
Director of the Agency for Healthcare Research and Quality shall give
priority to those entities that--
``(1) have experience with health disparity elimination
programs;
``(2) facilitate training in the fields described in
subsection (c); and
``(3) provide counseling or other services designed to
assist such individuals in successfully completing their
education at the postsecondary level.
``(e) Stipends.--The Secretary may approve the payment of stipends
for individuals under this section for any period of education in
student-enhancement programs (other than regular courses) at health
professions schools or entities, except that such a stipend may not be
provided to an individual for more than 2 months, and such a stipend
may not exceed $100 per day (notwithstanding any other provision of law
regarding the amount of stipends).
``(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 2015 through 2020.''.
SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM.
Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a-
15) is amended by striking subsection (g) and inserting the following:
``(g) Collaboration in Health Profession Diversity Training
Programs.--The Secretary shall coordinate with the Secretary of Health
and Human Services to ensure that there is collaboration between the
goals of the program under this section and programs of the Health
Resources and Services Administration that promote health workforce
diversity. The Secretary of Education shall take such measures as may
be necessary to encourage students participating in projects assisted
under this section to consider health profession careers.
``(h) Funding.--From amounts appropriated pursuant to the authority
of section 402A(g), the Secretary shall, to the extent practicable,
allocate funds for projects authorized by this section in an amount
which is not less than $31,000,000 for each of the fiscal years 2015
through 2021.''.
SEC. 308. RULES FOR DETERMINATION OF FULL-TIME EQUIVALENT RESIDENTS FOR
COST-REPORTING PERIODS.
(a) DGME Determinations.--Section 1886(h)(4) of the Social Security
Act (42 U.S.C. 1395ww(h)(4)) is amended--
(1) in subparagraph (E), by striking ``Subject to
subparagraphs (J) and (K), such rules'' and inserting ``Subject
to subparagraphs (J), (K), and (L), such rules'';
(2) in subparagraph (J), by striking ``Such rules'' and
inserting ``Subject to subparagraph (L), such rules'';
(3) in subparagraph (K), by striking ``In determining'' and
inserting ``Subject to subparagraph (L), in determining''; and
(4) by adding at the end the following new subparagraph:
``(L) For purposes of cost-reporting periods
beginning on or after October 1, 2014, in determining
the hospital's number of full-time equivalent residents
for purposes of this paragraph, all the time spent by
an intern or resident in an approved medical residency
training program shall be counted toward the
determination of full-time equivalency if the
hospital--
``(i) is recognized as a subsection (d)
hospital;
``(ii) is recognized as a subsection (d)
Puerto Rico hospital;
``(iii) is reimbursed under a reimbursement
system authorized under section 1814(b)(3); or
``(iv) is a provider-based hospital
outpatient department.''.
(b) IME Determinations.--Section 1886(d)(5)(B)(x) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(x)) is amended--
(1) in subclause (II), by striking ``In determining'' and
inserting ``Subject to subclause (x)(IV), in determining'';
(2) in subclause (III), by striking ``In determining'' and
inserting ``Subject to subclause (x)(IV), in determining''; and
(3) by adding at the end the following new subclause:
``(IV) The provisions of
subparagraph (L) of subsection (h)(4)
shall apply under this subparagraph in
the same manner as they apply under
such subsection.''.
SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES FOR LOCAL HEALTH
EQUITY.
(a) Grants.--The Secretaries of Health and Human Services,
Education, and Labor, acting jointly, shall make grants to academic
institutions for the purposes of--
(1) in accordance with subsection (b), developing
capacity--
(A) to build an evidence base for successful
strategies for increasing local health equity; and
(B) to serve as national models of driving local
health equity;
(2) in accordance with subsection (c), developing a
strategic partnership with the community in which the academic
institution is located; and
(3) collecting data on, and periodically evaluating, the
effectiveness of the institution's programs funded through this
section to enable the institution to adapt accordingly for
maximum efficiency and success.
(b) Developing Capacity for Increasing Local Health Equity.--As a
condition on receipt of a grant under subsection (a), an academic
institution shall agree to use the grant to build an evidence base for
successful strategies for increasing local health equity, and to serve
as a national model of driving local health equity, by supporting--
(1) resources to strengthen institutional metrics and
capacity to execute institutionwide health workforce goals that
can serve as models for increasing health equity in communities
across the country;
(2) collaborations among a cohort of institutions in
implementing systemic change, partnership development, and
programmatic efforts supportive of health equity goals across
disciplines and populations; and
(3) enhanced or newly developed data systems and research
infrastructure capable of informing current and future
workforce efforts and building a foundation for a broader
research agenda targeting urban health disparities.
(c) Strategic Partnerships.--As a condition on receipt of a grant
under subsection (a), an academic institution shall agree to use the
grant to develop a strategic partnership with the community in which
the institution is located for the purposes of--
(1) strengthening connections between the institution and
the community--
(A) to improve evaluation of and address the
community's health and health workforce needs; and
(B) to engage the community in health workforce
development;
(2) developing, enhancing, or accelerating innovative
undergraduate and graduate programs in the biomedical sciences
and health professions; and
(3) strengthening pipeline programs in the biomedical
sciences and health professions, including by developing
partnerships between institutions of higher education and
elementary and secondary schools to recruit the next generation
of health professionals earlier in the pipeline to a health
care career.
SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAVIORAL HEALTH SOCIAL
WORKERS.
Section 455 of the Higher Education Act of 1965 (20 U.S.C. 1087e)
is amended by adding at the end the following new subsection:
``(r) Repayment Plan for Mental and Behavioral Health Social
Workers.--
``(1) In general.--The Secretary shall cancel the balance
of interest and principal due on any eligible Federal Direct
Loan not in default for a borrower who--
``(A) has made 120 monthly payments on the eligible
Federal Direct Loan after October 1, 2014, pursuant to
any one or a combination of the following--
``(i) payments under an income-based
repayment plan under section 493C;
``(ii) payments under a standard repayment
plan under subsection (d)(1)(A), based on a 10-
year repayment period;
``(iii) monthly payments under a repayment
plan under subsection (d)(1) or (g) of not less
than the monthly amount calculated under
subsection (d)(1)(A), based on a 10-year
repayment period; or
``(iv) payments under an income contingent
repayment plan under subsection (d)(1)(D); and
``(B)(i) is employed as a mental health or
behavioral health social worker, as defined by the
Secretary by regulation, at the time of such
forgiveness; and
``(ii) has been employed as such a mental health or
behavioral health social worker during the period in
which the borrower makes each of the 120 payments as
described in subparagraph (A).
``(2) Loan cancellation amount.--After the conclusion of
the employment period described in paragraph (1), the Secretary
shall cancel the obligation to repay the balance of principal
and interest due as of the time of such cancellation, on the
eligible Federal Direct Loans made to the borrower under this
part.
``(3) Ineligibility for double benefits.--No borrower may,
for the same employment as a mental heath or behavioral health
social worker, receive a reduction of loan obligations under
both this subsection and section 455(m), 428J, 428K, 428L, or
460.
``(4) Definition of eligible federal direct loan.--In this
subsection, the term `eligible Federal Direct Loan' means a
Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal
Direct Unsubsidized Stafford Loan, or a Federal Direct
Consolidation Loan.''.
SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND.
(a) Purpose.--It is the purpose of this section to establish a
Health Professions Workforce Fund to be administered through the Health
Resources and Services Administration within the Department of Health
and Human Services to provide for expanded and sustained national
investment in the health professions and nursing workforce development
programs under title VII and title VIII of the Public Health Service
Act.
(b) Establishing the Health Professions Workforce Fund.--There is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, to the Health
Professions Workforce Fund--
(1) $355,000,000 for fiscal year 2015;
(2) $375,000,000 for fiscal year 2016;
(3) $392,000,000 for fiscal year 2017;
(4) $412,000,000 for fiscal year 2018;
(5) $432,000,000 for fiscal year 2019;
(6) $454,000,000 for fiscal year 2020;
(7) $476,000,000 for fiscal year 2021;
(8) $500,000,000 for fiscal year 2022;
(9) $525,000,000 for fiscal year 2023; and
(10) $552,000,000 for fiscal year 2024.
(c) Funding.--
(1) For the purpose of carrying out health professions
education programs authorized under title VII of the Public
Health Service Act, in addition to any other amounts authorized
to be appropriated for such purpose, there is authorized to be
appropriated out of any monies in the Health Professions
Workforce Fund, the following:
(A) $240,000,000 for fiscal year 2015.
(B) $253,000,000 for fiscal year 2016.
(C) $265,000,000 for fiscal year 2017.
(D) $278,000,000 for fiscal year 2018.
(E) $292,000,000 for fiscal year 2019.
(F) $307,000,000 for fiscal year 2020.
(G) $322,000,000 for fiscal year 2021.
(H) $338,000,000 for fiscal year 2022.
(I) $355,000,000 for fiscal year 2023.
(J) $373,000,000 for fiscal year 2024.
(2) For the purpose of carrying out nursing workforce
development programs authorized under Title VIII of the Public
Health Service Act, in addition to any other amounts authorized
to be appropriated for such purpose, there is authorized to be
appropriated out of any monies in the Health Professions
Workforce Fund, the following:
(A) $115,000,000 for fiscal year 2015.
(B) $122,000,000 for fiscal year 2016.
(C) $127,000,000 for fiscal year 2017.
(D) $134,000,000 for fiscal year 2018.
(E) $140,000,000 for fiscal year 2019.
(F) $147,000,000 for fiscal year 2020.
(G) $154,000,000 for fiscal year 2021.
(H) $162,000,000 for fiscal year 2022.
(I) $170,000,000 for fiscal year 2023.
(J) $179,000,000 for fiscal year 2024.
SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO GRADUATE MEDICAL
EDUCATION.
(a) Findings.--Congress finds the following:
(1) Projections by the Association of American Medical
Colleges (AAMC) and other expert entities, such as the Health
Resources and Services Administration (HRSA), have indicated a
nationwide shortage of up to 130,600 physicians, split evenly
between primary care and specialists, by 2025.
(2) The coverage of an additional 25 million uninsured
Americans under the Patient Protection and Affordable Care Act
is expected to increase the projected shortage by 25 percent.
(3) The United States Census projects that the Nation's
population will grow from 310 million in 2010 to 400 million in
2044, with the Nation becoming majority-minority in 2043, and
the number of Medicare beneficiaries increasing from 50.7
million in 2012 to 90 million in 2045.
(4) One-third of currently practicing physicians are over
55 years of age and likely to retire in the next 20 years.
(5) A nationwide physician shortage will result in many
Americans waiting longer and traveling farther for health care;
seeking nonemergent care in emergency departments; and delaying
treatment until their health care needs become more serious,
complex, and costly.
(6) Changing demographics (such as an aging population),
new health care delivery models (such as medical homes), and
other factors (such as disaster preparedness) are contributing
to a shortage of both generalist and specialist physicians.
(7) These shortages will have the most severe impact on
vulnerable and underserved populations, including racial/ethnic
minorities and the approximately 20 percent of Americans who
live in rural or inner-city locations designated as health
professional shortage areas.
(8) United States medical schools have committed to and
have initiated a 30 percent increase in enrollment by 2017 to
help reduce the Nation's shortage of quality physicians.
(9) An increase in United States medical school graduates
must be accompanied by an increase of 4,000 graduate medical
education (GME) training positions each year.
(10) Graduate medical education programs and teaching
hospitals provide venues in which the next generation of
physicians learns to work collaboratively with other physicians
and health professionals, adopt more efficient care delivery
models (such as care coordination and medical homes),
incorporate health information technology and electronic health
records in every aspect of their work, apply new methods of
assuring quality and safety, and participate in groundbreaking
clinical and public health research.
(11) The Medicare Program under title XVIII of the Social
Security Act (having more beneficiaries than any other health
care program), supports its ``fair share'' of the costs
associated with graduate medical education (GME).
(12) In general, the level of support of graduate medical
education by the Medicare Program has been capped since 1997
and has not been increased to support the expansion of graduate
medical education programs needed to avert the projected
physician shortage or to accommodate the increase in United
States medical school graduates.
(b) Sense of Congress.--It is the sense of Congress that
eliminating the limit of the number of residency positions that receive
some level of Medicare support under section 1886(h) of the Social
Security Act (42 U.S.C. 1395ww(h)), also referred to as the Medical
graduate medical education cap, is critical to--
(1) ensuring an appropriate supply of physicians to meet
the Nation's health care needs;
(2) facilitating equitable access for all who seek health
care; and
(3) mitigating disparities in health and health care.
SEC. 313. CAREER SUPPORT FOR SKILLED INTERNATIONALLY EDUCATED HEALTH
PROFESSIONALS.
(a) Findings.--Congress finds the following:
(1) According to the Association of Schools of Public
Health, projections indicate a nationwide shortage of up to
250,000 public health workers needed by 2020.
(2) Similar trends are projected for other health
professions indicating shortages across disciplines, including
within the fields of nursing, dentistry, pharmacy, mental and
behavioral health, primary care, and community and allied
health.
(3) A nationwide health workforce shortage will result in
serious health threats and more severe and costly health care
needs, due to, in part, a delayed response to food-borne
outbreaks, emerging infectious diseases, and natural disasters,
fewer cancer screenings and delayed treatment.
(4) Vulnerable and underserved populations and health
professional shortage areas will be most severely impacted by
the health workforce shortage.
(5) According to the Migration Policy Institute, over 2
million college-educated immigrants in the United States today
are unemployed or underemployed in low- or semi-skilled jobs
that fail to draw on their education and expertise.
(6) Approximately two out of every five internationally
educated immigrants are unemployed or underemployed.
(7) According to Drexel University Center for Labor Markets
and Policy, underemployment for internationally educated
immigrant women is 28 percent higher than for their male
counterparts.
(8) According to the Drexel University Center for Labor
Markets and Policy, the mean annual earnings of underemployed
immigrants were $32,000, or 43 percent less than U.S.-born
college graduates employed in the college labor market.
(9) According to Upwardly Global and the Welcome Back
Initiative, with proper guidance and support underemployed
skilled immigrants typically increase their income by 215
percent to 900 percent.
(10) According to the Brookings Institution and the
Partnership for a New American Economy, immigrants working in
the health workforce are, on average, better-educated than
U.S.-born workers in the health workforce.
(b) Grants to Eligible Entities.--
(1) Authority to provide grants.--The Secretary of Health
and Human Services, acting through the Bureau of Health
Workforce within the Health Resources and Services
Administration, the National Institute on Minority Health and
Health Disparities, or the Office of Minority Health (in this
section referred to as the ``Secretary''), may award grants to
eligible entities to carry out activities described in
subsection (c).
(2) Eligibility.--To be eligible to receive a grant under
this section, an entity shall--
(A) be a clinical, public health, or health
services organization, a community-based or nonprofit
entity, an academic institution, a faith-based
organization, a State, county, or local government, a
National Area Health Education Center, or another
entity determined appropriate by the Secretary; and
(B) submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require.
(c) Authorized Activities.--A grant awarded under this section
shall be used--
(1) to provide services to assist unemployed and
underemployed skilled immigrants, residing in the United
States, who have legal, permanent work authorization and who
are internationally educated health professions, enter into the
American health workforce with employment matching their health
professional skills and education, and advance in employment to
positions that better match their health professional education
and expertise;
(2) to reduce disparities in incomes between skilled health
professional immigrants and other workers in the health
workforce;
(3) to reduce barriers to entry and advancement in the
health workforce for internationally educated skilled
immigrants; and
(4) to educate employers regarding the abilities and
capacities of internationally educated health professionals.
(d) Definitions.--In this section:
(1) The term ``health professional'' means an individual
trained for employment or intended employment in the field of
public health, health management, dentistry, health
administration, medicine, nursing, pharmacy, psychology, social
work, psychiatry, other mental and behavioral health, allied
health, community health, social work, or wellness work,
including fitness and nutrition, or other fields as determined
appropriate by the Secretary.
(2) The term ``underemployed'' means being employed at less
skilled tasks than an employee's training or abilities would
otherwise permit.
(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 2015 through 2019.
TITLE IV--IMPROVEMENT OF HEALTH CARE SERVICES
Subtitle A--Health Empowerment Zones
SEC. 401. SHORT TITLE.
This subtitle may be cited as the ``Health Empowerment Zone Act of
2014''.
SEC. 402. FINDINGS.
The Congress finds the following:
(1) Numerous studies and reports, including the 2012
National Healthcare Disparities Report of the Administration on
Healthcare Research and Quality and the 2002 Unequal Treatment
Report of the Institute of Medicine, document the extensiveness
to which health disparities exist across the country.
(2) These studies have found that, on average, racial and
ethnic minorities are disproportionately afflicted with chronic
and acute conditions--such as cancer, diabetes, musculoskeletal
disease, obesity, and hypertension--and suffer worse health
outcomes, worse health status, and higher mortality rates than
their White counterparts.
(3) Several recent studies also show that health
disparities are a function of not only access to health care,
but also the social determinants of health--including the
environment, the physical structure of communities, nutrition
and food options, educational attainment, employment, race,
ethnicity, geography, and language preference--that directly
and indirectly affect the health, health care, and wellness of
individuals and communities.
(4) Integrally involving and fully supporting the
communities most affected by health inequities in the
assessment, planning, launch, and evaluation of health
disparity elimination efforts are among the leading
recommendations made to adequately address and ultimately
reduce health disparities.
(5) Recommendations also include supporting the efforts of
community stakeholders from a broad cross section--including,
but not limited to local businesses, local departments of
commerce, education, labor, urban planning, and transportation,
and community-based and other nonprofit organizations--to find
areas of common ground around health disparity elimination and
collaborate to improve the overall health and wellness of a
community and its residents.
SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT ZONES.
(a) In General.--At the request of an eligible community
partnership, the Secretary may designate an eligible area as a health
empowerment zone.
(b) Eligibility Criteria.--
(1) Eligible community partnership.--A community
partnership is eligible to submit a request under this section
if the partnership--
(A) demonstrates widespread public support from key
individuals and entities in the eligible area,
including members of the target community, State and
local governments, nonprofit organizations, and
community and industry leaders, for designation of the
eligible area as a health empowerment zone; and
(B) includes representatives of--
(i) a broad cross section of stakeholders
and residents from communities in the eligible
area experiencing disproportionate disparities
in health status and health care; and
(ii) organizations, facilities, and
institutions that have a history of working
within and serving such communities.
(2) Eligible area.--An area is eligible to be designated as
a health empowerment zone under this section if one or more
communities in the area experience disproportionate disparities
in health status and health care. In determining whether a
community experiences such disparities, the Secretary shall
consider the data collected by the Department of Health and
Human Services focusing on the following areas:
(A) Access to affordable, high-quality health
services.
(B) The prevalence of disproportionate rates of
certain illnesses or diseases including the following:
(i) Arthritis, osteoporosis, chronic back
conditions, and other musculoskeletal diseases.
(ii) Cancer.
(iii) Chronic kidney disease.
(iv) Diabetes.
(v) Injury (intentional and unintentional).
(vi) Violence (intimate and nonintimate).
(vii) Maternal and paternal illnesses and
diseases.
(viii) Infant mortality.
(ix) Mental illness and other disabilities.
(x) Substance abuse treatment and
prevention, including underage drinking.
(xi) Nutrition, obesity, and overweight
conditions.
(xii) Heart disease.
(xiii) Hypertension.
(xiv) Cerebrovascular disease or stroke.
(xv) Tuberculosis.
(xvi) HIV/AIDS and other sexually
transmitted diseases.
(xvii) Viral hepatitis.
(xviii) Asthma.
(xix) Tooth decay and other oral health
issues.
(C) Within the target community, the historical and
persistent presence of conditions that have been found
to contribute to health disparities including any such
conditions respecting the following:
(i) Poverty.
(ii) Educational status and the quality of
community schools.
(iii) Income.
(iv) Access to high-quality affordable
health care.
(v) Work and work environment.
(vi) Environmental conditions in the
community, including with respect to clean
water, clean air, and the presence or absence
of pollutants.
(vii) Language and English proficiency.
(viii) Access to affordable healthy food.
(ix) Access to ethnically and culturally
diverse health and human service providers and
practitioners.
(x) Access to culturally and linguistically
competent health and human services and health
and human service providers.
(xi) Health-supporting infrastructure.
(xii) Health insurance that is adequate and
affordable.
(xiii) Race, racism, and bigotry (conscious
and unconscious).
(xiv) Sexual orientation.
(xv) Health literacy.
(xvi) Place of residence (such as urban
areas, rural areas, and tribal reservations).
(xvii) Stress.
(c) Procedure.--
(1) Request.--A request under subsection (a) shall--
(A) describe the bounds of the area to be
designated as a health empowerment zone and the process
used to select those bounds;
(B) demonstrate that the partnership submitting the
request is an eligible community partnership described
in subsection (b)(1);
(C) demonstrate that the area is an eligible area
described in subsection (b)(2);
(D) include a comprehensive assessment of
disparities in health status and health care experience
by one or more communities in the area;
(E) set forth--
(i) a vision and a set of values for the
area; and
(ii) a comprehensive and holistic set of
goals to be achieved in the area through
designation as a health empowerment zone; and
(F) include a strategic plan and an action plan for
achieving the goals described in subparagraph (E)(ii).
(2) Approval.--Not later than 60 days after the receipt of
a request for designation of an area as a health empowerment
zone under this section, the Secretary shall approve or
disapprove the request.
(d) Minimum Number.--The Secretary--
(1) shall designate not more than 110 health empowerment
zones under this section; and
(2) shall designate at least one health empowerment zone in
each of the several States, the District of Columbia, and each
territory or possession of the United States.
SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION.
At the request of any organization or entity seeking to submit a
request under section 403(a), the Secretary shall provide technical
assistance, and may award a grant, to assist such organization or
entity--
(1) to form an eligible community partnership described in
section 403(b)(1);
(2) to complete a health assessment, including an
assessment of health disparities under section 403(c)(1)(D); or
(3) to prepare and submit a request, including a strategic
plan, in accordance with section 403.
SEC. 405. BENEFITS OF DESIGNATION.
(a) Priority.--In awarding any competitive grant, a Federal
official shall give priority to any applicant that--
(1) meets the eligibility criteria for the grant;
(2) proposes to use the grant for activities in a health
empowerment zone; and
(3) demonstrates that such activities will directly and
significantly further the goals of the strategic plan approved
for such zone under section 403.
(b) Grants for Initial Implementation of Strategic Plan.--
(1) In general.--Upon designating an eligible area as a
health empowerment zone at the request of an eligible community
partnership, the Secretary shall, subject to the availability
of appropriations, make a grant to the community partnership
for implementation of the strategic plan for such zone.
(2) Grant period.--A grant under paragraph (1) for a health
empowerment zone shall be for a period of 2 years and may be
renewed, except that the total period of grants under paragraph
(1) for such zone may not exceed 10 years.
(3) Limitation.--In awarding grants under this subsection,
the Secretary shall not give less priority to an applicant or
reduce the amount of a grant because the Secretary rendered
technical assistance or made a grant to the same applicant
under section 404.
(4) Reporting.--The Secretary shall require each recipient
of a grant under this subsection to report to the Secretary not
less than every 6 months on the progress in implementing the
strategic plan for the health empowerment zone.
SEC. 406. DEFINITION.
In this subtitle, the term ``Secretary'' means the Secretary of
Health and Human Services, acting through the Administrator of the
Health Resources and Services Administration and the Deputy Assistant
Secretary for Minority Health, and in cooperation with the Director of
the Office of Community Services and the Director of the National
Institute for Minority Health and Health Disparities.
SEC. 407. AUTHORIZATION OF APPROPRIATIONS.
To carry out this subtitle, there is authorized to be appropriated
$100,000,000 for fiscal year 2015.
Subtitle B--Other Improvements of Health Care Services
CHAPTER 1--EXPANSION OF COVERAGE
SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as amended by titles
I, II, III, and IX of this Act, is further amended by inserting after
subtitle C the following:
``Subtitle D--Reconstruction and Improvement Grants for Public Health
Care Facilities Serving Pacific Islanders and the Insular Areas
``SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT INITIATIVES.
``(a) In General.--The Secretary, in collaboration with the
Administrator of the Health Resources and Services Administration, the
Director of the Agency for Healthcare Research and Quality, and the
Administrator of the Centers for Medicare & Medicaid Services, shall
award grants to eligible entities for the conduct of demonstration
projects to improve the quality of and access to health care.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
``(1) be a health center, hospital, health plan, health
system, community clinic. or other health entity determined
appropriate by the Secretary--
``(A) that, by legal mandate or explicitly adopted
mission, provides patients with access to services
regardless of their ability to pay;
``(B) that provides care or treatment for a
substantial number of patients who are uninsured, are
receiving assistance under a State program under title
XIX of the Social Security Act, or are members of
vulnerable populations, as determined by the Secretary;
and
``(C)(i) with respect to which, not less than 50
percent of the entity's patient population is made up
of racial and ethnic minorities; or
``(ii) that--
``(I) serves a disproportionate percentage
of local, minority racial and ethnic patients,
or that has a patient population, at least 50
percent of which is limited-English-proficient;
and
``(II) provides an assurance that amounts
received under the grant will be used only to
support quality improvement activities in the
racial and ethnic population served; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
``(c) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to applicants under subsection (b)(2)
that--
``(1) demonstrate an intent to operate as part of a health
care partnership, network, collaborative, coalition, or
alliance where each member entity contributes to the design,
implementation, and evaluation of the proposed intervention; or
``(2) intend to use funds to carry out systemwide changes
with respect to health care quality improvement, including--
``(A) improved systems for data collection and
reporting;
``(B) innovative collaborative or similar
processes;
``(C) group programs with behavioral or self-
management interventions;
``(D) case management services;
``(E) physician or patient reminder systems;
``(F) educational interventions; or
``(G) other activities determined appropriate by
the Secretary.
``(d) Use of Funds.--An entity shall use amounts received under a
grant under subsection (a) to support the implementation and evaluation
of health care quality improvement activities or minority health and
health care disparity reduction activities that include--
``(1) with respect to health care systems, activities
relating to improving--
``(A) patient safety;
``(B) timeliness of care;
``(C) effectiveness of care;
``(D) efficiency of care;
``(E) patient centeredness; and
``(F) health information technology; and
``(2) with respect to patients, activities relating to--
``(A) staying healthy;
``(B) getting well, mentally and physically;
``(C) living effectively 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 are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2015 through 2020.
``SEC. 3452. CENTERS OF EXCELLENCE.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall designate
centers of excellence at public hospitals, and other health systems
serving large numbers of minority patients, that--
``(1) meet the requirements of section 3451(b)(1);
``(2) demonstrate excellence in providing care to minority
populations; and
``(3) demonstrate excellence in reducing disparities in
health and health care.
``(b) Requirements.--A hospital or health system that serves as a
center of excellence under subsection (a) shall--
``(1) design, implement, and evaluate programs and policies
relating to the delivery of care in racially, ethnically, and
linguistically diverse populations;
``(2) provide training and technical assistance to other
hospitals and health systems relating to the provision of
quality health care to minority populations; and
``(3) develop activities for graduate or continuing medical
education that institutionalize a focus on cultural competence
training for health care providers.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2015 through 2020.
``SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS FOR PUBLIC HEALTH
CARE FACILITIES SERVING PACIFIC ISLANDERS AND THE INSULAR
AREAS.
``(a) In General.--The Secretary shall provide direct financial
assistance to designated health care providers and community health
centers in American Samoa, Guam, the Commonwealth of the Northern
Mariana Islands, the United States Virgin Islands, Puerto Rico, and
Hawaii for the purposes of reconstructing and improving health care
facilities and services in a culturally competent and sustainable
manner.
``(b) Eligibility.--To be eligible to receive direct financial
assistance under subsection (a), an entity shall be a public health
facility or community health center located in American Samoa, Guam,
the Commonwealth of the Northern Mariana Islands, the United States
Virgin Islands, Puerto Rico, or Hawaii that--
``(1) is owned or operated by--
``(A) the Government of American Samoa, Guam, the
Commonwealth of the Northern Mariana Islands, the
United States Virgin Islands, Puerto Rico, or Hawaii or
a unit of local government; or
``(B) a nonprofit organization; and
``(2)(A) provides care or treatment for a substantial
number of patients who are uninsured, receiving assistance
under a State program under a title XVIII of the Social
Security Act, or a State program under title XIX of such Act,
or who are members of a vulnerable population, as determined by
the Secretary; or
``(B) serves a disproportionate percentage of local,
minority racial and ethnic patients.
``(c) Report.--Not later than 180 days after the date of enactment
of this title and annually thereafter, the Secretary shall submit to
the Congress and the President a report that includes an assessment of
health resources and facilities serving populations in American Samoa,
Guam, the Commonwealth of the Northern Mariana Islands, the United
States Virgin Islands, Puerto Rico, and Hawaii. In preparing such
report, the Secretary shall--
``(1) consult with and obtain information on all health
care facilities needs from the entities described in subsection
(b);
``(2) include all amounts of Federal assistance received by
each entity in the preceding fiscal year;
``(3) review the total unmet needs of each jurisdiction for
health care facilities, including needs for renovation and
expansion of existing facilities;
``(4) include a strategic plan for addressing the needs of
each jurisdiction identified in the report; and
``(5) evaluate the effectiveness of the care provided by
measuring patient outcomes and cost measures.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as necessary to carry out this section.''.
SEC. 412. REMOVING CITIZENSHIP AND IMMIGRATION BARRIERS TO ACCESS TO
AFFORDABLE HEALTH CARE UNDER THE ACA.
(a) In General.--
(1) Premium tax credits.--Section 36B of the Internal
Revenue Code of 1986 is amended--
(A) in subsection (c)(1)(B)--
(i) by amending the subparagraph heading to
read as follows: ``Special rule for certain
individuals ineligible for medicaid due to
status'', and
(ii) in clause (ii), by striking ``lawfully
present in the United States, but'' and
inserting ``who'', and
(B) by striking subsection (e).
(2) Cost-sharing reductions.--Section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071) is amended
by striking subsection (e).
(3) Preexisting condition insurance plan.--Section 1101(d)
of the Patient Protection and Affordable Care Act (42 U.S.C.
18001(d)) is amended by striking paragraph (1) and
redesignating paragraphs (2) and (3) as paragraphs (1) and (2),
respectively.
(4) Basic health program eligibility.--Section
1331(e)(1)(B) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18051(e)(1)(B)) is amended by striking ``lawfully
present in the United States,''.
(5) Restrictions on federal payments.--Section 1412 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18082) is
amended by striking subsection (d).
(6) Requirement to maintain minimum essential coverage.--
Subsection (d) of section 5000A of the Internal Revenue Code of
1986 is amended by striking paragraph (3) and by redesignating
paragraph (4) as paragraph (3).
(b) Conforming Amendment.--
(1) Section 1411(a) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18081(a)) is amended by striking
paragraph (1) and redesignating paragraphs (2), (3), and (4) as
paragraphs (1), (2), and (3), respectively.
(2) Section 1312(f) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18032(f)) is amended--
(A) in the subsection heading, by striking
``employers;'' and all that follows through
``residents''; and
(B) by striking paragraph (3).
SEC. 413. STUDY ON THE UNINSURED.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall--
(1) conduct a study, in accordance with the standards under
section 3101 of the Public Health Service Act (42 U.S.C.
300kk), on the demographic characteristics of the population of
individuals who do not have health insurance coverage; and
(2) predict, based on such study, the demographic
characteristics of the population of individuals who would
remain without health insurance coverage after the end of open
enrollment or any special enrollment period.
(b) Reporting Requirements.--
(1) In general.--Not later than 12 months after the date of
the enactment of this Act, the Secretary shall submit to the
Congress the results of the study under subsection (a)(1) and
the prediction made under subsection (a)(2).
(2) Reporting of demographic characteristics.--The
Secretary shall report the demographic characteristics under
paragraphs (1) and (2) of subsection (a) on the basis of racial
and ethnic group, and shall stratify the reporting on each
racial and ethnic group by other demographic characteristics
that can impact access to health insurance coverage, such as
sexual orientation, gender identity, primary language,
disability status, sex, socioeconomic status, age group, and
citizenship and immigration status, in a manner consistent with
title I of this Act.
SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRITORIES.
(a) Elimination of Funding Limitations for Puerto Rico, the United
States Virgin Islands, Guam, the Commonwealth of the Northern Mariana
Islands, and American Samoa.--
(1) In general.--Section 1108 of the Social Security Act
(42 U.S.C. 1308) is amended--
(A) in subsection (f), in the matter preceding
paragraph (1), by striking ``subsection (g)'' and
inserting ``subsections (g) and (h)'';
(B) in subsection (g)(2), in the matter preceding
subparagraph (A)--
(i) by striking ``Notwithstanding
subsection (f) and subject to and'' and
inserting ``Notwithstanding subsection (f) and
subject to''; and
(ii) by striking ``paragraphs (3) and (5)''
and inserting ``, paragraphs (3) and (5) of
this subsection, and subsection (h)''.
(C) by adding at the end the following new
subsection:
``(h) Sunset of Funding Limitations for Puerto Rico, the United
States Virgin Islands, Guam, the Commonwealth of the Northern Mariana
Islands, and American Samoa.--Subsections (f) and (g) shall not apply
to Puerto Rico, the United States Virgin Islands, Guam, the
Commonwealth of the Northern Mariana Islands, and American Samoa for
any fiscal year after fiscal year 2015.''.
(2) Conforming amendment.--Section 1903(u) of such Act (42
U.S.C. 1396c(u)) is amended by striking paragraph (4).
(3) Effective date.--The amendments made by this subsection
shall apply beginning with fiscal year 2016.
(b) Parity in FMAP.--
(1) In general.--Section 1905(b) of such Act (42 U.S.C.
1396d(b)) is amended by inserting after ``and American Samoa
shall be 55 percent,'' the following: ``(except that, beginning
with fiscal year 2018, the Federal medical assistance
percentage for Puerto Rico, the United States Virgin Islands,
Guam, the Commonwealth of the Northern Mariana Islands, and
American Samoa shall be the Federal medical assistance
percentage determined by the Secretary in consultation (for the
United States Virgin Islands, Guam, the Commonwealth of the
Northern Mariana Islands, and American Samoa) with the
Secretary of the Interior)''.
(2) 2-fiscal-year transition.--Notwithstanding any other
provision of law, during fiscal years 2016 and 2017, the
Federal medical assistance percentage established under section
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) for
Puerto Rico, the United States Virgin Islands, Guam, the
Commonwealth of the Northern Mariana Islands, and American
Samoa shall be the highest such Federal medical assistance
percentage applicable to any of the 50 States or the District
of Columbia for the fiscal year involved.
(3) Per capita income data.--
(A) Report to congress.--Not later than October 1,
2016, the Secretary of Health and Human Services shall
submit to Congress a report that describes the per
capita income data used to promulgate the Federal
medical assistance percentage in the territories and
how such data differ from the per capita income data
used to promulgate Federal medical assistance
percentages for the 50 States and the District of
Columbia. The report should include recommendations on
how the Federal medical assistance percentages can be
calculated for the territories to ensure parity with
the 50 States and the District of Columbia.
(B) Application.--Section 1101(a)(8)(B) of the
Social Security Act (42 U.S.C. 1308(a)(8)(B)) is
amended--
(i) by striking ``(other than Puerto Rico,
the United States Virgin Islands, and Guam)''
and inserting ``(including Puerto Rico, the
United States Virgin Islands, Guam, the
Commonwealth of the Northern Mariana Islands,
and American Samoa)''; and
(ii) by inserting ``(or, if such
satisfactory data are not available in the case
of the United States Virgin Islands, Guam, the
Northern Mariana Islands, or American Samoa,
satisfactory data available from the Department
of the Interior for the same period, or if such
satisfactory data are not available in the case
of Puerto Rico, satisfactory data available
from the government of the Commonwealth of
Puerto Rico for the same period)'' after
``Department of Commerce''.
SEC. 415. EXTENSION OF MEDICARE SECONDARY PAYER.
(a) In General.--Section 1862(b)(1)(C) of the Social Security Act
(42 U.S.C. 1395y(b)(1)(C)) is amended--
(1) in the last sentence, by inserting ``, and before
January 1, 2015'' after ``prior to such date)''; and
(2) by adding at the end the following new sentence:
``Effective for items and services furnished on or after
January 1, 2015 (with respect to periods beginning on or after
the date that is 42 months prior to such date), clauses (i) and
(ii) shall be applied by substituting `42-month' for `12-month'
each place it appears in the first sentence.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act. For purposes of
determining an individual's status under section 1862(b)(1)(C) of the
Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by
subsection (a), an individual who is within the coordinating period as
of the date of enactment of this Act shall have that period extended to
the full 42 months described in the last sentence of such section, as
added by the amendment made by subsection (a)(2).
SEC. 416. 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 of Health and Human Services (in this section referred to
as the ``Secretary''), acting through the United States members of the
United States-Mexico Border Health Commission, shall award grants to
eligible entities to address priorities and recommendations to improve
the health of border area residents that are established by--
(1) the United States members of the United States-Mexico
Border Health Commission;
(2) the State border health offices; and
(3) the Secretary.
(c) Application.--An eligible entity that desires a grant under
subsection (b) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may require.
(d) Use of Funds.--An eligible entity that receives a grant under
subsection (b) shall use the grant funds for--
(1) programs relating to--
(A) maternal and child health;
(B) primary care and preventative health;
(C) public health and public health infrastructure;
(D) musculoskeletal health and obesity;
(E) health education and promotion;
(F) oral health;
(G) mental and behavioral health;
(H) substance abuse;
(I) health conditions that have a high prevalence
in the border area;
(J) medical and health services research;
(K) workforce training and development;
(L) community health workers or promotoras;
(M) health care infrastructure problems in the
border area (including planning and construction
grants);
(N) health disparities in the border area;
(O) environmental health; and
(P) 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 are authorized to be
appropriated to carry out this section, $200,000,000 for fiscal year
2015, and such sums as may be necessary for each succeeding fiscal
year.
SEC. 417. REMOVING MEDICARE BARRIER TO HEALTH CARE.
(a) Part A.--Section 1818(a)(3) of the Social Security Act (42
U.S.C. 1395i-2(a)(3)) is amended by striking ``(B)'' and all that
follows through ``under this section'' and inserting ``(B) an
individual who is lawfully present in the United States''.
(b) Part B.--Section 1836(2) of the Social Security Act (42 U.S.C.
1395o(2)) is amended by striking ``(B)'' and all that follows through
``under this part'' and inserting ``(B) an individual who is lawfully
present in the United States''.
SEC. 418. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED BY URBAN
INDIAN HEALTH CENTERS.
(a) In General.--The third sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396(b)), as amended by section 415(c),
is further amended by inserting ``or are received through a program
operated by an urban Indian organization through a grant or contract
under title V of such Act'' after ``(as defined in section 4 of the
Indian Health Care Improvement Act)''.
(b) Effective Date.--The amendment made by this section shall apply
to medical assistance provided on or after the date of enactment of
this Act.
SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED TO A NATIVE
HAWAIIAN THROUGH A FEDERALLY QUALIFIED HEALTH CENTER OR A
NATIVE HAWAIIAN HEALTH CARE SYSTEM UNDER THE MEDICAID
PROGRAM.
(a) In General.--The third sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), as amended by section 419, is
amended by inserting ``; and, with respect to medical assistance
provided to a Native Hawaiian (as defined in section 12(2) of the
Native Hawaiian Health Care Improvement Act) through a federally
qualified health center or a Native Hawaiian health care system (as
defined in section 12(6) of such Act), whether directly, by referral,
or under contract or other arrangement between such federally qualified
health center or Native Hawaiian health care system and another health
care provider'' before the period.
(b) Effective Date.--The amendment made by this section shall apply
to medical assistance provided on or after the date of enactment of
this Act.
CHAPTER 2--EXPANSION OF ACCESS
SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH.
(a) Purpose.--It is the purpose of this section to provide for the
awarding of grants to assist communities in mobilizing and organizing
resources in support of effective and sustainable programs that will
reduce or eliminate disparities in health and health care experienced
by racial and ethnic minority individuals.
(b) Authority To Award Grants.--The Secretary of Health and Human
Services, acting through the Administrator of the Health Resources and
Services Administration, shall award grants to eligible entities to
assist in designing, implementing, and evaluating culturally and
linguistically appropriate, science-based, and community-driven
sustainable strategies to eliminate racial and ethnic health and health
care disparities.
(c) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall--
(1) represent a coalition--
(A) whose principal purpose is to develop and
implement interventions to reduce or eliminate a health
or health care disparity in a targeted racial or ethnic
minority group in the community served by the
coalition; and
(B) that includes--
(i) members selected from among--
(I) public health departments;
(II) community-based organizations;
(III) university and research
organizations;
(IV) American Indian tribal
organizations, national American Indian
organizations, Indian Health Service,
or organizations serving Alaska
Natives; and
(V) interested public or private
health care providers or organizations
as deemed appropriate by the Secretary;
and
(ii) at least 1 member from a community-
based organization that represents the targeted
racial or ethnic minority group; and
(2) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary
may require, which shall include--
(A) a description of the targeted racial or ethnic
populations in the community to be served under the
grant;
(B) a description of at least 1 health disparity
that exists in the racial or ethnic targeted
populations, including health issues such as infant
mortality, breast and cervical cancer screening and
management, musculoskeletal diseases and obesity,
prostate cancer screening and management,
cardiovascular disease, diabetes, child and adult
immunization levels, or other health priority areas as
designated by the Secretary; and
(C) a demonstration of a proven record of
accomplishment of the coalition members in serving and
working with the targeted community.
(d) Sustainability.--The Secretary shall give priority to an
eligible entity under this section if the entity agrees that, with
respect to the costs to be incurred by the entity in carrying out the
activities for which the grant was awarded, the entity (and each of the
participating partners in the coalition represented by the entity) will
maintain its expenditures of non-Federal funds for such activities at a
level that is not less than the level of such expenditures during the
fiscal year immediately preceding the first fiscal year for which the
grant is awarded.
(e) Nonduplication.--Funds provided through this grant program
should supplement, not supplant, existing Federal funding, and the
funds should not be used to duplicate the activities of the other
health disparity grant programs in this Act.
(f) Technical Assistance.--The Secretary may, either directly or by
grant or contract, provide any entity that receives a grant under this
section with technical and other nonfinancial assistance necessary to
meet the requirements of this section.
(g) Dissemination.--The Secretary shall encourage and enable
grantees to share best practices, evaluation results, and reports with
communities not affiliated with grantees using the Internet,
conferences, and other pertinent information regarding the projects
funded by this section, including the outreach efforts of the Office of
Minority Health and Health Disparity Elimination and the Centers for
Disease Control and Prevention.
(h) Administrative Burdens.--The Secretary shall make every effort
to minimize duplicative or unnecessary administrative burdens on
grantees.
(i) Definition.--In this section, the term ``Secretary'' means the
Secretary of Health and Human Services.
(j) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section.
SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS.
(a) Elimination of Isolation Test for Cost-Based Ambulance
Reimbursement.--
(1) In general.--Section 1834(l)(8) of the Social Security
Act (42 U.S.C. 1395m(l)(8)) is amended--
(A) in subparagraph (B)--
(i) by striking ``owned and''; and
(ii) by inserting ``(including when such
services are provided by the entity under an
arrangement with the hospital)'' after
``hospital''; and
(B) by striking the comma at the end of
subparagraph (B) and all that follows and inserting a
period.
(2) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after January 1, 2015.
(b) Provision of a More Flexible Alternative to the CAH Designation
25 Inpatient Bed Limit Requirement.--
(1) In general.--Section 1820(c)(2) of the Social Security
Act (42 U.S.C. 1395i-4(c)(2)) is amended--
(A) in subparagraph (B)(iii), by striking
``provides not more than'' and inserting ``subject to
subparagraph (F), provides not more than''; and
(B) by adding at the end the following new
subparagraph:
``(F) Alternative to 25 inpatient bed limit
requirement.--
``(i) In general.--A State may elect to
treat a facility, with respect to the
designation of the facility for a cost-
reporting period, as satisfying the requirement
of subparagraph (B)(iii) relating to a maximum
number of acute care inpatient beds if the
facility elects, in accordance with a method
specified by the Secretary and before the
beginning of the cost reporting period, to meet
the requirement under clause (ii).
``(ii) Alternate requirement.--The
requirement under this clause, with respect to
a facility and a cost-reporting period, is that
the total number of inpatient bed days
described in subparagraph (B)(iii) during such
period will not exceed 7,300. For purposes of
this subparagraph, an individual who is an
inpatient in a bed in the facility for a single
day shall be counted as one inpatient bed day.
``(iii) Withdrawal of election.--The option
described in clause (i) shall not apply to a
facility for a cost-reporting period if the
facility (for any two consecutive cost-
reporting periods during the previous 5 cost-
reporting periods) was treated under such
option and had a total number of inpatient bed
days for each of such two cost-reporting
periods that exceeded the number specified in
such clause.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to cost-reporting periods beginning on or after the
date of the enactment of this Act.
SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL (RCH) PROGRAM.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x), as amended by section 203(b)(1), is amended by adding at the
end of the following new subsection:
``Rural Community Hospital; Rural Community Hospital Services
``(jjj)(1) The term `rural community hospital' means a hospital (as
defined in subsection (e)) that--
``(A) is located in a rural area (as defined in section
1886(d)(2)(D)) or treated as being so located pursuant to
section 1886(d)(8)(E);
``(B) subject to paragraph (2), has less than 51 acute care
inpatient beds, as reported in its most recent cost report;
``(C) makes available 24-hour emergency care services;
``(D) subject to paragraph (3), has a provider agreement in
effect with the Secretary and is open to the public as of
January 1, 2010; and
``(E) applies to the Secretary for such designation.
``(2) For purposes of paragraph (1)(B), beds in a psychiatric or
rehabilitation unit of the hospital which is a distinct part of the
hospital shall not be counted.
``(3) Paragraph (1)(D) shall not be construed to prohibit any of
the following from qualifying as a rural community hospital:
``(A) A replacement facility (as defined by the Secretary
in regulations in effect on January 1, 2012) with the same
service area (as defined by the Secretary in regulations in
effect on such date).
``(B) A facility obtaining a new provider number pursuant
to a change of ownership.
``(C) A facility which has a binding written agreement with
an outside, unrelated party for the construction,
reconstruction, lease, rental, or financing of a building as of
January 1, 2012.
``(4) Nothing in this subsection shall be construed as prohibiting
a critical access hospital from qualifying as a rural community
hospital if the critical access hospital meets the conditions otherwise
applicable to hospitals under subsection (e) and section 1866.
``(5) Nothing in this subsection shall be construed as prohibiting
a rural community hospital participating in the demonstration program
under section 410A of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2313) from
qualifying as a rural community hospital if the rural community
hospital meets the conditions otherwise applicable to hospitals under
subsection (e) and section 1866.''.
(b) Payment.--
(1) Inpatient hospital services.--Section 1814 of the
Social Security Act (42 U.S.C. 1395f) is amended by adding at
the end the following new subsection:
``Payment for Inpatient Services Furnished in Rural Community Hospitals
``(m) The amount of payment under this part for inpatient hospital
services furnished in a rural community hospital, other than such
services furnished in a psychiatric or rehabilitation unit of the
hospital which is a distinct part, is, at the election of the hospital
in the application referred to in section 1861(jjj)(1)(E)--
``(1) 101 percent of the reasonable costs of providing such
services, without regard to the amount of the customary or
other charge, or
``(2) the amount of payment provided for under the
prospective payment system for inpatient hospital services
under section 1886(d).''.
(2) Outpatient services.--Section 1834 of such Act (42
U.S.C. 1395m) is amended by adding at the end the following new
subsection:
``(p) Payment for Outpatient Services Furnished in Rural Community
Hospitals.--The amount of payment under this part for outpatient
services furnished in a rural community hospital is, at the election of
the hospital in the application referred to in section
1861(jjj)(1)(E)--
``(1) 101 percent of the reasonable costs of providing such
services, without regard to the amount of the customary or
other charge and any limitation under section 1861(v)(1)(U), or
``(2) the amount of payment provided for under the
prospective payment system for covered OPD services under
section 1833(t).''.
(3) Exemption from 30-percent reduction in reimbursement
for bad debt.--Section 1861(v)(1)(T) of such Act (42 U.S.C.
1395x(v)(1)(T)) is amended by inserting ``(other than for a
rural community hospital)'' after ``In determining such
reasonable costs for hospitals''.
(c) Beneficiary Cost-Sharing for Outpatient Services.--Section
1834(p) of such Act (as added by subsection (b)(2)) is amended--
(1) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively;
(2) by inserting ``(1)'' after ``(p)''; and
(3) by adding at the end the following:
``(2) The amounts of beneficiary cost-sharing for outpatient
services furnished in a rural community hospital under this part shall
be as follows:
``(A) For items and services that would have been paid
under section 1833(t) if provided by a hospital, the amount of
cost-sharing determined under paragraph (8) of such section.
``(B) For items and services that would have been paid
under section 1833(h) if furnished by a provider or supplier,
no cost-sharing shall apply.
``(C) For all other items and services, the amount of cost-
sharing that would apply to the item or service under the
methodology that would be used to determine payment for such
item or service if provided by a physician, provider, or
supplier, as the case may be.''.
(d) Conforming Amendments.--
(1) Part a payment.--Section 1814(b) of such Act (42 U.S.C.
1395f(b)) is amended in the matter preceding paragraph (1) by
inserting ``other than inpatient hospital services furnished by
a rural community hospital,'' after ``critical access hospital
services,''.
(2) Part b payment.--Section 1833(a) of such Act (42 U.S.C.
1395l(a)), as amended by section 203(b)(2), is amended--
(A) in paragraph (2), in the matter before
subparagraph (A), by striking ``and (I)'' and inserting
``(I), and (K)'';
(B) by striking ``and'' at the end of paragraph
(9);
(C) by striking the period at the end of paragraph
(10) and inserting ``; and''; and
(D) by adding at the end the following:
``(11) in the case of outpatient services furnished by a
rural community hospital, the amounts described in section
1834(p).''.
(3) Technical amendments.--
(A) Consultation with state agencies.--Section 1863
of such Act (42 U.S.C. 1395z) is amended by striking
``and (dd)(2)'' and inserting ``(dd)(2), (mm)(1), and
(jjj)(1)''.
(B) Provider agreements.--Section 1866(a)(2)(A) of
such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by
inserting ``section 1834(p)(2),'' after ``section
1833(b),''.
(e) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after October 1, 2014.
SEC. 424. MEDICARE REMOTE MONITORING PILOT PROJECTS.
(a) Pilot Projects.--
(1) In general.--Not later than 9 months after the date of
enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall conduct pilot projects under title XVIII of the Social
Security Act for the purpose of providing incentives to home
health agencies to utilize home monitoring and communications
technologies that--
(A) enhance health outcomes for Medicare
beneficiaries; and
(B) reduce expenditures under such title.
(2) Site requirements.--
(A) Urban and rural.--The Secretary shall conduct
the pilot projects under this section in both urban and
rural areas.
(B) Site in a small state.--The Secretary shall
conduct at least 3 of the pilot projects in a State
with a population of less than 1,000,000.
(3) Definition of home health agency.--In this section, the
term ``home health agency'' has the meaning given that term in
section 1861(o) of the Social Security Act (42 U.S.C.
1395x(o)).
(b) Medicare Beneficiaries Within the Scope of Projects.--The
Secretary shall specify the criteria for identifying those Medicare
beneficiaries who shall be considered within the scope of the pilot
projects under this section for purposes of the application of
subsection (c) and for the assessment of the effectiveness of the home
health agency in achieving the objectives of this section. Such
criteria may provide for the inclusion in the projects of Medicare
beneficiaries who begin receiving home health services under title
XVIII of the Social Security Act after the date of the implementation
of the projects.
(c) Incentives.--
(1) Performance targets.--The Secretary shall establish for
each home health agency participating in a pilot project under
this section a performance target using one of the following
methodologies, as determined appropriate by the Secretary:
(A) Adjusted historical performance target.--The
Secretary shall establish for the agency--
(i) a base expenditure amount equal to the
average total payments made to the agency under
parts A and B of title XVIII of the Social
Security Act for Medicare beneficiaries
determined to be within the scope of the pilot
project in a base period determined by the
Secretary; and
(ii) an annual per capita expenditure
target for such beneficiaries, reflecting the
base expenditure amount adjusted for risk and
adjusted growth rates.
(B) Comparative performance target.--The Secretary
shall establish for the agency a comparative
performance target equal to the average total payments
under such parts A and B during the pilot project for
comparable individuals in the same geographic area that
are not determined to be within the scope of the pilot
project.
(2) Incentive.--Subject to paragraph (3), the Secretary
shall pay to each participating home care agency an incentive
payment for each year under the pilot project equal to a
portion of the Medicare savings realized for such year relative
to the performance target under paragraph (1).
(3) Limitation on expenditures.--The Secretary shall limit
incentive payments under this section in order to ensure that
the aggregate expenditures under title XVIII of the Social
Security Act (including incentive payments under this
subsection) do not exceed the amount that the Secretary
estimates would have been expended if the pilot projects under
this section had not been implemented.
(d) Waiver Authority.--The Secretary may waive such provisions of
titles XI and XVIII of the Social Security Act as the Secretary
determines to be appropriate for the conduct of the pilot projects
under this section.
(e) Report to Congress.--Not later than 5 years after the date that
the first pilot project under this section is implemented, the
Secretary shall submit to Congress a report on the pilot projects. Such
report shall contain a detailed description of issues related to the
expansion of the projects under subsection (f) and recommendations for
such legislation and administrative actions as the Secretary considers
appropriate.
(f) Expansion.--If the Secretary determines that any of the pilot
projects under this section enhance health outcomes for Medicare
beneficiaries and reduce expenditures under title XVIII of the Social
Security Act, the Secretary may initiate comparable projects in
additional areas.
(g) Incentive Payments Have No Effect on Other Medicare Payments to
Agencies.--An incentive payment under this section--
(1) shall be in addition to the payments that a home health
agency would otherwise receive under title XVIII of the Social
Security Act for the provision of home health services; and
(2) shall have no effect on the amount of such payments.
SEC. 425. RURAL HEALTH QUALITY ADVISORY COMMISSION AND DEMONSTRATION
PROJECTS.
(a) Rural Health Quality Advisory Commission.--
(1) Establishment.--Not later than 6 months after the date
of the enactment of this section, the Secretary of Health and
Human Services (in this section referred to as the
``Secretary'') shall establish a commission to be known as the
Rural Health Quality Advisory Commission (in this section
referred to as the ``Commission'').
(2) Duties of commission.--
(A) National plan.--The Commission shall develop,
coordinate, and facilitate implementation of a national
plan for rural health quality improvement. The national
plan shall--
(i) identify objectives for rural health
quality improvement;
(ii) identify strategies to eliminate known
gaps in rural health system capacity and
improve rural health quality; and
(iii) provide for Federal programs to
identify opportunities for strengthening and
aligning policies and programs to improve rural
health quality.
(B) Demonstration projects.--The Commission shall
design demonstration projects to test alternative
models for rural health quality improvement, including
with respect to both personal and population health.
(C) Monitoring.--The Commission shall monitor
progress toward the objectives identified pursuant to
paragraph (1)(A).
(3) Membership.--
(A) Number.--The Commission shall be composed of 11
members appointed by the Secretary.
(B) Selection.--The Secretary shall select the
members of the Commission from among individuals with
significant rural health care and health care quality
expertise, including expertise in clinical health care,
health care quality research, population or public
health, or purchaser organizations.
(4) Contracting authority.--Subject to the availability of
funds, the Commission may enter into contracts and make other
arrangements, as may be necessary to carry out the duties
described in paragraph (2).
(5) Staff.--Upon the request of the Commission, the
Secretary may detail, on a reimbursable basis, any of the
personnel of the Office of Rural Health Policy of the Health
Resources and Services Administration, the Agency for
Healthcare Quality and Research, or the Centers for Medicare &
Medicaid Services to the Commission to assist in carrying out
this subsection.
(6) Reports to congress.--Not later than 1 year after the
establishment of the Commission, and annually thereafter, the
Commission shall submit a report to the Congress on rural
health quality. Each such report shall include the following:
(A) An inventory of relevant programs and
recommendations for improved coordination and
integration of policy and programs.
(B) An assessment of achievement of the objectives
identified in the national plan developed under
paragraph (2) and recommendations for realizing such
objectives.
(C) Recommendations on Federal legislation,
regulations, or administrative policies to enhance
rural health quality and outcomes.
(b) Rural Health Quality Demonstration Projects.--
(1) In general.--Not later than 270 days after the date of
the enactment of this section, the Secretary, in consultation
with the Rural Health Quality Advisory Commission, the Office
of Rural Health Policy of the Health Resources and Services
Administration, the Agency for Healthcare Research and Quality,
and the Centers for Medicare & Medicaid Services, shall make
grants to eligible entities for 5 demonstration projects to
implement and evaluate methods for improving the quality of
health care in rural communities. Each such demonstration
project shall include--
(A) alternative community models that--
(i) will achieve greater integration of
personal and population health services; and
(ii) address safety, effectiveness,
patient- or community-centeredness, timeliness,
efficiency, and equity (the 6 aims identified
by the Institute of Medicine of the National
Academies in its report entitled ``Crossing the
Quality Chasm: A New Health System for the 21st
Century'' released on March 1, 2001);
(B) innovative approaches to the financing and
delivery of health services to achieve rural health
quality goals; and
(C) development of quality improvement support
structures to assist rural health systems and
professionals (such as workforce support structures,
quality monitoring and reporting, clinical care
protocols, and information technology applications).
(2) Eligible entities.--In this subsection, the term
``eligible entity'' means a consortium that--
(A) shall include--
(i) at least one health care provider or
health care delivery system located in a rural
area; and
(ii) at least one organization representing
multiple community stakeholders; and
(B) may include other partners such as rural
research centers.
(3) Consultation.--In developing the program for awarding
grants under this subsection, the Secretary shall consult with
the Administrator of the Agency for Healthcare Research and
Quality, rural health care providers, rural health care
researchers, and private and nonprofit groups (including
national associations) which are undertaking similar efforts.
(4) Expedited waivers.--The Secretary shall expedite the
processing of any waiver that--
(A) is authorized under title XVIII or XIX of the
Social Security Act (42 U.S.C. 1395 et seq.); and
(B) is necessary to carry out a demonstration
project under this subsection.
(5) Demonstration project sites.--The Secretary shall
ensure that the 5 demonstration projects funded under this
subsection are conducted at a variety of sites representing the
diversity of rural communities in the Nation.
(6) Duration.--Each demonstration project under this
subsection shall be for a period of 4 years.
(7) Independent evaluation.--The Secretary shall enter into
an arrangement with an entity that has experience working
directly with rural health systems for the conduct of an
independent evaluation of the program carried out under this
subsection.
(8) Report.--Not later than 1 year after the conclusion of
all of the demonstration projects funded under this subsection,
the Secretary shall submit a report to the Congress on the
results of such projects. The report shall include--
(A) an evaluation of patient access to care,
patient outcomes, and an analysis of the cost
effectiveness of each such project; and
(B) recommendations on Federal legislation,
regulations, or administrative policies to enhance
rural health quality and outcomes.
(c) Appropriation.--
(1) In general.--Out of funds in the Treasury not otherwise
appropriated, there are appropriated to the Secretary to carry
out this section $30,000,000 for the period of fiscal years
2015 through 2019.
(2) Availability.--
(A) In general.--Funds appropriated under paragraph
(1) shall remain available for expenditure through
fiscal year 2019.
(B) Report.--For purposes of carrying out
subsection (b)(8), funds appropriated under paragraph
(1) shall remain available for expenditure through
fiscal year 2020.
(3) Reservation.--Of the amount appropriated under
paragraph (1), the Secretary shall reserve--
(A) $5,000,000 to carry out subsection (a); and
(B) $25,000,000 to carry out subsection (b), of
which--
(i) 2 percent shall be for the provision of
technical assistance to grant recipients; and
(ii) 5 percent shall be for independent
evaluation under subsection (b)(7).
SEC. 426. RURAL HEALTH CARE SERVICES.
Section 330A of the Public Health Service Act (42 U.S.C. 254c) is
amended to read as follows:
``SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK
DEVELOPMENT, DELTA RURAL DISPARITIES AND HEALTH SYSTEMS
DEVELOPMENT, AND SMALL RURAL HEALTH CARE PROVIDER QUALITY
IMPROVEMENT GRANT PROGRAMS.
``(a) Purpose.--The purpose of this section is to provide for
grants--
``(1) under subsection (b), to promote rural health care
services outreach;
``(2) under subsection (c), to provide for the planning and
implementation of integrated health care networks in rural
areas;
``(3) under subsection (d), to assist rural communities in
the Delta Region to reduce health disparities and to promote
and enhance health system development; and
``(4) under subsection (e), to provide for the planning and
implementation of small rural health care provider quality
improvement activities.
``(b) Rural Health Care Services Outreach Grants.--
``(1) Grants.--The Director of the Office of Rural Health
Policy of the Health Resources and Services Administration may
award grants to eligible entities to promote rural health care
services outreach by expanding the delivery of health care
services to include new and enhanced services in rural areas.
The Director may award the grants for periods of not more than
3 years.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection for a project, an entity--
``(A) shall be a rural public or rural nonprofit
private entity, a facility that qualifies as a rural
health clinic under title XVIII of the Social Security
Act, a public or nonprofit entity existing exclusively
to provide services to migrant and seasonal farm
workers in rural areas, or a tribal government whose
grant-funded activities will be conducted within
federally recognized tribal areas;
``(B) shall represent a consortium composed of
members--
``(i) that include 3 or more independently
owned health care entities; and
``(ii) that may be nonprofit or for-profit
entities; and
``(C) shall not previously have received a grant
under this subsection for the same or a similar
project, unless the entity is proposing to expand the
scope of the project or the area that will be served
through the project.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity shall prepare and
submit to the Director an application at such time, in such
manner, and containing such information as the Director may
require, including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) a description of the manner in which the
project funded under the grant will meet the health
care needs of rural populations in the local community
or region to be served;
``(C) a plan for quantifying how health care needs
will be met through identification of the target
population and benchmarks of service delivery or health
status, such as--
``(i) quantifiable measurements of health
status improvement for projects focusing on
health promotion; or
``(ii) benchmarks of increased access to
primary care, including tracking factors such
as the number and type of primary care visits,
identification of a medical home, or other
general measures of such access;
``(D) a description of how the local community or
region to be served will be involved in the development
and ongoing operations of the project;
``(E) a plan for sustaining the project after
Federal support for the project has ended;
``(F) a description of how the project will be
evaluated;
``(G) the administrative capacity to submit annual
performance data electronically as specified by the
Director; and
``(H) other such information as the Director
determines to be appropriate.
``(c) Rural Health Network Development Grants.--
``(1) Grants.--
``(A) In general.--The Director may award rural
health network development grants to eligible entities
to promote, through planning and implementation, the
development of integrated health care networks that
have combined the functions of the entities
participating in the networks in order to--
``(i) achieve efficiencies and economies of
scale;
``(ii) expand access to, coordinate, and
improve the quality of the health care delivery
system through development of organizational
efficiencies;
``(iii) implement health information
technology to achieve efficiencies, reduce
medical errors, and improve quality;
``(iv) coordinate care and manage chronic
illness; and
``(v) strengthen the rural health care
system as a whole in such a manner as to show a
quantifiable return on investment to the
participants in the network.
``(B) Grant periods.--The Director may award such a
rural health network development grant--
``(i) for a period of 3 years for
implementation activities; or
``(ii) for a period of 1 year for planning
activities to assist in the initial development
of an integrated health care network, if the
proposed participants in the network do not
have a history of collaborative efforts and a
3-year grant would be inappropriate.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection, an entity--
``(A) shall be a rural public or rural nonprofit
private entity, a facility that qualifies as a rural
health clinic under title XVIII of the Social Security
Act, a public or nonprofit entity existing exclusively
to provide services to migrant and seasonal farm
workers in rural areas, or a tribal government whose
grant-funded activities will be conducted within
federally recognized tribal areas;
``(B) shall represent a network composed of
participants--
``(i) that include 3 or more independently
owned health care entities; and
``(ii) that may be nonprofit or for-profit
entities; and
``(C) shall not previously have received a grant
under this subsection (other than a 1-year grant for
planning activities) for the same or a similar project.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity, in consultation with
the appropriate State office of rural health or another
appropriate State entity, shall prepare and submit to the
Director an application at such time, in such manner, and
containing such information as the Director may require,
including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of--
``(i) the history of collaborative
activities carried out by the participants in
the network;
``(ii) the degree to which the participants
are ready to integrate their functions; and
``(iii) how the local community or region
to be served will benefit from and be involved
in the activities carried out by the network;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services across the continuum of
care as a result of the integration activities carried
out by the network, including a description of--
``(i) return on investment for the
community and the network members; and
``(ii) other quantifiable performance
measures that show the benefit of the network
activities;
``(E) a plan for sustaining the project after
Federal support for the project has ended;
``(F) a description of how the project will be
evaluated;
``(G) the administrative capacity to submit annual
performance data electronically as specified by the
Director; and
``(H) other such information as the Director
determines to be appropriate.
``(d) Delta Rural Disparities and Health Systems Development
Grants.--
``(1) Grants.--The Director may award grants to eligible
entities to support reduction of health disparities, improve
access to health care, and enhance rural health system
development in the Delta Region.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection, an entity shall be a rural public or rural
nonprofit private entity, a facility that qualifies as a rural
health clinic under title XVIII of the Social Security Act, a
public or nonprofit entity existing exclusively to provide
services to migrant and seasonal farm workers in rural areas,
or a tribal government whose grant-funded activities will be
conducted within federally recognized tribal areas.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity shall prepare and
submit to the Director an application at such time, in such
manner, and containing such information as the Director may
require, including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of the manner in which the
project funded under the grant will meet the health
care needs of the Delta Region;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services as a result of the
activities carried out by the entity;
``(E) a description of how health disparities will
be reduced or the health system will be improved;
``(F) a plan for sustaining the project after
Federal support for the project has ended;
``(G) a description of how the project will be
evaluated including process and outcome measures
related to the quality of care provided or how the
health care system improves its performance;
``(H) a description of how the grantee will develop
an advisory group made up of representatives of the
communities to be served to provide guidance to the
grantee to best meet community need; and
``(I) other such information as the Director
determines to be appropriate.
``(e) Small Rural Health Care Provider Quality Improvement
Grants.--
``(1) Grants.--The Director may award grants to provide for
the planning and implementation of small rural health care
provider quality improvement activities. The Director may award
the grants for periods of 1 to 3 years.
``(2) Eligibility.--To be eligible for a grant under this
subsection, an entity--
``(A) shall be--
``(i) a rural public or rural nonprofit
private health care provider or provider of
health care services, such as a rural health
clinic; or
``(ii) another rural provider or network of
small rural providers identified by the
Director as a key source of local care; and
``(B) shall not previously have received a grant
under this subsection for the same or a similar
project.
``(3) Preference.--In awarding grants under this
subsection, the Director shall give preference to facilities
that qualify as rural health clinics under title XVIII of the
Social Security Act.
``(4) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity shall prepare and
submit to the Director an application at such time, in such
manner, and containing such information as the Director may
require, including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of the manner in which the
project funded under the grant will assure continuous
quality improvement in the provision of services by the
entity;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services as a result of the
activities carried out by the entity;
``(E) a plan for sustaining the project after
Federal support for the project has ended;
``(F) a description of how the project will be
evaluated including process and outcome measures
related to the quality of care provided; and
``(G) other such information as the Director
determines to be appropriate.
``(f) General Requirements.--
``(1) Prohibited uses of funds.--An entity that receives a
grant under this section may not use funds provided through the
grant--
``(A) to build or acquire real property; or
``(B) for construction.
``(2) Coordination with other agencies.--The Director shall
coordinate activities carried out under grant programs
described in this section, to the extent practicable, with
Federal and State agencies and nonprofit organizations that are
operating similar grant programs, to maximize the effect of
public dollars in funding meritorious proposals.
``(g) Report.--Not later than September 30, 2016, the Secretary
shall prepare and submit to the appropriate committees of Congress a
report on the progress and accomplishments of the grant programs
described in subsections (b), (c), (d), and (e).
``(h) Definitions.--In this section:
``(1) The term `Delta Region' has the meaning given to the
term `region' in section 382A of the Consolidated Farm and
Rural Development Act (7 U.S.C. 2009aa).
``(2) The term `Director' means the Director of the Office
of Rural Health Policy of the Health Resources and Services
Administration.
``(i) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $40,000,000 for fiscal year
2015, and such sums as may be necessary for each of fiscal years 2016
through 2019.''.
SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE ACCESS EXPANSION.
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is
amended by adding at the end the following:
``(t) Miscellaneous Provisions.--
``(1) Rule of construction with respect to rural health
clinics.--Nothing in this section shall be construed to prevent
a community health center from contracting with a federally
certified rural health clinic (as defined by section
1861(aa)(2) of the Social Security Act) for the delivery of
primary health care and other mental, dental, and physical
health services that are available at the rural health clinic
to individuals who would otherwise be eligible for free or
reduced cost care if that individual were able to obtain that
care at the community health center. Such services may be
limited in scope to those primary health care and other mental,
dental, and physical health services available in that rural
health clinic.
``(2) Enabling services.--To the extent possible, enabling
services such as transportation and translation assistance
shall be provided by rural health clinics described in
paragraph (1).
``(3) Assurances.--In order for a rural health clinic to
receive funds under this section through a contract with a
community health center for the delivery of primary health care
and other services described in paragraph (1), such rural
health clinic shall establish policies to ensure--
``(A) nondiscrimination based upon the ability of a
patient to pay;
``(B) the establishment of a sliding fee scale for
low-income patients; and
``(C) any such services should be subject to full
reimbursement according to the Prospective Payment
System scale.''.
SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS
STATE LINES.
(a) In General.--For purposes of expediting the provision of
telehealth services, for which payment is made under the Medicare
Program, across State lines, the Secretary of Health and Human Services
shall, in consultation with representatives of States, physicians,
health care practitioners, and patient advocates, encourage and
facilitate the adoption of provisions allowing for multistate
practitioner practice across State lines.
(b) Definitions.--In subsection (a):
(1) Telehealth service.--The term ``telehealth service''
has the meaning given that term in subparagraph (F) of section
1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
(2) Physician, practitioner.--The terms ``physician'' and
``practitioner'' have the meaning given those terms in
subparagraphs (D) and (E), respectively, of such section.
(3) Medicare program.--The term ``Medicare Program'' means
the program of health insurance administered by the Secretary
of Health and Human Services under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS.
Section 202 of the Congressional Budget and Impoundment Control Act
of 1974 (2 U.S.C. 602) is amended by adding at the end the following
new subsection:
``(h) Scoring of Preventive Health Savings.--
``(1) Determination by the director.--Upon a request by the
chairman or ranking minority member of the Committee on the
Budget of the Senate, or by the chairman or ranking minority
member of the Committee on the Budget of the House of
Representatives, the Director shall determine if a proposed
measure would result in reductions in budget outlays in
budgetary outyears through the use of preventive health and
preventive health services.
``(2) Projections.--If the Director determines that a
measure would result in substantial reductions in budget
outlays as described in paragraph (1), the Director--
``(A) shall include, in any projection prepared by
the Director, a description and estimate of the
reductions in budget outlays in the budgetary outyears
and a description of the basis for such conclusions;
and
``(B) may prepare a budget projection that includes
some or all of the budgetary outyears, notwithstanding
the time periods for projections described in
subsection (e) and sections 308, 402, and 424.
``(3) Definitions.--As used in this subsection--
``(A) the term `preventive health' means an action
that focuses on the health of the public, individuals,
and defined populations in order to protect, promote,
and maintain health, wellness, and functional ability,
and prevent disease, disability, and premature death
that is demonstrated by credible and publicly available
epidemiological projection models, incorporating
clinical trials or observational studies in humans, to
avoid future health care costs; and
``(B) the term `budgetary outyears' means the 2
consecutive 10-year periods beginning with the first
fiscal year that is 10 years after the budget year
provided for in the most recently agreed to concurrent
resolution on the budget.''.
SEC. 430. SENSE OF CONGRESS.
It is the sense of the Congress that--
(1) the maintenance of effort provisions added to sections
1902 and 2105(d) of the Social Security Act by sections 2001(b)
and 2101(b) of the Patient Protection and Affordable Care Act
were written to maintain the eligibility standards for the
Medicaid program under title XIX of the Social Security Act and
Children's Health Insurance Program under title XXI of such Act
until the American Health Benefit Exchanges in the States are
fully operational;
(2) it is imperative that the maintenance of effort
provisions are enforced to the strict standard intended by the
Congress;
(3) waiving the maintenance of effort provisions should not
be permitted, except in the case of a request for a waiver that
meets the explicit nonapplication requirements;
(4) the maintenance of effort provisions ensure the
continued success of the Medicaid program and Children's Health
Insurance Program and were written deliberately to specifically
protect vulnerable and disabled individuals, children, and
senior citizens, many of whom are also members of communities
of color; and
(5) the maintenance of effort provisions must be strictly
enforced and proposals to weaken the maintenance of effort
provisions must not be considered.
SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTATION EVIDENCING
CITIZENSHIP OR NATIONALITY UNDER THE MEDICAID PROGRAM.
(a) Repeal.--Subsections (i)(22) and (x) of section 1903 of the
Social Security Act (42 U.S.C. 1396b) are each repealed.
(b) Conforming Amendments.--
(1) Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(A) by amending paragraph (46) of subsection (a) to
read as follows:
``(46) provide that information is requested and exchanged
for purposes of income and eligibility verification in
accordance with a State system which meets the requirements of
section 1137 of this Act;'';
(B) in subsection (e)(13)(A)(i)--
(i) in the matter preceding subclause (I),
by striking ``sections 1902(a)(46)(B) and
1137(d)'' and inserting ``section 1137(d)'';
and
(ii) in subclause (IV), by striking
``1902(a)(46)(B) or''; and
(C) by striking subsection (ee).
(2) Section 1903 of the Social Security Act (42 U.S.C.
1396b) is amended--
(A) in subsection (i), by redesignating paragraphs
(23) through (26) as paragraphs (22) through (25),
respectively; and
(B) by redesignating subsections (y) and (z) as
subsections (x) and (y), respectively.
(3) Subsection (c) of section 6036 of the Deficit Reduction
Act of 2005 (42 U.S.C. 1396b note) is repealed.
(c) Effective Date.--The repeals and amendments made by this
section shall take effect as if included in the enactment of the
Deficit Reduction Act of 2005.
SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS HEALTH ADMINISTRATION
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Establishment and Functions.--Subchapter I of chapter 73 of
title 38, United States Code, is amended by adding at the end the
following new section:
``Sec. 7310. Office of Minority Health
``(a) Establishment.--There is established in the Department within
the Office of the Under Secretary for Health an office to be known as
the `Office of Minority Health' (in this section referred to as the
`Office').
``(b) Head.--The Director of the Office of Minority Health shall be
the head of the Office. The Director of the Office of Minority Health
shall be appointed by the Under Secretary of Health from among
individuals qualified to perform the duties of the position.
``(c) Functions.--The functions of the Office are as follows:
``(1) To establish short-range and long-range goals and
objectives and coordinate all other activities within the
Veterans Health Administration that relate to disease
prevention, health promotion, health care services delivery,
and health care research concerning veterans who are members of
a racial or ethnic minority group.
``(2) To support research, demonstrations, and evaluations
to test new and innovative models for the discharge of
activities described in paragraph (1).
``(3) To increase knowledge and understanding of health
risk factors for veterans who are members of a racial or ethnic
minority group.
``(4) To develop mechanisms that support better health care
information dissemination, education, prevention, and services
delivery to veterans from disadvantaged backgrounds, including
veterans who are members of a racial or ethnic minority group.
``(5) To enter into contracts or agreements with
appropriate public and nonprofit private entities to develop
and carry out programs to provide bilingual or interpretive
services to assist veterans who are members of a racial or
ethnic minority group and who lack proficiency in speaking the
English language in accessing and receiving health care
services through the Veterans Health Administration.
``(6) To carry out programs to improve access to health
care services through the Veterans Health Administration for
veterans with limited proficiency in speaking the English
language, including the development and evaluation of
demonstration and pilot projects for that purpose.
``(7) To advise the Under Secretary of Health on matters
relating to the development, implementation, and evaluation of
health professions education in decreasing disparities in
health care outcomes between veterans who are members of a
racial or ethnic minority group and other veterans, including
cultural competency as a method of eliminating such health
disparities.
``(8) To perform such other functions and duties as the
Secretary or the Under Secretary for Health considers
appropriate.
``(d) Definitions.--In this section:
``(1) The term `racial or ethnic minority group' means the
following:
``(A) American Indians (including Alaska Natives,
Eskimos, and Aleuts).
``(B) Asian-Americans.
``(C) Native Hawaiians and other Pacific Islanders.
``(D) Blacks.
``(E) Hispanics.
``(2) The term `Hispanic' means individuals whose origin is
Mexican, Puerto Rican, Cuban, Central or South American, or any
other Spanish-speaking country.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7309 the following new item:
``7310. Office of Minority Health.''.
SEC. 433. INDIAN DEFINED IN PPACA.
(a) Definition of Indian.--Section 1304 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the
end the following:
``(f) Indian.--
``(1) In general.--In this title, the term `Indian' means
any individual--
``(A) described in paragraph (13) or (28) of
section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603);
``(B) who is eligible for health services provided
by the Indian Health Service under section 809 of the
Indian Health Care Improvement Act (25 U.S.C. 1679);
``(C) who is of Indian descent and belongs to the
Indian community served by the local facilities and
program of the Indian Health Service; or
``(D) who is described in paragraph (2).
``(2) Included individuals.--The following individuals
shall be considered to be an `Indian':
``(A) A member of a federally recognized Indian
tribe.
``(B) A resident of an urban center who meets 1 or
more of the following 4 criteria:
``(i) Membership in a tribe, band, or other
organized group of Indians, including those
tribes, bands, or groups terminated since 1940
and those recognized as of the date of
enactment of the Health Equity and
Accountability Act of 2014 or later by the
State in which they reside, or being a
descendant, in the first or second degree, of
any such member.
``(ii) Is an Eskimo or Aleut or other
Alaska Native.
``(iii) Is considered by the Secretary of
the Interior to be an Indian for any purpose.
``(iv) Is determined to be an Indian under
regulations promulgated by the Secretary.
``(C) An individual who is considered by the
Secretary of the Interior to be an Indian for any
purpose.
``(D) An individual who is considered by the
Secretary to be an Indian for purposes of eligibility
for Indian health care services, including as a
California Indian, Eskimo, Aleut, or other Alaska
Native.''.
(b) Conforming Amendments.--
(1) Affordable choices health benefit plans.--Section
1311(c)(6)(D) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031(c)(6)(D)) is amended by striking ``section 4
of the Indian Health Care Improvement Act'' and inserting
``section 1304(f)''.
(2) Reduced cost-sharing for individuals enrolling in
qualified health plans.--Section 1402(d) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071(d)) is
amended--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by striking ``section 4(d) of the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450b(d))'' and inserting ``section
1304(f)''; and
(B) in paragraph (2), in the matter preceding
subparagraph (A), by striking ``(as so defined)'' and
inserting ``(as defined in section 1304(f))''.
(3) Exemption from penalty for not maintaining minimum
essential coverage.--Section 5000A(e) of the Internal Revenue
Code of 1986 is amended by striking paragraph (3) and inserting
the following:
``(3) Indians.--Any applicable individual who is an Indian
(as defined in section 1304(f) of the Patient Protection and
Affordable Care Act).''.
SEC. 434. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL ACCESS FOR LOW-
INCOME PATIENTS.
(a) In General.--Not later than January 1, 2016, the Comptroller
General of the United States shall conduct a study on how certain
amendments made by the Patient Protection and Affordable Care Act
(Public Law 111-148) to titles XVIII and XIX of the Social Security Act
affect the timely access to health care services for low-income
patients. Such study shall--
(1) evaluate and examine whether States electing to make
medical assistance available under section
1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(i)(VIII)) (including States making such an
election through a waiver of the State plan) to individuals
described in such section mitigates the need for payments to
disproportionate share hospitals under section 1886(d)(5)(F) of
the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section
1923 of such Act (42 U.S.C. 1396r-4), including the impact of
such States electing to make medical assistance available to
such individuals on--
(A) the number of individuals in the United States
who are without health insurance and the distribution
of such individuals in relation to areas primarily
served by disproportionate share hospitals; and
(B) the low-income utilization rate of such
hospitals and the resulting fiscal sustainability of
such hospitals;
(2) evaluate the appropriate level and distribution of such
payments among disproportionate hospitals for purposes of--
(A) sufficiently accounting for the level of
uncompensated care provided by such hospitals to low-
income patients; and
(B) providing timely access to health services for
individuals in medically underserved areas; and
(3) assess, with respect to disproportionate hospitals--
(A) the role played by such hospitals in providing
critical access to emergency, inpatient, and outpatient
health services, as well as the location of such
hospitals in relation to medically underserved areas;
and
(B) the extent to which such hospitals satisfy the
requirements established for charitable hospital
organizations under section 501(r) of the Internal
Revenue Code of 1986 with respect to community health
needs assessments, financial assistance policy
requirements, limitations on charges, and billing and
collection requirements.
(b) Reports.--
(1) Report to congress.--Not later than 180 days after the
date on which the study under subsection (a) is completed, the
Comptroller General of the United States shall submit to the
Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate a report that contains--
(A) the results of the study;
(B) recommendations to Congress for any legislative
changes to the payments to disproportionate share
hospitals under section 1886(d)(5)(F) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section
1923 of such Act (42 U.S.C. 1396r-4) that are needed to
ensure access to health services for low-income
patients that--
(i) are based on the number of individuals
without health insurance, the amount of
uncompensated care provided by such hospitals,
and the impact of reduced payments levels on
low-income communities; and
(ii) takes into account any reports
submitted by the Secretary of the Treasury, in
consultation with the Secretary of Health and
Human Services, to Congressional committees
regarding the costs incurred by charitable
hospital organizations for charity care, bad
debt, nonreimbursed expenses for services
provided to individuals under the Medicare
Program under title XVIII of the Social
Security Act and the Medicaid Program under
title XIX of such Act, and any community
benefit activities provided by such
organizations.
(2) Report to the secretary of health and human services.--
Not later than 180 days after the date on which the study under
subsection (a) is completed, the Comptroller General of the
United States shall submit to the Secretary of Health and Human
Services a report that contains--
(A) the results of the study; and
(B) any recommendations for purposes of assisting
in the development of the methodology for the
adjustment of payments to disproportionate share
hospitals, as required under section 1886(r) of the
Social Security Act (42 U.S.C. 1395ww(r)) and the
reduction of such payments section 1923(f)(7) of such
Act (42 U.S.C. 1396r-4(f)(7)), taking into account the
reports referred to in paragraph (1)(B)(ii).
SEC. 435. ASSISTANT SECRETARY OF THE INDIAN HEALTH SERVICE.
(a) References.--Any reference in a law, regulation, document,
paper, or other record of the United States to the Director of the
Indian Health Service shall be deemed to be a reference to the
Assistant Secretary of the Indian Health Service.
(b) Executive Schedule.--Section 5315 of title 5, United States
Code, is amended in the matter relating to the Assistant Secretaries of
Health and Human Services by striking ``(6)'' and inserting ``(7), 1 of
whom shall be the Assistant Secretary of the Indian Health Service''.
(c) Conforming Amendment.--Section 5316 of title 5, United States
Code, is amended by striking ``Director, Indian Health Service,
Department of Health and Human Services.''.
SEC. 436. REAUTHORIZATION OF THE NATIVE HAWAIIAN HEALTH CARE
IMPROVEMENT ACT.
(a) Native Hawaiian Health Care Systems.--Section 6(h)(1) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(h)(1)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
(b) Administrative Grant for Papa Ola Lokahi.--Section 7(b) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11706(b)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
(c) Native Hawaiian Health Scholarships.--Section 10(c) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11709(c)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES
SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN AND
CHILDREN.
Part Q 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. 399Z-2. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN AND
CHILDREN.
``(a) Grants Authorized.--The Secretary, in collaboration with the
Administrator of the Health Resources and Services Administration and
other Federal officials determined appropriate by the Secretary, is
authorized to award grants to eligible entities to promote positive
health behaviors for women and children in target populations,
especially racial and ethnic minority women and children in medically
underserved communities.
``(b) Use of Funds.--Grants awarded pursuant to subsection (a) may
be used to support the activities of community health workers,
including such activities--
``(1) to educate and provide outreach regarding enrollment
in health insurance including the State Children's Health
Insurance Program under title XXI of the Social Security Act,
Medicare under title XVIII of such Act, and Medicaid under
title XIX of such Act;
``(2) to educate, guide, and provide outreach in a
community setting regarding health problems prevalent among
women and children and especially among racial and ethnic
minority women and children;
``(3) to educate, guide, and provide experiential learning
opportunities that target risk factors that impede achieving
healthy behaviors and good health outcomes, including--
``(A) poor nutrition;
``(B) physical inactivity;
``(C) being overweight or obese;
``(D) tobacco use;
``(E) alcohol and substance use;
``(F) injury and violence;
``(G) risky sexual behavior;
``(H) mental health problems;
``(I) musculoskeletal health and arthritis;
``(J) dental and oral health problems;
``(K) understanding informed consent; and
``(L) stigma;
``(4) to educate and guide regarding effective strategies
to promote positive health behaviors within the family;
``(5) to promote community wellness and awareness; and
``(6) to educate and refer target populations to
appropriate health care agencies and community-based programs
and organizations in order to increase access to quality health
care services, including preventive health services.
``(c) Application.--
``(1) In general.--Each eligible entity that desires to
receive a grant under subsection (a) shall submit an
application to the Secretary, at such time, in such manner, and
accompanied by such additional information as the Secretary may
require.
``(2) Contents.--Each application submitted pursuant to
paragraph (1) shall--
``(A) describe the activities for which assistance
under this section is sought;
``(B) contain an assurance that, with respect to
each community health worker program receiving funds
under the grant awarded, such program provides in-
language training and supervision to community health
workers to enable such workers to provide authorized
program activities in (at least) the most commonly used
languages within a particular geographic region;
``(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 culturally competent services in the
linguistic context most appropriate for the individuals
served by the program;
``(E) contain a plan to document and disseminate
project descriptions 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, which
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 that--
``(A)(i) have a high percentage of residents who
are uninsured or underinsured (if the targeted
geographic area is located in a State that has elected
to make medical assistance available under section
1902(a)(10)(A)(i)(VIII) of the Social Security Act to
individuals described in such section); or
``(ii) have a high percentage of underinsured
residents in a particular geographic area (if the
targeted geographic area is located in a State that has
not so elected); and
``(B) have a high percentage of families for whom
English is not their primary language or including
smaller limited-English-proficient communities within
the region that are not otherwise reached by
linguistically appropriate health services;
``(2) with experience in providing health or health-related
social services to individuals who are underserved with respect
to such services; and
``(3) with documented community activity and experience
with community health workers.
``(e) Collaboration With Academic Institutions.--The Secretary
shall encourage community health worker programs receiving funds under
this section to collaborate with academic institutions, including
minority-serving institutions. Nothing in this section shall be
construed to require such collaboration.
``(f) Quality Assurance and Cost Effectiveness.--The Secretary
shall establish guidelines for ensuring the quality of the training and
supervision of community health workers under the programs funded under
this section and for ensuring the cost effectiveness of such programs.
``(g) Monitoring.--The Secretary shall monitor community health
worker programs identified in approved applications and shall determine
whether such programs are in compliance with the guidelines established
under subsection (f).
``(h) Technical Assistance.--The Secretary may provide technical
assistance to community health worker programs identified in approved
applications with respect to planning, developing, and operating
programs under the grant.
``(i) Report to Congress.--
``(1) In general.--Not later than 4 years after the date on
which the Secretary first awards grants under subsection (a),
the Secretary shall submit to Congress a report regarding the
grant project.
``(2) Contents.--The report required under paragraph (1)
shall include the following:
``(A) A description of the programs for which grant
funds were used.
``(B) The number of individuals served.
``(C) An evaluation of--
``(i) the effectiveness of these programs;
``(ii) the cost of these programs; and
``(iii) the impact of the project on the
health outcomes of the community residents.
``(D) Recommendations for sustaining the community
health worker programs developed or assisted under this
section.
``(E) Recommendations regarding training to enhance
career opportunities for community health workers.
``(j) Definitions.--In this section:
``(1) Community health worker.--The term `community health
worker' means an individual who promotes health or nutrition
within the community in which the individual resides--
``(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, including dental, oral, mental, and
environmental health, or nutrition needs;
``(F) by taking into consideration the needs of the
communities served, including the prevalence rates of
risk factors that impede achieving healthy behaviors
and good health outcomes among women and children,
especially among racial and ethnic minority women and
children; and
``(G) by providing referral and followup services.
``(2) Community setting.--The term `community setting'
means a home or a community organization that serves a
population.
``(3) Eligible entity.--The term `eligible entity' means--
``(A) a unit of State, territorial, local, or
tribal government (including a federally recognized
tribe or Alaska Native village); or
``(B) a community-based organization.
``(4) Medically underserved community.--The term `medically
underserved community' means a community--
``(A) that has a substantial number of individuals
who are members of a medically underserved population,
as defined by section 330(b)(3);
``(B) a significant portion of which is a health
professional shortage area as designated under section
332; and
``(C) that includes populations that are
linguistically isolated, such as geographic areas with
a shortage of health professionals able to provide
linguistically appropriate services.
``(5) Support.--The term `support' means the provision of
training, supervision, and materials needed to effectively
deliver the services described in subsection (b), reimbursement
for services, and other benefits.
``(6) Target population.--The term `target population'
means women of reproductive age, regardless of their current
childbearing status and children under 21 years of age.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $15,000,000 for each of fiscal
years 2015 through 2019.''.
SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NUTRITION ASSISTANCE FOR
CHILDREN, PREGNANT WOMEN, AND LAWFULLY PRESENT
INDIVIDUALS.
(a) Medicaid.--Section 1903(v) of the Social Security Act (42
U.S.C. 1396b(v)) is amended by striking paragraph (4) and inserting the
following new paragraph:
``(4)(A) Notwithstanding sections 401(a), 402(b), 403, and
421 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 and paragraph (1), payment shall be
made to a State under this section for medical assistance
furnished to an alien under this title (including an alien
described in such paragraph) who meets any of the following
conditions:
``(i) The alien is otherwise eligible for such
assistance under the State plan approved under this
title (other than the requirement of the receipt of aid
or assistance under title IV, supplemental security
income benefits under title XVI, or a State
supplementary payment) within either or both of the
following eligibility categories:
``(I) Children under 21 years of age,
including any optional targeted low-income
child (as such term is defined in section
1905(u)(2)(B)).
``(II) Pregnant women during pregnancy and
during the 60-day period beginning on the last
day of the pregnancy.
``(ii) The alien is lawfully present in the United
States.
``(B) No debt shall accrue under an affidavit of support
against any sponsor of an alien who meets the conditions
specified in subparagraph (A) on the basis of the provision of
medical assistance to such alien under this paragraph and the
cost of such assistance shall not be considered as an
unreimbursed cost.''.
(b) SCHIP.--Subparagraph (J) of section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
``(J) Paragraph (4) of section 1903(v) (relating to
coverage of categories of children, pregnant women, and
other lawfully present individuals).''.
(c) Supplemental Nutrition Assistance.--Notwithstanding sections
401(a), 402(a), and 403(a) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(a); 1612(a);
1613(a)) and section 6(f) of the Food and Nutrition Act of 2008 (7
U.S.C. 2015(f)), persons who are lawfully present in the United States
shall be not be ineligible for benefits under the supplemental
nutrition assistance program on the basis of their immigration status
or date of entry into the United States.
(d) Eligibility for Families With Children.--Section of the
421(d)(3) of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1631(d)(3)) is amended by striking
``to the extent that a qualified alien is eligible under section
402(a)(2)(J)'' and inserting, ``to the extent that a child is a member
of a household under the supplemental nutrition assistance program''.
(e) Ensuring Proper Screening.--Section 11(e)(2)(B) of the Food and
Nutrition Act of 2008 (7 U.S.C. 2020(e)(2)(B)) is amended--
(1) by redesignating clauses (vi) and (vii) as clauses
(vii) and (viii); and
(2) by inserting after clause (v) the following:
``(vi) shall provide a method for
implementing section 421 of the Personal
Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1631) that
does not require any unnecessary information
from persons who may be exempt from that
provision;''.
SEC. 503. REPEAL OF DENIAL OF BENEFITS.
Section 115 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (21 U.S.C. 862a) is amended--
(1) in subsection (a) by striking paragraph (2);
(2) in subsection (b) by striking paragraph (2); and
(3) in subsection (e) by striking paragraph (2).
SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, AND AWARENESS.
(a) In General.--The Secretary shall establish and implement a
birth defects prevention and public awareness program, consisting of
the activities described in subsections (c) and (d).
(b) Definitions.--In this section:
(1) The term ``pregnancy and breastfeeding information
services'' includes only--
(A) information services to provide accurate,
evidence-based, clinical information regarding maternal
exposures during pregnancy that may be associated with
birth defects or other health risks, such as exposures
to medications, chemicals, infections, foodborne
pathogens, illnesses, nutrition, or lifestyle factors;
(B) information services to provide accurate,
evidence-based, clinical information regarding maternal
exposures during breastfeeding that may be associated
with health risks to a breast-fed infant, such as
exposures to medications, chemicals, infections,
foodborne pathogens, illnesses, nutrition, or lifestyle
factors;
(C) the provision of accurate, evidence-based
information weighing risks of exposures during
breastfeeding against the benefits of breastfeeding;
and
(D) the provision of information described in
subparagraph (A), (B), or (C) through counselors, Web
sites, fact sheets, telephonic or electronic
communication, community outreach efforts, or other
appropriate means.
(2) The term ``Secretary'' means the Secretary of Health
and Human Services, acting through the Director of the Centers
for Disease Control and Prevention.
(c) Nationwide Media Campaign.--In carrying out subsection (a), the
Secretary shall conduct or support a nationwide media campaign to
increase awareness among health care providers and at-risk populations
about pregnancy and breastfeeding information services.
(d) Grants for Pregnancy and Breastfeeding Information Services.--
(1) In general.--In carrying out subsection (a), the
Secretary shall award grants to State or regional agencies or
organizations for any of the following:
(A) Information services.--The provision of, or
campaigns to increase awareness about, pregnancy and
breastfeeding information services.
(B) Surveillance and research.--The conduct or
support of--
(i) surveillance of or research on--
(I) maternal exposures and maternal
health conditions that may influence
the risk of birth defects, prematurity,
or other adverse pregnancy outcomes;
and
(II) maternal exposures that may
influence health risks to a breastfed
infant; or
(ii) networking to facilitate surveillance
or research described in this subparagraph.
(2) Preference for certain states.--The Secretary, in
making any grant under this subsection, shall give preference
to States, otherwise equally qualified, that have or had a
pregnancy and breastfeeding information service in place on or
after January 1, 2006.
(3) Matching funds.--The Secretary may only award a grant
under this subsection to a State or regional agency or
organization that agrees, with respect to the costs to be
incurred in carrying out the grant activities, to make
available (directly or through donations from public or private
entities) non-Federal funds toward such costs in an amount
equal to not less than 25 percent of the amount of the grant.
(4) Coordination.--The Secretary shall ensure that
activities funded through a grant under this subsection are
coordinated, to the maximum extent practicable, with other
birth defects prevention and environmental health activities of
the Federal Government, including with respect to pediatric
environmental health specialty units and children's
environmental health centers.
(e) Evaluation.--In furtherance of the program under subsection
(a), the Secretary shall provide for an evaluation of pregnancy and
breastfeeding information services to identify efficient and effective
models of--
(1) providing information;
(2) raising awareness and increasing knowledge about birth
defects prevention measures and targeting education to at-risk
groups;
(3) modifying risk behaviors; or
(4) other outcome measures as determined appropriate by the
Secretary.
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $5,000,000 for fiscal year
2015, $6,000,000 for fiscal year 2016, $7,000,000 for fiscal year 2017,
$8,000,000 for fiscal year 2018, and $9,000,000 for fiscal year 2019.
SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW COMMITTEES ON
PREGNANCY-RELATED DEATHS.
(a) In General.--Title V of the Social Security Act (42 U.S.C. 701
et seq.) is amended by adding at the end the following new section:
``SEC. 514. UNIFORM STATE MATERNAL MORTALITY REVIEW COMMITTEES ON
PREGNANCY-RELATED DEATHS.
``(a) Grants.--
``(1) In general.--Notwithstanding any other provision of
this title, for each of fiscal years 2015 through 2021, in
addition to payments from allotments for States under section
502 for such year, the Secretary shall, subject to paragraph
(3) and in accordance with the criteria established under
paragraph (2), award grants to States to--
``(A) carry out the activities described in
subsection (b)(1);
``(B) establish a State maternal mortality review
committee, in accordance with subsection (b)(2), to
carry out the activities described in subsection
(b)(2)(A), and to establish the processes described in
subsection (b)(1);
``(C) ensure the State department of health carries
out the applicable activities described in subsection
(b)(3), with respect to pregnancy-related deaths
occurring within the State during such fiscal year;
``(D) implement and use the comprehensive case
abstraction form developed under subsection (c), in
accordance with such subsection; and
``(E) provide for public disclosure of information,
in accordance with subsection (e).
``(2) Criteria.--The Secretary shall establish criteria for
determining eligibility for and the amount of a grant awarded
to a State under paragraph (1). Such criteria shall provide
that in the case of a State that receives such a grant for a
fiscal year and is determined by the Secretary to have not used
such grant in accordance with this section, such State shall
not be eligible for such a grant for any subsequent fiscal
year.
``(3) Authorization of appropriations.--For purposes of
carrying out the grant program under this section, including
for administrative purposes, there is authorized to be
appropriated $10,000,000 for each of fiscal years 2015 through
2021.
``(b) Pregnancy-Related Death Review.--
``(1) Review of pregnancy-related death and pregnancy-
associated death cases.--For purposes of subsection (a), with
respect to a State that receives a grant under subsection (a),
the following shall apply:
``(A) Mandatory reporting of pregnancy-related
deaths.--
``(i) In general.--The State shall, through
the State maternal mortality review committee,
develop a process, separate from any reporting
process established by the State department of
health prior to the date of the enactment of
this section, that provides for mandatory and
confidential case reporting by individuals and
entities described in clause (ii) of pregnancy-
related deaths to the State department of
health.
``(ii) Individuals and entities
described.--Individuals and entities described
in this clause include each of the following:
``(I) Health care providers.
``(II) Medical examiners.
``(III) Medical coroners.
``(IV) Hospitals.
``(V) Free-standing birth centers.
``(VI) Federally qualified health
centers.
``(VII) Other health care
facilities.
``(VIII) Any other individuals
responsible for completing death
certificates.
``(IX) Any other appropriate
individuals or entities specified by
the Secretary.
``(B) Voluntary reporting of pregnancy-related and
pregnancy-associated deaths.--
``(i) The State shall, through the State
maternal mortality review committee, develop a
process for and encourage, separate from any
reporting process established by the State
department of health prior to the date of the
enactment of this section, voluntary and
confidential case reporting by individuals
described in clause (ii) of pregnancy-
associated deaths to the State department of
health.
``(ii) The State shall, through the State
maternal mortality review committee, develop a
process for voluntary and confidential
reporting by family members of the deceased and
by other individuals on possible pregnancy-
related and pregnancy-associated deaths to the
State department of health. Such process shall
include--
``(I) making publicly available on
the Internet Web site of the State
department of health a telephone
number, Internet Web link, and email
address for such reporting; and
``(II) publicizing to local
professional organizations, community
organizations, and social services
agencies the availability of the
telephone number, Internet Web link,
and email address made available under
subclause (I).
``(C) Development of case-finding.--The State,
through the vital statistics unit of the State, shall
annually identify pregnancy-related and pregnancy-
associated deaths occurring in such State during the
year involved by--
``(i) matching all death records, with
respect to such year, for women of childbearing
age to live birth certificates and infant death
certificates to identify deaths of women that
occurred during pregnancy and within one year
after the end of a pregnancy;
``(ii) identifying deaths reported during
such year as having an underlying or
contributing cause of death related to
pregnancy, regardless of the time that has
passed between the end of the pregnancy and the
death;
``(iii) collecting data from medical
examiner and coroner reports; and
``(iv) any other methods the States may
devise to identify maternal deaths, such as
through review of a random sample of reported
deaths of women of childbearing age to
ascertain cases of pregnancy-related and
pregnancy-associated deaths that are not
discernable from a review of death certificates
alone.
When feasible and for purposes of effectively
collecting and obtaining data on pregnancy-related and
pregnancy-associated deaths, the State shall adopt the
most recent standardized birth and death certificates,
as issued by the National Center for Vital Health
Statistics, including the recommended checkbox section
for pregnancy on the death certificates.
``(D) Case investigation and development of case
summaries.--Following receipt of reports by the State
department of health pursuant to subparagraph (A) or
(B) and collection by the vital statistics unit of the
State of possible cases of pregnancy-related and
pregnancy-associated deaths pursuant to subparagraph
(C), the State, through the State maternal mortality
review committee established under subsection (a),
shall investigate each case, utilizing the case
abstraction form described in subsection (c), and
prepare de-identified case summaries, which shall be
reviewed by the committee and included in applicable
reports. For purposes of subsection (a), under the
processes established under subparagraphs (A), (B), and
(C), a State department of health or vital statistics
unit of a State shall provide to the State maternal
mortality review committee access to information
collected pursuant to such subparagraphs as necessary
to carry out this subparagraph. Data and information
collected for the case summary and review are for
purposes of public health activities, in accordance
with HIPAA privacy and security law (as defined in
section 3009(a)(2) of the Public Health Service Act).
Such case investigations shall include data and
information obtained through--
``(i) medical examiner and autopsy reports
of the woman involved;
``(ii) medical records of the woman,
including such records related to health care
prior to pregnancy, prenatal and postnatal
care, labor and delivery care, emergency room
care, hospital discharge records including
immunization status and screening status for
prevalent diseases, and any care delivered up
until the time of death of the woman for
purposes of public health activities, in
accordance with HIPAA privacy and security law
(as defined in section 3009(a)(2) of the Public
Health Service Act);
``(iii) oral and written interviews of
individuals directly involved in the maternal
care of the woman during and immediately
following the pregnancy of the woman, including
health care, mental health, and social service
providers in-language when possible, as
applicable;
``(iv) optional oral or written interviews
of the family of the woman;
``(v) socioeconomic and other relevant
background information about the woman;
``(vi) information collected in
subparagraph (C)(i); and
``(vii) other information on the cause of
death of the woman, such as social services and
child welfare reports, including experiences
with intimate partner violence.
``(2) State maternal mortality review committees.--
``(A) Duties.--
``(i) Required committee activities.--For
purposes of subsection (a), a maternal
mortality review committee established by a
State pursuant to a grant under such subsection
shall carry out the following pregnancy-related
death and pregnancy-associated death review
activities and shall include all information
relevant to the death involved on the case
abstraction form developed under subsection
(d):
``(I) With respect to a case of
pregnancy-related or pregnancy-
associated death of a woman, review the
case summaries prepared under
subparagraphs (A), (B), (C), and (D) of
paragraph (1).
``(II) Review aggregate statistical
reports developed by the vital
statistics unit of the State under
paragraph (1)(C) regarding pregnancy-
related and pregnancy-associated deaths
to identify trends, patterns, and
disparities in adverse outcomes and
address medical, nonmedical, and
system-related factors that may have
contributed to such pregnancy-related
and pregnancy-associated deaths and
disparities.
``(III) Develop recommendations,
based on the review of the case
summaries under paragraph (1)(D) and
aggregate statistical reports under
subclause (II), to improve maternal
care, social and health services, and
public health policy and institutions,
including with respect to improving
access to maternal care, improving the
availability of social services, and
eliminating disparities in maternal
care and outcomes.
``(ii) Optional committee activities.--For
purposes of subsection (a), a maternal
mortality review committee established by a
State under such subsection may present
findings and recommendations regarding a
specific case or set of circumstances directly
to a health care facility or its local or State
professional organization for the purpose of
instituting policy changes, educational
activities, or otherwise improving the quality
of care provided by the facilities.
``(B) Composition of maternal mortality review
committees.--
``(i) In general.--Each State maternal
mortality review committee established pursuant
to a grant under subsection (a) shall be
multidisciplinary, consisting of health care,
behavioral health, and social service
providers, public health officials, other
persons with professional expertise on maternal
health and mortality, and patient and community
advocates who represent those communities
within such State that are the most affected by
maternal mortality. Membership on such a
committee of a State shall be reviewed annually
by the State department of health to ensure
that membership representation requirements are
being fulfilled in accordance with this
paragraph.
``(ii) Required membership.--Each such
review committee shall include--
``(I) representatives from medical
specialties providing care to pregnant
and postpartum patients, including
obstetricians (including generalists
and maternal fetal medicine
specialists), and family practice
physicians;
``(II) representatives from
midwifery specialties (including
certified professional midwives and
certified midwives);
``(III) advanced practice nurses;
``(IV) hospital-based nurses;
``(V) representatives of the State
department of health maternal and child
health department;
``(VI) social service providers or
social workers;
``(VII) the chief medical examiners
or designees;
``(VIII) facility representatives,
such as from hospitals or free-standing
birth centers; and
``(IX) community or patient
advocates who represent those
communities within the State that are
the most affected by maternal
mortality.
``(iii) Additional members.--Each such
review committee may also include
representatives from other relevant academic,
health, social service, or policy professions,
or community organizations, on an ongoing
basis, or as needed, as determined beneficial
by the review committee, including--
``(I) anesthesiologists;
``(II) emergency physicians;
``(III) pathologists;
``(IV) epidemiologists or
biostatisticians;
``(V) intensivists;
``(VI) orthopedic surgeons and/or
orthopedic physicians;
``(VII) vital statistics officers;
``(VIII) nutritionists;
``(IX) mental health professionals;
``(X) substance abuse treatment
specialists;
``(XI) representatives of relevant
advocacy groups;
``(XII) academics;
``(XIII) representatives of
beneficiaries of the State plan under
the Medicaid Program under title XIX;
``(XIV) paramedics;
``(XV) lawyers;
``(XVI) risk management
specialists;
``(XVII) representatives of the
departments of health or public health
of major cities in the State involved;
and
``(XVIII) policymakers.
``(iv) Diverse community membership.--The
composition of such a committee, with respect
to a State, shall include--
``(I) representatives from diverse
communities, particularly those
communities within such State most
severely affected by pregnancy-related
deaths or pregnancy-associated deaths
and by a lack of access to relevant
maternal care services, from community
maternal child health organizations,
and from minority advocacy groups;
``(II) members, including health
care providers, from different
geographic regions in the State,
including any rural, urban, and tribal
areas; and
``(III) health care and social
service providers who work in
communities that are diverse with
regard to race, ethnicity, immigration
status, indigenous status, and English
proficiency.
``(v) Maternal mortality review staff.--
Staff of each such review committee shall
include--
``(I) vital health statisticians,
maternal child health statisticians, or
epidemiologists;
``(II) a coordinator of the State
maternal mortality review committee, to
be designated by the State; and
``(III) administrative staff.
``(C) Option for states to form regional maternal
mortality reviews.--States with a low rate of
occurrence of pregnancy-associated or pregnancy-related
deaths may choose to partner with one or more
neighboring States to fulfill the activities described
in paragraph (1)(C). In such a case, with respect to
States in such a partnership, any requirement under
this section relating to the reporting of information
related to such activities shall be deemed to be
fulfilled by each such State if a single such report is
submitted for the partnership.
``(3) State department of health activities.--For purposes
of subsection (a), a State department of health of a State
receiving a grant under such subsection shall--
``(A) in consultation with the maternal mortality
review committee of the State and in conjunction with
relevant professional organizations, develop a plan for
ongoing health care provider education, based on the
findings and recommendations of the committee, in order
to improve the quality of maternal care; and
``(B) take steps to widely disseminate the findings
and recommendations of the State maternal mortality
review committees of the State and to implement the
recommendations of such committee.
``(c) Case Abstraction Form.--
``(1) Development.--The Director of the Centers for Disease
Control and Prevention shall develop a uniform, comprehensive
case abstraction form and make such form available to States
for State maternal mortality review committees for use by such
committees in order to--
``(A) ensure that the cases and information
collected and reviewed by such committees can be pooled
for review by the Department of Health and Human
Services and its agencies; and
``(B) preserve the uniformity of the information
and its use for Federal public health purposes.
``(2) Permissible state modification.--Each State may
modify the form developed under paragraph (1) for
implementation and use by such State or by the State maternal
mortality review committee of such State by including on such
form additional information to be collected, but may not alter
the standard questions on such form, in order to ensure that
the information can be collected and reviewed centrally at the
Federal level.
``(d) Treatment as Public Health Authority for Purposes of HIPAA.--
For purposes of applying HIPAA privacy and security law (as defined in
section 3009(a)(2) of the Public Health Service Act), a State maternal
mortality review committee of a State established pursuant to this
section to carry out activities described in subsection (b)(2)(A) shall
be deemed to be a public health authority described in section 164.501
(and referenced in section 164.512(b)(1)(i)) of title 45, Code of
Federal Regulations (or any successor regulation), carrying out public
health activities and purposes described in such section
164.512(b)(1)(i) (or any such successor regulation).
``(e) Public Disclosure of Information.--
``(1) In general.--For fiscal year 2015 or a subsequent
fiscal year, each State receiving a grant under this section
for such year shall, subject to paragraph (3), provide for the
public disclosure, and submission to the information
clearinghouse established under paragraph (2), of the
information included in the report of the State under section
506(a)(2)(F) for such year (relating to the findings for such
year of the State maternal mortality review committee
established by the State under this section).
``(2) Information clearinghouse.--The Secretary of Health
and Human Services shall establish an information
clearinghouse, that shall be administered by the Director of
the Centers for Disease Control and Prevention, that will
maintain findings and recommendations submitted pursuant to
paragraph (1) and provide such findings and recommendations for
public review and research purposes by State health
departments, maternal mortality review committees, and health
providers and institutions.
``(3) Confidentiality of information.--In no case shall any
individually identifiable health information be provided to the
public, or submitted to the information clearinghouse, under
paragraph (1).
``(f) Confidentiality of Review Committee Proceedings.--
``(1) In general.--All proceedings and activities of a
State maternal mortality review committee under this section,
opinions of members of such a committee formed as a result of
such proceedings and activities, and records obtained, created,
or maintained pursuant to this section, including records of
interviews, written reports, and statements procured by the
Department of Health and Human Services or by any other person,
agency, or organization acting jointly with the Department, in
connection with morbidity and mortality reviews under this
section, shall be confidential, and not subject to discovery,
subpoena, or introduction into evidence in any civil, criminal,
legislative, or other proceeding. Such records shall not be
open to public inspection.
``(2) Testimony of members of committee.--
``(A) In general.--Members of a State maternal
mortality review committee under this section may not
be questioned in any civil, criminal, legislative, or
other proceeding regarding information presented in, or
opinions formed as a result of, a meeting or
communication of the committee.
``(B) Clarification.--Nothing in this subsection
shall be construed to prevent a member of such a
committee from testifying regarding information that
was obtained independent of such member's participation
on the committee, or that is public information.
``(3) Availability of information for research purposes.--
Nothing in this subsection shall prohibit the publishing by
such a committee or the Department of Health and Human Services
of statistical compilations and research reports that--
``(A) are based on confidential information,
relating to morbidity and mortality review; and
``(B) do not contain identifying information or any
other information that could be used to ultimately
identify the individuals concerned.
``(g) Definitions.--For purposes of this section:
``(1) The term `pregnancy-associated death' means the death
of a woman while pregnant or during the one-year period
following the date of the end of pregnancy, irrespective of the
cause of such death.
``(2) The term `pregnancy-related death' means the death of
a woman while pregnant or during the one-year period following
the date of the end of pregnancy, irrespective of the duration
or site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management, but not from any
accidental or incidental cause.
``(3) The term `woman of childbearing age' means a woman
who is at least 10 years of age and not more than 54 years of
age.''.
(b) Inclusion of Findings of Review Committees in Required
Reports.--
(1) State triennial reports.--Paragraph (2) of section
506(a) of such Act (42 U.S.C. 706(a)) is amended by inserting
after subparagraph (E) the following new subparagraph:
``(F) In the case of a State receiving a grant
under section 514, beginning for the first fiscal year
beginning after 3 years after the date of establishment
of the State maternal mortality review committee
established by the State pursuant to such grant and
once every 3 years thereafter, information containing
the findings and recommendations of such committee and
information on the implementation of such
recommendations during the period involved.''.
(2) Annual reports to congress.--Paragraph (3) of such
section is amended--
(A) in subparagraph (D), at the end, by striking
``and'';
(B) in subparagraph (E), at the end, by striking
the period and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(F) For fiscal year 2015 and each subsequent
fiscal year, taking into account the findings,
recommendations, and implementation information
submitted by States pursuant to paragraph (2)(F), on
the status of pregnancy-related deaths and pregnancy-
associated deaths in the United States and including
recommendations on methods to prevent such deaths in
the United States.''.
SEC. 506. ELIMINATING DISPARITIES IN MATERNITY HEALTH OUTCOMES.
Part B of title III of the Public Health Service Act is amended by
inserting after section 317V, as added, the following new section:
``SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY HEALTH OUTCOMES.
``(a) In General.--The Secretary (in consultation with the Deputy
Assistant Secretary for Minority Health, the Director of the National
Institutes of Health, the Director of the Centers for Disease Control
and Prevention, the Administrator of the Centers for Medicare &
Medicaid Services, and the Administrator of the Agency for Healthcare
Research & Quality, and in consultation with relevant national
stakeholder organizations such as national medical specialty
organizations, national maternal child health organizations, national
groups that represent minority populations, and national health
disparity organizations) shall carry out the following activities to
eliminate disparities in maternal health outcomes:
``(1) Conduct research into the determinants and the
distribution of disparities in maternal care, health risks, and
health outcomes, and improve the capacity of the performance
measurement infrastructure to measure such disparities.
``(2) Expand access to services that have been demonstrated
to improve the quality and outcomes of maternity care for
vulnerable populations.
``(3) Establish a demonstration project to compare the
effectiveness of interventions to reduce disparities in
maternity services and outcomes, and implement and assess
effective interventions.
``(b) Scope and Selection of States for Demonstration Project.--The
demonstration project under subsection (a)(3) shall be conducted in no
more than 8 States, which shall be selected by the Secretary based on--
``(1) applications submitted by States, which specify which
regions and populations the State involved will serve under the
demonstration project;
``(2) criteria designed by the Secretary to ensure that, as
a whole, the demonstration project is, to the greatest extent
possible, representative of the demographic and geographic
composition of communities most affected by disparities;
``(3) criteria designed by the Secretary to ensure that a
variety of types of models are tested through the demonstration
project and that such models include interventions that have an
existing evidence base for effectiveness; and
``(4) criteria designed by the Secretary to assure that the
demonstration projects and models will be carried out in
consultation with local and regional provider organizations,
such as community health centers, hospital systems, and medical
societies representing providers of maternity services.
``(c) Duration of Demonstration Project.--The demonstration project
under subsection (a)(3) shall begin on January 1, 2015, and end on
December 31, 2019.
``(d) Grants for Evaluation and Monitoring.--The Secretary may make
grants to States and health care providers participating in the
demonstration project under subsection (a)(3) for the purpose of
collecting data necessary for the evaluation and monitoring of such
project.
``(e) Reports.--
``(1) State reports.--Each State that participates in the
demonstration project under subsection (a)(3) shall report to
the Secretary, in a time, form, and manner specified by the
Secretary, the data necessary to--
``(A) monitor the--
``(i) outcomes of the project;
``(ii) costs of the project; and
``(iii) quality of maternity care provided
under the project; and
``(B) evaluate the rationale for the selection of
the items and services included in any bundled payment
made by the State under the project.
``(2) Final report.--Not later than December 31, 2020, the
Secretary shall submit to Congress a report on the results of
the demonstration project under subsection (a)(3).''.
SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN UNEXPECTED INFANT
DEATH AND SUDDEN UNEXPLAINED DEATH IN CHILDHOOD.
(a) Establishment.--The Secretary of Health and Human Services,
acting through the Administrator of the Health Resources and Services
Administration and in consultation with the Director of the Centers for
Disease Control and Prevention and the Director of the National
Institutes of Health (in this section referred to as the
``Secretary''), shall establish and implement a culturally competent
public health awareness and education campaign to provide information
that is focused on decreasing the risk factors for sudden unexpected
infant death and sudden unexplained death in childhood, including
educating individuals about safe sleep environments, sleep positions,
and reducing exposure to smoking during pregnancy and after birth.
(b) Targeted Populations.--The campaign under subsection (a) shall
be designed to reduce health disparities through the targeting of
populations with high rates of sudden unexpected infant death and
sudden unexplained death in childhood.
(c) Consultation.--In establishing and implementing the campaign
under subsection (a), the Secretary shall consult with national
organizations representing health care providers, including nurses and
physicians, parents, child care providers, children's advocacy and
safety organizations, maternal and child health programs, nutrition
professionals focusing on women, infants, and children, and other
individuals and groups determined necessary by the Secretary for such
establishment and implementation.
(d) Grants.--
(1) In general.--In carrying out the campaign under
subsection (a), the Secretary shall award grants to national
organizations, State and local health departments, and
community-based organizations for the conduct of education and
outreach programs for nurses, parents, child care providers,
public health agencies, and community organizations.
(2) Application.--To be eligible to receive a grant under
paragraph (1), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
(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 2015 through 2019.
SEC. 508. REDUCING UNINTENDED TEENAGE PREGNANCIES.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following new part:
``PART W--YOUTH PREGNANCY PREVENTION PROGRAMS
``SEC. 399OO. PURPOSE.
``It is the purpose of this part to develop and carry out research
and demonstration projects on new and existing program interventions to
provide youth in communities at disproportionate risk for unintended
teen pregnancy (particularly youth in racial or ethnic minority or
immigrant communities, youth in the foster care system, youth in the
juvenile justice system, rural youth, and LGBT youth) the information
and skills needed to prevent unintended teenage pregnancies, build
healthy relationships, and improve overall health and well-being.
``SEC. 399OO-1. LIMITATION.
``No Federal funds provided under this Act may be used for health
education programs or media awareness campaigns that--
``(1) deliberately withhold life-saving information about
the human immunodeficiency virus (HIV);
``(2) undermine young people's confidence in the
effectiveness of contraception;
``(3) are medically inaccurate or have been scientifically
shown to be ineffective;
``(4) promote gender, racial, or ethnic stereotypes;
``(5) are insensitive and unresponsive to the needs of
sexually active youth or LGBT youth;
``(6) are inconsistent with the ethical imperatives of
medicine and public health; or
``(7) stigmatize and shame youth who are parenting or
choose to parent.
``SEC. 399OO-2. DEMONSTRATION GRANTS TO REDUCE UNINTENDED TEENAGE
PREGNANCIES.
``(a) In General.--The Secretary shall award competitive grants to
eligible entities for establishing or expanding programs to provide
youth in communities at disproportionate risk for unintended teen
pregnancy (particularly youth in racial or ethnic minority or immigrant
communities, youth in the foster care system, youth in the juvenile
justice system, rural youth, and LGBT youth) the information and skills
needed to prevent unintended teenage pregnancy and develop healthy
relationships.
``(b) Priority.--In awarding grants under this section, the
Secretary shall give priority to applicants--
``(1) proposing to carry out projects in communities at
disproportionate risk for unintended teen pregnancy
(particularly youth in racial or ethnic minority or immigrant
communities, youth in the foster care system, youth in the
juvenile justice system, rural youth, and LGBT youth);
``(2) that have a demonstrated history of effectively
working with such targeted communities;
``(3) that have a demonstrated history of engaging in a
meaningful and significant partnership with such targeted
communities; or
``(4) that have an integrated approach that also promotes
the skills necessary to build healthy relationships and
recognize abusive or unhealthy behaviors.
``(c) Program Settings.--Programs funded through a grant under
subsection (a) shall be provided--
``(1) through classroom-based settings, such as school
health education, humanities, language arts, or family and
consumer science education; after-school programs; community-
based programs; workforce development programs; and health care
settings, including community health centers; or
``(2) in collaboration with systems that serve large
numbers of at-risk youth such as juvenile justice or foster
care systems.
``(d) Project Requirements.--As a condition of receipt of a grant
under this section, an entity shall agree that, with respect to
information and skills provided through the grant--
``(1) such information and skills will be--
``(A) age-appropriate;
``(B) evidence-based or evidence-informed;
``(C) provided in accordance with section 399OO-
6(b); and
``(D) culturally sensitive and relevant to the
target populations; and
``(2) any information provided about contraceptives shall
include the health benefits and side effects of all
contraceptives and barrier methods.
``(e) Evaluation.--Of the total amount made available to carry out
this section for a fiscal year, the Secretary, acting through the
Director of the Centers for Disease Control and Prevention and other
agencies as appropriate, shall allot up to 10 percent of such amount to
carry out a rigorous, independent evaluation to determine the extent
and the effectiveness of activities funded through this section during
such fiscal year in changing attitudes and behavior of teenagers with
respect to healthy relationships and childbearing.
``(f) Grants for Indian Tribes or Tribal Organizations.--Of the
total amount made available to carry out this section for a fiscal
year, the Secretary shall reserve 5 percent of such amount to award
grants under this section to Indian tribes and tribal organizations in
such manner, and subject to such requirements, as the Secretary, in
consultation with Indian tribes and tribal organizations, determines
appropriate.
``(g) Eligible Entity Defined.--
``(1) In general.--In this section, the term `eligible
entity' means a State, local, or tribal agency; a school or
postsecondary institution; an after-school program; a nonprofit
organization; or a community or faith-based organization.
``(2) Preventing exclusion of smaller community-based
organizations.--In carrying out this section, the Secretary
shall ensure that the amounts and requirements of grants
provided under this section do not preclude receipt of such
grants by community-based organizations with a demonstrated
history of effectively working with adolescents in racial or
ethnic minority or immigrant communities or engaged in
meaningful and significant partnership with such communities.
``SEC. 399OO-3. MULTIMEDIA CAMPAIGNS TO REDUCE UNINTENDED TEENAGE
PREGNANCIES.
``(a) In General.--The Secretary shall award competitive grants to
public and private entities to carry out multimedia campaigns to
provide public education and increase public awareness regarding
unintended teenage pregnancy and related social and emotional issues,
such as violence prevention.
``(b) Priority.--In awarding grants under this section, the
Secretary shall give priority to applicants proposing to carry out
campaigns developed for communities at disproportionate risk for
unintended teen pregnancy (particularly youth in racial or ethnic
minority or immigrant communities, youth in the foster care system,
youth in the juvenile justice system, rural youth, and LGBT youth).
``(c) Information To Be Provided.--As a condition of receipt of a
grant under this section, an entity shall agree to use the grant to
carry out multimedia campaigns described in subsection (a) that--
``(1) at a minimum, shall provide information on--
``(A) the prevention of unintended teenage
pregnancy; and
``(B) healthy relationship development; and
``(2) may provide information on the prevention of dating
violence and sexual assault.
``SEC. 399OO-4. RESEARCH ON REDUCING UNINTENDED TEENAGE PREGNANCIES AND
TEENAGE DATING VIOLENCE AND IMPROVING HEALTHY
RELATIONSHIPS.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall make grants to
public and private entities to conduct, support, or coordinate research
on unintended teenage pregnancy, dating violence, and healthy
relationships among racial or ethnic minority or immigrant communities
that--
``(1) improves data collection on--
``(A) sexual and reproductive health, including
unintended teenage pregnancies and births, among all
minority communities and subpopulations in which such
data are not collected, including American Indian and
Alaska Native youth;
``(B) sexual behavior, reproductive and sexual
coercion, and teenage contraceptive use patterns at the
State level, as appropriate;
``(C) unintended teenage pregnancies among youth in
and aging out of foster care or juvenile justice
systems and the underlying factors that lead to
unintended teenage pregnancy among youth in foster care
or juvenile justice systems; and
``(D) sexual and reproductive health, including
teenage pregnancies and births, sexual behavior,
reproductive and sexual coercion, and teenage
contraceptive use among--
``(i) LGBT youth; and
``(ii) rural youth;
``(2) investigates--
``(A) the variance in the rates of unintended
teenage pregnancy by--
``(i) racial and ethnic group (such as
Hispanic, Asian-American, African-American,
Pacific Islander, American Indian, and Alaska
Native); and
``(ii) socioeconomic status, based on the
income of the family and education attainment;
``(B) factors affecting the risk for youth of
unintended teenage pregnancy or dating violence,
including the physical and social environment, level of
acculturation, access to health care, aspirations for
the future, and history of physical or sexual violence
or abuse;
``(C) the role that violence and abuse play in
teenage sex, pregnancy, and childbearing;
``(D) strategies to address the disproportionate
rates of unintended teenage pregnancies and dating
violence in racial or ethnic minority or immigrant
communities;
``(E) how effective interventions can be replicated
or adapted in other settings to serve racial or ethnic
minority or immigrant communities in a culturally
appropriate manner; and
``(F) the effectiveness of media campaigns in
addressing healthy relationship development, dating
violence prevention, and unintended teenage pregnancy;
and
``(3) tests research-based strategies for addressing high
rates of unintended teenage pregnancy through programs that
emphasize healthy relationships and violence prevention.
``(b) Priority.--In carrying out this section, the Secretary shall
give priority to research that incorporates--
``(1) interdisciplinary approaches;
``(2) a strong emphasis on community-based participatory
research; or
``(3) translational research.
``SEC. 399OO-5. HHS ADOLESCENT HEALTH WORK GROUP.
``(a) Purpose.--Not later than 30 days after the date of the
enactment of this part, the Secretary shall direct the interagency
adolescent health workgroup within the Office of Adolescent Health of
the Department of Health and Human Services to--
``(1) include in the work of the group strategies for
teenage dating violence prevention and healthy teenage
relationships with a particular focus among racial or ethnic
minority or immigrant communities; and
``(2) with respect to including such strategies, consult,
to the greatest extent possible, with the Federal Interagency
Workgroup on Teen Dating Violence formed under the leadership
of the National Institute of Justice of the Department of
Justice.
``(b) Report Requirement.--The Secretary, through the Office of
Adolescent Health, shall periodically submit to Congress a report
that--
``(1) includes a review of the evidence-based programs on
preventing unintended teenage pregnancy, which are carried out
and identified by the Office; and
``(2) identifies the programs of the Department of Health
and Human Services that include teenage dating violence
prevention and the promotion of healthy teenage relationships
as part of a strategy to prevent unintended teenage pregnancy.
``SEC. 399OO-6. GENERAL GRANT PROVISIONS.
``(a) Applications.--To seek a grant under this part, an entity
shall submit an application to the Secretary in such form, in such
manner, and containing such agreements, assurances, and information as
the Secretary may require.
``(b) Additional Requirements.--A grant may be made under this part
only if the applicant involved agrees that information, activities, and
services provided under the grant--
``(1) will be evidence-based or evidence-informed;
``(2) will be factually and medically accurate and
complete; and
``(3) if directed to a particular population group, will be
provided in an appropriate language and cultural context.
``(c) Training and Technical Assistance.--
``(1) In general.--Of the total amount made available to
carry out this part for a fiscal year, the Secretary shall use
10 percent to provide, directly or through a competitive grant
process, training and technical assistance to the grant
recipients under this part, including by disseminating research
and information regarding effective and promising practices,
providing consultation and resources on a broad array of
teenage and unintended pregnancy and violence prevention
strategies, and developing resources and materials.
``(2) Collaboration.--In carrying out this subsection, the
Secretary shall collaborate with entities that have expertise
in the prevention of teenage pregnancy, healthy relationship
development, minority health and health disparities, and
violence prevention.
``SEC. 399OO-7. DEFINITIONS.
``In this part:
``(1) Medically accurate and complete.--The term `medically
accurate and complete' means, with respect to information,
activities, or services, verified or supported by the weight of
research conducted in compliance with accepted scientific
methods and--
``(A) published in peer-reviewed journals, where
applicable; or
``(B) comprising information that leading
professional organizations and agencies with relevant
expertise in the field recognize as accurate,
objective, and complete.
``(2) LGBT youth.--The term `LGBT youth' means lesbian,
gay, bisexual, and transgender youth.
``(3) Racial or ethnic minority or immigrant communities.--
The term `racial or ethnic minority or immigrant communities'
means communities with a substantial number of residents who
are members of racial or ethnic minority groups or who are
immigrants.
``(4) Reproductive and sexual coercion.--The term
`reproductive and sexual coercion'--
``(A) means, with respect to a person, coercive
behavior that interferes with the ability of such
person to control the reproductive decisionmaking of
such person, such as intentionally exposing such person
to sexually transmitted infections; in the case such
person is a female, attempting to impregnate such
person against her will; intentionally interfering with
the person's birth control; or threatening or acting
violent if the person does not comply with the
perpetrator's wishes regarding contraception or the
decision whether to terminate or continue a pregnancy;
and
``(B) includes a range of behaviors that a partner
may use related to sexual decision-making to pressure
or coerce a person to have sex without using physical
force, such as repeatedly pressuring a partner to have
sex when he or she does not want to; threatening to end
a relationship if a person does not have sex; and
threatening retaliation if notified of a positive
sexually transmitted disease test result.
``(5) Youth.--The term `youth' means individuals who are 11
to 19 years of age.
``SEC. 399OO-8. REPORTS.
``(a) Report on Use of Funds.--Not later than 1 year after the date
of the enactment of this part, the Secretary shall submit to Congress a
report on the use of funds provided pursuant to this part.
``(b) Report on Impact of Programs.--Not later than March 1, 2019,
the Secretary shall submit to Congress a report on the impact of the
programs under this part on reducing unintended teenage pregnancies.
``SEC. 399OO-9. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--There are authorized to be appropriated to carry
out this part such sums as may be necessary for each of the fiscal
years 2015 through 2019.
``(b) Availability.--Amounts appropriated pursuant to subsection
(a)--
``(1) are authorized to remain available until expended;
and
``(2) are in addition to amounts otherwise made available
for such purposes.''.
SEC. 509. GESTATIONAL DIABETES.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by adding after section 317H the following:
``SEC. 317H-1. GESTATIONAL DIABETES.
``(a) Understanding and Monitoring Gestational Diabetes.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, in
consultation with the Diabetes Mellitus Interagency
Coordinating Committee established under section 429 and
representatives of appropriate national health organizations,
shall develop a multisite gestational diabetes research project
within the diabetes program of the Centers for Disease Control
and Prevention to expand and enhance surveillance data and
public health research on gestational diabetes.
``(2) Areas to be addressed.--The research project
developed under paragraph (1) shall address--
``(A) procedures to establish accurate and
efficient systems for the collection of gestational
diabetes data within each State and commonwealth,
territory, or possession of the United States;
``(B) the progress of collaborative activities with
the National Vital Statistics System, the National
Center for Health Statistics, and State health
departments with respect to the standard birth
certificate, in order to improve surveillance of
gestational diabetes;
``(C) postpartum methods of tracking women with
gestational diabetes after delivery as well as targeted
interventions proven to lower the incidence of type 2
diabetes in that population;
``(D) variations in the distribution of diagnosed
and undiagnosed gestational diabetes, and of impaired
fasting glucose tolerance and impaired fasting glucose,
within and among groups of women; and
``(E) factors and culturally sensitive
interventions that influence risks and reduce the
incidence of gestational diabetes and related
complications during childbirth, including cultural,
behavioral, racial, ethnic, geographic, demographic,
socioeconomic, and genetic factors.
``(3) Report.--Not later than 2 years after the date of the
enactment of this section, and annually thereafter, the
Secretary shall generate a report on the findings and
recommendations of the research project including prevalence of
gestational diabetes in the multisite area and disseminate the
report to the appropriate Federal and non-Federal agencies.
``(b) Expansion of Gestational Diabetes Research.--
``(1) In general.--The Secretary shall expand and intensify
public health research regarding gestational diabetes. Such
research may include--
``(A) developing and testing novel approaches for
improving postpartum diabetes testing or screening and
for preventing type 2 diabetes in women with a history
of gestational diabetes; and
``(B) conducting public health research to further
understanding of the epidemiologic, socioenvironmental,
behavioral, translation, and biomedical factors and
health systems that influence the risk of gestational
diabetes and the development of type 2 diabetes in
women with a history of gestational diabetes.
``(2) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $5,000,000 for
each of fiscal years 2015 through 2019.
``(c) Demonstration Grants To Lower the Rate of Gestational
Diabetes.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall award grants, on a competitive basis, to eligible
entities for demonstration projects that implement evidence-
based interventions to reduce the incidence of gestational
diabetes, the recurrence of gestational diabetes in subsequent
pregnancies, and the development of type 2 diabetes in women
with a history of gestational diabetes.
``(2) Priority.--In making grants under this subsection,
the Secretary shall give priority to projects focusing on--
``(A) helping women who have 1 or more risk factors
for developing gestational diabetes;
``(B) working with women with a history of
gestational diabetes during a previous pregnancy;
``(C) providing postpartum care for women with
gestational diabetes;
``(D) tracking cases where women with a history of
gestational diabetes developed type 2 diabetes;
``(E) educating mothers with a history of
gestational diabetes about the increased risk of their
child developing diabetes;
``(F) working to prevent gestational diabetes and
prevent or delay the development of type 2 diabetes in
women with a history of gestational diabetes; and
``(G) achieving outcomes designed to assess the
efficacy and cost-effectiveness of interventions that
can inform decisions on long-term sustainability,
including third-party reimbursement.
``(3) Application.--An eligible entity desiring to receive
a grant under this subsection shall submit to the Secretary--
``(A) an application at such time, in such manner,
and containing such information as the Secretary may
require; and
``(B) a plan to--
``(i) lower the rate of gestational
diabetes during pregnancy; or
``(ii) develop methods of tracking women
with a history of gestational diabetes and
develop effective interventions to lower the
incidence of the recurrence of gestational
diabetes in subsequent pregnancies and the
development of type 2 diabetes.
``(4) Uses of funds.--An eligible entity receiving a grant
under this subsection shall use the grant funds to carry out
demonstration projects described in paragraph (1), including--
``(A) expanding community-based health promotion
education, activities, and incentives focused on the
prevention of gestational diabetes and development of
type 2 diabetes in women with a history of gestational
diabetes;
``(B) aiding State- and tribal-based diabetes
prevention and control programs to collect, analyze,
disseminate, and report surveillance data on women
with, and at risk for, gestational diabetes, the
recurrence of gestational diabetes in subsequent
pregnancies, and, for women with a history of
gestational diabetes, the development of type 2
diabetes; and
``(C) training and encouraging health care
providers--
``(i) to promote risk assessment, high-
quality care, and self-management for
gestational diabetes and the recurrence of
gestational diabetes in subsequent pregnancies;
and
``(ii) to prevent the development of type 2
diabetes in women with a history of gestational
diabetes, and its complications in the practice
settings of the health care providers.
``(5) Report.--Not later than 4 years after the date of the
enactment of this section, the Secretary shall prepare and
submit to the Congress a report concerning the results of the
demonstration projects conducted through the grants awarded
under this subsection.
``(6) Definition of eligible entity.--In this subsection,
the term `eligible entity' means a nonprofit organization (such
as a nonprofit academic center or community health center) or a
State, tribal, or local health agency.
``(7) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $5,000,000 for
each of fiscal years 2015 through 2019.
``(d) Postpartum Followup Regarding Gestational Diabetes.--The
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, shall work with the State- and tribal-based
diabetes prevention and control programs assisted by the Centers to
encourage postpartum followup after gestational diabetes, as medically
appropriate, for the purpose of reducing the incidence of gestational
diabetes, the recurrence of gestational diabetes in subsequent
pregnancies, the development of type 2 diabetes in women with a history
of gestational diabetes, and related complications.''.
SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.
(a) Emergency Contraception Public Education Program.--
(1) In general.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall
develop and disseminate to the public information on emergency
contraception.
(2) Dissemination.--The Secretary may disseminate
information under paragraph (1) directly or through
arrangements with nonprofit organizations, consumer groups,
institutions of higher education, clinics, the media, and
Federal, State, and local agencies.
(3) Information.--The information disseminated under
paragraph (1) shall include, at a minimum, a description of
emergency contraception and an explanation of the use, safety,
efficacy, and availability of such contraception.
(b) Emergency Contraception Information Program for Health Care
Providers.--
(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in consultation with major medical and
public health organizations, shall develop and disseminate to
health care providers information on emergency contraception.
(2) Information.--The information disseminated under
paragraph (1) shall include, at a minimum--
(A) information describing the use, safety,
efficacy, and availability of emergency contraception;
(B) a recommendation regarding the use of such
contraception in appropriate cases; and
(C) information explaining how to obtain copies of
the information developed under subsection (a) for
distribution to the patients of the providers.
(c) Definitions.--In this section:
(1) Emergency contraception.--The term ``emergency
contraception'' means a drug or device (as the terms are
defined in section 201 of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 321)) or a drug regimen that--
(A) is used postcoitally;
(B) prevents pregnancy primarily by preventing or
delaying ovulation, and does not terminate an
established pregnancy; and
(C) is approved by the Food and Drug
Administration.
(2) Health care provider.--The term ``health care
provider'' means an individual who is licensed or certified
under State law to provide health care services and who is
operating within the scope of such license. Such term shall
include a pharmacist.
(3) Institution of higher education.--The term
``institution of higher education'' has the same meaning given
such term in section 101(a) of the Higher Education Act of 1965
(20 U.S.C. 1001(a)).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of the fiscal years 2015 through 2019.
SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOPMENT.
(a) In General.--The Secretary may award a grant to each eligible
State to conduct programs of sex education described in subsection (b),
including education on both abstinence and contraception for the
prevention of teenage pregnancy and sexually transmitted diseases,
including HIV/AIDS and viral hepatitis.
(b) Requirements for Sex Education Programs.--A program of sex
education described in this subsection is a program that--
(1) is age appropriate and medically accurate;
(2) stresses the value of abstinence while not ignoring
those young people who have been or are sexually active;
(3) includes information providing a factual understanding
of male and female reproductive anatomy;
(4) provides information about the health benefits and side
effects of contraceptive and barrier methods used--
(A) as a means to prevent pregnancy; and
(B) to reduce the risk of contracting sexually
transmitted disease, including HIV/AIDS and viral
hepatitis;
(5) encourages family communication between parent and
child about sexuality;
(6) cultivates a respectful dialogue about sexuality,
including sexual orientation and gender identity, and embraces
the principles of nondiscrimination based on sexual orientation
and gender identity;
(7) counters the perpetuation of narrow gender roles,
including the sexualization of female children, adolescents,
and adults;
(8) teaches young people the skills to make responsible
decisions about sexuality, including how to avoid unwanted
verbal, physical, and sexual advances and how to avoid making
verbal, physical, and sexual advances that are not wanted by
the other party;
(9) develops healthy relationships, including the
prevention of dating and sexual violence;
(10) teaches young people how alcohol and drug use can
affect responsible decisionmaking; and
(11) does not teach or promote religion.
(c) Additional Activities.--In carrying out a program of sex
education, a State may expend grant funds awarded under subsection (a)
to carry out educational and motivational activities that help young
people--
(1) gain knowledge about the physical, emotional,
biological, and hormonal changes of adolescence and subsequent
stages of human maturation;
(2) develop the knowledge and skills necessary--
(A) to ensure and protect their sexual and
reproductive health from unintended pregnancy and
sexually transmitted disease, including HIV/AIDS,
throughout their lifespan;
(B) to be aware that certain racial and ethnic
groups are more affected by certain sexually
transmitted diseases; and
(C) to receive the education to prevent further
transmission;
(3) gain knowledge about the specific involvement and
responsibility of each individual in sexual decisionmaking;
(4) develop healthy attitudes and values about adolescent
growth and development, body image, gender roles, racial and
ethnic diversity, sexual orientation and gender identity, and
other subjects;
(5) develop and practice healthy life skills including
goal-setting, decisionmaking, negotiation, communication, and
stress management; and
(6) promote self-esteem and positive interpersonal skills
focusing on relationship dynamics, including friendships,
dating, romantic involvement, marriage, and family
interactions.
(d) Matching Funds.--The Secretary may not make payments to a State
under this section in an amount exceeding Federal medical assistance
percentage for such State (as such term is defined in section 1905(b)
of the Social Security Act (42 U.S.C. 1396d(b))) of the costs of the
programs conducted by the State under this section.
(e) Evaluation of Programs.--
(1) In general.--For the purpose of evaluating the
effectiveness of programs of sex education carried out with a
grant under this section, evaluations shall be carried out in
accordance with paragraphs (2) and (3).
(2) National evaluation.--
(A) Method.--The Secretary shall provide for a
national evaluation of a representative sample of
programs of sex education carried out with grants under
this section to determine--
(i) the effectiveness of such programs in
helping to delay the initiation of sexual
intercourse and other high-risk behaviors;
(ii) the effectiveness of such programs in
preventing adolescent pregnancy;
(iii) the effectiveness of such programs in
preventing sexually transmitted disease,
including HIV/AIDS and viral hepatitis;
(iv) the effectiveness of such programs in
increasing contraceptive knowledge and
contraceptive behaviors when sexual intercourse
occurs; and
(v) a list of best practices that--
(I) is based upon essential
programmatic components of evaluated
programs that have led to success
described in clauses (i) through (iv);
and
(II) documents the racial and
ethnic minority populations that are
recipients of grant funds under this
section or are served by programs of
sex education funded under this
section.
(B) Grant condition.--A condition for the receipt
of a grant to a State under this section is that the
State cooperate with the evaluation under subparagraph
(A).
(C) Report.--The Secretary shall submit to the
Congress--
(i) not later than the end of each fiscal
year during the 5-year period beginning with
fiscal year 2015, an interim report on the
national evaluation under subparagraph (A); and
(ii) not later than March 31, 2020, a final
report providing the results of such national
evaluation.
(3) Individual state evaluations.--A condition for the
receipt of a grant under this section is that the State
evaluate the programs of sex education funded through such
grant in accordance with the following requirements:
(A) The evaluation will be conducted by an
external, independent entity.
(B) The purposes of the evaluation will be the
determination of--
(i) the effectiveness of such programs in
helping to delay the initiation of sexual
intercourse and other high-risk behaviors;
(ii) the effectiveness of such programs in
preventing adolescent pregnancy;
(iii) the effectiveness of such programs in
preventing sexually transmitted disease,
including HIV/AIDS; and
(iv) the effectiveness of such programs in
increasing contraceptive and barrier method
knowledge and contraceptive behaviors when
sexual intercourse occurs.
(f) Limitations on Use of Funds.--
(1) Limitations on secretary.--Of the amounts appropriated
for a fiscal year for purposes of this section, the Secretary
may not use more than--
(A) 7 percent of such amounts for administrative
expenses related to carrying out this section for that
fiscal year; and
(B) 10 percent of such amounts for the national
evaluation under subsection (e)(2).
(2) Limitations to states.--Of amounts provided to an
eligible State under this subsection, the State may not use
more than 10 percent of the grant to conduct any evaluation
under subsection (e)(3).
(g) Nondiscrimination Required.--Programs funded under this section
shall not discriminate on the basis of sex, race, ethnicity, national
origin, disability, religion, marital status, familial status, sexual
orientation, or gender identity. Nothing in this section shall be
construed to invalidate or limit rights, remedies, procedures, or legal
standards available to victims of discrimination under any other
Federal law or any law of a State or a political subdivision of a
State, including title VI of the Civil Rights Act of 1964 (42 U.S.C.
2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C.
1681 et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C.
794), and the Americans with Disabilities Act of 1990 (42 U.S.C. 12101
et seq.).
(h) Definitions.--For purposes of this section:
(1) The term ``age appropriate'' means, with respect to
topics, messages, and teaching methods, those suitable to
particular ages or age groups of children, adolescents, and
adults, based on developing cognitive, emotional, and
behavioral capacity typical for the age or age group.
(2) The term ``eligible State'' means a State that submits
to the Secretary an application for a grant under this section
that is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary
determines to be necessary to carry out this section.
(3) The term ``HIV/AIDS'' means the human immunodeficiency
virus, and includes acquired immune deficiency syndrome.
(4) The term ``medically accurate'', with respect to
information, means information that is supported by research,
recognized as accurate and objective by leading medical,
psychological, psychiatric, and public health organizations and
agencies, and, published in journals that are peer reviewed.
(5) The term ``State'' means the 50 States, the District of
Columbia, the Commonwealth of Puerto Rico, the Commonwealth of
the Northern Mariana Islands, American Samoa, Guam, the United
States Virgin Islands, and any other territory or possession of
the United States.
(i) Authorization of Appropriations.--For the purpose of carrying
out this section, there is authorized to be appropriated $50,000,000
for each of the fiscal years 2015 through 2019.
SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES.
(a) Medicare.--
(1) Limitation on payment.--Section 1866(a)(1) of the
Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
(A) by striking ``and'' at the end of subparagraph
(V);
(B) in the subparagraph (W) added by section
3005(1)(C) of Public Law 111-148--
(i) by striking the period at the end and
inserting a comma;
(ii) by moving the indentation 2 ems to the
left; and
(iii) by moving such subparagraph to
immediately follow subparagraph (V);
(C) in the subparagraph (W) added by section
6406(b)(3) of Public Law 111-148--
(i) by striking the period at the end and
inserting ``, and'';
(ii) by moving the indentation 2 ems to the
left;
(iii) by redesignating such subparagraph as
subparagraph (X); and
(iv) by moving such subparagraph to
immediately follow subparagraph (W), as moved
under paragraph (2)(C); and
(D) by inserting after the subparagraph (X), as
redesignated and moved under paragraph (3), the
following:
``(Y) in the case of a hospital or critical access
hospital, to adopt and enforce a policy to ensure
compliance with the requirements of subsection (l) and
to meet the requirements of such subsection.''.
(2) Assistance to victims.--Section 1866 of the Social
Security Act (42 U.S.C. 1395cc) is amended by adding at the end
the following new subsection:
``(l) Compassionate Assistance for Rape Emergencies.--
``(1) In general.--For purposes of section 1866(a)(1)(Y), a
hospital meets the requirements of this subsection if the
hospital provides each of the services described in paragraph
(2) to each female individual, whether or not eligible for
benefits under this title or under any other form of health
insurance. who comes to the hospital on or after January 1,
2015, and--
``(A) who states to hospital personnel that she is
a victim of sexual assault;
``(B) who is accompanied by an individual who
states to hospital personnel that the female individual
is a victim of sexual assault; or
``(C) whom hospital personnel, during the course of
treatment and care for the female individual, have
reason to believe is a victim of sexual assault.
``(2) Required services described.--For purposes of
paragraph (1), the services described in this subparagraph are
the following:
``(A) Provision of medically and factually accurate
and unbiased written and oral information about
emergency contraception that--
``(i) is written in clear and concise
language;
``(ii) is readily comprehensible;
``(iii) includes an explanation that--
``(I) emergency contraception has
been approved by the Food and Drug
Administration as an over-the-counter
medication for female individuals, and
is a safe and effective way to prevent
pregnancy after unprotected intercourse
or contraceptive failure if taken in a
timely manner;
``(II) emergency contraception is
more effective the sooner it is taken;
and
``(III) emergency contraception
does not cause an abortion and cannot
interrupt an established pregnancy;
``(iv) meets such conditions regarding the
provision of such information in languages
other than English as the Secretary may
establish; and
``(v) is provided without regard to the
ability of the individual or her family to pay
costs associated with the provision of such
information to the individual.
``(B) Prompt offer to provide emergency
contraception to the individual, and in the case that
the individual accepts such offer, prompt provision of
such contraception to such individual without regard to
the inability of the individual or her family to pay
costs associated with the offer and provision of such
contraception.
``(3) Definitions.--For purposes of this paragraph:
``(A) The term `emergency contraception' means a
drug or device (as such terms are defined in section
201 of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 321)) or a drug regimen that--
``(i) is used postcoitally;
``(ii) prevents pregnancy primarily by
preventing or delaying ovulation, and does not
terminate an established pregnancy; and
``(iii) is approved by the Food and Drug
Administration.
``(B) The term `hospital' includes a critical
access hospital, as defined in section 1861(mm)(1).
``(C) The term `sexual assault' means coitus in
which the individual involved does not consent or lacks
the legal capacity to consent.''.
(b) Limitation on Payment Under Medicaid.--Section 1903(i) of the
Social Security Act (42 U.S.C. 1396b(i)) is amended by inserting after
paragraph (11) the following new paragraph:
``(12) with respect to any amount expended for care or
services furnished under the plan by a hospital on or after
January 1, 2015, unless such hospital meets the requirements
specified in section 1866(l) for purposes of title XVIII.''.
SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHARMACIES TO ENSURE
PROVISION OF FDA-APPROVED CONTRACEPTION.
Part B of title II of the Public Health Service Act (42 U.S.C. 238
et seq.) is amended by adding at the end the following:
``SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION OF FDA-APPROVED
CONTRACEPTION.
``(a) In General.--Subject to subsection (c), a pharmacy that
receives Food and Drug Administration-approved drugs or devices in
interstate commerce shall maintain compliance with the following:
``(1) If a customer requests a contraceptive that is in
stock, the pharmacy shall ensure that the contraceptive is
provided to the customer without delay.
``(2) If a customer requests a contraceptive that is not in
stock and the pharmacy in the normal course of business stocks
contraception, the pharmacy shall immediately inform the
customer that the contraceptive is not in stock and without
delay offer the customer the following options:
``(A) If the customer prefers to obtain the
contraceptive through a referral or transfer, the
pharmacy shall--
``(i) locate a pharmacy of the customer's
choice or the closest pharmacy confirmed to
have the contraceptive in stock; and
``(ii) refer the customer or transfer the
prescription to that pharmacy.
``(B) If the customer prefers for the pharmacy to
order the contraceptive, the pharmacy shall obtain the
contraceptive under the pharmacy's standard procedure
for expedited ordering of medication and notify the
customer when the contraceptive arrives.
``(3) The pharmacy shall ensure that its employees do not--
``(A) intimidate, threaten, or harass customers in
the delivery of services relating to a request for
contraception;
``(B) interfere with or obstruct the delivery of
services relating to a request for contraception;
``(C) intentionally misrepresent or deceive
customers about the availability of contraception or
its mechanism of action;
``(D) breach medical confidentiality with respect
to a request for contraception or threaten to breach
such confidentiality; or
``(E) refuse to return a valid, lawful prescription
for contraception upon customer request.
``(b) Contraceptives Not Ordinarily Stocked.--Nothing in subsection
(a)(2) shall be construed to require any pharmacy to comply with such
subsection if the pharmacy does not ordinarily stock contraceptives in
the normal course of business.
``(c) Refusals Pursuant to Standard Pharmacy Practice.--This
section does not prohibit a pharmacy from refusing to provide a
contraceptive to a customer in accordance with any of the following:
``(1) If it is unlawful to dispense the contraceptive to
the customer without a valid, lawful prescription and no such
prescription is presented.
``(2) If the customer is unable to pay for the
contraceptive.
``(3) If the employee of the pharmacy refuses to provide
the contraceptive on the basis of a professional clinical
judgment.
``(d) Rule of Construction.--Nothing in this section shall be
construed to invalidate or limit rights, remedies, procedures, or legal
standards under title VII of the Civil Rights Act of 1964.
``(e) Preemption.--This section does not preempt any provision of
State law or any professional obligation made applicable by a State
board or other entity responsible for licensing or discipline of
pharmacies or pharmacists, to the extent that such State law or
professional obligation provides protections for customers that are
greater than the protections provided by this section.
``(f) Enforcement.--
``(1) Civil penalty.--A pharmacy that violates a
requirement of subsection (a) is liable to the United States
for a civil penalty in an amount not exceeding $1,000 per day
of violation, not to exceed $100,000 for all violations
adjudicated in a single proceeding.
``(2) Private cause of action.--Any person aggrieved as a
result of a violation of a requirement of subsection (a) may,
in any court of competent jurisdiction, commence a civil action
against the pharmacy involved to obtain appropriate relief,
including actual and punitive damages, injunctive relief, and a
reasonable attorney's fee and cost.
``(3) Limitations.--A civil action under paragraph (1) or
(2) may not be commenced against a pharmacy after the
expiration of the 5-year period beginning on the date on which
the pharmacy allegedly engaged in the violation involved.
``(g) Definitions.--In this section:
``(1) The term `contraception' or `contraceptive' means any
drug or device approved by the Food and Drug Administration to
prevent pregnancy.
``(2) The term `employee' means a person hired, by contract
or any other form of an agreement, by a pharmacy.
``(3) The term `pharmacy' means an entity that--
``(A) is authorized by a State to engage in the
business of selling prescription drugs at retail; and
``(B) employs one or more employees.
``(4) The term `product' means a Food and Drug
Administration-approved drug or device.
``(5) The term `professional clinical judgment' means the
use of professional knowledge and skills to form a clinical
judgment, in accordance with prevailing medical standards.
``(6) The term `without delay', with respect to a pharmacy
providing, providing a referral for, or ordering contraception,
or transferring the prescription for contraception, means
within the usual and customary timeframe at the pharmacy for
providing, providing a referral for, or ordering other
products, or transferring the prescription for other products,
respectively.
``(h) Effective Date.--This section shall take effect on the 31st
day after the date of the enactment of this section, without regard to
whether the Secretary has issued any guidance or final rule regarding
this section.''.
SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON WOMEN'S HEALTH.
Section 229(b) of the Public Health Service Act (42 U.S.C. 237a(b))
is amended--
(1) in paragraph (6), at the end, by striking ``and'';
(2) in paragraph (7), at the end, by striking the period
and inserting ``; and''; and
(3) by adding at the end the following new paragraph:
``(8) facilitate policymakers, health system leaders and
providers, consumers, and other stakeholders in understanding
optimal maternity care and support for the provision of such
care, including the priorities of--
``(A) protecting, promoting, and supporting the
innate capacities of childbearing women and their
newborns for childbirth, breastfeeding, and attachment;
``(B) using obstetric interventions only when such
interventions are supported by strong, high-quality
evidence, and minimizing overuse of maternity practices
that have been shown to have benefit in limited
situations and that can expose women, infants, or both
to risk of harm if used routinely and indiscriminately,
including continuous electronic fetal monitoring, labor
induction, epidural analgesia, primary cesarean
section, and routine repeat cesarean birth;
``(C) reliably incorporating noninvasive, evidence-
based practices that have documented correlation with
considerable improvement in outcomes with no
detrimental side effects, such as smoking cessation
programs in pregnancy and proven models of group
prenatal care that integrate health assessment,
education, and support into a unified program;
``(D) a shared understanding of the qualifications
of licensed providers of maternity care and the best
evidence about the safety, satisfaction, outcomes, and
costs of their care, and appropriate deployment of such
caregivers within the maternity care workforce to
address the needs of childbearing women and newborns
and the growing shortage of maternity caregivers;
``(E) a shared understanding of the results of the
best available research comparing hospital, birth
center, and planned home births, including information
about each setting's safety, satisfaction, outcomes,
and costs; and
``(F) high-quality, evidence-based childbirth
education that promotes a natural, healthy, and safe
approach to pregnancy, childbirth, and early parenting;
is taught by certified educators, peer counselors, and
health professionals; and promotes informed
decisionmaking by childbearing women.''.
SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF
OPTIMAL MATERNITY OUTCOMES.
(a) In General.--Part A of title II of the Public Health Service
Act (42 U.S.C. 202 et seq.) is amended by adding at the end the
following new section:
``SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF
OPTIMAL MATERNITY OUTCOMES.
``(a) In General.--The Secretary of Health and Human Services,
acting through the Deputy Assistant Secretary for Women's Health under
section 229 and in collaboration with the Federal officials specified
in subsection (b), shall establish the Interagency Coordinating
Committee on the Promotion of Optimal Maternity Outcomes (referred to
in this subsection as the `ICCPOM').
``(b) Other Agencies.--The officials specified in this subsection
are the Secretary of Labor, the Secretary of Defense, the Secretary of
Veterans Affairs, the Surgeon General, the Director of the Centers for
Disease Control and Prevention, the Administrator of the Health
Resources and Services Agency, the Administrator of the Centers for
Medicare & Medicaid Services, the Director of the Indian Health
Service, the Administrator of the Substance Abuse and Mental Health
Services Administration, the Director of the National Institute on
Child Health and Development, the Director of the Agency for Healthcare
Research and Quality, the Assistant Secretary for Children and
Families, the Deputy Assistant Secretary for Minority Health, the
Director of the Office of Personnel Management, and such other Federal
officials as the Secretary of Health and Human Services determines to
be appropriate.
``(c) Chair.--The Deputy Assistant Secretary for Women's Health
shall serve as the chair of the ICCPOM.
``(d) Duties.--The ICCPOM shall guide policy and program
development across the Federal Government with respect to promotion of
optimal maternity care, provided, however, that nothing in this section
shall be construed as transferring regulatory or program authority from
an agency to the ICCPOM.
``(e) Consultations.--The ICCPOM shall actively seek the input of,
and shall consult with, all appropriate and interested stakeholders,
including State health departments, public health research and interest
groups, foundations, childbearing women and their advocates, and
maternity care professional associations and organizations, reflecting
racially, ethnically, demographically, and geographically diverse
communities.
``(f) Annual Report.--
``(1) In general.--The Secretary, on behalf of the ICCPOM,
shall annually submit to Congress a report that summarizes--
``(A) all programs and policies of Federal agencies
(including the Medicare Program under title XVIII of
the Social Security Act and the Medicaid program under
title XIX of such Act) designed to promote optimal
maternity care, focusing particularly on programs and
policies that support the adoption of evidence based
maternity care, as defined by timely, scientifically
sound systematic reviews;
``(B) all programs and policies of Federal agencies
(including the Medicare Program under title XVIII of
the Social Security Act and the Medicaid program under
title XIX of such Act) designed to address the problems
of maternal mortality and morbidity, infant mortality,
prematurity, and low birth weight, including such
programs and policies designed to address racial and
ethnic disparities with respect to each of such
problems;
``(C) the extent of progress in reducing maternal
mortality and infant mortality, low birth weight, and
prematurity at State and national levels; and
``(D) such other information regarding optimal
maternity care as the Secretary determines to be
appropriate.
The information specified in subparagraph (C) shall be included
in each such report in a manner that disaggregates such
information by race, ethnicity, and indigenous status in order
to determine the extent of progress in reducing racial and
ethnic disparities and disparities related to indigenous
status.
``(2) Certain information.--Each report under paragraph (1)
shall include information (disaggregated by race, ethnicity,
and indigenous status, as applicable) on the following rates
and costs by State:
``(A) The rate of primary cesarean deliveries and
repeat cesarean deliveries.
``(B) The rate of vaginal births after cesarean.
``(C) The rate of vaginal breech births.
``(D) The rate of induction of labor.
``(E) The rate of freestanding birth center births.
``(F) The rate of planned and unplanned home birth.
``(G) The rate of attended births by provider,
including by an obstetrician-gynecologist, family
practice physician, obstetrician-gynecologist physician
assistant, certified nurse-midwife, certified midwife,
and certified professional midwife.
``(H) The cost of maternity care disaggregated by
place of birth and provider of care, including--
``(i) uncomplicated vaginal birth;
``(ii) complicated vaginal birth;
``(iii) uncomplicated cesarean birth; and
``(iv) complicated cesarean birth.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated, in addition to such amounts authorized to be appropriated
under section 229(e), to carry out this section $1,000,000 for each of
the fiscal years 2015 through 2019.''.
(b) Conforming Amendments.--
(1) Inclusion as duty of hhs office on women's health.--
Section 229(b) of such Act (42 U.S.C. 237a(b)), as amended, is
amended--
(A) in paragraph (7), at the end, by striking
``and'';
(B) in paragraph (8), at the end, by striking the
period and inserting ``; and''; and
(C) by adding at the end the following new
paragraph:
``(9) establish the Interagency Coordinating Committee on
the Promotion of Optimal Maternity Outcomes in accordance with
section 229A.''.
(2) Treatment of biennial reports.--Section 229(d) of such
Act (42 U.S.C. 237a(d)) is amended by inserting ``(other than
under subsection (b)(9))'' after ``under this section''.
SEC. 516. CONSUMER EDUCATION CAMPAIGN.
Section 229 of the Public Health Service Act (42 U.S.C. 237a), as
amended, is further amended in subsection (b)--
(1) in paragraph (8), at the end, by striking ``and'';
(2) in paragraph (9), at the end, by striking the period
and inserting ``; and''; and
(3) by adding at the end the following new paragraph:
``(10) not later than one year after the date of the
enactment of the Health Equity and Accountability Act of 2014,
develop and implement a 4-year culturally and linguistically
appropriate multimedia consumer education campaign that is
designed to promote understanding and acceptance of evidence-
based maternity practices and models of care for optimal
maternity outcomes among women of childbearing ages and
families of such women and that--
``(A) highlights the importance of protecting,
promoting, and supporting the innate capacities of
childbearing women and their newborns for childbirth,
breastfeeding, and attachment;
``(B) promotes understanding of the importance of
using obstetric interventions when medically necessary
and when supported by strong, high-quality evidence;
``(C) highlights the widespread overuse of
maternity practices that have been shown to have
benefit when used appropriately in situations of
medical necessity, but which can expose women, infants,
or both to risk of harm if used routinely and
indiscriminately, including continuous fetal
monitoring, labor induction, epidural anesthesia,
elective primary cesarean section, and repeat cesarean
delivery;
``(D) emphasizes the noninvasive maternity
practices that have strong proven correlation or may be
associated with considerable improvement in outcomes
with no detrimental side effects, and are significantly
underused in the United States, including smoking
cessation programs in pregnancy, group model prenatal
care, continuous labor support, nonsupine positions for
birth, and external version to turn breech babies at
term;
``(E) educates consumers about the qualifications
of licensed providers of maternity care and the best
evidence about their safety, satisfaction, outcomes,
and costs;
``(F) informs consumers about the best available
research comparing birth center births, planned home
births, and hospital births, including information
about each setting's safety, satisfaction, outcomes,
and costs;
``(G) fosters participation in high-quality,
evidence-based childbirth education that promotes a
natural, healthy, and safe approach to pregnancy,
childbirth, and early parenting; is taught by certified
educators, peer counselors, and health professionals;
and promotes informed decisionmaking by childbearing
women; and
``(H) is pilot tested for consumer comprehension,
cultural sensitivity, and acceptance of the messages
across geographically, racially, ethnically, and
linguistically diverse populations.''.
SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC REVIEWS FOR CARE OF
CHILDBEARING WOMEN AND NEWBORNS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Health and Human Services,
through the Agency for Healthcare Research and Quality, shall--
(1) make publicly available an online bibliographic
database identifying systematic reviews, including an
explanation of the level and quality of evidence, for care of
childbearing women and newborns; and
(2) initiate regular updates that incorporate newly issued
and updated systematic reviews.
(b) Sources.--To aim for a comprehensive inventory of systematic
reviews relevant to maternal and newborn care, the database shall
identify reviews from diverse sources, including--
(1) scientific peer-reviewed journals;
(2) databases, including Cochrane Database of Systematic
Reviews, Clinical Evidence, and Database of Abstracts of
Reviews of Effects; and
(3) Internet Web sites of agencies and organizations
throughout the world that produce such systematic reviews.
(c) Features.--The database shall--
(1) provide bibliographic citations for each record within
the database, and for each such citation include an explanation
of the level and quality of evidence;
(2) include abstracts, as available;
(3) provide reference to companion documents as may exist
for each review, such as evidence tables and guidelines or
consumer educational materials developed from the review;
(4) provide links to the source of the full review and to
any companion documents;
(5) provide links to the source of a previous version or
update of the review;
(6) be searchable by intervention or other topic of the
review, reported outcomes, author, title, and source; and
(7) offer to users periodic electronic notification of
database updates relating to users' topics of interest.
(d) Outreach.--Not later than the first date the database is made
publicly available and periodically thereafter, the Secretary of Health
and Human Services shall publicize the availability, features, and uses
of the database under this section to the stakeholders described in
subsection (e).
(e) Consultation.--For purposes of developing the database under
this section and maintaining and updating such database, the Secretary
of Health and Human Services shall convene and consult with an advisory
committee composed of relevant stakeholders, including--
(1) Federal Medicaid administrators and State agencies
administrating State plans under title XIX of the Social
Security Act pursuant to section 1902(a)(5) of such Act (42
U.S.C. 1396a(a)(5));
(2) providers of maternity and newborn care from both
academic and community-based settings, including obstetrician-
gynecologists, family physicians, certified nurse midwives,
certified midwives, certified professional midwives, physician
assistants, perinatal nurses, pediatricians, and nurse
practitioners;
(3) maternal-fetal medicine specialists;
(4) neonatologists;
(5) childbearing women and advocates for such women,
including childbirth educators certified by a nationally
accredited program, representing communities that are diverse
in terms of race, ethnicity, indigenous status, and geographic
area;
(6) employers and purchasers;
(7) health facility and system leaders, including both
hospital and birth center facilities;
(8) journalists; and
(9) bibliographic informatics specialists.
(f) Authorization of Appropriations.--There is authorized to be
appropriated $2,500,000 for each of the fiscal years 2015 through 2017
for the purpose of developing the database and such sums as may be
necessary for each subsequent fiscal year for updating the database and
providing outreach and notification to users, as described in this
section.
SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL SHORTAGE AREAS.
Section 332 of the Public Health Service Act (42 U.S.C. 254e) is
amended by adding at the end the following new subsection:
``(k)(1) The Secretary, acting through the Administrator of the
Health Resources and Services Administration, shall designate maternity
care health professional shortage areas in the States, publish a
descriptive list of the area's population groups, medical facilities,
and other public facilities so designated, and at least annually review
and, as necessary, revise such designations.
``(2) For purposes of paragraph (1), a complete descriptive list
shall be published in the Federal Register not later than one year
after the date of the enactment of the Health Equity and Accountability
Act of 2014 and annually thereafter.
``(3) The provisions of subsections (b), (c), (e), (f), (g), (h),
(i), and (j) (other than (j)(1)(B)) of this section shall apply to the
designation of a maternity care health professional shortage area in a
similar manner and extent as such provisions apply to the designation
of health professional shortage areas, except in applying subsection
(b)(3), the reference in such subsection to `physicians' shall be
deemed to be a reference to nationally certified and State licensed
obstetricians, family practice physicians who practice full-scope
maternity care, certified nurse midwives, certified midwives, certified
professional midwives, and physician's assistants who practice full
scope maternity care.
``(4) For purposes of this subsection, the term `maternity care
health professional shortage area' means--
``(A) an area in an urban or rural area (which need not
conform to the geographic boundaries of a political subdivision
and which is a rational area for the delivery of health
services) which the Secretary determines has a shortage of
providers of maternity care health services including those
referenced in paragraph (3) or an urban or rural area that the
Secretary determines has lost a significant number of such
providers during the 10-year period beginning with 2004 or has
no obstetrical providers licensed to provide operative
obstetrical services;
``(B) an area in an urban or rural area (which need not
conform to the geographic boundaries of a political subdivision
and which is a rational area for the delivery of health
services) which the Secretary determines has a shortage of
hospital or labor and delivery units, hospital birth center
units, or freestanding birth centers or an area that lost a
significant number of these units during the 10-year period
beginning with 2004; or
``(C) a population group which the Secretary determines has
such a shortage of providers or facilities.''.
SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH CENTERS PROGRAM TO
INCLUDE CENTERS ON OPTIMAL MATERNITY OUTCOMES.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Health and Human Services,
shall support the establishment of additional Prevention Research
Centers under the Prevention Research Center Program administered by
the Centers for Disease Control and Prevention. Such additional centers
shall each be known as a Center for Excellence on Optimal Maternity
Outcomes.
(b) Research.--Each Center for Excellence on Optimal Maternity
Outcomes shall--
(1) conduct at least one focused program of research to
improve maternity outcomes, including the reduction of cesarean
birth rates, elective inductions, prematurity rates, and low
birth weight rates within an underserved population that has a
disproportionately large burden of suboptimal maternity
outcomes, including maternal mortality and morbidity, infant
mortality, prematurity, or low birth weight;
(2) work with partners on special interest projects, as
specified by the Centers for Disease Control and Prevention and
other relevant agencies within the Department of Health and
Human Services, and on projects funded by other sources; and
(3) involve a minimum of two distinct birth setting models,
such as a hospital labor and delivery model and freestanding
birth center model; or a hospital labor and delivery model and
planned home birth model.
(c) Interdisciplinary Providers.--Each Center for Excellence on
Optimal Maternity Outcomes shall include the following
interdisciplinary providers of maternity care:
(1) Obstetrician-gynecologists.
(2) At least two of the following providers:
(A) Family practice physicians.
(B) Nurse practitioners.
(C) Physician assistants.
(D) Certified professional midwives.
(d) Services.--Research conducted by each Center for Excellence on
Optimal Maternity Outcomes shall include at least 2 (and preferably
more) of the following supportive provider services:
(1) Mental health.
(2) Doula labor support.
(3) Nutrition education.
(4) Childbirth education.
(5) Social work.
(6) Physical therapy or occupation therapy.
(7) Substance abuse services.
(8) Home visiting.
(e) Coordination.--The programs of research at each of the two
Centers of Excellence on Optimal Maternity Outcomes shall compliment
and not replicate the work of the other.
(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of the
fiscal years 2015 through 2019.
SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY CENTER FOR MEDICARE
AND MEDICAID INNOVATION TO INCLUDE MATERNITY CARE MODELS.
Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C.
1315a(b)(2)(B)) is amended by adding at the end the following new
clause:
``(xxi) Promoting evidence-based models of
care that have been associated with reductions
in maternal and infant health disparities,
including incorporating the use of doula and
promotoras support for pregnant and
childbearing women into evidence-based models
of prenatal care, labor and delivery, and
postpartum care, and supporting the appropriate
use of out-of-hospital birth models, including
births at home and in freestanding birth
centers.''.
SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATERNITY CARE EDUCATIONAL
MODELS AND TOOLS.
(a) In General.--Not later than 6 months after the date of the
enactment of this Act, the Secretary of Health and Human Services,
acting in conjunction with the Administrator of Health Resources and
Services Administration, shall convene, for a 1-year period, an
Interprofessional Maternity Provider Education Commission to discuss
and make recommendations for--
(1) a consensus standard physiologic maternity care
curriculum that takes into account the core competencies for
basic midwifery practice such as those developed by the
American College of Nurse Midwives and the North American
Registry of Midwives, and the educational objectives for
physicians practicing in obstetrics and gynecology as
determined by the Council on Resident Education in Obstetrics
and Gynecology;
(2) suggestions for multidisciplinary use of the consensus
physiologic curriculum;
(3) strategies to integrate and coordinate education across
maternity care disciplines, including recommendations to
increase medical and midwifery student exposure to out-of-
hospital birth; and
(4) pilot demonstrations of interprofessional educational
models.
(b) Participants.--The Commission shall include maternity care
educators, curriculum developers, service leaders, certification
leaders, and accreditation leaders from the various professions that
provide maternity care in this country. Such professions shall include
obstetrician gynecologists, certified nurse midwives or certified
midwives, family practice physicians, nurse practitioners, physician
assistants, certified professional midwives, and perinatal nurses.
Additionally, the Commission shall include representation from
maternity care consumer advocates.
(c) Curriculum.--The consensus standard physiologic maternity care
curriculum described in subsection (a)(1) shall--
(1) have a public health focus with a foundation in health
promotion and disease prevention;
(2) foster physiologic childbearing and woman and family
centered care;
(3) integrate strategies to reduce maternal and infant
morbidity and mortality;
(4) incorporate recommendations to ensure respectful, safe,
and seamless consultation, referral, transport, and transfer of
care when necessary; and
(5) include cultural sensitivity and strategies to decrease
disparities in maternity outcomes.
(d) Report.--Not later than 6 months after the final meeting of the
Commission, the Secretary of Health and Human Services shall--
(1) submit to Congress a report containing the
recommendations made by the Commission under this section; and
(2) make such report publicly available.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $1,000,000 for each of the
fiscal years 2015 and 2016, and such sums as are necessary for each of
the fiscal years 2017 through 2019.
SEC. 522. INCLUDING WITHIN INPATIENT HOSPITAL SERVICES UNDER MEDICARE
SERVICES FURNISHED BY CERTAIN STUDENTS, INTERNS, AND
RESIDENTS SUPERVISED BY CERTIFIED NURSE MIDWIVES.
(a) In General.--Section 1861(b) of the Social Security Act (42
U.S.C. 1395x(b)) is amended--
(1) in paragraph (6), by striking ``; or'' and inserting
``, or in the case of services in a hospital or osteopathic
hospital by a student midwife or an intern or resident-in-
training under a teaching program previously described in this
paragraph who is in the field of obstetrics and gynecology, if
such student midwife, intern, or resident-in-training is
supervised by a certified nurse-midwife to the extent permitted
under applicable State law and as may be authorized by the
hospital;'';
(2) in paragraph (7), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(8) a certified nurse-midwife where the hospital has a
teaching program approved as specified in paragraph (6), if (A)
the hospital elects to receive any payment due under this title
for reasonable costs of such services, and (B) all certified
nurse-midwives in such hospital agree not to bill charges for
professional services rendered in such hospital to individuals
covered under the insurance program established by this
title.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to services furnished on or after the date of the enactment of
this Act.
SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO INCREASE DIVERSITY IN
MATERNITY CARE PROFESSIONALS.
(a) In General.--The Secretary of Health and Human Services,
through the Administrator of the Health Resources and Services
Administration, shall carry out a grant program under which the
Secretary may make to eligible health professional organizations--
(1) for fiscal year 2015, planning grants described in
subsection (b); and
(2) for the subsequent 4-year period, implementation grants
described in subsection (c).
(b) Planning Grants.--
(1) In general.--Planning grants described in this
subsection are grants for the following purposes:
(A) To collect data and identify any workforce
disparities, with respect to a health profession, at
each of the following areas along the health
professional continuum:
(i) Pipeline availability with respect to
students at the high school and college or
university levels considering and working
toward entrance in the profession.
(ii) Entrance into the training program for
the profession.
(iii) Graduation from such training
program.
(iv) Entrance into practice.
(v) Retention in practice for more than a
5-year period.
(B) To develop one or more strategies to address
the workforce disparities within the health profession,
as identified under (and in response to the findings
pursuant to) subparagraph (A).
(2) Application.--To be eligible to receive a grant under
this subsection, an eligible health professional organization
shall submit to the Secretary of Health and Human Services an
application in such form and manner and containing such
information as specified by the Secretary.
(3) Amount.--Each grant awarded under this subsection shall
be for an amount not to exceed $300,000.
(4) Report.--Each recipient of a grant under this
subsection shall submit to the Secretary of Health and Human
Services a report containing--
(A) information on the extent and distribution of
workforce disparities identified through the grant; and
(B) reasonable objectives and strategies developed
to address such disparities within a 5-, 10-, and 25-
year period.
(c) Implementation Grants.--
(1) In general.--Implementation grants described in this
subsection are grants to implement one or more of the
strategies developed pursuant to a planning grant awarded under
subsection (b).
(2) Application.--To be eligible to receive a grant under
this subsection, an eligible health professional organization
shall submit to the Secretary of Health and Human Services an
application in such form and manner as specified by the
Secretary. Each such application shall contain information on
the capability of the organization to carry out a strategy
described in paragraph (1), involvement of partners or
coalitions, plans for developing sustainability of the efforts
after the culmination of the grant cycle, and any other
information specified by the Secretary.
(3) Amount.--Each grant awarded under this subsection shall
be for an amount not to exceed $500,000 each year during the 4-
year period of the grant.
(4) Reports.--For each of the first 3 years for which an
eligible health professional organization is awarded a grant
under this subsection, the organization shall submit to the
Secretary of Health and Human Services a report on the
activities carried out by such organization through the grant
during such year and objectives for the subsequent year. For
the fourth year for which an eligible health professional
organization is awarded a grant under this subsection, the
organization shall submit to the Secretary a report that
includes an analysis of all the activities carried out by the
organization through the grant and a detailed plan for
continuation of out-reach efforts.
(d) Eligible Health Professional Organization Defined.--For
purposes of this section, the term ``eligible health professional
organization'' means a professional organization representing
obstetrician-gynecologists, certified nurse midwives, certified
midwives, family practice physicians, nurse practitioners whose scope
of practice includes maternity care, physician assistants whose scope
of practice includes obstetrical care, or certified professional
midwives.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for fiscal year 2015
and $3,000,000 for each of the fiscal years 2016 through 2019.
TITLE VI--MENTAL HEALTH
SEC. 601. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES, MENTAL
HEALTH COUNSELOR SERVICES, AND SUBSTANCE ABUSE COUNSELOR
SERVICES UNDER PART B OF THE MEDICARE PROGRAM.
(a) Coverage of Services.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (EE), by striking ``and'' at
the end;
(B) in subparagraph (FF), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(GG) marriage and family therapist services (as defined
in subsection (kkk)(1)) and mental health counselor services
(as defined in subsection (kkk)(3)) and substance abuse
counselor services (as defined in subsection (kkk)(5));''.
(2) Definitions.--Section 1861 of such Act (42 U.S.C.
1395x), as amended by sections 202(b)(1)(A) and 423(a), is
amended by adding at the end the following new subsection:
``Marriage and Family Therapist Services; Marriage and Family
Therapist; Mental Health Counselor Services; Mental Health Counselor
``(kkk)(1) The term `marriage and family therapist services' means
services performed by a marriage and family therapist (as defined in
paragraph (2)) for the diagnosis and treatment of mental illnesses,
which the marriage and family therapist is legally authorized to
perform under State law (or the State regulatory mechanism provided by
State law) of the State in which such services are performed, as would
otherwise be covered if furnished by a physician or as an incident to a
physician's professional service, but only if no facility or other
provider charges or is paid any amounts with respect to the furnishing
of such services.
``(2) The term `marriage and family therapist' means an individual
who--
``(A) possesses a master's or doctoral degree which
qualifies for licensure or certification as a marriage and
family therapist pursuant to State law;
``(B) after obtaining such degree has performed at least 2
years of clinical supervised experience in marriage and family
therapy; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of marriage
and family therapists, is licensed or certified as a marriage
and family therapist in such State.
``(3) The term `mental health counselor services' means services
performed by a mental health counselor (as defined in paragraph (4))
for the diagnosis and treatment of mental illnesses which the mental
health counselor is legally authorized to perform under State law (or
the State regulatory mechanism provided by the State law) of the State
in which such services are performed, as would otherwise be covered if
furnished by a physician or as incident to a physician's professional
service, but only if no facility or other provider charges or is paid
any amounts with respect to the furnishing of such services.
``(4) The term `mental health counselor' means an individual who--
``(A) possesses a master's or doctor's degree in mental
health counseling or a related field;
``(B) after obtaining such a degree has performed at least
2 years of supervised mental health counselor practice; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of mental
health counselors or professional counselors, is licensed or
certified as a mental health counselor or professional
counselor in such State.
``(5) The term `substance abuse counselor services' means services
performed by a substance abuse counselor (as defined in paragraph (6))
for the diagnosis and treatment of substance abuse and addiction which
the substance abuse counselor is legally authorized to perform under
State law (or the State regulatory mechanism provided by the State law)
of the State in which such services are performed, as would otherwise
be covered if furnished by a physician or as incident to a physician's
professional service, but only if no facility or other provider charges
or is paid any amounts with respect to the furnishing of such services.
``(6) The term `substance abuse counselor' means an individual
who--
``(A) has performed at least 2 years of supervised
substance abuse counselor practice;
``(B) in the case of an individual performing services in a
State that provides for licensure or certification of substance
abuse counselors or professional counselors, is licensed or
certified as a substance abuse counselor or professional
counselor in such State; or
``(C) the individual is a drug and alcohol counselor as
defined in section 40.281 of title 49, Code of Federal
Regulations.''.
(3) Provision for payment under part b.--Section
1832(a)(2)(B) of such Act (42 U.S.C. 1395k(a)(2)(B)) is amended
by adding at the end the following new clause:
``(v) marriage and family therapist
services, mental health counselor services, and
substance abuse counselor services;''.
(4) Amount of payment.--Section 1833(a)(1) of such Act (42
U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (Z)'' and inserting ``(Z)'';
and
(B) by inserting before the semicolon at the end
the following: ``, and (AA) with respect to marriage
and family therapist services, mental health counselor
services, and substance abuse counselor services under
section 1861(s)(2)(GG), the amounts paid shall be 80
percent of the lesser of the actual charge for the
services or 75 percent of the amount determined for
payment of a psychologist under subparagraph (L)''.
(5) Exclusion of marriage and family therapist services and
mental health counselor services from skilled nursing facility
prospective payment system.--Section 1888(e)(2)(A)(ii) of such
Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
``marriage and family therapist services (as defined in section
1861(kkk)(1)), mental health counselor services (as defined in
section 1861(kkk)(3)),'' after ``qualified psychologist
services,''.
(6) Inclusion of marriage and family therapists, mental
health counselors, and substance abuse counselors as
practitioners for assignment of claims.--Section 1842(b)(18)(C)
of such Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at
the end the following new clauses:
``(vii) A marriage and family therapist (as defined in
section 1861(kkk)(2)).
``(viii) A mental health counselor (as defined in section
1861(kkk)(4)).
``(ix) A substance abuse counselor (as defined in section
1861 (kkk)(6)).''.
(b) Coverage of Certain Mental Health Services Provided in Certain
Settings.--
(1) Rural health clinics and federally qualified health
centers.--Section 1861(aa)(1)(B) of the Social Security Act (42
U.S.C. 1395x(aa)(1)(B)) is amended by striking ``or by a
clinical social worker (as defined in subsection (hh)(1)),''
and inserting ``, by a clinical social worker (as defined in
subsection (hh)(1)), by a marriage and family therapist (as
defined in subsection (kkk)(2)), or by a mental health
counselor (as defined in subsection (kkk)(4)), or by a
substance abuse counselor (as defined in section 1861
(kkk)(6)).''.
(2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) of
such Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by
inserting ``or one marriage and family therapist (as defined in
subsection (kkk)(2))'' after ``social worker''.
(c) Authorization of Marriage and Family Therapists To Develop
Discharge Plans for Post-Hospital Services.--Section 1861(ee)(2)(G) of
the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended by
inserting ``marriage and family therapist (as defined in subsection
(kkk)(2)),'' after ``social worker,''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to services furnished on or after January 1, 2015.
SEC. 602. MINORITY FELLOWSHIP PROGRAM.
Title V of the Public Health Service Act is amended by inserting
after section 506B of such Act (42 U.S.C. 290aa-5b) the following:
``SEC. 506C. MINORITY FELLOWSHIP PROGRAM.
``(a) Fellowships.--The Administrator shall maintain a program, to
be known as the Minority Fellowship Program, under which the
Administrator awards grants or contracts to national associations or
other appropriate entities for the financial support of graduate
students, postdoctoral fellows, and residents in the professions of
psychology, psychiatry, social work, psychiatric advance-practice
nursing, marriage and family therapy, and professional counseling to
students who demonstrate a commitment to clinical or research careers
focused on racial and ethnic minority populations.
``(b) Term of Financial Support.--Financial support provided to an
individual pursuant to subsection (a) shall be for a term of not more
than 12 months and may be renewed thereafter.
``(c) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for each of fiscal
years 2015 through 2019.''.
SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION PROGRAM.
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
et seq.) is amended by adding at the end the following:
``SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR PROVISION OF
BEHAVIORAL HEALTH CARE IN PRIMARY CARE SETTINGS.
``(a) Grants.--The Secretary, acting through the Deputy Assistant
Secretary for Minority Health, shall award grants to eligible entities
for the purpose of providing technical assistance and training
regarding the effective development and implementation of integrated
interprofessional health care teams that provide behavioral health
care.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be a federally qualified health center
(as defined in section 1861(aa) of the Social Security Act) serving a
high proportion of individuals from racial and ethnic minority groups
(as defined in section 1707(g)).
``(c) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $20,000,000 for each of fiscal
years 2014 through 2016.''.
SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY MENTAL HEALTH
DISPARITIES RESEARCH GAPS.
Not later than 6 months after the date of the enactment of this
Act, the Director of the National Institute on Minority Health and
Health Disparities shall enter into an arrangement with the Institute
of Medicine (or, if the Institute declines to enter into such an
arrangement, another appropriate entity)--
(1) to conduct a study with respect to mental and
behavioral health disparities in racial and ethnic minority
groups (as defined in section 1707(g) of the Public Health
Service Act (42 U.S.C. 300u-6(g)); and
(2) to submit to the Congress a report on the results of
such study, including--
(A) a compilation of information on the dynamics of
mental disorders in such racial and ethnic minority
groups;
(B) an identification of gaps in knowledge and
research needs; and
(C) recommendations for an interprofessional
research agenda at the National Institutes of Health
aimed at reducing and ultimately eliminating mental and
behavioral health disparities in such racial and ethnic
minority groups.
SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO ADDRESS RACIAL AND ETHNIC
MINORITY MENTAL HEALTH DISPARITIES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator of the Substance Abuse and Mental Health
Services Administration, shall award grants to qualified national
organizations for the purpose of developing, and disseminating to
health professional educational programs, curricula or core
competencies addressing mental health disparities among racial and
ethnic minority groups.
(b) Use of Funds.--Organizations receiving funds under subsection
(a) shall use the funds to develop and disseminate curricula or core
competencies, as described in such subsection, for use in the training
of students in the professions of social work, psychology, psychiatry,
marriage and family therapy, mental health counseling, and substance
abuse counseling.
(c) Allowable Activities.--Organizations receiving funds under
subsection (a) may use the funds to engage in the following activities
related to the development and dissemination of curricula or core
competencies:
(1) Formation of committees or working groups comprised of
experts from accredited health professions schools to identify
core competencies relating to mental health disparities among
racial and ethnic minority groups.
(2) Planning of workshops in national fora to allow for
public input into the educational needs associated with mental
health disparities among racial and ethnic minority groups.
(3) Dissemination and promotion of the use of curricula or
core competencies in undergraduate and graduate health
professions training programs nationwide.
(d) Definitions.--In this section:
(1) The term ``qualified national organization'' means a
national organization that focuses on the education of students
in programs of social work, psychology, psychiatry, and
marriage and family therapy.
(2) The term ``racial and ethnic minority group'' has the
meaning given to such term in section 1707(g) of the Public
Health Service Act (42 U.S.C. 300u-6(g)).
(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 2014 through 2018.
TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES
Subtitle A--Cancer
SEC. 701. LUNG CANCER MORTALITY REDUCTION.
(a) Short Title.--This section may be cited as the ``Lung Cancer
Mortality Reduction Act of 2014''.
(b) Findings.--Congress makes the following findings:
(1) Lung cancer is the leading cause of cancer death for
both men and women, accounting for 28 percent of all cancer
deaths.
(2) Lung cancer kills more people annually than breast
cancer, prostate cancer, colon cancer, liver cancer, melanoma,
and kidney cancer combined.
(3) Since the National Cancer Act of 1971 (Public Law 92-
218; 85 Stat. 778), coordinated and comprehensive research has
raised the 5-year survival rates for breast cancer to 88
percent, for prostate cancer to 99 percent, and for colon
cancer to 64 percent.
(4) However, the 5-year survival rate for lung cancer is
still only 15 percent and a similar coordinated and
comprehensive research effort is required to achieve increases
in lung cancer survivability rates.
(5) Sixty percent of lung cancer cases are now diagnosed
nonsmokers or former smokers.
(6) Two-thirds of nonsmokers diagnosed with lung cancer are
women.
(7) Certain minority populations, such as African-American
males, have disproportionately high rates of lung cancer
incidence and mortality, notwithstanding their similar smoking
rate.
(8) Members of the baby boomer generation are entering
their sixties, the most common age at which people develop lung
cancer.
(9) Tobacco addiction and exposure to other lung cancer
carcinogens such as Agent Orange and other herbicides and
battlefield emissions are serious problems among military
personnel and war veterans.
(10) Significant and rapid improvements in lung cancer
mortality can be expected through greater use and access to
lung cancer screening tests for at-risk individuals.
(11) Additional strategies are necessary to further enhance
the existing tests and therapies available to diagnose and
treat lung cancer in the future.
(12) The August 2001 Report of the Lung Cancer Progress
Review Group of the National Cancer Institute stated that
funding for lung cancer research was ``far below the levels
characterized for other common malignancies and far out of
proportion to its massive health impact''.
(13) The Report of the Lung Cancer Progress Review Group
identified as its ``highest priority'' the creation of
integrated, multidisciplinary, multi-institutional research
consortia organized around the problem of lung cancer rather
than around specific research disciplines.
(14) The United States must enhance its response to the
issues raised in the Report of the Lung Cancer Progress Review
Group, and this can be accomplished through the establishment
of a coordinated effort designed to reduce the lung cancer
mortality rate by 50 percent by 2015 and targeted funding to
support this coordinated effort.
(c) Sense of Congress Concerning Investment in Lung Cancer
Research.--It is the sense of the Congress that--
(1) lung cancer mortality reduction should be made a
national public health priority; and
(2) a comprehensive mortality reduction program coordinated
by the Secretary of Health and Human Services is justified and
necessary to adequately address and reduce lung cancer
mortality.
(d) Lung Cancer Mortality Reduction Program.--
(1) In general.--Subpart 1 of part C of title IV of the
Public Health Service Act (42 U.S.C. 285 et seq.) is amended by
adding at the end the following:
``SEC. 417H. LUNG CANCER MORTALITY REDUCTION PROGRAM.
``(a) In General.--Not later than 6 months after the date of the
enactment of this section, the Secretary, in consultation with the
Secretary of Defense, the Secretary of Veterans Affairs, the Director
of the National Institutes of Health, the Director of the Centers for
Disease Control and Prevention, the Commissioner of Food and Drugs, the
Administrator of the Centers for Medicare & Medicaid Services, the
Director of the National Institute on Minority Health and Health
Disparities, and other members of the Lung Cancer Advisory Board
established under section 701 of the Health Equity and Accountability
Act of 2014, shall implement a comprehensive program, to be known as
the Lung Cancer Mortality Reduction Program, to achieve a reduction of
at least 25 percent in the mortality rate of lung cancer by 2020.
``(b) Requirements.--The Program shall include at least the
following:
``(1) With respect to the National Institutes of Health--
``(A) a strategic review and prioritization by the
National Cancer Institute of research grants to achieve
the goal of the Lung Cancer Mortality Reduction Program
in reducing lung cancer mortality;
``(B) the provision of funds to enable the Airway
Biology and Disease Branch of the National Heart, Lung,
and Blood Institute to expand its research programs to
include predispositions to lung cancer, the
interrelationship between lung cancer and other
pulmonary and cardiac disease, and the diagnosis and
treatment of these interrelationships;
``(C) the provision of funds to enable the National
Institute of Biomedical Imaging and Bioengineering to
expedite the development of computer-assisted
diagnostic, surgical, treatment, and drug-testing
innovations to reduce lung cancer mortality, such as
through expansion of the Institute's Quantum Grant
Program and Image-Guided Interventions programs; and
``(D) the provision of funds to enable the National
Institute of Environmental Health Sciences to implement
research programs relative to the lung cancer
incidence.
``(2) With respect to the Food and Drug Administration--
``(A) activities under section 530 of the Federal
Food, Drug, and Cosmetic Act; and
``(B) activities under section 561 of the Federal
Food, Drug, and Cosmetic Act to expand access to
investigational drugs and devices for the diagnosis,
monitoring, or treatment of lung cancer.
``(3) With respect to the Centers for Disease Control and
Prevention, the establishment of an early disease research and
management program under section 1511.
``(4) With respect to the Agency for Healthcare Research
and Quality, the conduct of a biannual review of lung cancer
screening, diagnostic, and treatment protocols, and the
issuance of updated guidelines.
``(5) The cooperation and coordination of all minority and
health disparity programs within the Department of Health and
Human Services to ensure that all aspects of the Lung Cancer
Mortality Reduction Program under this section adequately
address the burden of lung cancer on minority and rural
populations.
``(6) The cooperation and coordination of all tobacco
control and cessation programs within agencies of the
Department of Health and Human Services to achieve the goals of
the Lung Cancer Mortality Reduction Program under this section
with particular emphasis on the coordination of drug and other
cessation treatments with early detection protocols.''.
(2) Federal food, drug, and cosmetic act.--Subchapter B of
chapter V of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 360aaa et seq.) is amended by adding at the end the
following:
``drugs relating to lung cancer
``Sec. 530. (a) In General.--The provisions of this subchapter
shall apply to a drug described in subsection (b) to the same extent
and in the same manner as such provisions apply to a drug for a rare
disease or condition.
``(b) Qualified Drugs.--A drug described in this subsection is--
``(1) a chemoprevention drug for precancerous conditions of
the lung;
``(2) a drug for targeted therapeutic treatments, including
any vaccine, for lung cancer; and
``(3) a drug to curtail or prevent nicotine addiction.
``(c) Board.--The Board established under the Health Equity and
Accountability Act of 2014 shall monitor the program implemented under
this section.''.
(3) Access to unapproved therapies.--Section 561(e) of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb(e)) is
amended by inserting before the period the following: ``and
shall include expanding access to drugs under section 530, with
substantial consideration being given to whether the totality
of information available to the Secretary regarding the safety
and effectiveness of an investigational drug, as compared to
the risk of morbidity and death from the disease, indicates
that a patient may obtain more benefit than risk if treated
with the drug''.
(4) CDC.--Title XV of the Public Health Service Act (42
U.S.C. 300k et seq.) is amended by adding at the end the
following:
``SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT PROGRAM.
``The Secretary shall establish and implement an early disease
research and management program targeted at the high incidence and
mortality rates of lung cancer among minority and low-income
populations.''.
(e) Department of Defense and the Department of Veterans Affairs.--
The Secretary of Defense and the Secretary of Veterans Affairs shall
coordinate with the Secretary of Health and Human Services--
(1) in the development of the Lung Cancer Mortality
Reduction Program under section 417H;
(2) in the implementation within the Department of Defense
and the Department of Veterans Affairs of an early detection
and disease management research program for military personnel
and veterans whose smoking history and exposure to carcinogens
during active duty service has increased their risk for lung
cancer; and
(3) in the implementation of coordinated care programs for
military personnel and veterans diagnosed with lung cancer.
(f) Lung Cancer Advisory Board.--
(1) In general.--The Secretary of Health and Human Services
shall convene a Lung Cancer Advisory Board (referred to in this
section as the ``Board'')--
(A) to monitor the programs established under this
section (and the amendments made by this section); and
(B) to provide annual reports to the Congress
concerning benchmarks, expenditures, lung cancer
statistics, and the public health impact of such
programs.
(2) Composition.--The Board shall be composed of--
(A) the Secretary of Health and Human Services;
(B) the Secretary of Defense;
(C) the Secretary of Veterans Affairs; and
(D) two representatives each from the fields of
clinical medicine focused on lung cancer, lung cancer
research, imaging, drug development, and lung cancer
advocacy, to be appointed by the Secretary of Health
and Human Services.
(g) Authorization of Appropriations.--
(1) In general.--To carry out this section (and the
amendments made by this section), there are authorized to be
appropriated such sums as may be necessary for each of fiscal
years 2015 through 2019.
(2) Lung cancer mortality reduction program.--Of the
amounts authorized to be appropriated by subsection (a), there
are authorized to be appropriated--
(A) $25,000,000 for fiscal year 2015, and such sums
as may be necessary for each of fiscal years 2016
through 2019, for the activities described in section
417H(b)(1)(B) of the Public Health Service Act, as
added by subsection (d)(1);
(B) $25,000,000 for fiscal year 2015, and such sums
as may be necessary for each of fiscal years 2016
through 2019, for the activities described in section
417H(b)(1)(C) of such Act;
(C) $10,000,000 for fiscal year 2015, and such sums
as may be necessary for each of fiscal years 2016
through 2019, for the activities described in section
417H(b)(1)(D) of such Act; and
(D) $15,000,000 for fiscal year 2015, and such sums
as may be necessary for each of fiscal years 2016
through 2019, for the activities described in section
417H(b)(3) of such Act.
SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUTREACH, SCREENING,
TESTING, ACCESS, AND TREATMENT EFFECTIVENESS.
(a) Short Title.--This section may be cited as the ``Prostate
Research, Outreach, Screening, Testing, Access, and Treatment
Effectiveness Act of 2014'' or the ``PROSTATE Act''.
(b) Findings.--Congress makes the following findings:
(1) Prostate cancer is the second leading cause of cancer
death among men.
(2) In 2010, more than 217,730 new patients were diagnosed
with prostate cancer and more than 32,000 men died from this
disease.
(3) Roughly 2,000,000 Americans are living with a diagnosis
of prostate cancer and its consequences.
(4) While prostate cancer generally affects older
individuals, younger men are also at risk for the disease, and
when prostate cancer appears in early middle age it frequently
takes on a more aggressive form.
(5) There are significant racial and ethnic disparities
that demand attention, namely African-Americans have prostate
cancer mortality rates that are more than double those in the
White population.
(6) Underserved rural populations have higher rates of
mortality compared to their urban counterparts, and innovative
and cost-efficient methods to improve rural access to high
quality care should take advantage of advances in telehealth to
diagnose and treat prostate cancer when appropriate.
(7) Certain veterans populations may have nearly twice the
incidence of prostate cancer as the general population of the
United States.
(8) Urologists may constitute the specialists who diagnose
and treat the vast majority of prostate cancer patients.
(9) Although much basic and translational research has been
completed and much is currently known, there are still many
unanswered questions. For example, it is not fully understood
how much of known disparities are attributable to disease
etiology, access to care, or education and awareness in the
community.
(10) Causes of prostate cancer are not known. There is not
good information regarding how to differentiate accurately,
early on, between aggressive and indolent forms of the disease.
As a result, there is significant overtreatment in prostate
cancer. There are no treatments that can durably arrest growth
or cure prostate cancer once it has metastasized.
(11) A significant proportion (roughly 23 to 54 percent) of
cases may be clinically indolent and ``overdiagnosed'',
resulting in significant overtreatment. More accurate tests
will allow men and their families to face less physical,
psychological, financial, and emotional trauma and billions of
dollars could be saved in private and public health care
systems in an area that has been identified by the Medicare
Program as one of eight high-volume, high-cost areas in the
Resource Utilization Report Program authorized by Congress
under the Medicare Improvements for Patients and Providers Act
of 2008.
(12) Prostate cancer research and health care programs
across Federal agencies should be coordinated to improve
accountability and actively encourage the translation of
research into practice, to identify and implement best
practices, in order to foster an integrated and consistent
focus on effective prevention, diagnosis, and treatment of this
disease.
(c) Prostate Cancer Coordination and Education.--
(1) Interagency prostate cancer coordination and education
task force.--Not later than 180 days after the date of the
enactment of this section, the Secretary of Veterans Affairs,
in cooperation with the Secretary of Defense and the Secretary
of Health and Human Services, shall establish an Interagency
Prostate Cancer Coordination and Education Task Force (in this
section referred to as the ``Prostate Cancer Task Force'').
(2) Duties.--The Prostate Cancer Task Force shall--
(A) develop a summary of advances in prostate
cancer research supported or conducted by Federal
agencies relevant to the diagnosis, prevention, and
treatment of prostate cancer, including psychosocial
impairments related to prostate cancer treatment, and
compile a list of best practices that warrant broader
adoption in health care programs;
(B) consider establishing, and advocating for, a
guidance to enable physicians to allow screening of men
who are over age 74, on a case-by-case basis, taking
into account quality of life and family history of
prostate cancer;
(C) share and coordinate information on Federal
research and health care program activities, including
activities related to--
(i) determining how to improve research and
health care programs, including psychosocial
impairments related to prostate cancer
treatment;
(ii) identifying any gaps in the overall
research inventory and in health care programs;
(iii) identifying opportunities to promote
translation of research into practice; and
(iv) maximizing the effects of Federal
efforts by identifying opportunities for
collaboration and leveraging of resources in
research and health care programs that serve
those susceptible to or diagnosed with prostate
cancer;
(D) develop a comprehensive interagency strategy
and advise relevant Federal agencies in the
solicitation of proposals for collaborative,
multidisciplinary research and health care programs,
including proposals to evaluate factors that may be
related to the etiology of prostate cancer, that
would--
(i) result in innovative approaches to
study emerging scientific opportunities or
eliminate knowledge gaps in research to improve
the prostate cancer research portfolio of the
Federal Government;
(ii) outline key research questions,
methodologies, and knowledge gaps; and
(iii) ensure consistent action, as outlined
by section 402(b) of the Public Health Service
Act;
(E) develop a coordinated message related to
screening and treatment for prostate cancer to be
reflected in educational and beneficiary materials for
Federal health programs as such documents are updated;
and
(F) not later than 2 years after the date of the
establishment of the Prostate Cancer Task Force, submit
to the Expert Advisory Panel to be reviewed and
returned within 30 days, and then within 90 days
submitted to Congress recommendations--
(i) regarding any appropriate changes to
research and health care programs, including
recommendations to improve the research
portfolio of the Department of Veterans
Affairs, Department of Defense, National
Institutes of Health, and other Federal
agencies to ensure that scientifically based
strategic planning is implemented in support of
research and health care program priorities;
(ii) designed to ensure that the research
and health care programs and activities of the
Department of Veterans Affairs, the Department
of Defense, the Department of Health and Human
Services, and other Federal agencies are free
of unnecessary duplication;
(iii) regarding public participation in
decisions relating to prostate cancer research
and health care programs to increase the
involvement of patient advocates, community
organizations, and medical associations
representing a broad geographical area;
(iv) on how to best disseminate information
on prostate cancer research and progress
achieved by health care programs;
(v) about how to expand partnerships
between public entities, including Federal
agencies, and private entities to encourage
collaborative, cross-cutting research and
health care delivery;
(vi) assessing any cost savings and
efficiencies realized through the efforts
identified and supported in this section and
recommending expansion of those efforts that
have proved most promising while also ensuring
against any conflicts in directives from other
congressional or statutory mandates or enabling
statutes;
(vii) identifying key priority action items
from among the recommendations; and
(viii) with respect to the level of funding
needed by each agency to implement the
recommendations contained in the report.
(3) Members of the prostate cancer task force.--The
Prostate Cancer Task Force described in subsection (a) shall be
composed of representatives from such Federal agencies, as each
Secretary determines necessary, to coordinate a uniform message
relating to prostate cancer screening and treatment where
appropriate, including representatives of the following:
(A) The Department of Veterans Affairs, including
representatives of each relevant program areas of the
Department of Veterans Affairs.
(B) The Prostate Cancer Research Program of the
Congressionally Directed Medical Research Program of
the Department of Defense.
(C) The Department of Health and Human Services,
including at a minimum representatives of the
following:
(i) The National Institutes of Health.
(ii) National research institutes and
centers, including the National Cancer
Institute, the National Institute of Allergy
and Infectious Diseases, and the Office of
Minority Health.
(iii) The Centers for Medicare & Medicaid
Services.
(iv) The Food and Drug Administration.
(v) The Centers for Disease Control and
Prevention.
(vi) The Agency for Healthcare Research and
Quality.
(vii) The Health Resources and Services
Administration.
(4) Appointing expert advisory panels.--The Prostate Cancer
Task Force shall appoint expert advisory panels, as determined
appropriate, to provide input and concurrence from individuals
and organizations from the medical, prostate cancer patient and
advocate, research, and delivery communities with expertise in
prostate cancer diagnosis, treatment, and research, including
practicing urologists, primary care providers, and others and
individuals with expertise in education and outreach to
underserved populations affected by prostate cancer.
(5) Meetings.--The Prostate Cancer Task Force shall convene
not less than twice a year, or more frequently as the Secretary
determines to be appropriate.
(6) Submission of recommendations to congress.--The
Secretary of Veterans Affairs shall submit to Congress any
recommendations submitted to the Secretary under paragraph
(2)(E).
(7) Federal advisory committee act.--
(A) In general.--Except as provided in subparagraph
(B), the Federal Advisory Committee Act (5 U.S.C. App.)
shall apply to the Prostate Cancer Task Force.
(B) Exception.--Section 14(a)(2)(B) of such Act
(relating to the termination of advisory committees)
shall not apply to the Prostate Cancer Task Force.
(8) Sunset date.--The Prostate Cancer Task Force shall
terminate at the end of fiscal year 2019.
(d) Prostate Cancer Research.--
(1) Research coordination.--The Secretary of Veterans
Affairs, in coordination with the Secretaries of Defense and of
Health and Human Services, shall establish and carry out a
program to coordinate and intensify prostate cancer research as
needed. Specifically, such research program shall--
(A) develop advances in diagnostic and prognostic
methods and tests, including biomarkers and an improved
prostate cancer screening blood test, including
improvements or alternatives to the prostate specific
antigen test and additional tests to distinguish
indolent from aggressive disease;
(B) better understand the etiology of the disease
(including an analysis of lifestyle factors proven to
be involved in higher rates of prostate cancer, such as
obesity and diet, and in different ethnic, racial, and
socioeconomic groups, such as the African-American,
Latino or Hispanic, and American Indian populations and
men with a family history of prostate cancer) to
improve prevention efforts;
(C) expand basic research into prostate cancer,
including studies of fundamental molecular and cellular
mechanisms;
(D) identify and provide clinical testing of novel
agents for the prevention and treatment of prostate
cancer;
(E) establish clinical registries for prostate
cancer;
(F) use the National Institute of Biomedical
Imaging and Bioengineering and the National Cancer
Institute for assessment of appropriate imaging
modalities; and
(G) address such other matters relating to prostate
cancer research as may be identified by the Federal
agencies participating in the program under this
section.
(2) Prostate cancer advisory board.--There is established
in the Office of the Chief Scientist of the Food and Drug
Administration a Prostate Cancer Scientific Advisory Board.
Such board shall be responsible for accelerating real-time
sharing of the latest research data and accelerating movement
of new medicines to patients.
(3) Underserved minority grant program.--In carrying out
such program, the Secretary shall--
(A) award grants to eligible entities to carry out
components of the research outlined in paragraph (1);
(B) integrate and build upon existing knowledge
gained from comparative effectiveness research; and
(C) recognize and address--
(i) the racial and ethnic disparities in
the incidence and mortality rates of prostate
cancer and men with a family history of
prostate cancer;
(ii) any barriers in access to care and
participation in clinical trials that are
specific to racial, ethnic, and other
underserved minorities and men with a family
history of prostate cancer;
(iii) needed outreach and educational
efforts to raise awareness in these
communities; and
(iv) appropriate access and utilization of
imaging modalities.
(e) Telehealth and Rural Access Pilot Project.--
(1) In general.--The Secretary of Veterans Affairs, the
Secretary of Defense, and the Secretary of Health and Human
Services (in this section referred to as the ``Secretaries'')
shall establish 4-year telehealth pilot projects for the
purpose of analyzing the clinical outcomes and cost
effectiveness associated with telehealth services in a variety
of geographic areas that contain high proportions of medically
underserved populations, including African-Americans, Latino or
Hispanic, American Indians/Alaska Natives, and those in rural
areas. Such projects shall promote efficient use of specialist
care through better coordination of primary care and physician
extender teams in underserved areas and more effectively employ
tumor boards to better counsel patients.
(2) Eligible entities.--
(A) In general.--The Secretaries shall select
eligible entities to participate in the pilot projects
under this section.
(B) Priority.--In selecting eligible entities to
participate in the pilot projects under this section,
the Secretaries shall give priority to such entities
located in medically underserved areas, particularly
those that include African-Americans, Latinos and
Hispanics, and facilities of the Indian Health Service,
including Indian Health Service operated facilities,
tribally operated facilities, and Urban Indian Clinics,
and those in rural areas.
(3) Evaluation.--The Secretaries shall, through the pilot
projects, evaluate--
(A) the effective and economic delivery of care in
diagnosing and treating prostate cancer with the use of
telehealth services in medically underserved and tribal
areas including collaborative uses of health
professionals and integration of the range of
telehealth and other technologies;
(B) the effectiveness of improving the capacity of
nonmedical providers and nonspecialized medical
providers to provide health services for prostate
cancer in medically underserved and tribal areas,
including the exploration of innovative medical home
models with collaboration between urologists, other
relevant medical specialists, including oncologists,
radiologists, and primary care teams and coordination
of care through the efficient use of primary care teams
and physician extenders; and
(C) the effectiveness of using telehealth services
to provide prostate cancer treatment in medically
underserved areas, including the use of tumor boards to
facilitate better patient counseling.
(4) Report.--Not later than 12 months after the completion
of the pilot projects under this subsection, the Secretaries
shall submit to Congress a report describing the outcomes of
such pilot projects, including any cost savings and
efficiencies realized, and providing recommendations, if any,
for expanding the use of telehealth services.
(f) Education and Awareness.--
(1) In general.--The Secretary of Veterans Affairs shall
develop a national education campaign for prostate cancer. Such
campaign shall involve the use of written educational materials
and public service announcements consistent with the findings
of the Prostate Cancer Task Force under subsection (c), that
are intended to encourage men to seek prostate cancer screening
when appropriate.
(2) Racial disparities and the population of men with a
family history of prostate cancer.--In developing the national
campaign under paragraph (1), the Secretary shall ensure that
such educational materials and public service announcements are
more readily available in communities experiencing racial
disparities in the incidence and mortality rates of prostate
cancer and by men of any race classification with a family
history of prostate cancer.
(3) Grants.--In carrying out the national campaign under
this section, the Secretary shall award grants to nonprofit
private entities to enable such entities to test alternative
outreach and education strategies.
(g) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
carry out this section for the period of fiscal years 2015
through 2019 an amount equal to the savings described in
paragraph (2).
(2) Corresponding reduction.--The amount authorized to be
appropriated by provisions of law other than this section for
the period of fiscal years 2015 through 2019 for Federal
research and health care program activities related to prostate
cancer is reduced by the amount of Federal savings projected to
be achieved over such period by implementation of subsection
(c)(2)(C) of this section.
SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN BREAST AND CERVICAL
CANCER PATIENTS IN THE TERRITORIES.
(a) Elimination of Funding Limitations.--
(1) In general.--Section 1108(g)(4) of the Social Security
Act (42 U.S.C. 1308(g)(4)) is amended by adding at the end the
following: ``With respect to fiscal years beginning with fiscal
year 2015, payment for medical assistance for individuals who
are eligible for such assistance only on the basis of section
1902(a)(10)(A)(ii)(XVIII) shall not be taken into account in
applying subsection (f) (as increased in accordance with
paragraphs (1), (2), (3), and (5) of this subsection) to such
commonwealth or territory for such fiscal year.''.
(2) Technical amendment.--Such section is further amended
by striking ``(3), and (4)'' and inserting ``(3), and (5)''.
(b) Application of Enhanced FMAP for Highest State.--Section
1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding at the
end the following: ``Notwithstanding the first sentence of this
subsection, with respect to medical assistance described in clause (4)
of such sentence that is furnished in Puerto Rico, the United States
Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands,
or American Samoa in a fiscal year, the Federal medical assistance
percentage is equal to the highest such percentage applied under such
clause for such fiscal year for any of the 50 States or the District of
Columbia that provides such medical assistance for any portion of such
fiscal year.''
(c) Effective Date.--The amendments made by this section shall
apply to payment for medical assistance for items and services
furnished on or after October 1, 2014.
SEC. 704. CANCER PREVENTION AND TREATMENT DEMONSTRATION FOR ETHNIC AND
RACIAL MINORITIES.
(a) Demonstration.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall
conduct demonstration projects (in this section referred to as
``demonstration projects'') for the purpose of developing
models and evaluating methods that--
(A) improve the quality of items and services
provided to target individuals in order to facilitate
reduced disparities in early detection and treatment of
cancer;
(B) improve clinical outcomes, satisfaction,
quality of life, appropriate use of items and services
covered under the Medicare Program under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.), and
referral patterns with respect to target individuals
with cancer;
(C) eliminate disparities in the rate of preventive
cancer screening measures, such as Pap smears, prostate
cancer screenings, colon cancer screenings, breast
cancer screenings, and computed tomography (CT) scans,
for lung cancer among target individuals;
(D) promote collaboration with community-based
organizations to ensure cultural competency of health
care professionals and linguistic access for target
individuals who are persons with limited-English
proficiency; and
(E) encourage the incorporation of community health
workers to increase the efficiency and appropriateness
of cancer screening programs.
(2) Community health worker defined.--In this section, the
term ``community health worker'' includes a community health
advocate, a lay health worker, a community health
representative, a peer health promotor, a community health
outreach worker, and a promotore de salud, who promotes health
or nutrition within the community in which the individual
resides.
(3) Target individual defined.--In this section, the term
``target individual'' means an individual of a racial and
ethnic minority group, as defined in section 1707(g)(1) of the
Public Health Service Act (42 U.S.C. 300u-6(g)(1)), who is
entitled to benefits under part A, and enrolled under part B,
of title XVIII of the Social Security Act.
(b) Program Design.--
(1) Initial design.--Not later than 1 year after the date
of the enactment of this Act, the Secretary shall evaluate best
practices in the private sector, community programs, and
academic research of methods that reduce disparities among
individuals of racial and ethnic minority groups in the
prevention and treatment of cancer and shall design the
demonstration projects based on such evaluation.
(2) Number and project areas.--Not later than 2 years after
the date of the enactment of this Act, the Secretary shall
implement at least nine demonstration projects, including the
following:
(A) Two projects, each of which shall target
different ethnic subpopulations, for each of the four
following major racial and ethnic minority groups:
(i) American Indians and Alaska Natives,
Eskimos and Aleuts.
(ii) Asian-Americans.
(iii) Blacks/African-Americans.
(iv) Latinos or Hispanics.
(v) Native Hawaiians and other Pacific
Islanders.
(B) One project within the Pacific Islands or
United States insular areas.
(C) At least one project each in a rural area and
inner-city area.
(3) Expansion of projects; implementation of demonstration
project results.--If the initial report under subsection (c)
contains an evaluation that demonstration projects--
(A) reduce expenditures under the Medicare Program
under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.); or
(B) do not increase expenditures under the Medicare
Program and reduce racial and ethnic health disparities
in the quality of health care services provided to
target individuals and increase satisfaction of
Medicare beneficiaries and health care providers;
the Secretary shall continue the existing demonstration
projects and may expand the number of demonstration projects.
(c) Report to Congress.--
(1) In general.--Not later than 2 years after the date the
Secretary implements the initial demonstration projects, and
biannually thereafter, the Secretary shall submit to Congress a
report regarding the demonstration projects.
(2) Contents of report.--Each report under paragraph (1)
shall include the following:
(A) A description of the demonstration projects.
(B) An evaluation of--
(i) the cost effectiveness of the
demonstration projects;
(ii) the quality of the health care
services provided to target individuals under
the demonstration projects; and
(iii) beneficiary and health care provider
satisfaction under the demonstration projects.
(C) Any other information regarding the
demonstration projects that the Secretary determines to
be appropriate.
(d) Waiver Authority.--The Secretary shall waive compliance with
the requirements of title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) to such extent and for such period as the Secretary
determines is necessary to conduct demonstration projects.
SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDICARE.
(a) Development of Measures of Disparities in Quality of Cancer
Care.--
(1) Development of measures.--The Secretary of Health and
Human Services (in this section referred to as the
``Secretary'') shall enter into an agreement with an entity
that specializes in developing quality measures for cancer care
under which the entity shall develop a uniform set of measures
to evaluate disparities in the quality of cancer care and
annually update such set of measures.
(2) Measures to be included.--Such set of measures shall
include, with respect to the treatment of cancer, measures of
patient outcomes, the process for delivering medical care
related to such treatment, patient counseling and engagement in
decisionmaking, patient experience of care, resource use, and
practice capabilities, such as care coordination.
(b) Establishment of Reporting Process.--
(1) In general.--The Secretary shall establish a reporting
process that requires and provides for a method for health care
providers specified under paragraph (2) to submit to the
Secretary and make public data on the performance of such
providers during each reporting period through use of the
measures developed pursuant to subsection (a). Such data shall
be submitted in a form and manner and at a time specified by
the Secretary.
(2) Specification of providers to report on measures.--The
Secretary shall specify the classes of Medicare providers of
services and suppliers, including hospitals, cancer centers,
physicians, primary care providers, and specialty providers,
that will be required under such process to publicly report on
the measures specified under subsection (a).
(3) Assessment of changes.--Under such reporting process,
the Secretary shall establish a format that assesses changes in
both the absolute and relative disparities in cancer care over
time. These measures shall be presented in an easily
comprehensible format, such as those presented in the final
publications relating to Healthy People 2010 or the National
Healthcare Disparities Report.
(4) Initial implementation.--The Secretary shall implement
the reporting process under this subsection for reporting
periods beginning not later than 6 months after the date that
measures are first established under subsection (a).
Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention
SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL AND PREVENTION.
(a) Short Title.--This subtitle may be cited as the ``Viral
Hepatitis and Liver Cancer Control and Prevention Act of 2014''.
(b) Findings.--Congress finds the following:
(1) Approximately 5,300,000 Americans are chronically
infected with the hepatitis B virus (referred to in this
section as ``HBV''), the hepatitis C virus (referred to in this
section as ``HCV''), or both.
(2) In the United States, chronic HBV and HCV are the most
common cause of liver cancer, one of the most lethal and
fastest growing cancers in this country. It is the most common
cause of chronic liver disease, liver cirrhosis, and the most
common indication for liver transplantation. At least 15,000
deaths per year in the United States can be attributed to
chronic HBV and HCV. Chronic HCV is also a leading cause of
death in Americans living with HIV/AIDS, many of those living
with HIV/AIDS are coinfected with chronic HBV, chronic HCV, or
both.
(3) According to the Centers for Disease Control and
Prevention (referred to in this section as the ``CDC''),
approximately 2 percent of the population of the United States
is living with chronic HBV, chronic HCV, or both. The CDC has
recognized HCV as the Nation's most common chronic bloodborne
virus infection and HBV as the deadliest vaccine-preventable
disease.
(4) HBV is easily transmitted and is 100 times more
infectious than HIV. According to the CDC, HBV is transmitted
through contact with infectious blood, semen, or other body
fluids. HCV is transmitted by contact with infectious blood,
particularly through percutaneous exposures (i.e. puncture
through the skin).
(5) The CDC conservatively estimates that in 2010
approximately 17,000 Americans were newly infected with HCV and
more than 35,000 Americans were newly infected with HBV. These
estimates could be much higher due to many reasons, including
lack of screening education and awareness, and perceived
marginalization of the populations at risk.
(6) In 2012, CDC released new guidelines recommending every
person born between 1945 and 1965 receive a one-time test.
Among the estimated 102 million (1.6 million chronically HCV-
infected) eligible for screening, birth-cohort screening leads
to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer
cases of hepatocellular carcinoma, 10,000 fewer liver
transplants, and 78,000 fewer HCV-related deaths gained versus
risk-based screening.
(7) In 2013, the United States Preventive Task Force
(USPSTF) issued a Grade B rating for screening for the
hepatitis C virus (HCV) infection in persons at high risk for
infection and adults born between 1945 and 1965. In 2014, the
USPSTF issued a Grade B for screening for the hepatitis B virus
(HBV) in persons at high-risk of hepatitis B infection. In
2009, the USPSTF issued a Grade A for screening pregnant women
for the hepatitis B virus (HBV) during their first prenatal
visit.
(8) There were 35 outbreaks (19 of HBV, 16 of HCV) reported
to CDC for investigation from 2008 through 2012 related to
health care acquired infection of HBV and HCV, 33 of which
occurred in nonhospital settings. There were more than 99,975
patients potentially exposed to one of the viruses.
(9) Chronic HBV and chronic HCV usually do not cause
symptoms early in the course of the disease, but after many
years of a clinically ``silent'' phase, CDC estimates show more
than 33 percent of infected individuals will develop cirrhosis,
end-stage liver disease, or liver cancer. Since most
individuals with chronic HBV, HCV, or both are unaware of their
infection, they do not know to take precautions to prevent the
spread of their infection and can unknowingly exacerbate their
own disease progression.
(10) HBV and HCV disproportionately affect certain
populations in the United States. Although representing only 6
percent of the population, Asian-Americans and Pacific
Islanders account for over half of the 1,400,000 domestic
chronic HBV cases. Baby boomers (those born between 1945 and
1965) account for more than half of domestic chronic hepatitis
C cases. In addition, African-Americans, Latinos (Latinas), and
American Indian/Native Alaskans are among the groups which have
disproportionately high rates of HBV and/or HCV infections in
the United States.
(11) For both chronic HBV and chronic HCV, behavioral
changes can slow disease progression if diagnosis is made
early. Early diagnosis, which is determined through simple
blood tests, can reduce the risk of transmission and disease
progression through education and vaccination of household
members and other susceptible persons at risk.
(12) Advancements have led to the development of improved
diagnostic tests for viral hepatitis. These tests, including
rapid, point of care testing and others in development, can
facilitate testing, notification of results and post-test
counseling, and referral to care at the time of the testing
visit. In particular, these tests are also advantageous because
they can be used simultaneously with HIV rapid testing for
persons at risk for both HCV and HIV infections.
(13) For those chronically infected with HBV or HCV,
regular monitoring can lead to the early detection of liver
cancer at a stage where a cure is still possible. Liver cancer
is the second deadliest cancer in the United States; however,
liver cancer has received little funding for research,
prevention, or treatment.
(14) Treatment for chronic HCV can eradicate the disease in
approximately 75 percent of those currently treated. The
treatment of chronic HBV can effectively suppress viral
replication in the overwhelming majority (over 80 percent) of
those treated, thereby reducing the risk of transmission and
progression to liver scarring or liver cancer, even though a
complete cure is much less common than for HCV.
(15) To combat the viral hepatitis epidemic in the United
States, in May 2011, the Department of Health and Human
Services released ``Combating the Silent Epidemic of Viral
Hepatitis: Action Plan for the Prevention, Care & Treatment of
Viral Hepatitis'' (hereafter referred to as the HHS Action
Plan). The Institute of Medicine (IOM) of the National
Academies produced a 2010 report on the Federal response to HBV
and HCV titled: ``Hepatitis and Liver Cancer: A National
Strategy for Prevention and Control of Hepatitis B and C''.
These recommendations and guidelines provide a framework for
HBV and HCV prevention, education, control, research, and
medical management programs.
(16) The annual health care costs attributable to HBV and
HCV in the United States are significant. For HBV, it is
estimated to be approximately $2,500,000,000 ($2,000 per
infected person). In 2000, the lifetime cost of HBV---before
the availability of most current therapies---was approximately
$80,000 per chronically infected person, totaling more than
$100,000,000,000. For HCV, medical costs for patients are
expected to increase from $30,000,000,000 in 2009 to over
$85,000,000,000 in 2024. Avoiding these costs by screening and
diagnosing individuals earlier--and connecting them to
appropriate treatment and care, will save lives and critical
health care dollars. Currently, without a comprehensive
screening, testing, and diagnosis program, most patients are
diagnosed too late when they need a liver transplant costing at
least $314,000 for uncomplicated cases or when they have liver
cancer or end stage liver disease which costs $30,980 to
$110,576 per hospital admission. As health care costs continue
to grow, it is critical that the Federal Government invests in
effective mechanisms to avoid documented cost drivers.
(17) According to the IOM report in 2010 (described in
paragraph (15)), chronic HBV and HCV infections cause
substantial morbidity and mortality despite being preventable
and treatable. Deficiencies in the implementation of
established guidelines for the prevention, diagnosis, and
medical management of chronic HBV and HCV infections perpetuate
personal and economic burdens. Existing grants are not
sufficient for the scale of the health burden presented by HBV
and HCV.
(18) Screening and testing for HBV and HCV is aligned with
the Healthy People 2020 goal to increase immunization rates and
reduce preventable infectious diseases. Awareness of disease
and access to prevention and treatment remain essential
components for reducing infectious disease transmission.
(19) Federal support is necessary to increase knowledge and
awareness of HBV and HCV and to assist State and local
prevention and control efforts in reducing the morbidity and
mortality of these epidemics.
(20) The Secretary of Health and Human Services has the
discretion to carry out this Act directly and through whichever
of the agencies of the Public Health Service the Secretary
determines to be appropriate, which may (in the Secretary's
discretion) include the Centers for Disease Control and
Prevention, the Health Resources and Services Administration,
the Substance Abuse and Mental Health Services Administration,
the National Institutes of Health (including the National
Institute on Minority Health and Health Disparities), and other
agencies of such Service.
(c) Biennial Assessment of HHS Hepatitis B and Hepatitis C
Prevention, Education, Research, and Medical Management Plan.--Title
III of the Public Health Service Act (42 U.S.C. 241 et seq.) is
amended--
(1) by striking section 317N (42 U.S.C. 247b-15); and
(2) by adding at the end the following:
``PART W--BIENNIAL ASSESSMENT OF HHS HEPATITIS B AND HEPATITIS C
PREVENTION, EDUCATION, RESEARCH, AND MEDICAL MANAGEMENT PLAN
``SEC. 399NN. BIENNIAL UPDATE OF THE PLAN.
``(a) In General.--The Secretary shall conduct a biennial
assessment of the Secretary's plan for the prevention, control, and
medical management of, and education and research relating to,
hepatitis B and hepatitis C, for the purposes of--
``(1) incorporating into such plan new knowledge or
observations relating to hepatitis B and hepatitis C (such as
knowledge and observations that may be derived from clinical,
laboratory, and epidemiological research and disease detection,
prevention, and surveillance outcomes);
``(2) addressing gaps in the coverage or effectiveness of
the plan; and
``(3) evaluating and, if appropriate, updating
recommendations, guidelines, or educational materials of the
Centers for Disease Control and Prevention or the National
Institutes of Health for health care providers or the public on
viral hepatitis in order to be consistent with the plan.
``(b) Publication of Notice of Assessments.--Not later than October
1 of the first even-numbered year beginning after the date of the
enactment of this part, and October 1 of each even-numbered year
thereafter, the Secretary shall publish in the Federal Register a
notice of the results of the assessments conducted under paragraph (1).
Such notice shall include--
``(1) a description of any revisions to the plan referred
to in subsection (a) as a result of the assessment;
``(2) an explanation of the basis for any such revisions,
including the ways in which such revisions can reasonably be
expected to further promote the original goals and objectives
of the plan; and
``(3) in the case of a determination by the Secretary that
the plan does not need revision, an explanation of the basis
for such determination.
``SEC. 399NN-1. ELEMENTS OF PROGRAM.
``(a) Education and Awareness Programs.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
the Administrator of the Health Resources and Services Administration,
and the Administrator of the Substance Abuse and Mental Health Services
Administration, and in accordance with the plan referred to in section
399NN(a), shall implement programs to increase awareness and enhance
knowledge and understanding of hepatitis B and hepatitis C. Such
programs shall include--
``(1) the conduct of culturally and language appropriate
health education in primary and secondary schools, college
campuses, public awareness campaigns, and community outreach
activities (especially to the ethnic communities with high
rates of chronic hepatitis B and chronic hepatitis C and other
high-risk groups) to promote public awareness and knowledge
about the value of hepatitis A and hepatitis B immunization,
risk factors, the transmission and prevention of hepatitis B
and hepatitis C, the value of screening for the early detection
of hepatitis B and hepatitis C, and options available for the
treatment of chronic hepatitis B and chronic hepatitis C;
``(2) the promotion of immunization programs that increase
awareness and access to hepatitis A and hepatitis B vaccines
for susceptible adults and children;
``(3) the training of health care professionals regarding
the importance of vaccinating individuals infected with
hepatitis C and individuals who are at risk for hepatitis C
infection against hepatitis A and hepatitis B;
``(4) the training of health care professionals regarding
the importance of vaccinating individuals chronically infected
with hepatitis B and individuals who are at risk for chronic
hepatitis B infection against the hepatitis A virus;
``(5) the training of health care professionals and health
educators to make them aware of the high rates of chronic
hepatitis B and chronic hepatitis C in certain adult ethnic
populations, and the importance of prevention, detection, and
medical management of hepatitis B and hepatitis C and of liver
cancer screening;
``(6) the development and distribution of health education
curricula (including information relating to the special needs
of individuals infected with hepatitis B and hepatitis C, such
as the importance of prevention and early intervention, regular
monitoring, the recognition of psychosocial needs, appropriate
treatment, and liver cancer screening) for individuals
providing hepatitis B and hepatitis C counseling; and
``(7) support for the implementation curricula described in
paragraph (6) by State and local public health agencies.
``(b) Immunization, Prevention, and Control Programs.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall support the integration of activities described in
paragraph (3) into existing clinical and public health programs
at State, local, territorial, and tribal levels (including
community health clinics, programs for the prevention and
treatment of HIV/AIDS, sexually transmitted diseases, and
substance abuse, and programs for individuals in correctional
settings).
``(2) Coordination of development of federal screening
guidelines.--
``(A) References.--For purposes of this subsection,
the term `CDC Director' means the Director of the
Centers for Disease Control and Prevention, and the
term `AHRQ Director' means the Director of the Agency
for Healthcare Research and Quality.
``(B) Agency for healthcare research and quality.--
Due to the rapidly evolving standard of care associated
with diagnosing and treating viral hepatitis infection,
the AHRQ Director shall convene the Preventive Services
Task Force under section 915(a) of the Public Health
Service Act to review its recommendation for screening
for HBV and HCV infection every 3 years.
``(3) Activities.--
``(A) Voluntary testing programs.--
``(i) In general.--The Secretary shall
establish a mechanism by which to support and
promote the development of State, local,
territorial, and tribal voluntary hepatitis B
and hepatitis C testing programs to screen the
high-prevalence populations to aid in the early
identification of chronically infected
individuals.
``(ii) Confidentiality of the test
results.--The Secretary shall prohibit the use
of the results of a hepatitis B or hepatitis C
test conducted by a testing program developed
or supported under this subparagraph for any of
the following:
``(I) Issues relating to health
insurance.
``(II) To screen or determine
suitability for employment.
``(III) To discharge a person from
employment.
``(B) Counseling regarding viral hepatitis.--The
Secretary shall support State, local, territorial, and
tribal programs in a wide variety of settings,
including those providing primary and specialty health
care services in nonprofit private and public sectors,
to--
``(i) provide individuals with ongoing risk
factors for hepatitis B and hepatitis C
infection with client-centered education and
counseling which concentrates on--
``(I) promoting testing of
individuals that have been exposed to
their blood, family members, and their
sexual partners; and
``(II) changing behaviors that
place individuals at risk for
infection;
``(ii) provide individuals chronically
infected with hepatitis B or hepatitis C with
education, health information, and counseling
to reduce their risk of--
``(I) dying from end-stage liver
disease and liver cancer; and
``(II) transmitting viral hepatitis
to others; and
``(iii) provide women chronically infected
with hepatitis B or hepatitis C who are
pregnant or of childbearing age with culturally
and language appropriate health information,
such as how to prevent hepatitis B perinatal
infection, and to alleviate fears associated
with pregnancy or raising a family.
``(C) Immunization.--The Secretary shall support
State, local, territorial, and tribal efforts to expand
the current vaccination programs to protect every child
in the country and all susceptible adults, particularly
those infected with hepatitis C and high-prevalence
ethnic populations and other high-risk groups, from the
risks of acute and chronic hepatitis B infection by--
``(i) ensuring continued funding for
hepatitis B vaccination for all children 19
years of age or younger through the Vaccines
for Children Program;
``(ii) ensuring that the recommendations of
the Advisory Committee on Immunization
Practices are followed regarding the birth dose
of hepatitis B vaccinations for newborns;
``(iii) requiring proof of hepatitis B
vaccination for entry into public or private
daycare, preschool, elementary school,
secondary school, and institutions of higher
education;
``(iv) expanding the availability of
hepatitis B vaccination for all susceptible
adults to protect them from becoming acutely or
chronically infected, including ethnic and
other populations with high prevalence rates of
chronic hepatitis B infection;
``(v) expanding the availability of
hepatitis B vaccination for all susceptible
adults, particularly those in their
reproductive age (women and men less than 45
years of age), to protect them from the risk of
hepatitis B infection;
``(vi) ensuring the vaccination of
individuals infected, or at risk for infection,
with hepatitis C against hepatitis A, hepatitis
B, and other infectious diseases, as
appropriate, for which such individuals may be
at increased risk; and
``(vii) ensuring the vaccination of
individuals infected, or at risk for infection,
with hepatitis B against hepatitis A virus and
other infectious diseases, as appropriate, for
which such individuals may be at increased
risk.
``(D) Medical referral.--The Secretary shall
support State, local, territorial, and tribal programs
that support--
``(i) referral of persons chronically
infected with hepatitis B or hepatitis C--
``(I) for medical evaluation to
determine the appropriateness for
antiviral treatment to reduce the risk
of progression to cirrhosis and liver
cancer; and
``(II) for ongoing medical
management including regular monitoring
of liver function and screening for
liver cancer; and
``(ii) referral of persons infected with
acute or chronic hepatitis B infection or acute
or chronic hepatitis C infection for drug and
alcohol abuse treatment where appropriate.
``(4) Increased support for adult viral hepatitis
coordinators.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, shall provide
increased support to Adult Viral Hepatitis Coordinators in
State, local, territorial, and tribal health departments in
order to enhance the additional management, networking, and
technical expertise needed to ensure successful integration of
hepatitis B and hepatitis C prevention and control activities
into existing public health programs.
``(c) Epidemiological Surveillance.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall support the establishment and maintenance of a national
chronic and acute hepatitis B and hepatitis C surveillance
program, in order to identify--
``(A) trends in the incidence of acute and chronic
hepatitis B and acute and chronic hepatitis C;
``(B) trends in the prevalence of acute and chronic
hepatitis B and acute and chronic hepatitis C infection
among groups that may be disproportionately affected;
and
``(C) trends in liver cancer and end-stage liver
disease incidence and deaths, caused by chronic
hepatitis B and chronic hepatitis C in the high-risk
ethnic populations.
``(2) Seroprevalence and liver cancer studies.--The
Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall prepare a report
outlining the population-based seroprevalence studies currently
underway, future planned studies, the criteria involved in
determining which seroprevalence studies to conduct, defer, or
suspend, and the scope of those studies, the economic and
clinical impact of hepatitis B and hepatitis C, and the impact
of chronic hepatitis B and chronic hepatitis C infections on
the quality of life. Not later than one year after the date of
the enactment of this part, the Secretary shall submit the
report to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate.
``(3) Confidentiality.--The Secretary shall not disclose
any individually identifiable information identified under
paragraph (1) or derived through studies under paragraph (2).
``(d) Research.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, the Director of the
National Cancer Institute, and the Director of the National Institutes
of Health, shall--
``(1) conduct epidemiologic and community-based research to
develop, implement, and evaluate best practices for hepatitis B
and hepatitis C prevention especially in the ethnic populations
with high rates of chronic hepatitis B and chronic hepatitis C
and other high-risk groups;
``(2) conduct research on hepatitis B and hepatitis C
natural history, pathophysiology, improved treatments and
prevention (such as the hepatitis C vaccine), and noninvasive
tests that help to predict the risk of progression to liver
cirrhosis and liver cancer;
``(3) conduct research that will lead to better noninvasive
or blood tests to screen for liver cancer, and more effective
treatments of liver cancer caused by chronic hepatitis B and
chronic hepatitis C; and
``(4) conduct research comparing the effectiveness of
screening, diagnostic, management, and treatment approaches for
chronic hepatitis B, chronic hepatitis C, and liver cancer in
the affected communities.
``(e) Underserved and Disproportionately Affected Populations.--In
carrying out this section, the Secretary shall provide expanded support
for individuals with limited access to health education, testing, and
health care services and groups that may be disproportionately affected
by hepatitis B and hepatitis C.
``(f) Evaluation of Program.--The Secretary shall develop
benchmarks for evaluating the effectiveness of the programs and
activities conducted under this section and make determinations as to
whether such benchmarks have been achieved.
``SEC. 399NN-2. GRANTS.
``(a) In General.--The Secretary may award grants to, or enter into
contracts or cooperative agreements with, States, political
subdivisions of States, territories, Indian tribes, or nonprofit
entities that have special expertise relating to hepatitis B, hepatitis
C, or both, to carry out activities under this part.
``(b) Application.--To be eligible for a grant, contract, or
cooperative agreement under subsection (a), an entity shall prepare and
submit to the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require.
``SEC. 399NN-3. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated to carry out this part
$90,000,000 for fiscal year 2015, $90,000,000 for fiscal year 2016,
$110,000,000 for fiscal year 2017, $130,000,000 for fiscal year 2018,
and $150,000,000 for fiscal year 2019.''.
(d) Enhancing SAMHSA's Role in Hepatitis Activities.--Paragraph (6)
of section 501(d) of the Public Health Service Act (42 U.S.C. 290aa(d))
is amended by striking ``HIV or tuberculosis'' and inserting ``HIV,
tuberculosis, or hepatitis''.
Subtitle C--Acquired Bone Marrow Failure Diseases
SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES.
(a) Short Title.--This subtitle may be cited as the ``Bone Marrow
Failure Disease Research and Treatment Act of 2014''.
(b) Findings.--The Congress finds the following:
(1) Between 20,000 and 30,000 Americans are diagnosed each
year with myelodysplastic syndromes, aplastic anemia,
paroxysmal nocturnal hemoglobinuria, and other acquired bone
marrow failure diseases.
(2) Acquired bone marrow failure diseases have a
debilitating and often fatal impact on those diagnosed with
these diseases.
(3) While some treatments for acquired bone marrow failure
diseases can prolong and improve the quality of patients'
lives, there is no single cure for these diseases.
(4) The prevalence of acquired bone marrow failure diseases
in the United States will continue to grow as the general
public ages.
(5) Evidence exists suggesting that acquired bone marrow
failure diseases occur more often in minority populations,
particularly in Asian-American and Latino or Hispanic
populations.
(6) The National Heart, Lung, and Blood Institute and the
National Cancer Institute have conducted important research
into the causes of and treatments for acquired bone marrow
failure diseases.
(7) The National Marrow Donor Program Registry has made
significant contributions to the fight against bone marrow
failure diseases by connecting millions of potential marrow
donors with individuals and families suffering from these
conditions.
(8) Despite these advances, a more comprehensive Federal
strategic effort among numerous Federal agencies is needed to
discover a cure for acquired bone marrow failure disorders.
(9) Greater Federal surveillance of acquired bone marrow
failure diseases is needed to gain a better understanding of
the causes of acquired bone marrow failure diseases.
(10) The Federal Government should increase its research
support for and engage with public and private organizations in
developing a comprehensive approach to combat and cure acquired
bone marrow failure diseases.
(c) National Acquired Bone Marrow Failure Disease Registry.--Part B
of the Public Health Service Act (42 U.S.C. 311 et seq.) is amended by
inserting after section 317W, as added, the following:
``SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE DISEASE REGISTRY.
``(a) Establishment of Registry.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Director of the Centers for Disease Control and Prevention,
shall--
``(A) develop a system to collect data on acquired
bone marrow failure diseases; and
``(B) establish and maintain a national and
publicly available registry, to be known as the
National Acquired Bone Marrow Failure Disease Registry,
in accordance with paragraph (3).
``(2) Recommendations of advisory committee.--In carrying
out this subsection, the Secretary shall take into
consideration the recommendations of the Advisory Committee on
Acquired Bone Marrow Failure Diseases established under
subsection (b).
``(3) Purposes of registry.--The National Acquired Bone
Marrow Failure Disease Registry--
``(A) shall identify the incidence and prevalence
of acquired bone marrow failure diseases in the United
States;
``(B) shall be used to collect and store data on
acquired bone marrow failure diseases, including data
concerning--
``(i) the age, race or ethnicity, general
geographic location, sex, and family history of
individuals who are diagnosed with acquired
bone marrow failure diseases, and any other
characteristics of such individuals determined
appropriate by the Secretary;
``(ii) the genetic and environmental
factors that may be associated with developing
acquired bone marrow failure diseases;
``(iii) treatment approaches for dealing
with acquired bone marrow failure diseases;
``(iv) outcomes for individuals treated for
acquired bone marrow failure diseases,
including outcomes for recipients of stem cell
therapeutic products as contained in the
database established pursuant to section 379A;
and
``(v) any other factors pertaining to
acquired bone marrow failure diseases
determined appropriate by the Secretary; and
``(C) shall be made available--
``(i) to the general public; and
``(ii) to researchers to facilitate further
research into the causes of, and treatments
for, acquired bone marrow failure diseases in
accordance with standard practices of the
Centers for Disease Control and Preventions.
``(b) Advisory Committee.--
``(1) Establishment.--Not later than 6 months after the
date of the enactment of this section, the Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, shall establish an advisory committee, to be known
as the Advisory Committee on Acquired Bone Marrow Failure
Diseases.
``(2) Members.--The members of the Advisory Committee on
Acquired Bone Marrow Failure Diseases shall be appointed by the
Secretary, acting through the Director of the Centers for
Disease Control and Prevention, and shall include at least one
representative from each of the following:
``(A) A national patient advocacy organization with
experience advocating on behalf of patients suffering
from acquired bone marrow failure diseases.
``(B) The National Institutes of Health, including
at least one representative from each of--
``(i) the National Cancer Institute;
``(ii) the National Heart, Lung, and Blood
Institute; and
``(iii) the Office of Rare Diseases.
``(C) The Centers for Disease Control and
Prevention.
``(D) Clinicians with experience in--
``(i) diagnosing or treating acquired bone
marrow failure diseases; and
``(ii) medical data registries.
``(E) Epidemiologists who have experience with data
registries.
``(F) Publicly or privately funded researchers who
have experience researching acquired bone marrow
failure diseases.
``(G) The entity operating the C.W. Bill Young Cell
Transplantation Program established pursuant to section
379 and the entity operating the C.W. Bill Young Cell
Transplantation Program Outcomes Database.
``(3) Responsibilities.--The Advisory Committee on Acquired
Bone Marrow Failure Diseases shall provide recommendations to
the Secretary on the establishment and maintenance of the
National Acquired Bone Marrow Failure Disease Registry,
including recommendations on the collection, maintenance, and
dissemination of data.
``(4) Public availability.--The Secretary shall make the
recommendations of the Advisory Committee on Acquired Bone
Marrow Failure Disease publicly available.
``(c) Grants.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, may award grants to, and
enter into contracts and cooperative agreements with, public or private
nonprofit entities for the management of, as well as the collection,
analysis, and reporting of data to be included in, the National
Acquired Bone Marrow Failure Disease Registry.
``(d) Definition.--In this section, the term `acquired bone marrow
failure disease' means--
``(1) myelodysplastic syndromes (MDS);
``(2) aplastic anemia;
``(3) paroxysmal nocturnal hemoglobinuria (PNH);
``(4) pure red cell aplasia;
``(5) acute myeloid leukemia that has progressed from
myelodysplastic syndromes; or
``(6) large granular lymphocytic leukemia.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $3,000,000 for each of fiscal
years 2015 through 2019.''.
(d) Pilot Studies Through the Agency for Toxic Substances and
Disease Registry.--
(1) Pilot studies.--The Secretary of Health and Human
Services, acting through the Administrator of the Agency for
Toxic Substances and Disease Registry, shall conduct pilot
studies to determine which environmental factors, including
exposure to toxins, may cause acquired bone marrow failure
diseases.
(2) Collaboration with the radiation injury treatment
network.--In carrying out the directives of this section, the
Secretary may collaborate with the Radiation Injury Treatment
Network of the C.W. Bill Young Cell Transplantation Program
established pursuant to section 379 of the Public Health
Service Act (42 U.S.C. 274j) to--
(A) augment data for the pilot studies authorized
by this section;
(B) access technical assistance that may be
provided by the Radiation Injury Treatment Network; or
(C) perform joint research projects.
(3) Authorization of appropriations.--There is authorized
to be appropriated to carry out this section $1,000,000 for
each of fiscal years 2015 through 2019.
(e) Minority-Focused Programs on Acquired Bone Marrow Failure
Diseases.--Title XVII of the Public Health Service Act (42 U.S.C. 300u
et seq.) is amended by inserting after section 1707A the following:
``minority-focused programs on acquired bone marrow failure diseases
``Sec. 1707B. (a) Information and Referral Services.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Deputy Assistant Secretary for Minority Health, shall
establish and coordinate outreach and informational programs
targeted to minority populations affected by acquired bone
marrow failure diseases.
``(2) Program requirements.--Minority-focused outreach and
informational programs authorized by this section--
``(A) shall make information about treatment
options and clinical trials for acquired bone marrow
failure diseases publicly available, and
``(B) shall provide referral services for treatment
options and clinical trials,
at the National Minority Health Resource Center supported under
section 1707(b)(8) (including by means of the Center's Web
site, through appropriate locations such as the Center's
knowledge center, and through appropriate programs such as the
Center's resource persons network) and through minority health
consultants located at each Department of Health and Human
Services regional office.
``(b) Hispanic and Asian-American and Pacific Islander Outreach.--
``(1) In general.--The Secretary, acting through the Deputy
Assistant Secretary for Minority Health, shall undertake a
coordinated outreach effort to connect Hispanic, Asian-
American, and Pacific Islander communities with comprehensive
services focused on treatment of, and information about,
acquired bone marrow failure diseases.
``(2) Collaboration.--In carrying out this subsection, the
Secretary may collaborate with public health agencies,
nonprofit organizations, community groups, and online entities
to disseminate information about treatment options and clinical
trials for acquired bone marrow failure diseases.
``(c) Grants and Cooperative Agreements.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Deputy Assistant Secretary for Minority Health, shall award
grants to, or enter into cooperative agreements with, entities
to perform research on acquired bone marrow failure diseases.
``(2) Requirement.--Grants and cooperative agreements
authorized by this subsection shall be awarded or entered into
on a competitive, peer-reviewed basis.
``(3) Scope of research.--Research funded under this
section shall examine factors affecting the incidence of
acquired bone marrow failure diseases in minority populations.
``(d) Definition.--In this section, the term `acquired bone marrow
failure disease' has the meaning given to such term in section 317X(d).
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of fiscal
years 2015 through 2019.''.
(f) Diagnosis and Quality of Care for Acquired Bone Marrow Failure
Diseases.--
(1) Grants.--The Secretary of Health and Human Services,
acting through the Director of the Agency for Healthcare
Research and Quality, shall award grants to entities to improve
diagnostic practices and quality of care with respect to
patients with acquired bone marrow failure diseases.
(2) Authorization of appropriations.--There is authorized
to be appropriated to carry out this section $2,000,000 for
each of fiscal years 2015 through 2019.
(g) Definition.--In this section, the term ``acquired bone marrow
failure disease'' means--
(1) myelodysplastic syndromes (MDS);
(2) aplastic anemia;
(3) paroxysmal nocturnal hemoglobinuria (PNH);
(4) pure red cell aplasia;
(5) acute myeloid leukemia that progressed from
myelodysplastic syndromes; or
(6) large granular lymphocytic leukemia.
Subtitle D--Cardiovascular Disease, Chronic Disease, and Other Disease
Issues
SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MINORITY PATIENTS.
(a) In General.--The Secretary, acting through the Director of the
Agency for Healthcare Research and Quality, shall convene a series of
meetings to develop guidelines for disease screening for minority
patient populations which have a higher than average risk for many
chronic diseases and cancers.
(b) Participants.--In convening meetings under subsection (a), the
Secretary shall ensure that meeting participants include
representatives of--
(1) professional societies and associations;
(2) minority health organizations;
(3) health care researchers and providers, including those
with expertise in minority health;
(4) Federal health agencies, including the Office of
Minority Health, the National Institute on Minority Health and
Health Disparities, and the National Institutes of Health; and
(5) other experts determined appropriate by the Secretary.
(c) Diseases.--Screening guidelines for minority populations shall
be developed as appropriate under subsection (a) for--
(1) hypertension;
(2) hypercholesterolemia;
(3) diabetes;
(4) cardiovascular disease;
(5) cancers, including breast, prostate, colon, cervical,
and lung cancer;
(6) asthma;
(7) diabetes;
(8) kidney diseases;
(9) eye diseases and disorders, including glaucoma;
(10) HIV/AIDS and sexually transmitted diseases;
(11) uterine fibroids;
(12) autoimmune disease;
(13) mental health conditions;
(14) dental health conditions and oral diseases, including
oral cancer;
(15) environmental and related health illnesses and
conditions;
(16) Sickle cell disease;
(17) violence and injury prevention and control;
(18) genetic and related conditions;
(19) heart disease and stroke;
(20) tuberculosis;
(21) chronic obstructive pulmonary disease;
(22) musculoskeletal diseases, arthritis, and obesity; and
(23) other diseases determined appropriate by the
Secretary.
(d) Dissemination.--Not later than 24 months after the date of
enactment of this title, the Secretary shall publish and disseminate to
health care provider organizations the guidelines developed under
subsection (a).
(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 2015 through 2019.
SEC. 732. CDC WISEWOMAN SCREENING PROGRAM.
Section 1509 of the Public Health Service Act (42 U.S.C. 300n-4a)
is amended--
(1) in subsection (a)--
(A) by striking the heading and inserting ``In
General.--''; and
(B) in the matter preceding paragraph (1), by
striking ``may make grants'' and all that follows
through ``purpose'' and inserting the following: ``may
make grants to such States for the purpose''; and
(2) in subsection (d)(1), by striking ``there are
authorized'' and all that follows through the period and
inserting ``there are authorized to be appropriated $23,000,000
for fiscal year 2015, $25,300,000 for fiscal year 2016,
$27,800,000 for fiscal year 2017, $30,800,000 for fiscal year
2018, and $34,000,000 for fiscal year 2019.''.
SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-6. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.
``Not later than September 30, 2015, and annually thereafter, the
Secretary shall prepare and submit to the Congress a report on the
quality of and access to care for women and minorities with heart
disease, stroke, and other cardiovascular diseases. The report shall
contain recommendations for eliminating disparities in, and improving
the treatment of, heart disease, stroke, and other cardiovascular
diseases in women, racial and ethnic minorities, those for whom English
is not their primary language, and individuals with disabilities.''.
SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES IN
MEDICAID.
(a) Requiring Coverage of Counseling and Pharmacotherapy for
Cessation of Tobacco Use.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended--
(1) in subsection (a)(4)(D) is amended by striking ``by
pregnant women''; and
(2) in subsection (bb)--
(A) by striking ``by pregnant women'' each place it
appears;
(B) in paragraph (1), in the matter before
subparagraph (A), by inserting ``by individuals''
before ``who use tobacco''; and
(C) in paragraph (2)(A), by striking ``with respect
to pregnant women''.
(b) Exception From Optional Restriction Under Medicaid Prescription
Drug Coverage.--Section 1927(d)(2)(F) of the Social Security Act (42
U.S.C. 1396r-8(d)(2)(F)) is amended by striking ``in the case of
pregnant women''.
(c) Removal of Cost Sharing for Counseling and Pharmacotherapy for
Cessation of Tobacco Use.--
(1) General cost sharing limitations.--Section 1916 of the
Social Security Act (42 U.S.C. 1396o) is amended--
(A) in subsections (a)(2)(B) and (b)(2)(B), by
striking ``and counseling and pharmacotherapy for
cessation of tobacco use by pregnant women (as defined
in section 1905(bb)) and covered outpatient drugs (as
defined in subsection (k)(2) of section 1927 and
including nonprescription drugs described in subsection
(d)(2) of such section) that are prescribed for
purposes of promoting, and when used to promote,
tobacco cessation by pregnant women in accordance with
the Guideline referred to in section 1905(bb)(2)(A)''
each place it appears; and
(B) in each of subsections (a)(2)(D) and (b)(2)(D)
by inserting ``and counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1905(bb)) and covered outpatient drugs (as defined in
subsection (k)(2) of section 1927 and including
nonprescription drugs described in subsection (d)(2) of
such section) that are prescribed for purposes of
promoting, and when used to promote, tobacco cessation
in accordance with the Guideline referred to in section
1905(bb)(2)(A),'' after ``section 1905(a)(4)(C),''.
(2) Application to alternative cost sharing.--Section
1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-1(b)(3)(B)42 U.S.C.
1396o-1(b)(3)(B)) is amended--
(A) in clause (iii), by striking ``, and counseling
and pharmacotherapy for cessation of tobacco use by
pregnant women (as defined in section 1905(bb))''; and
(B) by adding at the end the following:
``(xi) Counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1905(bb)) and covered outpatient drugs (as
defined in subsection (k)(2) of section 1927
and including nonprescription drugs described
in subsection (d)(2) of such section) that are
prescribed for purposes of promoting, and when
used to promote, tobacco cessation in
accordance with the Guideline referred to in
section 1905(bb)(2)(A).''.
(d) Effective Date.--The amendments made by this section shall take
effect on October 1, 2014.
SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL HEALTH.
(a) In General.--The Secretary of Health and Human Services shall
expand and intensify the conduct and support of the research activities
of the National Institutes of Health and the National Institute of
Dental and Craniofacial Research to improve the oral health of the
population through the prevention and management of oral diseases and
conditions.
(b) Included Research Activities.--Research activities under
subsection (a) shall include--
(1) comparative effectiveness research and clinical disease
management research addressing early childhood caries and oral
cancer; and
(2) awarding of grants and contracts to support the
training and development of health services researchers,
comparative effectiveness researchers, and clinical researchers
whose research improves the oral health of the population.
SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN APPROVED CLINICAL
TRIALS.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by inserting after section 1943 the following
new section:
``SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL TRIAL.
``(a) Coverage of Routine Patient Costs Associated With Approved
Clinical Trials.--
``(1) Inclusion.--Subject to paragraph (2), routine patient
costs shall include all items and services consistent with the
medical assistance provided under the State plan that would
otherwise be provided to the individual under such State plan
if such individual was not enrolled in an approved clinical
trial, including any items or services related to the
prevention, detection, and treatment of any medical
complications that arise as a result of participation in the
approved clinical trial.
``(2) Exclusion.--For purposes of paragraph (1), routine
patient costs does not include--
``(A) the investigational item, device, or service
itself;
``(B) items and services that are provided solely
to satisfy data collection and analysis needs and that
are not used in the direct clinical management of the
patient; or
``(C) a service that is clearly inconsistent with
widely accepted and established standards of care for a
particular diagnosis.
``(3) Information concerning clinical trials.--
``(A) In general.--Subject to subparagraph (B), the
Secretary, in consultation with relevant stakeholders,
shall develop a single standardized electronic form for
use by the individual or the referring health care
provider to submit to the State agency administering
the State plan in order to verify that the clinical
trial meets the conditions established for an approved
clinical trial (as defined in subsection (c)).
``(B) Excluded information.--For purposes of
subparagraph (A) or any such request by the State
agency for information regarding a clinical trial, an
individual or referring health care provider shall not
be required to submit--
``(i) the clinical protocol document for
the clinical trial; or
``(ii) subject to subparagraph (C), any
additional information other than such
information as is required pursuant to the form
described in subparagraph (A).
``(C) Optional information.--For purposes of
subparagraphs (A) and (B)(ii), the form may include a
requirement that the referring health care provider
attest that the individual is eligible to participate
in the clinical trial pursuant to the trial protocol
and that their participation in such trial would be
appropriate.
``(D) Review of information.--
``(i) In general.--A State plan under this
title shall establish a process for timely
review by the State agency of the form and
information submitted pursuant to subparagraph
(A) and, not later than 48 hours after receipt
of such form, confirmation that the information
provided in such form satisfies the
requirements established under such
subparagraph, with such process to include
establishment and operation of a 24-hour, toll-
free telephone number and e-mail address to
provide for expedited communication.
``(ii) Failure to respond.--If an
individual or the referring health care
provider does not receive a response or request
for additional information from the State
agency following the 48-hour period described
in clause (i), the information provided in the
form may be presumed to satisfy the
requirements established under this paragraph.
``(b) Encouragement of Participation in Approved Clinical Trials.--
``(1) Reasonably accessible provider.--For purposes of
participation in an approved clinical trial by an individual
eligible for medical assistance under this title, the State
agency administering the State plan shall make reasonable
efforts to ensure that the individual is provided with access
to a provider who is--
``(A) participating in the approved clinical trial;
``(B) located not more than 25 miles from the
residence of the individual (or, if no such provider is
available, as close as possible to the residence of the
individual); and
``(C) a participating provider under the State plan
or has been deemed to be a participating provider under
the State plan for purposes of providing medical
assistance to the individual during their participation
in the approved clinical trial.
``(2) Informational materials.--The State agency
administering the plan approved under this title shall develop
informational materials and programs to encourage participating
providers to make appropriate referrals to physicians and other
appropriate health care professionals who can provide
individuals with access to approved clinical trials.
``(c) Definition of Approved Clinical Trial.--The term `approved
clinical trial' has the same meaning as provided under section 2709(d)
of the Public Health Service Act.''.
(b) Conforming Amendment.--Section 1902(a) of such Act (42 U.S.C.
1396a(a)) is amended by inserting after paragraph (77) the following
new paragraph:
``(78) provide that participation in an approved clinical
trial and coverage of routine patient costs associated with
such trial for an individual eligible for medical assistance
under this title is conducted in accordance with the
requirements under section 1944;''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to calendar
quarters beginning on or after October 1, 2014.
(2) Delay permitted for state plan amendment.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
Subtitle E--HIV/AIDS
SEC. 741. STATEMENT OF POLICY.
It is the policy of the United States to achieve an AIDS-free
generation, and to--
(1) expand access to lifesaving antiretroviral therapy for
people living with HIV/AIDS and immediately link people to
continuous and coordinated high-quality care when they learn
they are infected with HIV;
(2) expand targeted efforts to prevent HIV infection using
a combination of effective, evidence-based approaches,
including routine HIV screening, and universal access to HIV
prevention tools in the communities where HIV/AIDS is most
heavily concentrated, particularly communities of color;
(3) ensure laws, policies, and regulations do not impede
access to prevention, treatment, and care for people living
with HIV/AIDS or at risk for acquiring HIV;
(4) accelerate research for more efficacious HIV prevention
and treatments tools, a cure, and a vaccine; and
(5) respect the human rights and dignity of persons living
with HIV/AIDS.
SEC. 742. FINDINGS.
The Congress finds the following:
(1) Over one million people are estimated to be living with
HIV in the United States according to the Centers for Disease
Control and Prevention, 18 percent of whom are unaware of their
HIV-positive status.
(2) Annually there are over 50,000 new HIV infections and
20,000 deaths in people with an HIV diagnoses in 50 States and
6 dependent areas of the United States.
(3) The Centers for Disease Control and Prevention
estimates that in 2011 there were approximately 50,199 people
newly diagnosed with HIV. Though this number seems to be
staying relatively stable, the number of new infections is
rapidly increasing among certain populations especially among
young African-American men who have sex with men (MSM) who, in
2010, accounted for 45 percent of new HIV infections among
black MSM and 55 percent of HIV infections among young MSM
overall.
(4) HIV disproportionately affects certain populations in
the United States. Though African-Americans represent less than
13 percent of the population, African-Americans account for
almost half (44 percent) of all people living with HIV in the
United States. Men who have sex with men (MSM) make up
approximately 4 percent of the population, but account for 63
percent of all new HIV infections and are the only risk group
in which HIV infections continue to increase.
(5) Disparities exist among Latinos/Hispanics; they make up
16 percent of US population and 22 percent of new infections
(2011).
(6) Though American Indians/Alaska Natives represent less
than 2 percent of the total number of HIV/AIDS cases, American
Indians and Alaska Natives rank fifth in rates of HIV/AIDS
diagnosis, still higher than their White counterparts.
(7) While Asian-Americans, Native Hawaiians, and Pacific
Islanders HIV/AIDS cases account for approximately 1 percent of
cases nationally, between 2010 and 2011, the rate of new HIV
diagnoses increased for Asian-Americans by 22 percent.
(8) The latest data from the CDC (2013) indicate that women
account for 1 in 5 (20 percent) new HIV infections in the
United States women of color, particularly Black women, have
been especially hard hit and represent the majority of women
living with the disease and women newly infected. In addition,
Black women accounted for nearly two-thirds (64 percent) of all
estimated new HIV infections among women, while only accounting
for 13 percent of the female population; White women accounted
for 18 percent and Latinas 15 percent of new infections.
(9) The history of HIV shows that culturally relevant and
gender-responsive supportive services, including psychosocial
support, treatment literacy, case management, and
transportation are necessary strategies to reach and engage
women and girls in medical care.
(10) The limited data available on transgender individuals
point to a disproportionate burden of HIV infection.
(11) Stigma and discrimination contribute to these
disparities.
(12) The Centers for Disease Control and Prevention has
determined that increasing the proportion of people who know
their HIV status is an essential component of comprehensive
HIV/AIDS treatment and prevention efforts and that early
diagnosis is critical in order for people with HIV/AIDS to
receive life-extending therapy. Additionally, the Centers for
Disease Control and Prevention recommend routine HIV screening
in health care settings for all patients aged 13 to 64,
regardless of risk.
(13) In 1998, Congress created the National Minority AIDS
Initiative to provide technical assistance, build capacity, and
strengthen outreach efforts among local institutions and
community-based organizations that serve racial and ethnic
minorities living with or vulnerable to HIV/AIDS.
(14) To combat the HIV epidemic in the United States, the
National HIV/AIDS Strategy (NHAS) from the White House Office
of National AIDS Policy provides a framework of increasing
access to care, reducing new infections, and eliminating HIV-
related health disparities. The vision of NHAS is ``The United
States will become a place where new HIV infections are rare
and when they do occur, every person, regardless of age,
gender, race/ethnicity, gender identity, or socioeconomic
circumstance, will have unfettered access to high quality,
life-extending care, free from stigma and discrimination.''.
(15) In recent years, several thousand people across the
country were waiting to receive AIDS treatment through the AIDS
Drug Assistance Program authorized by the provisions popularly
known as the Ryan White CARE Act.
(16) At present, 34 States and 2 United States territories
have criminal statutes based on ``exposure'' to HIV. Most of
these laws were adopted before the availability of effective
antiretroviral treatment for HIV/AIDS.
(17) Although the cost of education, treatment and care,
and research are not inconsequential, they are substantially
less than the annual health care cost attributable to HIV in
the United States. The lifetime cost of HIV care and treatment
in 2004 was estimated to be $405,000 to $648,000 annually.
Preventing 40,000 new infections in the United States each year
would save $12.8 billion annually.
(18) According to the Centers for Disease Control and
Prevention (CDC), latex condoms, when used consistently and
correctly, are highly effective in preventing the transmission
of HIV. Latex condoms also reduce the risk of other STIs.
Despite the effectiveness of condoms in reducing the spread of
STIs, the Bureau of Prisons does not recommend their use in
correctional facilities.
(19) The distribution of condoms in correctional facilities
is currently legal in certain parts of the United States and
the world. The States of Vermont and Mississippi, the District
of Columbia, and the cities of New York, San Francisco, Los
Angeles, Washington, DC, and Philadelphia allow condom
distribution in their correctional facilities. However, these
States and cities operate fewer than 1 percent of all
correctional facilities.
(20) Many correctional facilities in the United States do
not provide comprehensive testing and treatment programs to
reduce the spread of STIs. Fewer than half of correctional
facilities provide counseling to HIV-positive incarcerated
persons.
(21) Incarcerated individuals living with HIV/AIDS who are
eligible for Medicaid would benefit from prompt and automatic
enrollment upon their release in order to ensure their
continued ability to access health services, including
antiretroviral treatment.
(22) Research shows that stable housing leads to better
health outcomes for those living with HIV. Inadequate or
unstable housing is not only a barrier to effective treatment,
but also increases the likelihood of engaging in risky
behaviors leading to HIV infection. Insecure housing puts
people with HIV/AIDS at risk of premature death from exposure
to other diseases, poor nutrition, and lack of medical care.
(23) Due to advances in treatment, many people living with
HIV/AIDS (PLWHA) today are living healthy lives and have the
ability and desire to fully participate in all aspects of
community life, including employment. Research associates being
employed with tremendous economic, social, and health benefits
for many people living with HIV/AIDS.
(24) The common benefits associated with employment include
income, autonomy, productivity, and status within society,
daily structure, making a contribution to one's community, and
increased skills and self-esteem. Research also indicates that
many people with disabilities, including PLWHA, report
perceiving themselves as being less disabled or not disabled at
all, when working. Furthermore, some studies link working with
better physical and mental health outcomes for PLWHA when
compared to those who are not working. Preliminary data also
suggest that transitioning to employment is associated with
reduced HIV-related health risk behavior for many people.
(25) On July 16, 2012, the Food and Drug Administration
approved the first drug to reduce the risk of HIV infection in
uninfected individuals who are at high risk of HIV infection
and who may engage in sexual activity with HIV-infected
partners.
SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSISTANCE PROGRAM
TREATMENTS.
Section 2623 of the Public Health Service Act (42 U.S.C. 300ff-31b)
is amended by adding at the end the following:
``(c) Additional Funding for AIDS Drug Assistance Program
Treatments.--In addition to amounts otherwise authorized to be
appropriated for carrying out this subpart, there are authorized to be
appropriated such sums as may be necessary to carry out sections
2612(b)(3)(B) and 2616 for each of fiscal years 2015 through 2017.''.
SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE SYSTEM.
(a) Grants.--The Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control and Prevention,
shall make grants to States to support integration of public health
surveillance systems into all electronic health records in order to
allow rapid communications between the clinical setting and health
departments, by means that include--
(1) providing technical assistance and policy guidance to
State and local health departments, clinical providers, and
other agencies serving individuals with HIV to improve the
interoperability of data systems relevant to monitoring HIV
care and supportive services;
(2) capturing longitudinal data pertaining to the
initiation and ongoing prescription or dispensing of
antiretroviral therapy for individuals diagnosed with HIV (such
as through pharmacy-based reporting);
(3) obtaining information--
(A) on a voluntary basis, on sexual orientation and
gender identity; and
(B) on sources of coverage (or the lack thereof)
for medical treatment (including coverage through
Medicaid, Medicare, the program under title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-11 et seq.;
commonly referred to as the ``Ryan White HIV/AIDS
Program''), other public funding, private insurance,
and health maintenance organizations); and
(4) obtaining and using current geographic markers of
residence (such as current address, zip code, partial zip code,
and census block).
(b) Privacy and Security Safeguards.--In carrying out this section,
the Secretary of Health and Human Services shall ensure that
appropriate privacy and security safeguards are met to prevent
unauthorized disclosure of protected health information and compliance
with the HIPAA privacy and security law (as defined in section 3009 of
the Public Health Service Act (42 U.S.C. 300jj-19)) and other relevant
laws and regulations.
(c) Prohibition Against Improper Use of Data.--No grant under this
section may be used to allow or facilitate the collection or use of
surveillance or clinical data or records--
(1) for punitive measures of any kind, civil or criminal,
against the subject of such data or records; or
(2) for imposing any requirement or restriction with
respect to an individual without the individual's written
consent.
(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2015 through 2019.
SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING LINKAGE TO AND
RETENTION IN APPROPRIATE CARE.
(a) Strategies.--The Secretary of Health and Human Services, in
collaboration with the Director of the Centers for Disease Control and
Prevention, the Administrator of the Substance Abuse and Mental Health
Services Administration, the Director of the Office of AIDS Research,
the Administrator of the Health Resources and Services Administration,
and the Administrator of the Centers for Medicare & Medicaid Services,
shall--
(1) identify evidence-based strategies most effective at
addressing the multifaceted issues that impede disease status
awareness and linkage to and retention in appropriate care,
taking into consideration health care systems issues, clinic
and provider issues, and individual psychosocial,
environmental, and other contextual factors;
(2) support the wide-scale implementation of the evidence-
based strategies identified pursuant to paragraph (1),
including through incorporating such strategies into health
care coverage supported by the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.), the
program under title XXVI of the Public Health Service Act (42
U.S.C. 300ff-11 et seq.; commonly referred to as the ``Ryan
White HIV/AIDS Program''), and health plans purchased through
an American Health Benefit Exchange established pursuant to
section 1311 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031); and
(3) not later than 12 months after the date of the
enactment of this Act, submit a report to the Congress on the
status of activities under paragraphs (1) and (2).
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2019.
SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN CARE AND ANTIRETROVIRAL
ADHERENCE FOR PERSONS WITH HIV.
(a) Sense of Congress.--It is the sense of the Congress that AIDS
research has led to scientific advancements that have--
(1) saved the lives of millions of people with HIV/AIDS;
(2) prevented millions of people from being infected; and
(3) had broad benefits that extend far beyond helping
people at risk for or living with HIV.
(b) In General.--The Secretary of Health and Human Services, acting
through the Director of the National Institutes of Health, shall
expand, intensify, and coordinate operational and translational
research and other activities of the National Institutes of Health
regarding methods--
(1) to increase adoption of evidence-based adherence
strategies within HIV care and treatment programs;
(2) to increase HIV testing and case detection rates;
(3) to reduce HIV-related health disparities;
(4) to ensure that research to improve adherence to HIV
care and treatment programs address the unique concerns of
women;
(5) to integrate HIV/AIDS prevention and care services with
mental health and substance use prevention and treatment
delivery systems; and
(6) to increase knowledge on the implementation of
preexposure prophylaxis (PrEP), including with respect to--
(A) who can benefit most from PrEP;
(B) how to provide PrEP safely and efficiently;
(C) how to integrate PrEP with other essential
prevention methods such as condoms; and
(D) how to ensure high levels of adherence.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2019.
SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND ETHNIC MINORITY
COMMUNITIES.
(a) In General.--For the purpose of reducing HIV/AIDS in racial and
ethnic minority communities, the Secretary, acting through the Deputy
Assistant Secretary for Minority Health, may make grants to public
health agencies and faith-based organizations to conduct--
(1) outreach activities related to HIV/AIDS prevention and
testing activities;
(2) HIV/AIDS prevention activities; and
(3) HIV/AIDS testing activities.
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $50,000,000 for fiscal year
2015, and such sums as may be necessary for fiscal years 2016 through
2019.
SEC. 748. MINORITY AIDS INITIATIVE.
(a) Expanded Funding.--The Secretary, in collaboration with the
Deputy Assistant Secretary for Minority Health, the Director of the
Centers for Disease Control and Prevention, the Administrator of the
Health Resources and Services Administration, and the Administrator of
the Substance Abuse and Mental Health Services Administration, shall
provide funds and carry out activities to expand the Minority HIV/AIDS
Initiative.
(b) Use of Funds.--The additional funds made available under this
section may be used, through the Minority AIDS Initiative, to support
the following activities:
(1) Providing technical assistance and infrastructure
support to reduce HIV/AIDS in minority populations.
(2) Increasing minority populations' access to HIV/AIDS
prevention and care services.
(3) Building strong community programs and partnerships to
address HIV prevention and the health care needs of specific
racial and ethnic minority populations.
(c) Priority Interventions.--Within the racial and ethnic minority
populations referred to in subsection (b), priority in conducting
intervention services shall be given to--
(1) men who have sex with men;
(2) youth;
(3) persons who engage in intravenous drug abuse;
(4) women;
(5) homeless individuals; and
(6) individuals incarcerated or in the penal system.
(d) Authorization of Appropriations.--For carrying out this
section, there are authorized to be appropriated $610,000,0000 for
fiscal year 2015 and such sums as may be necessary for each of fiscal
years 2016 through 2019.
SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV/AIDS.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator of the Health Resources and Services
Administration, shall expand, intensify, and coordinate workforce
initiatives of the Health Resources and Services Administration to
increase the capacity of the health workforce focusing primarily on
HIV/AIDS to meet the demand for culturally competent care, and may
award grants for any of the following:
(1) Development of curricula for training primary care
providers in HIV/AIDS prevention and care, including routine
HIV testing.
(2) Support to expand access to culturally and
linguistically accessible benefits counselors, trained peer
navigators, and mental and behavioral health professionals with
expertise in HIV/AIDS.
(3) Training health care professionals to provide care to
individuals with HIV/AIDS.
(4) Development by grant recipients under title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-11 et seq.; commonly
referred to as the Ryan White HIV/AIDS Program) and other
persons, of policies for providing culturally relevant and
sensitive treatment to individuals with HIV/AIDS, with
particular emphasis on treatment to racial and ethnic
minorities, men who have sex with men, and women, young people,
and children with HIV/AIDS.
(5) Development and implementation of programs to increase
the use of telehealth to respond to HIV/AIDS-specific health
care needs in rural and minority communities, with particular
emphasis given to medically underserved communities and insular
areas.
(6) Evaluating interdisciplinary medical provider care team
models that promote high quality care, with particular emphasis
on care to racial and ethnic minorities.
(7) Training health care professionals to make them aware
of the high rates of chronic hepatitis B and chronic hepatitis
C in adult racial and ethnic populations, and the importance of
prevention, detection, and medical management of hepatitis B
and hepatitis C and of liver cancer screening.
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2019.
SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PROGRAM.
(a) In General.--The Secretary may enter into an agreement with any
physician, nurse practitioner, or physician assistant under which--
(1) the physician, nurse practitioner, or physician
assistant agrees to serve as a medical provider for a period of
not less than 2 years--
(A) at a Ryan White-funded or title X-funded
facility with a critical shortage of doctors (as
determined by the Secretary); or
(B) in an area with a high incidence of HIV/AIDS;
and
(2) the Secretary agrees to make payments in accordance
with subsection (b) on the professional education loans of the
physician, nurse practitioner, or physician assistant.
(b) Manner of Payments.--The payments described in subsection (a)
shall be made by the Secretary as follows:
(1) Upon completion by the physician, nurse practitioner,
or physician assistant for whom the payments are to be made of
the first year of the service specified in the agreement
entered into with the Secretary under subsection (a), the
Secretary shall pay 30 percent of the principal of and the
interest on the individual's professional education loans.
(2) Upon completion by the physician, nurse practitioner,
or physician assistant of the second year of such service, the
Secretary shall pay another 30 percent of the principal of and
the interest on such loans.
(3) Upon completion by that individual of a third year of
such service, the Secretary shall pay another 25 percent of the
principal of and the interest on such loans.
(c) Applicability of Certain Provisions.--The provisions of subpart
III of part D of title III of the Public Health Service Act (42 U.S.C.
254l et seq.) shall, except as inconsistent with this section, apply to
the program carried out under this section in the same manner and to
the same extent as such provisions apply to the National Health Service
Corps Loan Repayment Program.
(d) Reports.--Not later than 18 months after the date of the
enactment of this Act, and annually thereafter, the Secretary shall
prepare and submit to the Congress a report describing the program
carried out under this section, including statements regarding the
following:
(1) The number of physicians, nurse practitioners, and
physician assistants enrolled in the program.
(2) The number and amount of loan repayments.
(3) The placement location of loan repayment recipients at
facilities described in subsection (a)(1).
(4) The default rate and actions required.
(5) The amount of outstanding default funds.
(6) To the extent that it can be determined, the reason for
the default.
(7) The demographics of individuals participating in the
program.
(8) An evaluation of the overall costs and benefits of the
program.
(e) Definitions.--In this section:
(1) The term ``HIV/AIDS'' means human immunodeficiency
virus and acquired immune deficiency syndrome.
(2) The term ``nurse practitioner'' means a registered
nurse who has completed an accredited graduate degree program
in advanced nurse practice and has successfully passed a
national certification exam.
(3) The term ``physician'' means a graduate of a school of
medicine who has completed postgraduate training in general or
pediatric medicine.
(4) The term ``physician assistant'' means a medical
provider who completed an accredited physician assistant
training program and successfully passed the Physician
Assistant National Certifying Examination.
(5) The term ``professional education loan''--
(A) means a loan that is incurred for the cost of
attendance (including tuition, other reasonable
educational expenses, and reasonable living costs) at a
school of medicine, nursing, or physician assistant
training program; and
(B) includes only the portion of the loan that is
outstanding on the date the physician, nurse
practitioner, or physician assistant involved begins
the service specified in the agreement under subsection
(a).
(6) The term ``Ryan White-funded'' means, with respect to a
facility, receiving funds under title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-11 et seq.).
(7) The term ``Secretary'' means the Secretary of Health
and Human Services.
(8) The term ``school of medicine'' has the meaning given
to that term in section 799B of the Public Health Service Act
(42 U.S.C. 295p).
(9) The term ``title X-funded'' means, with respect to a
facility, receiving funds under title X of the Public Health
Service Act (42 U.S.C. 300 et seq.).
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2019.
SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PROGRAM.
(a) In General.--The Secretary of Health and Human Services may
enter into an agreement with any dentist under which--
(1) the dentist agrees to serve as a dentist for a period
of not less than 2 years at a facility with a critical shortage
of dentists (as determined by the Secretary) in an area with a
high incidence of HIV/AIDS; and
(2) the Secretary agrees to make payments in accordance
with subsection (b) on the dental education loans of the
dentist.
(b) Manner of Payments.--The payments described in subsection (a)
shall be made by the Secretary as follows:
(1) Upon completion by the dentist for whom the payments
are to be made of the first year of the service specified in
the agreement entered into with the Secretary under subsection
(a), the Secretary shall pay 30 percent of the principal of and
the interest on the dental education loans of the dentist.
(2) Upon completion by the dentist of the second year of
such service, the Secretary shall pay another 30 percent of the
principal of and the interest on such loans.
(3) Upon completion by that individual of a third year of
such service, the Secretary shall pay another 25 percent of the
principal of and the interest on such loans.
(c) Applicability of Certain Provisions.--The provisions of subpart
III of part D of title III of the Public Health Service Act (42 U.S.C.
254l et seq.) shall, except as inconsistent with this section, apply to
the program carried out under this section in the same manner and to
the same extent as such provisions apply to the National Health Service
Corps Loan Repayment Program.
(d) Reports.--Not later than 18 months after the date of the
enactment of this Act, and annually thereafter, the Secretary shall
prepare and submit to the Congress a report describing the program
carried out under this section, including statements regarding the
following:
(1) The number of dentists enrolled in the program.
(2) The number and amount of loan repayments.
(3) The placement location of loan repayment recipients at
facilities described in subsection (a)(1).
(4) The default rate and actions required.
(5) The amount of outstanding default funds.
(6) To the extent that it can be determined, the reason for
the default.
(7) The demographics of individuals participating in the
program.
(8) An evaluation of the overall costs and benefits of the
program.
(e) Definitions.--In this section:
(1) The term ``dental education loan''--
(A) means a loan that is incurred for the cost of
attendance (including tuition, other reasonable
educational expenses, and reasonable living costs) at a
school of dentistry; and
(B) includes only the portion of the loan that is
outstanding on the date the dentist involved begins the
service specified in the agreement under subsection
(a).
(2) The term ``dentist'' means a graduate of a school of
dentistry who has completed postgraduate training in general or
pediatric dentistry.
(3) The term ``HIV/AIDS'' means human immunodeficiency
virus and acquired immune deficiency syndrome.
(4) The term ``school of dentistry'' has the meaning given
to that term in section 799B of the Public Health Service Act
(42 U.S.C. 295p).
(5) The term ``Secretary'' means the Secretary of Health
and Human Services.
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2015 through 2019.
SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECTING DRUG USERS.
(a) Sense of Congress.--It is the sense of the Congress that
providing sterile syringes and sterilized equipment to injecting drug
users substantially reduces risk of HIV infection, increases the
probability that they will initiate drug treatment, and does not
increase drug use.
(b) In General.--The Secretary of Health and Human Services may
provide grants and technical assistance for the purpose of reducing the
rate of HIV infections among injecting drug users through a
comprehensive package of services for such users, including the
provision of sterile syringes, education and outreach, access to
infectious disease testing, overdose prevention, and treatment for drug
dependence.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2019.
SEC. 753. SUPPORT FOR EXPANSION OF COMPREHENSIVE SEXUAL HEALTH AND
EDUCATION PROGRAMS.
(a) Sense of Congress.--It is the sense of Congress that--
(1) federally funded sex education programs should aim to--
(A) reduce unintended pregnancy and sexually
transmitted infections, including HIV;
(B) promote safe and healthy relationships;
(C) use, and be informed by, the best scientific
information available;
(D) be built on characteristics of effective
programs;
(E) expand the existing body of evidence on
comprehensive sex education programs through program
evaluation;
(F) expand training programs for teachers of
comprehensive sex education;
(G) build on the personal responsibility education
programs funded under section 513 of the Social
Security Act (42 U.S.C. 713) and the President's Teen
Pregnancy Prevention program, funded under title II of
the Consolidated Appropriations Act, 2010 (Public Law
111-117; 123 Stat. 3253); and
(H) promote and uphold the rights of young people
to information in order to make healthy and responsible
decisions about their sexual health; and
(2) no Federal funds should be used for health education
programs that--
(A) deliberately withhold life-saving information
about HIV;
(B) are medically inaccurate or have been
scientifically shown to be ineffective;
(C) promote gender stereotypes;
(D) are insensitive and unresponsive to the needs
of sexually active adolescents;
(E) are insensitive and unresponsive to the needs
of lesbian, gay, bisexual, or transgender youth; or
(F) are inconsistent with the ethical imperatives
of medicine and public health.
(b) Grants for Comprehensive Sex Education for Adolescents.--
(1) Program authorized.--The Secretary, in coordination
with the Director of the Office of Adolescent Health, shall
award grants, on a competitive basis, to eligible entities to
enable such eligible entities to carry out programs that
provide adolescents with comprehensive sex education, as
described in paragraph (6).
(2) Duration.--Grants awarded under this subsection shall
be for a period of 5 years.
(3) Eligible entity.--In this subsection, the term
``eligible entity'' means a public or private entity that
focuses on adolescent health or education or has experience
working with adolescents, which may include--
(A) a State educational agency;
(B) a local educational agency;
(C) a tribe or tribal organization, as defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b);
(D) a State or local department of health;
(E) a State or local department of education;
(F) a nonprofit organization;
(G) a nonprofit or public institution of higher
education; or
(H) a hospital.
(4) Applications.--An eligible entity desiring a grant
under this subsection shall submit an application to the
Secretary at such time, in such manner, and containing such
information as the Secretary may require, including the
evaluation plan described in paragraph (7)(A).
(5) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to eligible entities that--
(A) are State or local public entities, with an
additional priority for State or local educational
agencies; and
(B) address health disparities among young people
that are at highest risk for not less than 1 of the
following:
(i) Unintended pregnancies.
(ii) Sexually transmitted infections,
including HIV.
(iii) Dating violence and sexual assault.
(6) Use of funds.--
(A) In general.--Each eligible entity that receives
a grant under this subsection shall use grant funds to
carry out a program that provides adolescents with
comprehensive sex education that--
(i) replicates evidence-based sex education
programs;
(ii) substantially incorporates elements of
evidence-based sex education programs; or
(iii) creates a demonstration project based
on generally accepted characteristics of
effective sex education programs.
(B) Contents of sex education programs.--The sex
education programs funded under this subsection shall
include curricula and program materials that address--
(i) abstinence and delaying sexual
initiation;
(ii) the health benefits and side effects
of all contraceptive and barrier methods as a
means to prevent pregnancy and sexually
transmitted infections, including HIV;
(iii) healthy relationships, including the
development of healthy attitudes and skills
necessary for understanding--
(I) healthy relationships between
oneself and family, others, and
society; and
(II) the prevention of sexual
abuse, teen dating violence, bullying,
harassment, and suicide;
(iv) healthy life skills including goal-
setting, decisionmaking, interpersonal skills
(such as communication, assertiveness, and peer
refusal skills), critical thinking, self-esteem
and self-efficacy, and stress management;
(v) how to make responsible decisions about
sex and sexuality, including--
(I) how to avoid, and how to avoid
making, unwanted verbal, physical, and
sexual advances; and
(II) how alcohol and drug use can
affect responsible decisionmaking;
(vi) the development of healthy attitudes
and values about such topics as adolescent
growth and development, body image, gender
roles and gender identity, racial and ethnic
diversity, and sexual orientation; and
(vii) referral services for local health
clinics and services where adolescents can
obtain additional information and services
related to sexual and reproductive health,
dating violence and sexual assault, and suicide
prevention.
(7) Evaluation; report.--
(A) Independent evaluation.--Each eligible entity
applying for a grant under this subsection shall
develop and submit to the Secretary a plan for a
rigorous independent evaluation of such grant program.
The plan shall describe an independent evaluation
that--
(i) uses sound statistical methods and
techniques relating to the behavioral sciences,
including random assignment methodologies,
whenever possible;
(ii) uses quantitative data for assessments
and impact evaluations, whenever possible; and
(iii) is carried out by an entity
independent from such eligible entity.
(B) Selection of evaluated programs; budget.--
(i) Selection of evaluated programs.--The
Secretary shall select, at random, a subset of
the eligible entities that the Secretary has
selected to receive a grant under this
subsection to receive additional funding to
carry out the evaluation plan described in
subparagraph (A).
(ii) Budget for evaluation activities.--The
Secretary, in coordination with the Director of
the Office of Adolescent Health, shall
establish a budget for each eligible entity
selected under clause (i) for the costs of
carrying out the evaluation plan described in
subparagraph (A).
(C) Funds for evaluation.--The Secretary shall
provide eligible entities who are selected under
subparagraph (B)(i) with additional funds, in
accordance with the budget described in subparagraph
(B)(ii), to carry out and report to the Secretary on
the evaluation plan described in subparagraph (A).
(D) Performance measures.--The Secretary, in
coordination with the Director of the Centers for
Disease Control and Prevention, shall establish a
common set of performance measures to assess the
implementation and impact of grant programs funded
under this subsection. Such performance measures shall
include--
(i) output measures, such as the number of
individuals served and the number of hours of
service delivery;
(ii) outcome measures, including measures
relating to--
(I) the knowledge that youth
participating in the grant program have
gained about--
(aa) adolescent growth and
development;
(bb) relationship dynamics;
(cc) ways to prevent
unintended pregnancy and
sexually transmitted
infections, including HIV; and
(dd) sexual health;
(II) the skills that adolescents
participating in the grant program have
gained regarding--
(aa) negotiation and
communication;
(bb) decisionmaking and
goal-setting;
(cc) interpersonal skills
and healthy relationships; and
(dd) condom use; and
(III) the behaviors of adolescents
participating in the grant program,
including data about--
(aa) age of first
intercourse;
(bb) number of sexual
partners;
(cc) condom and
contraceptive use at first
intercourse;
(dd) recent condom and
contraceptive use; and
(ee) dating abuse and
lifetime history of domestic
violence, sexual assault,
dating violence, bullying,
harassment, and stalking.
(E) Report to the secretary.--Eligible entities
receiving a grant under this subsection who have been
selected to receive funds to carry out the evaluation
plan described in subparagraph (A), in accordance with
subparagraph (B)(i), shall collect and report to the
Secretary--
(i) the results of the independent
evaluation described in subparagraph (A); and
(ii) information about the performance
measures described in subparagraph (B).
(F) Effective programs.--The Secretary, in
coordination with the Director of the Centers for
Disease Control and Prevention, shall publish on the
Web site of the Centers for Disease Control and
Prevention, a list of programs funded under this
subsection that the Secretary has determined to be
effective programs.
(c) Grants for Comprehensive Sex Education at Institutions of
Higher Education.--
(1) Program authorized.--The Secretary, in coordination
with the Office of Adolescent Health and the Secretary of
Education, shall award grants, on a competitive basis, to
institutions of higher education to enable such institutions to
provide young people with comprehensive sex education,
described in paragraph (5)(B), with an emphasis on reducing
HIV, other sexually transmitted infections, and unintended
pregnancy through instruction about--
(A) abstinence and contraception;
(B) reducing dating violence, sexual assault,
bullying, and harassment;
(C) increasing healthy relationships; and
(D) academic achievement.
(2) Duration.--Grants awarded under this subsection shall
be for a period of 5 years.
(3) Applications.--An institution of higher education
desiring a grant under this subsection shall submit an
application to the Secretary at such time, in such manner, and
containing such information as the Secretary may require.
(4) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to an institution of higher
education that--
(A) has an enrollment of needy students as defined
in section 318(b) of the Higher Education Act of 1965
(20 U.S.C. 1059e(b));
(B) is a Hispanic-serving institution, as defined
in section 502(a) of such Act (20 U.S.C. 1101a(a));
(C) is a Tribal College or University, as defined
in section 316(b) of such Act (20 U.S.C. 1059c(b));
(D) is an Alaska Native-serving institution, as
defined in section 317(b) of such Act (20 U.S.C.
1059d(b));
(E) is a Native Hawaiian-serving institution, as
defined in section 317(b) of such Act (20 U.S.C.
1059d(b));
(F) is a Predominately Black Institution, as
defined in section 318(b) of such Act (20 U.S.C.
1059e(b));
(G) is a Native American-serving, nontribal
institution, as defined in section 319(b) of such Act
(20 U.S.C. 1059f(b));
(H) is an Asian American and Native American
Pacific Islander-serving institution, as defined in
section 320(b) of such Act (20 U.S.C. 1059g(b)); or
(I) is a minority institution, as defined in
section 365 of such Act (20 U.S.C. 1067k), with an
enrollment of needy students, as defined in section 312
of such Act (20 U.S.C. 1058).
(5) Uses of funds.--
(A) In general.--An institution of higher education
receiving a grant under this subsection may use grant
funds to integrate issues relating to comprehensive sex
education into the academic or support sectors of the
institution of higher education in order to reach a
large number of students, by carrying out 1 or more of
the following activities:
(i) Developing educational content for
issues relating to comprehensive sex education
that will be incorporated into first-year
orientation or core courses.
(ii) Developing and employing schoolwide
educational programming outside of class that
delivers elements of comprehensive sex
education programs to students, faculty, and
staff.
(iii) Creating innovative technology-based
approaches to deliver sex education to
students, faculty, and staff.
(iv) Developing and employing peer-outreach
and education programs to generate discussion,
educate, and raise awareness among students
about issues relating to comprehensive sex
education.
(B) Contents of sex education programs.--Each
institution of higher education's program of
comprehensive sex education funded under this
subsection shall include curricula and program
materials that address information about--
(i) safe and responsible sexual behavior
with respect to the prevention of pregnancy and
sexually transmitted infections, including HIV,
including through--
(I) abstinence;
(II) a reduced number of sexual
partners; and
(III) the use of condoms and
contraception;
(ii) healthy relationships, including the
development of healthy attitudes and insights
necessary for understanding--
(I) relationships between oneself,
family, partners, others, and society;
and
(II) the prevention of sexual
abuse, dating violence, bullying,
harassment, and suicide; and
(iii) referral services to local health
clinics where young people can obtain
additional information and services related to
sexual and reproductive health, dating violence
and sexual assault, and suicide prevention.
(C) Optional components of sex education.--Each
institution of higher education's program of
comprehensive sex education may also include
information and skills development relating to--
(i) how to make responsible decisions about
sex and sexuality, including--
(I) how to avoid, and avoid making,
unwanted verbal, physical, and sexual
advances; and
(II) how alcohol and drug use can
affect responsible decisionmaking;
(ii) healthy life skills, including--
(I) goal-setting and
decisionmaking;
(II) interpersonal skills, such as
communication, assertiveness, and peer
refusal skills;
(III) critical thinking;
(IV) self-esteem and self-efficacy;
and
(V) stress management;
(iii) the development of healthy attitudes
and values about such topics as body image,
gender roles and gender identity, racial and
ethnic diversity, and sexual orientation; and
(iv) the responsibilities of parenting and
the skills necessary to parent well.
(6) Evaluation; report.--The requirements described in
section 125B(g) shall also apply to eligible entities receiving
a grant under this subsection in the same manner as such
requirements apply to eligible entities receiving grants under
section 125B.
(d) Grants for Pre-Service and In-Service Teacher Training.--
(1) Program authorized.--The Secretary, in coordination
with the Director of the Centers for Disease Control and
Prevention and the Secretary of Education, shall award grants,
on a competitive basis, to eligible entities to enable such
eligible entities to carry out the activities described in
paragraph (5).
(2) Duration.--Grants awarded under this subsection shall
be for a period of 5 years.
(3) Eligible entity.--In this subsection, the term
``eligible entity'' means--
(A) a State educational agency;
(B) a local educational agency;
(C) a tribe or tribal organization, as defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450b);
(D) a State or local department of health;
(E) a State or local department of education;
(F) a nonprofit institution of higher education;
(G) a national or statewide nonprofit organization
that has as its primary purpose the improvement of
provision of comprehensive sex education through
effective teaching of comprehensive sex education; or
(H) a consortium of nonprofit organizations that
has as its primary purpose the improvement of provision
of comprehensive sex education through effective
teaching of comprehensive sex education.
(4) Application.--An eligible entity desiring a grant under
this subsection shall submit an application to the Secretary at
such time, in such manner, and containing such information as
the Secretary may require.
(5) Authorized activities.--
(A) Required activity.--Each eligible entity
receiving a grant under this subsection shall use grant
funds to train targeted faculty and staff, in order to
increase effective teaching of comprehensive sex
education for elementary school and secondary school
students.
(B) Permissible activities.--Each eligible entity
receiving a grant under this subsection may use grant
funds to--
(i) strengthen and expand the eligible
entity's relationships with--
(I) institutions of higher
education;
(II) State educational agencies;
(III) local educational agencies;
or
(IV) other public and private
organizations with a commitment to
comprehensive sex education and the
benefits of comprehensive sex
education;
(ii) support and promote research-based
training of teachers of comprehensive sex
education and related disciplines in elementary
schools and secondary schools as a means of
broadening student knowledge about issues
related to human development, relationships,
personal skills, sexual behavior, sexual
health, and society and culture;
(iii) support the dissemination of
information on effective practices and research
findings concerning the teaching of
comprehensive sex education;
(iv) support research on--
(I) effective comprehensive sex
education teaching practices; and
(II) the development of assessment
instruments and strategies to
document--
(aa) student understanding
of comprehensive sex education;
and
(bb) the effects of
comprehensive sex education;
(v) convene national conferences on
comprehensive sex education, in order to
effectively train teachers in the provision of
comprehensive sex education; and
(vi) develop and disseminate appropriate
research-based materials to foster
comprehensive sex education.
(C) Subgrants.--Each eligible entity receiving a
grant under this subsection may award subgrants to
nonprofit organizations, State educational agencies, or
local educational agencies to enable such organizations
or agencies to--
(i) train teachers in comprehensive sex
education;
(ii) support Internet or distance learning
related to comprehensive sex education;
(iii) promote rigorous academic standards
and assessment techniques to guide and measure
student performance in comprehensive sex
education;
(iv) encourage replication of best
practices and model programs to promote
comprehensive sex education;
(v) develop and disseminate effective,
research-based comprehensive sex education
learning materials;
(vi) develop academic courses on the
pedagogy of sex education at institutions of
higher education; or
(vii) convene State-based conferences to
train teachers in comprehensive sex education
and to identify strategies for improvement.
(e) Report to Congress.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter for a period
of 5 years, the Secretary shall prepare and submit to the
appropriate committees of Congress a report on the activities
to provide adolescents and young people with comprehensive sex
education funded under this section.
(2) Report elements.--The report described in paragraph (1)
shall include information about--
(A) the number of eligible entities and
institutions of higher education that are receiving
grant funds under subsections (b) and (c);
(B) the specific activities supported by grant
funds awarded under subsections (b) and (c);
(C) the number of adolescents served by grant
programs funded under subsection (b);
(D) the number of young people served by grant
programs funded under subsection (c); and
(E) the status of program evaluations described
under subsections (b) and (c).
(f) Limitation.--No Federal funds provided under this section may
be used for health education programs that--
(1) deliberately withhold life-saving information about
HIV;
(2) are medically inaccurate or have been scientifically
shown to be ineffective;
(3) promote gender stereotypes;
(4) are insensitive and unresponsive to the needs of
sexually active youth or lesbian, gay, bisexual, or transgender
youth; or
(5) are inconsistent with the ethical imperatives of
medicine and public health.
(g) Definitions.--In this section:
(1) ESEA definitions.--The terms ``elementary school'',
``local educational agency'', ``secondary school'', and ``State
educational agency'' have the meanings given the terms in
section 9101 of the Elementary and Secondary Education Act of
1965 (20 U.S.C. 7801).
(2) Age and developmentally appropriate.--The term ``age
and developmentally appropriate'' means suitable for a
particular age or age group of children and adolescents, based
on developing cognitive, emotional, and behavioral capacity
typical for that age or age group.
(3) Adolescents.--The term ``adolescents'' means
individuals who are ages 10 through 19 at the time of
commencement of participation in a program supported under this
section.
(4) Characteristics of effective programs.--The term
``characteristics of effective programs'' means the aspects of
evidence-based programs, including development, content, and
implementation of such programs, that--
(A) have been shown to be effective in terms of
increasing knowledge, clarifying values and attitudes,
increasing skills, and impacting upon behavior; and
(B) are widely recognized by leading medical and
public health agencies to be effective in changing
sexual behaviors that lead to sexually transmitted
infections, including HIV, unintended pregnancy, and
dating violence and sexual assault among young people.
(5) Comprehensive sex education.--The term ``comprehensive
sex education'' means a program that--
(A) includes age- and developmentally appropriate,
culturally and linguistically relevant information on a
broad set of topics related to sexuality including
human development, relationships, decisionmaking,
communication, abstinence, contraception, and disease
and pregnancy prevention;
(B) provides students with opportunities for
developing skills as well as learning information;
(C) is inclusive of lesbian, gay, bisexual,
transgender, and heterosexual young people; and
(D) aims to--
(i) provide scientifically accurate and
realistic information about human sexuality;
(ii) provide opportunities for individuals
to understand their own, their families', and
their communities' values, attitudes, and
insights about sexuality;
(iii) help individuals develop healthy
relationships and interpersonal skills; and
(iv) help individuals exercise
responsibility regarding sexual relationships,
which includes addressing abstinence, pressures
to become prematurely involved in sexual
intercourse, and the use of contraception and
other sexual health measures.
(6) Evidence-based program.--The term ``evidence-based
program'' means a sex education program that has been proven
through rigorous evaluation to be effective in changing sexual
behavior or incorporates elements of other sex education
programs that have been proven to be effective in changing
sexual behavior.
(7) Institution of higher education.--The term
``institution of higher education'' has the meaning given the
term in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
(8) Medically accurate and complete.--The term ``medically
accurate and complete'', when used with respect to a sex
education program, means that--
(A) the information provided through the program is
verified or supported by the weight of research
conducted in compliance with accepted scientific
methods and is published in peer-reviewed journals,
where applicable; or
(B)(i) the program contains information that
leading professional organizations and agencies with
relevant expertise in the field recognize as accurate,
objective, and complete; and
(ii) the program does not withhold information
about the effectiveness and benefits of correct and
consistent use of condoms and other contraceptives.
(9) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(10) Young people.--The term ``young people'' means
individuals who are ages 10 through 24 at the time of
commencement of participation in a program supported under this
section.
(h) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2015 through 2019.
SEC. 754. ELIMINATION OF ABSTINENCE-ONLY EDUCATION PROGRAM.
(a) In General.--Title V of the Social Security Act (42 U.S.C. 701
et seq.) is amended by striking section 510.
(b) Rescission.--Amounts appropriated for fiscal years 2013 and
2014 under section 510(d) of the Social Security Act (42 U.S.C. 710(d))
(as in effect on the day before the date of enactment of this Act) that
are unobligated as of the date of enactment of this Act are rescinded.
(c) Reprogram of Eliminated Abstinence-Only Funds for the Personal
Responsibility Education Program (PREP).--Section 513(f) of the Social
Security Act (42 U.S.C. 713(f)) is amended by striking ``$75,000,000
for each of fiscal years 2011 through 2015'' and inserting
``$75,000,000 for each of fiscal years 2011 through 2014, an amount for
fiscal year 2015 equal to $75,000,000 increased by an amount equal to
the unobligated portion of funds appropriated for fiscal year 2014 and
2015 under section 510(d) that are rescinded by section 754(b) of the
Health Equity and Accountability Act of 2014, and $125,000,000 for each
of fiscal years 2016 and 2017''.
SEC. 755. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE POPULATIONS.
(a) In General.--The Secretary shall submit to the Congress and the
President an annual report on the impact of HIV/AIDS for racial and
ethnic minority communities, women, and youth aged 24 and younger.
(b) Contents.--The report under subsection (a) shall include
information on the--
(1) progress that has been made in reducing the impact of
HIV/AIDS in such communities;
(2) opportunities that exist to make additional progress in
reducing the impact of HIV/AIDS in such communities;
(3) challenges that may impede such additional progress;
and
(4) Federal funding necessary to achieve substantial
reductions in HIV/AIDS in racial and ethnic minority
communities.
SEC. 756. NATIONAL HIV/AIDS OBSERVANCE DAYS.
(a) National Observance Days.--It is the sense of the Congress that
national observance days highlighting the impact of HIV/AIDS on
communities of color include the following:
(1) National Black HIV/AIDS Awareness Day.
(2) National Latino AIDS Awareness Day.
(3) National Asian and Pacific Islander HIV/AIDS Awareness
Day.
(4) National Native American HIV/AIDS Awareness Day.
(5) Caribbean-American HIV/AIDS Awareness Day.
(6) National Youth HIV/AIDS Awareness Day.
(7) National Black Clergy HIV/AIDS Awareness Sunday.
(b) Call to Action.--It is the sense of the Congress that the
President should call on members of communities of color--
(1) to become involved at the local community level in HIV/
AIDS testing, policy, and advocacy;
(2) to become aware, engaged, and empowered on the HIV/AIDS
epidemic within their communities; and
(3) to urge members of their communities to reduce risk
factors, practice safe sex and other preventive measures, be
tested for HIV/AIDS, and seek care when appropriate.
SEC. 757. REVIEW OF ALL FEDERAL AND STATE LAWS, POLICIES, AND
REGULATIONS REGARDING THE CRIMINAL PROSECUTION OF
INDIVIDUALS FOR HIV-RELATED OFFENSES.
(a) Definitions.--
(1) HIV and hiv/aids.--The terms ``HIV'' and ``HIV/AIDS''
have the meanings given to such terms in section 2689 of the
Public Health Service Act (42 U.S.C. 300ff-88).
(2) State.--The term ``State'' includes the District of
Columbia, American Samoa, the Commonwealth of the Northern
Mariana Islands, Guam, Puerto Rico, and the United States
Virgin Islands.
(b) Sense of Congress Regarding Laws or Regulations Directed at
People Living With HIV/AIDS.--It is the sense of the Congress that
Federal and State laws, policies, and regulations regarding people
living with HIV/AIDS--
(1) should not place unique or additional burdens on such
individuals solely as a result of their HIV status; and
(2) should instead demonstrate a public health-oriented,
evidence-based, medically accurate, and contemporary
understanding of--
(A) the multiple factors that lead to HIV
transmission;
(B) the relative risk of HIV transmission routes;
(C) the current health implications of living with
HIV;
(D) the associated benefits of treatment and
support services for people living with HIV; and
(E) the impact of punitive HIV-specific laws and
policies on public health, on people living with or
affected by HIV, and on their families and communities.
(c) Review of All Federal and State Laws, Policies, and Regulations
Regarding the Criminal Prosecution of Individuals for HIV-Related
Offenses.--
(1) Review of federal and state laws.--
(A) In general.--No later than 90 days after the
date of the enactment of this Act, the Attorney
General, the Secretary of Health and Human Services,
and the Secretary of Defense acting jointly (in this
paragraph and paragraph (2) referred to as the
``designated officials'') shall initiate a national
review of Federal and State laws, policies,
regulations, and judicial precedents and decisions
regarding criminal and related civil commitment cases
involving people living with HIV/AIDS, including in
regards to the Uniform Code of Military Justice.
(B) Consultation.--In carrying out the review under
subparagraph (A), the designated officials shall ensure
diverse participation and consultation from each State,
including with--
(i) State attorneys general (or their
representatives);
(ii) State public health officials (or
their representatives);
(iii) State judicial and court system
officers, including judges, district attorneys,
prosecutors, defense attorneys, law
enforcement, and correctional officers;
(iv) members of the United States Armed
Forces, including members of other Federal
services subject to the Uniform Code of
Military Justice;
(v) people living with HIV/AIDS,
particularly those who have been subject to
HIV-related prosecution or who are from
communities whose members have been
disproportionately subject to HIV-specific
arrests and prosecutions;
(vi) legal advocacy and HIV/AIDS service
organizations that work with people living with
HIV/AIDS;
(vii) nongovernmental health organizations
that work on behalf of people living with HIV/
AIDS; and
(viii) trade organizations or associations
representing persons or entities described in
clauses (i) through (vii).
(C) Relation to other reviews.--In carrying out the
review under subparagraph (A), the designated officials
may utilize other existing reviews of criminal and
related civil commitment cases involving people living
with HIV/AIDS, including any such review conducted by
any Federal or State agency or any public health, legal
advocacy, or trade organization or association if the
designated officials determine that such reviews were
conducted in accordance with the principles set forth
in subsection (b).
(2) Report.--No later than 180 days after initiating the
review required by paragraph (1), the Attorney General shall
transmit to the Congress and make publicly available a report
containing the results of the review, which includes the
following:
(A) For each State and for the Uniform Code of
Military Justice, a summary of the relevant laws,
policies, regulations, and judicial precedents and
decisions regarding criminal cases involving people
living with HIV/AIDS, including, if applicable, the
following:
(i) A determination of whether such laws,
policies, regulations, and judicial precedents
and decisions place any unique or additional
burdens upon people living with HIV/AIDS.
(ii) A determination of whether such laws,
policies, regulations, and judicial precedents
and decisions demonstrate a public health-
oriented, evidence-based, medically accurate,
and contemporary understanding of--
(I) the multiple factors that lead
to HIV transmission;
(II) the relative risk of HIV
transmission routes;
(III) the current health
implications of living with HIV;
(IV) the associated benefits of
treatment and support services for
people living with HIV; and
(V) the impact of punitive HIV-
specific laws and policies on public
health, on people living with or
affected by HIV, and on their families
and communities.
(iii) An analysis of the public health and
legal implications of such laws, policies,
regulations, and judicial precedents, including
an analysis of the consequences of having a
similar penal scheme applied to comparable
situations involving other communicable
diseases.
(iv) An analysis of the proportionality of
punishments imposed under HIV-specific laws,
policies, regulations, and judicial precedents,
taking into consideration penalties attached to
violation of State laws against similar degrees
of endangerment or harm, such as driving while
intoxicated (DWI) or transmission of other
communicable diseases, or more serious harms,
such as vehicular manslaughter offenses.
(B) An analysis of common elements shared among
State laws, policies, regulations, and judicial
precedents.
(C) A set of best practice recommendations directed
to State governments, including State attorneys
general, public health officials, and judicial
officers, in order to ensure that laws, policies,
regulations, and judicial precedents regarding people
living with HIV/AIDS are in accordance with the
principles set forth in subsection (b).
(D) Recommendations for adjustments to the Uniform
Code of Military Justice, as may be necessary, in order
to ensure that laws, policies, regulations, and
judicial precedents regarding people living with HIV/
AIDS are in accordance with the principles set forth in
subsection (b).
(3) Guidance.--Within 90 days of the release of the report
required by paragraph (2), the Attorney General and the
Secretary of Health and Human Services, acting jointly, shall
develop and publicly release updated guidance for States based
on the set of best practice recommendations required by
paragraph (2)(C) in order to assist States dealing with
criminal and related civil commitment cases regarding people
living with HIV/AIDS.
(4) Monitoring and evaluation system.--Within 60 days of
the release of the guidance required by paragraph (3), the
Attorney General and the Secretary of Health and Human
Services, acting jointly, shall establish an integrated
monitoring and evaluation system which includes, where
appropriate, objective and quantifiable performance goals and
indicators to measure progress toward statewide implementation
in each State of the best practice recommendations required in
paragraph (2)(C), including to monitor, track, and evaluate the
effectiveness of assistance provided pursuant to subsection
(d).
(5) Adjustments to federal laws, policies, or
regulations.--Within 90 days of the release of the report
required by paragraph (2), the Attorney General, the Secretary
of Health and Human Services, and the Secretary of Defense,
acting jointly, shall develop and transmit to the President and
the Congress, and make publicly available, such proposals as
may be necessary to implement adjustments to Federal laws,
policies, or regulations, including to the Uniform Code of
Military Justice, based on the recommendations required by
paragraph (2)(D), either through Executive order or through
changes to statutory law.
(6) Authorization of appropriations.--
(A) In general.--There are authorized to be
appropriated such sums as may be necessary for the
purpose of carrying out this subsection. Amounts
authorized to be appropriated by the preceding sentence
are in addition to amounts otherwise authorized to be
appropriated for such purpose.
(B) Availability of funds.--Amounts appropriated
pursuant to the authorization of appropriations in
subparagraph (A) are authorized to remain available
until expended.
(d) Authorization To Provide Grants.--
(1) Grants by attorney general.--
(A) In general.--The Attorney General may provide
assistance to eligible State and local entities and
eligible nongovernmental organizations for the purpose
of incorporating the best practice recommendations
developed under subsection (c)(2)(C) within relevant
State laws, policies, regulations, and judicial
decisions regarding people living with HIV/AIDS.
(B) Authorized activities.--The assistance
authorized by subparagraph (A) may include--
(i) direct technical assistance to eligible
State and local entities in order to develop,
disseminate, or implement State laws, policies,
regulations, or judicial decisions that conform
with the best practice recommendations
developed under subsection (c)(2)(C);
(ii) direct technical assistance to
eligible nongovernmental organizations in order
to provide education and training, including
through classes, conferences, meetings, and
other educational activities, to eligible State
and local entities; and
(iii) subcontracting authority to allow
eligible State and local entities and eligible
nongovernmental organizations to seek technical
assistance from legal and public health experts
with a demonstrated understanding of the
principles underlying the best practice
recommendations developed under subsection
(c)(2)(C).
(2) Grants by secretary of health and human services.--
(A) In general.--The Secretary of Health and Human
Services, acting through the Director of the Centers
for Disease Control and Prevention, may provide
assistance to State and local public health departments
and eligible nongovernmental organizations for the
purpose of supporting eligible State and local entities
to incorporate the best practice recommendations
developed under subsection (c)(2)(C) within relevant
State laws, policies, regulations, and judicial
decisions regarding people living with HIV/AIDS.
(B) Authorized activities.--The assistance
authorized by subparagraph (A) may include--
(i) direct technical assistance to State
and local public health departments in order to
support the development, dissemination, or
implementation of State laws, policies,
regulations, or judicial decisions that conform
with the set of best practice recommendations
developed under subsection (c)(2)(C);
(ii) direct technical assistance to
eligible nongovernmental organizations in order
to provide education and training, including
through classes, conferences, meetings, and
other educational activities, to State and
local public health departments; and
(iii) subcontracting authority to allow
State and local public health departments and
eligible nongovernmental organizations to seek
technical assistance from legal and public
health experts with a demonstrated
understanding of the principles underlying the
best practice recommendations developed under
subsection (c)(2)(C).
(3) Limitation.--As a condition of receiving assistance
through this subsection, eligible State and local entities,
State and local public health departments, and eligible
nongovernmental organizations shall agree--
(A) not to place any unique or additional burdens
on people living with HIV/AIDS solely as a result of
their HIV status; and
(B) that if the entity, department, or organization
promulgates any laws, policies, regulations, or
judicial decisions regarding people living with HIV/
AIDS, such actions shall demonstrate a public health-
oriented, evidence-based, medically accurate, and
contemporary understanding of--
(i) the multiple factors that lead to HIV
transmission;
(ii) the relative risk of HIV transmission
routes;
(iii) the current health implications of
living with HIV;
(iv) the associated benefits of treatment
and support services for people living with
HIV; and
(v) the impact of punitive HIV-specific
laws and policies on public health, on people
living with or affected by HIV, and on their
families and communities.
(4) Report.--No later than 1 year after the date of the
enactment of this Act, and annually thereafter, the Attorney
General and the Secretary of Health and Human Services, acting
jointly, shall transmit to Congress and make publicly available
a report describing, for each State, the impact and
effectiveness of the assistance provided through this Act. Each
such report shall include--
(A) a detailed description of the progress each
State has made, if any, in implementing the best
practice recommendations developed under subsection
(c)(2)(C) as a result of the assistance provided under
this subsection, and based on the performance goals and
indicators established as part of the monitoring and
evaluation system in subsection (c)(4);
(B) a brief summary of any outreach efforts
undertaken during the prior year by the Attorney
General and the Secretary of Health and Human Services
to encourage States to seek assistance under this
subsection in order to implement the best practice
recommendations developed under subsection (c)(2)(C);
(C) a summary of how assistance provided through
this subsection is being utilized by eligible State and
local entities, State and local public health
departments, and eligible nongovernmental organizations
and, if applicable, any contractors, including with
respect to nongovernmental organizations, the type of
technical assistance provided, and an evaluation of the
impact of such assistance on eligible State and local
entities; and
(D) a summary and description of eligible State and
local entities, State and local public health
departments, and eligible nongovernmental organizations
receiving assistance through this subsection, including
if applicable, a summary and description of any
contractors selected to assist in implementing such
assistance.
(5) Definitions.--For the purposes of this subsection:
(A) Eligible state and local entities.--The term
``eligible State and local entities'' means the
relevant individuals, offices, or organizations that
directly participate in the development, dissemination,
or implementation of State laws, policies, regulations,
or judicial decisions, including--
(i) State governments, including State
attorneys general, State departments of
justice, and State National Guards, or their
equivalents;
(ii) State judicial and court systems,
including trial courts, appellate courts, State
supreme courts and courts of appeal, and State
correctional facilities, or their equivalents;
and
(iii) local governments, including city and
county governments, district attorneys, and
local law enforcement departments, or their
equivalents.
(B) State and local public health departments.--The
term ``State and local public health departments''
means the following:
(i) State public health departments, or
their equivalents, including the chief officer
of such departments and infectious disease and
communicable disease specialists within such
departments.
(ii) Local public health departments, or
their equivalents, including city and county
public health departments, the chief officer of
such departments, and infectious disease and
communicable disease specialists within such
departments.
(iii) Public health departments or
officials, or their equivalents, within State
or local correctional facilities.
(iv) Public health departments or
officials, or their equivalents, within State
National Guards.
(v) Any other recognized State or local
public health organization or entity charged
with carrying out official State or local
public health duties.
(C) Eligible nongovernmental organizations.--The
term ``eligible nongovernmental organizations'' means
the following:
(i) Nongovernmental organizations,
including trade organizations or associations
that represent--
(I) State attorneys general, or
their equivalents;
(II) State public health officials,
or their equivalents;
(III) State judicial and court
officers, including judges, district
attorneys, prosecutors, defense
attorneys, law enforcement, and
correctional officers;
(IV) State National Guards;
(V) people living with HIV/AIDS;
(VI) legal advocacy and HIV/AIDS
service organizations that work with
people living with HIV/AIDS; and
(VII) nongovernmental health
organizations that work on behalf of
people living with HIV/AIDS.
(ii) Nongovernmental organizations,
including trade organizations or associations
that demonstrate a public-health oriented,
evidence-based, medically accurate, and
contemporary understanding of--
(I) the multiple factors that lead
to HIV transmission;
(II) the relative risk of HIV
transmission routes;
(III) the current health
implications of living with HIV;
(IV) the associated benefits of
treatment and support services for
people living with HIV; and
(V) the impact of punitive HIV-
specific laws and policies on public
health, on people living with or
affected by HIV, and on their families
and communities.
(6) Authorization of appropriations.--
(A) In general.--In addition to amounts otherwise
made available, there are authorized to be appropriated
to the Attorney General and the Secretary of Health and
Human Services such sums as may be necessary to carry
out this subsection for each of the fiscal years 2015
through 2019.
(B) Availability of funds.--Amounts appropriated
pursuant to the authorizations of appropriations in
subparagraph (A) are authorized to remain available
until expended.
SEC. 758. REPEAL OF LIMITATION AGAINST USE OF FUNDS FOR EDUCATION OR
INFORMATION DESIGNED TO PROMOTE OR ENCOURAGE, DIRECTLY,
HOMOSEXUAL OR HETEROSEXUAL ACTIVITY OR INTRAVENOUS
SUBSTANCE ABUSE.
Section 2500 of the Public Health Service Act (42 U.S.C. 300ee) is
amended--
(1) by striking subsection (c); and
(2) by redesignating subsection (d) as subsection (c).
SEC. 759. EXPANDING SUPPORT FOR CONDOMS IN PRISONS.
(a) Authority To Allow Community Organizations To Provide STI
Counseling, STI Prevention Education, and Sexual Barrier Protection
Devices in Federal Correctional Facilities.--
(1) Directive to attorney general.--Not later than 30 days
after the date of enactment of this Act, the Attorney General
shall direct the Bureau of Prisons to allow community
organizations to distribute sexual barrier protection devices
and to engage in STI counseling and STI prevention education in
Federal correctional facilities. These activities shall be
subject to all relevant Federal laws and regulations which
govern visitation in correctional facilities.
(2) Information requirement.--Any community organization
permitted to distribute sexual barrier protection devices under
paragraph (1) shall ensure that the persons to whom the devices
are distributed are informed about the proper use and disposal
of sexual barrier protection devices in accordance with
established public health practices. Any community organization
conducting STI counseling or STI prevention education under
paragraph (1) shall offer comprehensive sexuality education.
(3) Possession of device protected.--No Federal
correctional facility may, because of the possession or use of
a sexual barrier protection device--
(A) take adverse action against an incarcerated
person; or
(B) consider possession or use as evidence of
prohibited activity for the purpose of any Federal
correctional facility administrative proceeding.
(4) Implementation.--The Attorney General and Bureau of
Prisons shall implement this section according to established
public health practices in a manner that protects the health,
safety, and privacy of incarcerated persons and of correctional
facility staff.
(b) Sense of Congress Regarding Distribution of Sexual Barrier
Protection Devices in State Prison Systems.--It is the sense of the
Congress that States should allow for the legal distribution of sexual
barrier protection devices in State correctional facilities to reduce
the prevalence and spread of STIs in those facilities.
(c) Survey of and Report on Correctional Facility Programs Aimed at
Reducing the Spread of STIs.--
(1) Survey.--The Attorney General, after consulting with
the Secretary of Health and Human Services, State officials,
and community organizations, shall, to the maximum extent
practicable, conduct a survey of all Federal and State
correctional facilities, not later than 180 days after the date
of enactment of this Act and annually thereafter for 5 years,
to determine the following:
(A) Counseling, treatment, and supportive
services.--Whether the correctional facility requires
incarcerated persons to participate in counseling,
treatment, and supportive services related to STIs, or
whether it offers such programs to incarcerated
persons.
(B) Access to sexual barrier protection devices.--
Whether incarcerated persons can--
(i) possess sexual barrier protection
devices;
(ii) purchase sexual barrier protection
devices;
(iii) purchase sexual barrier protection
devices at a reduced cost; and
(iv) obtain sexual barrier protection
devices without cost.
(C) Incidence of sexual violence.--The incidence of
sexual violence and assault committed by incarcerated
persons and by correctional facility staff.
(D) Prevention education offered.--The type of
prevention education, information, or training offered
to incarcerated persons and correctional facility staff
regarding sexual violence and the spread of STIs,
including whether such education, information, or
training--
(i) constitutes comprehensive sexuality
education;
(ii) is compulsory for new incarcerated
persons and for new staff; and
(iii) is offered on an ongoing basis.
(E) STI testing.--Whether the correctional facility
tests incarcerated persons for STIs or gives them the
option to undergo such testing--
(i) at intake;
(ii) on a regular basis; and
(iii) prior to release.
(F) STI test results.--The number of incarcerated
persons who are tested for STIs and the outcome of such
tests at each correctional facility, disaggregated to
include results for--
(i) the type of sexually transmitted
infection tested for;
(ii) the race and/or ethnicity of
individuals tested;
(iii) the age of individuals tested; and
(iv) the gender of individuals tested.
(G) Prerelease referral policy.--Whether
incarcerated persons are informed prior to release
about STI-related services or other health services in
their communities, including free and low-cost
counseling and treatment options.
(H) Prerelease referrals made.--The number of
referrals to community-based organizations or public
health facilities offering STI-related or other health
services provided to incarcerated persons prior to
release, and the type of counseling or treatment for
which the referral was made.
(I) Reinstatement of medicaid benefits.--Whether
the correctional facility assists incarcerated persons
that were enrolled in the State Medicaid program prior
to their incarceration, in reinstating their enrollment
upon release and whether such individuals receive
referrals as provided by subparagraph (G) to entities
that accept the State Medicaid program, including if
applicable--
(i) the number of such individuals,
including those diagnosed with the human
immunodeficiency virus, that have been
reinstated;
(ii) a list of obstacles to reinstating
enrollment or to making determinations of
eligibility for reinstatement, if any; and
(iii) the number of individuals denied
enrollment.
(J) Other actions taken.--Whether the correctional
facility has taken any other action, in conjunction
with community organizations or otherwise, to reduce
the prevalence and spread of STIs in that facility.
(2) Privacy.--In conducting the survey, the Attorney
General shall not request or retain the identity of any person
who has sought or been offered counseling, treatment, testing,
or prevention education information regarding an STI (including
information about sexual barrier protection devices), or who
has tested positive for an STI.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available the results of the survey
required under paragraph (1), both for the Nation as a whole
and disaggregated as to each State and each correctional
facility. To the maximum extent possible, the Attorney General
shall issue the first report no later than 1 year after the
date of enactment of this Act and shall issue reports annually
thereafter for 5 years.
(d) Strategy.--
(1) Directive to attorney general.--The Attorney General,
in consultation with the Secretary of Health and Human
Services, State officials, and community organizations, shall
develop and implement a 5-year strategy to reduce the
prevalence and spread of STIs in Federal and State correctional
facilities. To the maximum extent possible, the strategy shall
be developed, transmitted to Congress, and made publicly
available no later than 180 days after the transmission of the
first report required under subsection (c)(3).
(2) Contents of strategy.--The strategy shall include the
following:
(A) Prevention education.--A plan for improving
prevention education, information, and training offered
to incarcerated persons and correctional facility
staff, including information and training on sexual
violence and the spread of STIs, and comprehensive
sexuality education.
(B) Sexual barrier protection device access.--A
plan for expanding access to sexual barrier protection
devices in correctional facilities.
(C) Sexual violence reduction.--A plan for reducing
the incidence of sexual violence among incarcerated
persons and correctional facility staff, developed in
consultation with the National Prison Rape Elimination
Commission.
(D) Counseling and supportive services.--A plan for
expanding access to counseling and supportive services
related to STIs in correctional facilities.
(E) Testing.--A plan for testing incarcerated
persons for STIs during intake, during regular health
exams, and prior to release, and that--
(i) is conducted in accordance with
guidelines established by the Centers for
Disease Control and Prevention;
(ii) includes pretest counseling;
(iii) requires that incarcerated persons
are notified of their option to decline testing
at any time;
(iv) requires that incarcerated persons are
confidentially notified of their test results
in a timely manner; and
(v) ensures that incarcerated persons
testing positive for STIs receive post-test
counseling, care, treatment, and supportive
services.
(F) Treatment.--A plan for ensuring that
correctional facilities have the necessary medicine and
equipment to treat and monitor STIs and for ensuring
that incarcerated persons living with or testing
positive for STIs receive and have access to care and
treatment services.
(G) Strategies for demographic groups.--A plan for
developing and implementing culturally appropriate,
sensitive, and specific strategies to reduce the spread
of STIs among demographic groups heavily impacted by
STIs.
(H) Linkages with communities and facilities.--A
plan for establishing and strengthening linkages to
local communities and health facilities that--
(i) provide counseling, testing, care, and
treatment services;
(ii) may receive persons recently released
from incarceration who are living with STIs;
and
(iii) accept payment through the State
Medicaid program.
(I) Enrollment in state medicaid programs.--Plans
to ensure that incarcerated persons who were--
(i) enrolled in their State Medicaid
program prior to incarceration in a
correctional facility are automatically re-
enrolled in such program upon their release;
and
(ii) not enrolled in their State Medicaid
program prior to incarceration, but who are
diagnosed with the human immunodeficiency virus
while incarcerated in a correctional facility,
are automatically enrolled in such program upon
their release.
(J) Other plans.--Any other plans developed by the
Attorney General for reducing the spread of STIs or
improving the quality of health care in correctional
facilities.
(K) Monitoring system.--A monitoring system that
establishes performance goals related to reducing the
prevalence and spread of STIs in correctional
facilities and which, where feasible, expresses such
goals in quantifiable form.
(L) Monitoring system performance indicators.--
Performance indicators that measure or assess the
achievement of the performance goals described in
subparagraph (K).
(M) Cost estimate.--A detailed estimate of the
funding necessary to implement the strategy at the
Federal and State levels for all 5 years, including the
amount of funds required by community organizations to
implement the parts of the strategy in which they take
part.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available an annual progress report
regarding the implementation and effectiveness of the strategy
described in paragraph (1). The progress report shall include
an evaluation of the implementation of the strategy using the
monitoring system and performance indicators provided for in
subparagraphs (K) and (L) of paragraph (2).
(e) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated
such sums as may be necessary to carry out this section for
each of fiscal years 2015 through 2020.
(2) Availability of funds.--Amounts made available under
paragraph (1) are authorized to remain available until
expended.
(f) Definitions.--For the purposes of this section:
(1) Community organization.--The term ``community
organization'' means a public health care facility or a
nonprofit organization which provides health- or STI-related
services according to established public health standards.
(2) Comprehensive sexuality education.--The term
``comprehensive sexuality education'' means sexuality education
that includes information about abstinence and about the proper
use and disposal of sexual barrier protection devices and which
is--
(A) evidence-based;
(B) medically accurate;
(C) age and developmentally appropriate;
(D) gender and identity sensitive;
(E) culturally and linguistically appropriate; and
(F) structured to promote critical thinking, self-
esteem, respect for others, and the development of
healthy attitudes and relationships.
(3) Correctional facility.--The term ``correctional
facility'' means any prison, penitentiary, adult detention
facility, juvenile detention facility, jail, or other facility
to which persons may be sent after conviction of a crime or act
of juvenile delinquency within the United States.
(4) Incarcerated person.--The term ``incarcerated person''
means any person who is serving a sentence in a correctional
facility after conviction of a crime.
(5) Sexually transmitted infection.--The term ``sexually
transmitted infection'' or ``STI'' means any disease or
infection that is commonly transmitted through sexual activity,
including HIV/AIDS, gonorrhea, chlamydia, syphilis, genital
herpes, viral hepatitis, and human papillomavirus.
(6) Sexual barrier protection device.--The term ``sexual
barrier protection device'' means any FDA-approved physical
device which has not been tampered with and which reduces the
probability of STI transmission or infection between sexual
partners, including female condoms, male condoms, and dental
dams.
(7) State.--The term ``State'' includes the District of
Columbia, American Samoa, the Commonwealth of the Northern
Mariana Islands, Guam, Puerto Rico, and the United States
Virgin Islands.
SEC. 760. AUTOMATIC REINSTATEMENT OR ENROLLMENT IN MEDICAID FOR PEOPLE
WHO TEST POSITIVE FOR HIV BEFORE REENTERING COMMUNITIES.
(a) In General.--Section 1902(e) of the Social Security Act (42
U.S.C. 1396a(e)) is amended by adding at the end the following:
``(15) Enrollment of ex-offenders.--
``(A) Automatic enrollment or reinstatement.--
``(i) In general.--The State plan shall
provide for the automatic enrollment or
reinstatement of enrollment of an eligible
individual--
``(I) if such individual is
scheduled to be released from a public
institution due to the completion of
sentence, not less than 30 days prior
to the scheduled date of the release;
and
``(II) if such individual is to be
released from a public institution on
parole or on probation, as soon as
possible after the date on which the
determination to release such
individual was made, and before the
date such individual is released.
``(ii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date by
which the individual would be enrolled
under clause (i), such clause shall not
apply to such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(B) Relationship of enrollment to payment for
services.--
``(i) In general.--Subject to subparagraph
(A)(ii), an eligible individual who is
enrolled, or whose enrollment is reinstated,
under subparagraph (A) shall be eligible for
medical assistance that is provided after the
date that the eligible individual is released
from the public institution.
``(ii) Relationship to payment prohibition
for inmates.--No provision of this paragraph
may be construed to permit payment for care or
services for which payment is excluded under
the subdivision (A) that follows paragraph (29)
of section 1905(a).
``(C) Treatment of continuous eligibility.--
``(i) Suspension for inmates.--Any period
of continuous eligibility under this title
shall be suspended on the date an individual
enrolled under this title becomes an inmate of
a public institution (except as a patient of a
medical institution).
``(ii) Determination of remaining period.--
Notwithstanding any changes to State law
related to continuous eligibility during the
time that an individual is an inmate of a
public institution (except as a patient of a
medical institution), subject to clause (iii),
with respect to an eligible individual who was
subject to a suspension under clause (i), on
the date that such individual is released from
a public institution the suspension of
continuous eligibility under such clause shall
be lifted for a period that is equal to the
time remaining in the period of continuous
eligibility for such individual on the date
that such period was suspended under such
clause.
``(iii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date that
the suspension of continuous
eligibility is lifted under clause
(ii), such clause shall not apply to
such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(D) Automatic enrollment or reinstatement of
enrollment defined.--For purposes of this paragraph,
the term `automatic enrollment or reinstatement of
enrollment' means that the State determines eligibility
for medical assistance under the State plan without a
program application from, or on behalf of, the eligible
individual, but an individual can only be automatically
enrolled in the State Medicaid plan if the individual
affirmatively consents to being enrolled through
affirmation in writing, by telephone, orally, through
electronic signature, or through any other means
specified by the Secretary.
``(E) Eligible individual defined.--For purposes of
this paragraph, the term `eligible individual' means an
individual who is an inmate of a public institution
(except as a patient in a medical institution)--
``(i) who was enrolled under the State plan
for medical assistance immediately before
becoming an inmate of such an institution; or
``(ii) is diagnosed with human
immunodeficiency virus.''.
(b) Supplemental Funding for State Implementation of Automatic
Reinstatement of Medicaid Benefits.--
(1) In general.--Subject to paragraph (6), for each State
for which the Secretary of Health and Human Services has
approved an application under paragraph (3), the Federal
matching payments (including payments based on the Federal
medical assistance percentage) made to such State under section
1903 of the Social Security Act (42 U.S.C. 1396b) shall be
increased by 5.0 percentage points for payments to the State
for the activities permitted under paragraph (2) or a period of
one year.
(2) Use of funds.--A State may only use increased matching
payments authorized under paragraph (1)--
(A) to strengthen the State's enrollment and
administrative resources for the purpose of improving
processes for enrolling (or reinstating the enrollment
of) eligible individuals (as such term is defined in
subparagraph (E) of paragraph (15) of section 1902(e)
of the Social Security Act (as amended by subsection
(a))); and
(B) for medical assistance (as such term is defined
in section 1905(a) of the Social Security Act) provided
to such eligible individuals.
(3) Application and agreement.--The Secretary may only make
payments to a State in the increased amount if--
(A) the State has amended the State plan under
section 1902(e) of the Social Security Act to
incorporate the requirements of paragraph (15) of such
section (as added by subsection (a));
(B) the State has submitted an application to the
Secretary that includes a plan for implementing the
requirements of section 1902(e)(15) of the Social
Security Act under the State's amended State plan
before the end of the 90-day period beginning on the
date that the State receives increased matching
payments under paragraph (1);
(C) the State's application meets the satisfaction
of the Secretary; and
(D) the State enters an agreement with the
Secretary that states that--
(i) the State will only use the increased
matching funds for the uses permitted under
paragraph (2); and
(ii) at the end of the period under
paragraph (1), the State will submit to the
Secretary, and make publicly available, a
report that contains the information required
under paragraph (4).
(4) Required report information.--The information that is
required in the report under paragraph (3)(D)(ii) includes--
(A) the results of an evaluation of the impact of
the implementation of the requirements of section
1902(e)(15) of the Social Security Act on improving the
State's processes for enrolling of individuals who are
released from public institutions into the Medicaid
program;
(B) the number of individuals who were
automatically enrolled (or whose enrollment is
reinstated) under such section 1902(e)(15) during the
period under paragraph (1); and
(C) any other information that is required by the
Secretary.
(5) Increase in cap on medicaid payments to territories.--
Subject to paragraph (6), the amounts otherwise determined for
Puerto Rico, the United States Virgin Islands, Guam, the
Northern Mariana Islands, and American Samoa under subsections
(f) and (g) of section 1108 of the Social Security Act (42
U.S.C. 1308) shall each be increased by the necessary amount to
allow for the increase in the Federal matching payments under
paragraph (1), but only for the period under such paragraph for
such State. In the case of such an increase for a territory,
subsection (a)(1) of such section 1108 shall be applied without
regard to any increase in payment made to the territory under
part E of title IV of such Act that is attributable to the
increase in Federal medical assistance percentage effected
under paragraph (1) for the territory.
(6) Limitations.--
(A) Timing.--With respect to a State, at the end of
the period under paragraph (1), no increased matching
payments may be made to such State under this
subsection.
(B) Maintenance of eligibility.--
(i) In general.--Subject to clause (ii), a
State is not eligible for an increase in its
Federal matching payments under paragraph (1),
or an increase in a cap amount under paragraph
(5), if eligibility standards, methodologies,
or procedures under its State plan under title
XIX of the Social Security Act (including any
waiver under such title or under section 1115
of such Act (42 U.S.C. 1315)) are more
restrictive than the eligibility standards,
methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on the
date of enactment of this Act.
(ii) State reinstatement of eligibility
permitted.--A State that has restricted
eligibility standards, methodologies, or
procedures under its State plan under title XIX
of the Social Security Act (including any
waiver under such title or under section 1115
of such Act (42 U.S.C. 1315)) after the date of
enactment of this Act, is no longer ineligible
under subparagraph (A) beginning with the first
calendar quarter in which the State has
reinstated eligibility standards,
methodologies, or procedures that are no more
restrictive than the eligibility standards,
methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on
such date.
(C) No waiver authority.--The Secretary may not
waive the application of this subsection under section
1115 of the Social Security Act or otherwise.
(D) Limitation of matching payments to 100
percent.--In no case shall an increase in Federal
matching payments under this subsection result in
Federal matching payments that exceed 100 percent.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by subsection (a) shall take effect 180 days
after the date of the enactment of this Act and shall apply to
services furnished on or after such date.
(2) Rule for changes requiring state legislation.--In the
case of a State plan for medical assistance under title XIX of
the Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
SEC. 761. STOP AIDS IN PRISON.
(a) Short Title.--This section may be cited as the ``Stop AIDS in
Prison Act''.
(b) In General.--The Bureau of Prisons (hereinafter in this section
referred to as the ``Bureau'') shall develop a comprehensive policy to
provide HIV testing, treatment, and prevention for inmates within the
correctional setting and upon reentry.
(c) Purpose.--The purposes of this policy shall be as follows:
(1) To stop the spread of HIV/AIDS among inmates.
(2) To protect prison guards and other personnel from HIV/
AIDS infection.
(3) To provide comprehensive medical treatment to inmates
who are living with HIV/AIDS.
(4) To promote HIV/AIDS awareness and prevention among
inmates.
(5) To encourage inmates to take personal responsibility
for their health.
(6) To reduce the risk that inmates will transmit HIV/AIDS
to other persons in the community following their release from
prison.
(d) Consultation.--The Bureau shall consult with appropriate
officials of the Department of Health and Human Services, the Office of
National Drug Control Policy, the Office of National AIDS Policy, and
the Centers for Disease Control and Prevention regarding the
development of this policy.
(e) Time Limit.--The Bureau shall draft appropriate regulations to
implement this policy not later than 1 year after the date of the
enactment of this Act.
(f) Requirements for Policy.--The policy created under subsection
(b) shall provide for the following:
(1) Testing and counseling upon intake.--
(A) Health care personnel shall provide routine HIV
testing to all inmates as a part of a comprehensive
medical examination immediately following admission to
a facility. (Health care personnel need not provide
routine HIV testing to an inmate who is transferred to
a facility from another facility if the inmate's
medical records are transferred with the inmate and
indicate that the inmate has been tested previously.)
(B) To all inmates admitted to a facility prior to
the effective date of this policy, health care
personnel shall provide routine HIV testing within no
more than 6 months. HIV testing for these inmates may
be performed in conjunction with other health services
provided to these inmates by health care personnel.
(C) All HIV tests under this paragraph shall comply
with the opt-out provision.
(2) Pre-test and post-test counseling.--Health care
personnel shall provide confidential pre-test and post-test
counseling to all inmates who are tested for HIV. Counseling
may be included with other general health counseling provided
to inmates by health care personnel.
(3) HIV/AIDS prevention education.--
(A) Health care personnel shall improve HIV/AIDS
awareness through frequent educational programs for all
inmates. HIV/AIDS educational programs may be provided
by community-based organizations, local health
departments, and inmate peer educators.
(B) HIV/AIDS educational materials shall be made
available to all inmates at orientation, at health care
clinics, at regular educational programs, and prior to
release. Both written and audiovisual materials shall
be made available to all inmates.
(C)(i) The HIV/AIDS educational programs and
materials under this paragraph shall include
information on--
(I) modes of transmission, including
transmission through tattooing, sexual contact,
and intravenous drug use;
(II) prevention methods;
(III) treatment; and
(IV) disease progression.
(ii) The programs and materials shall be culturally
sensitive, written or designed for low-literacy levels,
available in a variety of languages, and present
scientifically accurate information in a clear and
understandable manner.
(4) HIV testing upon request.--
(A) Health care personnel shall allow inmates to
obtain HIV tests upon request once per year or whenever
an inmate has a reason to believe the inmate may have
been exposed to HIV. Health care personnel shall, both
orally and in writing, inform inmates, during
orientation and periodically throughout incarceration,
of their right to obtain HIV tests.
(B) Health care personnel shall encourage inmates
to request HIV tests if the inmate is sexually active,
has been raped, uses intravenous drugs, receives a
tattoo, or if the inmate is concerned that the inmate
may have been exposed to HIV/AIDS.
(C) An inmate's request for an HIV test shall not
be considered an indication that the inmate has put
him/herself at risk of infection and/or committed a
violation of prison rules.
(5) HIV testing of pregnant woman.--
(A) Health care personnel shall provide routine HIV
testing to all inmates who become pregnant.
(B) All HIV tests under this paragraph shall comply
with the opt-out provision.
(6) Comprehensive treatment.--
(A) Health care personnel shall provide all inmates
who test positive for HIV--
(i) timely, comprehensive medical
treatment;
(ii) confidential counseling on managing
their medical condition and preventing its
transmission to other persons; and
(iii) voluntary partner notification
services.
(B) Health care provided under this paragraph shall
be consistent with current Department of Health and
Human Services guidelines and standard medical
practice. Health care personnel shall discuss treatment
options, the importance of adherence to antiretroviral
therapy, and the side effects of medications with
inmates receiving treatment.
(C) Health care personnel and pharmacy personnel
shall ensure that the facility formulary contains all
Food and Drug Administration-approved medications
necessary to provide comprehensive treatment for
inmates living with HIV/AIDS, and that the facility
maintains adequate supplies of such medications to meet
inmates' medical needs. Health care personnel and
pharmacy personnel shall also develop and implement
automatic renewal systems for these medications to
prevent interruptions in care.
(D) Correctional staff, health care personnel, and
pharmacy personnel shall develop and implement
distribution procedures to ensure timely and
confidential access to medications.
(7) Protection of confidentiality.--
(A) Health care personnel shall develop and
implement procedures to ensure the confidentiality of
inmate tests, diagnoses, and treatment. Health care
personnel and correctional staff shall receive regular
training on the implementation of these procedures.
Penalties for violations of inmate confidentiality by
health care personnel or correctional staff shall be
specified and strictly enforced.
(B) HIV testing, counseling, and treatment shall be
provided in a confidential setting where other routine
health services are provided and in a manner that
allows the inmate to request and obtain these services
as routine medical services.
(8) Testing, counseling, and referral prior to reentry.--
(A) Health care personnel shall provide routine HIV
testing to all inmates no more than 3 months prior to
their release and reentry into the community. (Inmates
who are already known to be infected need not be tested
again.) This requirement may be waived if an inmate's
release occurs without sufficient notice to the Bureau
to allow health care personnel to perform a routine HIV
test and notify the inmate of the results.
(B) All HIV tests under this paragraph shall comply
with the opt-out provision.
(C) To all inmates who test positive for HIV and
all inmates who already are known to have HIV/AIDS,
health care personnel shall provide--
(i) confidential prerelease counseling on
managing their medical condition in the
community, accessing appropriate treatment and
services in the community, and preventing the
transmission of their condition to family
members and other persons in the community;
(ii) referrals to appropriate health care
providers and social service agencies in the
community that meet the inmate's individual
needs, including voluntary partner notification
services and prevention counseling services for
people living with HIV/AIDS; and
(iii) a 30-day supply of any medically
necessary medications the inmate is currently
receiving.
(9) Opt-out provision.--Inmates shall have the right to
refuse routine HIV testing. Inmates shall be informed both
orally and in writing of this right. Oral and written
disclosure of this right may be included with other general
health information and counseling provided to inmates by health
care personnel. If an inmate refuses a routine test for HIV,
health care personnel shall make a note of the inmate's refusal
in the inmate's confidential medical records. However, the
inmate's refusal shall not be considered a violation of prison
rules or result in disciplinary action. Any reference in this
section to the ``opt-out provision'' shall be deemed a
reference to the requirement of this paragraph.
(10) Exclusion of tests performed under section 4014(b)
from the definition of routine hiv testing.--HIV testing of an
inmate under section 4014(b) of title 18, United States Code,
is not routine HIV testing for the purposes of the opt-out
provision. Health care personnel shall document the reason for
testing under section 4014(b) of title 18, United States Code,
in the inmate's confidential medical records.
(11) Timely notification of test results.--Health care
personnel shall provide timely notification to inmates of the
results of HIV tests.
(g) Changes in Existing Law.--
(1) Screening in genera.--Section 4014(a) of title 18,
United States Code, is amended--
(A) by striking ``for a period of 6 months or
more'';
(B) by striking ``, as appropriate,''; and
(C) by striking ``if such individual is determined
to be at risk for infection with such virus in
accordance with the guidelines issued by the Bureau of
Prisons relating to infectious disease management'' and
inserting ``unless the individual declines. The
Attorney General shall also cause such individual to be
so tested before release unless the individual
declines.''.
(2) Inadmissibility of hiv test results in civil and
criminal proceedings.--Section 4014(d) of title 18, United
States Code, is amended by inserting ``or under the Stop AIDS
in Prison Act'' after ``under this section''.
(3) Screening as part of routine screening.--Section
4014(e) of title 18, United States Code, is amended by adding
at the end the following: ``Such rules shall also provide that
the initial test under this section be performed as part of the
routine health screening conducted at intake.''.
(h) Reporting Requirements.--
(1) Report on hepatitis and other diseases.--Not later than
1 year after the date of the enactment of this Act, the Bureau
shall provide a report to the Congress on Bureau policies and
procedures to provide testing, treatment, and prevention
education programs for hepatitis and other diseases transmitted
through sexual activity and intravenous drug use. The Bureau
shall consult with appropriate officials of the Department of
Health and Human Services, the Office of National Drug Control
Policy, the Office of National AIDS Policy, and the Centers for
Disease Control and Prevention regarding the development of
this report.
(2) Annual reports.--
(A) Generally.--Not later than 2 years after the
date of the enactment of this Act, and then annually
thereafter, the Bureau shall report to Congress on the
incidence among inmates of diseases transmitted through
sexual activity and intravenous drug use.
(B) Matters pertaining to various diseases.--
Reports under paragraph (1) shall discuss--
(i) the incidence among inmates of HIV/
AIDS, hepatitis, and other diseases transmitted
through sexual activity and intravenous drug
use; and
(ii) updates on Bureau testing, treatment,
and prevention education programs for these
diseases.
(C) Matters pertaining to hiv/aids only.--Reports
under paragraph (1) shall also include--
(i) the number of inmates who tested
positive for HIV upon intake;
(ii) the number of inmates who tested
positive prior to reentry;
(iii) the number of inmates who were not
tested prior to reentry because they were
released without sufficient notice;
(ix) the number of inmates who opted-out of
taking the test;
(x) the number of inmates who were tested
under section 4014(b) of title 18, United
States Code; and
(xi) the number of inmates under treatment
for HIV/AIDS.
(D) Consultation.--The Bureau shall consult with
appropriate officials of the Department of Health and
Human Services, the Office of National Drug Control
Policy, the Office of National AIDS Policy, and the
Centers for Disease Control and Prevention regarding
the development of reports under paragraph (1).
SEC. 762. SUPPORT DATA SYSTEM REVIEW AND INDICATORS FOR MONITORING HIV
CARE.
The Secretary of Health and Human Services, in collaboration with
the Assistant Secretary for Health, the Director of the Office of HIV/
AIDS and Infectious Disease Policy, the Director of the Centers for
Disease Control and Prevention, the Administrator of the Substance
Abuse and Mental Health Services Administration, the Director of the
Department of Housing and Urban Development, the Director of the Office
of AIDS Research, the Administrator of the Health Resources and
Services Administration, and the Administrator of the Centers for
Medicare & Medicaid Services, shall expand and coordinate efforts to
align metrics across agencies and modify Federal data systems, to--
(1) adopt the Institute of Medicine's clinical HIV care
indicators as the core metrics for monitoring the quality of
HIV care, mental health, substance abuse, and supportive
services;
(2) better enable assessment of the impact of the National
HIV/AIDS Strategy and the Patient Protection and Affordable
Care Act on improving HIV/AIDS care and access to supportive
services for individuals with HIV;
(3) expand the demographic data elements to be captured by
Federal data systems relevant to HIV care to permit calculation
of the indicators for subgroups of the population of people
with diagnosed HIV infection, including--
(A) age;
(B) race;
(C) ethnicity;
(D) sex (assigned at birth);
(E) gender identity;
(F) sexual orientation;
(G) current geographic marker of residence;
(H) income or poverty level; and
(I) primary means of reimbursement for medical
services (including Medicaid, Medicare, the Ryan White
HIV/AIDS Program, private insurance, health maintenance
organizations, and no coverage); and
(4) streamline data collection and systematically review
all existing reporting requirements for federally funded HIV/
AIDS programs to ensure that only essential data are collected.
SEC. 763. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS
STRATEGY.
Title II of the Public Health Service Act (42 U.S.C. 202 et seq.)
is amended by inserting after section 241 the following:
``SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS
STRATEGY.
``(a) Transfer Authorization.--Of the discretionary appropriations
made available to the Department of Health and Human Services for any
fiscal year for programs and activities that, as determined by the
Secretary of Health and Human Services, pertain to HIV/AIDS, the
Secretary, in coordination with the Director of the Office of National
HIV/AIDS Policy, may transfer up to 1 percent of such appropriations to
the Office of the Assistant Secretary for Health for implementation of
the National HIV/AIDS Strategy.
``(b) Congressional Notification.--Not less than 30 days before
making any transfer under this section, the Secretary shall give notice
of the transfer to the Congress.
``(c) Definitions.--In this section:
``(1) The term `HIV/AIDS' has the meaning given to such
term in section 2689.
``(2) The term `National HIV/AIDS Strategy' means the
National HIV/AIDS Strategy for the United States issued by the
President in July 2010 and includes any subsequent revisions to
such Strategy.''.
SEC. 764. HIV INTEGRATED SERVICES DELIVERY MODEL DEMONSTRATION.
(a) In General.--Consistent with the National HIV/AIDS Strategy for
the United States and in accordance with this section, the Secretary of
Health and Human Services acting through the Center for Medicare &
Medicaid Innovation and in cooperation with CDC, HRSA, SAMHSA, and HUD,
shall conduct a 3-year demonstration project that is designed to
integrate services and funding under the Medicare and Medicaid
programs, under HIV-related programs conducted by the CDC, and under
the Ryan White HIV/AIDS Program, to reduce new HIV infections, to
increase the proportion of people who know their status, to increase
access to care, to improve health outcomes, to reduce HIV-related
health disparities among Medicaid and Medicare beneficiaries, and to
reduce the cost of care provided to HIV positive Medicare and Medicaid
beneficiaries.
(b) Objectives.--The objectives of the demonstration are the
following:
(1) To ensure the early identification of HIV positive
beneficiaries to reduce costly HIV-related clinical conditions
through HIV screening and rapid linkage to high quality HIV
medical care.
(2) To reduce new HIV infections among Medicaid and
Medicare beneficiaries through routine HIV testing, prevention
services for HIV negative beneficiaries, and intensive
``prevention for positive'' services for HIV positive
beneficiaries.
(3) To reduce morbidity, mortality, and high cost inpatient
and specialty care among HIV positive beneficiaries by ensuring
access to high quality HIV medical care, HIV medications, and
support services.
(4) To promote HIV treatment adherence and retention in
care through intensive case management, treatment education,
and outreach services.
(5) To effectively treat behavioral health conditions among
HIV positive beneficiaries that impair their HIV treatment
adherence and lead to secondary HIV infections through services
funded under Medicare and Medicaid and programs administered by
SAMHSA.
(6) To promote independence, treatment adherence, and
stable housing for HIV positive beneficiaries through highly
coordinated HIV health, housing, and support services funded by
HRSA and HUD.
(c) Demonstration Design.--
(1) In general.--The Secretary shall design the
demonstration to test both--
(A) the service delivery model described in
paragraph (2); and
(B) the payment model described in paragraph (3).
(2) Service delivery model.--
(A) In general.--Under the service delivery model
described in this paragraph, the demonstration shall
test comprehensive HIV testing, linkage to care, HIV
medical care, and ancillary services to individuals
enrolled under Medicare, Medicaid, or both. The service
delivery model will integrate services furnished under
Medicare and Medicaid with prevention services funded
by CDC for HIV positive beneficiaries, intensive case
management services funded by HRSA, behavioral services
funded by SAMHSA, and housing assistance services
funded through HUD.
(B) Core elements.--The model under this paragraph
shall have the following 8 core elements:
(i) HIV testing services that apply the
CDC's 2006 recommendations for universal opt-
out testing among Medicare and Medicaid
beneficiary populations.
(ii) Rapid linkage from HIV testing
settings to treatment for HIV positive
beneficiaries to ensure they are engaged in
care in a timely basis.
(iii) Access to high quality HIV
experienced medical care, laboratory
monitoring, HIV medications, and other required
services.
(iv) Routine screening and treatment for
HIV-related and other chronic conditions,
including behavioral health.
(v) Prevention and treatment education
services, including an adapted Medication
Therapy Management (MTM) program model, to
optimize the benefit of HIV therapeutics.
(vi) Risk-stratified medical case
management.
(vii) Provision of preventive care,
including counseling to prevent secondary HIV
infection.
(viii) Wrap-around support and housing
services.
(3) Payment model.--Under the payment model described in
this paragraph, the demonstration shall test the following:
(A) A prepaid capitated payment model that adjusts
payment for HIV and behavioral health acuity, to be
applied under contracts with managed care organizations
with demonstrated HIV experience.
(B) Use of funds under the Ryan White HIV/AIDS
Program to purchase capitated services from the
contracted managed care organizations.
(C) Provision of additional funds to support
services to the extent that Medicaid and Medicare
coverage is limited, including for services such as HIV
testing (for Medicaid beneficiaries), medical case
management, prevention case management, treatment
education, case finding, behavioral health services,
and housing assistance.
(d) Beneficiary Criteria.--Beneficiaries eligible for participation
in the demonstration are the following:
(1) Medicaid ffs beneficiaries.--Fee-for-service Medicaid
beneficiaries 18 years of age or older.
(2) Dual eligibles.--Individuals who are--
(A) entitled to medical assistance under Medicaid;
and
(B) entitled to benefits under part A, and enrolled
under part B, of Medicare but are not enrolled under a
Medicare Advantage plan under Medicare.
(e) Roles and Responsibilities in Demonstration.--
(1) In general.--Consistent with the National HIV/AIDS
Strategy for the United States, Federal agencies shall
coordinate their funding for the selected States or cities
covered under the demonstration to provide resources to fund
the delivery of services within the demonstration.
(2) HHS.--In carrying out the demonstration, the Secretary
shall--
(A) design the application process;
(B) solicit applications from 5 to 7 State Medicaid
agencies to host the demonstration;
(C) with respect to the service delivery model
described in subsection (c)(2), collaborate with the
CDC, HRSA, and the National Institutes of Health to
design a minimum service delivery model that reflects
the current standard of care as established by the
Public Health Service and CDC guidelines and
recommendations; and
(D) fund an evaluation of the demonstration to
ensure collection of system, provider, and beneficiary-
level data to address their routine reporting
requirements.
The Secretary may carry out the Secretary's authority under
this paragraph through CMMI.
(3) CDC.--The CDC shall collaborate with the Secretary and
CDC-funded HIV prevention grantees in the selected States and
cities to provide technical assistance to design cost-effective
HIV and sexually transmitted infection (STI) screening and
testing services for Medicaid and Medicare beneficiaries,
including partner notification services and communicable
disease reporting. CDC and CMS shall determine the extent to
which testing funds shall be supported jointly or separately by
these agencies.
(4) HRSA.--HRSA shall allocate funds available through the
Special Projects of National Significance (SPNS) Initiative
Program (under subpart I of part F of the Ryan White HIV/AIDS
Program) to support wrap-around core and support services not
covered under Medicare or Medicaid and shall authorize the use
of Ryan White HIV/AIDS Program funds to purchase services
through capitated managed care programs that meet or exceed the
services covered by the Ryan White HIV/AIDS Program at rates
that are no greater than current per capita expenditures. HRSA
is authorized to use funds under SPNS, and to waive such
requirements of SPNS as may be necessary, to carry out the
demonstration.
(5) SAMHSA.--SAMHSA shall allocate funds through the
Minority HIV/AIDS Initiative or other programs to support
behavioral health services not covered under Medicare or
Medicaid.
(6) HOPWA.--HUD shall directly allocate funds under the
Housing Opportunities for People With AIDS (HOPWA) program to
the States or cities participating in the demonstration to
provide supportive housing and other housing assistance to
beneficiaries who otherwise meet HOPWA eligibility criteria.
HUD is authorized to use such HOPWA funds, and to waive such
requirements under HOPWA as may be necessary, to carry out the
demonstration.
(7) State medicaid agencies.--Single State agencies
responsible for administration of the Medicaid program for
individuals who are accepted to participate in the
demonstration shall--
(A) collaborate with CMS to design or refine a
prepaid capitated payment model, to allocate and award
contracts with capitated managed care plans, to ensure
such plans meet State statutory or regulatory
requirements, to contract with a coordinating agency to
organize and deliver integrated HIV testing, medical
care, support, and housing services funded under
Medicare and Medicaid, other Federal, State, and local
government sponsors, and to coordinate their activities
with the State HIV/AIDS program; and
(B) identify and contract with a coordinating
agency to organize the demonstration in the State, to
establish a coordinating body representing State,
local, and provider agencies participating in the
demonstration, to establish systems of care that
integrate HIV prevention, testing, treatment, support,
and housing services, to establish mechanisms to gather
evaluation data for reporting to CMMI and other
participating Federal agencies, and to establish a
quality management program to monitor provider
performance in delivering the services provided to
participating beneficiaries under the demonstration.
(8) Managed care organizations.--Capitated managed care
organizations participating in the demonstration shall organize
and deliver services as specified by the minimum service
delivery model established by CMMI through a network of
providers with demonstrated HIV experience, high quality, and
sufficient provider capacity.
(f) Definitions.--In this section:
(1) CDC.--The term ``CDC'' means the Director of the
Centers for Disease Control and Prevention.
(2) CMMI.--The term ``CMMI'' means the Director of the
Center for Medicare & Medicaid Innovation.
(3) CMS.--The term ``CMS'' means the Administrator of the
Centers for Medicare & Medicaid Services.
(4) Demonstration.--The term ``demonstration'' means the
demonstration conducted under this section.
(5) HRSA.--The term ``HRSA'' means the Administrator of the
Health Resources and Services Administration.
(6) HUD.--The term ``HUD'' means the Secretary of Housing
and Urban Development.
(7) Medicare; medicaid.--The terms ``Medicare'' and
``Medicaid'' mean the programs under titles XVIII and XIX,
respectively, of the Social Security Act.
(8) National hiv/aids strategy for the united states.--The
term ``National HIV/AIDS Strategy for the United States'' has
the meaning given such term under section 241A(b) of the Public
Health Service Act.
(9) Ryan white hiv/aids program.--The term ``Ryan White
HIV/AIDS Program'' means the program under title XXVI of the
Public Health Service Act.
(10) SAMHSA.--The term ``SAMHSA'' means the Substance Abuse
and Mental Health Services Administration.
(11) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services, acting through CMMI.
SEC. 765. REPORT ON THE IMPLEMENTATION OF GOAL 4 (IMPROVED
COORDINATION) OF THE NATIONAL HIV/AIDS STRATEGY.
(a) Report Required.--The President, in consultation with the heads
of all relevant Federal departments and agencies including the
Department of Education, the Department of Health and Human Services,
the Department of Housing and Urban Development, the Department of
Justice, the Department of Labor, the Department of Veteran Affairs,
and the Social Security Administration, shall transmit to the Congress
and make publicly available a report on the status of implementation of
Goal 4 of the National HIV/AIDS Strategy.
(b) Contents.--The report required by subsection (a) shall include
a description, an analysis, and an evaluation of--
(1) the extent to which the National HIV/AIDS Strategy has
improved coordination of efforts, enhanced capacity, and
strengthened infrastructure in order to maximize the effective
delivery of HIV/AIDS prevention, care, and treatment services
at the community level, including coordination--
(A) within and among Federal agencies and
departments;
(B) between the Federal Government and State and
local governments and health departments;
(C) between the Federal Government and nonprofit
foundations and civil society organizations, including
community- and faith-based organizations focused on
addressing the issue of HIV/AIDS; and
(D) between the Federal Government and private
businesses; and
(2) efforts by the Federal Government to educate, involve,
and establish and strengthen partnerships with civil society
organizations, including community- and faith-based
organizations, in order to implement the National HIV/AIDS
Strategy and achieve its goals.
(c) Definition.--In this section, the term ``National HIV/AIDS
Strategy'' means the National HIV/AIDS Strategy for the United States
issued by the President in July 2010 and includes any subsequent
revisions to such Strategy.
Subtitle F--Diabetes
SEC. 771. RESEARCH, TREATMENT, AND EDUCATION.
Subpart 3 of part C of title IV of the Public Health Service Act
(42 U.S.C. 285c et seq.) is amended by adding at the end the following
new section:
``SEC. 434B. DIABETES IN MINORITY POPULATIONS.
``(a) In General.--The Director of NIH shall expand, intensify, and
support ongoing research and other activities with respect to
prediabetes and diabetes, particularly type 2, in minority populations.
``(b) Research.--
``(1) Description.--Research under subsection (a) shall
include investigation into--
``(A) the causes of diabetes, including
socioeconomic, geographic, clinical, environmental,
genetic, and other factors that may contribute to
increased rates of diabetes in minority populations;
and
``(B) the causes of increased incidence of diabetes
complications in minority populations, and possible
interventions to decrease such incidence.
``(2) Inclusion of minority participants.--In conducting
and supporting research described in subsection (a), the
Director of NIH shall seek to include minority participants as
study subjects in clinical trials.
``(c) Report; Comprehensive Plan.--
``(1) In general.--The Diabetes Mellitus Interagency
Coordinating Committee shall--
``(A) prepare and submit to the Congress, not later
than 6 months after the date of enactment of this
section, a report on Federal research and public health
activities with respect to prediabetes and diabetes in
minority populations; and
``(B) develop and submit to the Congress, not later
than 1 year after the date of enactment of this
section, an effective and comprehensive Federal plan
(including all appropriate Federal health programs) to
address prediabetes and diabetes in minority
populations.
``(2) Contents.--The report under paragraph (1)(A) shall at
minimum address each of the following:
``(A) Research on diabetes and prediabetes in
minority populations, including such research on--
``(i) genetic, behavioral, and
environmental factors; and
``(ii) prevention and complications among
individuals within these populations who have
already developed diabetes.
``(B) Surveillance and data collection on diabetes
and prediabetes in minority populations, including with
respect to--
``(i) efforts to better determine the
prevalence of diabetes among Asian-American and
Pacific Islander subgroups; and
``(ii) efforts to coordinate data
collection on the American Indian population.
``(C) Community-based interventions to address
diabetes and prediabetes targeting minority
populations, including--
``(i) the evidence base for such
interventions;
``(ii) the cultural appropriateness of such
interventions; and
``(iii) efforts to educate the public on
the causes and consequences of diabetes.
``(D) Education and training programs for health
professionals (including community health workers) on
the prevention and management of diabetes and its
related complications that is supported by the Health
Resources and Services Administration, including such
programs supported by--
``(i) the National Health Service Corps; or
``(ii) the community health centers program
under section 330.
``(d) Education.--The Director of NIH shall--
``(1) through the National Institute on Minority Health and
Health Disparities and the National Diabetes Education
Program--
``(A) make grants to programs funded under section
464z-4 (relating to centers of excellence) for the
purpose of establishing a mentoring program for health
care professionals to be more involved in weight
counseling, obesity research, and nutrition; and
``(B) provide for the participation of minority
health professionals in diabetes-focused research
programs; and
``(2) make grants for programs to establish a pipeline from
high school to professional school that will increase minority
representation in diabetes-focused health fields by expanding
Minority Access to Research Careers (MARC) program internships
and mentoring opportunities for recruitment.
``(e) Definitions.--For purposes of this section:
``(1) The `Diabetes Mellitus Interagency Coordinating
Committee' means the Diabetes Mellitus Interagency Coordinating
Committee established under section 429.
``(2) The term `minority population' means a racial and
ethnic minority group, as defined in section 1707.''.
SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317T the following
section:
``SEC. 317U. DIABETES IN MINORITY POPULATIONS.
``(a) Research and Other Activities.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall conduct and support research and public health activities
with respect to diabetes in minority populations.
``(2) Certain activities.--Activities under paragraph (1)
regarding diabetes in minority populations shall include the
following:
``(A) Further enhancing the National Health and
Nutrition Examination Survey by over-sampling Asian-
American, Native Hawaiian, and Other Pacific Islanders
in appropriate geographic areas to better determine the
prevalence of diabetes in such populations as well as
to improve the data collection of diabetes penetration
disaggregated into major ethnic groups within such
populations. The Secretary shall ensure that any such
oversampling does not reduce the oversampling of other
minority populations including African-American and
Latino populations.
``(B) Through the Division of Diabetes
Translation--
``(i) providing for prevention research to
better understand how to influence health care
systems changes to improve quality of care
being delivered to such populations;
``(ii) carrying out model demonstration
projects to design, implement, and evaluate
effective diabetes prevention and control
interventions for minority populations,
including culturally appropriate community-
based interventions;
``(iii) developing and implementing a
strategic plan to reduce diabetes in minority
populations through applied research to reduce
disparities and culturally and linguistically
appropriate community-based interventions;
``(iv) supporting, through the national
diabetes prevention program under section 399V-
3, diabetes prevention program sites in
underserved regions highly impacted by
diabetes; and
``(v) implementing, through the national
diabetes prevention program under section 399V-
3, a demonstration program developing new
metrics measuring health outcomes related to
diabetes that can be stratified by specific
minority populations.
``(b) Education.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall direct the Division
of Diabetes Translation to conduct and support both programs to educate
the public on diabetes in minority populations and programs to educate
minority populations about the causes and effects of diabetes.
``(c) Diabetes; Health Promotion, Prevention Activities, and
Access.--The Secretary, acting through the Director of the Centers for
Disease Control and Prevention and the National Diabetes Education
Program, shall conduct and support programs to educate specific
minority populations through culturally appropriate and linguistically
appropriate information campaigns about prevention of, and managing,
diabetes.
``(d) Definition.--For purposes of this section, the term `minority
population' means a racial and ethnic minority group, as defined in
section 1707.''.
SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.), as amended, is further amended by adding at the end the
following new section:
``SEC. 399V-7. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON THE CAUSES AND
EFFECTS OF DIABETES IN MINORITY POPULATIONS.
``(a) In General.--The Secretary, acting through the Director of
the Health Resources and Services Administration, shall conduct and
support programs described in subsection (b) to educate health
professionals on the causes and effects of diabetes in minority
populations.
``(b) Programs.--Programs described in this subsection, with
respect to education on diabetes in minority populations, shall include
the following:
``(1) Giving priority, under the primary care training and
enhancement program under section 747--
``(A) to awarding grants to focus on or address
diabetes; and
``(B) adding minority populations to the list of
vulnerable populations that should be served by such
grants.
``(2) Providing additional funds for the Health Careers
Opportunity Program, Centers for Excellence, and the Minority
Faculty Fellowship Program to partner with the Office of
Minority Health under section 1707 and the National Institutes
of Health to strengthen programs for career opportunities
focused on diabetes treatment and care within underserved
regions highly impacted by diabetes.
``(3) Developing a diabetes focus within, and providing
additional funds for, the National Health Service Corps
Scholarship Program--
``(A) to place individuals in areas that are
disproportionately affected by diabetes and to provide
diabetes treatment and care in such areas; and
``(B) to provide such individuals continuing
medical education specific to diabetes care.''.
SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.), as amended, is further amended by adding at the end the
following section:
``SEC. 399V-8. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING
DIABETES IN AMERICAN INDIAN POPULATIONS.
``In addition to activities under sections 317V-6 and 434B, the
Secretary, acting through the Indian Health Service and in
collaboration with other appropriate Federal agencies, shall--
``(1) conduct and support research and other activities
with respect to diabetes; and
``(2) coordinate the collection of data on clinically and
culturally appropriate diabetes treatment, care, prevention,
and services by health care professionals to the American
Indian population.''.
SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES.
The Secretary of Health and Human Services shall seek to enter into
an arrangement with the Institute of Medicine under which the Institute
will--
(1) not later than 1 year after the date of enactment of
this Act, submit to the Congress an updated version of the
Institute's 2002 report entitled ``Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care''; and
(2) in such updated version, address how racial and ethnic
health disparities have changed since the publication of the
original report.
Subtitle G--Lung Disease
SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDUCATION AND PREVENTION
PROGRAM.
(a) In General.--Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
convene a working group comprised of patient groups, nonprofit
organizations, medical societies, and other relevant governmental and
nongovernmental entities, including those that participate in the
National Asthma Education and Prevention Program, to develop a report
to Congress that--
(1) catalogs, with respect to asthma prevention,
management, and surveillance--
(A) the activities of the Federal Government,
including identifying all Federal programs that carry
out asthma-related activities, as well as assessment of
the progress of the Federal Government and States, with
respect to achieving the goals of the Healthy People
2020 initiative; and
(B) the activities of other entities that
participate in the program, including nonprofit
organizations, patient advocacy groups, and medical
societies; and
(2) makes recommendations for the future direction of
asthma activities, in consultation with researchers from the
National Institutes of Health and other member bodies of the
National Asthma Education and Prevention Program who are
qualified to review and analyze data and evaluate
interventions, including--
(A) description of how the Federal Government may
better coordinate and improve its response to asthma
including identifying any barriers that may exist;
(B) description of how the Federal Government may
continue, expand, and improve its private-public
partnerships with respect to asthma including
identifying any barriers that may exist;
(C) identification of steps that may be taken to
reduce the--
(i) morbidity, mortality, and overall
prevalence of asthma;
(ii) financial burden of asthma on society;
(iii) burden of asthma on
disproportionately affected areas, particularly
those in medically underserved populations (as
defined in section 330(b)(3) of the Public
Health Service Act (42 U.S.C. 254b(b)(3))); and
(iv) burden of asthma as a chronic disease;
(D) identification of programs and policies that
have achieved the steps described in subparagraph (C),
and steps that may be taken to expand such programs and
policies to benefit larger populations; and
(E) recommendations for future research and
interventions.
(b) Report to Congress.--At the end of the 5-year period following
the submission of the report under subsection (a), the National Asthma
Education and Prevention Program shall evaluate the analyses and
recommendations under such report and determine whether a new report to
the Congress is necessary, and make appropriate recommendations to the
Congress.
SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL
AND PREVENTION.
Section 317I of the Public Health Service Act (42 U.S.C. 247b-10)
is amended to read as follows:
``SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE
CONTROL AND PREVENTION.
``(a) Program for Providing Information and Education to the
Public.--The Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall collaborate with State and local
health departments to conduct activities, including the provision of
information and education to the public regarding asthma including--
``(1) deterring the harmful consequences of uncontrolled
asthma; and
``(2) disseminating health education and information
regarding prevention of asthma episodes and strategies for
managing asthma.
``(b) Development of State Asthma Plans.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
shall collaborate with State and local health departments to develop
State plans incorporating public health responses to reduce the burden
of asthma, particularly regarding disproportionately affected
populations.
``(c) Compilation of Data.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, shall, in
cooperation with State and local public health officials--
``(1) conduct asthma surveillance activities to collect
data on the prevalence and severity of asthma, the
effectiveness of public health asthma interventions, and the
quality of asthma management, including--
``(A) collection of household data on the local
burden of asthma;
``(B) surveillance of health care facilities; and
``(C) collection of data not containing
individually identifiable information from electronic
health records or other electronic communications;
``(2) compile and annually publish data regarding the
prevalence and incidence of childhood asthma, the child
mortality rate, and the number of hospital admissions and
emergency department visits by children associated with asthma
nationally and in each State and at the county level by age,
sex, race, and ethnicity, as well as lifetime and current
prevalence; and
``(3) compile and annually publish data regarding the
prevalence and incidence of adult asthma, the adult mortality
rate, and the number of hospital admissions and emergency
department visits by adults associated with asthma nationally
and in each State and at the county level by age, sex, race,
ethnicity, industry, and occupation, as well as lifetime and
current prevalence.
``(d) Coordination of Data Collection.--The Director of the Centers
for Disease Control and Prevention, in conjunction with State and local
health departments, shall coordinate data collection activities under
subsection (c)(2) so as to maximize comparability of results.
``(e) Collaboration.--The Centers for Disease Control and
Prevention are encouraged to collaborate with national, State, and
local nonprofit organizations to provide information and education
about asthma, and to strengthen such collaborations when possible.
``(f) 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 are
authorized to be appropriated to such Centers such sums as may be
necessary for each of fiscal years 2015 through 2019 for the purpose of
carrying out this section.''.
SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAMPAIGN.
(a) In General.--The Secretary of Health and Human Services shall--
(1) enhance the annual campaign by the Department of Health
and Human Services to increase the number of people vaccinated
each year for influenza and pneumonia; and
(2) include in such campaign the use of written educational
materials, public service announcements, physician education,
and any other means which the Secretary deems effective.
(b) Materials and Announcements.--In carrying out the annual
campaign described in subsection (a), the Secretary of Health and Human
Services shall ensure that--
(1) educational materials and public service announcements
are readily and widely available in communities experiencing
disparities in the incidence and mortality rates of influenza
and pneumonia; and
(2) the campaign uses targeted, culturally appropriate
messages and messengers to reach underserved communities.
(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2015 through 2019.
SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACTION PLAN.
(a) In General.--The Director of the Centers for Disease Control
and Prevention shall conduct, support, and expand public health
strategies, prevention, diagnosis, surveillance, and public and
professional awareness activities regarding chronic obstructive
pulmonary disease.
(b) National Action Plan.--
(1) Development.--Not later than 2 years after the date of
the enactment of this Act, the Director of the National Heart,
Lung, and Blood Institute, in consultation with the Director of
the Centers for Disease Control and Prevention, shall develop a
national action plan to address chronic obstructive pulmonary
disease in the United States with participation from patients,
caregivers, health professionals, patient advocacy
organizations, researchers, providers, public health
professionals, and other stakeholders.
(2) Contents.--At a minimum, such plan shall include
recommendations for--
(A) public health interventions for the purpose of
implementation of the national plan;
(B) biomedical, health services, and public health
research on chronic obstructive pulmonary disease; and
(C) inclusion of chronic obstructive pulmonary
disease in the health data collections of all Federal
agencies.
(3) Consideration.--In developing such plan, the Director
of the National Heart, Lung, and Blood Institute shall consider
the recommendations and findings of the Institute of Medicine
in the report entitled ``A Nationwide Framework for
Surveillance of Cardiovascular and Chronic Lung Diseases''
(July 22, 2011).
(c) Chronic Disease Prevention Programs.--The Director of the
National Heart, Lung, and Blood Institute shall carry out the
following:
(1) Conduct public education and awareness activities with
patient and professional organizations to stimulate earlier
diagnosis and improve patient outcomes from treatment of
chronic obstructive pulmonary disease. To the extent known and
relevant, such public education and awareness activities shall
reflect differences in chronic obstructive pulmonary disease by
cause (tobacco, environmental, occupational, biological, and
genetic) and include a focus on outreach to undiagnosed and, as
appropriate, minority populations.
(2) Supplement and expand upon the activities of the
National Heart, Lung, and Blood Institute by making grants to
nonprofit organizations, State and local jurisdictions, and
Indian tribes for the purpose of reducing the burden of chronic
obstructive pulmonary disease, especially in disproportionately
impacted communities, through public health interventions and
related activities.
(3) Coordinate with the Centers for Disease Control and
Prevention, the Indian Health Service, the Health Resources and
Services Administration, and the Department of Veterans Affairs
to develop pilot programs to demonstrate best practices for the
diagnosis and management of chronic obstructive pulmonary
disease.
(4) Develop improved techniques and identify best
practices, in coordination with the Secretary of Veterans
Affairs, for assisting chronic obstructive pulmonary disease
patients to successfully stop smoking, including identification
of subpopulations with different needs. Initiatives under this
paragraph may include research to determine whether successful
smoking cessation strategies are different for chronic
obstructive pulmonary disease patients compared to such
strategies for patients with other chronic diseases.
(d) Environmental and Occupational Health Programs.--The Director
of the Centers for Disease Control and Prevention shall--
(1) support research into the environmental and
occupational causes and biological mechanisms that contribute
to chronic obstructive pulmonary disease; and
(2) develop and disseminate public health interventions
that will lessen the impact of environmental and occupational
causes of chronic obstructive pulmonary disease.
(e) Data Collection.--Not later than 180 days after the enactment
of this Act, the Director of the National Heart, Lung, and Blood
Institute and the Director of the Centers for Disease Control and
Prevention, acting jointly, shall assess the depth and quality of
information on chronic obstructive pulmonary disease that is collected
in surveys and population studies conducted by the Centers for Disease
Control and Prevention, including whether there are additional
opportunities for information to be collected in the National Health
and Nutrition Examination Survey, the National Health Interview Survey,
and the Behavioral Risk Factors Surveillance System surveys. The
Director of the National Heart, Lung, and Blood Institute shall include
the results of such assessment in the national action plan under
subsection (b).
(f) 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 2015 through 2019.
Subtitle H--Osteoarthritis and Musculoskeletal Diseases
SEC. 781. FINDINGS.
The Congress finds as follows:
(1) Eighty percent of African-American women and nearly 74
percent of Hispanic men are either overweight or obese,
speeding the onset and progression of arthritis.
(2) Arthritis affects 46 million Americans, and that number
will rise to 67 million by the year 2030.
(3) Twenty-seven million Americans suffer from
osteoarthritis, the most common form of arthritis, making it
the leading cause of disability in the United States.
Osteoarthritis is sometimes referred to as degenerative joint
disease.
(4) Obesity accelerates the onset of arthritis: 70 percent
of obese adults with mild osteoarthritis of the knee at age 60
will develop advanced end-stage disease by age 80. In contrast,
just 43 percent of non-obese adults will have end-stage disease
over the same time period.
(5) Arthritis affects one in five Americans, and is the
single greatest cause of chronic pain and disability in the
United States.
(6) Women, African-Americans, and Hispanics have more
severe arthritis and functional limitations. These same
individuals are more likely to be obese, diabetic, and have
higher incidence of heart disease--medical conditions that can
be improved with physical activity. Instead of moving; however,
these groups have an inactivity rate of 40 to 50 percent, which
continues to increase.
(7) Arthritis costs $128 billion a year, including $81
billion in direct costs (medical) and $47 billion in indirect
costs (lost earnings). Each year, $309 billion in direct and
indirect costs is lost due to disparities in osteoarthritis and
musculoskeletal diseases.
(8) Obesity and other chronic health conditions exacerbate
the debilitating impact of arthritis, leading to inactivity,
loss of independence, and a perpetual cycle of comorbid chronic
conditions.
(9) Sixty-one percent of arthritis sufferers are women, and
women represent 64 percent of an estimated 43 million annual
visits to physicians' offices and outpatient clinics where
arthritis was the primary diagnosis. Women also represented 60
percent of approximately 1 million hospitalizations that
occurred in 2003 for which arthritis was the primary diagnosis.
(10) Women ages 65 and older have up to 2\1/2\ times more
disabilities than men of the same age. Higher rates of obesity
and arthritis among this group explained up to 48 percent of
the gender gap in disability, above all other common chronic
health conditions.
(11) The primary indication for total knee arthroplasty
(TKA), also known as knee replacement, is relief of
significant, disabling pain caused by severe arthritis.
(12) Knee replacement is surgery for people with severe
knee damage. Knee replacement can relieve pain and allow you to
be more active. When you have a total knee replacement, the
surgeon removes damaged cartilage and bone from the surface of
your knee joint and replaces them with a man-made surface of
metal and plastic. In a partial knee replacement, the surgeon
only replaces one part of your knee joint.
(13) Total hip replacement, also called total hip
arthroplasty (THA), is used if your hip pain interferes with
daily activities and more-conservative treatments have not
helped. Arthritis damage is the most common reason to need hip
replacement.
(14) The odds of a family practice physician recommending
TKA to a male patient with moderate arthritis are twice that of
a female patient, while the odds of an orthopaedic surgeon
recommending TKA to a male patient with moderate arthritis are
22 times that of a female patient.
(15) African-Americans with doctor-diagnosed arthritis have
a higher prevalence of severe pain attributable to arthritis,
compared with Whites (34.0 percent versus 22.6 percent).
African-Americans, compared to Whites, report a higher
proportion of work limitations (39.5 percent versus 28.0
percent) and a higher prevalence of arthritis-attributable work
limitation (6.6 percent versus 4.6 percent).
(16) Hispanics are 50 percent more likely than non-Hispanic
Whites to report needing assistance with at least one
instrumental activity of daily living and to have difficulty
walking.
(17) African-Americans and Hispanics were 1.3 times more
likely to have activity limitation, 1.6 times more likely to
have work limitations, and 1.9 times more likely to have severe
joint pain than Whites.
(18) In 2003, the Institute of Medicine reported that the
rates of TKA and THA among African-American and Hispanic
patients are significantly lower than for Whites--even for
those with equitable health care coverage such as through
Medicare or the Department of Veterans Affairs.
(19) According to the Centers for Disease Control and
Prevention, in 2000, African-American Medicare enrollees were
37 percent less likely than White Medicare enrollees to undergo
total knee replacements. In 2006, the disparity increased to 39
percent.
(20) Even after adjusting for insurance and health access,
Hispanics and African-Americans are almost 50 percent less
likely to undergo total knee replacement than Whites.
SEC. 782. OSTEOARTHRITIS AND OTHER MUSCULOSKELETAL HEALTH-RELATED
ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND
PREVENTION.
(a) Education and Awareness Activities.--The Secretary of Health
and Human Services, acting through the Director of the Centers for
Disease Control and Prevention, shall direct the National Center for
Chronic Disease Prevention and Health Promotion to conduct and expand
the Health Community Program and Arthritis Program to educate the
public on--
(1) the causes of, preventive health actions for, and
effects of arthritis and other musculoskeletal conditions in
minority patient populations; and
(2) the effects of such conditions on other comorbidities
including obesity, hypertension, and cardiovascular disease.
(b) Programs on Arthritis and Musculoskeletal Conditions.--
Education and awareness programs of the Centers for Disease Control and
Prevention on arthritis and other musculoskeletal conditions in
minority communities shall--
(1) be culturally and linguistically appropriate to
minority patients, targeting musculoskeletal health promotion
and prevention programs of each major ethnic group, including--
(A) Native Americans and Alaska Natives;
(B) Asian-Americans;
(C) African-Americans/Blacks;
(D) Hispanic/Latino-Americans; and
(E) Native Hawaiians and Pacific Islanders; and
(2) include public awareness campaigns directed toward
these patient populations that emphasize the importance of
musculoskeletal health, physical activity, diet and healthy
lifestyle, and weight reduction for overweight and obese
patients.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as necessary for
fiscal year 2015 and each subsequent fiscal year.
Subtitle I--Sleep and Circadian Rhythm Disorders
SEC. 791. SHORT TITLE; FINDINGS.
(a) Short Title.--This subtitle may be cited as the ``Sleep and
Circadian Rhythm Disorders Health Disparities Act''.
(b) Findings.--The Congress finds the following:
(1) Decrements in sleep health such as sleep apnea,
insufficient sleep time, and insomnia, affect 50-70 million
United States adults. Twelve to eighteen million United States
adults have sleep apnea, a chronic disorder characterized by
one or more pauses in breathing which can last from a few
seconds to minutes. They may occur 30 times or more an hour,
disrupting sleep and resulting in excessive daytime sleepiness
and loss in productivity.
(2) Seventy percent of high school students are not getting
enough sleep on school nights, while 33 percent of Americans
get fewer than 7 hours of sleep per night and roughly 6,000
fatal motor vehicle crashes are caused by drowsy drivers.
(3) Insufficient sleep and insomnia are more prevalent in
women. Women who are pregnant and have sleep apnea are at an
increased risk of cardiovascular complications during
pregnancy. The impact of disparities in sleep health is
associated with a growing number of health problems, including
the following:
(A) Hypertension.
(B) Cancer.
(C) Stroke.
(D) Cardiac arrhythmia.
(E) Chronic heart failure and heart disease.
(F) Diabetes.
(G) Cognitive functioning and behavior.
(H) Depression and bipolar disorder.
(I) Substance abuse.
(4) A ``sleep disparity'' exists in that poor sleep quality
is strongly associated with poverty and race. Factors such as
employment, education, and health status, amongst others,
significantly mediated this effect only in poor subjects,
suggesting a differential vulnerability to these factors in
poor relative to non-poor individuals in the context of sleep
quality.
(5) African-Americans sleep worse than Caucasian Americans.
African-Americans take longer to fall asleep, report poorer
sleep quality, have more light and less deep sleep, and nap
more often and longer.
(6) African-Americans and individuals in lower
socioeconomic status groups may be at an increased risk for
sleep disturbances and associated health consequences.
(7) Among young African-Americans, the likelihood of having
sleep disordered breathing and exhibiting risk factors for poor
sleep is twice that in young Caucasians. Frequent snoring is
more common among African-American and Hispanic women and
Hispanic men compared to non-Hispanic Caucasians, independent
of other factors including obesity.
(8) African-Americans with sleep disordered breathing
develop symptoms at a younger age than Caucasians but appear
less likely to be diagnosed and treated in a timely manner.
This delay may at least in part be due to reduced access to
care.
(9) Sleep loss contributes to increased risk for chronic
conditions such as obesity, diabetes, and hypertension, all of
which have increased prevalence in underserved,
underrepresented minorities. Racial and ethnic disparities
related to obesity may also contribute to disparities in health
outcomes related to sleep disordered breathing.
(10) Non-Caucasian adults report an insomnia rate of 12.9
percent compared to only 6.6 percent for Caucasians.
(11) African-American women have a higher incidence of
insomnia than African-American men, perhaps related in part to
higher risk for chronic persisting symptoms.
SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RESEARCH ACTIVITIES OF
THE NATIONAL INSTITUTES OF HEALTH.
(a) In General.--The Director of the National Institutes of Health,
acting through the Director of the National Heart, Lung, and Blood
Institute, shall--
(1) continue to expand research activities addressing sleep
health disparities; and
(2) continue implementation of the ``NIH Sleep Disorders
Research Plan'' across all institutes and centers of the
National Institutes of Health to improve treatment and
prevention of sleep health disparities.
(b) Required Research Activities.--In conducting or supporting
research relating to sleep and circadian rhythm, the Director of the
National Heart, Lung, and Blood Institute shall--
(1) advance epidemiology and clinical research to achieve a
more complete understanding of disparities in domains of sleep
health and across population subgroups for which cardiovascular
and metabolic health disparities exist, including--
(A) prevalence and severity of sleep apnea;
(B) habitual sleep duration;
(C) sleep timing and regularity; and
(D) insomnia;
(2) develop study designs and analytical approaches to
explain and predict multilevel and life-course determinants of
sleep health and to elucidate the sleep-related causes of
cardiovascular and metabolic health disparities across the age
spectrum, including such determinants and causes that are--
(A) environmental;
(B) biological or genetic;
(C) psychosocial;
(D) societal;
(E) political; or
(F) economic;
(3) determine the contribution of sleep impairments such as
sleep apnea, insufficient sleep duration, irregular sleep
schedules, and insomnia to unexplained disparities in
cardiovascular and metabolic risk and disease outcomes;
(4) develop study designs, data sampling and collection
tools, and analytical approaches to optimize understanding of
mediating and moderating factors, and feedback mechanisms
coupling sleep to cardiovascular and metabolic health
disparities;
(5) advance research to understand cultural and linguistic
barriers (on the person, provider, or system level) to access
to care, medical diagnosis, and treatment of sleep disorders in
diverse population groups;
(6) develop and test multilevel interventions (including
sleep health education in diverse communities) to reduce
disparities in sleep health that will impact ability to improve
disparities in cardiovascular and metabolic risk or disease;
(7) create opportunities to integrate sleep and health
disparity science by strategically utilizing resources
(existing or anticipated cohorts), exchanging scientific data
and ideas (cross-over into scientific meetings), and develop
multidisciplinary investigator-initiated grant applications;
and
(8) enhance the diversity and foster career development of
young investigators involved in sleep and health disparities
science.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal year 2015 and each subsequent fiscal year.
SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DISPARITIES-RELATED
ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND
PREVENTION.
(a) In General.--The Director of the Centers for Disease Control
and Prevention shall conduct, support, and expand public health
strategies and prevention, diagnosis, surveillance, and public and
professional awareness activities regarding sleep and circadian rhythm
disorders.
(b) Findings.--The Congress finds as follows:
(1) Sleep disorders and sleep deficiency unrelated to a
primary sleep disorder are underdiagnosed and are increasingly
detrimental to health status.
(2) The consequences to society include additional
diseases, motor vehicle accidents, decreased longevity,
elevated direct medical costs, and indirect costs related to
work absenteeism and property damage.
(c) Required Surveillance and Education Awareness Activities.--In
conducting or supporting research relating to sleep and circadian
rhythm disorders surveillance and education awareness activities, the
Director of the Centers for Disease Control and Prevention shall--
(1) ensure that such activities are culturally and
linguistically appropriate to minority patients, targeting
sleep and circadian rhythm health promotion and prevention
programs of each major ethnic group, including--
(A) Native Americans and Alaska Natives;
(B) Asian-Americans;
(C) African-Americans/Blacks;
(D) Hispanic/Latino-Americans; and
(E) Native Hawaiians and Pacific Islanders;
(2) collect and compile national and State surveillance
data on sleep disorders health disparities;
(3) continue to develop and implement new sleep questions
in public health surveillance systems to increase public
awareness of sleep health and sleep disorders and their impact
on health;
(4) publish monthly reports highlighting geographic,
racial, and ethnic disparities in sleep health, as well as
relationships between insufficient sleep and chronic disease,
health risk behaviors, and other outcomes as determined
necessary by the Director; and
(5) include public awareness campaigns that inform patient
populations from major ethnic groups about the prevalence of
sleep and circadian rhythm disorders and emphasize the
importance of sleep health.
(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal year 2015 and each subsequent fiscal year.
TITLE VIII--HEALTH INFORMATION TECHNOLOGY
SEC. 800. DEFINITIONS.
In this title:
(1) The term ``certified EHR technology'' has the meaning
given to that term in section 3000 of the Public Health Service
Act (42 U.S.C. 300jj).
(2) The term ``EHR'' means an electronic health record.
Subtitle A--Reducing Health Disparities Through Health IT
SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR PROMOTION OF HEALTH IT.
The Secretary of Health and Human Services, acting through the
Administrator of the Health Resources and Services Administration,
shall expand and intensify the programs and activities of the
Administration (directly or through grants or contracts) to provide
technical assistance and resources to health centers (as defined in
section 330(a) of the Public Health Service Act (42 U.S.C. 254b(a)) to
adopt and meaningfully use certified EHR technology for the management
of chronic diseases and health conditions and reduction of health
disparities.
SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RACIAL AND ETHNIC
MINORITY COMMUNITIES; OUTREACH AND ADOPTION OF HEALTH IT
IN SUCH COMMUNITIES.
(a) National Coordinator for Health Information Technology.--
(1) In general.--The National Coordinator for Health
Information Technology shall conduct an evaluation of the level
of use and accessibility of electronic health records in racial
and ethnic minority communities focusing on whether patients in
those communities have providers with EHRs, stratified by
disparity variables.
(2) Content.--In conducting the evaluation under paragraph
(1), the National Coordinator shall publish the results of a
study regarding the 100,000 providers recruited by the Regional
Extension Center established under section 3012 of the Public
Health Service Act (42 U.S.C. 300jj-32), including the race and
ethnicity of such providers and the populations served by such
providers, with the populations stratified by disparity
variables.
(b) National Center for Health Statistics.--As soon as practicable
after the date of enactment of this Act, the Director of the National
Center for Health Statistics shall provide to Congress a more detailed
analysis of the data presented in the Data Brief 79 published by such
Center in November 2011 (entitled ``Electronic Health Record Systems
and Intent to Apply for Meaningful Use Incentives Among Office-Based
Physician Practices'').
(c) Institute of Medicine.--The Secretary of Health and Human
Services may enter into an agreement with the Institute of Medicine of
the National Academies that provides such Institute will--
(1) evaluate the impact of health information technology in
racial and ethnic minority communities; and
(2) publish a report regarding such evaluation.
(d) Centers for Medicare & Medicaid Services.--
(1) In general.--As part of the process of collecting
information, with respect to a provider, at registration and
attestation for purposes of the Medicare and Medicaid
Electronic Health Records Incentive Programs, the Secretary of
Health and Human Services shall collect the race and ethnicity
of such provider.
(2) Medicare and medicaid electronic health records
incentive programs defined.--For purposes of paragraph (1), the
term ``Medicare and Medicaid Electronic Health Records
Incentive Programs'' means the incentive programs under section
1814(l)(3), subsections (a)(7) and (o) of section 1848,
subsections (l) and (m) of section 1853, subsections
(b)(3)(B)(ix)(I) and (n) of section 1886, and subsections
(a)(3)(F) and (t) of section 1903 of the Social Security Act
(42 U.S.C. 1395f(l)(3), 1395w-4, 1395w-23, 1395ww, and 1396b).
(e) National Coordinator's Assessment of Impact of HIT.--Section
3001(c)(6)(C) of the Public Health Service Act (42 U.S.C. 300jj-
11(c)(6)(C)) is amended--
(1) in the heading by inserting ``, racial and ethnic
minority communities,'' after ``health disparities'';
(2) by inserting ``, in communities with a high proportion
of individuals from racial and ethnic minority groups (as
defined in section 1707(g)), including people with disabilities
in these groups,'' after ``communities with health
disparities''; and
(3) by adding at the end the following new sentence: ``In
any publication under the previous sentence, the National
Coordinator shall include best practices for encouraging
partnerships between the Federal Government, States, and
private entities to expand outreach for and the adoption of
certified EHR technology in communities with a high proportion
of individuals from racial and ethnic minority groups (as so
defined), while also maintaining the accessibility requirements
of section 508 of the Rehabilitation Act to encourage patient
involvement in their own health care. The National Coordinator
shall--
``(i) not later than 6 months after the
submission to the Congress of the report
required by section 832 of the Health Equity
and Accountability Act of 2014, establish
criteria for evaluating the impact of health
information technology on communities with a
high proportion of individuals from racial and
ethnic minority groups (as so defined) taking
into account the findings in such report; and
``(ii) not later than 12 months after the
submission to the Congress of such reports,
conduct and publish the results of an
evaluation of such impact.''.
Subtitle B--Modifications To Achieve Parity in Existing Programs
SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE HEALTH IT INFRASTRUCTURE
IN RACIAL AND ETHNIC MINORITY COMMUNITIES.
Section 3011 of the Public Health Service Act (42 U.S.C. 300jj-31)
is amended--
(1) in subsection (a), by adding at the end the following
new paragraph:
``(8) Activities described in the previous paragraphs of
this subsection with respect to communities with a high
proportion of individuals from racial and ethnic minority
groups (as defined in section 1707(g)).''; and
(2) by adding at the end the following new subsection:
``(e) Annual Report on Expenditures.--The National Coordinator
shall report annually to the Congress on activities and expenditures
under this section.''.
SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER ASSISTANCE TO RACIAL
AND ETHNIC MINORITY GROUPS.
(a) In General.--Section 3012(c)(4)(C) of the Public Health Service
Act (42 U.S.C. 300jj-32(c)(4)(C)) is amended by inserting ``or
individuals from racial and ethnic minority groups (as defined in
section 1707(g))'' after ``medically underserved individuals''.
(b) Biennial Evaluation.--Section 3012(c)(8) of such Act (42 U.S.C.
300jj-32(c)(8)) is amended--
(1) by inserting: ``Each evaluation panel shall include at
least one consumer advocate from a racial and ethnic minority
community served by the center involved, at least one patient
or family caregiver, and at least one representative of a
minority-serving institution.'' after ```and of Federal
officials.''; and
(2) by inserting ``and shall determine the degree to which
such center provides outreach and assistance to providers
predominantly serving racial and ethnic minority groups (as
defined in section 1707(g))'' after ``specified in paragraph
(3)''.
SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DEVELOPMENT OF LOAN
PROGRAMS TO FACILITATE ADOPTION OF CERTIFIED EHR
TECHNOLOGY BY PROVIDERS SERVING RACIAL AND ETHNIC
MINORITY GROUPS.
Section 3014(e) of the Public Health Service Act (42 U.S.C. 300jj-
34(e)) is amended--
(1) in paragraph (3), by striking at the end ``or'';
(2) in paragraph (4), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(5) carry out any of the activities described in a
previous paragraph of this subsection with respect to
communities with a high proportion of individuals from racial
and ethnic minority groups (as defined in section 1707(g)).''.
SEC. 814. AUTHORIZATION OF APPROPRIATIONS.
Section 3018 of the Public Health Service Act (42 U.S.C. 300jj-38)
is amended by striking ``fiscal years 2009 through 2013'' and inserting
``fiscal years 2014 through 2021''.
Subtitle C--Additional Research and Studies
SEC. 831. DATA COLLECTION AND ASSESSMENTS CONDUCTED IN COORDINATION
WITH MINORITY-SERVING INSTITUTIONS.
Section 3001(c)(6) of the Public Health Service Act (42 U.S.C.
300jj-11(c)(6)) is amended by adding at the end the following new
subparagraph:
``(F) Data collection and assessments conducted in
coordination with minority-serving institutions.--
``(i) In general.--In carrying out
subparagraph (C) with respect to communities
with a high proportion of individuals from
racial and ethnic minority groups (as defined
in section 1707(g)), the National Coordinator
shall, to the greatest extent possible,
coordinate with an entity described in clause
(ii).
``(ii) Minority-serving institutions.--For
purposes of clause (i), an entity described in
this clause is a historically Black college or
university, a Hispanic-serving institution, a
tribal college or university, or an Asian-
American-, Native American-, and Pacific
Islander-serving institution with an accredited
public health, health policy, or health
services research program.''.
SEC. 832. STUDY OF HEALTH INFORMATION TECHNOLOGY IN MEDICALLY
UNDERSERVED COMMUNITIES.
(a) In General.--Not later than 24 months after the date of
enactment of this Act, the Secretary of Health and Human Services
shall--
(1) enter into an agreement with the Institute of Medicine
of the National Academies (or, if the Institute of Medicine
declines, another appropriate public or nonprofit private
entity) to conduct a study on the development, implementation,
and effectiveness of health information technology within
medically underserved areas (as described in subsection (c));
and
(2) submit a report to Congress describing the results of
such study, including any recommendations for legislative or
administrative action.
(b) Study.--The study described in subsection (a)(1) shall--
(1) identify barriers to successful implementation of
health information technology in medically underserved areas;
(2) examine the impact of health information technology on
providing quality care and reducing the cost of care to
individuals in such areas, including the impact of such
technology on improved health outcomes for individuals,
including which technology worked for which population and how
it improved health outcomes for that population;
(3) examine the impact of health information technology on
improving health-care-related decisions by both patients and
providers in such areas;
(4) identify specific best practices for using health
information technology to foster the consistent provision of
physical accessibility and reasonable policy accommodations in
health care to individuals with disabilities in such areas;
(5) assess the feasibility and costs associated with the
use of health information technology in such areas;
(6) evaluate whether the adoption and use of qualified
electronic health records (as described in section 3000(13) of
the Public Health Service Act (42 U.S.C. 300jj(13)) is
effective in reducing health disparities, including analysis of
clinical quality measures reported by Medicare and Medicaid
providers pursuant to programs to encourage the adoption and
use of certified EHR technology;
(7) identify providers in medically underserved areas that
are not electing to adopt and use electronic health records and
determine what barriers are preventing those providers from
adopting and using such records; and
(8) examine urban and rural community health systems and
determine the impact that health information technology may
have on the capacity of primary health providers in those
systems.
(c) Medically Underserved Area.--The term ``medically underserved
area'' means--
(1) a population that has been designated as a medically
underserved population under section 330(b)(3) of the Public
Health Service Act (42 U.S.C. 254b(b)(3));
(2) an area that has been designated as a health
professional shortage area under section 332 of the Public
Health Service Act (42 U.S.C. 254e);
(3) an area or population that has been designated as a
medically underserved community under section 799B(6) of the
Public Health Service Act (42 U.S.C. 295p(6)); or
(4) an area or population that--
(A) is not described in paragraphs (1) through (3)
of this subsection;
(B) experiences significant barriers to accessing
quality health services; and
(C) has a high prevalence of diseases or conditions
described in title VII of this Act, with such diseases
or conditions having a disproportionate impact on
racial and ethnic minority groups (as defined in
section 1707(g) of the Public Health Service Act (42
U.S.C. 300u-6(g))) or a subgroup of people with
disabilities who have specific functional impairments.
Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs
SEC. 841. APPLICATION OF MEDICARE HITECH PAYMENTS TO HOSPITALS IN
PUERTO RICO.
(a) In General.--Subsection (n)(6)(B) of section 1886 of the Social
Security Act (42 U.S.C. 1395ww) is amended by striking ``subsection (d)
hospital'' and inserting ``hospital that is a subsection (d) hospital
or a subsection (d) Puerto Rico hospital''.
(b) Offsetting Reduction.--Subsection (n)(2) of section 1886 of the
Social Security Act (42 U.S.C. 1395ww) is amended by adding at the end
the following new subparagraph:
``(H) Budget neutrality adjustment.--The Secretary
shall reduce the applicable amounts that would
otherwise be determined under this subsection with
respect to--
``(i) the first fiscal year to which this
subparagraph applies by an amount that the
Secretary estimates would ensure that estimated
aggregate payments under this subsection for
such fiscal year are not increased as a result
of the amendments made by subsection (a) of
section 841 of the Health Equity and
Accountability Act of 2014; or
``(ii) a succeeding fiscal year by an
amount that the Secretary estimates would
ensure that estimated aggregate payments under
this subsection for such fiscal year are not
increased as a result of the amendments made by
subsections (a) and (c) of such section.''.
(c) Conforming Amendments.--(1) Subsection (b)(3)(B)(ix) of such
section is amended--
(A) in subclause (I), by striking ``(n)(6)(A)'' and
inserting ``(n)(6)(B)''; and
(B) in subclause (II), by striking ``subsection (d)
hospital'' and inserting ``an eligible hospital''.
(2) Paragraphs (2) and (4)(A) of section 1853(m) of the Social
Security Act (42 U.S.C. 1395w-23(m)) are each amended by striking
``1886(n)(6)(A)'' and inserting ``1886(n)(6)(B)''.
(d) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by subsections (a), (b) and (c) by program instruction or
otherwise.
(e) Effective Date.--The amendments made by this section shall
apply to payments for payment years for fiscal years beginning after
the date of the enactment of this Act.
SEC. 842. EXTENDING MEDICAID EHR INCENTIVE PAYMENTS TO REHABILITATION
FACILITIES, LONG-TERM CARE FACILITIES, AND HOME HEALTH
AGENCIES.
Section 1903(t)(2)(B) of the Social Security Act (42 U.S.C.
1396b(t)(2)(B)) is amended--
(1) in clause (i), by striking ``, or'' and inserting a
semicolon;
(2) in clause (ii), by striking the period at the end and
inserting a semicolon; and
(3) by inserting after clause (ii) the following new
clauses:
``(iii) a rehabilitation facility (as defined in
section 1886(j)(1)) that furnishes acute or subacute
rehabilitation services;
``(iv) a long-term care hospital (as defined in
section 1886(d)(1)(B)(iv)(I)); or
``(v) a home health agency (as defined in section
1861(o)).''.
SEC. 843. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY FOR MEDICAID
ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS.
(a) In General.--Section 1903(t)(3)(B)(v) of the Social Security
Act (42 U.S.C. 1396b(t)(3)(B)(v)) is amended to read as follows:
``(v) physician assistant, in the case that
the assistant is a primary care provider,
including an assistant who practices in a rural
health clinic that is led by a physician
assistant or practices in a federally qualified
health center that is so led.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to amounts expended under section 1903(a)(3)(F) of
the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar
quarters beginning on or after the date of the enactment of this Act.
TITLE IX--ACCOUNTABILITY AND EVALUATION
SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL ASSISTED HEALTH CARE
SERVICES AND RESEARCH PROGRAMS ON THE BASIS OF SEX, RACE,
COLOR, NATIONAL ORIGIN, MARITAL STATUS, FAMILIAL STATUS,
SEXUAL ORIENTATION, GENDER IDENTITY, OR DISABILITY
STATUS.
(a) In General.--No person in the United States shall, on the basis
of sex, race, color, national origin, marital status, familial status,
sexual orientation, gender identity, or disability status, be excluded
from participation in, be denied the benefits of, or be subjected to
discrimination under any health program or activity, including any
health research program or activity, receiving Federal financial
assistance.
(b) Definition.--In this section, the term ``familial status''
means, with respect to one or more individuals--
(1) being domiciled with any individual related by blood or
affinity whose close association with the individual is the
equivalent of a family relationship;
(2) being in the process of securing legal custody of any
individual; or
(3) being pregnant.
SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER TITLE VI OF THE CIVIL
RIGHTS ACT OF 1964.
A payment to a provider of services, physician, or other supplier
under part B, C, or D of title XVIII of the Social Security Act shall
be deemed a grant, and not a contract of insurance or guaranty, for the
purposes of title VI of the Civil Rights Act of 1964.
SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES.
Title XXXIV of the Public Health Service Act, as amended by titles
I, II, and III of this Act, is further amended by inserting after
subtitle B the following:
``Subtitle C--Strengthening Accountability
``SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS.
``(a) In General.--The Secretary shall establish within the Office
for Civil Rights an Office of Health Disparities, which shall be headed
by a director to be appointed by the Secretary.
``(b) Purpose.--The Office of Health Disparities shall ensure that
the health programs, activities, and operations of health entities
which receive Federal financial assistance are in compliance with title
VI of the Civil Rights Act, which prohibits discrimination on the basis
of race, color, or national origin. The activities of the Office shall
include the following:
``(1) The development and implementation of an action plan
to address racial and ethnic health care disparities, which
shall address concerns relating to the Office for Civil Rights
as released by the United States Commission on Civil Rights in
the report entitled `Health Care Challenge: Acknowledging
Disparity, Confronting Discrimination, and Ensuring Equity'
(September 1999) in conjunction with the reports by the
Institute of Medicine entitled `Unequal Treatment: Confronting
Racial and Ethnic Disparities in Health Care', `Crossing the
Quality Chasm: A New Health System for the 21st Century', `In
the Nation's Compelling Interest: Ensuring Diversity in the
Health Care Workforce', `The National Partnership for Action to
End Health Disparities', and `The Health of Lesbian, Gay,
Bisexual, and Transgender People', and other related reports by
the Institute of Medicine. This plan shall be publicly
disclosed for review and comment and the final plan shall
address any comments or concerns that are received by the
Office.
``(2) Investigative and enforcement actions against
intentional discrimination and policies and practices that have
a disparate impact on minorities.
``(3) The review of racial, ethnic, gender identity, sexual
orientation, sex, disability status, socioeconomic status, and
primary language health data collected by Federal health
agencies to assess health care disparities related to
intentional discrimination and policies and practices that have
a disparate impact on minorities.
``(4) Outreach and education activities relating to
compliance with title VI of the Civil Rights Act.
``(5) The provision of technical assistance for health
entities to facilitate compliance with title VI of the Civil
Rights Act.
``(6) Coordination and oversight of activities of the civil
rights compliance offices established under section 3442.
``(7) Ensuring--
``(A) at a minimum, compliance with the 1997 Office
of Management and Budget Standards for Maintaining,
Collecting, and Presenting Federal Data on Race and
Ethnicity; and
``(B) consideration of available data and language
standards such as--
``(i) the standards for collecting and
reporting data under section 3101; and
``(ii) the National Standards on Culturally
and Linguistically Appropriate Services of the
Office of Minority Health within the Department
of Health and Human Services.
``(c) Funding and Staff.--The Secretary shall ensure the
effectiveness of the Office of Health Disparities by ensuring that the
Office is provided with--
``(1) adequate funding to enable the Office to carry out
its duties under this section; and
``(2) staff with expertise in--
``(A) epidemiology;
``(B) statistics;
``(C) health quality assurance;
``(D) minority health and health disparities;
``(E) cultural and linguistic competency;
``(F) civil rights; and
``(G) social, behavioral, and economic determinants
of health.
``(d) Report.--Not later than December 31, 2015, and annually
thereafter, the Secretary, in collaboration with the Director of the
Office for Civil Rights and the Deputy Assistant Secretary for Minority
Health, shall submit a report to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on Energy and
Commerce of the House of Representatives that includes--
``(1) the number of cases filed, broken down by category;
``(2) the number of cases investigated and closed by the
office;
``(3) the outcomes of cases investigated;
``(4) the staffing levels of the office including staff
credentials;
``(5) the number of other lingering and emerging cases in
which civil rights inequities can be demonstrated; and
``(6) the number of cases remaining open and an explanation
for their open status.
``(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 2015 through 2020.
``SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OFFICES FOR CIVIL RIGHTS
WITHIN FEDERAL HEALTH AND HUMAN SERVICES AGENCIES.
``(a) In General.--The Secretary shall establish civil rights
compliance offices in each agency within the Department of Health and
Human Services that administers health programs.
``(b) Purpose of Offices.--Each office established under subsection
(a) shall ensure that recipients of Federal financial assistance under
Federal health programs administer their programs, services, and
activities in a manner that--
``(1) does not discriminate, either intentionally or in
effect, on the basis of race, national origin, language,
ethnicity, sex, age, disability, sexual orientation, and gender
identity; and
``(2) promotes the reduction and elimination of disparities
in health and health care based on race, national origin,
language, ethnicity, sex, age, disability, sexual orientation,
and gender identity.
``(c) Powers and Duties.--The offices established in subsection (a)
shall have the following powers and duties:
``(1) The establishment of compliance and program
participation standards for recipients of Federal financial
assistance under each program administered by an agency within
the Department of Health and Human Services including the
establishment of disparity reduction standards to encompass
disparities in health and health care related to race, national
origin, language, ethnicity, sex, age, disability, sexual
orientation, and gender identity.
``(2) The development and implementation of program-
specific guidelines that interpret and apply Department of
Health and Human Services guidance under title VI of the Civil
Rights Act of 1964 and section 1557 of the Patient Protection
and Affordable Care Act to each Federal health program
administered by the agency.
``(3) The development of a disparity-reduction impact
analysis methodology that shall be applied to every rule issued
by the agency and published as part of the formal rulemaking
process under sections 555, 556, and 557 of title 5, United
States Code.
``(4) Oversight of data collection, analysis, and
publication requirements for all recipients of Federal
financial assistance under each Federal health program
administered by the agency; compliance with, at a minimum, the
1997 Office of Management and Budget Standards for Maintaining,
Collecting, and Presenting Federal Data on Race and Ethnicity;
and consideration of available data and language standards such
as--
``(A) the standards for collecting and reporting
data under section 3101; and
``(B) the National Standards on Culturally and
Linguistically Appropriate Services of the Office of
Minority Health within the Department of Health and
Human Services.
``(5) The conduct of publicly available studies regarding
discrimination within Federal health programs administered by
the agency as well as disparity reduction initiatives by
recipients of Federal financial assistance under Federal health
programs.
``(6) Annual reports to the Committee on Health, Education,
Labor, and Pensions and the Committee on Finance of the Senate
and the Committee on Energy and Commerce and the Committee on
Ways and Means of the House of Representatives on the progress
in reducing disparities in health and health care through the
Federal programs administered by the agency.
``(d) Relationship to Office for Civil Rights in the Department of
Justice.--
``(1) Department of health and human services.--The Office
for Civil Rights in the Department of Health and Human Services
shall provide standard-setting and compliance review
investigation support services to the Civil Rights Compliance
Office for each agency.
``(2) Department of justice.--The Office for Civil Rights
in the Department of Justice shall continue to maintain the
power to institute formal proceedings when an agency Office for
Civil Rights determines that a recipient of Federal financial
assistance is not in compliance with the disparity reduction
standards of the agency.
``(e) Definition.--In this section, the term `Federal health
programs' mean programs--
``(1) under the Social Security Act (42 U.S.C. 301 et seq.)
that pay for health care and services; and
``(2) under this Act that provide Federal financial
assistance for health care, biomedical research, health
services research, and programs designed to improve the
public's health, including health service programs.''.
SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS.
(a) Coordination Within Department of Justice of Activities
Regarding Health Disparities.--Section 3(a) of the Civil Rights
Commission Act of 1983 (42 U.S.C. 1975a(a)) is amended--
(1) in paragraph (1), by striking ``and'' at the end;
(2) in paragraph (2), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(3) shall, with respect to activities carried out in
health care and correctional facilities toward the goal of
eliminating health disparities between the general population
and members of racial or ethnic minority groups, coordinate
such activities of--
``(A) the Office for Civil Rights within the
Department of Justice;
``(B) the Office of Justice Programs within the
Department of Justice;
``(C) the Office for Civil Rights within the
Department of Health and Human Services; and
``(D) the Office of Minority Health within the
Department of Health and Human Services (headed by the
Deputy Assistant Secretary for Minority Health).''.
(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 2015, and such sums as may be necessary for
each of the fiscal years 2016 through 2020.''.
SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUNDING OF ACTIVITIES TO
ELIMINATE RACIAL AND ETHNIC HEALTH DISPARITIES.
(a) Findings.--Congress makes the following findings:
(1) The health status of the American populace is declining
and the United States currently ranks below most industrialized
nations in health status measured by longevity, sickness, and
mortality.
(2) Racial and ethnic minority populations tend have the
poorest health status and face substantial cultural, social,
and economic barriers to obtaining quality health care.
(3) Lesbian, gay, bisexual and transgender (LGBT)
populations experience significant personal and structural
barriers to obtaining high-quality health care.
(4) Efforts to improve minority health have been limited by
inadequate resources (funding, staffing, and stewardship) and
lack of accountability.
(b) Sense of Congress.--It is the sense of Congress that--
(1) funding should be doubled by fiscal year 2016 for the
National Institute for Minority Health Disparities, the Office
of Civil Rights in the Department of Health and Human Services,
the National Institute of Nursing Research, and the Office of
Minority Health;
(2) adequate funding by fiscal year 2016, and subsequent
funding increases, should be provided for health and human
service professions training programs, the Racial and Ethnic
Approaches to Community Health (REACH) Initiative at the
Centers for Disease Control and Prevention, the Minority HIV/
AIDS Initiative, and the Excellence Centers to Eliminate
Ethnic/Racial Disparities (EXCEED) Program at the Agency for
Healthcare Research and Quality;
(3) funding should be fully restored to the Racial and
Ethnic Approaches to Community Health (REACH) Initiative at the
Centers for Disease Control and Prevention, which has been a
successful program at the community health level, and efforts
should continue to place a strong emphasis on building
community capacity to secure financial resources and technical
assistance to eliminate health disparities;
(4) adequate funding for fiscal year 2016 and increased
funding for future years should be provided for the REACH
Initiative's United States Risk Factor Survey to ensure
adequate data collection to track health disparities, and there
should be appropriate avenues provided to disseminate findings
to the general public;
(5) 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 2016; and
(6) stewardship and accountability should be provided to
the Congress and the President for measurable and sustainable
progress toward health disparity elimination.
SEC. 906. GAO AND NIH REPORTS.
(a) GAO Report on NIH Grant Racial and Ethnic Diversity.--
(1) In general.--The Comptroller General of the United
States shall conduct a study on the racial and ethnic diversity
among the following groups:
(A) All applicants for grants, contracts, and
cooperative agreements awarded by the National
Institutes of Health during the period beginning on
January 1, 1990, and ending December 31, 2013.
(B) All recipients of such grants, contracts, and
cooperative agreements.
(C) All members of the peer review panels of such
applicants and recipients, respectively.
(2) Report.--Not later than six months after the date of
the enactment of this Act, the Comptroller General shall
complete the study under paragraph (1) and submit to Congress a
report containing the results of such study.
(b) NIH Report on Certain Authority of National Institute on
Minority Health and Health Disparities.--Not later than six months
after the date of the enactment of this Act, and biennially thereafter,
the Director of the National Institutes of Health, in collaboration
with the Director of the National Institute on Minority Health and
Health Disparities, shall submit to Congress a report that details and
evaluates--
(1) the steps taken during the applicable report period by
the Director of the National Institutes of Health to enforce
the expanded planning, coordination, review, and evaluation
authority provided the National Institute on Minority Health
and Health Disparities under section 464z-3(h) of the Public
Health Service Act (42 U.S.C. 285(h)), as added by section
10334(c) of the Patient Protection and Affordable Care Act,
over all minority health and health disparity research that is
conducted or supported by the Institutes and Centers at the
National Institutes of Health; and
(2) the outcomes of such steps.
(c) GAO Report Related to Recipients of PPACA Funding.--Not later
than one year after the date of the enactment of this Act and
biennially thereafter until 2024, the Comptroller General of the United
States shall submit to Congress a report that identifies, with respect
to minority community-based organizations that applied during the
applicable report period for Federal funding provided pursuant to the
provisions of (and amendments made by) the Patient Protection and
Affordable Care Act for purposes of achieving health equity and
eliminating health disparities, the percentage of such organizations
that were awarded such funding.
(d) Annual Report on Activities of National Institute on Minority
Health and Health Disparities.--The Director of the National Institute
on Minority Health and Health Disparities shall prepare an annual
report on the activities carried out or to be carried out by the
Institute, and shall submit each such report to the Committee on
Health, Education, Labor, and Pensions of the Senate, the Committee on
Energy and Commerce of the House of Representatives, the Secretary of
Health and Human Services, and the Director of the National Institutes
of Health. With respect to the fiscal year involved, the report shall--
(1) describe and evaluate the progress made in health
disparities research conducted or supported by institutes and
centers of the National Institutes of Health;
(2) summarize and analyze expenditures made for activities
with respect to health disparities research conducted or
supported by the National Institutes of Health;
(3) include a separate statement applying the requirements
of paragraphs (1) and (2) specifically to minority health
disparities research; and
(4) contain such recommendations as the Director of the
Institute considers appropriate.
TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
JUSTICE
SEC. 1001. DEFINITIONS.
(a) Determinants of Health.--The term ``determinants of health''--
(1) refers to the range of personal, social, economic, and
environmental factors that influence health status; and
(2) includes social determinants of health (which are
sometimes referred to as ``social and economic determinants of
health'' or ``socioeconomic determinants of health''),
environmental determinants of health, and personal determinants
of health.
(b) Environmental Determinants of Health.--The term ``environmental
determinants of health'' refers to the broad physical, psychological,
social, and aesthetic environment.
(c) Personal Determinants of Health.--The term ``personal
determinants of health'' refers to an individual's behavior, biology,
and genetics.
(d) Social Determinants of Health .--The term ``social determinants
of health'' refers to a subset of determinants of the health of
individuals and environments (such as communities, neighborhoods, and
societies) that describe people's social identity, describe the social
and economic resources to which people have access, and describe the
conditions in which people work, live, and play.
SEC. 1002. FINDINGS.
The Congress finds as follows:
(1) There are more opportunities to improve health for
everyone when we understand that health starts, first, not in a
medical setting, but in our families, in our schools and
workplaces, in our neighborhoods, and in the air we breathe and
water we drink.
(2) The social determinants of health are the largest
predictors of health outcomes.
(3) Healthy People 2020 identifies health and health care
quality as a function of not only access to health care, but
also the social determinants of health, categorized into the
following: neighborhoods and the built environment; social and
community context; education; and economic stability. The
following examples illustrate the nexus between the unequal
distribution of the social determinants of health and health
disparities:
(A) The built environment influences residents'
level of physical activity. Neighborhoods with high
levels of poverty are significantly less likely to have
places where children can be physically active, such as
parks, green spaces, and bike paths and lanes.
Neighborhoods and communities can provide opportunities
for physical activity and support active lifestyles
through accessible and safe parks and open spaces and
through land use policy, zoning, and healthy community
design.
(B) Emotional and physical health and well-being
are directly impacted by perceived levels of safety,
such as unlit streets at night. Community members have
expressed that safety is not only a barrier to
accessing programs and services that increase quality
of life but they are also not able to access physical
activity in their community through the built
environment.
(C) In many workplace environments, toxic chemicals
have lasting detrimental effects on employees' health.
The hazardous compounds found in most nail salon
products affect the respiratory system, reproductive
system, and central nervous system, and also cause
kidney and liver damage. Recognizing the importance of
addressing occupational hazards as a matter of public
health, especially for Asian-American women who
constitute 40 percent of nail salon technicians--with
Vietnamese-American women accounting for 37 percent of
this--the White House Initiative on Asian American
Pacific Islanders has created an interagency working
group to coordinate efforts by the Environmental
Protection Agency, Occupational and Safety Health
Administration, Food and Drug Administration, and other
Federal agencies to create programming, draft
regulations, and conduct more outreach on educating
workers on health and safety issues.
(D) Historical and institutional discrimination
against certain racial groups in the United States has
shaped the way in which social and economic resources
and exposure to health promoting environments are
distributed. Income, education, occupation,
neighborhood conditions, schools, workplaces, the use
of and health and social services, and experiences with
the criminal justice system are all highly patterned by
race, with racial minorities (compared to Whites)
experiencing more that is health harming. Finding ways
to uncouple the link between race and access to
resources and healthy environments is a principal means
of reducing health disparities. Additionally, the
anticipation of racism itself causes higher
psychological and cardiovascular stress levels that are
linked to poor health outcomes. Remedying
discriminatory practices at the individual and systemic
levels will likely reduce health disparities caused by
this unequal distribution of stress.
(E) Poor health among Native Americans has largely
been driven by post-colonial oppression and historical
trauma. The expropriation of native lands and
territories to the American state had severe
consequences on Native American health. This resulted
in the deprivation of traditional food sources--and
nutrients--for Native Americans and also the
destruction of traditional economies and community
organization. Today, Native Americans have twice the
rate of diabetes than non-Hispanic Whites. Recognition
of the origins of the diabetes as having a social and
community context, rather than just individual
responsibility and genetic predisposition, will shape
better policy to provide food security.
(F) In the context of prisons, overcrowding has led
to the deterioration of the physical and mental health
of individuals after they leave prison. In particular,
the mass incarceration of African-American males as a
result of unequal contact with and treatment in the
criminal justice system has contributed to an
overburdening of certain infectious diseases within the
African-American community. As a social institution,
incarceration amplifies existing adverse health
conditions by concentrating diseases and harm health
behaviors such as tobacco use, drug use, and violence.
(G) Educational attainment is the strongest
predictor of adult mortality. It is a basic component
of socioeconomic status by shaping earning potential to
access resources that promote health. People with more
education are less likely to report that they are in
poor health, and are also less likely to have diabetes
and other chronic diseases.
(H) Similarly, reading ability is a strong
predictor of adult health status and is often
correlated with other child health issues, such as
developmental problems, vision and hearing impairments,
and frequent school absence due to illness.
(I) Individuals with lower levels of educational
attainment are much more likely to report to be current
smokers. In 2011, smoking prevalence was 45.3 percent
among adults with a GED diploma, 34.6 percent with nine
to 11 years of education, and 23.8 percent with a high
school diploma, while dropping significantly to 9.3
percent among adults with an undergraduate college
degree and 5.0 percent with a postgraduate college
degree.
(J) Social class differences account for a large
part of health disparities. For example, children
living in poverty experience poorer housing conditions,
increased exposure to indoor allergens and toxins (such
as pesticides, lead, mercury, radon, air pollution, and
carcinogens), and more psychological stress. These
experiences culminate in worse adult health as compared
with children with higher socioeconomic status.
Specifically, children living in socioeconomic
neighborhoods have higher rates of asthma due to higher
rates of psychological stress resulting from higher
rates of violence.
(K) Lesbian, gay, bisexual, and transgender (LGBT)
individuals face health disparities linked to societal
stigma, discrimination, and denial of their civil and
human rights. Discrimination against LGBT individuals
has been associated with high rates of psychiatric
disorders, substance abuse, and suicide. Experiences of
violence and victimization are frequent for LGBT
individuals, and have long-lasting effects on the
individual and the community. Personal, family, and
social acceptance of sexual orientation and gender
identity affects the mental health and personal safety
of LGBT individuals.
(4) Laws and regulations that improve opportunities to live
in safe neighborhoods, with more social cohesion, attain higher
education, sustain stable employment, and bridge class
differences help foster the health and safety of individuals.
(5) The global public health community has reached
consensus through the Rio Political Declaration of Social
Determinants of Health that ``[c]ollaboration in coordinated
and intersectoral policy actions has proven to be effective.
Health in All Policies, together with intersectoral cooperation
and action, is one promising approach to enhance accountability
in other sectors of health, as well as the promotion of health
equity and more inclusive and productive societies.''
SEC. 1003. HEALTH IMPACT ASSESSMENTS.
(a) Findings.--Congress makes the following findings:
(1) Health Impact Assessment is a tool to help planners,
health officials, decisionmakers, and the public make more
informed decisions about the potential health effects of
proposed plans, policies, programs, and projects in order to
maximize health benefits and minimize harms.
(2) Health Impact Assessments can be done at a fraction of
the cost and time typically required for other planning and
permitting reviews.
(3) Health Impact Assessments can build community support
and reduce opposition to a project or policy, thereby
facilitating economic growth by aiding the development of
consensus regarding new development proposals.
(4) Health Impact Assessments facilitate collaboration
across sectors.
(b) Purposes.--It is the purpose of this section to--
(1) provide more information about the potential human
health effects of policy decisions and the distribution of
those effects;
(2) improve how health is considered in planning and
decisionmaking processes; and
(3) build stronger, healthier communities through the use
of Health Impact Assessment.
(c) Health Impact Assessments.--Part P of title III of the Public
Health Service Act (42 U.S.C. 280g et seq.), as amended, is further
amended by adding at the end the following:
``SEC. 399V-9. HEALTH IMPACT ASSESSMENTS.
``(a) Definitions.--In this section and section 399V-10:
``(1) Administrator.--The term `Administrator' means the
Administrator of the Environmental Protection Agency.
``(2) Built environment.--The term `built environment'
means the components of the environment, and the location of
these components in a geographically defined space, that are
created or modified by individuals to form the physical and
social characteristics of a community or enhance quality of
human life, including--
``(A) homes, schools, and places of work and
worship;
``(B) parks, recreation areas, and greenways;
``(C) transportation systems;
``(D) business, industry, and agriculture; and
``(E) land-use plans, projects, and policies that
impact the physical or social characteristics of a
community, including access to services and amenities.
``(3) Director.--The term `Director' means the Director of
the Centers for Disease Control and Prevention.
``(4) Eligible entity.--The term `eligible entity' means a
unit of State or tribal government the jurisdiction of which
includes individuals or populations the health of which are, or
will be, affected by an activity or a proposed activity.
``(5) Eligible institution.--The term `eligible
institution' means a public agency or private nonprofit
institution that submits to the Secretary, in consultation with
the Administrator, an application for a grant authorized under
such section at such time, in such manner, and containing such
agreements, assurances, and information as the Secretary and
Administrator may require.
``(6) Health impact assessment.--The term `Health Impact
Assessment' means a systematic process that uses an array of
data sources and analytic methods and considers input from
stakeholders to determine the potential effects of a proposed
policy, plan, program, or project on the health of a population
and the distribution of those effects within the population.
Such term includes identifying and recommending appropriate
actions on monitoring and maximizing potential benefits and
minimizing the potential harms.
``(7) Health disparities.--The term `health disparities'
are a particular type of health differences that are closely
linked with social, economic, and/or environmental
disadvantage. Health disparities adversely affect groups of
people who have systematically experienced greater obstacles to
health based on their racial or ethnic group; religion;
socioeconomic status; gender; age; mental health; cognitive,
sensory, or physical disability; sexual orientation or gender
identity; geographic location; or other characterisitics
historically linked to discrimination or exclusion.
``(8) Proposed activity.--The term `proposed activity'
means a proposed policy, program, plan, or project currently
under consideration by a local, State, tribal, or Federal
agency or government.
``(b) Establishment.--The Secretary, acting through the Director
and in collaboration with the Administrator, shall carry out the
following:
``(1) Establish a program at the National Center for
Environmental Health at the Centers for Disease Control and
Prevention focused on advancing the field of Health Impact
Assessment. In developing and implementing the program, the
Director of the National Center for Environmental Health shall
consult with the Director of the National Center for Chronic
Disease Prevention and Health Promotion as well as relevant
offices within the Department of Housing and Urban Development,
the Department of Transportation, and the Department of
Agriculture. The program shall include--
``(A) collecting and disseminating best practices;
``(B) administering capacity building grants to
States to support grantees in initiating Health Impact
Assessments, in accordance with subsection (d);
``(C) providing technical assistance;
``(D) developing training tools and providing
training on conducting Health Impact Assessment and the
implementation of built environment and health
indicators;
``(E) making information available, as appropriate,
regarding the existence of other community healthy
living tools, checklists, and indices that help connect
public health to other sectors, and tools to help
examine the effect of the indoor built environment and
building codes on population health;
``(F) conducting research and evaluations of Health
Impact Assessments; and
``(G) awarding competitive extramural research
grants.
``(2) In accordance with subsection (c), develop guidance
and guidelines to conduct Health Impact Assessments.
``(3) In accordance with subsection (d), establish a grant
program to allow States to fund eligible entities to conduct
Health Impact Assessments.
``(c) Guidance.--The Director, in consultation with the Director of
the National Center for Environmental Health and, the Director of the
National Center for Chronic Disease Prevention and Health Promotion,
and relevant offices within the Department of Housing and Urban
Development, the Department of Transportation, and the Department of
Agriculture, shall--
``(1) develop guidance for conducting Health Impact
Assessment, including--
``(A) background on national and international
efforts to bridge urban planning and public health
institutions and disciplines, including a review of
Health Impact Assessment best practices
internationally;
``(B) evidence-based direct and indirect pathways
that link land-use planning, transportation, and
housing policy and objectives to human health outcomes;
``(C) data resources and quantitative and
qualitative forecasting methods to evaluate both the
status of health determinants and health effects,
including identification of existing programs that can
disseminate these resources;
``(D) best practices for inclusive public
involvement in conducting Health Impact Assessments;
and
``(E) technical assistance for other agencies
seeking to develop their own guidelines and procedures
for Health Impact Assessment;
``(2) in developing the guidance, consider available
international Health Impact Assessment guidance, North American
Health Impact Assessment Practice Standards, and
recommendations from the National Academy of Science; and
``(3) not later than 1 year after the date of enactment of
this section, publish the guidance.
``(d) Grant Program.--The Secretary, acting through the Director
and in collaboration with the Administrator, shall establish a program
under which the Secretary shall award grants to States to fund eligible
entities for capacity building or to prepare Health Impact Assessments,
and shall ensure that States receiving a grant under this subsection
further support training and technical assistance for grantees under
the program by funding and overseeing appropriate local, State, tribal,
Federal, university, or nonprofit Health Impact Assessment experts to
provide technical assistance. Such assessments shall--
``(1) ensure that appropriate health factors are taken into
consideration as early as practicable during the planning,
review, or decisionmaking processes;
``(2) assess the effect on the health of individuals and
populations of proposed policies, projects, or plans that
result in modifications to the built environment; and
``(3) assess the distribution of health effects across
various factors, such as race, income, ethnicity, age,
disability status, gender, and geography.
``(e) Applications.--
``(1) In general.--To be eligible to receive a grant under
this section, an eligible entity shall submit to the Secretary
an application in accordance with this subsection, at such
time, in such manner, and containing such additional
information as the Secretary may require.
``(2) Inclusion.--An application under this subsection
shall include a list of proposed activities that require or
would benefit from conducting a Health Impact Assessment within
six months of awarding funds. The list should be accompanied by
supporting documentation, including letters of support, from
potential conductors of Health Impact Assessments for the
listed proposed activities. Each application should also
include an assessment by the eligible entity of the health of
the population of its jurisdiction and describe potential
adverse or positive effects on health that the proposed
activities may create.
``(3) Preference.--Preference in awarding funds under this
section may be given to eligible entities that demonstrate the
potential to significantly improve population health or lower
health care costs as a result of potential Health Impact
Assessment work.
``(f) Use of Funds.--
``(1) In general.--An eligible entity shall use amounts
provided under a grant under this section to conduct Health
Impact Assessment capacity building or to conduct or fund
subgrantees to conduct a Health Impact Assessment for a
proposed activity in accordance with this subsection.
``(2) Purposes.--The purposes of a Health Impact Assessment
under this subsection are--
``(A) to facilitate the involvement of tribal,
State, and local public health officials in community
planning, transportation, housing, and land use
decisions and other decisions affecting the built
environment to identify any potential health concern or
health benefit relating to an activity or proposed
activity;
``(B) to provide for an investigation of any
health-related issue of concern raised in a planning
process, an environmental impact assessment process, or
policy appraisal relating to a proposed activity;
``(C) to describe and compare alternatives
(including no-action alternatives) to a proposed
activity to provide clarification with respect to the
potential health outcomes associated with the proposed
activity and, where appropriate, to the related
benefit-cost or cost-effectiveness of the proposed
activity and alternatives;
``(D) to contribute, when applicable, to the
findings of a planning process, policy appraisal, or an
environmental impact statement with respect to the
terms and conditions of implementing a proposed
activity or related mitigation recommendations, as
necessary;
``(E) to ensure that the disproportionate
distribution of negative impacts among vulnerable
populations is minimized as much as possible;
``(F) to engage affected community members and
ensure adequate opportunity for public comment on all
stages of the Health Impact Assessment; and
``(G) where appropriate, to consult with local and
county health departments and appropriate
organizations, including planning, transportation, and
housing organizations and providing them with
information and tools regarding how to conduct and
integrate Health Impact Assessment into their work.
``(3) Eligible activities.--
``(A) In general.--Eligible entities funded under
this subsection shall conduct an evaluation of any
proposed activity to determine whether it will have a
significant adverse or positive effect on the health of
the affected population in the jurisdiction of the
eligible entity, based on the criteria described in
subparagraph (B).
``(B) Criteria.--The criteria described in this
subparagraph include, as applicable to the proposed
activity, the following:
``(i) Any substantial adverse effect or
significant health benefit on health outcomes
or factors known to influence health, including
the following:
``(I) Physical activity.
``(II) Injury.
``(III) Mental health.
``(IV) Accessibility to health-
promoting goods and services.
``(V) Respiratory health.
``(VI) Chronic disease.
``(VII) Nutrition.
``(VIII) Land use changes that
promote local, sustainable food
sources.
``(IX) Infectious disease.
``(X) Health disparities.
``(XI) Existing air quality, ground
or surface water quality or quantity,
or noise levels; and
``(ii) Other factors that may be
considered, including--
``(I) the potential for a proposed
activity to result in systems failure
that leads to a public health
emergency;
``(II) the probability that the
proposed activity will result in a
significant increase in tourism,
economic development, or employment in
the jurisdiction of the eligible
entity;
``(III) any other significant
potential hazard or enhancement to
human health, as determined by the
eligible entity; or
``(IV) whether the evaluation of a
proposed activity would duplicate
another analysis or study being
undertaken in conjunction with the
proposed activity.
``(C) Factors for consideration.--In evaluating a
proposed activity under subparagraph (A), an eligible
entity may take into consideration any reasonable,
direct, indirect, or cumulative effect that can be
clearly related to potential health effects and that is
related to the proposed activity, including the effect
of any action that is--
``(i) included in the long-range plan
relating to the proposed activity;
``(ii) likely to be carried out in
coordination with the proposed activity;
``(iii) dependent on the occurrence of the
proposed activity; or
``(iv) likely to have a disproportionate
impact on high-risk or vulnerable populations.
``(4) Requirements.--A Health Impact Assessment prepared
with funds awarded under this subsection shall incorporate the
following, after conducting the screening phase (identifying
projects or policies for which a Health Impact Assessment would
be valuable and feasible) through the application process:
``(A) Scoping.--Identifying which health effects to
consider and the research methods to be utilized.
``(B) Assessing risks and benefits.--Assessing the
baseline health status and factors known to influence
the health status in the affected community, which may
include aggregating and synthesizing existing health
assessment evidence and data from the community.
``(C) Developing recommendations.--Suggesting
changes to proposals to promote positive or mitigate
adverse health effects.
``(D) Reporting.--Synthesizing the assessment and
recommendations and communicating the results to
decisionmakers.
``(E) Monitoring and evaluating.--Tracking the
decision and implementation effect on health
determinants and health status.
``(5) Plan.--An eligible entity that is awarded a grant
under this section shall develop and implement a plan, to be
approved by the Director, for meaningful and inclusive
stakeholder involvement in all phases of the Health Impact
Assessment. Stakeholders may include community-based
organizations, youth-serving organizations, planners, public
health experts, State and local public health departments and
officials, health care experts or officials, housing experts or
officials, and transportation experts or officials.
``(6) Submission of findings.--An eligible entity that is
awarded a grant under this section shall submit the findings of
any funded Health Impact Assessment activities to the Secretary
and make these findings publicly available.
``(7) Assessment of impacts.--An eligible entity that is
awarded a grant under this section shall ensure the assessment
of the distribution of health impacts (related to the proposed
activity) across race, ethnicity, income, age, gender,
disability status, and geography.
``(8) Conduct of assessment.--To the greatest extent
feasible, a Health Impact Assessment shall be conducted under
this section in a manner that respects the needs and timing of
the decisionmaking process it evaluates.
``(9) Methodology.--In preparing a Health Impact Assessment
under this subsection, an eligible entity or partner shall
follow the guidance published under subsection (c).
``(g) Health Impact Assessment Database.--The Secretary, acting
through the Director and in collaboration with the Administrator, shall
establish, maintain, and make publicly available a Health Impact
Assessment database, including--
``(1) a catalog of Health Impact Assessments received under
this section;
``(2) an inventory of tools used by eligible entities to
conduct Health Impact Assessments; and
``(3) guidance for eligible entities with respect to the
selection of appropriate tools described in paragraph (2).
``(h) Evaluation of Grantee Activities.--The Secretary shall award
competitive grants to Prevention Research Centers, or nonprofit
organizations or academic institutions with expertise in Health Impact
Assessments to--
``(1) assist grantees with the provision of training and
technical assistance in the conducting of Health Impact
Assessments;
``(2) evaluate the activities carried out with grants under
subsection (d); and
``(3) assist the Secretary in disseminating evidence, best
practices, and lessons learned from grantees.
``(i) Report to Congress.--Not later than 1 year after the date of
enactment of this section, the Secretary shall submit to Congress a
report concerning the evaluation of the programs under this section,
including recommendations as to how lessons learned from such programs
can be incorporated into future guidance documents developed and
provided by the Secretary and other Federal agencies, as appropriate.
``(j) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary.
``SEC. 399V-10. ADDITIONAL RESEARCH ON THE RELATIONSHIP BETWEEN THE
BUILT ENVIRONMENT AND HEALTH OUTCOMES.
``(a) Research Grant Program.--
``(1) Grants.--The Secretary, in collaboration with the
Administrator, shall award grants to eligible institutions to
conduct and coordinate research on the built environment and
its influence on human health. Factors that influence health
that may be considered include--
``(A) levels of physical activity;
``(B) consumption of nutritional foods;
``(C) rates of crime;
``(D) air, water, and soil quality;
``(E) risk or rate of injury;
``(F) accessibility to health-promoting goods and
services;
``(G) chronic disease rates;
``(H) community design;
``(I) housing; and
``(J) other indicators as determined appropriate by
the Secretary.
``(2) Research.--The Secretary, in consultation with the
Administrator, shall support research under this section that--
``(A) investigates and defines links between the
built environment and human health and identifies
causal relationships;
``(B) examines--
``(i) the scope and intensity of the impact
that the built environment (including the
various characteristics of the built
environment) has on the human health; or
``(ii) the distribution of such impacts
by--
``(I) location; and
``(II) population subgroup;
``(C) is used to develop--
``(i) measures and indicators to address
health impacts and the connection of health to
the built environment;
``(ii) efforts to link the measures to
transportation, land use, and health databases;
and
``(iii) efforts to enhance the collection
of built environment surveillance data;
``(D) distinguishes carefully between personal
attitudes and choices and external influences on
behavior to determine how much the association between
the built environment and the health of residents,
versus the lifestyle preferences of the people that
choose to live in the neighborhood, reflects the
physical characteristics of the neighborhood; and
``(E)(i) identifies or develops effective
intervention strategies focusing on enhancements to the
built environment that promote increased use physical
activity, access to nutritious foods, or other health-
promoting activities by residents; and
``(ii) in developing the intervention strategies
under clause (i), ensures that the intervention
strategies will reach out to high-risk or vulnerable
populations, including low-income urban and rural
communities and aging populations, in addition to the
general population.
``(3) Surveys.--The Secretary may use funds appropriated
under this section to support the expansion of national surveys
and data tracking systems to provide more detailed information
about the connection between the built environment and health.
``(4) Priority.--In providing assistance under the grant
program under this section, the Secretary and the Administrator
shall give priority to research that incorporates--
``(A) interdisciplinary approaches; or
``(B) the expertise of the public health, physical
activity, urban planning, land use, and transportation
research communities in the United States and abroad.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section.
Not to exceed 20 percent of amounts appropriated for each fiscal year
under this subsection may be used for the research component of the
program under this section.''.
SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY ENVIRONMENTAL
PROTECTION AGENCY.
(a) Inspector General Recommendations.--The Administrator of the
Environmental Protection Agency shall, as promptly as practicable,
carry out each of the following recommendations of the Inspector
General of the Agency as set forth in Report No. 2006-P-00034 entitled
``EPA needs to conduct environmental justice reviews of its programs,
policies and activities'':
(1) The recommendation that the Agency's program and
regional offices identify which programs, policies, and
activities need environmental justice reviews and require these
offices to establish a plan to complete the necessary reviews.
(2) The recommendation that the Administrator of the Agency
ensure that these reviews determine whether the programs,
policies, and activities may have a disproportionately high and
adverse health or environmental impact on minority and low-
income populations.
(3) The recommendation that each program and regional
office develop specific environmental justice review guidance
for conducting environmental justice reviews.
(4) The recommendation that the Administrator designate a
responsible office to compile results of environmental justice
reviews and recommend appropriate actions.
(b) GAO Recommendations.--In developing rules under laws
administered by the Environmental Protection Agency, the Administrator
of the Agency shall, as promptly as practicable, carry out each of the
following recommendations of the Comptroller General of the United
States as set forth in GAO Report numbered GAO-05-289 entitled ``EPA
Should Devote More Attention to Environmental Justice when Developing
Clean Air Rules'':
(1) The recommendation that the Administrator ensure that
workgroups involved in developing a rule devote attention to
environmental justice while drafting and finalizing the rule.
(2) The recommendation that the Administrator enhance the
ability of such workgroups to identify potential environmental
justice issues through such steps as providing workgroup
members with guidance and training to help them identify
potential environmental justice problems and involving
environmental justice coordinators in the workgroups when
appropriate.
(3) The recommendation that the Administrator improve
assessments of potential environmental justice impacts in
economic reviews by identifying the data and developing the
modeling techniques needed to assess such impacts.
(4) The recommendation that the Administrator direct
appropriate Agency officers and employees to respond fully when
feasible to public comments on environmental justice, including
improving the Agency's explanation of the basis for its
conclusions, together with supporting data.
(c) 2004 Inspector General Report.--The Administrator of the
Environmental Protection Agency shall, as promptly as practicable,
carry out each of the following recommendations of the Inspector
General of the Agency as set forth in the report entitled ``EPA Needs
to Consistently Implement the Intent of the Executive Order on
Environmental Justice'' (Report No. 2004-P-00007):
(1) The recommendation that the Agency clearly define the
mission of the Office of Environmental Justice (OEJ) and
provide Agency staff with an understanding of the roles and
responsibilities of the Office.
(2) The recommendation that the Agency establish (through
issuing guidance or a policy statement from the Administrator)
specific timeframes for the development of definitions, goals,
and measurements regarding environmental justice and provide
the regions and program offices a standard and consistent
definition for a minority and low-income community, with
instructions on how the Agency will implement and put into
operation environmental justice in the Agency's daily
activities.
(3) The recommendation that the Agency ensure the
comprehensive training program currently under development
includes standard and consistent definitions of the key
environmental justice concepts (such as ``low-income'',
``minority'', and ``disproportionately impacted'') and
instructions for implementation of those concepts.
The Administrator shall submit an initial report to Congress within 6
months after the enactment of this Act regarding the Administrator's
strategy for implementing the recommendations referred to in paragraphs
(1), (2), and (3). Thereafter, the Administrator shall provide
semiannual reports to Congress regarding the Administrator's progress
in implementing such recommendations and modifying the Administrator's
emergency management procedures to incorporate environmental justice in
the Agency's Incident Command Structure (in accordance with the
December 18, 2006, letter from the Deputy Administrator to the Acting
Inspector General of the Agency).
(d) Federal Action Plan for Saving Lives, Protecting People and
Their Families From Radon.--
(1) In general.--Because radon is a naturally occurring
radioactive gas that is recognized as the leading cause of lung
cancer among nonsmokers and is a particular environmental
threat for low-income and minority individuals because of the
lack of information about radon levels in their own homes, the
Administrator of the Environmental Protection Agency shall
within 6 months after the date of the enactment of this Act,
implement the action plan entitled ``Protecting People and
Families from Radon: A Federal Action Plan for Saving Lives''
(June 20, 2011), working with the Secretary of Health and Human
Services acting through the Director of the Centers for Disease
Control and Prevention, and with the other Federal agencies
mentioned in and as set forth in the action plan.
(2) Specific steps.--In carrying out paragraph (1), the
Administrator shall take steps to achieve each of the
following:
(A) The recommendation that the workgroup comprised
of the Federal agencies participating in the
development of the action plan referred to in paragraph
(1) implement specific steps within the current
authority and activities of each Federal agency to
reduce exposure to radon.
(B) The recommendation that such workgroup meet on
the 1-year anniversary of the plan to assess and
recognize achievements of the plan.
(3) Report.--The Administrator shall report to the Congress
on the 1-year assessment of the plan's implementation,
including the challenges remaining and the progress in reducing
radon exposure particularly to low-income and minority
families.
SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRONMENTAL HEALTH IMPROVEMENT
ACTIVITIES AND TO IMPROVE SOCIAL DETERMINANTS OF HEALTH.
(a) Definitions.--In this section:
(1) Director.--The term ``Director'' means the Director of
the Centers for Disease Control and Prevention, acting in
collaboration with the Administrator of the Environmental
Protection Agency and the Director of the National Institute of
Environmental Health Sciences.
(2) Eligible entity.--The term ``eligible entity'' means a
State or local community that--
(A) bears a disproportionate burden of exposure to
environmental health hazards;
(B) bears a disproportionate burden of exposure to
unhealthy living conditions, low standard housing
conditions, low socioeconomic status, poor nutrition,
less opportunity for educational attainment,
disproportionate unemployment rates, or lower literacy
levels;
(C) has established a coalition--
(i) with not less than 1 community-based
organization or demonstration program; and
(ii) with not less than 1--
(I) public health entity;
(II) health care provider
organization;
(III) academic institution,
including any minority-serving
institution (including a Hispanic-
serving institution, a historically
Black college or university, and a
tribal college or university); or
(IV) child-serving institution;
(D) ensures planned activities and funding streams
are coordinated to improve community health; and
(E) submits an application in accordance with
subsection (c).
(b) Establishment.--The Director shall establish a grant program
under which eligible entities shall receive grants to conduct
environmental health improvement activities and to improve social
determinants of health.
(c) Application.--To receive a grant under this section, an
eligible entity shall submit an application to the Director at such
time, in such manner, and accompanied by such information as the
Director may require.
(d) Cooperative Agreements.--An eligible entity may use a grant
under this section--
(1) to promote environmental health;
(2) to address environmental health disparities among all
populations, including children; and
(3) to address racial and ethnic disparities in social
determinants of health.
(e) Amount of Cooperative Agreement.--
(1) In general.--The Director shall award grants to
eligible entities at the 3 different funding levels described
in this subsection.
(2) Level 1 cooperative agreements.--
(A) In general.--An eligible entity awarded a grant
under this paragraph shall use the funds to identify
environmental health problems and solutions by--
(i) establishing a planning and
prioritizing council in accordance with
subparagraph (B); and
(ii) conducting an environmental health
assessment in accordance with subparagraph (C).
(B) Planning and prioritizing council.--
(i) In general.--A prioritizing and
planning council established under subparagraph
(A)(i) (referred to in this paragraph as a
``PPC'') shall assist the environmental health
assessment process and environmental health
promotion activities of the eligible entity.
(ii) Membership.--Membership of a PPC shall
consist of representatives from various
organizations within public health, planning,
development, and environmental services and
shall include stakeholders from vulnerable
groups such as children, the elderly, disabled,
and minority ethnic groups that are often not
actively involved in democratic or
decisionmaking processes.
(iii) Duties.--A PPC shall--
(I) identify key stakeholders and
engage and coordinate potential
partners in the planning process;
(II) establish a formal advisory
group to plan for the establishment of
services;
(III) conduct an in-depth review of
the nature and extent of the need for
an environmental health assessment,
including a local epidemiological
profile, an evaluation of the service
provider capacity of the community, and
a profile of any target populations;
and
(IV) define the components of care
and form essential programmatic
linkages with related providers in the
community.
(C) Environmental health assessment.--
(i) In general.--A PPC shall carry out an
environmental health assessment to identify
environmental health concerns.
(ii) Assessment process.--The PPC shall--
(I) define the goals of the
assessment;
(II) generate the environmental
health issue list;
(III) analyze issues with a systems
framework;
(IV) develop appropriate community
environmental health indicators;
(V) rank the environmental health
issues;
(VI) set priorities for action;
(VII) develop an action plan;
(VIII) implement the plan; and
(IX) evaluate progress and planning
for the future.
(D) Evaluation.--Each eligible entity that receives
a grant under this paragraph shall evaluate, report,
and disseminate program findings and outcomes.
(E) Technical assistance.--The Director may provide
such technical and other non-financial assistance to
eligible entities as the Director determines to be
necessary.
(3) Level 2 cooperative agreements.--
(A) Eligibility.--
(i) In general.--The Director shall award
grants under this paragraph to eligible
entities that have already--
(I) established broad-based
collaborative partnerships; and
(II) completed environmental
assessments.
(ii) No level 1 requirement.--To be
eligible to receive a grant under this
paragraph, an eligible entity is not required
to have successfully completed a Level 1
Cooperative Agreement (as described in
paragraph (2)).
(B) Use of grant funds.--An eligible entity awarded
a grant under this paragraph shall use the funds to
further activities to carry out environmental health
improvement activities, including--
(i) addressing community environmental
health priorities in accordance with paragraph
(2)(C)(ii), including--
(I) geography;
(II) the built environment;
(III) air quality;
(IV) water quality;
(V) land use;
(VI) solid waste;
(VII) housing;
(VIII) crime;
(IX) socioeconomic status;
(X) ethnicity, social construct and
language preference;
(XI) educational attainment;
(XII) employment;
(XIII) food safety;
(XIV) nutrition;
(XV) health care services; and
(XVI) injuries;
(ii) building partnerships between
planning, public health, and other sectors,
including child-serving institutions, to
address how the built environment impacts food
availability and access and physical activity
to promote healthy behaviors and lifestyles and
reduce overweight and obesity, musculoskeletal
diseases, respiratory conditions, dental, oral
and mental health conditions, poverty, and
related co-morbidities;
(iii) establishing programs to address--
(I) how environmental and social
conditions of work and living choices
influence physical activity and dietary
intake; or
(II) how those conditions influence
the concerns and needs of people who
have impaired mobility and use
assistance devices, including
wheelchairs, lower limb prostheses, and
hip, knee, and other joint
replacements; and
(iv) convening intervention and
demonstration programs that examine the role of
the social environment in connection with the
physical and chemical environment in--
(I) determining access to
nutritional food; and
(II) improving physical activity to
reduce overweight, obesity, and co-
morbidities and increase quality of
life.
(4) Level 3 cooperative agreements.--
(A) In general.--An eligible entity awarded a grant
under this paragraph shall use the funds to identify
and address racial and ethnic disparities in social
determinants of health by creating demonstration
programs that assess the feasibility of establishing a
federally funded comprehensive program and describe key
outcomes that address racial and ethnic disparities in
social determinants of health.
(B) Program design.--
(i) Evaluation.--No later than 1 year after
enactment of this Act, the Director shall
evaluate the best practices of existing
programs from the private, public, community
based, and academically supported initiatives
focused on reducing disparities in the social
determinants of health for racial and ethnic
populations.
(ii) Demonstration projects.--Not later
than two years after the date of enactment of
this Act, the Director shall implement at least
ten demonstration projects including at least
one project for each major racial and ethnic
minority group, each of which is unique to the
cultural and linguistic needs of each of the
following groups:
(I) Native Americans and Alaska
Natives.
(II) Asian-Americans.
(III) African-Americans/Blacks.
(IV) Hispanic/Latino-Americans.
(V) Native Hawaiians and Pacific
Islanders.
(iii) Report to congress.--No later than 2
years after the implementation of the initial
demonstration projects, the Director shall
submit to Congress a report which includes--
(I) a description of each
demonstration project and design;
(II) an evaluation of the cost
effectiveness of each project's
prevention and treatment efforts;
(III) an evaluation of the cultural
and linguistic appropriateness of each
project by racial and ethnic group; and
(IV) an evaluation of the
beneficiary's health status improvement
under the demonstration project.
(iv) Any other information deemed
appropriate by the director.--The Director
shall require any other information deemed
appropriate to be shared by or developed by
eligible entities awarded a grant under this
paragraph, including the following:
(I) Developing models and
evaluating methods that improve the
cultural and linguistically appropriate
services provided through the Centers
for Disease Control and Prevention to
target individuals impacted by health
disparities based on their race,
ethnicity, and gender.
(II) Promoting the collaboration
between primary and specialty care
health care providers and patients, to
ensure patients impacted by health
disparities based on race, ethnicity,
and gender are receiving comprehensive
and organized treatment and care.
(III) Educating health care
professionals on the causes and effects
of disparities in the social
determinants of health as it relates to
minority and racial and ethnic
communities and the need for culturally
and linguistically appropriate care in
the prevention and treatment of high-
impact diseases.
(IV) Encouraging collaboration
among community and patient-based
organizations which work to address
disparities in the social determinants
of health as it relates to high-impact
diseases in minority and racial and
ethnic populations.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section--
(1) $25,000,000 for fiscal year 2015; and
(2) such sums as may be necessary for fiscal years 2016
through 2018.
SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP BETWEEN THE BUILT
ENVIRONMENT AND THE HEALTH OF COMMUNITY RESIDENTS.
(a) Definition of Eligible Institution.--In this section, the term
``eligible institution'' means a public or private nonprofit
institution that submits to the Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') and the
Administrator of the Environmental Protection Agency (in this section
referred to as the ``Administrator'') an application for a grant under
the grant program authorized under subsection (b)(2) at such time, in
such manner, and containing such agreements, assurances, and
information as the Secretary and Administrator may require.
(b) Research Grant Program.--
(1) Definition of health.--In this section, the term
``health'' includes--
(A) levels of physical activity;
(B) degree of mobility due to factors such as
musculoskeletal diseases, arthritis, and obesity;
(C) consumption of nutritional foods;
(D) rates of crime;
(E) air, water, and soil quality;
(F) risk of injury;
(G) accessibility to health care services;
(H) levels of educational attainment; and
(I) other indicators as determined appropriate by
the Secretary.
(2) Grants.--The Secretary, in collaboration with the
Administrator, shall provide grants to eligible institutions to
conduct and coordinate research on the built environment and
its influence on individual and population-based health.
(3) Research.--The Secretary shall support research that--
(A) investigates and defines the causal links
between all aspects of the built environment and the
health of residents;
(B) examines--
(i) the extent of the impact of the built
environment (including the various
characteristics of the built environment) on
the health of residents;
(ii) the variance in the health of
residents by--
(I) location (such as inner cities,
inner suburbs, and outer suburbs); and
(II) population subgroup (including
children, the elderly, the
disadvantaged); or
(iii) the importance of the built
environment to the total health of residents,
which is the primary variable of interest from
a public health perspective;
(C) is used to develop--
(i) measures to address health and the
connection of health to the built environment;
and
(ii) efforts to link the measures to travel
and health databases; and
(D) distinguishes carefully between personal
attitudes and choices and external influences on
observed behavior to determine how much an observed
association between the built environment and the
health of residents, versus the lifestyle preferences
of the people that choose to live in the neighborhood,
reflects the physical characteristics of the
neighborhood; and
(E)(i) identifies or develops effective
intervention strategies to promote better health among
residents with a focus on behavioral interventions and
enhancements of the built environment that promote
increased use by residents; and
(ii) in developing the intervention strategies
under clause (i), ensures that the intervention
strategies will reach out to high-risk populations,
including racial and ethnic minorities, low-income
urban and rural communities, and children.
(4) Priority.--In providing assistance under the grant
program authorized under paragraph (2), the Secretary and the
Administrator shall give priority to research that
incorporates--
(A) minority-serving institutions as grantees;
(B) interdisciplinary approaches; or
(C) the expertise of the public health, physical
activity, nutrition and health care (including child
health), urban planning, and transportation research
communities in the United States and abroad.
SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORATION.
(a) Findings.--
(1) General findings.--The Congress finds as follows:
(A) As human beings, we share our environment with
a wide variety of habitats and ecosystems that nurture
and sustain a diversity of species.
(B) The abundance of natural resources in our
environment forms the basis for our economy and has
greatly contributed to human development throughout
history.
(C) The accelerated pace of human development over
the last several hundred years has significantly
impacted our natural environment and its resources, the
health and diversity of plant and animal wildlife, the
availability of critical habitats, the quality of our
air and our water, and our global climate.
(D) The intervention of the Federal Government is
necessary to minimize and mitigate human impact on the
environment for the benefit of public health, to
maintain air quality and water quality, to sustain the
diversity of plants and animals, to combat global
climate change, and to protect the environment.
(E) Laws and regulations in the United States have
been created and promulgated to minimize and mitigate
human impact on the environment for the benefit of
public health, to maintain air quality and water
quality, to sustain wildlife, and to protect the
environment.
(F) Such laws include the Antiquities Act of 1906
(16 U.S.C. 431 et seq.) initiated by President Theodore
Roosevelt to create the national park system, the
National Environmental Policy Act of 1969 (42 U.S.C.
4321 et seq.), the Clean Air Act (42 U.S.C. 7401 et
seq.), the Federal Water Pollution Control Act (33
U.S.C. 1251 et seq.), the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980
(Public Law 96-510), the Endangered Species Act of 1973
(Public Law 93-205), and the National Forest Management
Act of 1976 (Public Law 94-588).
(G) Attempts to repeal or weaken key environmental
safeguards pose dangers to the public health, air
quality, water quality, wildlife, and the environment.
(2) Findings on changes and proposed changes in law.--The
Congress finds that, since 2001, the following changes and
proposed changes to existing law or regulations have negatively
impacted or will negatively impact the environment and public
health:
(A) Clean water.--
(i) On May 9, 2002, the Environmental
Protection Agency (EPA) and the Army Corps of
Engineers put forth a final rule that
reconciled regulations implementing section 404
of the Federal Water Pollution Control Act by
redefining the term ``fill material'' and
amending the definition of the term ``discharge
of fill material'', reversing a 25-year-old
regulation. The new rule fails to restrict the
dumping of hardrock mining waste, construction
debris, and other industrial wastes into
rivers, streams, lakes, and wetlands. The rule
further allows destructive mountaintop removal
coal mining companies to dump waste into
streams and lakes, polluting the surrounding
natural habitat and poisoning plants and
animals that depend on those water sources.
(ii) On February 12, 2003, the
Environmental Protection Agency published the
rule ``National Pollutant Discharge Elimination
System Permit Regulation and Effluent
Limitation Guidelines and Standards for
Concentrated Animal Feeding Operations'', new
livestock waste regulations that aimed to
control factory farm pollution but which would
severely undermine existing protections under
the Federal Water Pollution Control Act. This
regulation allows large-scale animal factories
to foul the Nation's waters with animal waste,
allows livestock owners to draft their own
pollution-management plans and avoid ground
water monitoring, legalizes the discharge of
contaminated runoff water rich in nitrogen,
phosphorus, bacteria, and metals, and ensures
that large factory farms are not held liable
for the environmental damage they cause. In a
2005 Federal court decision (``Waterkeeper
Alliance, et al. v. Enviromental Protection
Agency'', 399 F.3d 486 (2nd Cir. 2005)), major
parts of the rule were upheld, others vacated,
and still others remanded back to the EPA. On
November 20, 2008, the Environmental Protection
Agency published a revised final rule which
undermines environmental protection provisions
by removing mandatory permitting requirements
and allowing large animal farms to self-certify
the absence of pollutant discharge activity.
(iii) On March 19, 2003, the Environmental
Protection Agency published a new rule
regarding the Total Maximum Daily Load program
of the Federal Water Pollution Control Act that
regulates the maximum amount of a particular
pollutant that can be present in a body of
water and still meet water quality standards.
The new rule withdrew the existing regulation
put forth on July 13, 2000, and halted momentum
in cleaning up polluted waterways throughout
the Nation. By abandoning the existing rule,
the Environmental Protection Agency is
undermining the effectiveness of cleanup plans
and is allowing States to avoid cleaning
polluted waters entirely by dropping them from
their cleanup lists. Waterways play a crucial
role in the lives of the people of the United
States and are critical to the livelihood of
fish and wildlife. The result of dropping the
July 2000 rule is that the restoration of
polluted rivers, shorelines, and lakes will be
delayed, harming more fish and wildlife and
worsening the quality of drinking water.
(iv) On December 2, 2008, the Environmental
Protection Agency and the Army Corps of
Engineers jointly issued a guidance document in
the form of a legal memorandum, titled ``Clean
Water Act Jurisdiction Following the U.S.
Supreme Court's Decision in Rapanos v. United
States & Carabell v. United States''. This new
guidance dictates enforcement actions under the
Federal Water Pollution Control Act and calls
for a complicated ``case-by-case'' analysis to
determine jurisdiction for waterways that do
not flow all year. Such actions endanger small
streams and wetlands that serve as important
habitats for aquatic life, which play a
fundamental role in safeguarding sources of
clean drinking water and mitigate the risks and
effects of floods and droughts. Further, the
definition provided therein for ``waters of the
United States'' is applicable to the Federal
Water Pollution Control Act as a whole,
potentially affecting programs that control
industrial pollution and sewage levels, prevent
oil spills, and set water quality standards for
all waters in the United States protected under
the Federal Water Pollution Control Act.
(B) Forests and land management.--
(i) On December 3, 2003, the President
signed into law the Healthy Forests Restoration
Act of 2003 (Public Law 108-148; 16 U.S.C. 6501
et seq.). Although the law attempts to reduce
the risk of catastrophic forest fires, it
provides a boon to timber companies by
accelerating the aggressive thinning of
backcountry forests that are far from at-risk
communities. The law allows for increased
logging of large, fire-resistant trees that are
not in close proximity of homes and
communities; it undermines critical protections
for endangered species by exempting Federal
land management agencies from consulting with
the United States Fish and Wildlife Service
before approving any action that could harm
endangered plants or wildlife; and it limits
public participation by reducing the number of
environmental project reviews.
(ii) On April 21, 2008, the Department of
Agriculture issued a Final Planning Rule and
Record of Decision for National Forest System
Land Management Planning. Similar to rules
enacted by the Administration on January 5,
2005, later remanded back to the agency in
Federal district court for violating the
National Environmental Policy Act of 1969, the
Endangered Species Act of 1973, and the
Administrative Procedure Act (``Citizens for
Better Forestry v. United States Department of
Agriculture'', 481 F. Supp. 2d 1059 (N.D. Cal.
2007)), this revised rule eliminates strict
forest planning standards established in 1982,
and opens millions of acres of public lands to
damaging and invasive logging, mining, and
drilling operations. These regulations would
reverse more than 20 years of protection for
wildlife and national forests by removing the
overall goal of ensuring ecological
sustainability in managing the national forest
system, weakening the National Forest
Management Act of 1976, and effectively ending
the review of forest management plans under the
National Environmental Policy Act of 1969.
(iii) On September 20, 2006, the District
Court for the Northern District of California
vacated the Protection of Inventoried Roadless
Areas rule, enacted on May 13, 2005, which gave
State Governors 18 months to petition the
Federal Government to either restore the
previous rule for their States, or submit a new
management and development plan for national
forest areas inventoried under the rule.
Despite the enjoinment of the Administration's
2005 rule, and the subsequent restoration of
the original Roadless Area Conservation Rule,
the United States Forest Service has continued
to allow States to petition for a special rule
under the authority of the Administrative
Procedure Act, publishing a final special rule
for Idaho on October 16, 2008. As a result,
58.5 million acres of wild national forests are
still vulnerable to logging, road building, and
other developments that may fragment natural
habitats and negatively impact fish and
wildlife.
(iv) On November 17, 2008, the Department
of the Interior's Bureau of Land Management
(BLM) signed the Record of Decision (ROD)
amending 12 resource management plans in
Colorado, Utah, and Wyoming, opening 2,000,000
acres of public lands to commercial tar sands
and oil shale exploration and development. On
November 18, 2008, the BLM published a final
rule for Oil Shale Management setting the
policies and procedures for a commercial
leasing program for the management of federally
owned oil shale in those three States.
Previously barred by a congressional moratorium
on the commercial leasing regulations for oil
shale until September 30, 2008, the development
of oil shale on public lands poses a serious
threat to land conservation, endangered and
threatened species, and critical habitat.
Domestic shale oil production allowed by these
regulations is highly water and energy
intensive, the impacts of which will intensify
existing water scarcity in the arid Western
Region and potentially degrade air and water
quality for surrounding populations.
(C) Scientific review.--On December 16, 2008, the
United States Fish and Wildlife Service of the
Department of the Interior and the National Oceanic and
Atmospheric Administration of the Department of
Commerce jointly issued a new rule amending regulations
governing interagency cooperation under section 7 of
the Endangered Species Act of 1973 (ESA). This rule
undermines the intention of the ESA to protect species
and the ecosystems upon which they depend by allowing
Federal agencies to carry out, permit, or fund an
action without proper environmental review and expert
third-party consultation from Federal wildlife experts.
Under this new rule, Federal agencies can unilaterally
circumvent the formal review process, eliminating
longstanding and scientifically grounded safeguards
that serve to protect the biodiversity of our Nation's
ecosystems and avert harm to thousands of endangered
and threatened species.
(b) Statement of Policy.--It is the policy of the United States
Government to work in conjunction with States, territories, tribal
governments, international organizations, and foreign governments in
order to act as a steward of the environment for the benefit of public
health, to maintain air quality and water quality, to sustain the
diversity of plant and animal species, to combat global climate change,
and to protect the environment for future generations to enjoy.
(c) Study and Report on Public Health or Environmental Impact of
Revised Rules, Regulations, Laws, or Proposed Laws.--
(1) Study.--Not later than 30 days after the date of
enactment of this Act, the President shall enter into an
arrangement under which the National Academy of Sciences will
conduct a study to determine the impact on public health, air
quality, water quality, wildlife, and the environment of the
following regulations, laws, and proposed laws:
(A) Clean water.--
(i) Final revisions to the Federal Water
Pollution Control Act regulatory definitions of
``fill material'' and ``discharge of fill
material'', finalized and published in the
Federal Register on May 9, 2002 (67 Fed. Reg.
31129), amending part 232 of title 40, Code of
Federal Regulations.
(ii) Revised National Pollutant Discharge
Elimination System Permit Regulation and
Effluent Limitation Guidelines and Standards
for Concentrated Animal Feeding Operations in
response to the ``Waterkeeper Alliance, et al.
v. Enviromental Protection Agency'' decision,
finalized and published in the Federal Register
on November 20, 2008 (73 Fed. Reg. 225),
amending parts 9, 122, and 412 of title 40,
Code of Federal Regulations.
(iii) A March 19, 2003, rule published in
the Federal Register (68 Fed. Reg. 13608)
withdrawing a July 13, 2000, rule revising the
Total Maximum Daily Load program of the Federal
Water Pollution Control Act (65 Fed. Reg.
43586), amending parts 9, 122, 123, 124, and
130 of title 40, Code of Federal Regulations.
(iv) Official Guidance Document, ``Clean
Water Act Jurisdiction Following the United
States Supreme Court's Decision in Rapanos v.
United States & Carabell v. United States'',
issued on December 2, 2008, relating to
jurisdiction under section 404 of the Federal
Water Pollution Control Act.
(B) Forests and land management.--
(i) Healthy Forests Restoration Act of
2003, signed into law on December 3, 2003
(Public Law 108-148; 16 U.S.C. 6501 et seq.).
(ii) National Forest System Land Management
Planning Rule, finalized and published in the
Federal Register on April 21, 2008 (73 Fed.
Reg. 21468), replacing the 2005 final rule (70
Fed. Reg. 1022, Jan. 5, 2005), as amended March
3, 2006 (71 Fed. Reg. 10837) and the 2000 final
rule adopted on November 9, 2000 (65 Fed. Reg.
67514) as amended on September 29, 2004 (69
Fed. Reg. 58055), amending title 36, Code of
Federal Regulations, part 219.
(iii) The application of the Administrative
Procedure Act (5 U.S.C. 551 to 559, 701 to 706,
et seq.), such that States may petition for a
special rule for the roadless areas in all or
part of said State.
(iv) Record of Decision, ``Oil Shale and
Tar Sands Resources Resource Management Plan
Amendments'', issued on November 17, 2008,
along with the Final Rule, Oil Shale
Management-General, published in the Federal
Register on November 18, 2008 (73 Fed. Reg.
223), amending title 43, Code of Federal
Regulations, parts 3900, 3910, 3920, and 3930.
(C) Scientific review.--Final Rule, Interagency
Cooperation Under the Endangered Species Act, published
in the Federal Register on December 16, 2008, amending
title 50, Code of Federal Regulations, part 402.
(2) Method.--In conducting the study under paragraph (1),
the National Academy of Sciences may utilize and compare
existing scientific studies regarding the regulations, laws,
and proposed laws listed in paragraph (1).
(3) Report.--Under the arrangement entered into under
paragraph (1), not later than 270 days after the date on which
such arrangement is entered into, the National Academy of
Sciences shall make publicly available and shall submit to the
Congress and to the head of each department and agency of the
Federal Government that issued, implements, or would implement
a regulation, law, or proposed law listed in paragraph (1), a
report containing--
(A) a description of the impact of all such
regulations, laws, and proposed laws on public health,
air quality, water quality, wildlife, and the
environment, compared to the impact of preexisting
regulations, or laws in effect, including--
(i) any negative impacts to air quality or
water quality;
(ii) any negative impacts to wildlife;
(iii) any delays in hazardous waste cleanup
that are projected to be hazardous to public
health; and
(iv) any other negative impact on public
health or the environment; and
(B) any recommendations that the National Academy
of Sciences considers appropriate to maintain, restore,
or improve in whole or in part protections for public
health, air quality, water quality, wildlife, and the
environment for each of the regulations, laws, and
proposed laws listed in paragraph (1), which may
include recommendations for the adoption of any
regulation or law in place or proposed prior to January
1, 2001.
(d) Department and Agency Revision of Existing Rules, Regulations,
or Laws.--Not later than 180 days after the date on which the report is
submitted pursuant to subsection (c)(3), the head of each department
and agency that has issued or implemented a regulation or law listed in
subsection (c)(1) shall submit to the Congress a plan describing the
steps such department or such agency will take, or has taken, to
restore or improve protections for public health and the environment in
whole or in part that were in existence prior to the issuance of such
regulation or law.
SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEPWATER HORIZON OIL RIG
EXPLOSION IN THE GULF COAST.
(a) Study.--The Comptroller General of the United States shall
conduct a study on the type and scope of health care services
administered through the Department of Health and Human Services
addressing the provision of health care to racial and ethnic minorities
(whether residents, cleanup workers, or volunteers) affected by the
explosion of the mobile offshore drilling unit Deepwater Horizon that
occurred on April 20, 2010.
(b) Specific Components; Reporting.--In carrying out subsection
(a), the Comptroller General shall--
(1) assess the type, size, and scope of programs
administered by the Department of Health and Human Services
that focus on provision of health care to communities in the
Gulf Coast;
(2) identify the merits and disadvantages associated with
each the programs;
(3) perform an analysis of the costs and benefits of the
programs;
(4) determine whether there is any duplication of programs;
and
(5) not later than 180 days after the date of the enactment
of this Act, report findings and recommendations for improving
access to health care for racial and ethnic minorities to the
Congress.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR H7049)
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans' Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee Indian and Alaska Native Affairs.
Referred to the Subcommittee on Fisheries, Wildlife, Oceans, and Insular Affairs.
Referred to the Subcommittee on Energy and Mineral Resources.
Referred to the Subcommittee on Public Lands and Environmental Regulation.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Department Operations, Oversight, and Nutrition.
Referred to the Subcommittee on Higher Education and Workforce Training.