II 

117TH CONGRESS 

2D SESSION S. 4486 

To improve the health of minority individuals, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 23, 2022 

Mr. BOOKER (for himself, Mr. WARNOCK, Mr. BROWN, Mr. MERKLEY, Mr. 

CARDIN, Mr. KAINE, Ms. HIRONO, Ms. WARREN, Ms. DUCKWORTH, Mrs. 

GILLIBRAND, and Mr. SANDERS) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To improve the health of minority individuals, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Equity and 

5 Accountability Act of 2022’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 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 


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Sec. 1001. Strengthening data collection, improving data analysis, and expanding data reporting. 

Sec. 1002. Elimination of prerequisite of direct appropriations for data collection and analysis. 

Sec. 1003. Collection of data for the Medicare program. 

Sec. 1004. Revision of HIPAA claims standards. 

Sec. 1005. National Center for Health Statistics. 

Sec. 1006. Disparities data collected by the Federal Government. 

Sec. 1007. Data collection and analysis grants to minority-serving institutions. 

Sec. 1008. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 1009. Improving health data regarding Native Hawaiians and Pacific Islanders. 

Sec. 1010. Clarification of simplified administrative reporting requirement. 

Sec. 1011. Data collection regarding pandemic preparedness, testing, infections, 

and deaths. 

Sec. 1012. Commission on Ensuring Data for Health Equity. 

Sec. 1013. Task Force on Preventing Bias in AI and Algorithms. 

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTH AND HEALTH CARE 

Sec. 2001. Definitions; findings. 

Sec. 2002. Improving access to services for individuals with limited English 

proficiency. 

Sec. 2003. Ensuring standards for culturally and linguistically appropriate 

services in health care. 

Sec. 2004. Culturally and linguistically appropriate health care in the Public 

Health Service Act. 

Sec. 2005. Pilot program for improvement and development of State medical 

interpreting services. 

Sec. 2006. Training tomorrow’s doctors for culturally and linguistically appropriate care: graduate medical education. 

Sec. 2007. Federal reimbursement for culturally and linguistically appropriate 

services under the Medicare, Medicaid, and State Children’s 

Health Insurance Programs. 

Sec. 2008. Increasing understanding of and improving health literacy. 

Sec. 2009. Requirements for health programs or activities receiving Federal 

funds. 

Sec. 2010. Report on Federal efforts to provide culturally and linguistically appropriate health care services. 

Sec. 2011. English instruction for individuals with limited English proficiency. 

Sec. 2012. Implementation. 

Sec. 2013. Language access services. 

Sec. 2014. Medically underserved populations. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

Sec. 3001. Amendment to the Public Health Service Act. 

Sec. 3002. Hispanic-serving institutions, historically Black colleges and universities, historically Black professional or graduate institutions, 

Asian American and Native American Pacific Islander-serving 

institutions, Tribal Colleges, regional community-based organizations, and national minority medical associations. 

Sec. 3003. Loan repayment program of Centers for Disease Control and Prevention. 


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Sec. 3004. Allied health workforce diversity. 

Sec. 3005. Cooperative agreements for online degree programs at schools of 

public health and schools of allied health. 

Sec. 3006. National Health Care Workforce Commission. 

Sec. 3007. Scholarship and fellowship programs. 

Sec. 3008. McNair Postbaccalaureate Achievement Program. 

Sec. 3009. Rules for determination of full-time equivalent residents for cost-reporting periods. 

Sec. 3010. Developing and implementing strategies for local health equity. 

Sec. 3011. Health Professions Workforce Fund. 

Sec. 3012. Future advancement of academic nursing. 

Sec. 3013. Findings; sense of Congress relating to graduate medical education. 

Sec. 3014. Career support for skilled, internationally educated health professionals. 

Sec. 3015. Study and report on strategies for increasing diversity. 

Sec. 3016. Conrad State 30 program; physician retention. 

Sec. 3017. National Hispanic Nurses Day. 

Sec. 3018. Expanding medical education. 

TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY 

Sec. 4000. Definition. 

Subtitle A—Reducing Barriers to Accessing Care 

Sec. 4001. Protecting protected areas. 

Sec. 4002. Repeal of requirement for documentation evidencing citizenship or 

nationality under the Medicaid program. 

Sec. 4003. Availability of basic assistance to lawfully present noncitizens. 

Sec. 4004. Improve affordability and reduce premium costs of health insurance 

for consumers. 

Sec. 4005. Removing citizenship and immigration barriers to access to affordable health care under the ACA. 

Sec. 4006. Removing barriers to access to affordable health care for lawfully residing immigrants under Medicaid and CHIP. 

Sec. 4007. Consistency in health insurance coverage for individuals with federally authorized presence, including deferred action. 

Sec. 4008. Study on the uninsured. 

Sec. 4009. Medicaid fallback coverage program for low-income adults in nonexpansion States. 

Sec. 4010. Increase and extension of temporary enhanced FMAP for States 

which begin to expend amounts for certain mandatory individuals. 

Subtitle B—Improvement of Coverage 

Sec. 4101. Medicaid in the territories. 

Sec. 4102. Extension of the Supplemental Security Income Program to Puerto 

Rico, the United States Virgin Islands, Guam, and American 

Samoa. 

Sec. 4103. Extension of Medicare secondary payer. 

Sec. 4104. Indian defined in title I of the Patient Protection and Affordable 

Care Act. 

Sec. 4105. Removing Medicare barrier to health care. 

Sec. 4106. Lowering Medicare premiums and prescription drug costs. 


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Sec. 4107. Reducing cost-sharing, aligning income and resource eligibility tests, 

simplifying enrollment, and other program improvements for 

low-income beneficiaries. 

Sec. 4108. 100 percent FMAP for medical assistance provided by urban Indian 

organizations. 

Sec. 4109. 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. 

Sec. 4110. Repeal of requirement for estate recovery under the Medicaid program. 

Sec. 4111. Allow for suspension of Medicare benefits and premium liability for 

individuals who are incarcerated and provide a special enrollment period around the date of release. 

Sec. 4112. Federal Employee Health Benefit Plans. 

Sec. 4113. Continuation of Medicaid income eligibility standard for pregnant 

individuals and infants. 

Subtitle C—Expansion of Access 

PART 1—GENERAL PROVISIONS

Sec. 4201. Amendment to the Public Health Service Act. 

Sec. 4202. Border health grants. 

Sec. 4203. Critical access hospital improvements. 

Sec. 4204. Medicare remote monitoring pilot projects. 

Sec. 4205. Community health center collaborative access expansion. 

Sec. 4206. Facilitating the provision of telehealth services across State lines. 

Sec. 4207. Scoring of preventive health savings. 

Sec. 4208. Sense of Congress on maintenance of effort provisions regarding 

children’s health. 

Sec. 4209. Protection of the HHS Offices of Minority Health. 

Sec. 4210. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs. 

Sec. 4211. Study of DSH payments to ensure hospital access for low-income 

patients. 

Sec. 4212. Reauthorization of programs under the Native Hawaiian Health 

Care Improvement Act. 

PART 2—RURAL

Sec. 4221. Establishment of Rural Community Hospital (RCH) Program. 

Sec. 4222. Rural Health Quality Advisory Commission and demonstration 

projects. 

Sec. 4223. Rural health care services. 

PART 3—INDIAN COMMUNITIES

Sec. 4231. Assistant Secretary of the Indian Health Service. 

Sec. 4232. Extension of full Federal medical assistance percentage to Indian 

health care providers. 

Sec. 4233. Conferring with urban Indian organizations. 

PART 4—PROVIDERS

Sec. 4241. Availability of non-English language speaking providers. 

Sec. 4242. Access to essential community providers. 

Sec. 4243. Provider network adequacy in communities of color. 


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PART 5—DENTAL

Sec. 4251. Improving access to dental care. 

Sec. 4252. Oral health literacy and awareness campaign. 

Subtitle D—Advancing Health Equity Through Payment and Delivery Reform 

Sec. 4301. Sense of Congress. 

Sec. 4302. Centers for Medicare & Medicaid Services reporting and value-based 

programs. 

Sec. 4303. Development and testing of disparity reducing delivery and payment 

models. 

Sec. 4304. Diversity in Centers for Medicare and Medicaid consultation. 

Sec. 4305. Supporting safety net and community-based providers to compete in 

value-based payment systems. 

Subtitle E—Health Empowerment Zones 

Sec. 4401. Designation of health empowerment zones. 

Sec. 4402. Assistance to those seeking designation. 

Sec. 4403. Benefits of designation. 

Sec. 4404. Definition of Secretary. 

Sec. 4405. Authorization of appropriations. 

Subtitle F—Equitable Health Care for All 

Sec. 4501. Findings. 

Sec. 4502. Data collection and reporting. 

Sec. 4503. Requiring equitable health care in the hospital value-based purchasing program. 

Sec. 4504. Provision of inequitable health care as a basis for permissive exclusion from Medicare and State health care programs. 

Sec. 4505. Office for Civil Rights and Health Equity of the Department of 

Health and Human Services. 

Sec. 4506. Prohibiting discrimination in health care. 

Sec. 4507. Federal Health Equity Commission. 

Sec. 4508. Grants for hospitals to promote equitable health care and outcomes. 

Subtitle G—Investing in Equity 

Sec. 4601. Definitions. 

Sec. 4602. Strategy to incentivize health equity. 

Sec. 4603. Pay for Equity Advisory Council. 

TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 

CHILDREN, AND FAMILIES 

Subtitle A—In General 

Sec. 5001. Grants to promote health for underserved communities. 

Subtitle B—Pregnancy Screening 

Sec. 5101. Pregnancy intention screening initiative demonstration program. 

Sec. 5102. Birth defects prevention, risk reduction, and awareness. 

Subtitle C—Pregnancy-Related Care 

Sec. 5201. Mothers and offspring mortality and morbidity awareness. 


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Sec. 5202. MOMMIES. 

Sec. 5203. Justice for incarcerated moms. 

Sec. 5204. IMPACT To Save Moms Act. 

Sec. 5205. Protecting moms and babies against climate change. 

Sec. 5206. Tech to save moms. 

Sec. 5207. Social determinants for moms. 

Sec. 5208. Data to save moms. 

Sec. 5209. Kira Johnson Act. 

Sec. 5210. Moms matter. 

Sec. 5211. Taskforce Recommending Improvements for Unaddressed Mental 

Perinatal & Postpartum Health (TRIUMPH) for New Moms. 

Sec. 5212. Protect moms from domestic violence. 

Sec. 5213. Perinatal workforce. 

Sec. 5214. Midwives schools and programs expansion. 

Sec. 5215. Gestational diabetes. 

Sec. 5216. Consumer education campaign. 

Sec. 5217. Bibliographic database of systematic reviews for care of childbearing 

individuals and newborns. 

Sec. 5218. Development of interprofessional maternity care educational models 

and tools. 

Sec. 5219. Dissemination of the quality family planning guidelines. 

Subtitle D—Federal Agency Coordination on Maternal Health 

Sec. 5301. Interagency Coordinating Committee on the Promotion of Optimal 

Maternity Outcomes. 

Sec. 5302. Expansion of CDC Prevention Research Centers Program to include 

Centers on Optimal Maternity Outcomes. 

Sec. 5303. Expanding models to be tested by Center for Medicare and Medicaid 

Innovation to explicitly include maternity care and children’s 

health models. 

Sec. 5304. Interagency update to the quality family planning guidelines. 

Subtitle E—Reproductive and Sexual Health 

Sec. 5401. Findings; sense of Congress on urgent barriers to abortion access 

and vital solutions. 

Sec. 5402. Emergency contraception education and information programs. 

Sec. 5403. Access to birth control duties of pharmacies to ensure provision of 

FDA-approved contraception. 

Sec. 5404. Real education and access for healthy youth. 

Sec. 5405. Compassionate assistance for rape emergencies. 

Sec. 5406. Menstrual Equity for All Act of 2022. 

Sec. 5407. Additional focus area for the Office on Women’s Health. 

Sec. 5408. Including services furnished by certain students, interns, and residents supervised by certified nurse midwives or certified midwives within inpatient hospital services under Medicare. 

Sec. 5409. Grants to professional organizations and minority-serving institutions to increase diversity in maternal, reproductive, and sexual 

health professionals. 

Subtitle F—Children’s Health 

Sec. 5501. CARING for Kids Act. 

Sec. 5502. End Diaper Need Act of 2022. 


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Sec. 5503. Decreasing the risk factors for sudden unexpected infant death and 

sudden unexplained death in childhood. 

Subtitle G—Nutrition for Women, Children, Families 

Sec. 5601. Closing the meal gap. 

Sec. 5602. Repeal of denial of Supplemental Nutrition Assistance Program benefits. 

Subtitle H—Universal School Meals Program 

Sec. 5701. Short title. 

Sec. 5702. Effective date. 

Sec. 5703. Free school breakfast program. 

Sec. 5704. Apportionment to States. 

Sec. 5705. Nutritional and other program requirements. 

Sec. 5706. Special assistance program. 

Sec. 5707. Price for a paid lunch. 

Sec. 5708. Summer food service program for children. 

Sec. 5709. Summer Electronic Benefit Transfer for Children Program. 

Sec. 5710. Child and adult care food program. 

Sec. 5711. Meals and supplements for children in afterschool care. 

Sec. 5712. Access to local foods: farm to school program. 

Sec. 5713. Fresh fruit and vegetable program. 

Sec. 5714. Training, technical assistance, and Food Service Management Institute. 

Sec. 5715. Reimbursement of school meal delinquent debt program. 

Sec. 5716. Conforming amendments. 

Sec. 5717. Measure of poverty. 

Sec. 5718. Supplemental nutrition assistance program. 

Sec. 5719. Higher Education Act of 1965. 

Sec. 5720. Elementary and Secondary Education Act of 1965. 

Sec. 5721. America COMPETES Act. 

Sec. 5722. Workforce Innovation and Opportunity Act. 

Sec. 5723. National Science Foundation Authorization Act of 2002. 

Sec. 5724. Child care and development block grant. 

Sec. 5725. Children’s Health Act of 2000. 

Sec. 5726. Juvenile justice and delinquency prevention. 

Subtitle I—Elder Care 

Sec. 5801. Expenses for household and elder care services necessary for gainful 

employment. 

Subtitle J—Miscellaneous Provisions 

Sec. 5901. Clarification supporting permissible use of funds for stillbirth prevention activities. 

TITLE VI—MENTAL HEALTH AND SUBSTANCE USE DISORDERS 

Sec. 6001. Mental health findings. 

Sec. 6002. Sense of Congress. 

Subtitle A—Access to Care and Funding Streams 


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Sec. 6011. Coverage of marriage and family therapist services, mental health 

counselor services, substance abuse counselor services, and peer 

support specialist services under part B of the Medicare program. 

Sec. 6012. Reauthorization of Minority Fellowship Program. 

Sec. 6013. Additional funds for National Institutes of Health. 

Sec. 6014. Additional funds for National Institute on Minority Health and 

Health Disparities. 

Sec. 6015. Grants for increasing racial and ethnic minority access to high-quality trauma support services and mental health care. 

Sec. 6016. Grants for unarmed 9–1–1 response programs. 

Subtitle B—Interprofessional Care 

Sec. 6021. Health professions competencies to address racial and ethnic mental 

health inequities. 

Sec. 6022. Interprofessional health care teams for behavioral health care. 

Sec. 6023. Integrated Health Care Demonstration Program. 

Subtitle C—Workforce Development 

Sec. 6031. Building an effective workforce in mental health. 

Sec. 6032. Pilot program to increase language access at Federally qualified 

health centers. 

Sec. 6033. Health professions competencies to address racial and ethnic minority mental health disparities. 

Subtitle D—Children’s Mental Health 

Sec. 6041. Pediatric behavioral health care. 

Sec. 6042. Mental health in schools. 

Sec. 6043. Additional support for youth and young adult mental health service 

provision. 

Sec. 6044. Early intervention and prevention programs for transition-age 

youth. 

Sec. 6045. Strategies to increase access to telehealth under Medicaid and Children’s Health Insurance Program. 

Sec. 6046. Youth and young adult mental health promotion, prevention, intervention, and treatment. 

Sec. 6047. Study on the effects of smartphone and social media use on adolescents. 

Subtitle E—Community-Based Care 

Sec. 6051. Mental health at the border. 

Sec. 6052. Asian American, African American, Native Hawaiian, Pacific Islander, Indigenous, Middle Eastern and North African, and 

Hispanic and Latino behavioral and mental health outreach 

and education strategy. 

Subtitle F—Reports 

Sec. 6061. Addressing racial and ethnic mental health inequities research gaps. 

Sec. 6062. Research on adverse health effects associated with interactions with 

law enforcement. 

Sec. 6063. GeoAccess study. 

Sec. 6064. Co-occurring conditions. 


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Sec. 6065. Technical correction. 

Subtitle G—Miscellaneous Provisions 

Sec. 6071. Children’s Mental Health Infrastructure Act. 

Sec. 6072. Mental health for Latinos. 

Sec. 6073. Strengthening mental health supports for BIPOC communities. 

Sec. 6074. STRONG support for children. 

Sec. 6075. Improving access to mental health. 

Sec. 6076. Mental Health in Schools Excellence Program. 

Sec. 6077. School social workers improving student success. 

Sec. 6078. Opioid grants to support caregivers, kinship care families, and kinship caregivers. 

TITLE VII—ADDRESSING HIGH-IMPACT MINORITY DISEASES 

Subtitle A—Cancer 

Sec. 7001. Lung cancer mortality reduction. 

Sec. 7002. Expansion of prostate cancer research, outreach, screening, testing, 

access, and treatment effectiveness. 

Sec. 7003. Prostate research, imaging, and men’s education. 

Sec. 7004. Prostate cancer detection research and education. 

Sec. 7005. National Prostate Cancer Council. 

Sec. 7006. Improved Medicaid coverage for certain breast and cervical cancer 

patients in the territories. 

Sec. 7007. Cancer prevention and treatment demonstration for ethnic and racial minorities. 

Sec. 7008. Reducing cancer disparities within Medicare. 

Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 

Sec. 7051. Viral hepatitis and liver cancer control and prevention. 

Sec. 7052. Liver cancer and disease prevention, awareness, and patient tracking grants. 

Subtitle C—Acquired Bone Marrow Failure Diseases 

Sec. 7101. Acquired bone marrow failure diseases. 

Subtitle D—Cardiovascular Disease, Chronic Disease, Obesity, and Other 

Disease Issues 

Sec. 7151. Guidelines for disease screening for minority patients. 

Sec. 7152. CDC Wisewoman Screening Program. 

Sec. 7153. Report on cardiovascular care for women and minorities. 

Sec. 7154. Coverage of comprehensive tobacco cessation services in Medicaid, 

CHIP, and private health insurance. 

Sec. 7155. Clinical research funding for oral health. 

Sec. 7156. Guide on evidence-based strategies for public health department obesity prevention programs. 

Sec. 7157. Stephanie Tubbs Jones Uterine Fibroid Research and Education 

Act. 

Subtitle E—HIV/AIDS 

Sec. 7201. Statement of policy. 

Sec. 7202. Findings. 


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Sec. 7203. Additional funding for AIDS drug assistance program treatments. 

Sec. 7204. Enhancing the national HIV surveillance system. 

Sec. 7205. Evidence-based strategies for improving linkage to, and retention in, 

appropriate care. 

Sec. 7206. Improving entry into, and retention in, care and antiretroviral adherence for persons with HIV. 

Sec. 7207. Services to reduce HIV/AIDS in racial and ethnic minority communities. 

Sec. 7208. Minority AIDS initiative. 

Sec. 7209. Health care professionals treating individuals with HIV. 

Sec. 7210. HIV/AIDS provider loan repayment program. 

Sec. 7211. Dental education loan repayment program. 

Sec. 7212. Reducing new HIV infections among injecting drug users. 

Sec. 7213. Report on impact of HIV/AIDS in vulnerable populations. 

Sec. 7214. National HIV/AIDS observance days. 

Sec. 7215. Review of all Federal and State laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related 

offenses. 

Sec. 7216. Expanding support for condoms in prisons. 

Sec. 7217. Automatic reinstatement or enrollment in Medicaid for people who 

test positive for HIV before reentering communities. 

Sec. 7218. Stop HIV in prison. 

Sec. 7219. Transfer of funds for implementation of Ending the HIV Epidemic: 

A Plan for America. 

Sec. 7220. PrEP access and coverage. 

Subtitle F—Diabetes 

Sec. 7251. Research, treatment, and education. 

Sec. 7252. Research, education, and other activities. 

Sec. 7253. Programs to educate health providers on the causes and effects of 

diabetes in minority populations. 

Sec. 7254. Research, education, and other activities regarding diabetes in 

American Indian populations. 

Sec. 7255. Updated report on health disparities. 

Subtitle G—Lung Disease 

Sec. 7301. National asthma burden. 

Sec. 7302. Asthma-related activities of the Centers for Disease Control and 

Prevention. 

Sec. 7303. Influenza and pneumonia vaccination campaign. 

Sec. 7304. Chronic obstructive pulmonary disease. 

Subtitle H—Tuberculosis 

Sec. 7351. Elimination of all forms of tuberculosis. 

Sec. 7352. Additional funding for States in combating and eliminating tuberculosis. 

Sec. 7353. Strengthening clinical research funding for tuberculosis. 

Subtitle I—Osteoarthritis and Musculoskeletal Diseases 

Sec. 7401. Findings. 

Sec. 7402. Osteoarthritis and other musculoskeletal health-related activities of 

the Centers for Disease Control and Prevention. 


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Sec. 7403. Grants for comprehensive osteoarthritis and musculoskeletal disease 

health education within health professions schools. 

Subtitle J—Sleep and Circadian Rhythm Disorders 

Sec. 7451. Short title; findings. 

Sec. 7452. Sleep and circadian rhythm disorders research activities of the National Institutes of Health. 

Sec. 7453. Sleep and circadian rhythm health disparities-related activities of 

the Centers for Disease Control and Prevention. 

Sec. 7454. Grants for comprehensive sleep and circadian health education within health professions schools. 

Sec. 7455. Report on impact of sleep and circadian health disorders in vulnerable and racial/ethnic populations. 

Subtitle K—Kidney Disease Research, Surveillance, Prevention, and 

Treatment 

Sec. 7501. Kidney disease, research, surveillance, prevention, and treatment. 

Sec. 7502. Kidney disease research in minority populations. 

Sec. 7503. Kidney disease action plan. 

Sec. 7504. Home dialysis and increasing end-stage renal disease treatment modalities in minority communities action plan. 

Sec. 7505. Increasing kidney transplants in minority populations. 

Sec. 7506. Environmental and occupational health programs. 

Sec. 7507. Understanding the treatment patterns associated with providing 

care and treatment of kidney failure in minority populations. 

Sec. 7508. Improving access in underserved areas. 

Sec. 7509. The Jack Reynolds Memorial Medigap Expansion Act; Medigap coverage for beneficiaries with end-stage renal disease. 

Subtitle L—Diversity in Clinical Trials 

Sec. 7551. FDA review of clinical trial best practices. 

Sec. 7552. Diversifying Investigations Via Equitable Research Studies for Everyone Trials Act. 

Sec. 7553. Clinical trial diversity. 

Sec. 7554. Patient experience data. 

Subtitle M—Additional Provisions Addressing High-Impact Minority Diseases 

Sec. 7601. Medicare coverage of multi-cancer early detection screening tests. 

Sec. 7602. Amputation Reduction and Compassion Act. 

Sec. 7603. Eliminating the coinsurance requirement for certain colorectal cancer screening tests furnished under the Medicare program. 

Sec. 7604. Expanding the availability of medical nutrition therapy services 

under the Medicare program. 

Sec. 7605. Encouraging the development and use of DISARM antimicrobial 

drugs. 

Sec. 7606. Treat and Reduce Obesity Act. 

Sec. 7607. Incentives, improvements, and outreach to increase diversity in Alzheimer’s disease research. 

TITLE VIII—HEALTH INFORMATION TECHNOLOGY 

Sec. 8001. Definitions. 

Subtitle A—Reducing Health Disparities Through Health IT 


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Sec. 8101. HRSA assistance to health centers for promotion of Health IT. 

Sec. 8102. Assessment of impact of Health IT on racial and ethnic minority 

communities; outreach and adoption of Health IT in such communities. 

Sec. 8103. Nondiscrimination and health equity in health information technology. 

Sec. 8104. Language access in health information technology. 

Subtitle B—Modifications To Achieve Parity in Existing Programs 

Sec. 8201. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities. 

Sec. 8202. 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. 8203. Authorization of appropriations. 

Subtitle C—Additional Research and Studies 

Sec. 8301. Data collection and assessments conducted in coordination with minority-serving institutions. 

Sec. 8302. Study of health information technology in medically underserved 

communities. 

Sec. 8303. Assessment of use and misuse of de-identified health data. 

Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 

Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation facilities, long-term care facilities, and home health agencies. 

Sec. 8402. Extending physician assistant eligibility for Medicaid electronic 

health record incentive payments. 

Subtitle E—Expanding Access to Telehealth Services 

Sec. 8501. Removing geographic requirements for telehealth services. 

Sec. 8502. Expanding originating sites. 

TITLE IX—ACCOUNTABILITY AND EVALUATION 

Sec. 9001. Prohibition on discrimination in Federal assisted health care services and research on the basis of sex (including sexual orientation, gender identity, and pregnancy, including termination of 

pregnancy), race, color, national origin, marital status, familial 

status, or disability status. 

Sec. 9002. Treatment of Medicare payments under title VI of the Civil Rights 

Act of 1964. 

Sec. 9003. Accountability and transparency within the Department of Health 

and Human Services. 

Sec. 9004. United States Commission on Civil Rights. 

Sec. 9005. Sense of Congress concerning full funding of activities to eliminate 

racial and ethnic health disparities. 

Sec. 9006. GAO and NIH reports. 

Sec. 9007. Investigative and enforcement actions. 

Sec. 9008. Federal Health Equity Commission. 

TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 

ENVIRONMENTAL JUSTICE 


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Subtitle A—In General 

Sec. 10001. Definitions. 

Sec. 10002. Findings. 

Sec. 10003. Health impact assessments. 

Sec. 10004. Grant program to conduct environmental health improvement activities and to improve social determinants of health. 

Sec. 10005. Additional research on the relationship between the built environment and the health of community residents. 

Sec. 10006. Environment and public health restoration. 

Sec. 10007. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast. 

Sec. 10008. Establish an interagency counsel and grant programs on social determinants of health. 

Sec. 10009. Correcting Hurtful and Alienating Names in Government Expression (CHANGE). 

Sec. 10010. Andrew Kearse Accountability for Denial of Medical Care. 

Sec. 10011. Investing in community healing. 

Sec. 10012. Environmental justice mapping and data collection. 

Sec. 10013. Antiracism in public health. 

Sec. 10014. LGBTQ essential data. 

Sec. 10015. Social determinants accelerator. 

Sec. 10016. Improving social determinants of health. 

Subtitle B—Gun Violence 

Sec. 10101. Reaffirming research authority of the Centers for Disease Control 

and Prevention. 

Sec. 10102. National Violent Death Reporting System. 

Sec. 10103. Report on effects of gun violence on public health. 

Sec. 10104. Report on effects of gun violence on mental health in minority 

communities. 

1 SEC. 3. FINDINGS. 

2 The Congress finds as follows: 

3 (1) The population of racial and ethnic minori4 ties is expected to increase over the next few dec5 ades, yet racial and ethnic minorities have the poor6 est health status and face substantial cultural, so7 cial, and economic barriers to obtaining high-quality 

8 health care. 

9 (2) Health disparities are a function of not only 

10 access to health care, but also the social deter11 minants of health—including the environment, the 


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1 physical structure of communities, nutrition and 

2 food options, educational attainment, employment, 

3 race, ethnicity, sex, geography, language preference, 

4 immigrant or citizenship status, sexual orientation, 

5 gender identity, socioeconomic status, or disability 

6 status—that directly and indirectly affect the health, 

7 health care, and wellness of individuals and commu8 nities. 

9 (3) Over the next few decades, the United 

10 States will face a shortage of health care providers 

11 and allied health workers. 

12 (4) All efforts to reduce health disparities and 

13 barriers to high-quality health services require better 

14 and more consistent data, and better and more con15 sistent collection of and access to data. 

16 (5) A full range of culturally and linguistically 

17 appropriate health care and public health services 

18 must be available and accessible in every community. 

19 (6) Racial and ethnic minorities and under20 served populations must be included early and equi21 tably in health reform innovations. 

22 (7) Efforts to improve minority health have 

23 been limited by inadequate resources in funding, 

24 staffing, stewardship, and accountability. Targeted 

25 investments that are focused on disparities elimiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 nation must be made in providing care and services 

2 that are community-based, including prevention and 

3 policies addressing social determinants of health. 

4 (8) In 2011, the Department of Health and 

5 Human Services developed the HHS Action Plan to 

6 Reduce Racial and Ethnic Health Disparities and 

7 the National Stakeholder Strategy for Achieving 

8 Health Equity, which are 2 strategic plans that rep9 resent the first coordinated roadmap in the United 

10 States to reducing health disparities. These com11 prehensive plans, along with the National Prevention 

12 Strategy issued by the National Prevention Council 

13 of the Department of Health and Human Services, 

14 Healthy People 2030, and the National Quality 

15 Strategy of the Agency for Healthcare Research and 

16 Quality, as well as critical resources such as the 

17 2012 National Healthcare Quality and Disparities 

18 Reports, will work to increase the number of people 

19 in the United States who are healthy at every stage 

20 of life. 

21 (9) The Secretary of Health and Human Serv22 ices has also reviewed and advanced updated clinical 

23 guidelines and developed other strategic planning 

24 documents to combat health disparities with a high 

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1 quality family planning services. Such guidelines and 

2 documents include the National HIV/AIDS Strategy, 

3 the Action Plan for the Prevention, Care, and Treat4 ment of Viral Hepatitis, and recommendations of the 

5 Centers for Disease Control and Prevention and the 

6 Office of Population Affairs. 

7 (10) The Patient Protection and Affordable 

8 Care Act (Public Law 111–148), as amended by the 

9 Health Care and Education Reconciliation Act of 

10 2010 (Public Law 111–152), represents the biggest 

11 advancement for minority health in the 40 years im12 mediately preceding the enactment of this Act. 

13 (11) The Health Information Technology for 

14 Economic and Clinical Health Act, part of the 

15 American Recovery and Reinvestment Act of 2009 

16 (Public Law 111–5), provides that the nationwide 

17 health information exchange infrastructure be devel18 oped and used to reduce health disparities, among 

19 other purposes. 


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1 TITLE I—DATA COLLECTION 

2 AND REPORTING 

3 SEC. 1001. STRENGTHENING DATA COLLECTION, IMPROV4 ING DATA ANALYSIS, AND EXPANDING DATA 

5 REPORTING. 

6 (a) AMENDMENTS TO THE PUBLIC HEALTH SERVICE

7 ACT.— 

8 (1) PURPOSE.—The purpose of the amend9 ments made by this subsection is to promote cul10 turally and linguistically appropriate data collection, 

11 analysis, and reporting by race, ethnicity, sex, pri12 mary language, sexual orientation, disability status, 

13 gender identity, age, and socioeconomic status in 

14 federally supported health programs. 

15 (2) AHRQ GENERAL AUTHORITIES.—Section 

16 902(a) of the Public Health Service Act (42 U.S.C. 

17 299a(a)) is amended— 

18 (A) in paragraph (8), by striking ‘‘and’’ at 

19 the end; 

20 (B) in paragraph (9), by striking the pe21 riod at the end and inserting ‘‘; and’’; and 

22 (C) by adding at the end the following: 

23 ‘‘(10) cultural and linguistic competence of 

24 health care services and of data collection activities 

25 described under section 3101.’’. 


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1 (3) OFFICE OF MINORITY HEALTH.—Section 

2 1707(g)(1) of the Public Health Service Act (42 

3 U.S.C. 300u–6(g)(1)) is amended by inserting ‘‘Mid4 dle Easterners and North Africans;’’ after 

5 ‘‘Blacks;’’. 

6 (4) OFFICE OF THE NATIONAL COORDINATOR

7 FOR HEALTH INFORMATION TECHNOLOGY.—Section 

8 3001 of the Public Health Service Act (42 U.S.C. 

9 300jj–11) is amended— 

10 (A) in subsection (b)— 

11 (i) in paragraph (10), by striking 

12 ‘‘and’’ at the end; 

13 (ii) in paragraph (11), by striking the 

14 period at the end and inserting ‘‘; and’’; 

15 and 

16 (iii) by adding at the end the fol17 lowing: 

18 ‘‘(12) ensures the interoperability of health in19 formation systems among federally conducted or 

20 supported health care or public health programs, 

21 State health agencies, and social service agencies.’’; 

22 and 

23 (B) by amending clause (vii) in subsection 

24 (c)(3)(A) to read as follows: 


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1 ‘‘(vii) Strategies to enhance the use of 

2 health information technology in improving 

3 the quality of health care; reducing medical 

4 errors; reducing health disparities and en5 suring the provision of equitable health 

6 services; improving public health; increas7 ing prevention and coordination with com8 munity resources; ensuring interoperability 

9 among federally conducted or supported 

10 health care or public health programs, 

11 State health agencies, and social service 

12 agencies; and improving the continuity of 

13 care among health care settings.’’. 

14 (5) DATA COLLECTION, ANALYSIS, AND QUAL15 ITY.—Section 3101 of the Public Health Service Act 

16 (42 U.S.C. 300kk) is amended— 

17 (A) in subsections (a)(1)(A), (a)(1)(C), 

18 (a)(2)(B), and (a)(2)(E), by striking ‘‘and dis19 ability status’’ and inserting ‘‘sexual orienta20 tion, gender identity, age, disability status, and 

21 socioeconomic status’’; 

22 (B) in subsection (a)(1), by amending sub23 paragraph (D) to read as follows: 

24 ‘‘(D) data for additional population groups 

25 if such groups can be aggregated into the data 


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1 collection standards described under paragraph 

2 (2).’’; 

3 (C) in subsection (a)(2)— 

4 (i) in subparagraph (C)— 

5 (I) in clause (i), by striking 

6 ‘‘and’’ at the end; 

7 (II) in clause (ii)— 

8 (aa) by striking ‘‘is a minor 

9 or legally incapacitated’’ and in10 serting ‘‘is a minor, requires as11 sistance with communication in 

12 speech or writing, or is legally in13 capacitated’’; and 

14 (bb) by striking the semi15 colon at the end and inserting ‘‘; 

16 and’’; and 

17 (III) by adding at the end the 

18 following: 

19 ‘‘(iii) collects data in a manner that is 

20 culturally and linguistically appropriate;’’; 

21 (ii) in subparagraph (D)(iii), by strik22 ing ‘‘and’’ at the end; 

23 (iii) in subparagraph (E), by striking 

24 the period at the end and inserting ‘‘; 

25 and’’; and 


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1 (iv) by adding at the end the fol2 lowing: 

3 ‘‘(F) use, where practicable, the standards 

4 developed by the Health and Medicine Division 

5 of the National Academies of Sciences, Engi6 neering, and Medicine (formerly known as the 

7 ‘Institute of Medicine’) in the 2009 publication 

8 titled ‘Race, Ethnicity, and Language Data: 

9 Standardization for Health Care Quality Im10 provement’.’’; and 

11 (6) in subsection (a)(3), by amending subpara12 graph (B) to read as follows: 

13 ‘‘(B) develop interoperability and security 

14 systems for data management among federally 

15 conducted or supported health care or public 

16 health programs, State health agencies, and so17 cial service agencies.’’. 

18 (b) COROLLARY PROVISIONS.— 

19 (1) RECOMMENDATIONS BY THE DATA COUN20 CIL.—The Data Council of the Department of 

21 Health and Human Services, in consultation with 

22 the Director of the National Center for Health Sta23 tistics, the Deputy Assistant Secretary for Minority 

24 Health, the Deputy Assistant Secretary for Women’s 

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1 care & Medicaid, the National Coordinator for 

2 Health Information Technology, and other appro3 priate public and private entities and officials, shall 

4 make recommendations to the Secretary of Health 

5 and Human Services concerning how to— 

6 (A) implement the amendments made by 

7 this section, while minimizing the cost and ad8 ministrative burdens of data collection and re9 porting on all parties, including patients and 

10 providers; 

11 (B) expand awareness among Federal 

12 agencies, States, territories, Indian Tribes, 

13 counties, municipalities, health providers, health 

14 plans, and the general public that data collec15 tion, analysis, and reporting by race, ethnicity, 

16 sex, primary language, sexual orientation, gen17 der identity, age, socioeconomic status, and dis18 ability status is legal and necessary to ensure 

19 equity and nondiscrimination in the quality of 

20 health care services; 

21 (C) ensure that future patient record sys22 tems follow Federal standards promulgated 

23 under the HITECH Act (42 U.S.C. 201 note) 

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1 mary language, sexual orientation, gender iden2 tity, age, socioeconomic status, and disability 

3 status; 

4 (D) improve health and health care data 

5 collection and analysis for more population 

6 groups if such groups can be aggregated into 

7 minimum race and ethnicity categories, includ8 ing exploring the feasibility of enhancing collec9 tion efforts in States, counties, and municipali10 ties for racial and ethnic groups that comprise 

11 a significant proportion of the population of the 

12 State, county, or municipality; 

13 (E) provide researchers with greater access 

14 to racial, ethnic, primary language, sex, sexual 

15 orientation, gender identity, age, socioeconomic 

16 status, and disability status data, subject to all 

17 applicable privacy and confidentiality require18 ments, including HIPAA privacy and security 

19 law as defined in section 3009(a) of the Public 

20 Health Service Act (42 U.S.C. 300jj–19(a)); 

21 (F) ensure the cultural and linguistic com22 petence of entities that receive Federal support 

23 to collect and report data pursuant to the 

24 amendments made by subsection (a); and 


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1 (G) safeguard and prevent the misuse of 

2 data collected under section 3101 of the Public 

3 Health Service Act (42 U.S.C. 300kk), as 

4 amended by subsection (a)(5). 

5 (2) RULES OF CONSTRUCTION.—Nothing in 

6 this section shall be construed to— 

7 (A) permit the use of information collected 

8 under this section or any provision amended by 

9 this section in a manner that would adversely 

10 affect any individual providing any such infor11 mation; or 

12 (B) diminish any requirements on health 

13 care providers to collect data, including such re14 quirements in effect on or after the date of en15 actment of this Act. 

16 (3) TECHNICAL ASSISTANCE FOR THE ANALYSIS

17 OF HEALTH DISPARITY DATA.—The Secretary of 

18 Health and Human Services, acting through the Di19 rector of the Agency for Healthcare Research and 

20 Quality, and in coordination with the Assistant Sec21 retary for Planning and Evaluation, the Adminis22 trator of the Centers for Medicare & Medicaid Serv23 ices, the Director of the National Center for Health 

24 Statistics, the Director of the National Institutes of 

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1 formation Technology, shall provide technical assist2 ance to agencies of the Department of Health and 

3 Human Services in meeting Federal standards for 

4 health disparity data collection and for analysis of 

5 racial, ethnic, and other disparities in health and 

6 health care in programs conducted or supported by 

7 such agencies by— 

8 (A) identifying appropriate quality assur9 ance mechanisms to monitor for health dispari10 ties; 

11 (B) specifying the clinical, diagnostic, or 

12 therapeutic measures which should be mon13 itored; 

14 (C) developing new quality measures relat15 ing to racial and ethnic disparities and their 

16 overlap with other disparity factors in health 

17 and health care; 

18 (D) identifying the level at which data 

19 analysis should be conducted; 

20 (E) sharing data with external organiza21 tions for research and quality improvement pur22 poses; and 

23 (F) identifying and addressing issues relat24 ing to the interoperability of Federal- and 

25 State-level health information systems which 


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1 undermine the ability of health-related pro2 grams collecting data under this section to 

3 achieve the purpose described in subsection 

4 (a)(1). 

5 (4) REFERENCES.—Except as otherwise speci6 fied, any reference to the term ‘‘racial and ethnic 

7 minority group’’ in any Federal regulation, guid8 ance, order, or document for establishment or imple9 mentation of any federally conducted or supported 

10 health care or public health program, activity, or 

11 survey shall be treated as having the definition given 

12 to such term in section 1707(g) of the Public Health 

13 Service Act (42 U.S.C. 300u–6(g)). 

14 (5) AUTHORIZATION OF APPROPRIATIONS.—To 

15 carry out this subsection, subsection (a), and the 

16 amendments made by subsection (a), there are au17 thorized to be appropriated such sums as may be 

18 necessary for each of fiscal years 2023 through 

19 2027. 

20 (c) ADDITIONS TO THE PUBLIC HEALTH SERVICE

21 ACT.—Title XXXIV of the Public Health Service Act, as 

22 added by titles II and III of this Act, is further amended 

23 by inserting after subtitle B the following: 


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1 ‘‘Subtitle C—Strengthening Data 

2 Collection, Improving Data 

3 Analysis, and Expanding Data 

4 Reporting 

5 ‘‘SEC. 3431. ESTABLISHING GRANTS FOR DATA COLLECTION 

6 IMPROVEMENT ACTIVITIES. 

7 ‘‘(a) IN GENERAL.—The Secretary, acting through 

8 the Director of the Agency for Healthcare Research and 

9 Quality and in consultation with the Deputy Assistant 

10 Secretary for Minority Health, the Director of the Na11 tional Institutes of Health, the Assistant Secretary for 

12 Planning and Evaluation, the National Coordinator for 

13 Health Information Technology, and the Director of the 

14 National Center for Health Statistics, shall establish a 

15 technical assistance program under which the Secretary 

16 provides grants to eligible entities to assist such entities 

17 in complying with section 3101. 

18 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided 

19 under this section may be used to— 

20 ‘‘(1) enhance or upgrade computer technology 

21 that will facilitate collection, analysis, and reporting 

22 of racial, ethnic, primary language, sexual orienta23 tion, sex, gender identity, socioeconomic status, and 

24 disability status data; 


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1 ‘‘(2) improve methods for health data collection 

2 and analysis, including additional population groups 

3 if such groups can be aggregated into the race and 

4 ethnicity categories outlined by standards developed 

5 under section 3101; 

6 ‘‘(3) develop mechanisms for submitting col7 lected data subject to any applicable privacy and 

8 confidentiality regulations; 

9 ‘‘(4) develop educational programs to inform 

10 health plans, health providers, health-related agen11 cies, and the general public that data collection and 

12 reporting by race, ethnicity, primary language, sex13 ual orientation, sex, gender identity, disability sta14 tus, and socioeconomic status are legal and essential 

15 for eliminating health and health care disparities; 

16 and 

17 ‘‘(5) develop educational programs to train 

18 health providers, health care organizations, health 

19 plans, health-related agencies, and frontline health 

20 care workers on how to collect and report 

21 disaggregated data in a culturally and linguistically 

22 appropriate manner. 

23 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 

24 under this section, an entity shall be a State, territory, 

25 Indian Tribe, municipality, county, health provider, health 


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1 care organization, or health plan making a demonstrated 

2 effort to bring data collections into compliance with sec3 tion 3101. 

4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

6 such sums as may be necessary for each of fiscal years 

7 2023 through 2027. 

8 ‘‘SEC. 3432. OVERSAMPLING OF UNDERREPRESENTED 

9 GROUPS IN FEDERAL HEALTH SURVEYS. 

10 ‘‘(a) NATIONAL STRATEGY.— 

11 ‘‘(1) IN GENERAL.—The Secretary, acting 

12 through the Director of the National Center for 

13 Health Statistics, and other officials within the De14 partment of Health and Human Services as the Sec15 retary determines appropriate, shall develop and im16 plement a sustainable national strategy for oversam17 pling underrepresented populations within the cat18 egories of race, ethnicity, sex, primary language, sex19 ual orientation, disability status, gender identity, 

20 and socioeconomic status as determined appropriate 

21 by the Secretary in Federal health surveys and pro22 gram data collections. Such national strategy shall 

23 include a strategy for oversampling of Middle East24 erners and North Africans, Asian Americans, Native 

25 Hawaiians, and Pacific Islanders. 


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1 ‘‘(2) CONSULTATION.—In developing and imple2 menting a national strategy, as described in para3 graph (1), not later than 180 days after the date of 

4 the enactment of this section, the Secretary shall— 

5 ‘‘(A) consult with representatives of com6 munity groups, nonprofit organizations, non7 governmental organizations, and government 

8 agencies working with underrepresented popu9 lations; 

10 ‘‘(B) solicit the participation of representa11 tives from other Federal departments and agen12 cies, including subagencies of the Department 

13 of Health and Human Services; and 

14 ‘‘(C) consult on, and use as models, the 

15 2014 National Health Interview Survey over16 sample of Native Hawaiian and Pacific Islander 

17 populations, the 2016 Behavioral Risk Factor 

18 Survey of Health Risk Behaviors Among Arab 

19 Adults Within the State of Michigan, and the 

20 2017 Behavioral Risk Factor Surveillance Sys21 tem oversample of American Indian and Alaska 

22 Native communities. 

23 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 

24 after the date of enactment of this section, the Secretary 

25 shall submit to the Congress a progress report, which shall 


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1 include the national strategy required by subsection 

2 (a)(1). 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this section, there are authorized to be appro5 priated such sums as may be necessary for fiscal years 

6 2023 through 2027.’’. 

7 SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT AP8 PROPRIATIONS FOR DATA COLLECTION AND 

9 ANALYSIS. 

10 Section 3101 of the Public Health Service Act (42 

11 U.S.C. 300kk), as amended by section 1001(a), is further 

12 amended— 

13 (1) by striking subsection (h); and 

14 (2) by redesignating subsection (i) as subsection 

15 (h). 

16 SEC. 1003. COLLECTION OF DATA FOR THE MEDICARE PRO17 GRAM. 

18 Part A of title XI of the Social Security Act (42 

19 U.S.C. 1301 et seq.) is amended by adding at the end 

20 the following: 

21 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM

22 ‘‘SEC. 1150D. 

23 ‘‘(a) REQUIREMENT.— 

24 ‘‘(1) IN GENERAL.—The Commissioner of So25 cial Security, in consultation with the Administrator 

26 of the Centers for Medicare & Medicaid Services, 


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1 shall collect data on the race, ethnicity, sex, primary 

2 language, sexual orientation, gender identity, socio3 economic status, and disability status of all appli4 cants for social security benefits under title II or 

5 Medicare benefits under title XVIII. 

6 ‘‘(2) DATA COLLECTION STANDARDS.—In col7 lecting data under paragraph (1), the Commissioner 

8 of Social Security shall at least use the standards 

9 for data collection developed under section 3101 of 

10 the Public Health Service Act or the standards de11 veloped by the Office of Management and Budget, 

12 whichever is more disaggregated. In the event there 

13 are no standards for the demographic groups listed 

14 under paragraph (1), the Commissioner shall consult 

15 with stakeholder groups representing the various 

16 identities as well as with the Office of Minority 

17 Health within the Centers for Medicare & Medicaid 

18 Services to develop appropriate standards. 

19 ‘‘(3) DATA FOR ADDITIONAL POPULATION

20 GROUPS.—Where practicable, the information col21 lected by the Commissioner of Social Security under 

22 paragraph (1) shall include data for additional popu23 lation groups if such groups can be aggregated into 

24 the race and ethnicity categories outlined by the 

25 data collection standards described in paragraph (2). 


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1 ‘‘(4) COLLECTION OF DATA FOR MINORS AND

2 LEGALLY INCAPACITATED INDIVIDUALS.—With re3 spect to the collection of the data described in para4 graph (1) of applicants who are under 18 years of 

5 age or otherwise legally incapacitated, the Commis6 sioner of Social Security shall require that— 

7 ‘‘(A) such data be collected from the par8 ent or legal guardian of such an applicant; and 

9 ‘‘(B) the primary language of the parent 

10 or legal guardian of such an applicant or recipi11 ent be used in collecting the data. 

12 ‘‘(5) QUALITY OF DATA.—The Commissioner of 

13 Social Security shall periodically review the quality 

14 and completeness of the data collected under para15 graph (1) and make adjustments as necessary to im16 prove both. 

17 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll18 ment in Medicare benefits under title XVIII, the 

19 Commissioner of Social Security shall transmit an 

20 individual’s demographic data as collected under 

21 paragraph (1) to the Centers for Medicare & Med22 icaid Services. 

23 ‘‘(7) ANALYSIS AND REPORTING OF DATA.— 

24 With respect to data transmitted under paragraph 

25 (5), the Administrator of the Centers for Medicare 


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1 & Medicaid Services, in consultation with the Com2 missioner of Social Security, shall— 

3 ‘‘(A) require that such data be uniformly 

4 analyzed and that such analysis be reported at 

5 least annually to Congress; 

6 ‘‘(B) incorporate such data in other anal7 ysis and reporting on health disparities and the 

8 provision of inequitable health care services by 

9 a health care provider, as appropriate; 

10 ‘‘(C) make such data available to research11 ers, under the protections outlined in paragraph 

12 (7); 

13 ‘‘(D) provide opportunities to individuals 

14 enrolled in Medicare to submit updated data; 

15 and 

16 ‘‘(E) ensure that the provision of assist17 ance or benefits to an applicant is not denied 

18 or otherwise adversely affected because of the 

19 failure of the applicant to provide any of the 

20 data collected under paragraph (1). 

21 ‘‘(8) PROTECTION OF DATA.—The Commis22 sioner of Social Security shall ensure (through the 

23 promulgation of regulations or otherwise) that all 

24 data collected pursuant to subsection (a) is pro25 tected— 


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1 ‘‘(A) under the same privacy protections as 

2 the Secretary applies to health data under the 

3 regulations promulgated under section 264(c) of 

4 the Health Insurance Portability and Account5 ability Act of 1996 (relating to the privacy of 

6 individually identifiable health information and 

7 other protections); and 

8 ‘‘(B) from all inappropriate internal use by 

9 any entity that collects, stores, or receives the 

10 data, including use of such data in determina11 tions of eligibility (or continued eligibility) in 

12 health plans, and from other inappropriate 

13 uses, as defined by the Secretary. 

14 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec15 tion shall be construed to permit the use of information 

16 collected under this section in a manner that would ad17 versely affect any individual providing any such informa18 tion. 

19 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary of 

20 Health and Human Services may, either directly or by 

21 grant or contract, provide technical assistance to enable 

22 any entity to comply with the requirements of this section 

23 or with regulations implementing this section. 

24 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section 


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1 $500 million for 2022 and $100 million for each fiscal 

2 year thereafter.’’. 

3 SEC. 1004. REVISION OF HIPAA CLAIMS STANDARDS. 

4 (a) IN GENERAL.—Not later than 1 year after the 

5 date of enactment of this Act, the Secretary of Health and 

6 Human Services shall revise the regulations promulgated 

7 under part C of title XI of the Social Security Act (42 

8 U.S.C. 1320d et seq.) (relating to the collection of data 

9 on demographics in a health-related transaction) to re10 quire— 

11 (1) the use, at a minimum, of standards for 

12 data collection on race, ethnicity, sex, primary lan13 guage, sexual orientation, gender identity, age, dis14 ability status, and socioeconomic status developed 

15 under section 3101 of the Public Health Service Act 

16 (42 U.S.C. 300kk), as amended by section 

17 1001(a)(5); and 

18 (2) in consultation with the Office of the Na19 tional Coordinator for Health Information Tech20 nology, the designation of the appropriate racial, 

21 ethnic, primary language, disability, sex, and other 

22 code sets as required for claims and enrollment data. 

23 (b) DISSEMINATION.—The Secretary of Health and 

24 Human Services shall disseminate the new standards de25 veloped under subsection (a) to all entities that are subject 


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1 to the regulations described in such subsection and provide 

2 technical assistance with respect to the collection of the 

3 data involved. 

4 (c) COMPLIANCE.—The Secretary of Health and 

5 Human Services shall require that entities comply with the 

6 new standards developed under subsection (a) not later 

7 than 2 years after the final promulgation of such stand8 ards. 

9 SEC. 1005. NATIONAL CENTER FOR HEALTH STATISTICS. 

10 Section 306(n) of the Public Health Service Act (42 

11 U.S.C. 242k(n)) is amended— 

12 (1) in paragraph (1), by striking ‘‘2003’’ and 

13 inserting ‘‘2024’’; 

14 (2) in paragraph (2), in the first sentence, by 

15 striking ‘‘2003’’ and inserting ‘‘2024’’; and 

16 (3) in paragraph (3), by striking ‘‘2002’’ and 

17 inserting ‘‘2024’’. 

18 SEC. 1006. DISPARITIES DATA COLLECTED BY THE FED19 ERAL GOVERNMENT. 

20 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec21 retary of Health and Human Services, in coordination 

22 with the officials referenced in subsection (b), shall estab23 lish a centralized electronic repository of Federal Govern24 ment data on factors related to the health and well-being 

25 of the population of the United States. 


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1 (b) COLLECTION; SUBMISSION.—Not later than 180 

2 days after the date of enactment of this Act, and January 

3 31 of each year thereafter, each department, agency, and 

4 office of the Federal Government that has collected data 

5 on race, ethnicity, sex, primary language, sexual orienta6 tion, gender identity, age, disability status, or socio7 economic status during the preceding calendar year shall 

8 submit such data to the repository of Federal Government 

9 data established under subsection (a). 

10 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 

11 Not later than April 30, 2021, and April 30 of each year 

12 thereafter, the Secretary of Health and Human Services, 

13 acting through the Assistant Secretary for Planning and 

14 Evaluation, the Assistant Secretary for Health, the Direc15 tor of the Agency for Healthcare Research and Quality, 

16 the Director of the National Center for Health Statistics, 

17 the Administrator of the Centers for Medicare & Medicaid 

18 Services, the Director of the National Institute on Minor19 ity Health and Health Disparities, and the Deputy Assist20 ant Secretary for Minority Health, shall— 

21 (1) prepare and make available datasets for 

22 public use that relate to disparities in health status, 

23 health care access, health care quality, health out24 comes, public health, the provision of equitable 

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1 being by factors that include race, ethnicity, sex, pri2 mary language, sexual orientation, gender identity, 

3 disability status, and socioeconomic status; 

4 (2) ensure that these datasets are publicly iden5 tified on the repository established under subsection 

6 (a) as ‘‘disparities’’ data; and 

7 (3) submit a report to the Congress on the 

8 availability and use of such data by public stake9 holders. 

10 SEC. 1007. DATA COLLECTION AND ANALYSIS GRANTS TO 

11 MINORITY-SERVING INSTITUTIONS. 

12 (a) AUTHORITY.—The Secretary of Health and 

13 Human Services, acting through the Director of the Na14 tional Institute on Minority Health and Health Disparities 

15 and the Deputy Assistant Secretary for Minority Health, 

16 shall award grants to eligible entities to access and analyze 

17 racial and ethnic data on disparities in health and health 

18 care, and where possible other data on disparities in health 

19 and health care, to monitor and report on progress to re20 duce and eliminate disparities in health and health care. 

21 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el22 igible entity’’ means an entity that has an accredited pub23 lic health, health policy, or health services research pro24 gram and is any of the following: 


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1 (1) A part B institution, as defined in section 

2 322 of the Higher Education Act of 1965 (20 

3 U.S.C. 1061). 

4 (2) A Hispanic-serving institution, as defined in 

5 section 502 of such Act (20 U.S.C. 1101a). 

6 (3) A Tribal College or University, as defined in 

7 section 316 of such Act (20 U.S.C. 1059c). 

8 (4) An Asian American and Native American 

9 Pacific Islander-serving institution, as defined in 

10 section 371(c) of such Act (20 U.S.C. 1067q(c)). 

11 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

12 out this section, there are authorized to be appropriated 

13 such sums as may be necessary for fiscal years 2023 

14 through 2027. 

15 SEC. 1008. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

16 RESPECT TO RACIAL AND ETHNIC BACK17 GROUND. 

18 (a) IN GENERAL.—Chapter V of the Federal Food, 

19 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend20 ed by inserting after section 505G (21 U.S.C. 355h) the 

21 following: 


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1 ‘‘SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

2 RESPECT TO RACIAL AND ETHNIC BACK3 GROUND. 

4 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence of 

5 a racial or ethnic disparity in safety or effectiveness with 

6 respect to a drug or biological product, then— 

7 ‘‘(1)(A) in the case of a drug, the investigations 

8 required under section 505(b)(1)(A) shall include 

9 adequate and well-controlled investigations of the 

10 disparity; or 

11 ‘‘(B) in the case of a biological product, the evi12 dence required under section 351(a) of the Public 

13 Health Service Act for approval of a biologics license 

14 application for the biological product shall include 

15 adequate and well-controlled investigations of the 

16 disparity; and 

17 ‘‘(2) if the investigations described in subpara18 graph (A) or (B) of paragraph (1) confirm that 

19 there is such a disparity, the labeling of the drug or 

20 biological product shall include appropriate informa21 tion about the disparity. 

22 ‘‘(b) POSTMARKET STUDIES.— 

23 ‘‘(1) IN GENERAL.—If there is evidence of a ra24 cial or ethnic disparity in safety or effectiveness with 

25 respect to a drug for which there is an approved ap26 plication under section 505 of this Act or of a bioVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 logical product for which there is an approved li2 cense under section 351 of the Public Health Service 

3 Act, the Secretary may by order require the holder 

4 of the approved application or license to conduct, by 

5 a date specified by the Secretary, postmarket studies 

6 to investigate the disparity. 

7 ‘‘(2) LABELING.—If the Secretary determines 

8 that the postmarket studies confirm that there is a 

9 disparity described in paragraph (1), the labeling of 

10 the drug or biological product shall include appro11 priate information about the disparity. 

12 ‘‘(3) STUDY DESIGN.—The Secretary may, in 

13 an order under paragraph (1), specify all aspects of 

14 the design of the postmarket studies required under 

15 such paragraph for a drug or biological product, in16 cluding the number of studies and study partici17 pants, and the other demographic characteristics of 

18 the study participants. 

19 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 

20 Secretary may, by order and as necessary, modify 

21 any aspect of the design of a postmarket study re22 quired in an order under paragraph (1) after issuing 

23 such order. 

24 ‘‘(5) STUDY RESULTS.—The results from a 

25 study required under paragraph (1) shall be subVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 mitted to the Secretary as a supplement to the drug 

2 application or biologics license application. 

3 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 

4 ‘‘(1) IN GENERAL.—A drug for which an appli5 cation has been submitted or approved under section 

6 505(j) shall not be considered ineligible for approval 

7 under that section or misbranded under section 502 

8 on the basis that the labeling of the drug omits in9 formation relating to a disparity on the basis of ra10 cial or ethnic background as to the safety or effec11 tiveness of the drug, whether derived from investiga12 tions or studies required under this section or de13 rived from other sources, when the omitted informa14 tion is protected by patent or by exclusivity under 

15 section 505(j)(5)(F). 

16 ‘‘(2) LABELING.—Notwithstanding paragraph 

17 (1), the Secretary may require that the labeling of 

18 a drug approved under section 505(j) that omits in19 formation relating to a disparity on the basis of ra20 cial or ethnic background as to the safety or effec21 tiveness of the drug include a statement of any ap22 propriate contraindications, warnings, or precautions 

23 related to the disparity that the Secretary considers 

24 necessary. 


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1 ‘‘(d) DEFINITION.—In this section, the term ‘evi2 dence of a racial or ethnic disparity in safety or effective3 ness’, with respect to a drug or biological product, in4 cludes— 

5 ‘‘(1) evidence that there is a disparity on the 

6 basis of racial or ethnic background as to safety or 

7 effectiveness of a drug or biological product in the 

8 same chemical class as the drug or biological prod9 uct; 

10 ‘‘(2) evidence that there is a disparity on the 

11 basis of racial or ethnic background in the way the 

12 drug or biological product is metabolized; and 

13 ‘‘(3) other evidence as the Secretary may deter14 mine appropriate.’’. 

15 (b) ENFORCEMENT.—Section 502 of the Federal 

16 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend17 ed by adding at the end the following: 

18 ‘‘(gg) If it is a drug and the holder of the approved 

19 application under section 505 or license under section 351 

20 of the Public Health Service Act for the drug has failed 

21 to complete the investigations or studies required under 

22 section 505H, or comply with any other requirement of 

23 such section 505H.’’. 

24 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 

25 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 


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1 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 

2 required’’ the following: ‘‘, including postmarket studies 

3 required under section 505H,’’. 

4 SEC. 1009. IMPROVING HEALTH DATA REGARDING NATIVE 

5 HAWAIIANS AND PACIFIC ISLANDERS. 

6 Part B of title III of the Public Health Service Act 

7 (42 U.S.C. 243 et seq.) is amended by inserting after sec8 tion 317U the following: 

9 ‘‘SEC. 317V. NATIVE HAWAIIAN AND PACIFIC ISLANDER 

10 HEALTH DATA. 

11 ‘‘(a) DEFINITIONS.—In this section: 

12 ‘‘(1) INSULAR AREA.—The term ‘insular area’ 

13 means Guam, the Commonwealth of the Northern 

14 Mariana Islands, American Samoa, the United 

15 States Virgin Islands, the Federated States of Mi16 cronesia, the Republic of Palau, or the Republic of 

17 the Marshall Islands. 

18 ‘‘(2) NATIVE HAWAIIANS AND PACIFIC ISLAND19 ERS (NHPI).—The term ‘Native Hawaiians and Pa20 cific Islanders’ or ‘NHPI’ means people having ori21 gins in any of the original peoples of American 

22 Samoa, the Commonwealth of the Northern Mariana 

23 Islands, the Federated States of Micronesia, Guam, 

24 Hawaii, the Republic of the Marshall Islands, the 

25 Republic of Palau, or any other Pacific Island. 


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1 ‘‘(3) NHPI STAKEHOLDER GROUPS.—The term 

2 ‘NHPI stakeholder group’ includes each of the fol3 lowing: 

4 ‘‘(A) COMMUNITY GROUP.—A group of 

5 NHPI who are organized at the community 

6 level, and may include a church group, social 

7 service group, national advocacy organization, 

8 or cultural group. 

9 ‘‘(B) NONPROFIT, NONGOVERNMENTAL

10 ORGANIZATION.—A group of NHPI with a dem11 onstrated history of addressing NHPI issues, 

12 including a NHPI coalition. 

13 ‘‘(C) DESIGNATED ORGANIZATION.—An 

14 entity established to represent NHPI popu15 lations and which has statutory responsibilities 

16 to provide, or has community support for pro17 viding, health care. 

18 ‘‘(D) GOVERNMENT REPRESENTATIVES OF

19 NHPI POPULATIONS.—Representatives from Ha20 waii, American Samoa, the Commonwealth of 

21 the Northern Mariana Islands, the Federated 

22 States of Micronesia, Guam, the Republic of 

23 Palau, and the Republic of the Marshall Is24 lands. 

25 ‘‘(b) PRELIMINARY HEALTH SURVEY.— 


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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Director of the National Center for 

3 Health Statistics of the Centers for Disease Control 

4 and Prevention (referred to in this section as 

5 ‘NCHS’), shall conduct a preliminary health survey 

6 in order to identify the major areas and regions in 

7 the continental United States, Hawaii, American 

8 Samoa, the Commonwealth of the Northern Mariana 

9 Islands, the Federated States of Micronesia, Guam, 

10 the Republic of Palau, and the Republic of the Mar11 shall Islands in which NHPI people reside. 

12 ‘‘(2) CONTENTS.—The health survey described 

13 in paragraph (1) shall include health data and any 

14 other data the Secretary determines to be— 

15 ‘‘(A) useful in determining health status 

16 and health care needs of NHPI populations; or 

17 ‘‘(B) required for developing or imple18 menting the national strategy under subsection 

19 (c). 

20 ‘‘(3) METHODOLOGY.—Methodology for the 

21 health survey described in paragraph (1), including 

22 plans for designing questions, implementation, sam23 pling, and analysis, shall be developed in consulta24 tion with NHPI stakeholder groups. 


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1 ‘‘(4) TIMEFRAME.—The survey required under 

2 this subsection shall be completed not later than 18 

3 months after the date of enactment of the Health 

4 Equity and Accountability Act of 2022. 

5 ‘‘(c) NATIONAL STRATEGY.— 

6 ‘‘(1) IN GENERAL.—The Secretary, acting 

7 through the Director of the NCHS and other agen8 cies within the Department of Health and Human 

9 Services as the Secretary determines appropriate, 

10 shall develop and implement a sustainable national 

11 strategy for identifying and evaluating the health 

12 status and health care needs of NHPI populations 

13 living in the continental United States, Hawaii, 

14 American Samoa, the Commonwealth of the North15 ern Mariana Islands, the Federated States of Micro16 nesia, Guam, the Republic of Palau, and the Repub17 lic of the Marshall Islands. 

18 ‘‘(2) CONSULTATION.—In developing and imple19 menting a national strategy, as described in para20 graph (1), not later than 180 days after the date of 

21 enactment of the Health Equity and Accountability 

22 Act of 2022, the Secretary— 

23 ‘‘(A) shall consult with representatives of 

24 NHPI stakeholder groups; and 


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1 ‘‘(B) may solicit the participation of rep2 resentatives from other Federal agencies. 

3 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 

4 after the date of enactment of the Health Equity and Ac5 countability Act of 2022, the Secretary shall submit to 

6 Congress a progress report, which shall include the na7 tional strategy described in subsection (c)(1). 

8 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND

9 MEDICINE DIVISION.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall seek to 

11 enter into an agreement with the Health and Medi12 cine Division of the National Academies of Sciences, 

13 Engineering, and Medicine to conduct a study, with 

14 input from stakeholders in insular areas, on each of 

15 the following: 

16 ‘‘(A) The standards and definitions of 

17 health care applied to health care systems in in18 sular areas and the appropriateness of such 

19 standards and definitions. 

20 ‘‘(B) The status and performance of health 

21 care systems in insular areas, evaluated based 

22 upon standards and definitions, as the Sec23 retary determines appropriate. 


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1 ‘‘(C) The effectiveness of donor aid in ad2 dressing health care needs and priorities in in3 sular areas. 

4 ‘‘(D) The progress toward implementation 

5 of recommendations of the Committee on 

6 Health Care Services in the United States—As7 sociated Pacific Basin that are set forth in the 

8 1998 report entitled ‘Pacific Partnerships for 

9 Health: Charting a New Course’. 

10 ‘‘(2) REPORT.—An agreement described in 

11 paragraph (1) shall require the Health and Medicine 

12 Division to submit to the Secretary and to Congress, 

13 not later than 2 years after the date of the enact14 ment of the Health Equity and Accountability Act of 

15 2022, a report containing a description of the results 

16 of the study conducted under paragraph (1), includ17 ing the conclusions and recommendations of the 

18 Health and Medicine Division for each of the items 

19 described in subparagraphs (A) through (D) of such 

20 paragraph. 

21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 

22 carry out this section, there are authorized to be appro23 priated such sums as may be necessary for fiscal years 

24 2023 through 2027.’’. 


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1 SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRA2 TIVE REPORTING REQUIREMENT. 

3 Section 11(a) of the Food and Nutrition Act of 2008 

4 (7 U.S.C. 2020(a)) is amended by adding at the end the 

5 following: 

6 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING

7 REQUIREMENT.—With respect to any obligation of a 

8 State agency to comply with the notification require9 ment under paragraph (2) of section 421(e) of the 

10 Personal Responsibility and Work Opportunity Rec11 onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith12 standing the requirement to include in that notifica13 tion the names of the sponsor and the sponsored 

14 alien involved, the State agency shall be considered 

15 to have complied with the notification requirement if 

16 the State agency submits to the Attorney General a 

17 report that includes the aggregate number of excep18 tions granted by the State agency under paragraph 

19 (1) of that section.’’. 

20 SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PRE21 PAREDNESS, TESTING, INFECTIONS, AND 

22 DEATHS. 

23 (a) SKILLED NURSING FACILITIES QUALITY RE24 PORTING.—Section 1819 of the Social Security Act (42 

25 U.S.C. 1395i–3) is amended by adding at the end the fol26 lowing new subsection: 


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1 ‘‘(l) REQUIREMENTS RELATING TO REPORTING DUR2 ING PUBLIC HEALTH EMERGENCIES.—During a public 

3 health emergency declared by the Secretary pursuant to 

4 section 319 of the Public Health Service Act, a skilled 

5 nursing facility shall, not later than one year after the first 

6 day of such declaration, and monthly thereafter during the 

7 application of such declaration, submit to the Secretary 

8 the following information, with respect to such facility and 

9 the residents of such facility: 

10 ‘‘(1) Information described in section 

11 483.80(g)(1) of title 42, Code of Federal Regula12 tions. 

13 ‘‘(2) The age, race, ethnicity, sex, sexual ori14 entation, gender identity, socioeconomic status, dis15 ability status, and preferred language of the resi16 dents of such skilled nursing facility.’’. 

17 (b) TRANSPARENCY OF DEMOGRAPHIC INFORMATION

18 IN CERTAIN SETTINGS.— 

19 (1) DEMOGRAPHIC INFORMATION.—The Sec20 retary of Health and Human Services shall post the 

21 following information with respect to skilled nursing 

22 facilities (as defined in section 1819(a) of the Social 

23 Security Act (42 U.S.C. 1395i–3(a))), congregate 

24 care settings (including skilled nursing facilities, as25 sisted living facilities, prisons and jails, residential 


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1 behavioral health care and psychiatric facilities, and 

2 facilities providing services for aging adults and peo3 ple with disabilities), and nursing facilities (as de4 fined in section 1919(a) of such Act (42 U.S.C. 

5 1396r(a))) on the Nursing Home Compare website 

6 (as described in section 1819(i) of the Social Secu7 rity Act (42 U.S.C. 1395i–3(i))), or a successor 

8 website, aggregated by State: 

9 (A) The age, race, ethnicity, sex, sexual 

10 orientation, gender identity, socioeconomic sta11 tus, disability status, and preferred language of 

12 the residents of such skilled nursing facilities, 

13 congregate care settings (including skilled nurs14 ing facilities, assisted living facilities, prisons 

15 and jails, residential behavioral health care and 

16 psychiatric facilities, and facilities providing 

17 services for aging adults and people with dis18 abilities), and nursing facilities with suspected 

19 or confirmed infections, including residents pre20 viously treated for COVID–19. 

21 (B) The age, race, ethnicity, sex, sexual 

22 orientation, gender identity, socioeconomic sta23 tus, disability status, and preferred language 

24 relating to total deaths and public health emer25 gency-related deaths among residents of such 


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1 skilled nursing facilities, congregate settings 

2 (including skilled nursing facilities, assisted liv3 ing facilities, prisons and jails, residential be4 havioral health care and psychiatric facilities, 

5 and facilities providing services for aging adults 

6 and people with disabilities), and nursing facili7 ties. 

8 (2) CONFIDENTIALITY.—Any information re9 ported under this subsection that is made available 

10 to the public shall be made so available in a manner 

11 that protects the identity of residents of skilled nurs12 ing facilities, congregate care settings (including 

13 skilled nursing facilities, assisted living facilities, 

14 prisons and jails, residential behavioral health care 

15 and psychiatric facilities, and facilities providing 

16 services for aging adults and people with disabil17 ities), and nursing facilities. 

18 (3) IMPLEMENTATION.—Notwithstanding any 

19 other provision of law, the Secretary of Health and 

20 Human Services may implement the provisions of 

21 this subsection by program instruction or otherwise. 

22 (c) EQUITABLE DATA COLLECTION AND DISCLOSURE

23 REGARDING PANDEMICS.—Part A of title XI of the Social 

24 Security Act (42 U.S.C. 1301 et seq.) as amended by secVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tion 1003, is further amended by adding at the end the 

2 following new section: 

3 ‘‘SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLO4 SURE REGARDING PANDEMICS. 

5 ‘‘(a) IN GENERAL.—Not later than 60 days after the 

6 Secretary submits to Congress written notification of the 

7 determination that a disease or disorder presents a public 

8 health emergency or that a public health emergency other9 wise exists, subject to the succeeding subsections, the Sec10 retary, acting through the Director of the Centers for Dis11 ease Control and Prevention and the Administrator of the 

12 Centers for Medicare & Medicaid Services and in consulta13 tion with the Director of the Indian Health Service, shall 

14 collect and make publicly available on the website of the 

15 Centers for Disease Control and Prevention and the Cen16 ters for Medicare & Medicaid Services, and update every 

17 day during a pandemic, data collected across all surveil18 lance systems relating to a public health emergency de19 clared under section 319 of the Public Health Service Act 

20 that is caused by a disease (as determined by the Sec21 retary), disaggregated by race, ethnicity, sex, sexual ori22 entation, gender identity, age, preferred language, socio23 economic status, disability status, and county, including 

24 the following: 


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1 ‘‘(1) Data relating to all testing for the patho2 gen or pathogens causing the pandemic, including 

3 the number of individuals tested and the number of 

4 tests that were positive. 

5 ‘‘(2) Data relating to treatment for the patho6 gen causing the pandemic, including hospitalizations 

7 and intensive care unit admissions. 

8 ‘‘(3) Data relating to pandemic outcomes, in9 cluding total fatalities and case fatality rates (ex10 pressed as the proportion of individuals who were in11 fected with the pathogen causing the pandemic and 

12 died from the pathogen). 

13 ‘‘(4) In the case a vaccine is developed in re14 sponse to a pandemic, data relating to such vaccina15 tion, including— 

16 ‘‘(A) the number of vaccines administered; 

17 ‘‘(B) the number of vaccinations offered, 

18 accepted, and refused; 

19 ‘‘(C) the most common reasons for refusal; 

20 and 

21 ‘‘(D) the percentage of vaccine doses allo22 cated and administered to each priority group. 

23 ‘‘(b) APPLICATION OF CERTAIN STANDARDS WITH

24 RESPECT TO DATA COLLECTION.—To the extent prac25 ticable, data collected under subsection (a) shall follow 


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1 standards developed by the Department of Health and 

2 Human Services Office of Minority Health and be col3 lected, analyzed, and reported in accordance with the 

4 standards promulgated by the Assistant Secretary for 

5 Planning and Evaluation under title XXXI of the Public 

6 Health Service Act. 

7 ‘‘(c) PRIVACY.—In publishing data pursuant to sub8 section (a), the Secretary shall take all necessary steps to 

9 protect the privacy of individuals whose information is in10 cluded in such data, including— 

11 ‘‘(1) complying with privacy protections pro12 vided under the regulations promulgated under sec13 tion 264(c) of the Health Insurance and Account14 ability Act of 1996; and 

15 ‘‘(2) protections from all inappropriate internal 

16 use by an entity that collects, stores, or receives the 

17 data, including use of such data in determinations of 

18 eligibility (or continued eligibility) in health plans, 

19 and from inappropriate uses.’’. 

20 (d) REPORT REQUIREMENTS FOLLOWING PUBLIC

21 HEALTH EMERGENCIES.— 

22 (1) PUBLICLY AVAILABLE SUMMARY.—Not later 

23 than 60 days after the date on which the Secretary 

24 of Health and Human Services certifies that a public 

25 health emergency declared under section 319 of the 


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1 Public Health Service Act has ended, the Secretary 

2 shall make publicly available on the website of the 

3 Department of Health and Human Services a sum4 mary of the final statistics related to such emer5 gency. 

6 (2) REPORT TO CONGRESS.—Not later than 60 

7 days after the date on which the Secretary of Health 

8 and Human Services certifies that a public health 

9 emergency declared under section 319 of the Public 

10 Health Service Act has ended, the Secretary shall 

11 submit to the Committee on Health, Education, 

12 Labor, and Pensions and the Committee on Finance 

13 of the Senate and the Committee on Energy and 

14 Commerce and the Committee on Ways and Means 

15 of the House of Representatives a report— 

16 (A) describing the testing, hospitalization, 

17 mortality rates, vaccination rates, and preferred 

18 language of patients associated with the pan19 demic by race and ethnicity, rural and urban 

20 areas (as defined in section 1886(d)(2)(D) of 

21 the Social Security Act (42 U.S.C. 

22 1395ww(d)(2)(D)), and congregate care set23 tings (including skilled nursing facilities, as24 sisted living facilities, prisons and jails, residen25 tial behavioral health care and psychiatric faciliVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ties, and facilities providing services for aging 

2 adults and people with disabilities) and noncon3 gregate care settings (as such terms are defined 

4 by the Secretary); and 

5 (B) proposing evidenced-based response 

6 strategies to safeguard the health of these com7 munities in future pandemics. 

8 SEC. 1012. COMMISSION ON ENSURING DATA FOR HEALTH 

9 EQUITY. 

10 (a) IN GENERAL.—Not later than 30 days after the 

11 date of enactment of this Act, the Secretary of Health and 

12 Human Services (referred to in this section as the ‘‘Sec13 retary’’) shall establish a commission, to be known as the 

14 ‘‘Commission on Ensuring Data for Health Equity’’ (re15 ferred to in this section as the ‘‘Commission’’) to provide 

16 clear and robust guidance to improve the collection, anal17 ysis, and use of demographic data in responding to future 

18 public health emergencies. 

19 (b) MEMBERSHIP AND CHAIRPERSON.— 

20 (1) MEMBERSHIP.—The Commission shall be 

21 composed of— 

22 (A) the Assistant Secretary for Prepared23 ness and Response; 

24 (B) the Director of the Centers for Disease 

25 Control and Prevention; 


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1 (C) the Director of the National Institutes 

2 of Health; 

3 (D) the Commissioner of Food and Drugs; 

4 (E) the Administrator of the Federal 

5 Emergency Management Agency; 

6 (F) the Director of the National Institute 

7 on Minority Health and Health Disparities; 

8 (G) the Director of the Indian Health 

9 Service; 

10 (H) the Administrator of the Centers for 

11 Medicare & Medicaid Services; 

12 (I) the Director of the Agency for 

13 Healthcare Research and Quality; 

14 (J) the Surgeon General; 

15 (K) the Administrator of the Health Re16 sources and Services Administration; 

17 (L) the Director of the Office of Minority 

18 Health; 

19 (M) the Director of the Office of Women’s 

20 Health; 

21 (N) the Chairperson of the National Coun22 cil on Disability; 

23 (O) at least 4 State, local, territorial, and 

24 Tribal public health officials representing de25 partments of public health, or an Urban Indian 


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1 health representative, who shall represent juris2 dictions from different regions of the United 

3 States with relatively high concentrations of 

4 historically marginalized populations and rural 

5 populations, to be appointed by the Secretary; 

6 (P) the National Coordinator for Health 

7 Information Technology; 

8 (Q) at least 3 independent individuals with 

9 expertise on racially and ethnically diverse rep10 resentation with knowledge or field experience 

11 with community-based participatory research on 

12 racial and ethnic disparities in public health, to 

13 be appointed by the Secretary; and 

14 (R) at least 4 individuals with expertise on 

15 health equity and demographic data disparities 

16 with knowledge of, or field experience in, lan17 guage, disability status, sex, sexual orientation, 

18 gender identity, or socioeconomic status. 

19 (2) CHAIRPERSON.—The Assistant Secretary 

20 for Preparedness and Response shall serve as the 

21 Chairperson of the Commission. 

22 (c) DUTIES.—The Commission shall— 

23 (1) examine barriers to collecting, analyzing, 

24 and using demographic data in public health; 


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1 (2) determine how to best use such data to pro2 mote health equity across the United States and re3 duce racial, Tribal, and other demographic dispari4 ties in health outcomes; 

5 (3)(A) gather available data related to treat6 ment of individuals with disabilities during the 

7 COVID–19 pandemic and other public health emer8 gencies, including access to vaccinations, denial of 

9 treatment for preexisting conditions, removal or de10 nial of disability related equipment (including ven11 tilators and continuous positive airway pressure 

12 (commonly referred to as ‘‘CPAP’’) machines), and 

13 data on completion of do-not-resuscitate orders; and 

14 (B) identify barriers to obtaining accurate and 

15 timely data related to treatment of such individuals; 

16 (4) solicit input from public health officials, 

17 community-connected organizations, health care pro18 viders, State and local agency officials, Tribal offi19 cials, and other experts on barriers to, and best 

20 practices for, collecting demographic data; and 

21 (5) recommend policy changes that the data in22 dicates are necessary to reduce demographic dispari23 ties in health outcomes. 

24 (d) REPORT.—Not later than 1 year after the date 

25 of the enactment of this Act, the Commission shall submit 


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1 to Congress, and publish on the website of the Department 

2 of Health and Human Services, a report containing— 

3 (1) the findings of the Commission pursuant to 

4 subsection (c); 

5 (2) to the extent possible, an analysis of— 

6 (A) racial and other demographic dispari7 ties in COVID–19 mortality, including an anal8 ysis of comorbidities and case fatality rates; 

9 (B) sex, sexual orientation, and gender 

10 identity disparities in COVID–19 treatment and 

11 mortality; and 

12 (C) Federal Government policies that dis13 parately exacerbate the COVID–19 impact, and 

14 recommendations to improve racial and other 

15 demographic disparities in health outcomes; 

16 (3) an analysis of COVID–19 treatment of indi17 viduals with disabilities, including equity of access to 

18 treatment and equipment and intersections of dis19 ability status with other demographic factors, includ20 ing race; 

21 (4) an analysis of what demographic data is 

22 currently being collected, the accuracy of that data 

23 and any gaps, how this data is currently being used 

24 to inform efforts to combat COVID–19, and what 


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1 resources are needed to supplement existing public 

2 health data collection; and 

3 (5) the Commission’s recommendations with re4 spect to— 

5 (A) how to enhance State, local, territorial, 

6 and Tribal capacity to conduct public health re7 search on COVID–19 and in future public 

8 health emergencies, with a focus on expanded 

9 capacity to analyze data on disparities cor10 related with race, ethnicity, income, sex, sexual 

11 orientation, gender identity, age, disability sta12 tus, specific geographic areas, and other rel13 evant demographic characteristics; 

14 (B) how to collect, process, and disclose to 

15 the public the data described in subparagraph 

16 (A) in a way that maintains individual privacy 

17 while helping direct the State, local, and Tribal 

18 response to public health emergencies; 

19 (C) how to improve demographic data col20 lection related to COVID–19 and other public 

21 health emergencies in the short-term and long22 term, including how to continue to grow and 

23 value the Tribal sovereignty of data and infor24 mation concerning urban and rural Tribal com25 munities; 


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1 (D) how to improve transparency and eq2 uity of treatment for individuals with disabil3 ities during the COVID–19 public health emer4 gency and future public health emergencies; and 

5 (E) how to support State, local, and Tribal 

6 capacity to eliminate barriers to vaccinations, 

7 testing, and treatment during the COVID–19 

8 public health emergency and future public 

9 health emergencies. 

10 (e) STAFF OF COMMISSION.— 

11 (1) ADDITIONAL STAFF.—The Chairperson of 

12 the Commission may appoint and fix the pay of ad13 ditional staff to the Commission as the Chairperson 

14 considers appropriate. 

15 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE

16 LAWS.—The staff of the Commission may be ap17 pointed without regard to the provisions of title 5, 

18 United States Code, governing appointments in the 

19 competitive service, and may be paid without regard 

20 to the provisions of chapter 51 and subchapter III 

21 of chapter 53 of that title relating to classification 

22 and General Schedule pay rates. 

23 (3) DETAILEES.—Any Federal Government em24 ployee may be detailed to the Commission without 

25 reimbursement from the Commission, and the 


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1 detailee shall retain the rights, status, and privileges 

2 of his or her regular employment without interrup3 tion. 

4 (f) COORDINATION WITH OTHER EFFORTS.—The 

5 Secretary shall, in establishing the Commission under this 

6 section, take such steps as may be necessary to ensure 

7 that the work of the Commission does not overlap with, 

8 or otherwise duplicate, other Federal Government efforts 

9 with respect to ensuring health equity in data collection 

10 in public health emergencies. 

11 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated such sums as may be 

13 necessary to carry out this section. 

14 SEC. 1013. TASK FORCE ON PREVENTING BIAS IN AI AND 

15 ALGORITHMS. 

16 (a) IN GENERAL.—Not later than 30 days after the 

17 date of enactment of this Act, the Secretary of Health and 

18 Human Services (referred to in this section as the ‘‘Sec19 retary’’) shall establish a Task Force to be known as the 

20 ‘‘Task Force on Preventing AI and Algorithmic Bias in 

21 Healthcare’’ (referred to in this section as the ‘‘Task 

22 Force’’) to provide clear and robust guidance on how to 

23 ensure that the development and integration of artificial 

24 intelligence and algorithmic technologies within the health 


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1 care service delivery process does not exacerbate health 

2 disparities and expands access to health care services. 

3 (b) MEMBERSHIP AND CHAIRPERSON.— 

4 (1) MEMBERSHIP.—The Task Force shall be 

5 composed of— 

6 (A) the Chief Information Officer of the 

7 Department of Health and Human Services; 

8 (B) the Director of the Centers for Disease 

9 Control and Prevention; 

10 (C) the Director of the National Institutes 

11 of Health; 

12 (D) the Commissioner of Food and Drugs; 

13 (E) the Administrator of the Federal 

14 Emergency Management Agency; 

15 (F) the Director of the National Institute 

16 on Minority Health and Health Disparities; 

17 (G) the Director of the Indian Health 

18 Service; 

19 (H) the Administrator of the Centers for 

20 Medicare & Medicaid Services; 

21 (I) the Director of the Agency for 

22 Healthcare Research and Quality; 

23 (J) the Surgeon General; 

24 (K) the Administrator of the Health Re25 sources and Services Administration; 


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1 (L) the Director of the Office of Minority 

2 Health; 

3 (M) the Director of the Office of Women’s 

4 Health; 

5 (N) the Chairperson of the National Coun6 cil on Disability; 

7 (O) the National Coordinator for Health 

8 Information Technology; 

9 (P) at least 4 State, local, territorial, and 

10 Tribal public health officials representing de11 partments of public health, or an Urban Indian 

12 health representative, who shall represent juris13 dictions from different regions of the United 

14 States with relatively high concentrations of 

15 historically marginalized populations, to be ap16 pointed by the Secretary; 

17 (Q) at least 3 independent individuals with 

18 expertise on racially and ethnically diverse rep19 resentation with knowledge or field experience 

20 with community-based participatory research on 

21 racial and ethnic disparities in public health, to 

22 be appointed by the Secretary; and 

23 (R) at least 4 individuals with expertise on 

24 health equity and demographic data disparities 

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1 guage, disability status, sex, sexual orientation, 

2 gender identity, or socioeconomic status. 

3 (2) CHAIRPERSON.—The Chief Information Of4 ficer of the Department of Health and Human Serv5 ices (or the Chief Information Officer’s designee) 

6 shall serve as the Chairperson of the Task Force. 

7 (c) DUTIES.—The Task Force shall— 

8 (1) examine where to place artificial intelligence 

9 and algorithms in the health care service delivery 

10 process relative to the use of autonomous human de11 cision makers; 

12 (2) identify the risks of health care system utili13 zation of artificial intelligence and algorithms in 

14 terms of civil rights, civil liberties, and discrimina15 tory bias in health care access, quality, and out16 comes; and 

17 (3) prepare and submit the report under sub18 section (d). 

19 (d) REPORT.—Not later than 1 year after the date 

20 of enactment of this Act, the Task Force shall— 

21 (1) submit a written report of the findings of 

22 the examination under paragraph (1) and rec23 ommendations to Congress with respect to imple24 mentation of artificial intelligence and algorithms in 


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1 health care delivery and mitigation of the risks asso2 ciated with that implementation; and 

3 (2) publish such report on the website of the 

4 Department of Health and Human Services. 

5 (e) PUBLIC COMMENT.—Not later than 60 days after 

6 the date of the enactment of this Act, the Task Force shall 

7 publish in the Federal Register a notice providing for a 

8 public comment period on the duties and activities of the 

9 Task Force of not less than 90 days, beginning on the 

10 date of that publication. 

11 (f) STAFF OF COMMISSION.— 

12 (1) ADDITIONAL STAFF.—The Chairperson of 

13 the Task Force may appoint and fix the pay of addi14 tional staff to the Task Force as the Chairperson 

15 considers appropriate. 

16 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE

17 LAWS.—The staff of the Task Force may be ap18 pointed without regard to the provisions of title 5, 

19 United States Code, governing appointments in the 

20 competitive service, and may be paid without regard 

21 to the provisions of chapter 51 and subchapter III 

22 of chapter 53 of that title relating to classification 

23 and General Schedule pay rates. 

24 (3) DETAILEES.—Any Federal Government em25 ployee may be detailed to the Task Force without reVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 imbursement from the Task Force, and the detailee 

2 shall retain the rights, status, and privileges of his 

3 or her regular employment without interruption. 

4 TITLE II—CULTURALLY AND LIN5 GUISTICALLY APPROPRIATE 

6 HEALTH AND HEALTH CARE 

7 SEC. 2001. DEFINITIONS; FINDINGS. 

8 (a) DEFINITIONS.—In this title, the definitions in 

9 section 3400 of the Public Health Service Act, as added 

10 by section 2004, shall apply. 

11 (b) FINDINGS.—Congress finds the following: 

12 (1) Effective communication is essential to 

13 meaningful access to quality physical and mental 

14 health care. 

15 (2) Research indicates that the lack of appro16 priate language services creates language barriers 

17 that result in increased risk of misdiagnosis, ineffec18 tive treatment plans, and poor health outcomes for 

19 individuals with limited English proficiency and indi20 viduals with communication disabilities such as cog21 nitive, hearing, vision, or print impairments. 

22 (3) The number of limited English speaking 

23 residents in the United States who speak English 

24 less than very well and, therefore, cannot effectively 


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1 communicate with health and social service providers 

2 continues to increase significantly. 

3 (4) The responsibility to fund language services 

4 in the provision of health care and health care-re5 lated services to individuals with limited English 

6 proficiency and individuals with communication dis7 abilities such as cognitive, hearing, vision, or print 

8 impairments is a societal one that cannot fairly be 

9 placed solely upon the health care, public health, or 

10 social services community. 

11 (5) Title VI of the Civil Rights Act of 1964 (42 

12 U.S.C. 2000d et seq.) prohibits discrimination based 

13 on the grounds of race, color, or national origin by 

14 any entity receiving Federal financial assistance. In 

15 order to avoid discrimination on the grounds of na16 tional origin, all programs or activities administered 

17 by the Federal Government must take adequate 

18 steps to ensure that their policies and procedures do 

19 not deny or have the effect of denying individuals 

20 with limited English proficiency with equal access to 

21 benefits and services for which such persons qualify. 

22 (6) Both the Americans with Disabilities Act of 

23 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita24 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 

25 discrimination on the basis of disability and require 


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1 the provision of appropriate auxiliary aids and serv2 ices necessary to ensure effective communication 

3 with individuals with disabilities. The type of auxil4 iary aid or service necessary to ensure effective com5 munication will vary in accordance with the method 

6 of communication used by the individual, the nature, 

7 length, and complexity of the communication in8 volved, and the context in which the communication 

9 is taking place. A public accommodation should con10 sult with individuals with disabilities whenever pos11 sible to determine what type of auxiliary aid is need12 ed to ensure effective communication. The public ac13 commodation should use the individual’s preferred 

14 method of communication whenever possible, unless 

15 it would be an undue burden to the public accommo16 dation and an alternative would provide an equally 

17 effective means of communication. The ultimate de18 cision as to what measures to take rests with the 

19 public accommodation, provided that the method 

20 chosen results in effective communication. 

21 (7) Section 1557 of the Patient Protection and 

22 Affordable Care Act (42 U.S.C. 18116) builds on 

23 title VI of the Civil Rights Act of 1964 (42 U.S.C. 

24 2000d et seq.) and section 504 of the Rehabilitation 

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1 tion on the basis of race, color, national origin, dis2 ability, sex, and age, requires the provision of lan3 guage services to ensure effective communication 

4 with individuals with limited English proficiency, 

5 and requires the provision of appropriate auxiliary 

6 aids and services necessary to ensure effective com7 munication with individuals with disabilities. 

8 (8) Linguistic diversity in the health care and 

9 health care-related services workforce is important 

10 for providing all patients the environment most con11 ducive to positive health outcomes. 

12 (9) All members of the health care and health 

13 care-related services community should continue to 

14 educate their staff and constituents about limited 

15 English proficient and disability communication 

16 issues and help them identify resources to improve 

17 access to quality care for individuals with limited 

18 English proficiency and individuals with communica19 tion disabilities such as cognitive, hearing, vision, or 

20 print impairments. 

21 (10) Access to English as a second language, 

22 foreign language, and sign language interpreters, 

23 translated and alternative format documents, read24 ers, and other auxiliary aids and services, are essen25 tial to ensure effective communication and eliminate 


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1 the language barriers that impede access to health 

2 care. 

3 (11) Culturally competent language services in 

4 health care settings should be available as a matter 

5 of course. 

6 SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVID7 UALS WITH LIMITED ENGLISH PROFICIENCY. 

8 (a) PURPOSE.—Consistent with the goals provided in 

9 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 

10 to improving access to services for persons with limited 

11 English proficiency), it is the purpose of this section— 

12 (1) to improve Federal agency performance re13 garding access to federally conducted and federally 

14 assisted programs and activities for individuals with 

15 limited English proficiency; 

16 (2) to require each Federal agency to examine 

17 the services it provides and develop and implement 

18 a system by which individuals with limited English 

19 proficiency can obtain culturally competent services 

20 and meaningful access to those services consistent 

21 with, and without substantially burdening, the fun22 damental mission of the agency; 

23 (3) to require each Federal agency to translate 

24 any English language written material prepared for 

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1 gency, including vaccine distribution and education, 

2 into the top 15 non-English languages in the United 

3 States (according to the most recent data from the 

4 American Community Survey or its replacement) not 

5 later than 7 days after any such material is made 

6 available in English; 

7 (4) to require each Federal agency to ensure 

8 that recipients of Federal financial assistance pro9 vide culturally competent services and meaningful 

10 access to applicants and beneficiaries who are indi11 viduals with limited English proficiency; 

12 (5) to ensure that recipients of Federal finan13 cial assistance take reasonable steps, consistent with 

14 the guidelines set forth in the ‘‘Guidance to Federal 

15 Financial Assistance Recipients Regarding Title VI 

16 Prohibition Against National Origin Discrimination 

17 Affecting Limited English Proficient Persons’’ (67 

18 Fed. Reg. 41455 (June 18, 2002)), to ensure cul19 turally and linguistically appropriate access to their 

20 programs and activities by individuals with limited 

21 English proficiency; and 

22 (6) to ensure compliance with title VI of the 

23 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 

24 and section 1557 of the Patient Protection and Af25 fordable Care Act (42 U.S.C. 18116) (prohibiting 


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1 health care providers and organizations from dis2 criminating in the provision of services). 

3 (b) FEDERALLY CONDUCTED PROGRAMS AND AC4 TIVITIES.— 

5 (1) IN GENERAL.—Not later than 120 days 

6 after the date of enactment of this Act, each Federal 

7 agency providing financial assistance to, or admin8 istering, a health program or activity described in 

9 section 2003(a) shall prepare a plan or update a 

10 plan to improve culturally and linguistically appro11 priate access to such program or activity with re12 spect to individuals with limited English proficiency. 

13 Not later than 1 year after the date of enactment 

14 of this title, each such Federal agency shall ensure 

15 that such plan is fully implemented. 

16 (2) PLAN REQUIREMENT.—Each plan under 

17 paragraph (1) shall include— 

18 (A) the steps the agency will take to en19 sure that individuals with limited English pro20 ficiency have access to each health program or 

21 activity supported or administered by the agen22 cy; 

23 (B) the policies and procedures for identi24 fying, assessing, and meeting the culturally and 

25 linguistically appropriate language needs of its 


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1 beneficiaries that are individuals with limited 

2 English proficiency served by such program or 

3 activity; 

4 (C) the steps the agency will take for such 

5 program or activity to be culturally and linguis6 tically appropriate by— 

7 (i) providing a range of language as8 sistance options; 

9 (ii) giving notice to individuals with 

10 limited English proficiency of the right to 

11 competent language services; 

12 (iii) training staff (at least annually); 

13 and 

14 (iv) monitoring and assessing the 

15 quality of the language services (at least 

16 annually); 

17 (D) the steps the agency will take for such 

18 program or activity to provide reasonable ac19 commodations necessary for individuals with 

20 limited English proficiency, including those in21 dividuals with a communication disability, to 

22 understand communications from the agency; 

23 (E) the steps the agency will take to en24 sure that applications, forms, and other signifi25 cant documents for such program or activity 


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1 are competently translated into the primary 

2 language of a client that is an individual with 

3 limited English proficiency where such mate4 rials are needed to improve access of such client 

5 to such program or activity; 

6 (F) the resources the agency will provide 

7 to improve cultural and linguistic appropriate8 ness to assist recipients of Federal funds to im9 prove access to health care-related programs 

10 and activities for individuals with limited 

11 English proficiency; 

12 (G) the resources the agency will provide 

13 to ensure that competent language assistance is 

14 provided to patients that are individuals with 

15 limited English proficiency by interpreters or 

16 trained bilingual staff; 

17 (H) the resources the agency will provide 

18 to ensure that family, particularly minor chil19 dren, and friends are not used to provide inter20 pretation services, except as permitted under 

21 section 1557 of the Patient Protection and Af22 fordable Care Act (42 U.S.C. 18116); and 

23 (I) the steps the agency will take and re24 sources the agency will provide to ensure that 


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1 individuals know their rights, including the abil2 ity to file a complaint. 

3 (3) SUBMISSION OF PLAN TO DOJ.—Each agen4 cy that is required to prepare a plan under para5 graph (1) shall— 

6 (A) consult with populations who are di7 rectly impacted by policies in the plan and their 

8 representatives in the development of the plan; 

9 and 

10 (B) when the plan is finalized, send a copy 

11 of such plan to the Attorney General, to serve 

12 as the central repository of all such plans. 

13 SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND 

14 LINGUISTICALLY APPROPRIATE SERVICES IN 

15 HEALTH CARE. 

16 (a) APPLICABILITY.—This section shall apply to any 

17 health program or activity— 

18 (1) of which any part is receiving Federal fi19 nancial assistance, including credits, subsidies, or 

20 contracts of insurance; or 

21 (2) that is carried out (including indirectly 

22 through contracts, subcontracts, or other support) 

23 by an executive agency or any entity established 

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1 able Care Act (42 U.S.C. 18001 et seq.) (or amend2 ments made thereby). 

3 (b) STANDARDS.—Each program or activity de4 scribed in subsection (a)— 

5 (1) shall implement strategies to recruit, retain, 

6 and promote individuals at all levels to maintain a 

7 diverse staff and leadership that can provide cul8 turally and linguistically appropriate health care to 

9 patient populations of the service area of the pro10 gram or activity; 

11 (2) shall educate and train governance, leader12 ship, and workforce at all levels and across all dis13 ciplines of the program or activity in culturally and 

14 linguistically appropriate policies and practices on an 

15 ongoing basis at least yearly; 

16 (3) shall offer and provide language assistance, 

17 including trained and competent bilingual staff and 

18 interpreter services, to individuals with limited 

19 English proficiency or who have other communica20 tion needs, at no cost to the individual at all points 

21 of contact, and during all hours of operation, to fa22 cilitate timely access to health care services and 

23 health care-related services; 

24 (4) shall for each language group consisting of 

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1 stitutes 5 percent or 500 individuals, whichever is 

2 less, of the population of persons eligible to be 

3 served or likely to be affected or encountered in the 

4 service area of the program or activity, make avail5 able at a fifth grade reading level— 

6 (A) easily understood patient-related mate7 rials, including print and multimedia materials, 

8 in the language of such language group; 

9 (B) information or notices about termi10 nation of benefits in such language; 

11 (C) signage; and 

12 (D) any other documents or types of docu13 ments designated by the Secretary; 

14 (5) shall develop and implement clear goals, 

15 policies, operational plans, and management, ac16 countability, and oversight mechanisms to provide 

17 culturally and linguistically appropriate services and 

18 infuse them throughout the planning and operations 

19 of the program or activity; 

20 (6) shall conduct initial and ongoing, at least 

21 annually, organizational assessments of culturally 

22 and linguistically appropriate services-related activi23 ties and integrate valid linguistic, competence-related 

24 National Standards for Culturally and Linguistically 

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1 ternal audits, performance improvement programs, 

2 patient satisfaction assessments, continuous quality 

3 improvement activities, and outcomes-based evalua4 tions of the program or activity and develop ways to 

5 standardize assessments; 

6 (7) shall ensure that, consistent with the pri7 vacy protections provided for under the regulations 

8 promulgated under section 264(c) of the Health In9 surance Portability and Accountability Act of 1996, 

10 data on an individual required to be collected pursu11 ant to section 3101, including the individual’s alter12 native format preferences and policy modification 

13 needs, are— 

14 (A) collected in health records; 

15 (B) integrated into the management infor16 mation systems of the program or activity; 

17 (C) reported in such a way as to be inter18 operable with health information systems at the 

19 Federal and State levels; and 

20 (D) periodically updated; 

21 (8) shall maintain a current demographic, cul22 tural, and epidemiological profile of the community, 

23 conduct regular assessments of community health 

24 assets and needs, and use the results of such assess25 ments to accurately plan for and implement services 


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1 that respond to the cultural and linguistic character2 istics of the service area of the program or activity; 

3 (9) shall develop participatory, collaborative 

4 partnerships with community-based organizations 

5 and utilize a variety of formal and informal mecha6 nisms to facilitate community and patient involve7 ment in designing, implementing, and evaluating 

8 policies and practices to ensure culturally and lin9 guistically appropriate service-related activities; 

10 (10) shall ensure that conflict and grievance 

11 resolution processes are culturally and linguistically 

12 appropriate and capable of identifying, preventing, 

13 and resolving cross-cultural conflicts or complaints 

14 by patients; 

15 (11) shall annually make available to the public 

16 information about their progress and successful in17 novations in implementing the standards under this 

18 section, translated materials of such information 

19 that is culturally and linguistically appropriate to 

20 the communities served under this section, and pro21 vide public notice in such communities about the 

22 availability of this information; and 

23 (12) shall, if requested, regularly make avail24 able to the head of each Federal entity from which 

25 Federal funds are provided, information about the 


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1 progress and successful innovations of the program 

2 or activity in implementing the standards under this 

3 section as required by the head of such entity. 

4 (c) COMMENTS ACCEPTED THROUGH NOTICE AND

5 COMMENT RULEMAKING.—An agency carrying out a pro6 gram or activity described in subsection (a)— 

7 (1) shall ensure that comments with respect to 

8 such program or activity that are accepted through 

9 notice and comment rulemaking are accepted in all 

10 languages; 

11 (2) may not require such comments to be sub12 mitted only in English; and 

13 (3) shall ensure that any such comments that 

14 are not submitted in English are considered, during 

15 the agency’s review of such comments, equally as 

16 such comments that are submitted in English. 

17 SEC. 2004. CULTURALLY AND LINGUISTICALLY APPRO18 PRIATE HEALTH CARE IN THE PUBLIC 

19 HEALTH SERVICE ACT. 

20 The Public Health Service Act (42 U.S.C. 201 et 

21 seq.) is amended by adding at the end the following: 


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1 ‘‘TITLE XXXIV—CULTURALLY 

2 AND LINGUISTICALLY APPRO3 PRIATE HEALTH CARE 

4 ‘‘SEC. 3400. DEFINITIONS. 

5 ‘‘(a) IN GENERAL.—In this title: 

6 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with 

7 respect to an individual, means an individual who 

8 has a sufficient degree of proficiency in 2 languages. 

9 ‘‘(2) CULTURAL.—The term ‘cultural’ means 

10 relating to integrated patterns of human behavior 

11 that include the language, thoughts, communica12 tions, actions, customs, beliefs, values, age, and in13 stitutions of racial, ethnic, religious, or social 

14 groups, including lesbian, gay, bisexual, transgender, 

15 queer, and questioning individuals, and individuals 

16 with physical and mental disabilities. 

17 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP18 PROPRIATE.—The term ‘culturally and linguistically 

19 appropriate’ means being respectful of and respon20 sive to the cultural and linguistic needs of all indi21 viduals. 

22 ‘‘(4) EFFECTIVE COMMUNICATION.—The term 

23 ‘effective communication’ means an exchange of in24 formation between the provider of health care or 

25 health care-related services and the recipient of such 


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1 services who is limited in English proficiency, or has 

2 a communication impairment such as a hearing, vi3 sion, speaking, or cognitive disability, that enables 

4 access to, understanding of, and benefit from health 

5 care or health care-related services, and full partici6 pation in the development of their treatment plan. 

7 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 

8 term ‘grievance resolution process’ means all aspects 

9 of dispute resolution including filing complaints, 

10 grievance and appeal procedures, and court action. 

11 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 

12 care group’ means a group of physicians organized, 

13 at least in part, for the purposes of providing physi14 cian services under the Medicaid program under title 

15 XIX of the Social Security Act, the State Children’s 

16 Health Insurance Program under title XXI of such 

17 Act, or the Medicare program under title XVIII of 

18 such Act, including a provider of services under part 

19 B of such title XVIII, and may include a hospital, 

20 a hospice provider, a palliative care provider, and 

21 any other individual or entity furnishing services 

22 covered under any such program that is affiliated 

23 with the health care group. 


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1 ‘‘(7) HEALTH CARE.—The term ‘health care’ 

2 includes all health care needed throughout the life 

3 cycle and the end of life. 

4 ‘‘(8) HEALTH CARE SERVICES.—The term 

5 ‘health care services’ means services that address 

6 physical and mental health conditions, as well as 

7 conditions impacted by social determinants of health, 

8 in all care settings throughout the life cycle and the 

9 end of life. 

10 ‘‘(9) HEALTH CARE-RELATED SERVICES.—The 

11 term ‘health care-related services’ means human or 

12 social services programs or activities that provide ac13 cess, referrals, or links to health care services. 

14 ‘‘(10) HEALTH EDUCATOR.—The term ‘health 

15 educator’ includes a professional with a bacca16 laureate degree who is responsible for designing, im17 plementing, and evaluating individual and population 

18 health promotion, health education (including edu19 cation on end-of-life care options), end-of-life care, 

20 or chronic disease prevention programs. 

21 ‘‘(11) INDIAN; INDIAN TRIBE.—The terms ‘In22 dian’ and ‘Indian Tribe’ have the meanings given 

23 such terms in section 4 of the Indian Self-Deter24 mination and Education Assistance Act. 


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1 ‘‘(12) INDIVIDUAL WITH A DISABILITY.—The 

2 term ‘individual with a disability’ means any indi3 vidual who has a disability as defined for the pur4 pose of section 504 of the Rehabilitation Act of 

5 1973. 

6 ‘‘(13) INDIVIDUAL WITH LIMITED ENGLISH

7 PROFICIENCY.—The term ‘individual with limited 

8 English proficiency’ means an individual who self9 identifies on the Census as speaking English less 

10 than ‘very well’. 

11 ‘‘(14) INTEGRATED HEALTH CARE DELIVERY

12 SYSTEM.—The term ‘integrated health care delivery 

13 system’ means an interdisciplinary system that 

14 brings together providers from the primary health, 

15 mental health, substance use disorder, hospice and 

16 palliative care, and related disciplines to improve the 

17 health outcomes of an individual and the community. 

18 Such providers may include hospitals, health, mental 

19 health, or substance use prevention and treatment 

20 clinics and providers, home health agencies, home21 and community-based services providers, congregate 

22 care settings (including any skilled nursing facilities, 

23 assisted living facilities, prisons and jails, residential 

24 behavioral health care and psychiatric facilities, and 

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1 ple with disabilities), ambulatory surgery centers, re2 habilitation centers, and employed, independent, or 

3 contracted physicians. 

4 ‘‘(15) INTERPRETING; INTERPRETATION.—The 

5 terms ‘interpreting’ and ‘interpretation’ mean the 

6 transmission of a spoken, written, or signed message 

7 from one language or format into another, faithfully, 

8 accurately, and objectively. 

9 ‘‘(16) LANGUAGE ACCESS.—The term ‘language 

10 access’ means the provision of language services to 

11 an individual with limited English proficiency or an 

12 individual with communication disabilities designed 

13 to enhance that individual’s access to, understanding 

14 of, or benefit from health care services or health 

15 care-related services. 

16 ‘‘(17) LANGUAGE ASSISTANCE SERVICES.—The 

17 term ‘language assistance services’ includes— 

18 ‘‘(A) oral language assistance, including in19 terpretation in non-English languages provided 

20 in person or remotely by a qualified interpreter 

21 for an individual with limited English pro22 ficiency, and the use of qualified bilingual or 

23 multilingual staff to communicate directly with 

24 individuals with limited English proficiency; 


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1 ‘‘(B) written translation, performed by a 

2 qualified translator, of written content in paper 

3 or electronic form into languages other than 

4 English; and 

5 ‘‘(C) taglines. 

6 ‘‘(18) MINORITY.— 

7 ‘‘(A) IN GENERAL.—The terms ‘minority’ 

8 and ‘minorities’ refer to individuals from a mi9 nority group. 

10 ‘‘(B) POPULATIONS.—The term ‘minority’, 

11 with respect to populations, refers to racial and 

12 ethnic minority groups, members of sexual and 

13 gender minority groups, and individuals with a 

14 disability. 

15 ‘‘(19) MINORITY GROUP.—The term ‘minority 

16 group’ means a racial and ethnic minority group as 

17 defined in this section. 

18 ‘‘(20) ONSITE INTERPRETATION.—The term 

19 ‘onsite interpretation’ means a method of inter20 preting or interpretation for which the interpreter is 

21 in the physical presence of the provider of health 

22 care services or health care-related services and the 

23 recipient of such services who is limited in English 

24 proficiency or has a communication impairment such 

25 as an impairment in hearing, vision, or learning. 


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1 ‘‘(21) QUALIFIED INDIVIDUAL WITH A DIS2 ABILITY.—The term ‘qualified individual with a dis3 ability’ means, with respect to a health program or 

4 activity, an individual with a disability who, with or 

5 without reasonable modifications to policies, prac6 tices, or procedures, the removal of architectural, 

7 communication, or transportation barriers, or the 

8 provision of auxiliary aids and services, meets the es9 sential eligibility requirements for the receipt of aids, 

10 benefits, or services offered or provided by the health 

11 program or activity. 

12 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI13 VIDUAL WITH A DISABILITY.—The term ‘qualified 

14 interpreter for an individual with a disability’, with 

15 respect to an individual with a disability— 

16 ‘‘(A) means an interpreter for such indi17 vidual who by means of a remote interpreting 

18 service or an onsite appearance— 

19 ‘‘(i) adheres to generally accepted in20 terpreter ethics principles, including client 

21 confidentiality; and 

22 ‘‘(ii) is able to interpret effectively, ac23 curately, and impartially, both receptively 

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1 cialized vocabulary, terminology, and phra2 seology; and 

3 ‘‘(B) may include— 

4 ‘‘(i) sign language interpreters; 

5 ‘‘(ii) oral transliterators, which are in6 dividuals who represent or spell in the 

7 characters of another alphabet; and 

8 ‘‘(iii) cued language transliterators, 

9 which are individuals who represent or 

10 spell by using a small number of 

11 handshapes. 

12 ‘‘(23) QUALIFIED INTERPRETER FOR AN INDI13 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 

14 The term ‘qualified interpreter for an individual with 

15 limited English proficiency’ means an interpreter 

16 who by means of a remote interpreting service or an 

17 onsite appearance— 

18 ‘‘(A) adheres to generally accepted inter19 preter ethics principles, including client con20 fidentiality; 

21 ‘‘(B) has demonstrated proficiency in 

22 speaking and understanding both spoken 

23 English and one or more other spoken lan24 guages; and 


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1 ‘‘(C) is able to interpret effectively, accu2 rately, and impartially, both receptively and ex3 pressly, to and from such languages and 

4 English, using any necessary specialized vocab5 ulary, terminology, and phraseology. 

6 ‘‘(24) QUALIFIED TRANSLATOR.—The term 

7 ‘qualified translator’ means a translator who— 

8 ‘‘(A) adheres to generally accepted trans9 lator ethics principles, including client confiden10 tiality; 

11 ‘‘(B) has demonstrated proficiency in writ12 ing and understanding both written English 

13 and one or more other written non-English lan14 guages; and 

15 ‘‘(C) is able to translate effectively, accu16 rately, and impartially to and from such lan17 guages and English, using any necessary spe18 cialized vocabulary, terminology, and phrase19 ology. 

20 ‘‘(25) RACIAL AND ETHNIC MINORITY GROUP.— 

21 The term ‘racial and ethnic minority group’ means 

22 Indians and Alaska Natives, African Americans (in23 cluding Caribbean Blacks, Africans, and other 

24 Blacks), Asian Americans, Hispanics (including 


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1 Latinos), Middle Easterners and North Africans, 

2 and Native Hawaiians and other Pacific Islanders. 

3 ‘‘(26) SECRETARY.—The term ‘Secretary’ 

4 means the Secretary of Health and Human Services, 

5 acting through the Director of the Agency for 

6 Healthcare Research and Quality. 

7 ‘‘(27) SEXUAL AND GENDER MINORITY

8 GROUP.—The term ‘sexual and gender minority 

9 group’ encompasses lesbian, gay, bisexual, and 

10 transgender populations, as well as those whose sex11 ual orientation, gender identity and expression, or 

12 reproductive development varies from traditional, so13 cietal, cultural, or physiological norms. 

14 ‘‘(28) SIGHT TRANSLATION.—The term ‘sight 

15 translation’ means the transmission of a written 

16 message in one language into a spoken or signed 

17 message in another language, or an alternative for18 mat in English or another language. 

19 ‘‘(29) STATE.—Notwithstanding section 2, the 

20 term ‘State’ means each of the several States, the 

21 District of Columbia, the Commonwealth of Puerto 

22 Rico, the United States Virgin Islands, Guam, 

23 American Samoa, and the Commonwealth of the 

24 Northern Mariana Islands. 


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1 ‘‘(30) TELEPHONIC INTERPRETATION.—The 

2 term ‘telephonic interpretation’ (also known as ‘over 

3 the phone interpretation’ or ‘OPI’) means, with re4 spect to interpretation for an individual with limited 

5 English proficiency, a method of interpretation in 

6 which the interpreter is not in the physical presence 

7 of the provider of health care services or health care8 related services and such individual receiving such 

9 services, but the interpreter is connected via tele10 phone. 

11 ‘‘(31) TRANSLATION.—The term ‘translation’ 

12 means the transmission of a written message in one 

13 language into a written or signed message in an14 other language, and includes translation into an15 other language or alternative format, such as large 

16 print font, Braille, audio recording, or CD. 

17 ‘‘(32) UNDERSERVED COMMUNITIES.—The 

18 term ‘underserved communities’ means populations 

19 sharing a particular characteristic, as well as geo20 graphic communities, who have been systematically 

21 denied a full opportunity to participate in aspects of 

22 economic, social, and civic life, such as— 

23 ‘‘(A) Black, Latino, and Indigenous and 

24 Native American persons, Asian Americans and 


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1 Pacific Islanders, Middle Easterners and North 

2 Africans, and other persons of color; 

3 ‘‘(B) members of religious minorities; 

4 ‘‘(C) lesbian, gay, bisexual, transgender, 

5 and queer persons; 

6 ‘‘(D) persons with disabilities; 

7 ‘‘(E) persons who live in rural areas; and 

8 ‘‘(F) persons otherwise adversely affected 

9 by persistent poverty or inequality as defined in 

10 Executive Order 13985. 

11 ‘‘(33) UNDERSERVED POPULATIONS.—The 

12 term ‘underserved populations’ means populations 

13 sharing a particular characteristic, as well as geo14 graphic communities, who have been systematically 

15 denied a full opportunity to participate in aspects of 

16 economic, social, and civic life, as defined in Execu17 tive Order 13985. 

18 ‘‘(34) VIDEO REMOTE INTERPRETING SERV19 ICES.—The term ‘video remote interpreting services’ 

20 means the provision, in health care services or health 

21 care-related services, through a qualified interpreter 

22 for an individual with limited English proficiency, of 

23 video remote interpreting services that are— 

24 ‘‘(A) in real-time, full-motion video, and 

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1 width video connection or wireless connection 

2 that delivers high-quality video images that do 

3 not produce lags, choppy, blurry, or grainy im4 ages, or irregular pauses in communication; and 

5 ‘‘(B) in a sharply delineated image that is 

6 large enough to display. 

7 ‘‘(35) VITAL DOCUMENT.—The term ‘vital doc8 ument’ includes applications for government pro9 grams that provide health care services, medical or 

10 financial consent forms, financial assistance docu11 ments, letters containing important information re12 garding patient instructions (such as prescriptions, 

13 referrals to other providers, and discharge plans) 

14 and participation in a program (such as a Medicaid 

15 managed care program), notices pertaining to the 

16 reduction, denial, or termination of services or bene17 fits, notices of the right to appeal such actions, and 

18 notices advising individuals with limited English pro19 ficiency with communication disabilities of the avail20 ability of free language services, alternative formats, 

21 and other outreach materials. 

22 ‘‘(b) REFERENCE.—In any reference in this title to 

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1 sion shall have the same meaning as the term ‘individual 

2 with a disability’ as defined in subsection (a). 

3 ‘‘Subtitle A—Resources and Innova4 tion for Culturally and Linguis5 tically Appropriate Health Care 

6 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 

7 AND LINGUISTICALLY APPROPRIATE HEALTH 

8 CARE. 

9 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab10 lish and support a center to be known as the ‘Robert T. 

11 Matsui Center for Culturally and Linguistically Appro12 priate Health Care’ (referred to in this section as the 

13 ‘Center’) to carry out each of the following activities: 

14 ‘‘(1) INTERPRETATION SERVICES.— 

15 ‘‘(A) IN GENERAL.—The Center shall pro16 vide resources via the internet to identify and 

17 link health care providers to competent and 

18 qualified interpreter and translation services. 

19 ‘‘(B) TRAINING.—For purposes of pro20 viding the services described in subparagraph 

21 (A), the Center shall adopt a language access 

22 plan that includes training requirements for 

23 Center staff to provide such services. 

24 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 


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1 ‘‘(A) VITAL DOCUMENTS.—The Center 

2 shall provide, directly or through contract, to 

3 providers of health care services and health 

4 care-related services, at no cost to such pro5 viders and in a timely and reasonable manner, 

6 vital documents— 

7 ‘‘(i) which may be submitted by cov8 ered entities (as defined in section 92.4 of 

9 title 45, Code of Federal Regulations, as in 

10 effect on May 18, 2016) for translation 

11 into non-English languages or alternative 

12 formats at a fifth-grade reading level; and 

13 ‘‘(ii) from competent translation serv14 ices, the quality of which shall be mon15 itored and reported publicly. 

16 ‘‘(B) FORMS.—For each form developed or 

17 revised by the Secretary that will be used by in18 dividuals with limited English proficiency in 

19 health care or health care-related settings, the 

20 Center shall, not later than 45 calendar days of 

21 the Secretary receiving final approval of the 

22 form from the Office of Management and 

23 Budget— 

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1 guages in the United States according to 

2 the most recent data from the American 

3 Community Survey or its replacement; and 

4 ‘‘(ii) post all translated forms on the 

5 Center’s website. 

6 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE7 PHONE NUMBER.—The Center shall provide, 

8 through a toll-free number, a customer service line 

9 for individuals with limited English proficiency that 

10 is linked to the toll-free telephone number 1–800– 

11 MEDICARE and a toll-free telephone hotline pro12 vided for pursuant to section 1311(d)(4)(B) of the 

13 Patient Protection and Affordable Care Act by an 

14 Exchange established under title I of such Act— 

15 ‘‘(A) to obtain information about federally 

16 conducted or funded health programs, including 

17 the Medicare program under title XVIII of the 

18 Social Security Act, the Medicaid program 

19 under title XIX of such Act, and the State Chil20 dren’s Health Insurance Program under title 

21 XXI of such Act, and coverage available 

22 through an Exchange established under title I 

23 of the Patient Protection and Affordable Care 

24 Act, and other sources of free or reduced care 

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1 ties receiving assistance under title X, and pub2 lic health departments; 

3 ‘‘(B) to obtain assistance with applying for 

4 or accessing these programs and understanding 

5 Federal notices written in English; and 

6 ‘‘(C) to learn how to access language serv7 ices. 

8 ‘‘(4) HEALTH INFORMATION CLEARING9 HOUSE.— 

10 ‘‘(A) IN GENERAL.—The Center shall de11 velop and maintain, and make available on the 

12 internet and in print, an information clearing13 house that includes the information described in 

14 subparagraphs (B) through (F)— 

15 ‘‘(i) to facilitate the provision of lan16 guage services by providers of health care 

17 services and health care-related services to 

18 reduce medical errors; 

19 ‘‘(ii) to improve medical outcomes, im20 prove cultural competence, reduce health 

21 care costs caused by miscommunication 

22 with individuals with limited English pro23 ficiency; and 

24 ‘‘(iii) to reduce or eliminate the dupli25 cation of efforts to translate materials. 


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1 ‘‘(B) DOCUMENT TEMPLATES.—The Cen2 ter shall collect and evaluate for accuracy, de3 velop, and make available templates for stand4 ard documents that are necessary for patients 

5 and consumers to access and make educated de6 cisions about their health care, including tem7 plates for each of the following: 

8 ‘‘(i) Administrative and legal docu9 ments, including— 

10 ‘‘(I) intake forms; 

11 ‘‘(II) forms related to the Medi12 care program under title XVIII of the 

13 Social Security Act, the Medicaid pro14 gram under title XIX of such Act, 

15 and the State Children’s Health In16 surance Program under title XXI of 

17 such Act, including eligibility informa18 tion for such programs; 

19 ‘‘(III) forms informing patients 

20 of the compliance and consent re21 quirements pursuant to the regula22 tions under section 264(c) of the 

23 Health Insurance Portability and Ac24 countability Act of 1996 (42 U.S.C. 

25 1320–2 note); and 


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1 ‘‘(IV) documents concerning in2 formed consent, advanced directives, 

3 and waivers of rights. 

4 ‘‘(ii) Clinical information, such as how 

5 to take medications, how to prevent trans6 mission of a contagious disease, and other 

7 prevention and treatment instructions. 

8 ‘‘(iii) Public health, patient education, 

9 and outreach materials, such as immuniza10 tion notices, health warnings, or screening 

11 notices. 

12 ‘‘(iv) Additional health or health care13 related materials as determined appro14 priate by the Director of the Center. 

15 ‘‘(C) STRUCTURE OF FORMS.—In oper16 ating the clearinghouse, the Center shall— 

17 ‘‘(i) ensure that the documents posted 

18 in English and non-English languages are 

19 culturally and linguistically appropriate; 

20 ‘‘(ii) allow public review of the docu21 ments before dissemination in order to en22 sure that the documents are understand23 able and culturally and linguistically ap24 propriate for the target populations; 


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1 ‘‘(iii) allow health care providers to 

2 customize the documents for their use; 

3 ‘‘(iv) facilitate access to such docu4 ments; 

5 ‘‘(v) provide technical assistance with 

6 respect to the access and use of such infor7 mation; and 

8 ‘‘(vi) carry out any other activities the 

9 Secretary determines to be useful to fulfill 

10 the purposes of the clearinghouse. 

11 ‘‘(D) LANGUAGE ASSISTANCE PRO12 GRAMS.—The Center shall provide for the col13 lection and dissemination of information on cur14 rent examples of language assistance programs 

15 and strategies to improve language services for 

16 individuals with limited English proficiency, in17 cluding case studies using de-identified patient 

18 information, program summaries, and program 

19 evaluations. 

20 ‘‘(E) CULTURALLY AND LINGUISTICALLY

21 APPROPRIATE MATERIALS.—The Center shall 

22 provide, at no cost, to all health care providers 

23 and all providers of health care-related services, 

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1 ulations residing in the United States, includ2 ing— 

3 ‘‘(i) tenets of culturally and linguis4 tically appropriate care; 

5 ‘‘(ii) culturally and linguistically ap6 propriate self-assessment tools; 

7 ‘‘(iii) culturally and linguistically ap8 propriate training tools; 

9 ‘‘(iv) strategic plans to increase cul10 tural and linguistic appropriateness in dif11 ferent types of providers of health care 

12 services and health care-related services, 

13 including regional collaborations among 

14 health care organizations for health care 

15 services and health care-related services; 

16 and 

17 ‘‘(v) culturally and linguistically ap18 propriate information for educators, practi19 tioners, students, and researchers. 

20 ‘‘(F) TRANSLATION GLOSSARIES.—The 

21 Center shall— 

22 ‘‘(i) develop and publish on its website 

23 translation glossaries that provide stand24 ardized translations of commonly used 


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1 terms and phrases utilized in documents 

2 translated by the Center; and 

3 ‘‘(ii) make such glossaries available— 

4 ‘‘(I) free of charge; 

5 ‘‘(II) in each language in which 

6 the Center translates forms under 

7 paragraph (2)(B); 

8 ‘‘(III) in alternative formats in 

9 accordance with the Americans with 

10 Disabilities Act of 1990 (42 U.S.C. 

11 12101 et seq.); and 

12 ‘‘(IV) in paper format upon re13 quest. 

14 ‘‘(G) INFORMATION ABOUT PROGRESS.— 

15 The Center shall— 

16 ‘‘(i) regularly collect and make pub17 licly available information about the 

18 progress of entities receiving grants under 

19 section 3402 regarding successful innova20 tions in implementing the requirements of 

21 this subsection; and 

22 ‘‘(ii) provide public notice in the enti23 ties’ communities about the availability of 

24 such information. 


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1 ‘‘(b) DIRECTOR.—The Center shall be headed by a 

2 Director who shall be appointed by, and who shall report 

3 to, the Director of the Agency for Healthcare Research 

4 and Quality. 

5 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di6 rector of the Center shall collaborate with the Deputy As7 sistant Secretary for Minority Health, the Administrator 

8 of the Centers for Medicare & Medicaid Services, and the 

9 Administrator of the Health Resources and Services Ad10 ministration to notify health care providers and health 

11 care organizations about the availability of language ac12 cess services by the Center. 

13 ‘‘(d) EDUCATION.—The Secretary, directly or 

14 through contract, shall undertake a national education 

15 campaign to inform providers, individuals with limited 

16 English proficiency, individuals with hearing or vision im17 pairments, health professionals, graduate schools, commu18 nity health centers, social service providers, and commu19 nity-based organizations about— 

20 ‘‘(1) Federal and State laws and guidelines gov21 erning access to language services; 

22 ‘‘(2) the value of using trained and competent 

23 interpreters and the risks associated with using fam24 ily members, friends, minors, and untrained bilin25 gual staff; 


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1 ‘‘(3) funding sources for developing and imple2 menting language services; and 

3 ‘‘(4) promising practices to effectively provide 

4 language services. 

5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section 

7 $5,000,000 for each of fiscal years 2023 through 2027. 

8 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS9 TICALLY APPROPRIATE HEALTH CARE 

10 GRANTS. 

11 ‘‘(a) IN GENERAL.— 

12 ‘‘(1) GRANTS.—The Secretary shall award 

13 grants to eligible entities to enable such entities to 

14 design, implement, and evaluate innovative, cost-ef15 fective programs to improve culturally and linguis16 tically appropriate access to health care services for 

17 individuals with limited English proficiency and com18 munication disabilities. 

19 ‘‘(2) COORDINATION.—In making grants under 

20 this section, and in the design and implementation 

21 of the program established under this section, the 

22 Secretary shall coordinate with, and ensure the par23 ticipation of, other agencies including the Health Re24 sources and Services Administration, the National 

25 Institute on Minority Health and Health Disparities 


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1 at the National Institutes of Health, and the Office 

2 of Minority Health. 

3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

4 under subsection (a), an entity shall be— 

5 ‘‘(1) a city, county, Indian Tribe, State, or sub6 division thereof; 

7 ‘‘(2) an organization described in section 

8 501(c)(3) of the Internal Revenue Code of 1986 and 

9 exempt from tax under section 501(a) of such Code; 

10 ‘‘(3) a community health, mental health, or 

11 substance use disorder center or clinic; 

12 ‘‘(4) a solo or group physician practice; 

13 ‘‘(5) an integrated health care delivery system; 

14 ‘‘(6) a public hospital; 

15 ‘‘(7) a health care group, university, or college; 

16 or 

17 ‘‘(8) any other entity designated by the Sec18 retary. 

19 ‘‘(c) APPLICATION.—An eligible entity seeking a 

20 grant under this section shall prepare and submit to the 

21 Secretary an application, at such time, in such manner, 

22 and containing such additional information as the Sec23 retary may reasonably require. 

24 ‘‘(d) USE OF FUNDS.—An entity shall use funds re25 ceived through a grant under this section to— 


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1 ‘‘(1) develop, implement, and evaluate models of 

2 providing competent interpretation services through 

3 onsite interpretation, telephonic interpretation, or 

4 video remote interpreting services; 

5 ‘‘(2) implement strategies to recruit, retain, and 

6 promote individuals at all levels of the organization 

7 to maintain a diverse staff and leadership that can 

8 promote and provide language services to patient 

9 populations of the service area of the entity; 

10 ‘‘(3) develop and maintain a needs assessment 

11 that identifies the current demographic, cultural, 

12 and epidemiological profile of the community to ac13 curately plan for and implement language services 

14 needed in the service area of the entity; 

15 ‘‘(4) develop a strategic plan to implement lan16 guage services; 

17 ‘‘(5) develop participatory, collaborative part18 nerships with communities encompassing the patient 

19 populations of individuals with limited English pro20 ficiency served by the grant to gain input in design21 ing and implementing language services; 

22 ‘‘(6) develop and implement grievance resolu23 tion processes that are culturally and linguistically 

24 appropriate and capable of identifying, preventing, 


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1 and resolving complaints by individuals with limited 

2 English proficiency; 

3 ‘‘(7) develop short-term medical and mental 

4 health interpretation training courses and incentives 

5 for bilingual health care staff who are asked to pro6 vide interpretation services in the workplace; 

7 ‘‘(8) develop formal training programs, includ8 ing continued professional development and edu9 cation programs as well as supervision, for individ10 uals interested in becoming dedicated health care in11 terpreters and culturally and linguistically appro12 priate providers; 

13 ‘‘(9) provide staff language training instruction, 

14 which shall include information on the practical limi15 tations of such instruction for nonnative speakers; 

16 ‘‘(10) develop policies that address compensa17 tion in salary for staff who receive training to be18 come either a staff interpreter or bilingual provider; 

19 ‘‘(11) develop other language assistance services 

20 as determined appropriate by the Secretary; 

21 ‘‘(12) develop, implement, and evaluate models 

22 of improving cultural competence, including cultural 

23 competence programs for community health workers; 

24 ‘‘(13) ensure that, consistent with the privacy 

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1 mulgated under section 264(c) of the Health Insur2 ance Portability and Accountability Act of 1996 and 

3 any applicable State privacy laws, data on the indi4 vidual patient or recipient’s race, ethnicity, and pri5 mary language are collected (and periodically up6 dated) in health records and integrated into the or7 ganization’s information management systems or 

8 any similar system used to store and retrieve data; 

9 and 

10 ‘‘(14) ensure that culturally competent care and 

11 language assistance are available to individuals with 

12 limited English proficiency. 

13 ‘‘(e) PRIORITY.—In awarding grants under this sec14 tion, the Secretary shall give priority to entities that pri15 marily engage in providing direct care and that have devel16 oped partnerships with community organizations or with 

17 agencies with experience in improving language access. 

18 ‘‘(f) EVALUATION.— 

19 ‘‘(1) BY GRANTEES.—An entity that receives a 

20 grant under this section shall submit to the Sec21 retary an evaluation that describes, in the manner 

22 and to the extent required by the Secretary, the ac23 tivities carried out with funds received under the 

24 grant, and how such activities improved access to 

25 health care services and health care-related services 


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1 and the quality of health care for individuals with 

2 limited English proficiency. Such evaluation shall be 

3 collected and disseminated through the Robert T. 

4 Matsui Center for Culturally and Linguistically Ap5 propriate Health Care established under section 

6 3401. The Director of the Agency for Healthcare 

7 Research and Quality shall notify grantees of the 

8 availability of technical assistance for the evaluation 

9 and provide such assistance upon request. 

10 ‘‘(2) BY SECRETARY.—The Director of the 

11 Agency for Healthcare Research and Quality shall 

12 evaluate or arrange with other individuals or organi13 zations to evaluate projects funded under this sec14 tion. 

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

16 is authorized to be appropriated to carry out this section 

17 $5,000,000 for each of fiscal years 2023 through 2027. 

18 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM19 PETENCE. 

20 ‘‘(a) IN GENERAL.—The Secretary shall expand re21 search concerning language access in the provision of 

22 health care services. 

23 ‘‘(b) ELIGIBILITY.—The Secretary may conduct the 

24 research described in subsection (a) or enter into contracts 


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1 with other individuals or organizations to conduct such re2 search. 

3 ‘‘(c) USE OF FUNDS.—Research conducted under 

4 this section shall be designed to do one or more of the 

5 following: 

6 ‘‘(1) To identify the barriers to mental and be7 havioral services that are faced by individuals with 

8 limited English proficiency. 

9 ‘‘(2) To identify health care providers’ and 

10 health administrators’ knowledge and awareness of 

11 the barriers to quality health care services that are 

12 faced by individuals with limited English proficiency 

13 and communication disabilities. 

14 ‘‘(3) To identify optimal approaches for deliv15 ering language access. 

16 ‘‘(4) To identify best practices for data collec17 tion, including— 

18 ‘‘(A) the collection by providers of health 

19 care services and health care-related services of 

20 data on the race, ethnicity, and primary lan21 guage of recipients of such services, taking into 

22 account existing research conducted by the Gov23 ernment or private sector; 

24 ‘‘(B) the development and implementation 

25 of data collection and reporting systems; and 


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1 ‘‘(C) effective privacy safeguards for col2 lected data. 

3 ‘‘(5) To develop a minimum data collection set 

4 for primary language. 

5 ‘‘(6) To evaluate the most effective ways in 

6 which the Secretary can create or coordinate, and 

7 subsidize or otherwise fund, telephonic interpretation 

8 services for health care providers, taking into consid9 eration, among other factors, the flexibility necessary 

10 for such a system to accommodate variations in— 

11 ‘‘(A) provider type; 

12 ‘‘(B) languages needed and their frequency 

13 of use; 

14 ‘‘(C) type of encounter; 

15 ‘‘(D) time of encounter, including whether 

16 the encounter occurs during regular business 

17 hours and after hours; and 

18 ‘‘(E) location of encounter. 

19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

21 $5,000,000 for each of fiscal years 2023 through 2027.’’. 


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1 SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DE2 VELOPMENT OF STATE MEDICAL INTER3 PRETING SERVICES. 

4 (a) GRANTS AUTHORIZED.—The Secretary of Health 

5 and Human Services (referred to in this section as the 

6 ‘‘Secretary’’) shall award 1 grant in accordance with this 

7 section to each of 3 States (to be selected by the Sec8 retary) to assist each such State in designing, imple9 menting, and evaluating a statewide program to provide 

10 onsite interpreter services under the State Medicaid plan. 

11 (b) GRANT PERIOD.—A grant awarded under this 

12 section is authorized for the period of 3 fiscal years begin13 ning on October 1, 2023, and ending on September 30, 

14 2026. 

15 (c) PREFERENCE.—In awarding a grant under this 

16 section, the Secretary shall give preference to a State— 

17 (1) that has a high proportion of qualified LEP 

18 enrollees, as determined by the Secretary; 

19 (2) that has a large number of qualified LEP 

20 enrollees, as determined by the Secretary; 

21 (3) that has a high growth rate of the popu22 lation of individuals with limited English proficiency, 

23 as determined by the Secretary; and 

24 (4) that has a population of qualified LEP en25 rollees that is linguistically diverse, requiring interVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 preter services in at least 200 non-English lan2 guages. 

3 (d) USE OF FUNDS.—A State receiving a grant under 

4 this section shall use the grant funds to— 

5 (1) ensure that all health care providers in the 

6 State participating in the State Medicaid plan have 

7 access to onsite interpreter services, for the purpose 

8 of enabling effective communication between such 

9 providers and qualified LEP enrollees during the 

10 furnishing of items and services and administrative 

11 interactions; 

12 (2) establish, expand, procure, or contract for— 

13 (A) a statewide health care information 

14 technology system that is designed to achieve 

15 efficiencies and economies of scale with respect 

16 to onsite interpreter services provided to health 

17 care providers in the State participating in the 

18 State Medicaid plan; and 

19 (B) an entity to administer such system, 

20 the duties of which shall include— 

21 (i) procuring and scheduling inter22 preter services for qualified LEP enrollees; 

23 (ii) procuring and scheduling inter24 preter services for individuals with limited 


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1 English proficiency seeking to enroll in the 

2 State Medicaid plan; 

3 (iii) ensuring that interpreters receive 

4 payment for interpreter services rendered 

5 under the system; and 

6 (iv) consulting regularly with organi7 zations representing LEP consumers, in8 terpreters, and health care providers; and 

9 (3) develop mechanisms to establish, improve, 

10 and strengthen the competency of the medical inter11 pretation workforce that serves qualified LEP enroll12 ees in the State, including a national certification 

13 process that is valid, credible, and vendor-neutral. 

14 (e) APPLICATION.—To receive a grant under this sec15 tion, a State shall submit an application at such time and 

16 containing such information as the Secretary may require, 

17 which shall include the following: 

18 (1) A description of the language access needs 

19 of individuals in the State enrolled in the State Med20 icaid plan. 

21 (2) A description of the extent to which the 

22 program will— 

23 (A) use the grant funds for the purposes 

24 described in subsection (d); 


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1 (B) meet the health care needs of rural 

2 populations of the State; and 

3 (C) collect information that accurately 

4 tracks the language services requested by con5 sumers as compared to the language services 

6 provided by health care providers in the State 

7 participating in the State Medicaid plan. 

8 (3) A description of how the program will be 

9 evaluated, including a proposal for collaboration with 

10 organizations representing interpreters, consumers, 

11 and individuals with limited English proficiency. 

12 (f) DEFINITIONS.—In this section: 

13 (1) QUALIFIED LEP ENROLLEE.—The term 

14 ‘‘qualified LEP enrollee’’ means an individual— 

15 (A) who is limited English proficient; and 

16 (B) who is enrolled in a State Medicaid 

17 plan. 

18 (2) STATE.—The term ‘‘State’’ has the mean19 ing given the term in section 1101(a)(1) of the So20 cial Security Act (42 U.S.C. 1301(a)(1)), for pur21 poses of title XIX of such Act (42 U.S.C. 1396 et 

22 seq.). 

23 (3) STATE MEDICAID PLAN.—The term ‘‘State 

24 Medicaid plan’’ means a State plan under title XIX 


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1 of the Social Security Act (42 U.S.C. 1396 et seq.) 

2 or a waiver of such a plan. 

3 (4) UNITED STATES.—The term ‘‘United 

4 States’’ has the meaning given the term in section 

5 1101(a)(2) of the Social Security Act (42 U.S.C. 

6 1301(a)(2)), for purposes of title XIX of such Act 

7 (42 U.S.C. 1396 et seq.). 

8 (g) CONTINUATION PAST DEMONSTRATION.—Any 

9 State receiving a grant under this section must agree to 

10 directly pay for language services in Medicaid for all Med11 icaid providers by the end of the grant period. 

12 (h) FUNDING.— 

13 (1) AUTHORIZATION OF APPROPRIATIONS.— 

14 There is authorized to be appropriated $5,000,000 

15 to carry out this section. 

16 (2) AVAILABILITY OF FUNDS.—Amounts appro17 priated pursuant to the authorization in paragraph 

18 (1) are authorized to remain available without fiscal 

19 year limitation. 

20 (3) INCREASED FEDERAL FINANCIAL PARTICI21 PATION.—Section 1903(a)(2)(E) of the Social Secu22 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 

23 inserting ‘‘(or, in the case of a State that was 

24 awarded a grant under section 2005 of the Health 

25 Equity and Accountability Act of 2022, 100 percent 


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1 for each quarter occurring during the grant period 

2 specified in subsection (b) of such section)’’ after 

3 ‘‘75 percent’’. 

4 (i) LIMITATION.—No Federal funds awarded under 

5 this section may be used to provide interpreter services 

6 from a location outside the United States. 

7 SEC. 2006. TRAINING TOMORROW’S DOCTORS FOR CUL8 TURALLY AND LINGUISTICALLY APPRO9 PRIATE CARE: GRADUATE MEDICAL EDU10 CATION. 

11 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec12 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 

13 1395ww(h)(4)) is amended by adding at the end the fol14 lowing new subparagraph: 

15 ‘‘(L) TREATMENT OF CULTURALLY AND

16 LINGUISTICALLY APPROPRIATE TRAINING.—In 

17 determining a hospital’s number of full-time 

18 equivalent residents for purposes of this sub19 section, all the time that is spent by an intern 

20 or resident in an approved medical residency 

21 training program for education and training in 

22 culturally and linguistically appropriate service 

23 delivery, which shall include all medically under24 served populations (as defined in section 

25 330(b)(3) of the Public Health Service Act), 


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1 shall be counted toward the determination of 

2 full-time equivalency.’’. 

3 (b) INDIRECT MEDICAL EDUCATION.—Section 

4 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

5 1395ww(d)(5)(B)) is amended— 

6 (1) by moving the left margin of clause (xii) 4 

7 ems to the left; and 

8 (2) by adding at the end the following new 

9 clause: 

10 ‘‘(xiii) The provisions of subparagraph (L) of 

11 subsection (h)(4) shall apply under this subpara12 graph in the same manner as they apply under such 

13 subsection.’’. 

14 (c) EFFECTIVE DATE.—The amendments made by 

15 subsections (a) and (b) shall apply with respect to pay16 ments made to hospitals on or after the date that is one 

17 year after the date of the enactment of this Act. 

18 SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY 

19 AND LINGUISTICALLY APPROPRIATE SERV20 ICES UNDER THE MEDICARE, MEDICAID, AND 

21 STATE CHILDREN’S HEALTH INSURANCE 

22 PROGRAMS. 

23 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE

24 PROVIDERS.— 

25 (1) ESTABLISHMENT.— 


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1 (A) IN GENERAL.—Not later than 6 

2 months after the date of the enactment of this 

3 Act, the Secretary of Health and Human Serv4 ices (in this subsection referred to as the ‘‘Sec5 retary’’), acting through the Centers for Medi6 care & Medicaid Services and in consultation 

7 with the Center for Medicare and Medicaid In8 novation (as referred to in section 1115A of the 

9 Social Security Act (42 U.S.C. 1315a)), shall 

10 establish a demonstration program under which 

11 the Secretary shall award grants to eligible 

12 Medicare service providers to provide culturally 

13 and linguistically appropriate services to Medi14 care beneficiaries who are limited English pro15 ficient, including beneficiaries who live in di16 verse and underserved communities. 

17 (B) APPLICATION OF INNOVATION

18 RULES.—The demonstration project under sub19 paragraph (A) shall be conducted in a manner 

20 that is consistent with the applicable provisions 

21 of subsections (b), (c), and (d) of section 1115A 

22 of the Social Security Act (42 U.S.C. 1315a). 

23 (C) NUMBER OF GRANTS.—To the extent 

24 practicable, the Secretary shall award not less 

25 than 24 grants under this subsection. 


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1 (D) GRANT PERIOD.—Except as provided 

2 in paragraph (2)(D), each grant awarded under 

3 this subsection shall be for a 3-year period. 

4 (2) ELIGIBILITY REQUIREMENTS.—To be eligi5 ble for a grant under this subsection, an entity must 

6 meet the following requirements: 

7 (A) MEDICARE PROVIDER.—The entity 

8 must be— 

9 (i) a provider of services under part A 

10 of title XVIII of the Social Security Act 

11 (42 U.S.C. 1395c et seq.); 

12 (ii) a provider of services under part 

13 B of such title (42 U.S.C. 1395j et seq.); 

14 (iii) a Medicare Advantage organiza15 tion offering a Medicare Advantage plan 

16 under part C of such title (42 U.S.C. 

17 1395w–21 et seq.); or 

18 (iv) a PDP sponsor offering a pre19 scription drug plan under part D of such 

20 title (42 U.S.C. 1395w–101 et seq.). 

21 (B) UNDERSERVED COMMUNITIES.—The 

22 entity must serve a community that, with re23 spect to necessary language services for improv24 ing access and utilization of health care among 


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1 individuals with limited English proficiency, is 

2 disproportionally underserved. 

3 (C) APPLICATION.—The entity must pre4 pare and submit to the Secretary an applica5 tion, at such time, in such manner, and accom6 panied by such additional information as the 

7 Secretary may require. 

8 (D) REPORTING.—In the case of a grantee 

9 that received a grant under this subsection in 

10 a previous year, such grantee is only eligible for 

11 continued payments under a grant under this 

12 subsection if the grantee met the reporting re13 quirements under paragraph (9) for such year. 

14 If a grantee fails to meet the requirements of 

15 such paragraph for the first year of a grant, the 

16 Secretary may terminate the grant and solicit 

17 applications from new grantees to participate in 

18 the demonstration program. 

19 (3) DISTRIBUTION.—To the extent feasible, the 

20 Secretary shall award— 

21 (A) at least 10 grants to providers of serv22 ices described in paragraph (2)(A)(i); 

23 (B) at least 10 grants to service providers 

24 described in paragraph (2)(A)(ii); 


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1 (C) at least 10 grants to organizations de2 scribed in paragraph (2)(A)(iii); and 

3 (D) at least 10 grants to sponsors de4 scribed in paragraph (2)(A)(iv). 

5 (4) CONSIDERATIONS IN AWARDING GRANTS.— 

6 (A) VARIATION AMONG GRANTEES.—In 

7 awarding grants under this subsection, the Sec8 retary shall select grantees to ensure the fol9 lowing: 

10 (i) The grantees provide many dif11 ferent types of language services. 

12 (ii) The grantees serve Medicare bene13 ficiaries who speak different languages, 

14 and who, as a population, have differing 

15 needs for language services. 

16 (iii) The grantees serve Medicare 

17 beneficiaries in both urban and rural set18 tings. 

19 (iv) The grantees represent each Cen20 ters for Medicare & Medicaid Services re21 gion, as defined by the Secretary. 

22 (v) The grantees serve Medicare bene23 ficiaries in at least two large metropolitan 

24 statistical areas with racial, ethnic, sexual, 


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1 gender, disability, and economically diverse 

2 populations. 

3 (B) PRIORITY FOR PARTNERSHIPS WITH

4 COMMUNITY ORGANIZATIONS AND AGENCIES.— 

5 In awarding grants under this subsection, the 

6 Secretary shall give priority to eligible entities 

7 that have a partnership with— 

8 (i) a community organization; or 

9 (ii) a consortium of community orga10 nizations, State agencies, and local agen11 cies; 

12 that has experience in providing language serv13 ices. 

14 (5) USE OF FUNDS FOR COMPETENT LANGUAGE

15 SERVICES.— 

16 (A) IN GENERAL.—Subject to subpara17 graph (E), a grantee may only use grant funds 

18 received under this subsection to pay for the 

19 provision of competent language services to 

20 Medicare beneficiaries who are individuals with 

21 limited English proficiency. 

22 (B) COMPETENT LANGUAGE SERVICES DE23 FINED.—For purposes of this subsection, the 

24 term ‘‘competent language services’’ means— 


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1 (i) interpreter and translation services 

2 that— 

3 (I) subject to the exceptions 

4 under subparagraph (C)— 

5 (aa) if the grantee operates 

6 in a State that has statewide 

7 health care interpreter standards, 

8 meet the State standards cur9 rently in effect; or 

10 (bb) if the grantee operates 

11 in a State that does not have 

12 statewide health care interpreter 

13 standards, utilize competent in14 terpreters who follow the Na15 tional Council on Interpreting in 

16 Health Care’s Code of Ethics and 

17 Standards of Practice and com18 ply with the requirements of sec19 tion 1557 of the Patient Protec20 tion and Affordable Care Act (42 

21 U.S.C. 18116) as published in 

22 the Federal Register on May 18, 

23 2016; and 

24 (II) in the case of interpreter 

25 services, are provided through— 


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1 (aa) onsite interpretation; 

2 (bb) telephonic interpreta3 tion; or 

4 (cc) video interpretation; 

5 and 

6 (ii) the direct provision of health care 

7 or health care-related services by a com8 petent bilingual health care provider. 

9 (C) EXCEPTIONS.—The requirements of 

10 subparagraph (B)(i)(I) do not apply, with re11 spect to interpreter and translation services and 

12 a grantee— 

13 (i) in the case of a Medicare bene14 ficiary who is limited English proficient, 

15 if— 

16 (I) such beneficiary has been in17 formed, in the beneficiary’s primary 

18 language, of the availability of free in19 terpreter and translation services and 

20 the beneficiary instead requests that a 

21 family member, friend, or other per22 son provide such services; and 

23 (II) the grantee documents such 

24 request in the beneficiary’s medical 

25 record; or 


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1 (ii) in the case of a medical emergency 

2 where the delay directly associated with ob3 taining a competent interpreter or trans4 lation services would jeopardize the health 

5 of the patient. 

6 Clause (ii) shall not be construed to exempt 

7 emergency rooms or similar entities that regu8 larly provide health care services in medical 

9 emergencies to patients who are individuals 

10 with limited English proficiency from any appli11 cable legal or regulatory requirements related to 

12 providing competent interpreter and translation 

13 services without undue delay. 

14 (D) MEDICARE ADVANTAGE ORGANIZA15 TIONS AND PDP SPONSORS.—A grantee that is 

16 a Medicare Advantage organization or a pre17 scription drug plan sponsor must provide at 

18 least 50 percent of the grant funds that the 

19 grantee receives under this subsection directly 

20 to the entity’s network providers (including all 

21 health providers and pharmacists) for the pur22 pose of providing support for such providers to 

23 provide competent language services to Medi24 care beneficiaries who are individuals with lim25 ited English proficiency. 


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1 (E) ADMINISTRATIVE AND REPORTING

2 COSTS.—A grantee may use up to 10 percent of 

3 the grant funds to pay for administrative costs 

4 associated with the provision of competent lan5 guage services and for reporting required under 

6 paragraph (9). 

7 (6) DETERMINATION OF AMOUNT OF GRANT

8 PAYMENTS.— 

9 (A) IN GENERAL.—Payments to grantees 

10 under this subsection shall be calculated based 

11 on the estimated numbers of Medicare bene12 ficiaries who are limited English proficiency in 

13 a grantee’s service area utilizing— 

14 (i) data on the numbers of English 

15 learners who speak English less than ‘‘very 

16 well’’ from the most recently available data 

17 from the Bureau of the Census or other 

18 State-based study the Secretary determines 

19 is likely to yield accurate data regarding 

20 the number of such individuals in such 

21 service area; or 

22 (ii) data provided by the grantee, if 

23 the grantee routinely collects data on the 

24 primary language of the Medicare bene25 ficiaries that the grantee serves and the 


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1 Secretary determines that the data is accu2 rate and shows a greater number of indi3 viduals with limited English proficiency 

4 than would be estimated using the data 

5 under clause (i). 

6 (B) DISCRETION OF SECRETARY.—Subject 

7 to subparagraph (C), the amount of payment 

8 made to a grantee under this subsection may be 

9 modified annually at the discretion of the Sec10 retary, based on changes in the data under sub11 paragraph (A) with respect to the service area 

12 of a grantee for the year. 

13 (C) LIMITATION ON AMOUNT.—The 

14 amount of a grant made under this subsection 

15 to a grantee may not exceed $500,000 for the 

16 period under paragraph (1)(D). 

17 (7) ASSURANCES.—Grantees under this sub18 section shall, as a condition of receiving a grant 

19 under this subsection— 

20 (A) ensure that clinical and support staff 

21 receive appropriate ongoing education and 

22 training in linguistically appropriate service de23 livery; 

24 (B) ensure the linguistic competence of bi25 lingual providers; 


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1 (C) offer and provide appropriate language 

2 services at no additional charge to each patient 

3 who is limited English proficient for all points 

4 of contact between the patient and the grantee, 

5 in a timely manner during all hours of oper6 ation; 

7 (D) notify Medicare beneficiaries of their 

8 right to receive language services in their pri9 mary language at least annually; 

10 (E) post signage in the primary languages 

11 commonly used by the patient population in the 

12 service area of the organization; and 

13 (F) ensure that— 

14 (i) primary language data are col15 lected for recipients of language services 

16 and such data are consistent with stand17 ards developed under title XXXIV of the 

18 Public Health Service Act, as added by 

19 section 2002 of this Act, to the extent such 

20 standards are available upon the initiation 

21 of the demonstration program; and 

22 (ii) consistent with the privacy protec23 tions provided under the regulations pro24 mulgated pursuant to section 264(c) of the 

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1 ability Act of 1996 (42 U.S.C. 1320d–2 

2 note), if the recipient of language services 

3 is a minor or is incapacitated, primary lan4 guage data must also be collected on the 

5 parent or legal guardian of such recipient. 

6 (8) NO COST SHARING.—Medicare beneficiaries 

7 who are limited English proficient shall not have to 

8 pay cost sharing or co-payments for competent lan9 guage services provided under this demonstration 

10 program. 

11 (9) REPORTING REQUIREMENTS FOR GRANT12 EES.—Not later than the end of each calendar year, 

13 a grantee that receives funds under this subsection 

14 in such year shall submit to the Secretary a report 

15 that includes the following information: 

16 (A) The number of Medicare beneficiaries 

17 to whom competent language services are pro18 vided, disaggregated by age and entitlement 

19 basis (on the basis of age, disability, or deter20 mination of end stage renal disease). 

21 (B) The primary languages of those Medi22 care beneficiaries. 

23 (C) The types of language services pro24 vided to such beneficiaries. 


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1 (D) Whether such language services were 

2 provided by employees of the grantee or 

3 through a contract with external contractors or 

4 agencies. 

5 (E) The types of interpretation services 

6 provided to such beneficiaries, and the approxi7 mate length of time such service is provided to 

8 such beneficiaries. 

9 (F) The costs of providing competent lan10 guage services. 

11 (G) An account of the training or accredi12 tation of bilingual staff, interpreters, and trans13 lators providing services funded by the grant 

14 under this subsection. 

15 (10) EVALUATION AND REPORT TO CON16 GRESS.—Not later than 1 year after the completion 

17 of a 3-year grant under this subsection, the Sec18 retary shall conduct an evaluation of the demonstra19 tion program under this subsection and shall submit 

20 to the Congress a report that includes the following: 

21 (A) An analysis of the patient outcomes 

22 and the costs of furnishing care to the Medicare 

23 beneficiaries who are individuals with limited 

24 English proficiency participating in the project 

25 as compared to such outcomes and costs for 


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1 such Medicare beneficiaries not participating, 

2 based on the data provided under paragraph (9) 

3 and any other information available to the Sec4 retary. 

5 (B) The effect of delivering language serv6 ices on— 

7 (i) Medicare beneficiary access to care 

8 and utilization of services; 

9 (ii) the efficiency and cost-effective10 ness of health care delivery; 

11 (iii) patient satisfaction with respect 

12 to both health service delivery and lan13 guage assistance; 

14 (iv) health outcomes; and 

15 (v) the provision of culturally appro16 priate services provided to such bene17 ficiaries. 

18 (C) The extent to which bilingual staff, in19 terpreters, and translators providing services 

20 under such demonstration were trained or ac21 credited and the nature of accreditation or 

22 training needed by type of provider, service, or 

23 other category as determined by the Secretary 

24 to ensure the provision of high-quality interpre25 tation, translation, or other language services to 


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1 Medicare beneficiaries if such services are ex2 panded pursuant to section 1115A(c) of the So3 cial Security Act (42 U.S.C. 1315a(c)). 

4 (D) Recommendations, if any, regarding 

5 the extension of such project to the entire Medi6 care Program, subject to the provisions of such 

7 section 1115A(c). 

8 (11) APPROPRIATIONS.—There is appropriated 

9 to carry out this subsection, in equal parts from the 

10 Federal Hospital Insurance Trust Fund under sec11 tion 1817 of the Social Security Act (42 U.S.C. 

12 1395i) and the Federal Supplementary Medical In13 surance Trust Fund under section 1841 of such Act 

14 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 

15 of the demonstration program. 

16 (12) LIMITED ENGLISH PROFICIENT DE17 FINED.—In this subsection, the term ‘‘limited 

18 English proficient’’ refers to individuals who self19 identify on the Census as speaking English less than 

20 ‘‘very well’’. 

21 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE

22 MEDICARE PROGRAM.— 

23 (1) INCLUSION AS RURAL HEALTH CLINIC

24 SERVICES.—Section 1861 of the Social Security Act 

25 (42 U.S.C. 1395x) is amended— 


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1 (A) in subsection (aa)(1)— 

2 (i) in subparagraph (B), by striking 

3 ‘‘and’’ at the end; 

4 (ii) in subparagraph (C), by adding 

5 ‘‘and’’ at the end; and 

6 (iii) by inserting after subparagraph 

7 (C) the following new subparagraph: 

8 ‘‘(D) language assistance services as defined in 

9 subsection (lll),’’; and 

10 (B) by adding at the end the following new 

11 subsection: 

12 ‘‘Language Assistance Services and Related Terms 

13 ‘‘(lll) The term ‘language assistance services’ means 

14 ‘language access’ or ‘language assistance services’ (as 

15 those terms are defined in section 3400 of the Public 

16 Health Service Act) furnished by a ‘qualified interpreter 

17 for an individual with limited English proficiency’ or a 

18 ‘qualified translator’ (as those terms are defined in such 

19 section 3400) to an ‘individual with limited English pro20 ficiency’ (as defined in such section 3400).’’. 

21 (2) COVERAGE.—Section 1832(a)(2) of the So22 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend23 ed— 

24 (A) in subparagraph (I), by striking ‘‘and’’ 

25 at the end; 


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1 (B) in subparagraph (J), by striking the 

2 period at the end and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(K) language assistance services (as de6 fined in section 1861(lll)).’’. 

7 (3) PAYMENT.—Section 1833(a) of the Social 

8 Security Act (42 U.S.C. 1395l(a)) is amended— 

9 (A) in paragraph (9), by striking ‘‘and’’ at 

10 the end; 

11 (B) in paragraph (10), by striking the pe12 riod at the end and inserting ‘‘; and’’; and 

13 (C) by inserting after paragraph (10) the 

14 following new paragraph: 

15 ‘‘(11) in the case of language assistance serv16 ices (as defined in section 1861(lll)), 100 percent of 

17 the reasonable charges for such services, as deter18 mined in consultation with the Medicare Payment 

19 Advisory Commission.’’. 

20 (4) WAIVER OF BUDGET NEUTRALITY.—For 

21 the 3-year period beginning on the date of enact22 ment of this section, the budget neutrality provision 

23 of section 1848(c)(2)(B)(ii) of the Social Security 

24 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 


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1 apply with respect to language assistance services 

2 (as defined in section 1861(lll) of such Act). 

3 (c) MEDICARE PARTS C AND D.— 

4 (1) IN GENERAL.—Medicare Advantage plans 

5 under part C of title XVIII of the Social Security 

6 Act (42 U.S.C. 1395w–21 et seq.) and prescription 

7 drug plans under part D of such title (42 U.S.C. 

8 1395q–101) shall comply with title VI of the Civil 

9 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 

10 section 1557 of the Patient Protection and Afford11 able Care Act (42 U.S.C. 18116) to provide effective 

12 language services to enrollees of such plans. 

13 (2) MEDICARE ADVANTAGE PLANS AND PRE14 SCRIPTION DRUG PLANS REPORTING REQUIRE15 MENT.—Section 1857(e) of the Social Security Act 

16 (42 U.S.C. 1395w–27(e)) is amended by adding at 

17 the end the following new paragraph: 

18 ‘‘(6) REPORTING REQUIREMENTS RELATING TO

19 EFFECTIVE LANGUAGE SERVICES.—A contract under 

20 this part shall require a Medicare Advantage organi21 zation (and, through application of section 1860D– 

22 12(b)(3)(D), a contract under section 1860D–12 

23 shall require a PDP sponsor) to annually submit 

24 (for each year of the contract) a report that contains 

25 information on the internal policies and procedures 


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1 of the organization (or sponsor) related to recruit2 ment and retention efforts directed to workforce di3 versity and linguistically and culturally appropriate 

4 provision of services in each of the following con5 texts: 

6 ‘‘(A) The collection of data in a manner 

7 that meets the requirements of title I of the 

8 Health Equity and Accountability Act of 2022, 

9 regarding the enrollee population. 

10 ‘‘(B) Education of staff and contractors 

11 who have routine contact with enrollees regard12 ing the various needs of the diverse enrollee 

13 population. 

14 ‘‘(C) Evaluation of the language services 

15 programs and services offered by the organiza16 tion (or sponsor) with respect to the enrollee 

17 population, such as through analysis of com18 plaints or satisfaction survey results. 

19 ‘‘(D) Methods by which the plan provides 

20 to the Secretary information regarding the eth21 nic diversity of the enrollee population. 

22 ‘‘(E) The periodic provision of educational 

23 information to plan enrollees on the language 

24 services and programs offered by the organiza25 tion (or sponsor).’’. 


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1 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID

2 AND CHIP.— 

3 (1) PAYMENTS TO STATES.—Section 

4 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 

5 1396b(a)(2)(E)), as amended by section 2005(h)(3), 

6 is further amended by— 

7 (A) striking ‘‘75’’ and inserting ‘‘95’’; 

8 (B) striking ‘‘translation or interpretation 

9 services’’ and inserting ‘‘language assistance 

10 services’’; and 

11 (C) striking ‘‘children of families’’ and in12 serting ‘‘individuals’’. 

13 (2) STATE PLAN REQUIREMENTS.—Section 

14 1902(a)(10)(A) of the Social Security Act (42 

15 U.S.C. 1396a(a)(10)(A)) is amended by striking 

16 ‘‘and (30)’’ and inserting ‘‘(30), and (31)’’. 

17 (3) DEFINITION OF MEDICAL ASSISTANCE.— 

18 (A) IN GENERAL.—Section 1905(a) of the 

19 Social Security Act (42 U.S.C. 1396d(a)) is 

20 amended— 

21 (i) in paragraph (30), by striking 

22 ‘‘and’’ at the end; 

23 (ii) by redesignating paragraph (31) 

24 as paragraph (32); and 


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1 (iii) by inserting after paragraph (30) 

2 the following new paragraph: 

3 ‘‘(31) language assistance services, as such 

4 term is defined in section 1861(lll), provided in a 

5 timely manner to individuals with limited English 

6 proficiency as defined in section 3400 of the Public 

7 Health Service Act; and’’. 

8 (B) CONFORMING AMENDMENTS.— 

9 (i) Section 1902(nn)(3) of the Social 

10 Security Act (42 U.S.C. 1396a(nn)(3)) is 

11 amended by striking ‘‘paragraph (30)’’ and 

12 inserting ‘‘the last paragraph’’. 

13 (ii) Section 1905(a) of the Social Se14 curity Act (42 U.S.C. 1396d(a)) is amend15 ed, in the 5th sentence, by striking ‘‘para16 graph (30)’’ and inserting ‘‘the last para17 graph’’. 

18 (4) USE OF DEDUCTIONS AND COST SHAR19 ING.—Subsections (a)(2) and (b)(2) of section 

20 1916(a)(2) of the Social Security Act (42 U.S.C. 

21 1396o(a)(2)) are each amended— 

22 (A) in subparagraph (G), by inserting a 

23 comma after ‘‘plan’’; 

24 (B) in subparagraph (H), by striking ‘‘; 

25 or’’ and inserting a comma; 


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1 (C) in subparagraph (I), by striking ‘‘; 

2 and’’ and inserting ‘‘, or’’; and 

3 (D) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(J) language assistance services described 

6 in section 1905(a)(31); and’’. 

7 (5) CHIP COVERAGE REQUIREMENTS.—Section 

8 2103 of the Social Security Act (42 U.S.C. 1397cc) 

9 is amended— 

10 (A) in subsection (a), in the matter before 

11 paragraph (1), by striking ‘‘(7) and (8)’’ and 

12 inserting ‘‘(7), (8), (9), (10), (11), and (12)’’; 

13 (B) in subsection (c), by adding at the end 

14 the following new paragraph: 

15 ‘‘(12) LANGUAGE ASSISTANCE SERVICES.—The 

16 child health assistance provided to a targeted low-in17 come child shall include coverage of language assist18 ance services, as such term is defined in section 

19 1861(lll), provided in a timely manner to individuals 

20 with limited English proficiency (as defined in sec21 tion 3400 of the Public Health Service Act).’’; and 

22 (C) in subsection (e)(2)— 

23 (i) in the heading, by striking ‘‘PRE24 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 


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1 (ii) by inserting ‘‘language assistance 

2 services described in subsection (c)(12),’’ 

3 before ‘‘visits described in’’. 

4 (6) DEFINITION OF CHILD HEALTH ASSIST5 ANCE.—Section 2110(a)(27) of the Social Security 

6 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik7 ing ‘‘translation’’ and inserting ‘‘language assistance 

8 services as described in section 2103(c)(12)’’. 

9 (7) STATE DATA COLLECTION.—Pursuant to 

10 the reporting requirement described in section 

11 2107(b)(1) of the Social Security Act (42 U.S.C. 

12 1397gg(b)(1)), the Secretary of Health and Human 

13 Services shall require that States collect data on— 

14 (A) the primary language of individuals re15 ceiving child health assistance under title XXI 

16 of the Social Security Act (42 U.S.C. 1397aa et 

17 seq.); and 

18 (B) in the case of such individuals who are 

19 minors or incapacitated, the primary language 

20 of the individual’s parent or guardian. 

21 (8) CHIP PAYMENTS TO STATES.—Section 

22 2105 of the Social Security Act (42 U.S.C. 1397ee) 

23 is amended— 

24 (A) in subsection (a)(1)— 


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1 (i) in the matter preceding subpara2 graph (A), by striking ‘‘75’’ and inserting 

3 ‘‘95’’; and 

4 (ii) in subparagraph (D)(iv), by strik5 ing ‘‘translation or interpretation services’’ 

6 and inserting ‘‘language assistance serv7 ices’’; and 

8 (B) in subsection (c)(2)(A), by inserting 

9 before the period at the end the following: ‘‘, 

10 except that expenditures pursuant to clause (iv) 

11 of subparagraph (D) of such paragraph shall 

12 not count towards this total’’. 

13 (e) FUNDING LANGUAGE ASSISTANCE SERVICES

14 FURNISHED BY PROVIDERS OF HEALTH CARE AND

15 HEALTH CARE-RELATED SERVICES THAT SERVE HIGH

16 RATES OF UNINSURED LEP INDIVIDUALS.— 

17 (1) PAYMENT OF COSTS.— 

18 (A) IN GENERAL.—Subject to subpara19 graph (B), the Secretary of Health and Human 

20 Services (referred to in this subsection as the 

21 ‘‘Secretary’’) shall make payments (on a quar22 terly basis) directly to eligible entities to sup23 port the provision of language assistance serv24 ices to individuals with limited English pro25 ficiency in an amount equal to an eligible entiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ty’s eligible costs for providing such services for 

2 the quarter. 

3 (B) FUNDING.—Out of any funds in the 

4 Treasury not otherwise appropriated, there are 

5 appropriated to the Secretary such sums as 

6 may be necessary for each of fiscal years 2022 

7 through 2026. 

8 (C) RELATION TO MEDICAID DSH.—Pay9 ments under this subsection shall not offset or 

10 reduce payments under section 1923 of the So11 cial Security Act (42 U.S.C. 1396r–4), nor 

12 shall payments under such section be consid13 ered when determining uncompensated costs as14 sociated with the provision of language assist15 ance services for the purposes of this sub16 section. 

17 (2) METHODOLOGY FOR PAYMENT OF

18 CLAIMS.— 

19 (A) IN GENERAL.—The Secretary shall es20 tablish a methodology to determine the average 

21 per person cost of language assistance services. 

22 (B) DIFFERENT ENTITIES.—In estab23 lishing such methodology, the Secretary may es24 tablish different methodologies for different 

25 types of eligible entities. 


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1 (C) NO INDIVIDUAL CLAIMS.—The Sec2 retary may not require eligible entities to sub3 mit individual claims for language assistance 

4 services for individual patients as a requirement 

5 for payment under this subsection. 

6 (3) DATA COLLECTION INSTRUMENT.—For pur7 poses of this subsection, the Secretary shall create a 

8 standard data collection instrument that is con9 sistent with any existing reporting requirements by 

10 the Secretary or relevant accrediting organizations 

11 regarding the number of individuals to whom lan12 guage access is provided. 

13 (4) GUIDELINES.—Not later than 6 months 

14 after the date of enactment of this Act, the Sec15 retary shall establish and distribute guidelines con16 cerning the implementation of this subsection. 

17 (5) REPORTING REQUIREMENTS.— 

18 (A) REPORT TO SECRETARY.—Entities re19 ceiving payment under this subsection shall pro20 vide the Secretary with a quarterly report on 

21 how the entity used such funds. Such report 

22 shall contain aggregate (and may not contain 

23 individualized) data collected using the instru24 ment under paragraph (3) and shall otherwise 


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1 be in a form and manner determined by the 

2 Secretary. 

3 (B) REPORT TO CONGRESS.—Not later 

4 than 2 years after the date of enactment of this 

5 Act, and every 2 years thereafter, the Secretary 

6 shall submit a report to Congress concerning 

7 the implementation of this subsection. 

8 (6) DEFINITIONS.—In this subsection: 

9 (A) ELIGIBLE COSTS.—The term ‘‘eligible 

10 costs’’ means, with respect to an eligible entity 

11 that provides language assistance services to 

12 limited English proficient individuals, the prod13 uct of— 

14 (i) the average per person cost of lan15 guage assistance services, determined ac16 cording to the methodology devised under 

17 paragraph (2); and 

18 (ii) the number of individuals with 

19 limited English proficiency who are pro20 vided language assistance services by the 

21 entity and for whom no reimbursement is 

22 available for such services under the 

23 amendments made by subsection (a), (b), 

24 (c), or (d) or by private health insurance. 


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1 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

2 entity’’ means an entity that— 

3 (i) is a Medicaid provider that is— 

4 (I) a physician; 

5 (II) a hospital with a low-income 

6 utilization rate (as defined in section 

7 1923(b)(3) of the Social Security Act 

8 (42 U.S.C. 1396r–4(b)(3))) of greater 

9 than 25 percent; 

10 (III) a federally qualified health 

11 center (as defined in section 

12 1905(l)(2)(B) of the Social Security 

13 Act (42 U.S.C. 1396d(l)(2)(B))); 

14 (IV) a hospice provider; or 

15 (V) a palliative care provider; 

16 (ii) not later than 6 months after the 

17 date of the enactment of this Act, provides 

18 language assistance services to not less 

19 than 8 percent of the entity’s total number 

20 of patients; and 

21 (iii) prepares and submits an applica22 tion to the Secretary, at such time, in such 

23 manner, and accompanied by such infor24 mation as the Secretary may require, to 


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1 ascertain the entity’s eligibility for funding 

2 under this subsection. 

3 (C) LANGUAGE ASSISTANCE SERVICES.— 

4 The term ‘‘language assistance services’’ has 

5 the meaning given such term in section 

6 1861(lll) of the Social Security Act, as added by 

7 subsection (b). 

8 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 

9 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND

10 OTHER LAWS.—Nothing in this section shall be construed 

11 to limit otherwise existing obligations of recipients of Fed12 eral financial assistance under title VI of the Civil Rights 

13 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 

14 the Affordable Care Act, or other laws that protect the 

15 civil rights of individuals. 

16 (g) EFFECTIVE DATE.— 

17 (1) IN GENERAL.—Except as otherwise pro18 vided and subject to paragraph (2), the amendments 

19 made by this section shall take effect on January 1, 

20 2023. 

21 (2) EXCEPTION IF STATE LEGISLATION RE22 QUIRED.—In the case of a State plan for medical as23 sistance under title XIX of the Social Security Act 

24 (42 U.S.C. 1396 et seq.) or a State plan for child 

25 health assistance under title XXI of such Act (42 


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1 U.S.C. 1397aa et seq.) which the Secretary of 

2 Health and Human Services determines requires 

3 State legislation (other than legislation appro4 priating funds) in order for the plan to meet the ad5 ditional requirement imposed by the amendments 

6 made by this section, such State plan shall not be 

7 regarded as failing to comply with the requirements 

8 of such title solely on the basis of its failure to meet 

9 this additional requirement before the first day of 

10 the first calendar quarter beginning after the close 

11 of the first regular session of the State legislature 

12 that begins after the date of the enactment of this 

13 Act. For purposes of the previous sentence, in the 

14 case of a State that has a 2-year legislative session, 

15 each year of such session shall be deemed to be a 

16 separate regular session of the State legislature. 

17 SEC. 2008. INCREASING UNDERSTANDING OF AND IMPROV18 ING HEALTH LITERACY. 

19 (a) IN GENERAL.—The Secretary, in consultation 

20 with the Director of the National Institute on Minority 

21 Health and Health Disparities and the Deputy Assistant 

22 Secretary for Minority Health, shall award grants to eligi23 ble entities to improve health care for patient populations 

24 that have low health literacy. 


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1 (b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a), an entity shall— 

3 (1) be a hospital, health center or clinic, health 

4 plan, or other health entity (including a nonprofit 

5 minority health organization or association); and 

6 (2) prepare and submit to the Secretary an ap7 plication at such time, in such manner, and con8 taining such information as the Secretary may rea9 sonably require. 

10 (c) USE OF FUNDS.— 

11 (1) AGENCY FOR HEALTHCARE RESEARCH AND

12 QUALITY.—A grant under subsection (a) that is 

13 awarded through the Director of the Agency for 

14 Healthcare Research and Quality shall be used— 

15 (A) to define and increase the under16 standing of health literacy across all areas of 

17 health care, including end of life care; 

18 (B) to investigate the correlation between 

19 low health literacy and health and health care; 

20 (C) to clarify which aspects of health lit21 eracy have an effect on health outcomes; and 

22 (D) for any other activity determined ap23 propriate by the Director. 

24 (2) HEALTH RESOURCES AND SERVICES ADMIN25 ISTRATION.—A grant under subsection (a) that is 


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1 awarded through the Administrator of the Health 

2 Resources and Services Administration shall be used 

3 to conduct demonstration projects for interventions 

4 for patients with low health literacy that may in5 clude— 

6 (A) the development of new disease man7 agement and end of life care programs for pa8 tients with low health literacy; 

9 (B) the tailoring of disease management 

10 programs and end of life care addressing men11 tal, physical, oral, and behavioral health condi12 tions for patients with low health literacy; 

13 (C) the translation of written health mate14 rials for patients with low health literacy; 

15 (D) the identification, implementation, and 

16 testing of low health literacy screening tools; 

17 (E) the conduct of educational campaigns 

18 for patients and providers about low health lit19 eracy; 

20 (F) the conduct of educational campaigns 

21 concerning health directed specifically at pa22 tients with mental disabilities, including those 

23 with cognitive and intellectual disabilities, de24 signed to reduce the incidence of low health lit25 eracy among these populations, which shall 


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1 have instructional materials in the plain lan2 guage standards promulgated under the Plain 

3 Writing Act of 2010 (5 U.S.C. 301 note) for 

4 Federal agencies; and 

5 (G) other activities determined appropriate 

6 by the Administrator. 

7 (d) DEFINITIONS.—In this section: 

8 (1) LOW HEALTH LITERACY.—The term ‘‘low 

9 health literacy’’ means the inability of an individual 

10 to obtain, process, and understand basic health in11 formation and services needed to make appropriate 

12 health decisions. 

13 (2) SECRETARY.—The term ‘‘Secretary’’ means 

14 the Secretary of Health and Human Services— 

15 (A) acting through the Director of the 

16 Agency for Healthcare Research and Quality, 

17 with respect to grants under subsection (c)(1); 

18 and 

19 (B) acting through the Administrator of 

20 the Health Resources and Services Administra21 tion with respect to grants under subsection 

22 (c)(2). 

23 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated to carry out this section 


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1 such sums as may be necessary for each of fiscal years 

2 2023 through 2027. 

3 SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR 

4 ACTIVITIES RECEIVING FEDERAL FUNDS. 

5 (a) COVERED ENTITY; COVERED PROGRAM OR AC6 TIVITY.—In this section— 

7 (1) the term ‘‘covered entity’’ has the meaning 

8 given such term in section 92.4 of title 45, Code of 

9 Federal Regulations, as in effect on May 18, 2016 

10 (81 Fed. Reg. 31466); and 

11 (2) the term ‘‘health program or activity’’ has 

12 the meaning given such term in section 92.4 of title 

13 45, Code of Federal Regulations, as in effect on May 

14 18, 2016 (81 Fed. Reg. 31466). 

15 (b) REQUIREMENTS.—A covered entity, in order to 

16 ensure the right of individuals with limited English pro17 ficiency to receive access to high-quality health care 

18 through the covered program or activity, shall— 

19 (1) ensure that appropriate clinical and support 

20 staff receive ongoing education and training in cul21 turally and linguistically appropriate service delivery 

22 at least annually; 

23 (2) offer and provide appropriate language as24 sistance services at no additional charge to each pa25 tient that is an individual with limited English proVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ficiency at all points of contact, in a timely manner 

2 during all hours of operation; 

3 (3) notify patients of their right to receive lan4 guage services in their primary language; and 

5 (4) utilize only qualified interpreters for an in6 dividual with limited English proficiency or qualified 

7 translators, except as provided in subsection (c). 

8 (c) EXEMPTIONS.—The requirements of subsection 

9 (b)(4) shall not apply as follows: 

10 (1) When a patient requests the use of family, 

11 friends, or other persons untrained in interpretation 

12 or translation if each of the following conditions are 

13 met: 

14 (A) The interpreter requested by the pa15 tient is over the age of 18. 

16 (B) The covered entity informs the patient 

17 in the primary language of the patient that he 

18 or she has the option of having the entity pro19 vide to the patient an interpreter and trans20 lation services without charge. 

21 (C) The covered entity informs the patient 

22 that the entity may not require an individual 

23 with a limited English proficiency to use a fam24 ily member or friend as an interpreter. 


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1 (D) The covered entity evaluates whether 

2 the person the patient wishes to use as an in3 terpreter is competent. If the covered entity has 

4 reason to believe that such person is not com5 petent as an interpreter, the entity provides its 

6 own interpreter to protect the covered entity 

7 from liability if the patient’s interpreter is later 

8 found not competent. 

9 (E) If the covered entity has reason to be10 lieve that there is a conflict of interest between 

11 the interpreter and patient, the covered entity 

12 may not use the patient’s interpreter. 

13 (F) The covered entity has the patient sign 

14 a waiver, witnessed by at least 1 individual not 

15 related to the patient, that includes the infor16 mation stated in subparagraphs (A) through 

17 (E) and is translated into the patient’s primary 

18 language. 

19 (2) When a medical emergency exists and the 

20 delay directly associated with obtaining competent 

21 interpreter or translation services would jeopardize 

22 the health of the patient, but only until a competent 

23 interpreter or translation service is available. 

24 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 

25 shall not be construed to mean that emergency rooms or 


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1 similar entities that regularly provide health care services 

2 in medical emergencies are exempt from legal or regu3 latory requirements related to competent interpreter serv4 ices. 

5 SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE 

6 CULTURALLY AND LINGUISTICALLY APPRO7 PRIATE HEALTH CARE SERVICES. 

8 (a) REPORT.—Not later than 1 year after the date 

9 of enactment of this Act, and annually thereafter, the Sec10 retary of Health and Human Services shall enter into a 

11 contract with the National Academy of Medicine for the 

12 preparation and publication of a report that describes 

13 Federal efforts to ensure that all individuals with limited 

14 English proficiency have meaningful access to health care 

15 services and health care-related services that are culturally 

16 and linguistically appropriate. Such report shall include— 

17 (1) a description and evaluation of the activities 

18 carried out under this Act; 

19 (2) a description and analysis of best practices, 

20 model programs, guidelines, and other effective 

21 strategies for providing access to culturally and lin22 guistically appropriate health care services; 

23 (3) recommendations on the development and 

24 implementation of policies and practices by providers 

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1 ices for individuals with limited English proficiency, 

2 including people with cognitive, hearing, vision, or 

3 print impairments; 

4 (4) recommend guidelines or standards for 

5 health literacy and plain language, informed consent, 

6 discharge instructions, and written communications, 

7 and for improvement of health care access; 

8 (5) a description of the effect of providing lan9 guage services on quality of health care and access 

10 to care; and 

11 (6) a description of the costs associated with or 

12 savings related to the provision of language services. 

13 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

15 such sums as may be necessary for each of fiscal years 

16 2023 through 2027. 

17 SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH 

18 LIMITED ENGLISH PROFICIENCY. 

19 (a) GRANTS AUTHORIZED.—The Secretary of Edu20 cation is authorized to provide grants to eligible entities 

21 for the provision of English as a second language (in this 

22 section referred to as ‘‘ESL’’) instruction to individuals 

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1 sultation with appropriate stakeholders, the mechanism 

2 for administering and distributing such grants. 

3 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el4 igible entity’’ means— 

5 (1) a State; or 

6 (2) a community-based organization that pre7 dominantly employs and serves racial and ethnic mi8 nority groups (as defined in section 1707(g) of the 

9 Public Health Service Act (42 U.S.C. 300u–6(g)). 

10 (c) APPLICATION.—An eligible entity that desires to 

11 receive a grant under this section shall apply by submit12 ting to the Secretary of Education an application at such 

13 time, in such manner, and containing such information as 

14 the Secretary may require. 

15 (d) USE OF GRANT.—An eligible entity shall use 

16 grant funds provided under this section to— 

17 (1) develop and implement a plan for assuring 

18 the availability of ESL instruction, free of charge, to 

19 the community served by the eligible entity, that ef20 fectively integrates information about the nature of 

21 the United States health care system, how to access 

22 care, and any special language skills that may be re23 quired for individuals with limited English pro24 ficiency to access and regularly negotiate the health 

25 care system effectively; 


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1 (2) develop a plan for making ESL instruction 

2 available free to charge to individuals with limited 

3 English proficiency in the community served by the 

4 eligible entity who are seeking instruction, including, 

5 where appropriate, through the use of public-private 

6 partnerships; and 

7 (3) provide ESL instruction to individuals with 

8 limited English proficiency in the community served 

9 by the eligible entity. 

10 (e) SUPPLEMENT, NOT SUPPLANT.—An eligible enti11 ty awarded a grant under this section shall use funds 

12 made available under this section to supplement, and not 

13 supplant, other Federal, State, and local funds that would 

14 otherwise be expended to carry out activities under this 

15 section. 

16 (f) DUTIES OF THE SECRETARY.—The Secretary of 

17 Education shall— 

18 (1) collect and make publicly available annual 

19 data on how much Federal, State, and local govern20 ments spend annually on ESL instruction; 

21 (2) collect data from eligible entities awarded a 

22 grant under this section to identify the unmet needs 

23 of individuals with limited English proficiency for 

24 appropriate ESL instruction, including— 


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1 (A) the preferred written and spoken lan2 guage of such individuals; 

3 (B) the availability of enrollment in ESL 

4 instruction programs in the communities served 

5 by each eligible entity awarded a grant under 

6 this section, including the extent of waiting lists 

7 for ESL instruction, how many programs main8 tain waiting lists, and, for programs that do not 

9 have waiting lists, the reasons why such a list 

10 is unnecessary or otherwise not maintained; 

11 (C) the availability of programs to geo12 graphically isolated communities; 

13 (D) the impact of course enrollment poli14 cies, including open enrollment, on the avail15 ability of ESL instruction; 

16 (E) the number of individuals with limited 

17 English proficiency and the number of individ18 uals enrolled in ESL instruction programs in 

19 the communities served by each eligible entity 

20 awarded a grant under this section; 

21 (F) the effectiveness of the ESL instruc22 tion provided through grants awarded under 

23 this section in meeting the needs of individuals 

24 receiving such instruction; and 


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1 (G) an assessment of the need for pro2 grams that integrate job training and ESL in3 struction, to assist individuals with limited 

4 English proficiency in obtaining better jobs; 

5 (3) determine the cost and most appropriate 

6 methods of making ESL instruction available to all 

7 individuals with limited English proficiency in the 

8 United States who are seeking instruction; and 

9 (4) not later than 1 year after the date of en10 actment of this Act, issue a report to Congress 

11 that— 

12 (A) assesses the information collected in 

13 paragraphs (1), (2), and (3) and makes rec14 ommendations on steps that should be taken to 

15 realize the goal of making ESL instruction 

16 available to all individuals with limited English 

17 proficiency in the United States who are seek18 ing instruction; and 

19 (B) evaluates the impact of the grant pro20 gram authorized under this section on the ac21 cessibility of, and ability to effectively negotiate, 

22 the health care system for individuals with lim23 ited English proficiency who have received ESL 

24 instruction funded by a grant under this sec25 tion. 


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1 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to the Secretary of Edu3 cation $250,000,000 for each of fiscal years 2023 through 

4 2027 to carry out this section. 

5 SEC. 2012. IMPLEMENTATION. 

6 (a) GENERAL PROVISIONS.— 

7 (1) IMMUNITY.—A person injured by a violation 

8 of this title (including an amendment made by this 

9 title) by a State may bring a civil action in the ap10 propriate Federal court for such injury in accord11 ance with this section. 

12 (2) REMEDIES.—In a civil action under this 

13 section for a violation of this title, such remedies 

14 shall be available as would be available in a civil ac15 tion for such violation against any party other than 

16 a State. 

17 (b) RULE OF CONSTRUCTION.—Nothing in this title 

18 may be construed to limit otherwise existing obligations 

19 of recipients of Federal financial assistance under title VI 

20 of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 

21 or any other Federal statute. 

22 SEC. 2013. LANGUAGE ACCESS SERVICES. 

23 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 

24 the Patient Protection and Affordable Care Act (42 


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1 U.S.C. 18022(b)(1)) is amended by adding at the end the 

2 following: 

3 ‘‘(K) Language access services, including 

4 oral interpretation and written translations.’’. 

5 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL

6 COVERAGE.— 

7 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 

8 Internal Revenue Code of 1986 is amended by redes9 ignating clauses (iii) and (iv) as clauses (iv) and (v), 

10 respectively, and by inserting after clause (ii) the fol11 lowing new clause: 

12 ‘‘(iii) COVERAGE MUST INCLUDE LAN13 GUAGE ACCESS AND SERVICES.—Except as 

14 provided in clause (iv), an employee shall 

15 not be treated as eligible for minimum es16 sential coverage if such coverage consists 

17 of an eligible employer-sponsored plan (as 

18 defined in section 5000A(f)(2)) and the 

19 plan does not provide coverage for lan20 guage access services, including oral inter21 pretation and written translations.’’. 

22 (2) CONFORMING AMENDMENTS.— 

23 (A) Section 36B(c)(2)(C) of such Code is 

24 amended by striking ‘‘clause (iii)’’ each place it 


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1 appears in clauses (i) and (ii) and inserting 

2 ‘‘clause (iv)’’. 

3 (B) Section 36B(c)(2)(C)(iv) of such Code, 

4 as redesignated by this subsection, is amended 

5 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 

6 and (iii)’’. 

7 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 

8 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 

9 amended— 

10 (1) by striking ‘‘and’’ at the end of subpara11 graph (C); 

12 (2) by striking the period at the end of sub13 paragraph (D) and inserting ‘‘; and’’; and 

14 (3) by adding at the end the following new sub15 paragraph: 

16 ‘‘(E) reduce health disparities through the 

17 provision of language access services, including 

18 oral interpretation and written translations.’’. 

19 (d) REGULATIONS REGARDING INTERNAL CLAIMS

20 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR

21 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 

22 The Secretary of the Treasury, the Secretary of Labor, 

23 and the Secretary of Health and Human Services shall 

24 amend the regulations in section 54.9815–2719(e) of title 

25 26, Code of Federal Regulations, section 2590.715– 


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1 2719(e) of title 29, Code of Federal Regulations, and sec2 tion 147.136(e) of title 45, Code of Federal Regulations 

3 (or a successor regulation), respectively, to require group 

4 health plans and health insurance issuers offering group 

5 or individual health insurance coverage to which such sec6 tions apply— 

7 (1) to provide oral interpretation services with8 out any threshold requirements; 

9 (2) to provide in the English versions of all no10 tices a statement prominently displayed in not less 

11 than 15 non-English languages clearly indicating 

12 how to access the language services provided by the 

13 plan or issuer; and 

14 (3) with respect to the requirements for pro15 viding relevant notices in a culturally and linguis16 tically appropriate manner in the applicable non17 English languages, to apply a threshold that 5 per18 cent of the population, or not less than 500 individ19 uals, in the county is literate only in the same non20 English language in order for the language to be 

21 considered an applicable non-English language. 

22 (e) DATA COLLECTION AND REPORTING.—The Sec23 retary of Health and Human Services shall— 

24 (1) amend the single streamlined application 

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1 tient Protection and Affordable Care Act (42 U.S.C. 

2 18083) to collect the preferred spoken and written 

3 language for each household member applying for 

4 coverage under a qualified health plan through an 

5 Exchange under title I of such Act (42 U.S.C. 

6 18001 et seq.); 

7 (2) require navigators, certified application 

8 counselors, and other individuals assisting with en9 rollment to collect and report requests for language 

10 assistance; and 

11 (3) require the toll-free telephone hotlines es12 tablished pursuant to section 1311(d)(4)(B) of the 

13 Patient Protection and Affordable Care Act (42 

14 U.S.C. 18031(d)(4)(B)) to submit an annual report 

15 documenting the number of language assistance re16 quests, the types of languages requested, the range 

17 and average wait time for a consumer to speak with 

18 an interpreter, the number of complaints and any 

19 steps the hotline, and any entity contracting with 

20 the Secretary to provide language services, have 

21 taken to actively address some of the consumer com22 plaints. 

23 (f) EFFECTIVE DATE.—The amendments made by 

24 this section shall not apply to plans beginning prior to the 

25 date of the enactment of this Act. 


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1 SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS. 

2 Section 330(b)(3) of the Public Health Service Act 

3 (42 U.S.C. 254b(b)(3)) is amended to read as follows: 

4 ‘‘(3) MEDICALLY UNDERSERVED.—The term 

5 ‘medically underserved’, with respect to a popu6 lation, refers to— 

7 ‘‘(A) the population of an urban or rural 

8 area designated by the Secretary as— 

9 ‘‘(i) an area with a shortage of per10 sonal health services; or 

11 ‘‘(ii) a population group having a 

12 shortage of such services; or 

13 ‘‘(B) a population of individuals, not con14 fined to a particular urban or rural area, who 

15 are designated by the Secretary as having a 

16 shortage of personal health services due to a 

17 specific demographic trait.’’. 

18 TITLE III—HEALTH WORKFORCE 

19 DIVERSITY 

20 SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

21 ACT. 

22 Title XXXIV of the Public Health Service Act, as 

23 added by section 2004, is amended by adding at the end 

24 the following: 


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1 ‘‘Subtitle B—Diversifying the 

2 Health Care Workplace 

3 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 

4 DIVERSITY. 

5 ‘‘(a) IN GENERAL.—The Secretary, acting through 

6 the Bureau of Health Workforce of the Health Resources 

7 and Services Administration, shall award a grant to an 

8 entity determined appropriate by the Secretary for the es9 tablishment of a national working group on workforce di10 versity. 

11 ‘‘(b) REPRESENTATION.—In establishing the national 

12 working group under subsection (a): 

13 ‘‘(1) The grantee shall ensure that the group 

14 has representatives of each of the following: 

15 ‘‘(A) The Health Resources and Services 

16 Administration. 

17 ‘‘(B) The Department of Health and 

18 Human Services Data Council. 

19 ‘‘(C) The Office of Minority Health of the 

20 Department of Health and Human Services. 

21 ‘‘(D) The Substance Abuse and Mental 

22 Health Services Administration. 

23 ‘‘(E) The Bureau of Labor Statistics of 

24 the Department of Labor. 


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1 ‘‘(F) The National Institute on Minority 

2 Health and Health Disparities. 

3 ‘‘(G) The Agency for Healthcare Research 

4 and Quality. 

5 ‘‘(H) The Institute of Medicine Study 

6 Committee for the 2004 workforce diversity re7 port. 

8 ‘‘(I) The Indian Health Service. 

9 ‘‘(J) The Department of Education. 

10 ‘‘(K) Minority-serving academic institu11 tions. 

12 ‘‘(L) Consumer organizations. 

13 ‘‘(M) Health professional associations, in14 cluding those that represent underrepresented 

15 minority populations. 

16 ‘‘(N) Researchers in the area of health 

17 workforce. 

18 ‘‘(O) Health workforce accreditation enti19 ties. 

20 ‘‘(P) Private (including nonprofit) founda21 tions that have sponsored workforce diversity 

22 initiatives. 

23 ‘‘(Q) Local and State health departments. 

24 ‘‘(R) Representatives of community mem25 bers to be included on admissions committees 


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1 for health profession schools pursuant to sub2 section (c)(9). 

3 ‘‘(S) National community-based organiza4 tions that serve as a national intermediary to 

5 their urban affiliate members and have dem6 onstrated capacity to train health care profes7 sionals. 

8 ‘‘(T) The Veterans Health Administration. 

9 ‘‘(U) Other entities determined appropriate 

10 by the Secretary. 

11 ‘‘(2) The grantee shall ensure that, in addition 

12 to the representatives under paragraph (1), the 

13 working group has not less than 5 health professions 

14 students representing various health profession fields 

15 and levels of training. 

16 ‘‘(c) ACTIVITIES.—The working group established 

17 under subsection (a) shall convene at least twice each year 

18 to complete the following activities: 

19 ‘‘(1) Review public and private health workforce 

20 diversity initiatives. 

21 ‘‘(2) Identify successful health workforce diver22 sity programs and practices. 

23 ‘‘(3) Examine challenges relating to the devel24 opment and implementation of health workforce di25 versity initiatives. 


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1 ‘‘(4) Draft a national strategic work plan for 

2 health workforce diversity, including recommenda3 tions for public and private sector initiatives. 

4 ‘‘(5) Develop a framework and methods for the 

5 evaluation of current and future health workforce di6 versity initiatives. 

7 ‘‘(6) Develop recommended standards for work8 force diversity that could be applicable to all health 

9 professions programs and programs funded under 

10 this Act. 

11 ‘‘(7) Develop guidelines to train health profes12 sionals to care for a diverse population. 

13 ‘‘(8) Develop a workforce data collection or 

14 tracking system to identify where racial and ethnic 

15 minority health professionals practice. 

16 ‘‘(9) Develop a strategy for the inclusion of 

17 community members on admissions committees for 

18 health profession schools. 

19 ‘‘(10) Help with monitoring of standards for di20 versity, equity, and inclusion. 

21 ‘‘(11) Other activities determined appropriate 

22 by the Secretary. 

23 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

24 the establishment of the working group under subsection 

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1 pare and make available to the general public for com2 ment, an annual report on the activities of the working 

3 group. Such report shall include the recommendations of 

4 the working group for improving health workforce diver5 sity. 

6 ‘‘(e) COORDINATION WITH OTHER EFFORTS.—In 

7 providing for the establishment of the working group 

8 under subsection (a), the Secretary shall take such steps 

9 as may be necessary to ensure that the work of the work10 ing group does not overlap with, or otherwise duplicate, 

11 other Federal Government efforts with respect to ensuring 

12 health equity in data collection in public health emer13 gencies. 

14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section 

16 such sums as may be necessary for each of fiscal years 

17 2023 through 2027. 

18 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 

19 WORKFORCE DIVERSITY. 

20 ‘‘(a) IN GENERAL.—The Secretary, acting through 

21 the Deputy Assistant Secretary for Minority Health, and 

22 in collaboration with the Bureau of Health Workforce 

23 within the Health Resources and Services Administration 

24 and the National Institute on Minority Health and Health 

25 Disparities, shall establish a technical clearinghouse on 


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1 health workforce diversity within the Office of Minority 

2 Health and coordinate current and future clearinghouses 

3 related to health workforce diversity. 

4 ‘‘(b) INFORMATION AND SERVICES.—The clearing5 house established under subsection (a) shall offer the fol6 lowing information and services: 

7 ‘‘(1) Information on the importance of health 

8 workforce diversity. 

9 ‘‘(2) Statistical information relating to under10 represented minority representation in health and al11 lied health professions and occupations. 

12 ‘‘(3) Model health workforce diversity practices 

13 and programs, including integrated models of care. 

14 ‘‘(4) Admissions policies that promote health 

15 workforce diversity and are in compliance with Fed16 eral and State laws. 

17 ‘‘(5) Retainment policies that promote comple18 tion of health profession degrees for underserved 

19 populations. 

20 ‘‘(6) Lists of scholarship, loan repayment, and 

21 loan cancellation grants as well as fellowship infor22 mation for underserved populations for health pro23 fessions schools. 

24 ‘‘(7) Foundation and other large organizational 

25 initiatives relating to health workforce diversity. 


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1 ‘‘(c) CONSULTATION.—In carrying out this section, 

2 the Secretary shall consult with non-Federal entities which 

3 may include minority health professional associations and 

4 minority sections of major health professional associations 

5 to ensure the adequacy and accuracy of information. 

6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section 

8 such sums as may be necessary for each of fiscal years 

9 2023 through 2027. 

10 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 

11 WORKFORCE DIVERSITY, EQUITY, AND IN12 CLUSION. 

13 ‘‘(a) IN GENERAL.—The Secretary, acting through 

14 the Administrator of the Health Resources and Services 

15 Administration and the Director of the Centers for Dis16 ease Control and Prevention, shall award grants to eligible 

17 entities that demonstrate a commitment to health work18 force diversity. 

19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

20 under subsection (a), an entity shall— 

21 ‘‘(1) be an educational institution or entity that 

22 historically produces or trains meaningful numbers 

23 of underrepresented minority health professionals, 

24 including— 


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1 ‘‘(A) part B institutions, as defined in sec2 tion 322 of the Higher Education Act of 1965; 

3 ‘‘(B) historically Black professional or 

4 graduate institutions eligible for grants under 

5 section 326 of the Higher Education Act of 

6 1965; 

7 ‘‘(C) Hispanic-serving health professions 

8 schools; 

9 ‘‘(D) Hispanic-serving institutions, as de10 fined in section 502 of such Act; 

11 ‘‘(E) Tribal Colleges or Universities, as de12 fined in section 316 of such Act; 

13 ‘‘(F) Asian American and Native American 

14 Pacific Islander-serving institutions, as defined 

15 in section 371(c) of such Act; 

16 ‘‘(G) institutions that have programs to re17 cruit and retain underrepresented minority 

18 health professionals, in which a significant 

19 number of the enrolled participants are under20 represented minorities; 

21 ‘‘(H) health professional associations, 

22 which may include underrepresented minority 

23 health professional associations; and 

24 ‘‘(I) institutions, including national and re25 gional community-based organizations with 


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1 demonstrated commitment to a diversified 

2 workforce— 

3 ‘‘(i) located in communities with pre4 dominantly underrepresented minority pop5 ulations; 

6 ‘‘(ii) with whom partnerships have 

7 been formed for the purpose of increasing 

8 workforce diversity; and 

9 ‘‘(iii) in which at least 20 percent of 

10 the enrolled participants are underrep11 resented minorities; and 

12 ‘‘(2) submit to the Secretary an application at 

13 such time, in such manner, and containing such in14 formation as the Secretary may require. 

15 ‘‘(c) USE OF FUNDS.—Amounts received under a 

16 grant under subsection (a) shall be used to expand existing 

17 workforce diversity programs, implement new workforce 

18 diversity programs, or evaluate existing or new workforce 

19 diversity programs, including with respect to mental 

20 health care professions. Such programs shall enhance di21 versity by considering minority status as part of an indi22 vidualized consideration of qualifications. Possible activi23 ties may include— 

24 ‘‘(1) educational outreach programs relating to 

25 opportunities in the health professions; 


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1 ‘‘(2) scholarship, fellowship, grant, loan repay2 ment, and loan cancellation programs; 

3 ‘‘(3) postbaccalaureate programs; 

4 ‘‘(4) academic enrichment programs, particu5 larly targeting those who would not be competitive 

6 for health professions schools; 

7 ‘‘(5) supporting workforce diversity in kinder8 garten through 12th grade and other health pipeline 

9 programs; 

10 ‘‘(6) mentoring programs; 

11 ‘‘(7) internship or rotation programs involving 

12 hospitals, health systems, health plans, and other 

13 health entities; 

14 ‘‘(8) community partnership development for 

15 purposes relating to workforce diversity; or 

16 ‘‘(9) leadership training. 

17 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

18 a grant under this section, and annually for the term of 

19 the grant, a grantee shall submit to the Secretary a report 

20 that summarizes and evaluates all activities conducted 

21 under the grant. 

22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section 

24 such sums as may be necessary for each of fiscal years 

25 2023 through 2027. 


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1 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 

2 RESEARCHERS. 

3 ‘‘(a) IN GENERAL.—The Secretary, acting through 

4 the Director of the National Institutes of Health, the Di5 rector of the Centers for Disease Control and Prevention, 

6 the Commissioner of Food and Drugs, the Director of the 

7 Agency for Healthcare Research and Quality, and the Ad8 ministrator of the Health Resources and Services Admin9 istration, shall award grants that expand existing opportu10 nities for scientists and researchers and promote the inclu11 sion of underrepresented minorities in the health profes12 sions. 

13 ‘‘(b) RESEARCH FUNDING.—The head of each agency 

14 listed in subsection (a) shall establish or expand existing 

15 programs to provide research funding to scientists and re16 searchers in training. Under such programs, the head of 

17 each such entity shall give priority in allocating research 

18 funding to support health research in traditionally under19 served communities, including underrepresented minority 

20 communities, and research classified as community or 

21 participatory. 

22 ‘‘(c) DATA COLLECTION.—The head of each agency 

23 listed in subsection (a) shall collect data on the number 

24 (expressed as an absolute number and a percentage) of 

25 underrepresented minority and nonminority applicants 

26 who receive and are denied agency funding at every stage 


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1 of review. Such data shall be reported annually to the Sec2 retary and the appropriate committees of Congress. 

3 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec4 retary shall establish a student loan reimbursement pro5 gram to provide student loan reimbursement assistance to 

6 researchers who focus on racial and ethnic disparities in 

7 health. The Secretary shall promulgate regulations to de8 fine the scope and procedures for the program under this 

9 subsection. 

10 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec11 retary shall establish a student loan cancellation program 

12 to provide student loan cancellation assistance to research13 ers who focus on racial and ethnic disparities in health. 

14 Students participating in the program shall make a min15 imum 5-year commitment to work at an accredited health 

16 professions school. The Secretary shall promulgate addi17 tional regulations to define the scope and procedures for 

18 the program under this subsection. 

19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

21 such sums as may be necessary for each of fiscal years 

22 2023 through 2027. 


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1 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 

2 PROFESSIONALS. 

3 ‘‘(a) IN GENERAL.—The Secretary, acting through 

4 the Director of the Centers for Disease Control and Pre5 vention, the Assistant Secretary for Mental Health and 

6 Substance Use, the Administrator of the Health Resources 

7 and Services Administration, and the Administrator of the 

8 Centers for Medicare & Medicaid Services, shall establish 

9 a program to award grants to universities and other insti10 tutions to enter into agreements with eligible individuals 

11 under which— 

12 ‘‘(1) the university or institution supports the 

13 eligible individual’s career in a nonresearch-related 

14 health and wellness profession; and 

15 ‘‘(2) the eligible individual commits to per16 forming a period of obligated service in such a ca17 reer to serve, or to work on health issues affecting, 

18 underserved communities, such as racial and ethnic 

19 minority communities. 

20 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be an eligible indi21 vidual for purposes of subsection (a), an individual shall 

22 be a student in a health professions school, a graduate 

23 of such a school who is working in a health profession, 

24 an individual working in a health or wellness profession 

25 (including mental and behavioral health), or a faculty 

26 member of such a school. 


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1 ‘‘(c) APPLICATION.—To seek a grant under this sec2 tion, a university or other institution shall submit to the 

3 Secretary an application at such time, in such manner, 

4 and containing such information as the Secretary may re5 quire. 

6 ‘‘(d) USE OF FUNDS.—A university or other institu7 tion receiving a grant under this section shall use the 

8 grant for agreements described in subsection (a). Such 

9 agreements may— 

10 ‘‘(1) support an eligible individual’s health ac11 tivities or projects that involve underserved commu12 nities, including racial and ethnic minority commu13 nities; 

14 ‘‘(2) support an eligible individual’s health-re15 lated career advancement activities; 

16 ‘‘(3) pay, or reimburse for payment of, student 

17 loans or training or credentialing costs for eligible 

18 individuals who are health professionals and are fo19 cused on health issues affecting underserved commu20 nities, including racial and ethnic minority commu21 nities; and 

22 ‘‘(4) establish and promote leadership training 

23 programs for eligible individuals to decrease health 

24 disparities and to increase cultural competence with 


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1 the goal of increasing diversity in leadership posi2 tions. 

3 ‘‘(e) DEFINITION.—In this section, the term ‘career 

4 in a nonresearch-related health and wellness profession’ 

5 means employment or intended employment in the field 

6 of public health, health policy, health management, health 

7 administration, medicine, nursing, pharmacy, psychology, 

8 social work, psychiatry, other mental and behavioral 

9 health, allied health, community health, social work, or 

10 other fields determined appropriate by the Secretary, 

11 other than in a position that involves research. 

12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 such sums as may be necessary for each of fiscal years 

15 2023 through 2027. 

16 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI17 VERSITY ON QUALITY. 

18 ‘‘(a) IN GENERAL.—The Director of the Agency for 

19 Healthcare Research and Quality (in this section referred 

20 to as the ‘Director’), in collaboration with the Deputy As21 sistant Secretary for Minority Health and the Director of 

22 the National Institute on Minority Health and Health Dis23 parities, shall award grants to eligible entities to expand 

24 research on the link between health workforce diversity 

25 and quality health care. 


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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a), an entity shall— 

3 ‘‘(1) be a clinical, public health, or health serv4 ices research entity or other entity determined ap5 propriate by the Director; and 

6 ‘‘(2) submit to the Secretary an application at 

7 such time, in such manner, and containing such in8 formation as the Secretary may require. 

9 ‘‘(c) USE OF FUNDS.—Amounts received under a 

10 grant awarded under subsection (a) shall be used to sup11 port research that investigates the effect of health work12 force diversity on— 

13 ‘‘(1) language access; 

14 ‘‘(2) cultural competence; 

15 ‘‘(3) patient satisfaction; 

16 ‘‘(4) timeliness of care; 

17 ‘‘(5) safety of care; 

18 ‘‘(6) effectiveness of care; 

19 ‘‘(7) efficiency of care; 

20 ‘‘(8) patient outcomes; 

21 ‘‘(9) community engagement; 

22 ‘‘(10) resource allocation; 

23 ‘‘(11) organizational structure; 

24 ‘‘(12) compliance of care; or 


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1 ‘‘(13) other topics determined appropriate by 

2 the Director. 

3 ‘‘(d) PRIORITY.—In awarding grants under sub4 section (a), the Director shall give individualized consider5 ation to all relevant aspects of the applicant’s background. 

6 Consideration of prior research experience involving the 

7 health of underserved communities shall be such a factor. 

8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to carry out this section 

10 such sums as may be necessary for each of fiscal years 

11 2023 through 2027. 

12 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 

13 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

14 through the Office of Minority Health, in collaboration 

15 with the National Institute on Minority Health and Health 

16 Disparities, the Office for Civil Rights, the Centers for 

17 Disease Control and Prevention, the Centers for Medicare 

18 & Medicaid Services, the Health Resources and Services 

19 Administration, and other appropriate public and private 

20 entities, shall establish and coordinate a health and health 

21 care disparities education program to support, develop, 

22 and implement educational initiatives and outreach strate23 gies that inform health care professionals and the public 

24 about the existence of and methods to reduce racial and 

25 ethnic disparities in health and health care. 


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1 ‘‘(b) ACTIVITIES.—The Secretary, through the edu2 cation program established under subsection (a), shall, 

3 through the use of public awareness and outreach cam4 paigns targeting the general public and the medical com5 munity at large— 

6 ‘‘(1) disseminate scientific evidence for the ex7 istence and extent of racial and ethnic disparities in 

8 health care, including disparities that are not other9 wise attributable to known factors such as access to 

10 care, patient preferences, or appropriateness of 

11 intervention, as described in the 2002 report of the 

12 National Academy of Medicine (formerly the ‘Insti13 tute of Medicine’) entitled ‘Unequal Treatment: Con14 fronting Racial and Ethnic Disparities in Health 

15 Care’, as well as the impact of disparities related to 

16 age, disability status, socioeconomic status, sex, gen17 der identity, and sexual orientation on racial and 

18 ethnic minorities; 

19 ‘‘(2) disseminate new research findings to 

20 health care providers and patients to assist them in 

21 understanding, reducing, and eliminating health and 

22 health care disparities; 

23 ‘‘(3) disseminate information about the impact 

24 of linguistic and cultural barriers on health care 

25 quality and the obligation of health providers who 


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1 receive Federal financial assistance to ensure that 

2 individuals with limited English proficiency have ac3 cess to language access services; 

4 ‘‘(4) disseminate information about the impor5 tance and legality of racial, ethnic, disability status, 

6 socioeconomic status, sex, gender identity, and sex7 ual orientation, and primary language data collec8 tion, analysis, and reporting; 

9 ‘‘(5) design and implement specific educational 

10 initiatives to health care providers relating to health 

11 and health care disparities; 

12 ‘‘(6) assess the impact of the programs estab13 lished under this section in raising awareness of 

14 health and health care disparities and providing in15 formation on available resources; and 

16 ‘‘(7) design and implement specific educational 

17 initiatives to educate the health care workforce relat18 ing to unconscious bias. 

19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

21 such sums as may be necessary for each of fiscal years 

22 2023 through 2027.’’. 


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1 SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORI2 CALLY BLACK COLLEGES AND UNIVERSITIES, 

3 HISTORICALLY BLACK PROFESSIONAL OR 

4 GRADUATE INSTITUTIONS, ASIAN AMERICAN 

5 AND NATIVE AMERICAN PACIFIC ISLANDER6 SERVING INSTITUTIONS, TRIBAL COLLEGES, 

7 REGIONAL COMMUNITY-BASED ORGANIZA8 TIONS, AND NATIONAL MINORITY MEDICAL 

9 ASSOCIATIONS. 

10 Part B of title VII of the Public Health Service Act 

11 (42 U.S.C. 293 et seq.) is amended by adding at the end 

12 the following: 

13 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI14 CALLY BLACK COLLEGES AND UNIVERSITIES, 

15 HISTORICALLY BLACK PROFESSIONAL OR 

16 GRADUATE INSTITUTIONS, ASIAN AMERICAN 

17 AND NATIVE AMERICAN PACIFIC ISLANDER18 SERVING INSTITUTIONS, AND TRIBAL COL19 LEGES. 

20 ‘‘(a) IN GENERAL.—The Secretary, acting through 

21 the Administrator of the Health Resources and Services 

22 Administration and in consultation with the Secretary of 

23 Education, shall award grants to Hispanic-serving institu24 tions, historically Black colleges and universities, histori25 cally Black professional or graduate institutions eligible 

26 for grants under section 326 of the Higher Education Act 


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1 of 1965, Asian American and Native American Pacific Is2 lander-serving institutions, Tribal Colleges or Universities, 

3 regional community-based organizations, and national mi4 nority medical associations, for counseling, mentoring, and 

5 providing information on financial assistance to prepare 

6 underrepresented minority individuals to enroll in and 

7 graduate from health professional schools and to increase 

8 services for underrepresented minority students includ9 ing— 

10 ‘‘(1) mentoring with underrepresented health 

11 professionals; 

12 ‘‘(2) providing financial assistance information 

13 for continued education and applications to health 

14 professional schools; and 

15 ‘‘(3) retaining existing enrolled underrep16 resented minority students in a health professions 

17 school. 

18 ‘‘(b) DEFINITIONS.—In this section: 

19 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN

20 PACIFIC ISLANDER-SERVING INSTITUTION.—The 

21 term ‘Asian American and Native American Pacific 

22 Islander-serving institution’ has the meaning given 

23 such term in section 320(b) of the Higher Education 

24 Act of 1965. 


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1 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 

2 term ‘Hispanic-serving institution’ means an entity 

3 that— 

4 ‘‘(A) is a school or program for which 

5 there is a definition under section 799B; 

6 ‘‘(B) has an enrollment of full-time equiva7 lent students that is made up of at least 9 per8 cent Hispanic students; 

9 ‘‘(C) has been effective in carrying out pro10 grams to recruit Hispanic individuals to enroll 

11 in and graduate from the school; 

12 ‘‘(D) has been effective in recruiting and 

13 retaining Hispanic faculty members; 

14 ‘‘(E) has a significant number of graduates 

15 who are providing health services to medically 

16 underserved populations or to individuals in 

17 health professional shortage areas; and 

18 ‘‘(F) is a Hispanic Center of Excellence in 

19 Health Professions Education designated under 

20 section 736(d)(2) of the Public Health Service 

21 Act (42 U.S.C. 293(d)(2)). 

22 ‘‘(3) HISTORICALLY BLACK COLLEGE AND UNI23 VERSITY.—The term ‘historically Black college and 

24 university’ has the meaning given the term ‘part B 


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1 institution’ as defined in section 322 of the Higher 

2 Education Act of 1965. 

3 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 

4 term ‘Tribal College or University’ has the meaning 

5 given such term in section 316(b) of the Higher 

6 Education Act of 1965. 

7 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 

8 carrying out the National Health Service Corps Loan Re9 payment Program established under subpart III of part 

10 D of title III and the loan repayment program under sec11 tion 317F, the Secretary shall ensure, notwithstanding 

12 such subpart or section, that loan repayments of not less 

13 than $50,000 per year per person are awarded for repay14 ment of loans incurred for enrollment or participation of 

15 underrepresented minority individuals in health profes16 sional schools and other health programs described in this 

17 section. 

18 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section 

20 such sums as may be necessary for each of fiscal years 

21 2023 through 2027.’’. 

22 SEC. 3003. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

23 DISEASE CONTROL AND PREVENTION. 

24 Section 317F(c)(1) of the Public Health Service Act 

25 (42 U.S.C. 247b–7(c)(1)) is amended by striking 


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1 ‘‘$500,000 for fiscal year 1994, and such sums as may 

2 be necessary for each of the fiscal years 1995 through 

3 2002’’ and inserting ‘‘such sums as may be necessary for 

4 each of fiscal years 2023 through 2027’’. 

5 SEC. 3004. ALLIED HEALTH WORKFORCE DIVERSITY. 

6 (a) INCREASING WORKFORCE DIVERSITY IN THE

7 PROFESSIONS OF PHYSICAL THERAPY, OCCUPATIONAL

8 THERAPY, RESPIRATORY THERAPY, AUDIOLOGY, AND

9 SPEECH-LANGUAGE PATHOLOGY.—Title VII of the Public 

10 Health Service Act is amended— 

11 (1) by redesignating part G (42 U.S.C. 295j et 

12 seq.) as part H; and 

13 (2) by inserting after part F (42 U.S.C. 295h) 

14 the following new part: 

15 ‘‘PART G—INCREASING WORKFORCE DIVERSITY 

16 IN THE PROFESSIONS OF PHYSICAL THER17 APY, OCCUPATIONAL THERAPY, RES18 PIRATORY THERAPY, AUDIOLOGY, AND 

19 SPEECH-LANGUAGE PATHOLOGY 

20 ‘‘SEC. 783. SCHOLARSHIPS AND STIPENDS. 

21 ‘‘(a) IN GENERAL.—The Secretary may award grants 

22 and contracts to eligible entities to increase educational 

23 opportunities in the professions of physical therapy, occu24 pational therapy, respiratory therapy, audiology, and 

25 speech-language pathology for eligible individuals by— 


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1 ‘‘(1) providing student scholarships or stipends, 

2 including for— 

3 ‘‘(A) completion of an accelerated degree 

4 program; 

5 ‘‘(B) completion of an associate’s, bach6 elor’s, master’s, or doctoral degree program; 

7 and 

8 ‘‘(C) entry by a diploma or associate’s de9 gree practitioner into a bridge or degree com10 pletion program; 

11 ‘‘(2) providing assistance for completion of pre12 requisite courses or other preparation necessary for 

13 acceptance for enrollment in the eligible entity; and 

14 ‘‘(3) carrying out activities to increase the re15 tention of students in one or more programs in the 

16 professions of physical therapy, occupational ther17 apy, respiratory therapy, audiology, and speech-lan18 guage pathology. 

19 ‘‘(b) CONSIDERATION OF RECOMMENDATIONS.—In 

20 carrying out subsection (a), the Secretary shall take into 

21 consideration the recommendations of national organiza22 tions representing the professions of physical therapy, oc23 cupational therapy, respiratory therapy, audiology, and 

24 speech-language pathology, including the American Phys25 ical Therapy Association, the American Occupational 


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1 Therapy Association, the American Speech-Language2 Hearing Association, the American Association for Res3 piratory Care, the American Academy of Audiology, and 

4 the Academy of Doctors of Audiology. 

5 ‘‘(c) REQUIRED INFORMATION AND CONDITIONS FOR

6 AWARD RECIPIENTS.— 

7 ‘‘(1) IN GENERAL.—The Secretary may require 

8 recipients of awards under this section to report to 

9 the Secretary concerning the annual admission, re10 tention, and graduation rates for eligible individuals 

11 in programs of the recipient leading to a degree in 

12 any of the professions of physical therapy, occupa13 tional therapy, respiratory therapy, audiology, and 

14 speech-language pathology. 

15 ‘‘(2) FALLING RATES.—If any of the rates re16 ported by a recipient under paragraph (1) fall below 

17 the average for such recipient over the 2 years pre18 ceding the year covered by the report, the recipient 

19 shall provide the Secretary with plans for imme20 diately improving such rates. 

21 ‘‘(3) INELIGIBILITY.—A recipient described in 

22 paragraph (2) shall be ineligible for continued fund23 ing under this section if the plan of the recipient 

24 fails to improve the rates within the 1-year period 

25 beginning on the date such plan is implemented. 


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1 ‘‘(d) DEFINITIONS.—In this section: 

2 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible 

3 entity’ means an accredited education program that 

4 is carrying out a program for recruiting and retain5 ing students underrepresented in the professions of 

6 physical therapy, occupational therapy, respiratory 

7 therapy, audiology, and speech-language pathology 

8 (including racial or ethnic minorities, or students 

9 from disadvantaged backgrounds). 

10 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

11 individual’ means an individual who— 

12 ‘‘(A) is a member of a class of persons who 

13 are underrepresented in the professions of phys14 ical therapy, occupational therapy, respiratory 

15 therapy, audiology, and speech-language pathol16 ogy, including individuals who are— 

17 ‘‘(i) racial or ethnic minorities; 

18 ‘‘(ii) from disadvantaged backgrounds; 

19 or 

20 ‘‘(iii) individuals with a disability (as 

21 defined in section 3(1) of the Americans 

22 with Disabilities Act of 1990), or who have 

23 an individualized education program (as 

24 defined in section 602 of the Individuals 

25 with Disabilities Education Act), are covVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ered under section 504 of the Rehabilita2 tion Act of 1973, or have other documenta3 tion establishing the student’s disability 

4 (as such term is defined in section 3(1) of 

5 the Americans with Disabilities Act of 

6 1990); 

7 ‘‘(B) has a financial need for a scholarship 

8 or stipend; and 

9 ‘‘(C) is enrolled (or accepted for enroll10 ment) at an audiology, speech-language pathol11 ogy, respiratory therapy, physical therapy, or 

12 occupational therapy program as a full-time 

13 student at an eligible entity. 

14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section 

16 $8,000,000 for the first fiscal year commencing after the 

17 date of enactment of the Health Equity and Accountability 

18 Act of 2022 and each of the 4 succeeding fiscal years.’’. 

19 (b) ELIGIBILITY CLARIFICATION REGARDING STU20 DENTS SUPPORTED THROUGH MENTAL AND BEHAV21 IORAL HEALTH EDUCATION AND TRAINING GRANTS.— 

22 Section 756(a)(1) of the Public Health Service Act (42 

23 U.S.C. 294e–1(a)(1)) is amended by inserting after ‘‘occu24 pational therapy’’ the following: ‘‘(which may include mas25 ter’s and doctoral level programs)’’. 


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1 SEC. 3005. COOPERATIVE AGREEMENTS FOR ONLINE DE2 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

3 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

4 Part D of title VII of the Public Health Service Act 

5 (42 U.S.C. 294 et seq.) is amended by inserting after sec6 tion 755 of such Act (42 U.S.C. 294e) the following: 

7 ‘‘SEC. 755A. COOPERATIVE AGREEMENTS FOR ONLINE DE8 GREE PROGRAMS. 

9 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

10 acting through the Administrator of the Health Resources 

11 and Services Administration, in consultation with the Di12 rector of the Centers for Disease Control and Prevention, 

13 the Director of the Agency for Healthcare Research and 

14 Quality, and the Deputy Assistant Secretary for Minority 

15 Health, shall enter into cooperative agreements with 

16 schools of public health and schools of allied health to de17 sign and implement online degree programs. 

18 ‘‘(b) PRIORITY.—In entering into cooperative agree19 ments under this section, the Secretary shall give priority 

20 to any school of public health or school of allied health 

21 that has an established track record of serving medically 

22 underserved communities. 

23 ‘‘(c) REQUIREMENTS.—As a condition of entering 

24 into a cooperative agreement with the Secretary under this 

25 section, a school of public health or school of allied health 


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1 shall agree to design and implement an online degree pro2 gram that meets the following restrictions: 

3 ‘‘(1) Enrollment of individuals who have ob4 tained a secondary school diploma or its recognized 

5 equivalent. 

6 ‘‘(2) Maintaining a significant enrollment of 

7 underrepresented minority or disadvantaged stu8 dents. 

9 ‘‘(3) Achieving a high completion rate of en10 rolled underrepresented minority or disadvantaged 

11 students. 

12 ‘‘(d) PERIOD OF COOPERATIVE AGREEMENTS.—The 

13 period during which payments are made through a cooper14 ative agreement entered into under this section may not 

15 exceed 3 years. 

16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 such sums as may be necessary for each of fiscal years 

19 2023 through 2027.’’. 

20 SEC. 3006. NATIONAL HEALTH CARE WORKFORCE COMMIS21 SION. 

22 (a) SENSE OF CONGRESS.—It is the sense of Con23 gress that the National Health Care Workforce Commis24 sion established by section 5101 of the Patient Protection 

25 and Affordable Care Act (42 U.S.C. 294q) should, in carVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 rying out its assigned duties under that section, give at2 tention to the needs of racial and ethnic minorities, indi3 viduals with lower socioeconomic status, individuals with 

4 mental, developmental, and physical disabilities, lesbian, 

5 gay, bisexual, transgender, queer, and questioning popu6 lations, and individuals who are members of multiple mi7 nority or special population groups. 

8 (b) REAUTHORIZATION.—Section 5101(h)(2) of the 

9 Patient Protection and Affordable Care Act (42 U.S.C. 

10 294q(h)(2)) is amended by striking ‘‘such sums as may 

11 be necessary’’ and inserting ‘‘$3,000,000 for each of fiscal 

12 years 2023 through 2025’’. 

13 SEC. 3007. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

14 Subtitle B of title XXXIV of the Public Health Serv15 ice Act, as added by section 3001, is further amended by 

16 inserting after section 3417 the following: 

17 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 

18 SERVICES CORPS. 

19 ‘‘(a) IN GENERAL.—The Director of the Centers for 

20 Disease Control and Prevention, in collaboration with the 

21 Administrator of the Health Resources and Services Ad22 ministration and the Deputy Assistant Secretary for Mi23 nority Health, shall award grants to eligible entities to in24 crease awareness among secondary and postsecondary stu25 dents of career opportunities in the health professions. 


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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a), an entity shall— 

3 ‘‘(1) be a clinical, public health, or health serv4 ices organization, community-based or nonprofit en5 tity, or other entity determined appropriate by the 

6 Director of the Centers for Disease Control and Pre7 vention; 

8 ‘‘(2) serve a health professional shortage area, 

9 as determined by the Secretary; 

10 ‘‘(3) work with students, including those from 

11 racial and ethnic minority backgrounds, that have 

12 expressed an interest in the health professions; and 

13 ‘‘(4) submit to the Secretary an application at 

14 such time, in such manner, and containing such in15 formation as the Secretary may require. 

16 ‘‘(c) USE OF FUNDS.—Grant awards under sub17 section (a) shall be used to support internships that will 

18 increase awareness among students of non-research-based, 

19 career opportunities in the following health professions: 

20 ‘‘(1) Medicine. 

21 ‘‘(2) Nursing. 

22 ‘‘(3) Public health. 

23 ‘‘(4) Pharmacy. 

24 ‘‘(5) Health administration and management. 

25 ‘‘(6) Health policy. 


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1 ‘‘(7) Psychology. 

2 ‘‘(8) Dentistry. 

3 ‘‘(9) International health. 

4 ‘‘(10) Social work. 

5 ‘‘(11) Allied health. 

6 ‘‘(12) Psychiatry. 

7 ‘‘(13) Hospice care. 

8 ‘‘(14) Community health, patient navigation, 

9 and peer support. 

10 ‘‘(15) Other professions determined appropriate 

11 by the Director of the Centers for Disease Control 

12 and Prevention. 

13 ‘‘(d) PRIORITY.—In awarding grants under sub14 section (a), the Director of the Centers for Disease Con15 trol and Prevention shall give priority to those entities 

16 that— 

17 ‘‘(1) serve a high proportion of individuals from 

18 disadvantaged backgrounds; 

19 ‘‘(2) have experience in health disparity elimi20 nation programs; 

21 ‘‘(3) facilitate the entry of disadvantaged indi22 viduals into institutions of higher education; and 

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1 fully completing their education at the postsecondary 

2 level. 

3 ‘‘(e) STIPENDS.— 

4 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

5 an entity receiving a grant under this section may 

6 use the funds made available through such grant to 

7 award stipends for educational and living expenses 

8 to students participating in the internship supported 

9 by the grant. 

10 ‘‘(2) LIMITATIONS.—A stipend awarded under 

11 paragraph (1) to an individual— 

12 ‘‘(A) may not be provided for a period that 

13 exceeds 6 months; and 

14 ‘‘(B) may not exceed $20 per day for an 

15 individual (notwithstanding any other provision 

16 of law regarding the amount of a stipend). 

17 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to carry out this section 

19 such sums as may be necessary for each of fiscal years 

20 2023 through 2027. 

21 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

22 PROGRAM. 

23 ‘‘(a) IN GENERAL.—The Director of the Centers for 

24 Disease Control and Prevention, in collaboration with the 

25 Deputy Assistant Secretary for Minority Health, shall 


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1 award scholarships to eligible individuals under subsection 

2 (b) who seek a career in public health. 

3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol4 arship under subsection (a), an individual shall— 

5 ‘‘(1) have interest, knowledge, or skill in public 

6 health research or public health practice, or other 

7 health professions as determined appropriate by the 

8 Director of the Centers for Disease Control and Pre9 vention; 

10 ‘‘(2) reside in a health professional shortage 

11 area as determined by the Secretary; 

12 ‘‘(3) demonstrate promise for becoming a leader 

13 in public health; 

14 ‘‘(4) secure admission to a 4-year institution of 

15 higher education; and 

16 ‘‘(5) submit to the Secretary an application at 

17 such time, in such manner, and containing such in18 formation as the Secretary may require. 

19 ‘‘(c) USE OF FUNDS.—Amounts received under an 

20 award under subsection (a) shall be used to support oppor21 tunities for students to become public health professionals. 

22 ‘‘(d) PRIORITY.—In awarding grants under sub23 section (a), the Director shall give priority to those stu24 dents that— 

25 ‘‘(1) are from disadvantaged backgrounds; 


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1 ‘‘(2) have secured admissions to a minority2 serving institution; and 

3 ‘‘(3) have identified a health professional as a 

4 mentor at their school or institution and an aca5 demic advisor to assist in the completion of their 

6 baccalaureate degree. 

7 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

8 payment of scholarships under this section for such indi9 viduals for any period of education in student under10 graduate tenure, except that such a scholarship may not 

11 be provided to an individual for more than 4 years, and 

12 such a scholarship may not exceed $10,000 per academic 

13 year for an individual (notwithstanding any other provi14 sion of law regarding the amount of a scholarship). 

15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to carry out this section 

17 such sums as may be necessary for each of fiscal years 

18 2023 through 2027. 

19 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 

20 FELLOWSHIP PROGRAM. 

21 ‘‘(a) IN GENERAL.—The Director of the Centers for 

22 Disease Control and Prevention, in collaboration with the 

23 Deputy Assistant Secretary for Minority Health, the As24 sistant Secretary for Mental Health and Substance Use, 

25 and the Director of the Indian Health Service, shall award 


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1 research fellowships to eligible individuals under sub2 section (b) to conduct research that will examine gender 

3 and health disparities and to pursue a career in the health 

4 professions. 

5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow6 ship under subsection (a), an individual shall— 

7 ‘‘(1) have experience in health research or pub8 lic health practice; 

9 ‘‘(2) reside in a health professional shortage 

10 area designated by the Secretary under section 332; 

11 ‘‘(3) have expressed an interest in the health 

12 professions; 

13 ‘‘(4) demonstrate promise for becoming a leader 

14 in the field of women’s sexual and reproductive 

15 health, including family planning; 

16 ‘‘(5) secure admission to a health professions 

17 school or graduate program with an emphasis in 

18 gender studies; and 

19 ‘‘(6) submit to the Secretary an application at 

20 such time, in such manner, and containing such in21 formation as the Secretary may require. 

22 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 

23 subsection (a) to an eligible individual under subsection 

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1 vidual to become a researcher and advance the research 

2 base on the intersection between gender and health. 

3 ‘‘(d) PRIORITY.—In awarding fellowships under sub4 section (a), the Director of the Centers for Disease Con5 trol and Prevention shall give priority to those applicants 

6 that— 

7 ‘‘(1) are from disadvantaged backgrounds; and 

8 ‘‘(2) have identified a mentor and academic ad9 visor who will assist in the completion of their grad10 uate or professional degree and have secured a re11 search assistant position with a researcher working 

12 in the area of gender and health. 

13 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

14 Disease Control and Prevention may approve fellowships 

15 for individuals under this section for any period of edu16 cation in the student’s graduate or health profession ten17 ure, except that such a fellowship may not be provided 

18 to an individual for more than 3 years, and such a fellow19 ship may not exceed $18,000 per academic year for an 

20 individual (notwithstanding any other provision of law re21 garding the amount of a fellowship). 

22 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section 

24 such sums as may be necessary for each of fiscal years 

25 2023 through 2027. 


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1 ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 

2 HEALTH FELLOWSHIP PROGRAM. 

3 ‘‘(a) IN GENERAL.—The Director of the Agency for 

4 Healthcare Research and Quality, in collaboration with 

5 the Deputy Assistant Secretary for Minority Health, shall 

6 award research fellowships to eligible individuals under 

7 subsection (b) to advance their understanding of inter8 national health. 

9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow10 ship under subsection (a), an individual shall— 

11 ‘‘(1) have educational experience in the field of 

12 international health; 

13 ‘‘(2) reside in a health professional shortage 

14 area as determined by the Secretary; 

15 ‘‘(3) demonstrate promise for becoming a leader 

16 in the field of international health; 

17 ‘‘(4) be in the fourth year of a 4-year institu18 tion of higher education or a recent graduate of a 

19 4-year institution of higher education; and 

20 ‘‘(5) submit to the Secretary an application at 

21 such time, in such manner, and containing such in22 formation as the Secretary may require. 

23 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 

24 subsection (a) to an eligible individual under subsection 

25 (b) shall be used to support an opportunity for the indi26 vidual to become a health professional and to advance the 


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1 knowledge of the individual about international issues re2 lating to health care access and quality. 

3 ‘‘(d) PRIORITY.—In awarding fellowships under sub4 section (a), the Director of the Agency for Healthcare Re5 search and Quality shall give priority to eligible individuals 

6 under subsection (b) that— 

7 ‘‘(1) are from a disadvantaged background; and 

8 ‘‘(2) have identified a mentor at a health pro9 fessions school or institution, an academic advisor to 

10 assist in the completion of their graduate or profes11 sional degree, and an advisor from an international 

12 health non-governmental organization, private volun13 teer organization, or other international institution 

14 or program that focuses on increasing health care 

15 access and quality for residents in developing coun16 tries. 

17 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 

18 this section may not— 

19 ‘‘(1) be provided to an eligible individual for 

20 more than a period of 6 months; 

21 ‘‘(2) be awarded to a graduate of a 4-year insti22 tution of higher education that has not been enrolled 

23 in such institution for more than 1 year; or 


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1 ‘‘(3) exceed $4,000 per academic year (notwith2 standing any other provision of law regarding the 

3 amount of a fellowship). 

4 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

6 such sums as may be necessary for each of fiscal years 

7 2023 through 2027. 

8 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO9 GRAM. 

10 ‘‘(a) IN GENERAL.—The Director of the Agency for 

11 Healthcare Research and Quality, the Administrator of 

12 the Centers for Medicare & Medicaid Services, and the Ad13 ministrator of the Health Resources and Services Admin14 istration, in collaboration with the Deputy Assistant Sec15 retary for Minority Health, shall award grants to eligible 

16 entities under subsection (b) to expose entering graduate 

17 students to the health professions. 

18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

19 under subsection (a), an entity shall— 

20 ‘‘(1) be a clinical, public health, or health serv21 ices organization, community-based, academic, or 

22 nonprofit entity, or other entity determined appro23 priate by the Director of the Agency for Healthcare 

24 Research and Quality; 


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1 ‘‘(2) serve in a health professional shortage 

2 area designated by the Secretary under section 332; 

3 ‘‘(3) work with students obtaining a degree in 

4 the health professions; and 

5 ‘‘(4) submit to the Secretary an application at 

6 such time, in such manner, and containing such in7 formation as the Secretary may require. 

8 ‘‘(c) USE OF FUNDS.—Amounts received under a 

9 grant awarded under subsection (a) shall be used to sup10 port opportunities that expose students to non-research11 based health professions, including— 

12 ‘‘(1) public health policy; 

13 ‘‘(2) health care and pharmaceutical policy; 

14 ‘‘(3) health care administration and manage15 ment; 

16 ‘‘(4) health economics; and 

17 ‘‘(5) other professions determined appropriate 

18 by the Director of the Agency for Healthcare Re19 search and Quality, the Administrator of the Centers 

20 for Medicare & Medicaid Services, or the Adminis21 trator of the Health Resources and Services Admin22 istration. 

23 ‘‘(d) PRIORITY.—In awarding grants under sub24 section (a), the Director of the Agency for Healthcare Re25 search and Quality, the Administrator of the Centers for 


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1 Medicare & Medicaid Services, and the Administrator of 

2 the Health Resources and Services Administration, in col3 laboration with the Deputy Assistant Secretary for Minor4 ity Health, shall give priority to entities that— 

5 ‘‘(1) have experience with health disparity elimi6 nation programs; 

7 ‘‘(2) facilitate training in the fields described in 

8 subsection (c); and 

9 ‘‘(3) provide counseling or other services de10 signed to assist students in successfully completing 

11 their education at the postsecondary level. 

12 ‘‘(e) STIPENDS.— 

13 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

14 an entity receiving a grant under this section may 

15 use the funds made available through such grant to 

16 award stipends for educational and living expenses 

17 to students participating in the opportunities sup18 ported by the grant. 

19 ‘‘(2) LIMITATIONS.—A stipend awarded under 

20 paragraph (1) to an individual— 

21 ‘‘(A) may not be provided for a period that 

22 exceeds 2 months; and 

23 ‘‘(B) may not exceed $100 per day (not24 withstanding any other provision of law regard25 ing the amount of a stipend). 


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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 such sums as may be necessary for each of fiscal years 

4 2023 through 2027. 

5 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 

6 ‘‘(a) IN GENERAL.—The Secretary shall award 

7 grants to national minority medical or health professional 

8 associations to develop leadership fellowship programs for 

9 underrepresented health professionals in order to— 

10 ‘‘(1) assist such professionals in becoming fu11 ture leaders in public health and health care delivery 

12 institutions; and 

13 ‘‘(2) increase diversity in decision-making posi14 tions that can improve the health of underserved 

15 communities. 

16 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro17 gram supported under this section shall— 

18 ‘‘(1) focus on training mid-career physicians 

19 and health care executives who have documented 

20 leadership experience and a commitment to public 

21 health services in underserved communities; and 

22 ‘‘(2) support Federal public health policy and 

23 budget programs, and priorities that impact health 

24 equity, through activities such as didactic lectures 

25 and leader site visits. 


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1 ‘‘(c) PERIOD OF GRANTS.—The period during which 

2 payments are made under a grant awarded under sub3 section (a) may not exceed 3 years. 

4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

6 such sums as may be necessary for each of fiscal years 

7 2023 through 2027.’’. 

8 SEC. 3008. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 

9 PROGRAM. 

10 Section 402E of the Higher Education Act of 1965 

11 (20 U.S.C. 1070a–15) is amended by striking subsection 

12 (g) and inserting the following: 

13 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI14 VERSITY TRAINING PROGRAMS.—The Secretary shall co15 ordinate with the Secretary of Health and Human Serv16 ices to ensure that there is collaboration between the goals 

17 of the program under this section and programs of the 

18 Health Resources and Services Administration that pro19 mote health workforce diversity. The Secretary of Edu20 cation shall take such measures as may be necessary to 

21 encourage students participating in projects assisted 

22 under this section to consider health profession careers. 

23 ‘‘(h) FUNDING.—From amounts appropriated pursu24 ant to the authority of section 402A(g), the Secretary 

25 shall, to the extent practicable, allocate funds for projects 


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1 authorized by this section in an amount that is not less 

2 than $31,000,000 for each of the fiscal years 2023 

3 through 2027.’’. 

4 SEC. 3009. RULES FOR DETERMINATION OF FULL-TIME 

5 EQUIVALENT RESIDENTS FOR COST-REPORT6 ING PERIODS. 

7 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 

8 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 

9 amended by section 2006(a), is amended— 

10 (1) in subparagraph (E), by striking ‘‘Subject 

11 to subparagraphs (J) and (K), such rules’’ and in12 serting ‘‘Subject to subparagraphs (J), (K), and 

13 (M), such rules’’; 

14 (2) in subparagraph (J), by striking ‘‘Such 

15 rules’’ and inserting ‘‘Subject to subparagraph (M), 

16 such rules’’; 

17 (3) in subparagraph (K), by striking ‘‘In deter18 mining’’ and inserting ‘‘Subject to subparagraph 

19 (M), in determining’’; and 

20 (4) by adding at the end the following new sub21 paragraph: 

22 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS

23 AND INTERNS.—For purposes of cost-reporting 

24 periods beginning on or after October 1, 2022, 

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1 time equivalent residents for purposes of this 

2 paragraph, all time spent by an intern or resi3 dent in an approved medical residency training 

4 program shall be counted toward the determina5 tion of full-time equivalency if the hospital— 

6 ‘‘(i) is recognized as a subsection (d) 

7 hospital; 

8 ‘‘(ii) is recognized as a subsection (d) 

9 Puerto Rico hospital; 

10 ‘‘(iii) is reimbursed under a reim11 bursement system authorized under section 

12 1814(b)(3); or 

13 ‘‘(iv) is a provider-based hospital out14 patient department.’’. 

15 (b) IME DETERMINATIONS.—Section 

16 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 

17 1395ww(d)(5)(B)(xi)) is amended— 

18 (1) in subclause (II), by striking ‘‘In deter19 mining’’ and inserting ‘‘Subject to subclause (IV), in 

20 determining’’; 

21 (2) in subclause (III), by striking ‘‘In deter22 mining’’ and inserting ‘‘Subject to subclause (IV), in 

23 determining’’; and 

24 (3) by inserting after subclause (III) the fol25 lowing new subclause: 


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1 ‘‘(IV) For purposes of cost-reporting peri2 ods beginning on or after October 1, 2022, the 

3 provisions of subparagraph (M) of subsection 

4 (h)(4) shall apply under this subparagraph in 

5 the same manner as they apply under such sub6 section.’’. 

7 SEC. 3010. DEVELOPING AND IMPLEMENTING STRATEGIES 

8 FOR LOCAL HEALTH EQUITY. 

9 (a) GRANTS.—The Secretary of Health and Human 

10 Services, acting jointly with the Secretary of Education 

11 and the Secretary of Labor, shall make grants to an eligi12 ble institution of higher education for the purposes of— 

13 (1) in accordance with subsection (b), devel14 oping capacity— 

15 (A) to build an evidence base for successful 

16 strategies for increasing local health equity; and 

17 (B) to serve as national models of driving 

18 local health equity; and 

19 (2) in accordance with subsection (c), devel20 oping a strategic partnership with the community in 

21 which the institution is located. 

22 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL

23 HEALTH EQUITY.—As a condition on receipt of a grant 

24 under subsection (a), an institution of higher education 

25 shall agree to use such grant to build an evidence base 


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1 for successful strategies for increasing local health equity, 

2 and to serve as a national model of driving local health 

3 equity, by supporting— 

4 (1) resources to strengthen institutional metrics 

5 and capacity to execute institution-wide health work6 force goals that can serve as models for increasing 

7 health equity in communities across the United 

8 States; 

9 (2) collaborations among a cohort of institu10 tions in implementing systemic change, partnership 

11 development, and programmatic efforts supportive of 

12 health equity goals across disciplines and popu13 lations; and 

14 (3) enhanced or newly developed data systems 

15 and research infrastructure capable of informing 

16 current and future workforce efforts and building a 

17 foundation for a broader research agenda targeting 

18 urban health disparities. 

19 (c) STRATEGIC PARTNERSHIPS.—As a condition on 

20 receipt of a grant under subsection (a), an institution of 

21 higher education shall agree to use the grant to develop 

22 a strategic partnership with the community in which such 

23 institution is located for the purposes of— 

24 (1) strengthening connections between such in25 stitution and the community— 


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1 (A) to improve evaluation of, and address, 

2 the health and health workforce needs of such 

3 community; and 

4 (B) to engage such community in health 

5 workforce development; 

6 (2) developing, enhancing, or accelerating inno7 vative undergraduate and graduate programs in the 

8 biomedical sciences and health professions; and 

9 (3) strengthening pipeline programs in the bio10 medical sciences and health professions, including by 

11 developing partnerships between institutions of high12 er education and elementary schools and secondary 

13 schools to recruit the next generation of health pro14 fessionals earlier in the pipeline to a health care ca15 reer. 

16 (d) ELIGIBLE INSTITUTION OF HIGHER EDUCATION

17 DEFINED.—For purposes of this section, an ‘‘eligible in18 stitution of higher education’’ includes— 

19 (1) a program authorized under section 317(a) 

20 of the Higher Education Act of 1965 (20 U.S.C. 

21 1059d(a)); or 

22 (2) a professional or graduate institution de23 scribed in section 326 of such Act (20 U.S.C. 

24 1063b). 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 such sums as may be necessary for each of fiscal years 

4 2023 through 2027. 

5 SEC. 3011. HEALTH PROFESSIONS WORKFORCE FUND. 

6 (a) ESTABLISHMENT.—There is established in the 

7 Health Resources and Services Administration of the De8 partment of Health and Human Services a Health Profes9 sions Workforce Fund to provide for expanded and sus10 tained national investment in the health professions and 

11 nursing workforce development programs under title VII 

12 and title VIII of the Public Health Service Act (42 U.S.C. 

13 292 et seq.; 42 U.S.C. 296 et seq.). 

14 (b) FUNDING.— 

15 (1) IN GENERAL.—There is authorized to be 

16 appropriated, and there is appropriated, out of any 

17 monies in the Treasury not otherwise appropriated, 

18 to the Health Professions Workforce Fund— 

19 (A) $392,000,000 for fiscal year 2023; 

20 (B) $412,000,000 for fiscal year 2024; 

21 (C) $432,000,000 for fiscal year 2025; 

22 (D) $454,000,000 for fiscal year 2026; 

23 (E) $476,000,000 for fiscal year 2027; 

24 (F) $500,000,000 for fiscal year 2028; 

25 (G) $525,000,000 for fiscal year 2029; and 


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1 (H) $552,000,000 for fiscal year 2030. 

2 (2) HEALTH PROFESSIONS EDUCATION PRO3 GRAMS.—For the purpose of carrying out health 

4 professions education programs authorized under 

5 title VII of the Public Health Service Act (42 U.S.C. 

6 292 et seq.), in addition to any other amounts au7 thorized to be appropriated for such purpose, there 

8 is authorized to be appropriated out of any monies 

9 in the Health Professions Workforce Fund, the fol10 lowing: 

11 (A) $265,000,000 for fiscal year 2023. 

12 (B) $278,000,000 for fiscal year 2024. 

13 (C) $292,000,000 for fiscal year 2025. 

14 (D) $307,000,000 for fiscal year 2026. 

15 (E) $322,000,000 for fiscal year 2027. 

16 (F) $338,000,000 for fiscal year 2028. 

17 (G) $355,000,000 for fiscal year 2029. 

18 (H) $373,000,000 for fiscal year 2030. 

19 (3) NURSING WORKFORCE DEVELOPMENT PRO20 GRAMS.—For the purpose of carrying out nursing 

21 workforce development programs authorized under 

22 title VIII of the Public Health Service Act (42 

23 U.S.C. 296 et seq.), in addition to any other 

24 amounts authorized to be appropriated for such pur25 pose, there is authorized to be appropriated out of 


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1 any monies in the Health Professions Workforce 

2 Fund, the following: 

3 (A) $127,000,000 for fiscal year 2023. 

4 (B) $134,000,000 for fiscal year 2024. 

5 (C) $140,000,000 for fiscal year 2025. 

6 (D) $147,000,000 for fiscal year 2026. 

7 (E) $154,000,000 for fiscal year 2027. 

8 (F) $162,000,000 for fiscal year 2028. 

9 (G) $170,000,000 for fiscal year 2029. 

10 (H) $179,000,000 for fiscal year 2030. 

11 SEC. 3012. FUTURE ADVANCEMENT OF ACADEMIC NURS12 ING. 

13 (a) SUPPORT FOR NURSING EDUCATION AND THE

14 FUTURE NURSING WORKFORCE.—Part D of title VIII of 

15 the Public Health Service Act (42 U.S.C. 296p et seq.) 

16 is amended by adding at the end the following: 

17 ‘‘SEC. 832. NURSING EDUCATION ENHANCEMENT AND MOD18 ERNIZATION GRANTS IN UNDERSERVED 

19 AREAS. 

20 ‘‘(a) IN GENERAL.—The Secretary, acting through 

21 the Administrator of the Health Resources and Services 

22 Administration, may award grants to schools of nursing 

23 for— 

24 ‘‘(1) increasing the number of faculty and stu25 dents at such schools in order to enhance the preVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 paredness of the United States for, and the ability 

2 of the United States to address and quickly respond 

3 to, public health emergencies declared under section 

4 319 and pandemics; or 

5 ‘‘(2) the enhancement and modernization of 

6 nursing education programs. 

7 ‘‘(b) PRIORITY.—In selecting grant recipients under 

8 this section, the Secretary shall give priority to schools of 

9 nursing that— 

10 ‘‘(1) are located in a medically underserved 

11 community; 

12 ‘‘(2) are located in a health professional short13 age area as defined under section 332(a); or 

14 ‘‘(3) are institutions of higher education listed 

15 under section 371(a) of the Higher Education Act of 

16 1965. 

17 ‘‘(c) CONSIDERATION.—In awarding grants under 

18 this section, the Secretary, to the extent practicable, may 

19 ensure equitable distribution of awards among the geo20 graphic regions of the United States. 

21 ‘‘(d) USE OF FUNDS.—A school of nursing that re22 ceives a grant under this section may use the funds award23 ed through such grant for activities that include— 

24 ‘‘(1) enhancing enrollment and retention of stu25 dents at such school, with a priority for students 


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1 from disadvantaged backgrounds (including racial or 

2 ethnic groups underrepresented in the nursing work3 force), individuals from rural and underserved areas, 

4 low-income individuals, and first generation college 

5 students (as defined in section 402A(h)(3) of the 

6 Higher Education Act of 1965); 

7 ‘‘(2) creating, supporting, or modernizing edu8 cational programs and curriculum at such school; 

9 ‘‘(3) retaining current faculty, and hiring new 

10 faculty, with an emphasis on faculty from racial or 

11 ethnic groups who are underrepresented in the nurs12 ing workforce; 

13 ‘‘(4) modernizing infrastructure at such school, 

14 including audiovisual or other equipment, personal 

15 protective equipment, simulation and augmented re16 ality resources, telehealth technologies, and virtual 

17 and physical laboratories; 

18 ‘‘(5) partnering with a health care facility, 

19 nurse-managed health clinic, community health cen20 ter, or other facility that provides health care in 

21 order to provide educational opportunities for the 

22 purpose of establishing or expanding clinical edu23 cation; 

24 ‘‘(6) enhancing and expanding nursing pro25 grams that prepare nurse researchers and scientists; 


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1 ‘‘(7) establishing nurse-led intradisciplinary and 

2 interprofessional educational partnerships; and 

3 ‘‘(8) other activities that the Secretary deter4 mines further the development, improvement, and 

5 expansion of schools of nursing. 

6 ‘‘(e) REPORTS FROM ENTITIES.—Each school of 

7 nursing awarded a grant under this section shall submit 

8 an annual report to the Secretary on the activities con9 ducted under such grant, and other information as the 

10 Secretary may require. 

11 ‘‘(f) REPORT TO CONGRESS.—Not later than 5 years 

12 after the date of the enactment of this section, the Sec13 retary shall submit to the Committee on Health, Edu14 cation, Labor, and Pensions of the Senate and the Com15 mittee on Energy and Commerce of the House of Rep16 resentatives a report that provides a summary of the ac17 tivities and outcomes associated with grants made under 

18 this section. Such report shall include— 

19 ‘‘(1) a list of schools of nursing receiving grants 

20 under this section, including the primary geographic 

21 location of any school of nursing that was improved 

22 or expanded through such a grant; 

23 ‘‘(2) the total number of students who are en24 rolled at or who have graduated from any school of 


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1 nursing that was improved or expanded through a 

2 grant under this section, which such statistic shall— 

3 ‘‘(A) to the extent such information is 

4 available, be deidentified and disaggregated by 

5 race, ethnicity, age, sex, geographic region, dis6 ability status, and other relevant factors; and 

7 ‘‘(B) include an indication of the number 

8 of such students who are from racial or ethnic 

9 groups underrepresented in the nursing work10 force, such students who are from rural or un11 derserved areas, such students who are low-in12 come students, and such students who are first 

13 generation college students (as defined in sec14 tion 402A(h)(3) of the Higher Education Act of 

15 1965); 

16 ‘‘(3) to the extent such information is available, 

17 the effects of the grants awarded under this section 

18 on retaining and hiring of faculty, including any in19 crease in diverse faculty, the number of clinical edu20 cation partnerships, the modernization of nursing 

21 education infrastructure, and other ways this section 

22 helps address and quickly respond to public health 

23 emergencies and pandemics; 

24 ‘‘(4) recommendations for improving the grants 

25 awarded under this section; and 


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1 ‘‘(5) any other considerations as the Secretary 

2 determines appropriate. 

3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this section, there is authorized to be appro5 priated $1,000,000,000, to remain available until ex6 pended.’’. 

7 (b) STRENGTHENING NURSE EDUCATION.—The 

8 heading of part D of title VIII of the Public Health Serv9 ice Act (42 U.S.C. 296p et seq.) is amended by striking 

10 ‘‘BASIC’’. 

11 SEC. 3013. FINDINGS; SENSE OF CONGRESS RELATING TO 

12 GRADUATE MEDICAL EDUCATION. 

13 (a) FINDINGS.—Congress finds the following: 

14 (1) Projections by the Association of American 

15 Medical Colleges and other expert entities, such as 

16 the Health Resources and Services Administration, 

17 have indicated a nationwide shortage of up to 

18 121,900 physicians, split evenly between primary 

19 care and specialists, by 2032. 

20 (2) Primarily due to the growing and aging 

21 population, over the next decade, physician demand 

22 is expected to grow up to 17 percent. 

23 (3) The United States Census Bureau estimates 

24 that the United States population will grow from 

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1 ther, the number of Medicare beneficiaries is esti2 mated to increase from 47,800,000 in 2015 to ap3 proximately 66,000,000 in 2025. 

4 (4) Approximately 36 percent of practicing phy5 sicians are over the age of 55 and are likely to retire 

6 within the next decade. 

7 (5) A nationwide physician shortage will result 

8 in many individuals in the United States waiting 

9 longer and traveling farther for health care; seeking 

10 nonemergent care in emergency departments; and 

11 delaying treatment until the health care needs of 

12 such individuals become more serious, complex, and 

13 costly. 

14 (6) Changing demographics (such as an aging 

15 population), new health care delivery models (such 

16 as medical homes), and other factors (such as dis17 aster preparedness) are contributing to a shortage of 

18 both generalist and specialist physicians. 

19 (7) These shortages will have the most severe 

20 impact on vulnerable and underserved populations, 

21 including racial and ethnic minorities and the ap22 proximately 20 percent of people in the United 

23 States who live in rural or inner-city locations des24 ignated as health professional shortage areas. 


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1 (8) The health care utilization equity model of 

2 the Association of American Medical Colleges esti3 mates that if racial and ethnic minorities and indi4 viduals from rural areas utilized health care in a 

5 similar way to their Caucasian counterparts living in 

6 metropolitan areas, the physician shortage would re7 quire an additional 96,000 physicians. 

8 (9) To address the physician shortage in rural 

9 and medically underserved areas, medical education 

10 and training need to be accessible to underrep11 resented minorities (including individuals who are 

12 African American, Hispanic, Native American, or 

13 Native Hawaiian), and need to increase pathway 

14 programs for such underrepresented minorities who 

15 make up less than 12 percent of individuals enrolled 

16 in graduate medical education and for international 

17 students who make up 25 percent of individuals en18 rolled in graduate medical education. Immigration 

19 pathways like student, exchange-visitor, and employ20 ment visas, and programs like the National Interest 

21 Waiver and Conrad State 30 J–1 Visa Waiver, help 

22 improve health access across the United States. 

23 (10) United States medical school enrollment 

24 was expected to grow by 30 percent from 2018 to 


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1 2019 to help reduce the shortage of quality physi2 cians in the United States. 

3 (11) An increase in United States medical 

4 school graduates must be accompanied by an in5 crease of 4,000 graduate medical education training 

6 positions each year. 

7 (12) Graduate medical education programs and 

8 teaching hospitals provide venues in which the next 

9 generation of physicians learns to work collabo10 ratively with other physicians and health profes11 sionals, adopt more efficient care delivery models 

12 (such as care coordination and medical homes), in13 corporate health information technology and elec14 tronic health records in every aspect of their work, 

15 apply new methods of assuring quality and safety, 

16 and participate in groundbreaking clinical and public 

17 health research. 

18 (13) The Medicare program under title XVIII 

19 of the Social Security Act (42 U.S.C. 1395 et seq.) 

20 (having more beneficiaries than any other health 

21 care program), supports its ‘‘fair share’’ of the costs 

22 associated with graduate medical education. 

23 (14) In general, the level of support of graduate 

24 medical education by the Medicare program has 

25 been capped since 1997 and has not been increased 


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1 to support the expansion of graduate medical edu2 cation programs needed to avert the projected physi3 cian shortage or to accommodate the increase in 

4 United States medical school graduates. 

5 (b) SENSE OF CONGRESS.—It is the sense of Con6 gress that eliminating the limit of the number of residency 

7 positions that receive some level of Medicare support 

8 under section 1886(h) of the Social Security Act (42 

9 U.S.C. 1395ww(h)), also referred to as the Medical grad10 uate medical education cap, is critical to— 

11 (1) ensuring an appropriate supply of physi12 cians to meet the health care needs in the United 

13 States; 

14 (2) facilitating equitable access for all who seek 

15 health care; 

16 (3) increasing the racial and ethnic diversity of 

17 physicians in the United States; and 

18 (4) mitigating disparities in health and health 

19 care. 

20 SEC. 3014. CAREER SUPPORT FOR SKILLED, INTERNATION21 ALLY EDUCATED HEALTH PROFESSIONALS. 

22 (a) FINDINGS.—Congress finds the following: 

23 (1) According to a 2018 study, the State and 

24 local public health workforce has shrunk by more 

25 than 50,000 individuals since the beginning of the 


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1 2008 Great Recession, and almost one quarter of in2 dividuals comprising the governmental public health 

3 workforce plan to leave or retire in the coming years. 

4 (2) Shortages are projected for other health 

5 professions, including within the fields of nursing 

6 (500,000 by 2025), dentistry (15,000 by 2025), 

7 pharmacy (38,000 by 2030), mental and behavioral 

8 health (236,880 by 2025), and primary care (46,000 

9 by 2025). 

10 (3) A nationwide health workforce shortage will 

11 result in serious health threats and more severe and 

12 costly health care needs, due to, in part, a delayed 

13 response to food-borne outbreaks, emerging infec14 tious diseases, natural disasters, fewer cancer 

15 screenings, and delayed treatment. 

16 (4) Vulnerable and underserved populations and 

17 health professional shortage areas will be most se18 verely impacted by the health workforce shortage. 

19 (5) According to the Migration Policy Institute, 

20 more than 2,000,000 college-educated immigrants in 

21 the United States today are unemployed or under22 employed in low- or semi-skilled jobs that fail to 

23 draw on their education and expertise. 


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1 (6) Approximately 2 out of every 5 internation2 ally educated immigrants are unemployed or under3 employed. 

4 (7) According to the Drexel University Center 

5 for Labor Markets and Policy, underemployment for 

6 internationally educated immigrant women is 28 per7 cent higher than for their male counterparts. 

8 (8) According to the Drexel University Center 

9 for Labor Markets and Policy, the mean annual 

10 earnings of underemployed immigrants were 

11 $32,000, or 43 percent less than United States-born 

12 college graduates employed in the college labor mar13 ket. 

14 (9) According to Upwardly Global and the Wel15 come Back Initiative, with proper guidance and sup16 port, underemployed skilled immigrants typically in17 crease their income by 215 percent to 900 percent. 

18 (10) According to the Brookings Institution and 

19 the Partnership for a New American Economy, im20 migrants working in the health workforce are, on av21 erage, better educated than United States-born 

22 workers in the health workforce. 

23 (b) GRANTS TO ELIGIBLE ENTITIES.— 

24 (1) AUTHORITY TO PROVIDE GRANTS.—The 

25 Secretary of Health and Human Services acting 


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1 through the Bureau of Health Workforce within the 

2 Health Resources and Services Administration, the 

3 National Institute on Minority Health and Health 

4 Disparities, or the Office of Minority Health (in this 

5 section referred to as the ‘‘Secretary’’) may award 

6 grants to eligible entities under paragraph (2) to 

7 carry out activities described in subsection (c). 

8 (2) ELIGIBILITY.—To be eligible to receive a 

9 grant under this section, an entity shall— 

10 (A) be a clinical, public health, or health 

11 services organization, a community-based or 

12 nonprofit entity, an academic institution, a 

13 faith-based organization, a State, county, or 

14 local government, an area health education cen15 ter, or another entity determined appropriate by 

16 the Secretary; and 

17 (B) submit to the Secretary an application 

18 at such time, in such manner, and containing 

19 such information as the Secretary may require. 

20 (c) AUTHORIZED ACTIVITIES.—A grant awarded 

21 under this section shall be used— 

22 (1) to provide services to assist unemployed and 

23 underemployed skilled immigrants, residing in the 

24 United States, who have legal, permanent work au25 thorization and who are internationally educated 


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1 health professionals, enter into the health workforce 

2 of the United States with employment matching 

3 their health professional skills and education, and 

4 advance in employment to positions that better 

5 match their health professional education and exper6 tise; 

7 (2) to provide training opportunities to reduce 

8 barriers to entry and advancement in the health 

9 workforce for skilled, internationally educated immi10 grants; 

11 (3) to educate employers regarding the abilities 

12 and capacities of internationally educated health 

13 professionals; 

14 (4) to assist in the evaluation of foreign creden15 tials; 

16 (5) to support preceptorships for international 

17 medical graduates in hospital primary care training; 

18 and 

19 (6) to facilitate access to contextualized and ac20 celerated courses on English as a second language. 

21 SEC. 3015. STUDY AND REPORT ON STRATEGIES FOR IN22 CREASING DIVERSITY. 

23 (a) STUDY.—The Comptroller General of the United 

24 States shall conduct a study on strategies for increasing 

25 the diversity of the health professional workforce. Such 


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1 study shall include an analysis of strategies for increasing 

2 the number of health professionals from rural, lower in3 come, and underrepresented minority communities, includ4 ing which strategies are most effective for achieving such 

5 goal. 

6 (b) REPORT.—Not later than 2 years after the date 

7 of enactment of this Act, the Comptroller General shall 

8 submit to Congress a report on the study conducted under 

9 subsection (a), together with recommendations for such 

10 legislation and administrative action as the Comptroller 

11 General determines appropriate. 

12 SEC. 3016. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN13 TION. 

14 (a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec15 tion 220(c) of the Immigration and Nationality Technical 

16 Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 

17 1182 note) is amended by striking ‘‘September 30, 2015’’ 

18 and inserting ‘‘September 30, 2022’’. 

19 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED

20 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 

21 201(b)(1) of the Immigration and Nationality Act (8 

22 U.S.C. 1151(b)(1)) is amended by adding at the end the 

23 following: 

24 ‘‘(F)(i) Alien physicians who have com25 pleted service requirements for a national interVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 est waiver requested under section 

2 203(b)(2)(B)(ii), including— 

3 ‘‘(I) alien physicians who completed 

4 such service before the date of the enact5 ment of the Health Equity and Account6 ability Act of 2022; and 

7 ‘‘(II) the spouse or children of an 

8 alien physician described in subclause (I). 

9 ‘‘(ii) Nothing in this subparagraph may be 

10 construed— 

11 ‘‘(I) to prevent the filing of a petition 

12 with the Secretary of Homeland Security 

13 for classification under section 204(a) or 

14 the filing of an application for adjustment 

15 of status under section 245 by an alien 

16 physician described in clause (i) before the 

17 date on which such alien physician com18 pletes the service described in section 

19 214(l) or worked full-time as a physician 

20 for an aggregate of 5 years at the location 

21 identified in the waiver of the 2-year for22 eign residence requirement under section 

23 214(l) or in an area or areas designated by 

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1 ices as having a shortage of health care 

2 professionals; or 

3 ‘‘(II) to permit the Secretary of 

4 Homeland Security to grant a petition or 

5 application described in subclause (I) until 

6 the alien has satisfied all of the require7 ments of the waiver received under section 

8 214(l).’’. 

9 (c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 

10 (1) EXCEPTIONS TO 2-YEAR FOREIGN RESI11 DENCY REQUIREMENT.—Section 214(l)(1) of the 

12 Immigration and Nationality Act (8 U.S.C. 

13 1184(l)(1)) is amended— 

14 (A) in the matter preceding subparagraph 

15 (A), by striking ‘‘Attorney General shall not’’ 

16 and inserting ‘‘Secretary of Homeland Security 

17 may not’’; 

18 (B) in subparagraph (A), by striking ‘‘Di19 rector of the United States Information Agen20 cy’’ and inserting ‘‘Secretary of State’’; 

21 (C) in subparagraph (B), by inserting ‘‘, 

22 except as provided in paragraphs (7) and (8)’’ 

23 before the semicolon at the end; 

24 (D) in subparagraph (C), by amending 

25 clauses (i) and (ii) to read as follows: 


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1 ‘‘(i) the alien demonstrates a bona 

2 fide offer of full-time employment at a 

3 health facility or health care organization, 

4 which employment has been determined by 

5 the Secretary of Homeland Security to be 

6 in the public interest; and 

7 ‘‘(ii) the alien— 

8 ‘‘(I) has accepted employment 

9 with the health facility or health care 

10 organization in a geographic area or 

11 areas which are designated by the 

12 Secretary of Health and Human Serv13 ices as having a shortage of health 

14 care professionals; 

15 ‘‘(II) begins employment by the 

16 later of the date that is— 

17 ‘‘(aa) 120 days after receiv18 ing such waiver; 

19 ‘‘(bb) 120 days after com20 pleting graduate medical edu21 cation or training under a pro22 gram approved pursuant to sec23 tion 212(j)(1); or 

24 ‘‘(cc) 120 days after receiv25 ing nonimmigrant status or emVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ployment authorization, if the 

2 alien or the alien’s employer peti3 tions for such nonimmigrant sta4 tus or employment authorization 

5 not later than 120 days after the 

6 date on which the alien completes 

7 his or her graduate medical edu8 cation or training under a pro9 gram approved pursuant to sec10 tion 212(j)(1); and 

11 ‘‘(III) agrees to continue to work 

12 for a total of not less than 3 years in 

13 the status authorized for such employ14 ment under this subsection, except as 

15 provided in paragraph (8); and’’; and 

16 (E) in subparagraph (D), in the matter 

17 preceding clause (i), by inserting ‘‘, subject to 

18 paragraph (8),’’ before ‘‘in the case’’. 

19 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS

20 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY

21 UNDERSERVED AREAS.—Section 214(l)(2)(A) of 

22 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 

23 read as follows: 

24 ‘‘(A) Upon the request of an interested 

25 Federal agency or an interested State agency 


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1 for recommendation of a waiver under this sec2 tion by a physician who is maintaining valid 

3 nonimmigrant status under section 

4 101(a)(15)(J) and received a favorable rec5 ommendation by the Secretary of State, the 

6 Secretary of Homeland Security may change 

7 the status of such physician to any status au8 thorized for employment under this Act. The 

9 numerical limitations set forth in subsection 

10 (g)(1)(A) shall not apply to any alien whose 

11 status is changed under this subparagraph.’’. 

12 (3) VIOLATION OF AGREEMENTS.—Section 

13 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

14 amended by inserting ‘‘substantial requirement of 

15 an’’ before ‘‘agreement entered into’’. 

16 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED

17 AREAS.—Section 214(l) of such Act (8 U.S.C. 

18 1184(l)), as amended by this section, is further 

19 amended by adding at the end the following: 

20 ‘‘(4)(A) If an interested State agency denies the 

21 application for a waiver under paragraph (1)(B) 

22 from a physician pursuing graduate medical edu23 cation or training pursuant to section 101(a)(15)(J) 

24 because the State has requested the maximum num25 ber of waivers permitted for that fiscal year, the 


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1 physician’s nonimmigrant status shall be extended 

2 for up to 6 months if the physician agrees to seek 

3 a waiver under this subsection (except for paragraph 

4 (1)(D)(ii)) to work for an employer described in 

5 paragraph (1)(C) in a State that has not yet re6 quested the maximum number of waivers. 

7 ‘‘(B) A physician described in subparagraph (A) 

8 may only work for the employer referred to in sub9 paragraph (A) during the period beginning on the 

10 date on which a new waiver application is filed with 

11 such State and ending on the earlier of— 

12 ‘‘(i) the date on which the Secretary of 

13 Homeland Security denies such waiver; or 

14 ‘‘(ii) the date on which the Secretary ap15 proves an application for change of status 

16 under paragraph (2)(A) pursuant to the ap17 proval of such waiver.’’. 

18 (5) CONTRACT REQUIREMENTS.—Section 214(l) 

19 of such Act, as amended by this section, is further 

20 amended by adding at the end the following: 

21 ‘‘(5) An alien granted a waiver under para22 graph (1)(C) shall enter into an employment agree23 ment with the contracting health facility or health 

24 care organization that— 


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1 ‘‘(A) specifies the maximum number of on2 call hours per week (which may be a monthly 

3 average) that the alien will be expected to be 

4 available and the compensation the alien will re5 ceive for on-call time; 

6 ‘‘(B) specifies— 

7 ‘‘(i) whether the contracting facility or 

8 organization will pay the alien’s mal9 practice insurance premiums; 

10 ‘‘(ii) whether the employer will provide 

11 malpractice insurance; and 

12 ‘‘(iii) the amount of such insurance 

13 that will be provided; 

14 ‘‘(C) describes all of the work locations 

15 that the alien will work including a statement 

16 that the contracting facility or organization will 

17 not add additional work locations without the 

18 approval of the Federal agency or State agency 

19 that requested the waiver; and 

20 ‘‘(D) does not include a non-compete provi21 sion. 

22 ‘‘(6) An alien granted a waiver under this sub23 section whose employment relationship with a health 

24 facility or health care organization terminates under 

25 paragraph (1)(C)(ii) during the 3-year service period 


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1 required under paragraph (1) shall be considered to 

2 be maintaining lawful status in an authorized period 

3 of stay during the 120-day period referred to in 

4 items (aa) and (bb) of subclause (III) of paragraph 

5 (1)(C)(ii) or the 45-day period referred to in sub6 clause (III)(cc) of such paragraph.’’. 

7 (6) RECAPTURING WAIVER SLOTS LOST TO

8 OTHER STATES.—Section 214(l) of such Act, as 

9 amended by this section, is further amended by add10 ing at the end the following: 

11 ‘‘(7) If a recipient of a waiver under this sub12 section terminates the recipient’s employment with a 

13 health facility or health care organization pursuant 

14 to paragraph (1)(C)(ii), including termination of em15 ployment because of circumstances described in 

16 paragraph (1)(C)(ii)(III), and accepts new employ17 ment with such a facility or organization in a dif18 ferent State, the State from which the alien is de19 parting may be accorded an additional waiver by the 

20 Secretary of State for use in the fiscal year in which 

21 the alien’s employment was terminated.’’. 

22 (7) EXCEPTION TO 3-YEAR WORK REQUIRE23 MENT.—Section 214(l) of such Act, as amended by 

24 this section, is further amended by adding at the 

25 end the following: 


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1 ‘‘(8) The 3-year work requirement set forth in 

2 subparagraphs (C) and (D) of paragraph (1) shall 

3 not apply if— 

4 ‘‘(A)(i) the Secretary of Homeland Secu5 rity determines that extenuating circumstances, 

6 including violations by the employer of the em7 ployment agreement with the alien or of labor 

8 and employment laws, exist that justify a lesser 

9 period of employment at such facility or organi10 zation; and 

11 ‘‘(ii) not later than 120 days after the em12 ployment termination date (unless the Secretary 

13 determines that extenuating circumstances 

14 would justify an extension), the alien dem15 onstrates another bona fide offer of employment 

16 at a health facility or health care organization 

17 in a geographic area or areas which are des18 ignated by the Secretary of Health and Human 

19 Services as having a shortage of health care 

20 professionals, for the remainder of such 3-year 

21 period; 

22 ‘‘(B)(i) the interested State agency that re23 quested the waiver attests that extenuating cir24 cumstances, including violations by the em25 ployer of the employment agreement with the 


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1 alien or of labor and employment laws, exist 

2 that justify a lesser period of employment at 

3 such facility or organization; and 

4 ‘‘(ii) the alien demonstrates, not later than 

5 120 days after the employment termination 

6 date (unless the Secretary determines that ex7 tenuating circumstances would justify an exten8 sion), another bona fide offer of employment at 

9 a health facility or health care organization in 

10 a geographic area or areas which are designated 

11 by the Secretary of Health and Human Services 

12 as having a shortage of health care profes13 sionals, for the remainder of such 3-year period; 

14 or 

15 ‘‘(C) the alien— 

16 ‘‘(i) elects not to pursue a determina17 tion of extenuating circumstances pursuant 

18 to subparagraph (A) or (B); 

19 ‘‘(ii) terminates the alien’s employ20 ment relationship with the health facility 

21 or health care organization at which the 

22 alien was employed; 

23 ‘‘(iii) not later than 45 days after the 

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1 ployment at a health facility or health care 

2 organization in a geographic area or areas, 

3 in the State that requested the alien’s 

4 waiver, which are designated by the Sec5 retary of Health and Human Services as 

6 having a shortage of health care profes7 sionals; and 

8 ‘‘(iv) agrees to be employed for the re9 mainder of such 3-year period, and 1 addi10 tional year for each termination under 

11 clause (ii).’’. 

12 (d) ALLOTMENT OF CONRAD STATE 30 WAIVERS.— 

13 (1) IN GENERAL.—Section 214(l) of the Immi14 gration and Nationality Act (8 U.S.C. 1184(l)), as 

15 amended by subsection (c), is further amended by 

16 adding at the end the following: 

17 ‘‘(9)(A)(i) All States shall be allotted 35 waivers 

18 under paragraph (1)(B) for each fiscal year if 90 percent 

19 of the waivers available to the States receiving at least 

20 5 waivers were used in the previous fiscal year. 

21 ‘‘(ii) When an allotment occurs under clause (i), all 

22 States shall be allotted an additional 5 waivers under 

23 paragraph (1)(B) for each subsequent fiscal year if 90 

24 percent of the waivers available to the States receiving at 

25 least 5 waivers were used in the previous fiscal year. If 


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1 the States are allotted 45 or more waivers for a fiscal year, 

2 the States will only receive an additional increase of 5 

3 waivers the following fiscal year if 95 percent of the waiv4 ers available to the States receiving at least 1 waiver were 

5 used in the previous fiscal year. 

6 ‘‘(B) Any increase in allotments under subparagraph 

7 (A) shall be maintained indefinitely, unless in a fiscal year 

8 the total number of such waivers granted is 5 percent 

9 lower than in the last year in which there was an increase 

10 in the number of waivers allotted pursuant to this para11 graph. In such case— 

12 ‘‘(i) the number of waivers allotted beginning in 

13 the next fiscal year shall be decreased by 5 for all 

14 States; and 

15 ‘‘(ii) each additional 5 percent decrease in such 

16 waivers granted from the last year in which there 

17 was an increase in the allotment, shall result in an 

18 additional decrease of 5 waivers allotted for all 

19 States, provided that the number of waivers allotted 

20 for all States shall not drop below 30.’’. 

21 (2) ACADEMIC MEDICAL CENTERS.—Section 

22 214(l)(1)(D) of such Act, as amended by subsection 

23 (c)(1)(E), is further amended— 

24 (A) in clause (ii), by striking ‘‘and’’ at the 

25 end; 


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1 (B) in clause (iii), by striking the period at 

2 the end and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following: 

4 ‘‘(iv) in the case of a request by an inter5 ested State agency— 

6 ‘‘(I) the head of such agency deter7 mines that the alien is to practice medicine 

8 in, or be on the faculty of a residency pro9 gram at, an academic medical center (as 

10 defined in section 411.355(e)(2) of title 42, 

11 Code of Federal Regulations), without re12 gard to whether such facility is located 

13 within an area designated by the Secretary 

14 of Health and Human Services as having 

15 a shortage of health care professionals; and 

16 ‘‘(II) the head of such agency deter17 mines that— 

18 ‘‘(aa) the alien physician’s work 

19 is in the public interest; and 

20 ‘‘(bb) subject to paragraph (6), 

21 the grant of such waiver would not 

22 cause the number of the waivers 

23 granted on behalf of aliens for such 

24 State for a fiscal year to exceed 3, 


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1 within the limitation under subpara2 graph (B).’’. 

3 (e) AMENDMENTS TO THE PROCEDURES, DEFINI4 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN

5 IMMIGRATION.— 

6 (1) DUAL INTENT FOR PHYSICIANS SEEKING

7 GRADUATE MEDICAL TRAINING.—Section 214(b) of 

8 the Immigration and Nationality Act (8 U.S.C. 

9 1184(b)) is amended by striking ‘‘and other than a 

10 nonimmigrant described in any provision of section 

11 101(a)(15)(H)(i) except subclause (b1) of such sec12 tion)’’ and inserting ‘‘a nonimmigrant described in 

13 any provision of section 101(a)(15)(H)(i) (except 

14 subclause (b1) of such section), and an alien coming 

15 to the United States to receive graduate medical 

16 education or training as described in section 212(j) 

17 or to take examinations required to receive graduate 

18 medical education or training as described in section 

19 212(j))’’. 

20 (2) PHYSICIAN NATIONAL INTEREST WAIVER

21 CLARIFICATIONS.— 

22 (A) PRACTICE AND GEOGRAPHIC AREA.— 

23 Section 203(b)(2)(B)(ii)(I) of the Immigration 

24 and Nationality Act (8 U.S.C. 


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1 1153(b)(2)(B)(ii)(I)) is amended by striking 

2 items (aa) and (bb) and inserting the following: 

3 ‘‘(aa) the alien physician agrees to 

4 work on a full-time basis practicing pri5 mary care, specialty medicine, or a com6 bination thereof, in an area or areas des7 ignated by the Secretary of Health and 

8 Human Services as having a shortage of 

9 health care professionals, or at a health 

10 care facility under the jurisdiction of the 

11 Secretary of Veterans Affairs; or 

12 ‘‘(bb) the alien physician is pursuing 

13 such waiver based upon service at a facility 

14 or facilities that serve patients who reside 

15 in a geographic area or areas designated 

16 by the Secretary of Health and Human 

17 Services as having a shortage of health 

18 care professionals (without regard to 

19 whether such facility or facilities are lo20 cated within such an area) and a Federal 

21 agency, or a local, county, regional, or 

22 State department of public health deter23 mines the alien physician’s work was or 

24 will be in the public interest.’’. 


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1 (B) FIVE-YEAR SERVICE REQUIREMENT.— 

2 Section 203(b)(2)(B)(ii) of such Act is amend3 ed— 

4 (i) by moving subclauses (II), (III), 

5 and (IV) 4 ems to the left; and 

6 (ii) in subclause (II)— 

7 (I) by inserting ‘‘(aa)’’ after 

8 ‘‘(II)’’; and 

9 (II) by adding at the end the fol10 lowing: 

11 ‘‘(bb) The 5-year service requirement 

12 described in item (aa) shall begin on the 

13 date on which the alien physician begins 

14 work in the shortage area in any legal sta15 tus and not on the date on which an immi16 grant visa petition is filed or approved. 

17 Such service shall be aggregated without 

18 regard to when such service began and 

19 without regard to whether such service 

20 began during or in conjunction with a 

21 course of graduate medical education. 

22 ‘‘(cc) An alien physician shall not be 

23 required to submit an employment contract 

24 with a term exceeding the balance of the 5- 

25 year commitment yet to be served or an 


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1 employment contract dated within a min2 imum time period before filing a visa peti3 tion under this subsection. 

4 ‘‘(dd) An alien physician shall not be 

5 required to file additional immigrant visa 

6 petitions upon a change of work location 

7 from the location approved in the original 

8 national interest immigrant petition.’’. 

9 (3) TECHNICAL CLARIFICATION REGARDING AD10 VANCED DEGREE FOR PHYSICIANS.—Section 

11 203(b)(2)(A) of such Act is amended by adding at 

12 the end the following: ‘‘An alien physician holding a 

13 foreign medical degree that has been deemed suffi14 cient for acceptance by an accredited United States 

15 medical residency or fellowship program shall be 

16 considered a member of the professions holding an 

17 advanced degree or its equivalent for purposes of 

18 this paragraph.’’. 

19 (4) SHORT-TERM WORK AUTHORIZATION FOR

20 PHYSICIANS COMPLETING THEIR RESIDENCIES.— 

21 (A) IN GENERAL.—A physician completing 

22 graduate medical education or training de23 scribed in section 212(j) of the Immigration 

24 and Nationality Act (8 U.S.C. 1182(j)) as a 

25 nonimmigrant described in section 


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1 101(a)(15)(H)(i) of such Act (8 U.S.C. 

2 1101(a)(15)(H)(i))— 

3 (i) shall have such nonimmigrant sta4 tus automatically extended until October 1 

5 of the fiscal year for which a petition for 

6 a continuation of such nonimmigrant sta7 tus has been submitted in a timely manner 

8 and the employment start date for the ben9 eficiary of such petition is October 1 of 

10 that fiscal year; and 

11 (ii) shall be authorized to be employed 

12 incident to status during the period be13 tween the filing of such petition and Octo14 ber 1 of such fiscal year. 

15 (B) TERMINATION.—The status and em16 ployment authorization of a physician described 

17 in subparagraph (A) shall terminate on the date 

18 that is 30 days after the date on which a peti19 tion described in clause (i)(I) is rejected, denied 

20 or revoked. 

21 (C) AUTOMATIC EXTENSION.—The status 

22 and employment authorization of a physician 

23 described in subparagraph (A) will automati24 cally extend to October 1 of the next fiscal year 

25 if all of the visas described in section 


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1 101(a)(15)(H)(i) of the Immigration and Na2 tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 

3 were authorized to be issued for the fiscal year 

4 have been issued. 

5 (5) APPLICABILITY OF SECTION 212(e) TO

6 SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI7 TORS.—A spouse or child of an exchange visitor de8 scribed in section 101(a)(15)(J) of the Immigration 

9 and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 

10 not be subject to the requirements under section 

11 212(e) of such Act (8 U.S.C. 1182(e)). 

12 SEC. 3017. NATIONAL HISPANIC NURSES DAY. 

13 (a) FINDINGS.—Congress finds the following: 

14 (1) A special group of nurses in the Nation are 

15 the Hispanic nurses. 

16 (2) Hispanic nurses provide culturally and eth17 nically competent care and are educated to be sen18 sitive to regional and community customs of persons 

19 needing care. 

20 (3) Hispanic nurses are well-positioned to pro21 vide leadership to eliminate health care disparities 

22 that exist in the Nation. 

23 (4) Since 1975, the National Association of 

24 Hispanic Nurses (NAHN) has represented Hispanic 

25 nurses (RNs/LPNs) in the United States and is the 


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1 only nursing organization for Hispanic nurses whose 

2 mission is to advance the health in Hispanic commu3 nities and to lead, promote, and advocate for edu4 cational, professional, and leadership opportunities 

5 for Hispanic nurses. 

6 (5) Since September is the month that has been 

7 set aside to honor the contributions of Hispanics, it 

8 is only fitting that Hispanic nurses be recognized 

9 and honored during this time for their outstanding 

10 contributions to their community and country. 

11 (6) The designation of an observation day will 

12 help to raise awareness of the accomplishments of 

13 Hispanic nurses and pave the way for the important 

14 work that they must continue to carry out. 

15 (7) Each February, the National Association of 

16 Hispanic Nurses convenes nearly 100 nursing lead17 ers from academia, research, education, and practice 

18 in the District of Columbia for a day on Capitol Hill 

19 promoting legislation that improves the health of 

20 Hispanic communities. 

21 (8) Hispanic nurses are strong allies to Con22 gress as they help inform, educate, and work closely 

23 with legislators to improve the education, retention, 

24 recruitment, and practice of all nurses and, more 


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1 importantly, the health and safety of the patients for 

2 whom they provide care. 

3 (9) Hispanic nurses add needed diversity to the 

4 nursing profession, and these nurses have engaged 

5 in numerous ways to support communities and the 

6 needs of an overlooked, under resourced, and under7 served population being severely impacted by 

8 COVID–19. 

9 (b) SENSE OF CONGRESS.—The Congress— 

10 (1) supports the goals and ideals, and the des11 ignation, of National Hispanic Nurses Day, as pro12 posed by the National Association of Hispanic 

13 Nurses; 

14 (2) recognizes the significant contributions of 

15 Hispanic nurses to the health care system of the 

16 United States; and 

17 (3) encourages the people of the United States 

18 to observe National Hispanic Nurses Day with ap19 propriate recognition, ceremonies, activities, and pro20 grams to demonstrate the importance of Hispanic 

21 nurses to the everyday lives of patients and the com22 munities they serve. 


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1 SEC. 3018. EXPANDING MEDICAL EDUCATION. 

2 Subpart II of part C of title VII of the Public Health 

3 Service Act (42 U.S.C. 293m et seq.) is amended by add4 ing at the end the following: 

5 ‘‘SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND 

6 SCHOOLS OF OSTEOPATHIC MEDICINE IN UN7 DERSERVED AREAS. 

8 ‘‘(a) IN GENERAL.—The Secretary, acting through 

9 the Administrator of the Health Resources and Services 

10 Administration, may award grants to institutions of high11 er education (including consortiums of such institutions) 

12 for the establishment, improvement, or expansion of a 

13 school of medicine or osteopathic medicine, or a branch 

14 campus of a school of medicine or osteopathic medicine. 

15 ‘‘(b) PRIORITY.—In selecting grant recipients under 

16 this section, the Secretary shall give priority to any insti17 tution of higher education (or consortium of such institu18 tions) that— 

19 ‘‘(1) proposes to use the grant for the establish20 ment of a school of medicine or osteopathic medi21 cine, or a branch campus of a school of medicine or 

22 osteopathic medicine, in an area— 

23 ‘‘(A) in which no other such school is 

24 based; and 


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1 ‘‘(B) that is a medically underserved com2 munity or a health professional shortage area; 

3 or 

4 ‘‘(2) is an institution described in section 

5 371(a) of the Higher Education Act of 1965. 

6 ‘‘(c) CONSIDERATIONS.—In awarding grants under 

7 this section, the Secretary, to the extent practicable, may 

8 ensure equitable distribution of awards among the geo9 graphical regions of the United States. 

10 ‘‘(d) USE OF FUNDS.—An institution of higher edu11 cation (or a consortium of such institutions)— 

12 ‘‘(1) shall use grant amounts received under 

13 this section to— 

14 ‘‘(A) recruit, enroll, and retain students, 

15 including individuals who are from disadvan16 taged backgrounds (including racial and ethnic 

17 groups underrepresented among medical stu18 dents and health professions), individuals from 

19 rural and underserved areas, low-income indi20 viduals, and first generation college students, at 

21 a school of medicine or osteopathic medicine or 

22 branch campus of a school of medicine or osteo23 pathic medicine; and 

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1 derserved populations, including accessible and 

2 culturally and linguistically appropriate care 

3 and services, at such school or branch campus; 

4 and 

5 ‘‘(2) may use grant amounts received under this 

6 section to— 

7 ‘‘(A) plan and construct— 

8 ‘‘(i) a school of medicine or osteo9 pathic medicine in an area in which no 

10 other such school is based; or 

11 ‘‘(ii) a branch campus of a school of 

12 medicine or osteopathic medicine in an 

13 area in which no other such school is 

14 based; 

15 ‘‘(B) plan, develop, and meet criteria for 

16 accreditation for a school of medicine or osteo17 pathic medicine or branch campus of a school 

18 of medicine or osteopathic medicine; 

19 ‘‘(C) hire faculty, including faculty from 

20 racial and ethnic groups who are underrep21 resented among the medical and other health 

22 professions, and other staff to serve at such a 

23 school or branch campus; 

24 ‘‘(D) support educational programs at such 

25 a school or branch campus; 


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1 ‘‘(E) modernize and expand infrastructure 

2 at such a school or branch campus; and 

3 ‘‘(F) support other activities that the Sec4 retary determines further the establishment, 

5 improvement, or expansion of a school of medi6 cine or osteopathic medicine or branch campus 

7 of a school of medicine or osteopathic medicine. 

8 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

9 under subsection (a), an institution of higher education 

10 (or a consortium of such institutions), shall submit an ap11 plication to the Secretary at such time, in such manner, 

12 and containing such information as the Secretary may re13 quire, including a description of the institution’s or con14 sortium’s planned activities described in subsection (d). 

15 ‘‘(f) REPORTING.— 

16 ‘‘(1) REPORTS FROM ENTITIES.—Each institu17 tion of higher education, or consortium of such insti18 tutions, awarded a grant under this section shall 

19 submit an annual report to the Secretary on the ac20 tivities conducted under such grant, and other infor21 mation as the Secretary may require. 

22 ‘‘(2) REPORT TO CONGRESS.—Not later than 5 

23 years after the date of enactment of this section and 

24 every 5 years thereafter, the Secretary shall submit 

25 to the Committee on Health, Education, Labor, and 


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1 Pensions of the Senate and the Committee on En2 ergy and Commerce of the House of Representatives 

3 a report that provides a summary of the activities 

4 and outcomes associated with grants made under 

5 this section. Such reports shall include— 

6 ‘‘(A) a list of awardees, including their pri7 mary geographic location, and location of any 

8 school of medicine or osteopathic medicine, or a 

9 branch campus of a school of medicine or osteo10 pathic medicine that was established, improved, 

11 or expanded under a grant awarded under this 

12 section; 

13 ‘‘(B) the total number of students (includ14 ing the number of students from racial and eth15 nic groups underrepresented among medical 

16 students and health professions, low-income 

17 students, and first generation college students) 

18 who— 

19 ‘‘(i) are enrolled at or who have grad20 uated from any school of medicine or os21 teopathic medicine, or a branch campus of 

22 a school of medicine or osteopathic medi23 cine, that was established, improved, or ex24 panded under a grant awarded under this 

25 section, deidentified and disaggregated by 


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1 race, ethnicity, age, sex, geographic region, 

2 disability status, and other relevant fac3 tors, to the extent such information is 

4 available; and 

5 ‘‘(ii) subsequently participate in an 

6 accredited internship or medical residency 

7 program upon graduation from any school 

8 of medicine or osteopathic medicine, or a 

9 branch campus of a school of medicine or 

10 osteopathic medicine, that was established, 

11 improved, or expanded under a grant 

12 awarded under this section, deidentified 

13 and disaggregated by race, ethnicity, age, 

14 sex, geographic region, disability status, 

15 medical specialty pursued, and other rel16 evant factors, to the extent such informa17 tion is available; 

18 ‘‘(C) the effects of the grants awarded 

19 under this section on the health care provider 

20 workforce, including any impact on demo21 graphic representation disaggregated by race, 

22 ethnicity, and sex, and the fields or specialties 

23 pursued by students who have graduated from 

24 any school of medicine or osteopathic medicine, 

25 or a branch campus of a school of medicine or 


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1 osteopathic medicine, that was established, im2 proved, or expanded under a grant awarded 

3 under this section; 

4 ‘‘(D) the effects of the grants awarded 

5 under this section on health care access in un6 derserved areas, including medically under7 served communities and health professional 

8 shortage areas; and 

9 ‘‘(E) recommendations for improving the 

10 grants awarded under this section, and any 

11 other considerations as the Secretary deter12 mines appropriate. 

13 ‘‘(3) PUBLIC AVAILABILITY.—The Secretary 

14 shall make reports submitted under paragraph (2) 

15 publicly available on the internet website of the De16 partment of Health and Human Services. 

17 ‘‘(g) DEFINITIONS.—In this section: 

18 ‘‘(1) BRANCH CAMPUS.— 

19 ‘‘(A) IN GENERAL.—The term ‘branch 

20 campus’, with respect to a school of medicine or 

21 osteopathic medicine, means an additional loca22 tion of such school that is geographically apart 

23 and independent of the main campus, at which 

24 the school offers at least 50 percent of the pro25 gram leading to a degree of doctor of medicine 


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1 or doctor of osteopathy that is offered at the 

2 main campus. 

3 ‘‘(B) INDEPENDENCE FROM MAIN CAM4 PUS.—For purposes of subparagraph (A), the 

5 location of a school described in such subpara6 graph shall be considered to be independent of 

7 the main campus described in such subpara8 graph if the location— 

9 ‘‘(i) is permanent in nature; 

10 ‘‘(ii) offers courses in educational pro11 grams leading to a degree, certificate, or 

12 other recognized educational credential; 

13 ‘‘(iii) has its own faculty and adminis14 trative or supervisory organization; and 

15 ‘‘(iv) has its own budgetary and hiring 

16 authority. 

17 ‘‘(2) FIRST GENERATION COLLEGE STUDENT.— 

18 The term ‘first generation college student’ has the 

19 meaning given such term in section 402A(h)(3) of 

20 the Higher Education Act of 1965. 

21 ‘‘(3) HEALTH PROFESSIONAL SHORTAGE

22 AREA.—The term ‘health professional shortage area’ 

23 has the meaning given such term in section 332(a). 

24 ‘‘(4) INSTITUTION OF HIGHER EDUCATION.— 

25 The term ‘institution of higher education’ has the 


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1 meaning given such term in section 101 of the High2 er Education Act of 1965. 

3 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this section, there is authorized to be appro5 priated $1,000,000,000, to remain available until ex6 pended.’’. 

7 TITLE IV—IMPROVING HEALTH 

8 CARE ACCESS AND QUALITY 

9 SEC. 4000. DEFINITION. 

10 In this title and the amendments made by this title, 

11 the term ‘‘health care’’ includes all health care needed 

12 throughout the life cycle and the end of life. 

13 Subtitle A—Reducing Barriers to 

14 Accessing Care 

15 SEC. 4001. PROTECTING PROTECTED AREAS. 

16 Section 287 of the Immigration and Nationality Act 

17 (8 U.S.C. 1357) is amended— 

18 (1) by striking ‘‘Service’’ each place such term 

19 appears and inserting ‘‘Department of Homeland 

20 Security’’; 

21 (2) by striking ‘‘Attorney General’’ each place 

22 such term appears and inserting ‘‘Secretary of 

23 Homeland Security’’; 


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1 (3) in subsection (f)(1), by striking ‘‘Commis2 sioner’’ and inserting ‘‘Director of U.S. Citizenship 

3 and Immigration Services’’; 

4 (4) in subsection (h)— 

5 (A) by striking ‘‘of the Immigration and 

6 Nationality Act’’; and 

7 (B) by striking ‘‘of such Act’’; and 

8 (5) by adding at the end the following: 

9 ‘‘(i)(1) In this subsection: 

10 ‘‘(A) The term ‘appropriate congressional com11 mittees’ means— 

12 ‘‘(i) the Committee on Homeland Security 

13 and Governmental Affairs of the Senate; 

14 ‘‘(ii) the Committee on the Judiciary of the 

15 Senate; 

16 ‘‘(iii) the Committee on Homeland Security 

17 of the House of Representatives; and 

18 ‘‘(iv) the Committee on the Judiciary of 

19 the House of Representatives. 

20 ‘‘(B) The term ‘enforcement action’— 

21 ‘‘(i) means an apprehension, arrest, inspec22 tion interview, request for identification, search, 

23 seizure, service of charging documents or sub24 poenas, or surveillance for the purposes of im25 migration enforcement; and 


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1 ‘‘(ii) includes an enforcement action at, or 

2 focused on, a protected area that is part of a 

3 joint case led by another law enforcement agen4 cy. 

5 ‘‘(C) The term ‘exigent circumstances’ means a 

6 situation involving— 

7 ‘‘(i) the imminent risk of death, violence, 

8 or physical harm to any person or property, in9 cluding a situation implicating terrorism or the 

10 national security of the United States; 

11 ‘‘(ii) the immediate arrest or pursuit of a 

12 dangerous felon, terrorist suspect, or other indi13 vidual presenting an imminent danger; or 

14 ‘‘(iii) the imminent risk of destruction of 

15 evidence that is material to an ongoing criminal 

16 case. 

17 ‘‘(D) The term ‘protected area’ includes all of 

18 the physical space located within 1,000 feet of— 

19 ‘‘(i) any medical treatment or mental 

20 health care facility, including any hospital, doc21 tor’s office, health clinic, alcohol or drug pre22 vention, counseling, or treatment facilities, sy23 ringe exchange services, vaccination, treatment, 

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1 ity, sites that serve pregnant individuals, or 

2 community health centers; 

3 ‘‘(ii) any public or private school, including 

4 any known and licensed day care facility, pre5 school, sites of early childhood programs, pri6 mary school, secondary school, postsecondary 

7 school (including colleges and universities), or 

8 other institution of learning (including voca9 tional or trade schools); 

10 ‘‘(iii) any scholastic or education-related 

11 activity or event or before or after school pro12 gram, including field trips and interscholastic 

13 events; 

14 ‘‘(iv) any school bus or school bus stop; 

15 ‘‘(v) places where children gather such as 

16 a playground, recreation center, library, foster 

17 care facility, or group home for children; 

18 ‘‘(vi) any physical structure of an organiza19 tion or subdivision of government that— 

20 ‘‘(I) assists children, pregnant women, 

21 victims of crime or abuse, or individuals 

22 with significant mental or physical disabil23 ities; 

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1 munity-based organizations, facilities that 

2 serve disabled persons, drug or alcohol 

3 counseling and treatment facilities, food 

4 banks or food pantries, and other places 

5 providing emergency and disaster services 

6 or assistance with food and nutrition, 

7 housing affordability and income or other 

8 services funded by State or local govern9 ment, charitable giving, the Special Sup10 plemental Nutrition Program for Women, 

11 Infants, and Children (WIC), Supple12 mental Nutrition Assistance Program 

13 (SNAP), Temporary Assistance for Needy 

14 Families (TANF), Social Security, or the 

15 United States Housing Act; or 

16 ‘‘(III) provides hospice, palliative, or 

17 other available end-of-life care services to 

18 terminally ill persons; 

19 ‘‘(vii) any church, synagogue, mosque, or 

20 other place of worship or religious study, in21 cluding buildings rented for the purpose of reli22 gious services, retreats, counseling, workshops, 

23 instruction, and education; 

24 ‘‘(viii) any Federal, State, or local court25 house, including the office of an individual’s 


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1 legal counsel or representative, and a probation, 

2 parole, or supervised release office; 

3 ‘‘(ix) the site of a funeral, grave-side cere4 mony, rosary, wedding, or other religious cere5 mony or observance; 

6 ‘‘(x) any public demonstration, such as a 

7 march, rally, or parade; 

8 ‘‘(xi) any domestic violence shelter, rape 

9 crisis center, child advocacy center, supervised 

10 visitation center, family justice center, or victim 

11 services provider; 

12 ‘‘(xii) congressional district offices; 

13 ‘‘(xiii) indoor and outdoor premises of de14 partments of motor vehicles; 

15 ‘‘(xiv) a place where disaster or emergency 

16 response and relief is provided, including evacu17 ation routes, places where shelter or emergency 

18 supplies, food, or water are distributed, or 

19 places where registration for disaster-relief as20 sistance or family reunification is underway; or 

21 ‘‘(xv) any other location specified by the 

22 Secretary of Homeland Security for purposes of 

23 this subsection. 

24 ‘‘(E) The term ‘prior approval’ means— 


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1 ‘‘(i) in the case of officers and agents of 

2 U.S. Immigration and Customs Enforcement, 

3 prior written approval to carry out an enforce4 ment action involving a specific individual or in5 dividuals authorized by— 

6 ‘‘(I) the Assistant Director of Oper7 ations, Homeland Security Investigations; 

8 ‘‘(II) the Executive Associate Direc9 tor, Homeland Security Investigations; 

10 ‘‘(III) the Assistant Director for Field 

11 Operations, Enforcement and Removal Op12 erations; or 

13 ‘‘(IV) the Executive Associate Direc14 tor for Field Operations, Enforcement and 

15 Removal Operations; 

16 ‘‘(ii) in the case of officers and agents of 

17 U.S. Customs and Border Protection, prior 

18 written approval to carry out an enforcement 

19 action involving a specific individual or individ20 uals authorized by— 

21 ‘‘(I) a Chief Patrol Agent; 

22 ‘‘(II) the Director of Field Operations; 

23 ‘‘(III) the Director of Air and Marine 

24 Operations; or 


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1 ‘‘(IV) the Internal Affairs Special 

2 Agent in Charge; and 

3 ‘‘(iii) in the case of other Federal, State, 

4 or local law enforcement officers, to carry out 

5 an enforcement action involving a specific indi6 vidual or individuals authorized by— 

7 ‘‘(I) the head of the Federal agency 

8 carrying out the enforcement action; or 

9 ‘‘(II) the head of the State or local 

10 law enforcement agency carrying out the 

11 enforcement action. 

12 ‘‘(2)(A) An enforcement action may not take place 

13 at, or be focused on, a protected area unless— 

14 ‘‘(i) the action involves exigent circumstances; 

15 and 

16 ‘‘(ii) prior approval for the enforcement action 

17 was obtained. 

18 ‘‘(B) If an enforcement action is initiated pursuant 

19 to subparagraph (A) and the exigent circumstances per20 mitting the enforcement action cease, the enforcement ac21 tion shall be discontinued until such exigent circumstances 

22 reemerge. 

23 ‘‘(C) If an enforcement action is carried out in viola24 tion of this subsection— 


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1 ‘‘(i) no information resulting from the enforce2 ment action may be entered into the record or re3 ceived into evidence in a removal proceeding result4 ing from the enforcement action; and 

5 ‘‘(ii) the noncitizen who is the subject of such 

6 removal proceeding may file a motion for the imme7 diate termination of the removal proceeding. 

8 ‘‘(3)(A) This subsection shall apply to any enforce9 ment action by officers or agents of the Department of 

10 Homeland Security, including— 

11 ‘‘(i) officers or agents of U.S. Immigration and 

12 Customs Enforcement; 

13 ‘‘(ii) officers or agents of U.S. Customs and 

14 Border Protection; and 

15 ‘‘(iii) any individual designated to perform im16 migration enforcement functions pursuant to sub17 section (g). 

18 ‘‘(B) While carrying out an enforcement action at a 

19 protected area, officers and agents referred to in subpara20 graph (A) shall make every effort— 

21 ‘‘(i) to limit the time spent at the protected 

22 area; 

23 ‘‘(ii) to limit the enforcement action at the pro24 tected area to the person or persons for whom prior 

25 approval was obtained; and 


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1 ‘‘(iii) to conduct themselves discreetly. 

2 ‘‘(C) If, while carrying out an enforcement action 

3 that is not initiated at or focused on a protected area, 

4 officers or agents are led to a protected area, and no exi5 gent circumstance and prior approval with respect to the 

6 protected area, such officers or agents shall— 

7 ‘‘(i) cease before taking any further enforce8 ment action; 

9 ‘‘(ii) conduct themselves in a discreet manner; 

10 ‘‘(iii) maintain surveillance on an individual; 

11 and 

12 ‘‘(iv) immediately consult their supervisor in 

13 order to determine whether such enforcement action 

14 should be discontinued. 

15 ‘‘(D) The limitations under this paragraph shall not 

16 apply to the transportation of an individual apprehended 

17 at or near a land or sea border to a hospital or health 

18 care provider for the purpose of providing medical care 

19 to such individual. 

20 ‘‘(4)(A) Each official specified in subparagraph (B) 

21 shall ensure that the employees under his or her super22 vision receive annual training on compliance with— 

23 ‘‘(i) the requirements under this subsection with 

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1 tected areas and enforcement actions that lead offi2 cers or agents to a protected area; and 

3 ‘‘(ii) the requirements under section 239 of this 

4 Act and section 384 of the Illegal Immigration Re5 form and Immigrant Responsibility Act of 1996 (8 

6 U.S.C. 1367). 

7 ‘‘(B) The officials specified in this subparagraph 

8 are— 

9 ‘‘(i) the Chief Counsel of each Field Office of 

10 U.S. Immigration and Customs Enforcement; 

11 ‘‘(ii) each Field Office Director of U.S. Immi12 gration and Customs Enforcement; 

13 ‘‘(iii) each Special Agent in Charge of U.S. Im14 migration and Customs Enforcement; 

15 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 

16 and Border Protection; 

17 ‘‘(v) the Director of Field Operations of U.S. 

18 Customs and Border Protection; 

19 ‘‘(vi) the Director of Air and Marine Operations 

20 of U.S. Customs and Border Protection; 

21 ‘‘(vii) the Internal Affairs Special Agent in 

22 Charge of U.S. Customs and Border Protection; and 

23 ‘‘(viii) the chief law enforcement officer of each 

24 State or local law enforcement agency that enters 


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1 into a written agreement with the Department of 

2 Homeland Security pursuant to subsection (g). 

3 ‘‘(5) Not later than 180 days after the date of the 

4 enactment of the Health Equity and Accountability Act 

5 of 2022, the Secretary of Homeland Security shall modify 

6 the Notice to Appear form (I–862)— 

7 ‘‘(A) to provide the subject of an enforcement 

8 action with information, written in plain language, 

9 summarizing the restrictions against enforcement 

10 actions at protected areas set forth in this sub11 section and the remedies available to the individual 

12 if such action violates such restrictions; 

13 ‘‘(B) to ensure that the information described 

14 in subparagraph (A) is accessible to an individual 

15 with limited English proficiency; and 

16 ‘‘(C) to ensure that a subject of an enforcement 

17 action is not permitted to verify that the officers or 

18 agents that carried out such action complied with 

19 the restrictions set forth in this subsection. 

20 ‘‘(6)(A) The Director of U.S. Immigration and Cus21 toms Enforcement and the Commissioner of U.S. Customs 

22 and Border Protection shall each submit an annual report 

23 to the appropriate congressional committees that includes 

24 the information set forth in subparagraph (B) with respect 

25 to the respective agency. 


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1 ‘‘(B) Each report submitted under subparagraph (A) 

2 shall include, with respect to the submitting agency during 

3 the reporting period— 

4 ‘‘(i) the number of enforcement actions that 

5 were carried out at, or focused on, a protected area; 

6 ‘‘(ii) the number of enforcement actions in 

7 which officers or agents were subsequently led to a 

8 protected area; and 

9 ‘‘(iii) for each enforcement action described in 

10 clause (i) or (ii)— 

11 ‘‘(I) the date on which it occurred; 

12 ‘‘(II) the specific site, city, county, and 

13 State in which it occurred; 

14 ‘‘(III) whether the site was a protected 

15 area and, if so— 

16 ‘‘(aa) identification of the protected 

17 area; 

18 ‘‘(bb) each reason why the enforce19 ment action was taken there; 

20 ‘‘(cc) where the enforcement action 

21 was taken without prior approval, certifi22 cation that notification to headquarters of 

23 a submitting agency was provided after the 

24 enforcement action took place; and 


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1 ‘‘(dd) a report of what occurred dur2 ing and immediately after the enforcement 

3 action; 

4 ‘‘(IV) the components of the agency in5 volved in the enforcement action; 

6 ‘‘(V) a description of the enforcement ac7 tion, including the nature of the criminal activ8 ity of its intended target; 

9 ‘‘(VI) the number of individuals, if any, ar10 rested or taken into custody; 

11 ‘‘(VII) the number of collateral arrests, if 

12 any, and the reasons for each such arrest; 

13 ‘‘(VIII) a certification whether the location 

14 administrator of a protected area was contacted 

15 before, during, or after the enforcement action; 

16 and 

17 ‘‘(IX) the percentage of all of the staff 

18 members and supervisors reporting to the offi19 cials listed in paragraph (4)(B) who completed 

20 the training required under paragraph (4)(A). 

21 ‘‘(7) Nothing in the subsection may be construed— 

22 ‘‘(A) to affect the authority of Federal, State, 

23 or local law enforcement agencies— 


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1 ‘‘(i) to enforce generally applicable Federal 

2 or State criminal laws unrelated to immigra3 tion; or 

4 ‘‘(ii) to protect residents from imminent 

5 threats to public safety; or 

6 ‘‘(B) to limit or override the protections pro7 vided in— 

8 ‘‘(i) section 239; or 

9 ‘‘(ii) section 384 of the Illegal Immigration 

10 Reform and Immigrant Responsibility Act of 

11 1996 (8 U.S.C. 1367).’’. 

12 SEC. 4002. REPEAL OF REQUIREMENT FOR DOCUMENTA13 TION EVIDENCING CITIZENSHIP OR NATION14 ALITY UNDER THE MEDICAID PROGRAM. 

15 (a) REPEAL.—Subsections (i)(22) and (x) of section 

16 1903 of the Social Security Act (42 U.S.C. 1396b) are 

17 each repealed. 

18 (b) CONFORMING AMENDMENTS.— 

19 (1) STATE PAYMENTS FOR MEDICAL ASSIST20 ANCE.—Section 1902 of the Social Security Act (42 

21 U.S.C. 1396a) is amended— 

22 (A) by amending paragraph (46) of sub23 section (a) to read as follows: 

24 ‘‘(46) provide that information is requested and 

25 exchanged for purposes of income and eligibility 


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1 verification in accordance with a State system which 

2 meets the requirements of section 1137 of this 

3 Act;’’; 

4 (B) in subsection (e)(13)(A)(i)— 

5 (i) in the matter preceding subclause 

6 (I), by striking ‘‘sections 1902(a)(46)(B) 

7 and 1137(d)’’ and inserting ‘‘section 

8 1137(d)’’; and 

9 (ii) in subclause (IV), by striking 

10 ‘‘1902(a)(46)(B) or’’; and 

11 (C) by striking subsection (ee). 

12 (2) REPEAL.—Subsection (c) of section 6036 of 

13 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 

14 note) is repealed. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section shall take effect on the date of enactment of 

17 this Act. 

18 SEC. 4003. AVAILABILITY OF BASIC ASSISTANCE TO LAW19 FULLY PRESENT NONCITIZENS. 

20 (a) ELIMINATION OF ARBITRARY ELIGIBILITY RE21 STRICTIONS.— 

22 (1) IN GENERAL.—Sections 402, 403, 411, 412, 

23 421, and 422 of the Personal Responsibility and 

24 Work Opportunity Reconciliation Act of 1996 (8 


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1 U.S.C. 1612, 1613, 1621, 1622, 1631, and 1632) 

2 are repealed. 

3 (2) CONFORMING AMENDMENTS.—Title IV of 

4 the Personal Responsibility and Work Opportunity 

5 Reconciliation Act of 1996 (8 U.S.C. 1601 et seq.) 

6 is amended— 

7 (A) in section 401(b)(5) of (8 U.S.C. 

8 1611(b)(5)), by striking ‘‘the program defined 

9 in section 402(a)(3)(A) (relating to the supple10 mental security income program)’’ and inserting 

11 ‘‘the Supplemental Security Income Program 

12 under title XVI of the Social Security Act (42 

13 U.S.C. 1381 et seq.)’’; 

14 (B) in section 404(a) (8 U.S.C. 1614(a)), 

15 by striking ‘‘, 402, or 403’’; 

16 (C) in section 413 (8 U.S.C. 1625)— 

17 (i) by striking ‘‘A State’’ and insert18 ing the following: 

19 ‘‘(a) STATE OR LOCAL PUBLIC BENEFIT DE20 FINED.—In this section, except as provided in paragraphs 

21 (2) and (3), the term ‘State or local public benefit’— 

22 ‘‘(1) means— 

23 ‘‘(A) any grant, contract, loan, professional 

24 license, or commercial license provided by an 

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1 propriated funds of a State or local govern2 ment; and 

3 ‘‘(B) any retirement, welfare, health, dis4 ability, public or assisted housing, postsec5 ondary education, food assistance, unemploy6 ment benefit, or any other similar benefit for 

7 which payments or assistance are provided to 

8 an individual, household, or family eligibility 

9 unit by an agency of a State or local govern10 ment or by appropriated funds of a State or 

11 local government; 

12 ‘‘(2) shall not apply— 

13 ‘‘(A) to any contract, professional license, 

14 or commercial license for a nonimmigrant 

15 whose visa for entry is related to such employ16 ment in the United States, or to a citizen of a 

17 freely associated state, if section 141 of the ap18 plicable compact of free association approved in 

19 Public Law 99–239 or 99–658 (or a successor 

20 provision) is in effect; 

21 ‘‘(B) with respect to benefits for an alien 

22 who as a work authorized nonimmigrant or as 

23 an alien lawfully admitted for permanent resi24 dence under the Immigration and Nationality 

25 Act qualified for such benefits and for whom 


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1 the United States under reciprocal treaty agree2 ments is required to pay benefits, as determined 

3 by the Secretary of State, after consultation 

4 with the Attorney General; or 

5 ‘‘(C) to the issuance of a professional li6 cense to, or the renewal of a professional license 

7 by, a foreign national not physically present in 

8 the United States; and 

9 ‘‘(3) does not include any Federal public ben10 efit. 

11 ‘‘(b) PROOF OF ELIGIBILITY REQUIREMENT.—A 

12 State’’; and 

13 (ii) in subsection (b), as so des14 ignated, by striking ‘‘(as defined in section 

15 411(c))’’; 

16 (D) in section 432(d) (8 U.S.C. 1642(d)), 

17 by striking ‘‘(as defined in section 411(c))’’ and 

18 inserting ‘‘(as defined in section 413(a))’’; 

19 (E) in section 435 (8 U.S.C. 1645), by 

20 striking ‘‘(as provided under section 403)’’; and 

21 (F) in section 436 (8 U.S.C. 1646)— 

22 (i) by striking ‘‘the food stamp pro23 gram (as defined in section 402(a)(3)(B))’’ 

24 and inserting ‘‘the supplemental nutrition 

25 assistance program established under the 


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1 Food and Nutrition Act of 2008 (7 U.S.C. 

2 2011 et seq.)’’; and 

3 (ii) by striking ‘‘the supplemental se4 curity income program (as defined in sec5 tion 402(a)(3)(A))’’ and inserting ‘‘the 

6 Supplemental Security Income Program 

7 under title XVI of the Social Security Act 

8 (42 U.S.C. 1381 et seq.)’’. 

9 (b) QUALIFIED NONCITIZENS.—Title IV of the Per10 sonal Responsibility and Work Opportunity Reconciliation 

11 Act of 1996 (8 U.S.C. 1601 et seq.) is amended— 

12 (1) in the title heading, by striking 

13 ‘‘ALIENS’’ and inserting ‘‘NONCITIZENS’’; 

14 (2) in section 401, in the section heading— 

15 (A) by striking ‘‘QUALIFIED ALIENS’’ 

16 and inserting ‘‘QUALIFIED NONCITIZENS’’; 

17 and 

18 (B) by striking ‘‘ALIENS’’ and inserting 

19 ‘‘NONCITIZENS’’; 

20 (3) by striking ‘‘qualified alien’’ each place it 

21 appears and inserting ‘‘qualified noncitizen’’; 

22 (4) by striking ‘‘qualified aliens’’ each place it 

23 appears and inserting ‘‘qualified noncitizens’’; 

24 (5) by striking ‘‘qualified alien’s’’ each place it 

25 appears and inserting ‘‘qualified noncitizen’s’’; 


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1 (6) by striking ‘‘an alien’’ each place that it ap2 pears and inserting ‘‘a noncitizen’’; 

3 (7) by striking ‘‘alien’’ each place it appears 

4 and inserting ‘‘noncitizen’’; 

5 (8) by striking ‘‘aliens’’ each place it appears 

6 and inserting ‘‘noncitizens’’; and 

7 (9) by striking ‘‘alien’s’’ each place it appears 

8 and inserting ‘‘noncitizen’s’’. 

9 (c) ACCESS TO BASIC SERVICES FOR LAWFULLY RE10 SIDING NONCITIZENS.—Section 431 of the Personal Re11 sponsibility and Work Opportunity Reconciliation Act of 

12 1996 (8 U.S.C. 1641) is amended— 

13 (1) in subsection (b)— 

14 (A) in the subsection heading, by striking 

15 ‘‘QUALIFIED ALIEN’’ and inserting ‘‘QUALIFIED

16 NONCITIZEN’’; and 

17 (B) in the matter preceding paragraph (1), 

18 by striking ‘‘benefit’’ and all that follows 

19 through the period at the end of the subsection 

20 and inserting ‘‘benefit, is lawfully present in the 

21 United States.’’; 

22 (2) in subsection (c)— 

23 (A) in the subsection heading, by striking 

24 ‘‘ALIENS AS QUALIFIED ALIENS’’ and inserting 

25 ‘‘NONCITIZENS AS QUALIFIED NONCITIZENS’’; 


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1 (B) in paragraph (3)(B), by striking ‘‘; or’’ 

2 and inserting a semicolon; 

3 (C) in paragraph (4), by striking the pe4 riod at the end and inserting ‘‘; or’’; and 

5 (D) by inserting after paragraph (4) the 

6 following: 

7 ‘‘(5) a noncitizen— 

8 ‘‘(A) in a category that was treated as law9 fully present for purposes of section 1101 of the 

10 Patient Protection and Affordable Care Act of 

11 2010 (42 U.S.C. 18001); 

12 ‘‘(B) who met the requirements of section 

13 402(a)(2)(D) of the Personal Responsibility and 

14 Work Opportunity Reconciliation Act of 1996 

15 (8 U.S.C. 1612(a)(2)(D)) on or before January 

16 1, 2023; 

17 ‘‘(C) who is granted special immigrant ju18 venile status as described by section 

19 101(a)(27)(J) of the Immigration and Nation20 ality Act (8 U.S.C. 1101(a)(27)(J)); 

21 ‘‘(D) who has a pending, bona fide applica22 tion for nonimmigrant status under section 

23 101(a)(15)(U) of the Immigration and Nation24 ality Act (8 U.S.C. 1101(a)(15)(U)); 


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1 ‘‘(E) who was granted relief under the De2 ferred Action for Childhood Arrivals program; 

3 or 

4 ‘‘(F) any other person who is not a citizen 

5 of the United States but who resides in a State 

6 or territory of the United States and is feder7 ally authorized to be present in the United 

8 States.’’; and 

9 (3) by adding at the end the following: 

10 ‘‘(d) NONCITIZEN.—In this title, the term ‘noncit11 izen’ means any individual who is not a citizen of the 

12 United States.’’. 

13 (d) CHILD NUTRITION PROGRAMS.—Section 742 of 

14 the Personal Responsibility and Work Opportunity Rec15 onciliation Act of 1996 (8 U.S.C. 1615) is amended— 

16 (1) in subsection (a)— 

17 (A) in the subsection heading, by striking 

18 ‘‘SCHOOL LUNCH AND BREAKFAST PROGRAMS’’ 

19 and inserting ‘‘CHILD NUTRITION PROGRAMS’’; 

20 (B) by striking ‘‘the school lunch pro21 gram’’ and inserting ‘‘any program’’; and 

22 (C) by striking ‘‘the school breakfast pro23 gram under section 4 of the’’ and inserting 

24 ‘‘any program under the’’; and 

25 (2) in subsection (b)(1)— 


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1 (A) by striking ‘‘Nothing in this Act shall 

2 prohibit or require a State to provide to an in3 dividual who is not a citizen or a qualified alien, 

4 as defined in section 431(b),’’ and inserting ‘‘A 

5 State shall not deny’’; and 

6 (B) by striking ‘‘paragraph (2)’’ and in7 serting ‘‘paragraph (2) on the basis of an indi8 vidual’s citizenship or citizenship, alienage, or 

9 immigration status’’. 

10 (e) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI11 TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 

12 Section 1108(h) of the Social Security Act (42 U.S.C. 

13 1308(h)) is amended— 

14 (1) by striking ‘‘Expenditures’’ and inserting: 

15 ‘‘(1) IN GENERAL.—Expenditures’’; and 

16 (2) by adding at the end the following: 

17 ‘‘(2) MEDICAID PROGRAMS.—With respect to 

18 eligibility for benefits for a State plan approved 

19 under title XIX, other than medical assistance de20 scribed in section 401(b)(1)(A), paragraph (1) shall 

21 not apply to any individual who lawfully resides in 

22 1 of the 50 States or the District of Columbia in ac23 cordance with the Compacts of Free Association be24 tween the Government of the United States and the 

25 Governments of the Federated States of Micronesia, 


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1 the Republic of the Marshall Islands, and the Re2 public of Palau and shall not apply, at the option of 

3 the Governor of Puerto Rico, the Virgin Islands, 

4 Guam, the Northern Mariana Islands, or American 

5 Samoa as communicated to the Secretary of Health 

6 and Human Services in writing, to any individual 

7 who lawfully resides in the respective territory in ac8 cordance with such Compacts.’’. 

9 (f) CHILD HEALTH INSURANCE PROGRAM.—Section 

10 2107(e)(1) of the Social Security Act (42 U.S.C. 

11 1397gg(e)(1)) is amended by striking subparagraph (O). 

12 (g) CONFORMING AMENDMENTS.— 

13 (1) SUPPLEMENTAL FOOD ASSISTANCE PRO14 GRAM.—The Food and Nutrition Act of 2008 (7 

15 U.S.C. 2011 et seq.) is amended— 

16 (A) in section 5 (7 U.S.C. 2014)— 

17 (i) in subsection (d)— 

18 (I) in paragraph (1), by striking 

19 ‘‘law)’’ and all that follows through 

20 the semicolon at the end and inserting 

21 ‘‘law);’’; and 

22 (II) in paragraph (10), by strik23 ing ‘‘subsection (k)’’ and inserting 

24 ‘‘subsection (j)’’; 

25 (ii) by striking subsection (i); 


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1 (iii) in subsection (j), by striking 

2 ‘‘subsections (a) through (i)’’ and inserting 

3 ‘‘subsections (a) through (h)’’; and 

4 (iv) by redesignating subsections (j) 

5 through (n) as subsection (i) through (m), 

6 respectively; 

7 (B) in section 6 (7 U.S.C. 2015)— 

8 (i) in subsection (f)(2)(B), by striking 

9 ‘‘an alien lawfully admitted for permanent’’ 

10 and all that follows through the end of the 

11 subsection and inserting ‘‘a noncitizen law12 fully present in the United States.’’; and 

13 (ii) in subsection (s)(2), by striking 

14 ‘‘(i), (k), (l), (m), and (n)’’ and inserting 

15 ‘‘(j), (k), (l), and (m)’’; and 

16 (C) in section 11(e)(2)(B)(v)(II) (7 U.S.C. 

17 2020(e)(2)(B)(v)(II)), by striking ‘‘aliens’’ and 

18 inserting ‘‘noncitizens’’. 

19 (2) MEDICAID.—Section 1903(v) of the Social 

20 Security Act (42 U.S.C. 1396b(v)) is amended— 

21 (A) in paragraph (1)— 

22 (i) by striking ‘‘paragraphs (2) and 

23 (4)’’ and inserting ‘‘paragraph (2)’’; and 

24 (ii) by striking ‘‘admitted for’’ and all 

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1 graph and inserting ‘‘present in the United 

2 States.’’; and 

3 (B) by striking paragraph (4). 

4 (3) HOUSING ASSISTANCE.—Section 214(a) of 

5 the Housing and Community Development Act of 

6 1980 (42 U.S.C. 1436a(a)) is amended— 

7 (A) in paragraph (6), by striking ‘‘; or’’ 

8 and inserting a semicolon; 

9 (B) in paragraph (7), by striking the pe10 riod at the end and inserting ‘‘; or’’; and 

11 (C) by adding at the end the following: 

12 ‘‘(8) a qualified noncitizen (as defined in sec13 tion 431 of the Personal Responsibility and Work 

14 Opportunity Reconciliation Act of 1996 (8 U.S.C. 

15 1641));’’. 

16 (4) ASSISTANCE NOT TREATED AS DEBT AB17 SENT FRAUD.—Section 213A of the Immigration 

18 and Nationality Act (8 U.S.C. 1183a) is amended— 

19 (A) in subsection (a)(3)— 

20 (i) in subparagraph (A), by striking 

21 ‘‘(as provided under section 403 of the 

22 Personal Responsibility and Work Oppor23 tunity Reconciliation Act of 1996)’’; and 

24 (ii) in subparagraph (B), in the un25 designated matter following clause (ii), by 


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1 striking ‘‘(as provided under section 403 of 

2 the Personal Responsibility and Work Op3 portunity Reconciliation Act of 1996)’’; 

4 and 

5 (B) in subsection (b)(1)(A), by striking 

6 ‘‘benefit,’’ and inserting ‘‘benefit by fraud,’’; 

7 and 

8 (C) in subsection (d)(2)(B), by striking ‘‘, 

9 403(c)(2), or 411(b)’’. 

10 (5) REPORT.—Section 565 of the Illegal Immi11 gration Reform and Immigrant Responsibility Act of 

12 1996 (8 U.S.C. 1371) is amended— 

13 (A) by striking paragraph (2); and 

14 (B) by redesignating paragraph (3) as 

15 paragraph (2). 

16 (h) PRESERVING ACCESS TO HEALTH CARE.—Sec17 tion 36B(c)(1)(B) of the Internal Revenue Code of 1986 

18 is amended to read as follows: 

19 ‘‘(B) SPECIAL RULE FOR CERTAIN INDI20 VIDUALS LAWFULLY PRESENT IN THE UNITED

21 STATES.—If— 

22 ‘‘(i) a taxpayer has a household in23 come which is not greater than 100 per24 cent of an amount equal to the poverty line 

25 for a family of the size involved, 


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1 ‘‘(ii) the taxpayer is a non-citizen law2 fully present in the United States, 

3 ‘‘(iii) the taxpayer is ineligible for 

4 minimum essential coverage under section 

5 5000A(f)(1)(A)(ii), and 

6 ‘‘(iv) under the Medicaid eligibility 

7 criteria for non-citizens in effect on De8 cember 26, 2020, the taxpayer would be 

9 ineligible for such minimum essential cov10 erage by reason of the taxpayer’s immigra11 tion status, 

12 the taxpayer shall, for purposes of the credit 

13 under this section, be treated as an applicable 

14 taxpayer with a household income which is 

15 equal to 100 percent of the poverty line for a 

16 family of the size involved.’’. 

17 (i) FEDERAL AGENCY GUIDANCE.—Not later than 

18 180 days after the date of the enactment of this Act, each 

19 Federal agency, as applicable, shall issue guidance with 

20 respect to implementing the amendments made by this 

21 section. 

22 (j) EFFECTIVE DATE.—The amendments made by 

23 this section shall take effect on the date of enactment of 

24 this Act. 


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1 SEC. 4004. IMPROVE AFFORDABILITY AND REDUCE PRE2 MIUM COSTS OF HEALTH INSURANCE FOR 

3 CONSUMERS. 

4 (a) IN GENERAL.—Section 36B(b)(3)(A) of the In5 ternal Revenue Code of 1986 is amended to read as fol6 lows: 

7 ‘‘(A) APPLICABLE PERCENTAGE.—The ap8 plicable percentage for any taxable year shall be 

9 the percentage such that the applicable percent10 age for any taxpayer whose household income is 

11 within an income tier specified in the following 

12 table shall increase, on a sliding scale in a lin13 ear manner, from the initial premium percent14 age to the final premium percentage specified in 

15 such table for such income tier: 

‘‘In the case of household income (expressed as a 

percent of poverty line) within the following income tier: 

The initial 

premium 

percentage 

is— 

The final 

premium 

percentage 

is— 

Up to 150 percent .................................................. 0.0 0.0

150 percent up to 200 percent ............................... 0.0 3.0

200 percent up to 250 percent ............................... 3.0 4.0

250 percent up to 300 percent ............................... 4.0 6.0

300 percent up to 400 percent ............................... 6.0 8.5

400 percent and higher .......................................... 8.5 8.5.’’. 

16 (b) CONFORMING AMENDMENT.—Section 

17 36B(c)(1)(A) of the Internal Revenue Code of 1986 is 

18 amended by striking ‘‘but does not exceed 400 percent’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to taxable years beginning after 

3 December 31, 2021. 

4 SEC. 4005. REMOVING CITIZENSHIP AND IMMIGRATION 

5 BARRIERS TO ACCESS TO AFFORDABLE 

6 HEALTH CARE UNDER THE ACA. 

7 (a) IN GENERAL.— 

8 (1) PREMIUM TAX CREDITS.—Section 36B of 

9 the Internal Revenue Code of 1986 is amended— 

10 (A) in subsection (c)(1)(B), as amended by 

11 section 4003(h)— 

12 (i) by amending the heading to read 

13 as follows: ‘‘SPECIAL RULE FOR CERTAIN

14 INDIVIDUALS INELIGIBLE FOR MEDICAID

15 DUE TO STATUS’’; and 

16 (ii) by amending clause (ii) to read as 

17 follows: 

18 ‘‘(ii) the taxpayer is a noncitizen who 

19 is not eligible for the Medicaid program 

20 under title XIX of the Social Security Act 

21 by reason of the individual’s immigration 

22 status,’’; and 

23 (B) by striking subsection (e). 


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1 (2) COST-SHARING REDUCTIONS.—Section 1402 

2 of the Patient Protection and Affordable Care Act 

3 (42 U.S.C. 18071) is amended— 

4 (A) by striking subsection (e); and 

5 (B) by redesignating subsections (f) and 

6 (g) as subsections (e) and (f), respectively. 

7 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

8 Section 1331(e)(1)(B) of the Patient Protection and 

9 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

10 amended by striking ‘‘lawfully present in the United 

11 States,’’. 

12 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

13 Section 1412 of the Patient Protection and Afford14 able Care Act (42 U.S.C. 18082) is amended— 

15 (A) by striking subsection (d); and 

16 (B) by redesignating subsection (e) as sub17 section (d). 

18 (5) REQUIREMENT TO MAINTAIN MINIMUM ES19 SENTIAL COVERAGE.—Section 5000A(d) of the In20 ternal Revenue Code of 1986 is amended— 

21 (A) by striking paragraph (3); and 

22 (B) by redesignating paragraph (4) as 

23 paragraph (3). 

24 (b) CONFORMING AMENDMENTS.— 


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1 (1) ESTABLISHMENT OF PROGRAM.—Section 

2 1411(a) of the Patient Protection and Affordable 

3 Care Act (42 U.S.C. 18081(a)) is amended— 

4 (A) by striking paragraph (1); and 

5 (B) by redesignating paragraphs (2), (3), 

6 and (4) as paragraphs (1), (2), and (3), respec7 tively. 

8 (2) QUALIFIED INDIVIDUALS.—Section 1312(f) 

9 of the Patient Protection and Affordable Care Act 

10 (42 U.S.C. 18032(f)) is amended— 

11 (A) in the heading, by striking ‘‘; ACCESS

12 LIMITED TO CITIZENS AND LAWFUL RESI13 DENTS’’; and 

14 (B) by striking paragraph (3). 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply to years, plan years, and taxable 

17 years, as applicable, beginning after December 31, 2022. 

18 SEC. 4006. REMOVING BARRIERS TO ACCESS TO AFFORD19 ABLE HEALTH CARE FOR LAWFULLY RESID20 ING IMMIGRANTS UNDER MEDICAID AND 

21 CHIP. 

22 (a) MEDICAID.—Section 1903(v) of the Social Secu23 rity Act (42 U.S.C. 1396b(v)(4)), as amended by section 

24 4003(g)(2), is amended by adding at the end the following: 


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1 ‘‘(4) COVERAGE OF LAWFULLY RESIDING IMMI2 GRANTS.— 

3 ‘‘(A) IN GENERAL.—Notwithstanding title 

4 IV of the Personal Responsibility and Work Op5 portunity Reconciliation Act of 1996, a State 

6 shall provide medical assistance under this title 

7 to individuals who are lawfully residing in the 

8 United States (including individuals described 

9 in paragraph (1), battered individuals described 

10 in section 431(c) of such Act, and individuals 

11 with an approved or pending application for de12 ferred action or other federally authorized pres13 ence), if they otherwise meet the eligibility re14 quirements for medical assistance under the 

15 State plan approved under this title (other than 

16 the requirement of the receipt of aid or assist17 ance under title IV, supplemental security in18 come benefits under title XVI, or a State sup19 plementary payment). 

20 ‘‘(B) TREATMENT OF MEDICAL ASSIST21 ANCE PROVIDED TO LAWFULLY RESIDING IMMI22 GRANTS.—No debt shall accrue under an affi23 davit of support against any sponsor of an indi24 vidual provided medical assistance under sub25 paragraph (A) on the basis of provision of asVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 sistance to such individual and the cost of such 

2 assistance shall not be considered as an unreim3 bursed cost. 

4 ‘‘(C) VERIFICATION REQUIREMENT.—As 

5 part of the State’s ongoing eligibility redeter6 mination requirements and procedures for an 

7 individual provided medical assistance as a re8 sult of the application of subparagraph (A), a 

9 State shall verify that the individual continues 

10 to lawfully reside or be lawfully present in the 

11 United States using the documentation pre12 sented to the State by the individual on initial 

13 enrollment. If the State cannot successfully 

14 verify that the individual is lawfully residing or 

15 present in the United States in this manner, it 

16 shall require that the individual provide the 

17 State with further documentation or other evi18 dence to verify that the individual is lawfully re19 siding or present in the United States.’’. 

20 (b) CHIP.—Section 2107(e)(1) of the Social Security 

21 Act (42 U.S.C. 1397gg(e)(1)), as amended by section 

22 4003(f), is amended by inserting after subparagraph (N) 

23 the following new subparagraph: 

24 ‘‘(O) Paragraph (4) of section 1903(v) (re25 lating to lawfully residing individuals).’’. 


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1 (c) EFFECTIVE DATE.— 

2 (1) IN GENERAL.—Except as provided in para3 graph (2), the amendments made by this section 

4 shall take effect on the date of enactment of this Act 

5 and shall apply to services furnished on or after the 

6 date that is 90 days after such date of enactment. 

7 (2) EXCEPTION IF STATE LEGISLATION RE8 QUIRED.—In the case of a State plan for medical as9 sistance under title XIX, or a State child health plan 

10 under title XXI, of the Social Security Act which the 

11 Secretary of Health and Human Services determines 

12 requires State legislation (other than legislation ap13 propriating funds) in order for the plan to meet the 

14 additional requirements imposed by the amendments 

15 made by this section, the respective State plan shall 

16 not be regarded as failing to comply with the re17 quirements of such title solely on the basis of its 

18 failure to meet these additional requirements before 

19 the first day of the first calendar quarter beginning 

20 after the close of the first regular session of the 

21 State legislature that begins after the date of enact22 ment of this Act. For purposes of the previous sen23 tence, in the case of a State that has a 2-year legis24 lative session, each year of such session shall be 


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1 deemed to be a separate regular session of the State 

2 legislature. 

3 (d) PRESERVING COVERAGE.— 

4 (1) IN GENERAL.—Nothing in this section, in5 cluding the amendments made by this section, shall 

6 prevent lawfully present noncitizens who are ineli7 gible for full benefits under the Medicaid program 

8 under title XIX of the Social Security Act from se9 curing a credit for which such lawfully present non10 citizens would be eligible under section 36B(c)(1)(B) 

11 of the Internal Revenue Code of 1986 and under the 

12 Medicaid provisions for lawfully present noncitizens, 

13 as in effect on the date prior to the date of enact14 ment of this Act. 

15 (2) DEFINITION.—For purposes of paragraph 

16 (1), the term ‘‘full benefits’’ means, with respect to 

17 an individual and State, medical assistance for all 

18 services covered under the State plan under title 

19 XIX of the Social Security Act that is not less in 

20 amount, duration, or scope, or is determined by the 

21 Secretary of Health and Human Services to be sub22 stantially equivalent to the medical assistance avail23 able for an individual described in section 

24 1902(a)(10)(A)(i) of the Social Security Act (42 

25 U.S.C. 1396a(a)(10)(A)(i)). 


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1 SEC. 4007. CONSISTENCY IN HEALTH INSURANCE COV2 ERAGE FOR INDIVIDUALS WITH FEDERALLY 

3 AUTHORIZED PRESENCE, INCLUDING DE4 FERRED ACTION. 

5 (a) IN GENERAL.—For purposes of eligibility under 

6 any of the provisions described in subsection (b), all indi7 viduals granted lawful presence in the United States shall 

8 be considered to be lawfully present in the United States. 

9 (b) PROVISIONS DESCRIBED.—The provisions de10 scribed in this subsection are the following: 

11 (1) EXCHANGE ELIGIBILITY.—Section 1311 of 

12 the Patient Protection and Affordable Care Act (42 

13 U.S.C. 18031). 

14 (2) REDUCED COST-SHARING ELIGIBILITY.— 

15 Section 1402 of the Patient Protection and Afford16 able Care Act (42 U.S.C. 18071). 

17 (3) PREMIUM SUBSIDY ELIGIBILITY.—Section 

18 36B of the Internal Revenue Code of 1986. 

19 (4) MEDICAID AND CHIP ELIGIBILITY.—Titles 

20 XIX and XXI of the Social Security Act (42 U.S.C. 

21 1396 et seq.; 1397aa et seq.), including under sec22 tion 1903(v) of such Act (42 U.S.C. 1396b(v)). 

23 (c) EFFECTIVE DATE.— 

24 (1) IN GENERAL.—Subsection (a) shall take ef25 fect on the date of enactment of this Act. 


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1 (2) TRANSITION THROUGH SPECIAL ENROLL2 MENT PERIOD.—In the case of an individual de3 scribed in subsection (a) who, before the first day of 

4 the first annual open enrollment period under sub5 paragraph (B) of section 1311(c)(6) of the Patient 

6 Protection and Affordable Care Act (42 U.S.C. 

7 18031(c)(6)) beginning after the date of enactment 

8 of this Act, is granted lawful presence in the United 

9 States and who, as a result of such subsection, 

10 qualifies for a subsidy under a provision described in 

11 paragraph (2) or (3) of subsection (b), the Secretary 

12 of Health and Human Services shall establish a spe13 cial enrollment period under subparagraph (C) of 

14 such section 1311(c)(6) during which such individual 

15 may enroll in qualified health plans through Ex16 changes under title I of the Patient Protection and 

17 Affordable Care Act (42 U.S.C. 18001 note et seq.) 

18 and qualify for such a subsidy. For such an indi19 vidual who has been granted federally authorized 

20 presence in the United States as of the date of en21 actment of this Act, such special enrollment period 

22 shall begin not later than 90 days after such date 

23 of enactment. Nothing in this paragraph shall be 

24 construed as affecting the authority of the Secretary 


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1 to establish additional special enrollment periods 

2 under such subparagraph (C). 

3 SEC. 4008. STUDY ON THE UNINSURED. 

4 (a) IN GENERAL.—The Secretary of Health and 

5 Human Services (in this section referred to as the ‘‘Sec6 retary’’) shall— 

7 (1) conduct a study, in accordance with the 

8 standards under section 3101 of the Public Health 

9 Service Act (42 U.S.C. 300kk), on the demographic 

10 characteristics of the population of individuals who 

11 do not have health insurance coverage or oral health 

12 coverage; and 

13 (2) predict, based on such study, the demo14 graphic characteristics of the population of individ15 uals who would remain without health insurance cov16 erage after the end of any annual open enrollment 

17 or any special enrollment period or upon enactment 

18 and implementation of any legislative changes to the 

19 Patient Protection and Affordable Care Act (Public 

20 Law 111–148) that affect the number of persons eli21 gible for coverage. 

22 (b) REPORTING REQUIREMENTS.— 

23 (1) IN GENERAL.—Not later than 12 months 

24 after the date of the enactment of this Act, the Sec25 retary shall submit to the Congress the results of 


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1 the study under subsection (a)(1) and the prediction 

2 made under subsection (a)(2). 

3 (2) REPORTING OF DEMOGRAPHIC CHARACTER4 ISTICS.—The Secretary shall— 

5 (A) report the demographic characteristics 

6 under paragraphs (1) and (2) of subsection (a) 

7 on the basis of racial and ethnic group (as de8 fined in section 1707(g)(1) of the Public Health 

9 Service Act), and stratify the reporting on each 

10 racial and ethnic group by other demographic 

11 characteristics that can impact access to health 

12 insurance coverage, such as sexual orientation, 

13 gender identity, primary language, disability 

14 status, sex, socioeconomic status, age group, 

15 citizenship, and immigration status, in a man16 ner consistent with title I of this Act, including 

17 the amendments made by such title; and 

18 (B) not use such report, or any informa19 tion gathered in preparing such report— 

20 (i) to engage in or anticipate any de21 portation or immigration related enforce22 ment action by any entity, including the 

23 Department of Homeland Security; or 


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1 (ii) for the exploitation of, or discrimi2 nation against, communities of color or the 

3 LGBTQ+ population. 

4 SEC. 4009. MEDICAID FALLBACK COVERAGE PROGRAM FOR 

5 LOW-INCOME ADULTS IN NON-EXPANSION 

6 STATES. 

7 (a) IN GENERAL.—As soon as possible after the date 

8 of enactment of this Act the Secretary of Health and 

9 Human Services (in this section referred to as the ‘‘Sec10 retary’’) shall— 

11 (1) directly or by contract, establish a program 

12 that offers eligible individuals the opportunity to en13 roll in health benefits coverage that meets the re14 quirements described in subsection (c) and any re15 quirements applicable to such coverage pursuant to 

16 subsection (d); and 

17 (2) ensure that such program is administered 

18 consistent with the requirements of section 

19 431.10(c)(2) of title 42, Code of Federal Regula20 tions. 

21 (b) DEFINITION OF ELIGIBLE INDIVIDUAL.—In this 

22 section, the term ‘‘eligible individual’’ means an individual 

23 who— 


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1 (1) is described in section 

2 1902(a)(10)(A)(i)(VIII) of the Social Security Act 

3 (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)); 

4 (2) resides in a State that— 

5 (A) does not expend amounts for medical 

6 assistance under title XIX of the Social Secu7 rity Act (42 U.S.C. 1396 et seq.) for all individ8 uals described in such section; and 

9 (B) did not expend amounts for medical 

10 assistance under such title for all such individ11 uals as of the date of enactment of this Act; 

12 and 

13 (3) would not be eligible for medical assistance 

14 under such State’s plan for medical assistance under 

15 title XIX of the Social Security Act (42 U.S.C. 1396 

16 et seq.), or a waiver of such plan, as such plan or 

17 waiver was in effect on such date. 

18 (c) HEALTH BENEFITS COVERAGE REQUIRE19 MENTS.—The requirements described in this subsection 

20 with respect to health benefits coverage are the following: 

21 (1) ESSENTIAL HEALTH BENEFITS.—At a min22 imum, the coverage meets the minimum standards 

23 required under paragraph (5) of section 1937(b) of 

24 the Social Security Act (42 U.S.C. 1396u–7(b)) for 

25 benchmark coverage described in paragraph (1) of 


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1 such section or benchmark equivalent coverage de2 scribed in paragraph (2) of such section. 

3 (2) PREMIUMS AND COST-SHARING.—No pre4 miums are imposed for the coverage, and deduct5 ibles, cost-sharing, or similar charges may only be 

6 imposed in accordance with the requirements im7 posed on State Medicaid plans under section 1916 of 

8 the Social Security Act (42 U.S.C. 1396o). 

9 (d) APPLICATION OF REQUIREMENTS AND PROVI10 SIONS OF TITLE XIX OF THE SOCIAL SECURITY ACT.— 

11 The Secretary shall specify that— 

12 (1) any requirement applicable to the furnishing 

13 of medical assistance under title XIX of the Social 

14 Security Act (42 U.S.C. 1396 et seq.) by States that 

15 have elected to make medical assistance available to 

16 individuals described in section 

17 1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 

18 1396a(a)(10)(A)(i)(VIII)) that does not conflict with 

19 the requirements specified in subsection (c) applies 

20 to the program established under this section; and 

21 (2) other provisions of such title apply to such 

22 program. 

23 (e) NO STATE MANDATE.—Nothing in this section 

24 shall be construed as requiring a State to make expendiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tures related to the program established under this section 

2 and the Secretary shall not impose any such requirement. 

3 (f) FUNDING.—There are appropriated to the Sec4 retary for each fiscal year beginning with fiscal year 2022 

5 from any funds in the Treasury not otherwise appro6 priated, such sums as are necessary to carry out this sec7 tion. 

8 SEC. 4010. INCREASE AND EXTENSION OF TEMPORARY EN9 HANCED FMAP FOR STATES WHICH BEGIN TO 

10 EXPEND AMOUNTS FOR CERTAIN MANDA11 TORY INDIVIDUALS. 

12 (a) IN GENERAL.—Section 1905(ii)(1) of the Social 

13 Security Act (42 U.S.C. 1396d(ii)(1)) is amended— 

14 (1) by striking ‘‘8-quarter period’’ and inserting 

15 ‘‘40-quarter period’’; and 

16 (2) by striking ‘‘5 percentage points’’ and in17 serting ‘‘10 percentage points’’. 

18 (b) EFFECTIVE DATE.—The amendments made by 

19 this section shall take effect as if included in the enact20 ment of section 9814 of the American Rescue Plan Act 

21 of 2021 (Public Law 117–2). 


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1 Subtitle B—Improvement of 

2 Coverage 

3 SEC. 4101. MEDICAID IN THE TERRITORIES. 

4 (a) ELIMINATION OF GENERAL MEDICAID FUNDING

5 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 

6 (1) IN GENERAL.—Section 1108 of the Social 

7 Security Act (42 U.S.C. 1308) is amended— 

8 (A) in subsection (f), in the matter pre9 ceding paragraph (1), by striking ‘‘subsections 

10 (g) and (h)’’ and inserting ‘‘subsections (g), 

11 (h), and (i)’’; 

12 (B) in subsection (g)(2), in the matter pre13 ceding subparagraph (A), by inserting ‘‘sub14 section (i) and’’ after ‘‘subject to’’; and 

15 (C) by adding at the end the following new 

16 subsection: 

17 ‘‘(i) SUNSET OF MEDICAID FUNDING LIMITATIONS

18 FOR PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE

19 NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 

20 Subsections (f) and (g) shall not apply to Puerto Rico, 

21 the Virgin Islands, Guam, the Northern Mariana Islands, 

22 and American Samoa beginning with fiscal year 2024.’’. 

23 (2) CONFORMING AMENDMENTS.— 


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1 (A) Section 1902(j) of the Social Security 

2 Act (42 U.S.C. 1396a(j)) is amended by strik3 ing ‘‘, the limitation in section 1108(f),,’’. 

4 (B) Section 1903(u) of the Social Security 

5 Act (42 U.S.C. 1396b(u)) is amended by strik6 ing paragraph (4). 

7 (3) EFFECTIVE DATE.—The amendments made 

8 by this section shall apply beginning with fiscal year 

9 2024. 

10 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL

11 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR

12 TERRITORIES.—Section 1905(b) of the Social Security 

13 Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 

14 inserting ‘‘for fiscal years before fiscal year 2024’’ after 

15 ‘‘American Samoa’’. 

16 (c) PERMITTING MEDICAID DSH ALLOTMENTS FOR

17 TERRITORIES.—Section 1923(f) of the Social Security Act 

18 (42 U.S.C. 1396r–4(f)) is amended— 

19 (1) in paragraph (6), by adding at the end the 

20 following new subparagraph: 

21 ‘‘(C) TERRITORIES.— 

22 ‘‘(i) FISCAL YEAR 2023.—For fiscal 

23 year 2023, the DSH allotment for Puerto 

24 Rico, the Virgin Islands, Guam, the North25 ern Mariana Islands, and American Samoa 


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1 shall bear the same ratio to $300,000,000 

2 as the ratio of the number of individuals 

3 who are low-income or uninsured and re4 siding in such respective territory (as esti5 mated from time to time by the Secretary) 

6 bears to the sums of the number of such 

7 individuals residing in all of the territories. 

8 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 

9 For each subsequent fiscal year, the DSH 

10 allotment for each such territory is subject 

11 to an increase in accordance with para12 graph (3).’’; and 

13 (2) in paragraph (9), by inserting before the pe14 riod at the end the following: ‘‘, and includes, begin15 ning with fiscal year 2023, Puerto Rico, the Virgin 

16 Islands, Guam, the Northern Mariana Islands, and 

17 American Samoa’’. 

18 SEC. 4102. EXTENSION OF THE SUPPLEMENTAL SECURITY 

19 INCOME PROGRAM TO PUERTO RICO, THE 

20 UNITED STATES VIRGIN ISLANDS, GUAM, AND 

21 AMERICAN SAMOA. 

22 (a) IN GENERAL.—Section 303 of the Social Security 

23 Amendments of 1972 (86 Stat. 1484) is amended by strik24 ing subsection (b). 

25 (b) CONFORMING AMENDMENTS.— 


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1 (1) DEFINITION OF STATE.—Section 

2 1101(a)(1) of the Social Security Act (42 U.S.C. 

3 1301(a)(1)) is amended by striking the 5th sentence 

4 and inserting the following: ‘‘Such term when used 

5 in title XVI includes Puerto Rico, the United States 

6 Virgin Islands, Guam, and American Samoa.’’. 

7 (2) ELIMINATION OF LIMIT ON TOTAL PAY8 MENTS TO THE TERRITORIES.—Section 1108 of 

9 such Act (42 U.S.C. 1308) is amended— 

10 (A) in the section heading, by striking ‘‘; 

11 LIMITATION ON TOTAL PAYMENTS’’; 

12 (B) by striking subsection (a); and 

13 (C) in subsection (c), by striking para14 graphs (2) and (4) and redesignating para15 graphs (3) and (5) as paragraphs (2) and (4), 

16 respectively. 

17 (3) UNITED STATES NATIONALS TREATED THE

18 SAME AS CITIZENS.—Section 1614(a)(1)(B) of such 

19 Act (42 U.S.C. 1382c(a)(1)(B)) is amended— 

20 (A) in clause (i)(I), by inserting ‘‘or na21 tional,’’ after ‘‘citizen’’; 

22 (B) in clause (i)(II), by adding ‘‘; or’’ at 

23 the end; and 

24 (C) in clause (ii), by inserting ‘‘or na25 tional’’ after ‘‘citizen’’. 


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1 (4) TERRITORIES INCLUDED IN GEOGRAPHIC

2 MEANING OF UNITED STATES.—Section 1614(e) of 

3 such Act (42 U.S.C. 1382c(e)) is amended by strik4 ing ‘‘and the District of Columbia’’ and inserting ‘‘, 

5 the District of Columbia, Puerto Rico, the United 

6 States Virgin Islands, Guam, and American 

7 Samoa’’. 

8 (c) WAIVER AUTHORITY.—The Commissioner of So9 cial Security may waive or modify any statutory require10 ment relating to the provision of benefits under the Sup11 plemental Security Income Program under title XVI of the 

12 Social Security Act in Puerto Rico, the United States Vir13 gin Islands, Guam, or American Samoa, to the extent that 

14 the Commissioner deems it necessary in order to adapt 

15 the program to the needs of the territory involved. 

16 (d) EFFECTIVE DATE.—This section and the amend17 ments made by this section shall take effect on the 1st 

18 day of the 1st Federal fiscal year that begins 1 year or 

19 more after the date of the enactment of this Act. 

20 SEC. 4103. EXTENSION OF MEDICARE SECONDARY PAYER. 

21 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So22 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend23 ed— 


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1 (1) in the last sentence, by inserting ‘‘, and be2 fore January 1, 2023’’ after ‘‘prior to such date)’’; 

3 and 

4 (2) by adding at the end the following new sen5 tence: ‘‘Effective for items and services furnished on 

6 or after January 1, 2023 (with respect to periods 

7 beginning on or after the date that is 42 months 

8 prior to such date), clauses (i) and (ii) shall be ap9 plied by substituting ‘42-month’ for ‘12-month’ each 

10 place it appears.’’. 

11 (b) EFFECTIVE DATE.—The amendments made by 

12 this section shall take effect on the date of enactment of 

13 this Act. For purposes of determining an individual’s sta14 tus under section 1862(b)(1)(C) of the Social Security Act 

15 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 

16 (a), an individual who is within the coordinating period 

17 as of the date of enactment of this Act shall have that 

18 period extended to the full 42 months described in the last 

19 sentence of such section, as added by the amendment 

20 made by subsection (a)(2). 

21 SEC. 4104. INDIAN DEFINED IN TITLE I OF THE PATIENT 

22 PROTECTION AND AFFORDABLE CARE ACT. 

23 (a) DEFINITION OF INDIAN.—Section 1304 of the 

24 Patient Protection and Affordable Care Act (42 U.S.C. 

25 18024) is amended by adding at the end the following: 


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1 ‘‘(f) INDIAN.—In this title: 

2 ‘‘(1) IN GENERAL.—The term ‘Indian’ means— 

3 ‘‘(A) an Indian, a California Indian, or an 

4 Urban Indian (as those terms are defined in 

5 section 4 of the Indian Health Care Improve6 ment Act (25 U.S.C. 1603)); or 

7 ‘‘(B) an individual who is of Indian de8 scent and a member of an Indian community 

9 served by a local facility or program of the In10 dian Health Service. 

11 ‘‘(2) INCLUSIONS.—The term ‘Indian’ includes 

12 the following individuals: 

13 ‘‘(A) A member of a federally recognized 

14 Indian Tribe. 

15 ‘‘(B) A resident of an urban center who 

16 meets 1 or more of the following criteria: 

17 ‘‘(i) A member of a Tribe, band, or 

18 other organized group of Indians, including 

19 those Tribes, bands, or groups terminated 

20 since 1940 and those recognized as of the 

21 date of enactment of the Health Equity 

22 and Accountability Act of 2022 or later by 

23 the State in which they reside, or being a 

24 descendant, in the first or second degree, 

25 of any such member. 


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1 ‘‘(ii) An Eskimo or Aleut or other 

2 Alaska Native. 

3 ‘‘(iii) An individual who is determined 

4 to be an Indian under regulations promul5 gated by the Secretary. 

6 ‘‘(C) An individual who is considered by 

7 the Secretary of the Interior to be an Indian for 

8 any purpose. 

9 ‘‘(D) An individual who is considered by 

10 the Secretary to be an Indian for purposes of 

11 eligibility for services provided by the Indian 

12 Health Service, including as a California In13 dian, Eskimo, Aleut, or other Alaska Native.’’. 

14 (b) CONFORMING AMENDMENTS.— 

15 (1) AFFORDABLE CHOICES OF HEALTH BEN16 EFIT PLANS.—Section 1311(c)(6)(D) of the Patient 

17 Protection and Affordable Care Act (42 U.S.C. 

18 18031(c)(6)(D)) is amended by striking ‘‘(as defined 

19 in section 4 of the Indian Health Care Improvement 

20 Act)’’. 

21 (2) REDUCED COST-SHARING FOR INDIVIDUALS

22 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 

23 1402(d) of the Patient Protection and Affordable 

24 Care Act (42 U.S.C. 18071(d)) is amended— 


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1 (A) in paragraph (1), in the matter pre2 ceding subparagraph (A), by striking ‘‘(as de3 fined in section 4(d) of the Indian Self-Deter4 mination and Education Assistance Act (25 

5 U.S.C. 450b(d)))’’; and 

6 (B) in paragraph (2), in the matter pre7 ceding subparagraph (A), by striking ‘‘(as so 

8 defined)’’. 

9 (3) EXEMPTION FROM PENALTY FOR NOT

10 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 

11 Section 5000A(e) of the Internal Revenue Code of 

12 1986 is amended by striking paragraph (3) and in13 serting the following: 

14 ‘‘(3) INDIANS.—Any applicable individual who 

15 is an Indian (as defined in section 1304(f) of the 

16 Patient Protection and Affordable Care Act).’’. 

17 (c) EFFECTIVE DATE OF IRC AMENDMENT.—The 

18 amendment made by subsection (b)(3) shall apply to tax19 able years beginning after the date of the enactment of 

20 this Act. 

21 SEC. 4105. REMOVING MEDICARE BARRIER TO HEALTH 

22 CARE. 

23 (a) PART A.—Section 1818(a)(3)(B) of the Social 

24 Security Act (42 U.S.C. 1395i–2(a)(3)(B)) is amended by 

25 striking ‘‘an alien’’ and all that follows through ‘‘under 


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1 this section’’ and inserting ‘‘an individual who is lawfully 

2 present in the United States’’. 

3 (b) PART B.—Section 1836(a)(2)(B) of the Social 

4 Security Act (42 U.S.C. 1395o(a)(2)(B)) is amended by 

5 striking ‘‘an alien’’ and all that follows through ‘‘under 

6 this part’’ and inserting ‘‘an individual who is lawfully 

7 present in the United States’’. 

8 SEC. 4106. LOWERING MEDICARE PREMIUMS AND PRE9 SCRIPTION DRUG COSTS. 

10 (a) MEDICARE COST ASSISTANCE PROGRAM.— 

11 (1) IN GENERAL.—Title XVIII of the Social Se12 curity Act (42 U.S.C. 1395 et seq.) is amended by 

13 adding at the end the following new section: 

14 ‘‘SEC. 1899C. MEDICARE COST ASSISTANCE PROGRAM. 

15 ‘‘(a) IN GENERAL.—Effective beginning January 1, 

16 2023, in the case of a Medicare Cost Assistance Program 

17 eligible individual (as defined in subsection (b)(1)), the 

18 Secretary shall provide Medicare cost assistance for the 

19 following costs incurred with respect to the individual: 

20 ‘‘(1) Premiums under section 1818. 

21 ‘‘(2) Premiums under section 1839. 

22 ‘‘(3) Coinsurance under this title (including co23 insurance described in section 1813). 


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1 ‘‘(4) Deductibles established under this title (in2 cluding those described in section 1813 and section 

3 1833(b)). 

4 ‘‘(5) The difference between the amount that is 

5 paid under section 1833(a) and the amount that 

6 would be paid under such section if any reference to 

7 a percent less than 100 percent therein were deemed 

8 a reference to ‘100 percent’. 

9 ‘‘(b) DETERMINATION OF ELIGIBILITY.— 

10 ‘‘(1) MEDICARE COST ASSISTANCE PROGRAM

11 ELIGIBLE INDIVIDUAL DEFINED.—The term ‘Medi12 care Cost Assistance Program eligible individual’ 

13 means an individual who— 

14 ‘‘(A) is eligible for, and is receiving, med15 ical assistance for the payment of medicare 

16 cost-sharing under a State Medicaid program 

17 pursuant to clause (i), (iii), or (iv) of section 

18 1902(a)(10)(E) as of December 31, 2022; or 

19 ‘‘(B)(i) is entitled to hospital insurance 

20 benefits under part A (including an individual 

21 entitled to such benefits pursuant to an enroll22 ment under section 1818); and 

23 ‘‘(ii) has income at or below 200 percent of 

24 the poverty line applicable to a family of the 

25 size involved. 


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1 ‘‘(2) JOINT DETERMINATION BY COMMISSIONER

2 OF SOCIAL SECURITY FOR LIS AND MEDICARE COST

3 ASSISTANCE.— 

4 ‘‘(A) IN GENERAL.—The determination of 

5 whether an individual is a Medicare Cost As6 sistance Program eligible individual shall be de7 termined by the Commissioner of Social Secu8 rity jointly with the determination of whether 

9 an individual is a subsidy eligible individual de10 scribed in section 1860D–14(a)(3). Such deter11 mination shall be made with respect to eligi12 bility for Medicare cost assistance under this 

13 section and premium and cost-sharing subsidies 

14 under section 1860D–14 upon application of an 

15 individual for a determination with respect to 

16 eligibility for either such assistance or such sub17 sidies. There are authorized to be appropriated 

18 to the Social Security Administration such 

19 sums as may be necessary for the determination 

20 of eligibility under this paragraph. 

21 ‘‘(B) EFFECTIVE PERIOD.—Determina22 tions under this paragraph with respect to eligi23 bility for each of such assistance or such sub24 sidies shall be effective beginning with the 

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1 termination described in subparagraph (A) and 

2 shall remain in effect until such time as the 

3 Secretary determines the individual is no longer 

4 eligible as determined under subparagraph 

5 (C)(ii). 

6 ‘‘(C) REDETERMINATIONS.—With respect 

7 to eligibility determinations under this para8 graph— 

9 ‘‘(i) redeterminations shall be made at 

10 the same time with respect to eligibility for 

11 Medicare cost assistance under this section 

12 and cost-sharing subsidies under section 

13 1860D–14, but not more frequently than 

14 once every 12 months; 

15 ‘‘(ii) a redetermination shall automati16 cally determine that an individual remains 

17 eligible for such assistance or subsidies un18 less— 

19 ‘‘(I) the Commissioner has infor20 mation indicating that the individual’s 

21 circumstances have changed such that 

22 the individual is no longer eligible for 

23 such assistance or subsidies; 

24 ‘‘(II) the Commissioner sends no25 tice to the individual regarding such 


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1 information that requests a response 

2 either confirming or correcting such 

3 information; and 

4 ‘‘(III) the individual either con5 firms such information or fails to pro6 vide documentation indicating that 

7 such circumstances have not changed 

8 within 60 days of receiving the notice 

9 described in subclause (II); 

10 ‘‘(iii) the Commissioner shall establish 

11 procedures for appeals of such determina12 tions that are similar to the procedures de13 scribed in the third sentence of section 

14 1631(c)(1)(A); and 

15 ‘‘(iv) judicial review of the final deci16 sion of the Commissioner made after a 

17 hearing shall be available to the same ex18 tent, and with the same limitations, as pro19 vided in subsections (g) and (h) of section 

20 205. 

21 ‘‘(D) TREATMENT OF MEDICAID BENE22 FICIARIES.—The Secretary shall provide that 

23 individuals who are full-benefit dual eligible in24 dividuals (as defined in section 1935(c)(6)) or 

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1 come benefits under title XVI shall be treated 

2 as a Medicare Cost Assistance Program eligible 

3 individual and, in the case of such individual 

4 who is a part D eligible individual, a subsidy el5 igible individual described in section 1860D– 

6 14(a)(3). 

7 ‘‘(E) SIMPLIFIED APPLICATION FORM.— 

8 ‘‘(i) IN GENERAL.—The Secretary 

9 shall develop and distribute a simplified 

10 application form for use by individuals in 

11 applying for Medicare cost assistance 

12 under this section and premium and cost13 sharing subsidies under section 1860D–14. 

14 Such form shall be easily readable based 

15 on culturally fluid language for all demo16 graphics beyond just the various languages 

17 offered. An audio version, digital version, 

18 and photo-voice option should also be pro19 vided for all learners. The Secretary shall 

20 provide for the translation of such applica21 tion form into at least the 10 languages 

22 (other than English) that are most often 

23 used by individuals applying for hospital 

24 insurance benefits under section 226 or 

25 226A and shall make the translated forms 


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1 available to the Commissioner of Social Se2 curity. 

3 ‘‘(ii) CONSULTATION.—In developing 

4 the form under clause (i), the Secretary 

5 shall consult with beneficiary groups. 

6 ‘‘(3) INCOME DETERMINATIONS.—For purposes 

7 of applying this section— 

8 ‘‘(A) in the case of an individual who is 

9 not treated as a Medicare Cost Assistance Pro10 gram eligible individual or a subsidy eligible in11 dividual under paragraph (2)(D), income shall 

12 be determined in the manner described under 

13 section 1612 for purposes of the supplemental 

14 security income program, except that support 

15 and maintenance furnished in kind shall not be 

16 counted as income; and 

17 ‘‘(B) the term ‘poverty line’ has the mean18 ing given such term in section 673(2) of the 

19 Community Services Block Grant Act (42 

20 U.S.C. 9902(2)), including any revision re21 quired by such section. 

22 ‘‘(c) BENEFICIARY PROTECTIONS.— 

23 ‘‘(1) IN GENERAL.—In the case in which the 

24 payment for Medicare cost assistance for a Medicare 

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1 spect to an item or service is reduced or eliminated, 

2 the individual shall not have any legal liability to 

3 make payment to a provider of services (as defined 

4 in section 1861(u)) or supplier (as defined in section 

5 1861(d)) or to an organization described in section 

6 1903(m)(1)(A) for the service, and any lawful sanc7 tion that may be imposed upon a provider of services 

8 or supplier or such an organization for excess 

9 charges under this title or title XIX shall apply to 

10 the imposition of any charge imposed upon the indi11 vidual in such case. 

12 ‘‘(2) CLARIFICATION.—This paragraph shall 

13 not be construed as preventing payment of any 

14 medicare cost assistance by a medicare supplemental 

15 policy or an employer retiree health plan on behalf 

16 of an individual. 

17 ‘‘(d) ADMINISTRATION.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall estab19 lish procedures for the administration of the pro20 gram under this section. 

21 ‘‘(2) FUNDING.—For purposes of carrying out 

22 this section, the Secretary shall make payments from 

23 the Federal Hospital Insurance Trust Fund under 

24 section 1817 and the Federal Supplementary Med25 ical Insurance Trust Fund under section 1841, in 


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1 such proportion as the Secretary determines appro2 priate, of such amounts as the Secretary determines 

3 necessary to provide Medicare cost assistance under 

4 this section. 

5 ‘‘(e) REFERENCES TO MEDICARE COST-SHARING.— 

6 Effective beginning January 1, 2023, any reference to 

7 medicare cost-sharing described in section 1905(p) shall 

8 be deemed a reference to Medicare cost assistance under 

9 this section. 

10 ‘‘(f) OUTREACH EFFORTS.—For provisions relating 

11 to outreach efforts to increase awareness of the availability 

12 of Medicare cost assistance, see section 1144.’’. 

13 (2) SPECIAL ENROLLMENT PERIOD.— 

14 (A) NO PREMIUM PENALTY.—Section 

15 1839(b) of the Social Security Act (42 U.S.C. 

16 1395r(b)) is amended, in the last sentence, by 

17 inserting the following before the period: ‘‘or, 

18 effective beginning January 1, 2023, for indi19 viduals who are Medicare Cost Assistance Pro20 gram eligible individuals (as defined in section 

21 1899B(b)(1)).’’. 

22 (B) SPECIAL ENROLLMENT PERIOD.—Sec23 tion 1837 of the Social Security Act (42 U.S.C. 

24 1395p) is amended by adding at the end the 

25 following new subsection: 


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1 ‘‘(p) SPECIAL ENROLLMENT PERIOD FOR MEDICARE

2 COST ASSISTANCE PROGRAM ELIGIBLE INDIVIDUAL.— 

3 ‘‘(1) IN GENERAL.—Effective beginning Janu4 ary 1, 2023, the Secretary shall establish special en5 rollment periods for Medicare Cost Assistance Pro6 gram eligible individuals (as defined in section 

7 1899C(b)(1)). 

8 ‘‘(2) COVERAGE PERIOD.—In the case of an in9 dividual who enrolls during the special enrollment 

10 period provided under paragraph (1), the coverage 

11 period under this part shall— 

12 ‘‘(A) begin on the first day of the first 

13 month in which the individual applies for a de14 termination under section 1899C(b)(2)(A); and 

15 ‘‘(B) remain in effect until such time as 

16 the Secretary determines the individual is no 

17 longer eligible as determined under section 

18 1899C(b)(2)(C)(ii).’’. 

19 (C) CONFORMING SUNSET OF STATE

20 AGREEMENTS RELATING TO ENROLLMENT OF

21 QUALIFIED MEDICARE BENEFICIARIES.— 

22 (i) PART A.—Section 1818(g) of the 

23 Social Security Act (42 U.S.C. 1395i–2(g)) 

24 is amended by adding at the end the fol25 lowing new paragraph: 


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1 ‘‘(3) SUNSET.—This subsection shall not apply on or 

2 after January 1, 2023.’’. 

3 (ii) PART B.—Section 1843(h) of the 

4 Social Security Act (42 U.S.C. 1395v(h)) 

5 is amended by adding at the end the fol6 lowing new paragraph: 

7 ‘‘(3) SUNSET WITH RESPECT TO QUALIFIED MEDI8 CARE BENEFICIARIES.—This subsection shall not apply 

9 with respect to qualified medicare beneficiaries on or after 

10 January 1, 2023.’’. 

11 (3) PUBLIC AWARENESS CAMPAIGN.—Section 

12 1144 of the Social Security Act (42 U.S.C. 1320b– 

13 14) is amended by adding at the end the following 

14 new subsection: 

15 ‘‘(d) PUBLIC AWARENESS CAMPAIGN.— 

16 ‘‘(1) IN GENERAL.—The Commissioner shall 

17 conduct a public awareness campaign to educate 

18 Medicare beneficiaries on the availability of Medicare 

19 cost assistance for low-income individuals under sec20 tion 1899B. 

21 ‘‘(2) COORDINATION.—In carrying out the pub22 lic awareness campaign under paragraph (1), the 

23 Commissioner shall coordinate with State health in24 surance assistance programs described in subsection 

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1 ments for Patients and Providers Act of 2008 (42 

2 U.S.C. 1395b–3 note), the Administrator of the Ad3 ministration for Community Living, and the Admin4 istrator of the Centers for Medicare & Medicaid 

5 Services. 

6 ‘‘(3) FUNDING.—There is appropriated to the 

7 Commissioner, out of any funds in the Treasury not 

8 otherwise appropriated, $10,000,000 for each of fis9 cal years 2023 through 2025, to provide grants to 

10 State health insurance assistance programs to carry 

11 out outreach and education activities under the pub12 lic awareness campaign pursuant to this sub13 section.’’. 

14 (b) MOVING MEDICARE COST-SHARING BENEFITS

15 FROM MEDICAID TO MEDICARE.— 

16 (1) ENDING MOST MEDICARE COST-SHARING

17 BENEFITS UNDER MEDICAID.—Section 1902(a)(10) 

18 of the Social Security Act (42 U.S.C. 1396a(a)(10)) 

19 is amended— 

20 (A) by inserting ‘‘for calendar quarters be21 ginning before January 1, 2023,’’ before ‘‘for 

22 making’’ each place it appears in clauses (i), 

23 (iii), and (iv) of subparagraph (E); and 

24 (B) in the matter following subparagraph 

25 (G)— 


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1 (i) by inserting ‘‘furnished during cal2 endar quarters beginning before January 

3 1, 2023’’ after ‘‘(described in section 

4 1905(p)(3))’’; 

5 (ii) by striking ‘‘(XV)’’ and inserting 

6 ‘‘, (XV)’’; 

7 (iii) by striking ‘‘and (XVIII)’’ and in8 serting ‘‘, (XVIII)’’; 

9 (iv) by striking ‘‘and (XIX)’’ and in10 serting ‘‘(XIX)’’; and 

11 (v) by inserting ‘‘, and (XX) no med12 ical assistance for medicare cost-sharing, 

13 other than medical assistance for medicare 

14 cost-sharing for qualified disabled and 

15 working individuals described in section 

16 1905(s), shall be made available after Jan17 uary 1, 2023’’ before the semicolon at the 

18 end. 

19 (2) CONFORMING AMENDMENTS.— 

20 (A) TITLE XIX.— 

21 (i) Section 1903(i) of such Act (42 

22 U.S.C. 1396b(i)), as amended by section 

23 4002, is amended— 

24 (I) in paragraph (26), by striking 

25 ‘‘or’’ at the end; 


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1 (II) in paragraph (27), by strik2 ing the period at the end and insert3 ing ‘‘; or’’; and 

4 (III) by inserting after paragraph 

5 (27) the following new paragraph: 

6 ‘‘(28) with respect to any amount expended for 

7 medical assistance for medicare cost-sharing (other 

8 than medical assistance for medicare cost-sharing 

9 for qualified disabled and working individuals de10 scribed in section 1905(s)) furnished during cal11 endar quarters beginning on or after January 1, 

12 2023.’’. 

13 (ii) Section 1905(a) of such Act (42 

14 U.S.C. 1396d(a)) is amended, in the first 

15 sentence, by inserting ‘‘furnished during 

16 calendar quarters beginning before Janu17 ary 1, 2023’’ after ‘‘medicare cost-shar18 ing’’. 

19 (iii) Section 1933(g) of such Act (42 

20 U.S.C. 1396u–3(g)) is amended— 

21 (I) in paragraph (2)(Q), by strik22 ing ‘‘paragraph (4), for each subse23 quent year’’ and inserting ‘‘para24 graphs (4) and (5), for each subse25 quent year before 2023’’; and 


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1 (II) by adding at the end the fol2 lowing: 

3 ‘‘(5) SUNSET.—No individual shall be selected 

4 to be a qualifying individual for any calendar year 

5 or period under this section beginning on or after 

6 January 1, 2023, and no State allocation shall be 

7 made for any fiscal year or period under this section 

8 beginning on or after January 1, 2023.’’. 

9 (iv) Section 1935(a) of such Act (42 

10 U.S.C. 1396u–5(a)) is amended— 

11 (I) in paragraph (2)(A), by strik12 ing ‘‘make determinations’’ and in13 serting ‘‘prior to January 1, 2023, 

14 make determinations’’; and 

15 (II) in paragraph (3), by insert16 ing ‘‘prior to January 1, 2023,’’ be17 fore ‘‘the State shall’’. 

18 (c) ENHANCING PRESCRIPTION DRUG AFFORD19 ABILITY BY EXPANDING ACCESS TO ASSISTANCE WITH

20 OUT-OF-POCKET COSTS UNDER MEDICARE PART D FOR

21 LOW-INCOME SENIORS AND INDIVIDUALS WITH DISABIL22 ITIES.— 

23 (1) EXPANDING ACCESS.—Section 1860D–14 of 

24 the Social Security Act (42 U.S.C. 1395w–114) is 

25 amended— 


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1 (A) in subsection (a)— 

2 (i) in the subsection heading, by strik3 ing ‘‘150 PERCENT’’ and inserting ‘‘200 

4 PERCENT’’; 

5 (ii) in paragraph (1)— 

6 (I) in the paragraph heading, by 

7 striking ‘‘135 PERCENT’’ and inserting 

8 ‘‘200 PERCENT’’; and 

9 (II) in the matter preceding sub10 paragraph (A)— 

11 (aa) by striking ‘‘135 per12 cent’’ and inserting ‘‘200 per13 cent’’; and 

14 (bb) by striking ‘‘and who 

15 meets the resources requirement 

16 described in paragraph (3)(D) or 

17 who is covered under this para18 graph under paragraph 

19 (3)(B)(i)’’ and inserting ‘‘or who 

20 is covered under this paragraph 

21 under paragraph (3)(B)(v)’’; 

22 (iii) by striking paragraph (2); 

23 (iv) in paragraph (3)— 

24 (I) in subparagraph (A)— 


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1 (aa) in clause (i), by adding 

2 ‘‘and’’ at the end; 

3 (bb) in clause (ii)— 

4 (AA) by striking ‘‘150 

5 percent’’ and inserting ‘‘200 

6 percent’’; and 

7 (BB) by striking ‘‘; 

8 and’’ at the end and insert9 ing a period; and 

10 (cc) by striking clause (iii); 

11 (II) by striking subparagraphs 

12 (B) and (C) and inserting the fol13 lowing: 

14 ‘‘(B) DETERMINATIONS.—For provisions 

15 relating to joint determinations with respect to 

16 eligibility for Medicare cost assistance under 

17 section 1899C and premium and cost-sharing 

18 subsidies under this section, see section 

19 1899C(b)(2). 

20 ‘‘(C) INCOME DETERMINATIONS.—For pur21 poses of applying this section— 

22 ‘‘(i) in the case of an individual who 

23 is not treated as a Medicare cost-sharing 

24 assistance eligible individual and a subsidy 

25 eligible individual under section 


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1 1899C(b)(2)(D), income shall be deter2 mined in the manner described under sec3 tion 1612 for purposes of the supplemental 

4 security income program, except that sup5 port and maintenance furnished in kind 

6 shall not be counted as income; and 

7 ‘‘(ii) the term ‘poverty line’ has the 

8 meaning given such term in section 673(2) 

9 of the Community Services Block Grant 

10 Act (42 U.S.C. 9902(2)), including any re11 vision required by such section.’’; and 

12 (III) by striking subparagraphs 

13 (D), (E), and (G); and 

14 (v) in paragraph (4), by striking sub15 paragraph (B); and 

16 (B) in subsection (c)(1), in the second sen17 tence, by striking ‘‘subsections (a)(1)(D) and 

18 (a)(2)(E)’’ and inserting ‘‘subsection 

19 (a)(1)(D)’’. 

20 (2) TREATMENT OF REDUCTION OF COST-SHAR21 ING FOR INDIVIDUALS RECEIVING HOME AND COM22 MUNITY-BASED SERVICES.—Section 1860D– 

23 14(a)(1)(D)(i) of the Social Security Act (42 U.S.C. 

24 1395w–114(a)(1)(D)(i)) is amended— 


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1 (A) by striking ‘‘who would be such an in2 stitutionalized individual or couple, if the full3 benefit dual eligible individual were not’’; and 

4 (B) by striking ‘‘or subsection (c) or (d) of 

5 section 1915 or under a State plan amendment 

6 under subsection (i) of such section’’ and in7 serting ‘‘, section 1115A, section 1915, or 

8 under a State plan amendment’’. 

9 (3) EFFECTIVE DATE.—The amendments made 

10 by this subsection shall apply to plan year 2023 and 

11 subsequent plan years. 

12 SEC. 4107. REDUCING COST-SHARING, ALIGNING INCOME 

13 AND RESOURCE ELIGIBILITY TESTS, SIMPLI14 FYING ENROLLMENT, AND OTHER PROGRAM 

15 IMPROVEMENTS FOR LOW-INCOME BENE16 FICIARIES. 

17 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER18 CENT OF FPL FOR QUALIFIED MEDICARE BENE19 FICIARIES.— 

20 (1) IN GENERAL.—Section 1905(p)(2)(A) of the 

21 Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 

22 amended by striking ‘‘shall be at least the percent 

23 provided under subparagraph (B) (but not more 

24 than 100 percent) of the official poverty line’’ and 


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1 all that follows through the period at the end and 

2 inserting the following: ‘‘shall be— 

3 ‘‘(i) before January 1, 2023, at least 

4 the percent provided under subparagraph 

5 (B) (but not more than 100 percent) of 

6 the official poverty line (as defined by the 

7 Office of Management and Budget, and re8 vised annually in accordance with section 

9 673(2) of the Omnibus Budget Reconcili10 ation Act of 1981) applicable to a family 

11 of the size involved; and 

12 ‘‘(ii) on or after January 1, 2023, 

13 equal to 135 percent of the official poverty 

14 line (as so defined and revised) applicable 

15 to a family of the size involved.’’. 

16 (2) NOT COUNTING IN-KIND SUPPORT AND

17 MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 

18 of the Social Security Act (42 U.S.C. 

19 1396d(p)(2)(D)) is amended by adding at the end 

20 the following new clause: 

21 ‘‘(iii) In determining income under this sub22 section, support and maintenance furnished in kind 

23 shall not be counted as income.’’. 


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1 (b) INCREASE IN INCOME ELIGIBILITY TO 200 PER2 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE

3 BENEFICIARIES.— 

4 (1) ELIGIBILITY OF INDIVIDUALS WITH IN5 COMES BELOW 150 PERCENT OF FPL.—Section 

6 1902(a)(10)(E) of the Social Security Act (42 

7 U.S.C. 1396a(a)(10)(E)) is amended— 

8 (A) by adding ‘‘and’’ at the end of clause 

9 (ii); 

10 (B) in clause (iii)— 

11 (i) by striking ‘‘and 120 percent in 

12 1995 and years thereafter’’ and inserting 

13 ‘‘120 percent in 1995 and years thereafter 

14 before 2023, and 200 percent in 2023 and 

15 years thereafter’’; and 

16 (ii) by striking ‘‘and’’ at the end; and 

17 (C) by striking clause (iv). 

18 (2) REFERENCES.—Section 1905(p)(1) of the 

19 Social Security Act (42 U.S.C. 1396d(p)(1)) is 

20 amended by adding at and below subparagraph (C) 

21 the following flush sentence: 

22 ‘‘The term ‘specified low-income medicare beneficiary’ 

23 means an individual described in section 

24 1902(a)(10)(E)(iii).’’. 

25 (3) CONFORMING AMENDMENTS.— 


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1 (A) The first sentence of section 1905(b) 

2 of such Act (42 U.S.C. 1396d(b)) is amended 

3 by striking ‘‘and section 1933(d)’’. 

4 (B) Section 1933 of such Act (42 U.S.C. 

5 1396u–3) is repealed. 

6 (c) 100 PERCENT FMAP.—Section 1905 of the So7 cial Security Act (42 U.S.C. 1396d) is amended by adding 

8 at the end the following new subsection: 

9 ‘‘(jj) INCREASED FMAP FOR EXPANDED MEDICARE

10 COST-SHARING POPULATIONS.— 

11 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

12 (b), with respect to expenditures described in para13 graph (2) the Federal medical assistance percentage 

14 shall be equal to 100 percent. 

15 ‘‘(2) EXPENDITURES DESCRIBED.—The expend16 itures described in this paragraph are expenditures 

17 made on or after January 1, 2023, for medical as18 sistance for medicare cost-sharing provided to any 

19 individual under clause (i), (ii), or (iii) of section 

20 1902(a)(10)(E) who would not have been eligible for 

21 medicare cost-sharing under any such clause under 

22 the income or resource eligibility standards in effect 

23 on October 1, 2018.’’. 

24 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE25 SOURCE ELIGIBILITY TESTS.— 


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1 (1) IN GENERAL.—Section 1860D–14(a)(3) of 

2 the Social Security Act (42 U.S.C. 1395w– 

3 114(a)(3)) is amended— 

4 (A) by striking subparagraph (D); 

5 (B) by redesignating subparagraphs (E) 

6 through (G) as subparagraphs (D) through (F), 

7 respectively; and 

8 (C) in the heading of subparagraph (D), as 

9 so redesignated, by striking ‘‘ALTERNATIVE’’. 

10 (2) CLARIFICATION OF CERTAIN RULES RELAT11 ING TO INCOME AND RESOURCE DETERMINA12 TIONS.—Section 1860D–14(a)(3) of the Social Secu13 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 

14 by paragraph (1), is amended by striking subpara15 graph (F) and inserting the following new subpara16 graphs: 

17 ‘‘(F) RESOURCE EXCLUSIONS.—In deter18 mining the resources of an individual (and the 

19 eligible spouse of the individual, if any) under 

20 section 1613 for purposes of subparagraph 

21 (D)— 

22 ‘‘(i) no part of the value of any life in23 surance policy shall be taken into account; 

24 ‘‘(ii) no part of the value of any vehi25 cle shall be taken into account; 


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1 ‘‘(iii) there shall be excluded an 

2 amount equal to $1,500 each with respect 

3 to any individual or eligible spouse of an 

4 individual who attests that some of the re5 sources of such individual or spouse will be 

6 used to meet the burial and related ex7 penses of such individual or spouse; and 

8 ‘‘(iv) no balance in, or benefits re9 ceived under, an employee pension benefit 

10 plan (as defined in section 3 of the Em11 ployee Retirement Income Security Act of 

12 1974) shall be taken into account. 

13 ‘‘(G) FAMILY SIZE.—In determining the 

14 size of the family of an individual for purposes 

15 of determining the income eligibility of such in16 dividual under this section, an individual’s fam17 ily shall consist of— 

18 ‘‘(i) the individual; 

19 ‘‘(ii) the individual’s spouse who lives 

20 in the same household as the individual (if 

21 any); and 

22 ‘‘(iii) any other individuals who— 

23 ‘‘(I) are related to the individual 

24 whose income eligibility is in question 


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1 or such individual’s spouse who lives 

2 in the same household; 

3 ‘‘(II) are living in the same 

4 household as such individual; and 

5 ‘‘(III) are dependent on such in6 dividual or such individual’s spouse 

7 who is living in the same household 

8 for at least one-half of their financial 

9 support.’’. 

10 (3) CONFORMING AMENDMENTS.—Section 

11 1860D–14(a) of the Social Security Act (42 U.S.C. 

12 1395w–114(a)) is amended— 

13 (A) in paragraph (1), in the matter pre14 ceding subparagraph (A), by inserting ‘‘(as de15 termined under paragraph (3)(G))’’ after ‘‘fam16 ily of the size involved’’; and 

17 (B) in paragraph (3), as amended by para18 graphs (1) and (2)— 

19 (i) in subparagraph (A), in the matter 

20 preceding clause (i), by striking ‘‘subpara21 graph (F)’’ and inserting ‘‘subparagraph 

22 (E)’’; 

23 (ii) in subparagraph (A)(ii), by insert24 ing ‘‘(as determined under subparagraph 

25 (G))’’ after ‘‘family of the size involved’’; 


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1 (iii) in subparagraph (A)(iii), by strik2 ing ‘‘or (E)’’; 

3 (iv) in subparagraph (B)(v), in the 

4 matter preceding subclause (I), by striking 

5 ‘‘subparagraph (F)’’ and inserting ‘‘sub6 paragraph (E)’’; and 

7 (v) in subparagraph (D)(i), in the 

8 matter preceding subclause (I), by striking 

9 ‘‘subject to the life insurance policy exclu10 sion provided under subparagraph (G)’’ 

11 and inserting ‘‘subject to the resource ex12 clusions provided under subparagraph 

13 (F)’’. 

14 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND

15 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE

16 ELIGIBILITY TESTS.— 

17 (1) APPLICATION OF MEDICAID SPOUSAL IM18 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND

19 LIS RESOURCE ELIGIBILITY.—Section 1905(p)(1)(C) 

20 of the Social Security Act (42 U.S.C. 

21 1396d(p)(1)(C)) is amended to read as follows: 

22 ‘‘(C) whose resources (as determined under sec23 tion 1613 for purposes of the supplemental security 

24 income program subject to the resource exclusions 


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•S 4486 IS

1 under subparagraph (G) of section 1860D–14(a)(3)) 

2 do not exceed— 

3 ‘‘(i) in the case of an individual with a 

4 spouse, an amount equal to the sum of the first 

5 amount specified in subsection (f)(2)(A)(i) of 

6 section 1924 (as adjusted under subsection (g) 

7 of such section) and the amount specified in 

8 subsection (f)(2)(A)(ii)(II) of such section (as 

9 so adjusted); or 

10 ‘‘(ii) in the case of an individual who does 

not have a spouse, an amount equal to 1 11 ⁄2 of 

12 the amount described in clause (i).’’. 

13 (2) APPLICATION TO QDWIS.—Section 

14 1905(s)(3) of the Social Security Act (42 U.S.C. 

15 1396d(s)(3)) is amended to read as follows: 

16 ‘‘(3) whose resources (as determined under sec17 tion 1613 for purposes of the supplemental security 

18 income program subject to the resource exclusions 

19 under subparagraph (G) of section 1860D–14(a)(3)) 

20 do not exceed— 

21 ‘‘(A) in the case of an individual with a 

22 spouse, the amount in effect for the year under 

23 clause (i) of subsection (p)(1)(C); and 

24 ‘‘(B) in the case of an individual who does 

25 not have a spouse, the amount in effect for the 


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•S 4486 IS

1 year under clause (ii) of subsection (p)(1)(C); 

2 and’’. 

3 (3) APPLICATION TO LIS.—Clause (i) of section 

4 1860D–14(a)(3)(D) of the Social Security Act (42 

5 U.S.C. 1395w–114(a)(3)(D)), as redesignated and 

6 amended by subsection (d)(1), is amended to read as 

7 follows: 

8 ‘‘(i) IN GENERAL.—The resources re9 quirement of this subparagraph is that an 

10 individual’s resources (as determined under 

11 section 1613 for purposes of the supple12 mental security income program subject to 

13 the resource exclusions provided under 

14 subparagraph (G)) do not exceed the 

15 amount in effect for the year under section 

16 1905(p)(1)(C)(ii).’’. 

17 (f) ENROLLMENT SIMPLIFICATIONS.— 

18 (1) APPLICATION OF 3-MONTH RETROACTIVE

19 ELIGIBILITY TO QMBS.— 

20 (A) IN GENERAL.—Section 1902(e)(8) of 

21 the Social Security Act (42 U.S.C. 1396a(e)(8)) 

22 is amended by striking ‘‘after the end of the 

23 month in which the determination first occurs’’ 

24 and inserting ‘‘in or after the third month beVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 fore the month in which the individual makes 

2 application for assistance’’. 

3 (B) PROCESS FOR SUBMITTING CLAIMS

4 DURING RETROACTIVE ELIGIBILITY PERIOD.— 

5 Section 1902(e)(8) of the Social Security Act 

6 (42 U.S.C. 1396a(e)(8)) is further amended by 

7 adding at the end the following: ‘‘The Secretary 

8 shall provide for a process under which claims 

9 for medical assistance under the State plan may 

10 be submitted for services furnished to such an 

11 individual during such 3-month period before 

12 the month in which the individual made appli13 cation for assistance.’’. 

14 (C) CONFORMING AMENDMENT.—Section 

15 1905(a) of the Social Security Act (42 U.S.C. 

16 1396d(a)) is amended, in the matter preceding 

17 paragraph (1), by striking ‘‘or, in the case of 

18 medicare cost-sharing with respect to a quali19 fied medicare beneficiary described in sub20 section (p)(1), if provided after the month in 

21 which the individual becomes such a bene22 ficiary’’. 

23 (2) STATE OPTION FOR 12-MONTH CONTINUOUS

24 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 


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1 1902(e)(12) of the Social Security Act (42 U.S.C. 

2 1396a(e)(12)) is amended— 

3 (A) by redesignating subparagraphs (A) 

4 and (B) as clauses (i) and (ii), respectively; 

5 (B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 

6 (C) by adding at the end the following: 

7 ‘‘(B) At the option of the State, the plan may provide 

8 that an individual who is determined to be eligible for ben9 efits under a State plan approved under this title under 

10 any of the following eligibility categories, or who is rede11 termined to be eligible for such benefits under any of such 

12 categories, shall be considered to meet the eligibility re13 quirements met on the date of application and shall re14 main eligible for those benefits until the end of the 12- 

15 month period following the date of the determination or 

16 redetermination of eligibility, except that a State may pro17 vide for such determinations more frequently, but not 

18 more frequently than once every 6 months for an indi19 vidual: 

20 ‘‘(i) A specified low-income medicare beneficiary 

21 described in subsection (a)(10)(E)(iii) of this section 

22 who is determined eligible for medicare cost-sharing 

23 described in section 1905(p)(3)(A)(ii). 

24 ‘‘(ii) A qualified disabled and working indi25 vidual described in section 1905(s) who is deterVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 mined eligible for medicare cost-sharing described in 

2 section 1905(p)(3)(A)(i).’’. 

3 (3) STATE OPTION TO USE EXPRESS LANE ELI4 GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 

5 Section 1902(e)(13)(A) of the Social Security Act 

6 (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 

7 at the end the following new clause: 

8 ‘‘(iii) STATE OPTION TO EXTEND EXPRESS

9 LANE ELIGIBILITY TO OTHER POPULATIONS.— 

10 ‘‘(I) IN GENERAL.—At the option of 

11 the State, the State may apply the provi12 sions of this paragraph with respect to de13 termining eligibility under this title for an 

14 eligible individual (as defined in subclause 

15 (II)). In applying this paragraph in the 

16 case of a State making such an option, any 

17 reference in this paragraph to a child with 

18 respect to this title (other than a reference 

19 to child health assistance) shall be deemed 

20 to be a reference to an eligible individual. 

21 ‘‘(II) ELIGIBLE INDIVIDUAL DE22 FINED.—In this clause, the term ‘eligible 

23 individual’ means any of the following: 

24 ‘‘(aa) A qualified medicare bene25 ficiary described in section 1905(p)(1) 


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1 for purposes of determining eligibility 

2 for medicare cost-sharing (as defined 

3 in section 1905(p)(3)). 

4 ‘‘(bb) A specified low-income 

5 medicare beneficiary described in sub6 section (a)(10)(E)(iii) of this section 

7 for purposes of determining eligibility 

8 for medicare cost-sharing described in 

9 section 1905(p)(3)(A)(ii). 

10 ‘‘(cc) A qualified disabled and 

11 working individual described in sec12 tion 1905(s) for purposes of deter13 mining eligibility for medicare cost14 sharing described in section 

15 1905(p)(3)(A)(i).’’. 

16 (g) MEDICAID TREATMENT OF CERTAIN MEDICARE

17 PROVIDERS.—Section 1902(n) of the Social Security Act 

18 (42 U.S.C. 1396a(n)) is amended by adding at the end 

19 the following new paragraph: 

20 ‘‘(4) A State plan shall not deny a claim from a pro21 vider or supplier with respect to medicare cost-sharing de22 scribed in subparagraph (B), (C), or (D) of section 

23 1905(p)(3) for an item or service which is eligible for pay24 ment under title XVIII on the basis that the provider or 

25 supplier does not have a provider agreement in effect 


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1 under this title or does not otherwise serve all individuals 

2 entitled to medical assistance under this title. The State 

3 shall create a mechanism through which providers or sup4 pliers that do not otherwise have provider agreements with 

5 the State can bill the State for medicare cost-sharing for 

6 qualified medicare beneficiaries.’’. 

7 (h) ELIGIBILITY FOR OTHER PROGRAMS.—Section 

8 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 

9 is amended by adding at the end the following new para10 graph: 

11 ‘‘(7) Notwithstanding any other provision of law, any 

12 medical assistance for some or all medicare cost-sharing 

13 under this title shall not be considered income or resources 

14 in determining eligibility for, or the amount of assistance 

15 or benefits provided under, any other public benefit pro16 vided under Federal law or the law of any State or polit17 ical subdivision thereof.’’. 

18 (i) TREATMENT OF QUALIFIED MEDICARE BENE19 FICIARIES, SPECIFIED LOW-INCOME MEDICARE BENE20 FICIARIES, AND OTHER DUAL ELIGIBLES AS MEDICARE

21 BENEFICIARIES.—Section 1862 of the Social Security Act 

22 (42 U.S.C. 1395y) is amended by adding at the end the 

23 following new subsection: 

24 ‘‘(p) TREATMENT OF QUALIFIED MEDICARE BENE25 FICIARIES (QMBS), SPECIFIED LOW-INCOME MEDICARE


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1 BENEFICIARIES (SLMBS), AND OTHER DUAL ELIGI2 BLES.—Nothing in this title shall be construed as author3 izing a provider of services or supplier to discriminate 

4 (through a private contractual arrangement or otherwise) 

5 against an individual who is otherwise entitled to services 

6 under this title on the basis that the individual is a quali7 fied medicare beneficiary (as defined in section 

8 1905(p)(1)), a specified low-income medicare beneficiary, 

9 or is otherwise eligible for medical assistance for medicare 

10 cost-sharing or other benefits under title XIX.’’. 

11 (j) ADDITIONAL FUNDING FOR STATE HEALTH IN12 SURANCE ASSISTANCE PROGRAMS.— 

13 (1) GRANTS.— 

14 (A) IN GENERAL.—The Secretary of 

15 Health and Human Services (in this subsection 

16 referred to as the ‘‘Secretary’’) shall use 

17 amounts made available under subparagraph 

18 (B) to make grants to States for State health 

19 insurance assistance programs receiving assist20 ance under section 4360 of the Omnibus Budg21 et Reconciliation Act of 1990. 

22 (B) FUNDING.—For purposes of making 

23 grants under this subsection, the Secretary 

24 shall provide for the transfer, from the Federal 

25 Hospital Insurance Trust Fund under section 


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•S 4486 IS

1 1817 of the Social Security Act (42 U.S.C. 

2 1395i) and the Federal Supplementary Medical 

3 Insurance Trust Fund under section 1841 of 

4 such Act (42 U.S.C. 1395t), in the same pro5 portion as the Secretary determines under sec6 tion 1853(f) of such Act (42 U.S.C. 1395w– 

7 23(f)), of $50,000,000 to the Centers for Medi8 care & Medicaid Services Program Management 

9 Account for each of the fiscal years 2024 

10 through 2028, to remain available until ex11 pended. 

12 (2) AMOUNT OF GRANTS.—The amount of a 

13 grant to a State under this subsection from the total 

14 amount made available under paragraph (1) shall be 

15 equal to the sum of the amount allocated to the 

16 State under paragraph (3)(A) and the amount allo17 cated to the State under subparagraph (3)(B). 

18 (3) ALLOCATION TO STATES.— 

19 (A) ALLOCATION BASED ON PERCENTAGE

20 OF LOW-INCOME BENEFICIARIES.—The amount 

21 allocated to a State under this subparagraph 

from 2 22 ⁄3 of the total amount made available 

23 under paragraph (1) shall be based on the num24 ber of individuals who meet the requirement 

25 under subsection (a)(3)(A)(ii) of section 


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1 1860D–14 of the Social Security Act (42 

2 U.S.C. 1395w–114) but who have not enrolled 

3 to receive a subsidy under such section 1860D– 

4 14 relative to the total number of individuals 

5 who meet the requirement under such sub6 section (a)(3)(A)(ii) in each State, as estimated 

7 by the Secretary. 

8 (B) ALLOCATION BASED ON PERCENTAGE

9 OF RURAL BENEFICIARIES.—The amount allo10 cated to a State under this subparagraph from 

1 11 ⁄3 of the total amount made available under 

12 paragraph (1) shall be based on the number of 

13 part D eligible individuals (as defined in section 

14 1860D–1(a)(3)(A) of such Act (42 U.S.C. 

15 1395w–101(a)(3)(A))) residing in a rural area 

16 relative to the total number of such individuals 

17 in each State, as estimated by the Secretary. 

18 (4) PORTION OF GRANT BASED ON PERCENT19 AGE OF LOW-INCOME BENEFICIARIES TO BE USED

20 TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY

21 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE

22 FOR THE MEDICARE SAVINGS PROGRAM.—Each 

23 grant awarded under this subsection with respect to 

24 amounts allocated under paragraph (3)(A) shall be 

25 used to provide outreach to individuals who may be 


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1 subsidy eligible individuals (as defined in section 

2 1860D–14(a)(3)(A) of the Social Security Act (42 

3 U.S.C. 1395w–114(a)(3)(A))) or eligible for the pro4 gram of medical assistance for payment of the cost 

5 of medicare cost-sharing under the Medicaid pro6 gram pursuant to sections 1902(a)(10)(E) and 1933 

7 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u–3). 

8 (k) EFFECTIVE DATE.— 

9 (1) IN GENERAL.—Except as provided in para10 graph (2), the amendments and repeal made by this 

11 section take effect on January 1, 2023, and, with re12 spect to title XIX of the Social Security Act, apply 

13 to calendar quarters beginning on or after January 

14 1, 2023. 

15 (2) EXCEPTION FOR STATE LEGISLATION.—In 

16 the case of a State plan for medical assistance under 

17 title XIX of the Social Security Act which the Sec18 retary of Health and Human Services determines re19 quires State legislation (other than legislation appro20 priating funds) in order for the plan to meet the ad21 ditional requirements imposed by the amendments 

22 and repeal made by this section, the State plan shall 

23 not be regarded as failing to comply with the re24 quirements of such title solely on the basis of its 

25 failure to meet these additional requirements before 


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1 the first day of the first calendar quarter beginning 

2 after the close of the first regular session of the 

3 State legislature that begins after the date of the en4 actment of this Act. For purposes of the previous 

5 sentence, in the case of a State that has a 2-year 

6 legislative session, each year of such session shall be 

7 deemed to be a separate regular session of the State 

8 legislature. 

9 SEC. 4108. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

10 PROVIDED BY URBAN INDIAN ORGANIZA11 TIONS. 

12 (a) IN GENERAL.—The third sentence of section 

13 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 

14 is amended by striking ‘‘for the 8 fiscal year quarters be15 ginning with the first fiscal year quarter beginning after 

16 the date of the enactment of the American Rescue Plan 

17 Act of 2021,’’ and inserting ‘‘and’’. 

18 (b) EFFECTIVE DATE.—The amendment made by 

19 this section shall apply to medical assistance provided on 

20 or after the date of enactment of this Act. 


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1 SEC. 4109. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

2 PROVIDED TO A NATIVE HAWAIIAN THROUGH 

3 A FEDERALLY QUALIFIED HEALTH CENTER 

4 OR A NATIVE HAWAIIAN HEALTH CARE SYS5 TEM UNDER THE MEDICAID PROGRAM. 

6 (a) IN GENERAL.—The third sentence of section 

7 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 

8 is amended by striking ‘‘, for such 8 fiscal year quarters’’. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 this section shall apply to medical assistance provided on 

11 or after the date of enactment of this Act. 

12 SEC. 4110. REPEAL OF REQUIREMENT FOR ESTATE RECOV13 ERY UNDER THE MEDICAID PROGRAM. 

14 Section 1917 of the Social Security Act (42 U.S.C. 

15 1396p) is amended— 

16 (1) in subsection (a)— 

17 (A) by amending paragraph (1) to read as 

18 follows: 

19 ‘‘(1) No lien may be imposed against the prop20 erty of any individual prior to his death on account 

21 of medical assistance paid or to be paid on his behalf 

22 under the State plan, except pursuant to the judg23 ment of a court on account of benefits incorrectly 

24 paid on behalf of such individual.’’; 

25 (B) by striking paragraph (2); 


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1 (C) in paragraph (3), by striking ‘‘(1)(B)’’ 

2 and inserting ‘‘(1)’’; and 

3 (D) by redesignating paragraph (3) as 

4 paragraph (2); and 

5 (2) by amending subsection (b) to read as fol6 lows: 

7 ‘‘(b) ADJUSTMENT OR RECOVERY OF MEDICAL AS8 SISTANCE CORRECTLY PAID UNDER A STATE PLAN.—No 

9 adjustment or recovery of any medical assistance correctly 

10 paid on behalf of an individual under the State plan may 

11 be made.’’. 

12 SEC. 4111. ALLOW FOR SUSPENSION OF MEDICARE BENE13 FITS AND PREMIUM LIABILITY FOR INDIVID14 UALS WHO ARE INCARCERATED AND PRO15 VIDE A SPECIAL ENROLLMENT PERIOD 

16 AROUND THE DATE OF RELEASE. 

17 (a) SPECIAL ENROLLMENT PERIOD FOR INDIVID18 UALS INCARCERATED AT TIME OF MEDICARE ELIGI19 BILITY.—Section 1837(i) of the Social Security Act (42 

20 U.S.C. 1395p(i)) is amended by adding at the end the fol21 lowing new paragraph: 

22 ‘‘(5)(A) In the case of an individual who— 

23 ‘‘(i) at the time the individual first satis24 fies paragraph (1) or (2) of section 1836(a), is 

25 incarcerated; or 


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1 ‘‘(ii) has elected not to enroll (or to be 

2 deemed enrolled) under this section during the 

3 individual’s initial enrollment period; 

4 there shall be a special enrollment period de5 scribed in subparagraph (B). 

6 ‘‘(B) The special enrollment period re7 ferred to in subparagraph (A) is the 6-month 

8 period beginning on the first day after which 

9 the individual is no longer incarcerated.’’. 

10 (b) PREMIUM AMOUNT.—Section 1839(a) of the So11 cial Security Act (42 U.S.C. 1395r(a)) is amended— 

12 (1) in paragraph (1), in the second sentence, by 

13 striking ‘‘or (7)’’ and inserting ‘‘(7) or (8)’’; and 

14 (2) by adding at the end the following new 

15 paragraph: 

16 ‘‘(8) In the case of an individual whose coverage pe17 riod includes months in which by reason of custody under 

18 penal authority coverage is excluded pursuant to section 

19 1862(a)(3), the premium amount for such months such 

20 individual is in custody under penal authority shall be 

21 zero.’’. 

22 (c) CONFORMING AMENDMENT.—Section 1818(d)(5) 

23 of the Social Security Act (42 U.S.C. 1395i–2(d)(5)) is 

24 amended by adding at the end the following: 


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1 ‘‘(D) In the case of an individual who is a 

2 person who is excluded from coverage pursuant 

3 to section 1862(a)(3) by reason of custody 

4 under penal authority, the amount of the 

5 monthly premium for such individual shall be 

6 zero for any month in which such individual is 

7 in custody under penal authority.’’. 

8 SEC. 4112. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

9 (a) COVERAGE OF PREGNANCY.—The Director of the 

10 Office of Personnel Management shall issue such regula11 tions as are necessary to ensure that pregnancy is consid12 ered a change in family status and a qualifying life event 

13 for an individual who is eligible to enroll, but is not en14 rolled, in a health benefits plan under chapter 89 of title 

15 5, United States Code. 

16 (b) EFFECTIVE DATE.—The requirement in para17 graph (1) shall apply with respect to any contract entered 

18 into under section 8902 of such title beginning 12 months 

19 after the date of enactment of this Act. 

20 SEC. 4113. CONTINUATION OF MEDICAID INCOME ELIGI21 BILITY STANDARD FOR PREGNANT INDIVID22 UALS AND INFANTS. 

23 Section 1902(l)(2)(A) of the Social Security Act (42 

24 U.S.C. 1396a(l)(2)(A)) is amended— 


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1 (1) in clause (i), by striking ‘‘and not more 

2 than 185 percent’’; 

3 (2) in clause (ii)— 

4 (A) in subclause (I), by striking ‘‘and’’ 

5 after the comma; 

6 (B) in subclause (II), by striking the pe7 riod at the end and inserting ‘‘, and’’; and 

8 (C) by adding at the end the following: 

9 ‘‘(III) January 1, 2023, is the 

10 percentage provided under clause 

11 (v).’’; and 

12 (3) by adding at the end the following new 

13 clause: 

14 ‘‘(v) The percentage provided under 

15 clause (ii) for medical assistance provided 

16 on or after January 1, 2023, with respect 

17 to individuals described in subparagraph 

18 (A) or (B) of paragraph (1) shall not be 

19 less than— 

20 ‘‘(I) the percentage specified for 

21 such individuals by the State in an 

22 amendment to its State plan (whether 

23 approved or not) as of January 1, 

24 2014; or 


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1 ‘‘(II) if no such percentage is 

2 specified as of January 1, 2014, the 

3 percentage established for such indi4 viduals under the State’s authorizing 

5 legislation or provided for under the 

6 State’s appropriations as of that 

7 date.’’. 

8 Subtitle C—Expansion of Access 

9 PART 1—GENERAL PROVISIONS 

10 SEC. 4201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

11 ACT. 

12 Title XXXIV of the Public Health Service Act, as 

13 amended by titles I, II, and III of this Act, is further 

14 amended by inserting after subtitle B the following: 

15 ‘‘Subtitle D—Reconstruction and 

16 Improvement Grants for Public 

17 Health Care Facilities Serving 

18 Pacific Islanders and the Insu19 lar Areas 

20 ‘‘SEC. 3441. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

21 INITIATIVES. 

22 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

23 with the Administrator of the Health Resources and Serv24 ices Administration, the Director of the Agency for 

25 Healthcare Research and Quality, and the Administrator 


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•S 4486 IS

1 of the Centers for Medicare & Medicaid Services, shall 

2 award grants to eligible entities for the conduct of dem3 onstration projects to improve the quality of and access 

4 to health care. 

5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

6 under subsection (a), an entity shall— 

7 ‘‘(1) be a health center, hospital, health plan, 

8 health system, community clinic, hospice or palliative 

9 care provider, or other health entity determined ap10 propriate by the Secretary— 

11 ‘‘(A) that, by legal mandate or explicitly 

12 adopted mission, provides patients with access 

13 to services regardless of their ability to pay; 

14 ‘‘(B) that provides care or treatment for a 

15 substantial number of patients who are unin16 sured, are receiving assistance under a State 

17 plan under title XIX of the Social Security Act 

18 (or under a waiver of such plan), or are mem19 bers of vulnerable populations, as determined 

20 by the Secretary; and 

21 ‘‘(C)(i) with respect to which, not less than 

22 50 percent of the entity’s patient population is 

23 made up of racial and ethnic minority groups 

24 (as defined in section 1707(g)(1)); or 

25 ‘‘(ii) that— 


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1 ‘‘(I) serves a disproportionate percent2 age of local patients who are from a racial 

3 and ethnic minority group, or has a patient 

4 population at least 50 percent of which is 

5 composed of individuals with limited 

6 English proficiency; and 

7 ‘‘(II) provides an assurance that 

8 amounts received under the grant will be 

9 used only to support quality improvement 

10 activities in the racial and ethnic minority 

11 population served; and 

12 ‘‘(2) prepare and submit to the Secretary an 

13 application at such time, in such manner, and con14 taining such information as the Secretary may re15 quire. 

16 ‘‘(c) PRIORITY.—In awarding grants under sub17 section (a), the Secretary shall give priority to eligible enti18 ties that— 

19 ‘‘(1) demonstrate an intent to operate as part 

20 of a health care partnership, network, collaborative, 

21 coalition, or alliance where each member entity con22 tributes to the design, implementation, and evalua23 tion of the proposed intervention; or 


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1 ‘‘(2) intend to use funds to carry out system2 wide changes with respect to health care quality im3 provement, including— 

4 ‘‘(A) improved systems for data collection 

5 and reporting; 

6 ‘‘(B) innovative collaborative or similar 

7 processes; 

8 ‘‘(C) group programs with behavioral or 

9 self-management interventions; 

10 ‘‘(D) case management services; 

11 ‘‘(E) physician or patient reminder sys12 tems; 

13 ‘‘(F) educational interventions; 

14 ‘‘(G) comprehensive and patient-centric 

15 health care; 

16 ‘‘(H) creation and distribution of education 

17 materials on available health care options; or 

18 ‘‘(I) other activities determined appropriate 

19 by the Secretary. 

20 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

21 received under a grant under subsection (a) to support 

22 the implementation and evaluation of health care quality 

23 improvement activities or minority health and health care 

24 disparity reduction activities that include— 


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1 ‘‘(1) with respect to health care systems, activi2 ties relating to improving— 

3 ‘‘(A) patient safety; 

4 ‘‘(B) timeliness of care; 

5 ‘‘(C) effectiveness of care; 

6 ‘‘(D) efficiency of care; 

7 ‘‘(E) patient centeredness; 

8 ‘‘(F) health information technology; 

9 ‘‘(G) accessibility and availability of infor10 mation on health care; 

11 ‘‘(H) comprehensiveness of health care; 

12 and 

13 ‘‘(I) patient involvement and choice in 

14 health care; and 

15 ‘‘(2) with respect to patients, activities relating 

16 to— 

17 ‘‘(A) staying healthy; 

18 ‘‘(B) getting well, mentally and physically; 

19 ‘‘(C) living effectively with illness or dis20 ability; 

21 ‘‘(D) preparing for end of life and ensuring 

22 that end-of-life care is accessible and available, 

23 as well as coping with end-of-life issues; and 

24 ‘‘(E) shared decision making. 


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1 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

2 provide financial and other technical assistance to grant3 ees under this section for the development of common data 

4 systems. 

5 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section 

7 such sums as may be necessary for each of fiscal years 

8 2023 through 2030. 

9 ‘‘SEC. 3442. CENTERS OF EXCELLENCE. 

10 ‘‘(a) IN GENERAL.—The Secretary, acting through 

11 the Administrator of the Health Resources and Services 

12 Administration, shall designate centers of excellence at 

13 public hospitals, and other health systems serving large 

14 numbers of minority patients, that— 

15 ‘‘(1) meet the requirements of section 

16 3441(b)(1); 

17 ‘‘(2) demonstrate excellence in providing care to 

18 minority populations; and 

19 ‘‘(3) demonstrate excellence in reducing dispari20 ties in health and health care. 

21 ‘‘(b) REQUIREMENTS.—A hospital or health system 

22 that serves as a center of excellence under subsection (a) 

23 shall— 

24 ‘‘(1) design, implement, and evaluate programs 

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1 cially, ethnically, and linguistically diverse popu2 lations; 

3 ‘‘(2) provide training and technical assistance 

4 to other hospitals and health systems relating to the 

5 provision of high-quality health care to minority pop6 ulations; and 

7 ‘‘(3) develop activities for graduate or con8 tinuing medical education that institutionalize a 

9 focus on cultural competence training for health care 

10 providers. 

11 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to carry out this section, 

13 such sums as may be necessary for each of fiscal years 

14 2023 through 2030. 

15 ‘‘SEC. 3443. RECONSTRUCTION AND IMPROVEMENT GRANTS 

16 FOR PUBLIC HEALTH CARE FACILITIES SERV17 ING PACIFIC ISLANDERS AND THE INSULAR 

18 AREAS. 

19 ‘‘(a) IN GENERAL.—The Secretary shall provide di20 rect financial assistance to designated health care pro21 viders and community health centers in American Samoa, 

22 Guam, the Commonwealth of the Northern Mariana Is23 lands, the United States Virgin Islands, Puerto Rico, and 

24 Hawaii for the purposes of reconstructing and improving 


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1 health care facilities and services in a culturally competent 

2 and sustainable manner. 

3 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi4 nancial assistance under subsection (a), an entity shall be 

5 a public health facility or community health center located 

6 in American Samoa, Guam, the Commonwealth of the 

7 Northern Mariana Islands, the United States Virgin Is8 lands, Puerto Rico, or Hawaii that— 

9 ‘‘(1) is owned or operated by— 

10 ‘‘(A) the Government of American Samoa, 

11 Guam, the Commonwealth of the Northern 

12 Mariana Islands, the United States Virgin Is13 lands, Puerto Rico, or Hawaii or a unit of local 

14 government; or 

15 ‘‘(B) a nonprofit organization; and 

16 ‘‘(2)(A) provides care or treatment for a sub17 stantial number of patients who are uninsured, are 

18 receiving assistance under title XVIII of the Social 

19 Security Act or under a State plan under title XIX 

20 of such Act (or under a waiver of such plan), or are 

21 members of a vulnerable population, as determined 

22 by the Secretary; or 

23 ‘‘(B) serves a disproportionate percentage of 

24 local patients that are from a racial and ethnic mi25 nority group. 


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1 ‘‘(c) REPORT.—Not later than 180 days after the 

2 date of enactment of this title and annually thereafter, the 

3 Secretary shall submit to the Congress and the President 

4 a report that includes an assessment of health resources 

5 and facilities serving populations in American Samoa, 

6 Guam, the Commonwealth of the Northern Mariana Is7 lands, the United States Virgin Islands, Puerto Rico, and 

8 Hawaii. In preparing such report, the Secretary shall— 

9 ‘‘(1) consult with and obtain information on all 

10 health care facilities needs from the entities receiv11 ing direct financial assistance under subsection (a); 

12 ‘‘(2) include all amounts of Federal assistance 

13 received by each such entity in the preceding fiscal 

14 year; 

15 ‘‘(3) review the total unmet needs of health care 

16 facilities serving American Samoa, Guam, the Com17 monwealth of the Northern Mariana Islands, the 

18 United States Virgin Islands, Puerto Rico, and Ha19 waii, including needs for renovation and expansion 

20 of existing facilities; 

21 ‘‘(4) include a strategic plan for addressing the 

22 needs of each such population identified in the re23 port; and 


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1 ‘‘(5) evaluate the effectiveness of the care pro2 vided by measuring patient outcomes and cost meas3 ures. 

4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated such sums as necessary 

6 to carry out this section.’’. 

7 SEC. 4202. BORDER HEALTH GRANTS. 

8 (a) DEFINITIONS.—In this section: 

9 (1) BORDER AREA.—The term ‘‘border area’’ 

10 means the United States-Mexico Border Area, as de11 fined in section 8 of the United States-Mexico Bor12 der Health Commission Act (22 U.S.C. 290n–6). 

13 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti14 ty’’ means an entity that is located in the border 

15 area and is any of the following: 

16 (A) A State, local government, or Tribal 

17 government. 

18 (B) A public institution of higher edu19 cation. 

20 (C) A nonprofit health organization. 

21 (D) A community health center. 

22 (E) A community clinic that is a health 

23 center receiving assistance under section 330 of 

24 the Public Health Service Act (42 U.S.C. 

25 254b). 


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1 (F) A nonprofit organization serving immi2 grants. 

3 (b) AUTHORIZATION.—From funds appropriated pur4 suant to subsection (f), the Secretary of Health and 

5 Human Services (in this section referred to as the ‘‘Sec6 retary’’), acting through the United States members of the 

7 United States-Mexico Border Health Commission, shall 

8 award grants to eligible entities to address priorities and 

9 recommendations to improve the health of border area 

10 residents that are established by— 

11 (1) the United States members of the United 

12 States-Mexico Border Health Commission; 

13 (2) the State border health offices; and 

14 (3) the Secretary. 

15 (c) APPLICATION.—An eligible entity that desires a 

16 grant under subsection (b) shall submit an application to 

17 the Secretary at such time, in such manner, and con18 taining such information as the Secretary may require and 

19 demonstrating the entity’s capacity to provide culturally 

20 and linguistically appropriate services to border area resi21 dents. 

22 (d) USE OF FUNDS.—An eligible entity that receives 

23 a grant under subsection (b) shall use the grant funds 

24 for— 

25 (1) programs relating to— 


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1 (A) maternal and child health; 

2 (B) primary care and preventative health; 

3 (C) public health and public health infra4 structure; 

5 (D) musculoskeletal health and obesity; 

6 (E) health education and promotion; 

7 (F) oral health; 

8 (G) mental and behavioral health; 

9 (H) substance use disorders; 

10 (I) health conditions that have a high prev11 alence in the border area; 

12 (J) medical and health services research; 

13 (K) workforce training and development; 

14 (L) community health workers, patient 

15 navigators, and promotores; 

16 (M) health care infrastructure problems in 

17 the border area (including planning and con18 struction grants); 

19 (N) health disparities in the border area; 

20 (O) environmental health; 

21 (P) outreach and enrollment services with 

22 respect to Federal programs (including pro23 grams authorized under titles XIX and XXI of 

24 the Social Security Act (42 U.S.C. 1396 et seq.; 

25 42 U.S.C. 1397aa et seq.)); 


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1 (Q) end-of-life care; and 

2 (R) addressing social determinants of 

3 health; and 

4 (2) other programs determined appropriate by 

5 the Secretary. 

6 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro7 vided to an eligible entity awarded a grant under sub8 section (b) shall be used to supplement and not supplant 

9 other funds available to the eligible entity to carry out the 

10 activities described in subsection (d). 

11 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to carry out this section, 

13 $200,000,000 for fiscal year 2024, and such sums as may 

14 be necessary for each succeeding fiscal year. 

15 SEC. 4203. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

16 (a) ELIMINATION OF ISOLATION TEST FOR COST17 BASED AMBULANCE REIMBURSEMENT.— 

18 (1) IN GENERAL.—Section 1834(l)(8) of the 

19 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

20 amended— 

21 (A) in subparagraph (B)— 

22 (i) by striking ‘‘owned and’’; and 

23 (ii) by inserting ‘‘(including when 

24 such services are provided by the entity 


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1 under an arrangement with the hospital)’’ 

2 after ‘‘hospital’’; and 

3 (B) by striking the comma at the end of 

4 subparagraph (B) and all that follows and in5 serting a period. 

6 (2) EFFECTIVE DATE.—The amendments made 

7 by this subsection shall apply to services furnished 

8 on or after January 1, 2023. 

9 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE

10 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT

11 REQUIREMENT.— 

12 (1) IN GENERAL.—Section 1820(c)(2) of the 

13 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 

14 amended— 

15 (A) in subparagraph (B)(iii), by striking 

16 ‘‘provides not more than’’ and inserting ‘‘sub17 ject to subparagraph (F), provides not more 

18 than’’; and 

19 (B) by adding at the end the following new 

20 subparagraph: 

21 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED

22 LIMIT REQUIREMENT.— 

23 ‘‘(i) IN GENERAL.—A State may elect 

24 to treat a facility, with respect to the des25 ignation of the facility for a cost reporting 


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1 period, as satisfying the requirement of 

2 subparagraph (B)(iii) relating to a max3 imum number of acute care inpatient beds 

4 if the facility elects, in accordance with a 

5 method specified by the Secretary and be6 fore the beginning of the cost reporting pe7 riod, to meet the requirement under clause 

8 (ii). 

9 ‘‘(ii) ALTERNATE REQUIREMENT.— 

10 The requirement under this clause, with 

11 respect to a facility and a cost reporting 

12 period, is that the total number of inpa13 tient bed days described in subparagraph 

14 (B)(iii) during such period will not exceed 

15 7,300. For purposes of this subparagraph, 

16 an individual who is an inpatient in a bed 

17 in the facility for a single day shall be 

18 counted as one inpatient bed day. 

19 ‘‘(iii) WITHDRAWAL OF ELECTION.— 

20 The option described in clause (i) shall not 

21 apply to a facility for a cost reporting pe22 riod if the facility (for any two consecutive 

23 cost reporting periods during the previous 

24 5 cost-reporting periods) was treated under 

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1 patient bed days for each of such two cost 

2 reporting periods that exceeded the num3 ber specified in such clause.’’. 

4 (2) EFFECTIVE DATE.—The amendments made 

5 by paragraph (1) shall apply to cost reporting peri6 ods beginning on or after the date of the enactment 

7 of this Act. 

8 SEC. 4204. MEDICARE REMOTE MONITORING PILOT 

9 PROJECTS. 

10 (a) PILOT PROJECTS.— 

11 (1) IN GENERAL.—Not later than 9 months 

12 after the date of enactment of this Act, the Sec13 retary of Health and Human Services (in this sec14 tion referred to as the ‘‘Secretary’’) shall conduct 

15 pilot projects under title XVIII of the Social Secu16 rity Act (42 U.S.C. 1395 et seq.) for the purpose of 

17 providing incentives to home health agencies to uti18 lize home monitoring and communications tech19 nologies that— 

20 (A) enhance health and health care out21 comes for Medicare beneficiaries; and 

22 (B) reduce expenditures under such title. 

23 (2) SITE REQUIREMENTS.— 


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1 (A) URBAN AND RURAL.—The Secretary 

2 shall conduct the pilot projects under this sec3 tion in both urban and rural areas. 

4 (B) SITE IN A SMALL STATE.—The Sec5 retary shall conduct at least 3 of the pilot 

6 projects in a State with a population of less 

7 than 1,000,000. 

8 (3) DEFINITION OF HOME HEALTH AGENCY.— 

9 In this section, the term ‘‘home health agency’’ has 

10 the meaning given that term in section 1861(o) of 

11 the Social Security Act (42 U.S.C. 1395x(o)). 

12 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

13 OF PROJECTS.—The Secretary shall specify the criteria 

14 for identifying those Medicare beneficiaries who shall be 

15 considered within the scope of the pilot projects under this 

16 section for purposes of the application of subsection (c) 

17 and for the assessment of the effectiveness of the home 

18 health agency in achieving the objectives of this section. 

19 Such criteria may provide for the inclusion in the projects 

20 of Medicare beneficiaries who begin receiving home health 

21 services under title XVIII of the Social Security Act (42 

22 U.S.C. 1395 et seq.) after the date of the implementation 

23 of the projects. 

24 (c) INCENTIVES.— 


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1 (1) PERFORMANCE TARGETS.—The Secretary 

2 shall establish for each home health agency partici3 pating in a pilot project under this section a per4 formance target using one of the following meth5 odologies, as determined appropriate by the Sec6 retary: 

7 (A) ADJUSTED HISTORICAL PERFORMANCE

8 TARGET.—The Secretary shall establish for the 

9 agency— 

10 (i) a base expenditure amount equal 

11 to the average total payments made to the 

12 agency under parts A and B of title XVIII 

13 of the Social Security Act (42 U.S.C. 1395 

14 et seq.) for Medicare beneficiaries deter15 mined to be within the scope of the pilot 

16 project in a base period determined by the 

17 Secretary; and 

18 (ii) an annual per capita expenditure 

19 target for such beneficiaries, reflecting the 

20 base expenditure amount adjusted for risk 

21 and adjusted growth rates. 

22 (B) COMPARATIVE PERFORMANCE TAR23 GET.—The Secretary shall establish for the 

24 agency a comparative performance target equal 

25 to the average total payments under such parts 


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1 A and B during the pilot project for comparable 

2 individuals in the same geographic area that 

3 are not determined to be within the scope of the 

4 pilot project. 

5 (2) INCENTIVE.—Subject to paragraph (3), the 

6 Secretary shall pay to each participating home care 

7 agency an incentive payment for each year under the 

8 pilot project equal to a portion of the Medicare sav9 ings realized for such year relative to the perform10 ance target under paragraph (1). 

11 (3) LIMITATION ON EXPENDITURES.—The Sec12 retary shall limit incentive payments under this sec13 tion in order to ensure that the aggregate expendi14 tures under title XVIII of the Social Security Act 

15 (42 U.S.C. 1395 et seq.) (including incentive pay16 ments under this subsection) do not exceed the 

17 amount that the Secretary estimates would have 

18 been expended if the pilot projects under this section 

19 had not been implemented. 

20 (d) WAIVER AUTHORITY.—The Secretary may waive 

21 such provisions of titles XI and XVIII of the Social Secu22 rity Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) 

23 as the Secretary determines to be appropriate for the con24 duct of the pilot projects under this section. 


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1 (e) REPORT TO CONGRESS.—Not later than 5 years 

2 after the date that the first pilot project under this section 

3 is implemented, the Secretary shall submit to Congress a 

4 report on the pilot projects. Such report shall contain a 

5 detailed description of issues related to the expansion of 

6 the projects under subsection (f) and recommendations for 

7 such legislation and administrative actions as the Sec8 retary considers appropriate. 

9 (f) EXPANSION.—If the Secretary determines that 

10 any of the pilot projects under this section enhance health 

11 outcomes for Medicare beneficiaries and reduce expendi12 tures under title XVIII of the Social Security Act (42 

13 U.S.C. 1395 et seq.), the Secretary may initiate com14 parable projects in additional areas. 

15 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

16 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen17 tive payment under this section— 

18 (1) shall be in addition to the payments that a 

19 home health agency would otherwise receive under 

20 title XVIII of the Social Security Act for the provi21 sion of home health services; and 

22 (2) shall have no effect on the amount of such 

23 payments. 


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1 SEC. 4205. COMMUNITY HEALTH CENTER COLLABORATIVE 

2 ACCESS EXPANSION. 

3 Section 330(r)(4) of the Public Health Service Act 

4 (42 U.S.C. 254b(r)(4)) is amended— 

5 (1) in subparagraph (A), by striking ‘‘primary 

6 health care services’’ each place it appears and in7 serting ‘‘primary health care and other mental, den8 tal, and physical health services’’; and 

9 (2) in subparagraph (B)— 

10 (A) in clause (i), by striking ‘‘and’’ at the 

11 end; 

12 (B) in clause (ii), by striking the period at 

13 the end and inserting ‘‘; and’’; and 

14 (C) by adding at the end the following: 

15 ‘‘(iii) in the case of a rural health 

16 clinic described in such subparagraph— 

17 ‘‘(I) that such clinic provides, to 

18 the extent possible, enabling services, 

19 such as transportation and language 

20 assistance (including translation and 

21 interpretation); and 

22 ‘‘(II) that the primary health 

23 care and other services described in 

24 such subparagraph are subject to full 

25 reimbursement according to the pro26 spective payment system for Federally 


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1 qualified health center services under 

2 section 1834(o) of the Social Security 

3 Act.’’. 

4 SEC. 4206. FACILITATING THE PROVISION OF TELEHEALTH 

5 SERVICES ACROSS STATE LINES. 

6 (a) IN GENERAL.—For purposes of expediting the 

7 provision of telehealth services, for which payment is made 

8 under the Medicare Program, across State lines, the Sec9 retary of Health and Human Services shall, in consulta10 tion with representatives of States, physicians, health care 

11 practitioners, and patient advocates, encourage and facili12 tate the adoption of provisions allowing for multistate 

13 practitioner practice across State lines. 

14 (b) DEFINITIONS.—In subsection (a): 

15 (1) TELEHEALTH SERVICE.—The term ‘‘tele16 health service’’ has the meaning given that term in 

17 subparagraph (F) of section 1834(m)(4) of the So18 cial Security Act (42 U.S.C. 1395m(m)(4)). 

19 (2) PHYSICIAN, PRACTITIONER.—The terms 

20 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

21 given those terms in subparagraphs (D) and (E), re22 spectively, of section 1834(m)(4) of the Social Secu23 rity Act (42 U.S.C. 1395m(m)(4)). 

24 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

25 Program’’ means the program of health insurance 


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1 administered by the Secretary of Health and Human 

2 Services under title XVIII of the Social Security Act 

3 (42 U.S.C. 1395 et seq.). 

4 SEC. 4207. SCORING OF PREVENTIVE HEALTH SAVINGS. 

5 Section 202 of the Congressional Budget and Im6 poundment Control Act of 1974 (2 U.S.C. 602) is amend7 ed by adding at the end the following: 

8 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 

9 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 

10 Upon a request by the chairman or ranking minority 

11 member of the Committee on the Budget of the Sen12 ate, or by the chairman or ranking minority member 

13 of the Committee on the Budget of the House of 

14 Representatives, the Director shall determine if a 

15 proposed measure would result in reductions in 

16 budget outlays in budgetary outyears through the 

17 use of preventive health and preventive health serv18 ices. 

19 ‘‘(2) PROJECTIONS.—If the Director determines 

20 that a measure would result in substantial reduc21 tions in budget outlays as described in paragraph 

22 (1), the Director— 

23 ‘‘(A) shall include, in any projection pre24 pared by the Director, a description and esti25 mate of the reductions in budget outlays in the 


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1 budgetary outyears and a description of the 

2 basis for such conclusions; and 

3 ‘‘(B) may prepare a budget projection that 

4 includes some or all of the budgetary outyears, 

5 notwithstanding the time periods for projections 

6 described in subsection (e) and sections 308, 

7 402, and 424. 

8 ‘‘(3) DEFINITIONS.—As used in this sub9 section— 

10 ‘‘(A) the term ‘budgetary outyears’ means 

11 the 2 consecutive 10-fiscal-year periods begin12 ning with the first fiscal year that is 10 years 

13 after the budget year provided for in the most 

14 recently agreed to concurrent resolution on the 

15 budget; and 

16 ‘‘(B) the term ‘preventive health’ means an 

17 action that focuses on the health of the public, 

18 individuals, and defined populations in order to 

19 protect, promote, and maintain health, wellness, 

20 and functional ability, and prevent disease, dis21 ability, and premature death that is dem22 onstrated by credible and publicly available epi23 demiological projection models, incorporating 

24 clinical trials or observational studies in hu25 mans, to avoid future health care costs.’’. 


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1 SEC. 4208. SENSE OF CONGRESS ON MAINTENANCE OF EF2 FORT PROVISIONS REGARDING CHILDREN’S 

3 HEALTH. 

4 It is the sense of the Congress that— 

5 (1) the maintenance of effort provisions added 

6 to sections 1902 and 2105(d) of the Social Security 

7 Act (42 U.S.C. 1396a; 42 U.S.C. 1397ee(d)) by sec8 tions 2001(b) and 2101(b) of the Patient Protection 

9 and Affordable Care Act were intended to maintain 

10 the eligibility standards for the Medicaid program 

11 under title XIX of the Social Security Act (42 

12 U.S.C. 1396 et seq.) and Children’s Health Insur13 ance Program under title XXI of such Act (42 

14 U.S.C. 1397aa et seq.) to protect vulnerable and dis15 abled adults, children, and senior citizens, many of 

16 whom are also members of communities of color; 

17 (2) the maintenance of effort provisions for 

18 children’s coverage have been extended by the Con19 gress through September 30, 2027; 

20 (3) the maintenance of effort provisions ensure 

21 the continued success of the Medicaid program and 

22 Children’s Health Insurance Program and were in23 tended to specifically protect vulnerable and disabled 

24 children, many of whom are also members of com25 munities of color; and 


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1 (4) the maintenance of effort provisions must 

2 be strictly enforced and proposals to weaken or 

3 waive the maintenance of effort provisions must not 

4 be considered. 

5 SEC. 4209. PROTECTION OF THE HHS OFFICES OF MINOR6 ITY HEALTH. 

7 (a) IN GENERAL.—Pursuant to section 1707A of the 

8 Public Health Service Act (42 U.S.C. 300u–6a), the Of9 fices of Minority Health established within the Centers for 

10 Disease Control and Prevention, the Health Resources 

11 and Services Administration, the Substance Abuse and 

12 Mental Health Services Administration, the Agency for 

13 Healthcare Research and Quality, the Food and Drug Ad14 ministration, and the Centers for Medicare & Medicaid 

15 Services, are offices that, regardless of change in the 

16 structure of the Department of Health and Human Serv17 ices, shall report to the Secretary of Health and Human 

18 Services. 

19 (b) SENSE OF CONGRESS.—It is the sense of the 

20 Congress that the Offices of Minority Health referred to 

21 in subsection (a) play a critical role in addressing health 

22 disparities and should be adequately funded and given a 

23 prominent role in evaluating and establishing health poli24 cies and programs. 


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1 SEC. 4210. OFFICE OF MINORITY HEALTH IN VETERANS 

2 HEALTH ADMINISTRATION OF DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 

5 I of chapter 73 of title 38, United States Code, is amended 

6 by inserting after section 7308 the following new section: 

7 ‘‘§ 7308A. Office of Minority Health 

8 ‘‘(a) ESTABLISHMENT.—There is established in the 

9 Department within the Office of the Under Secretary for 

10 Health an office to be known as the ‘Office of Minority 

11 Health’ (in this section referred to as the ‘Office’). 

12 ‘‘(b) HEAD.—The Director of the Office of Minority 

13 Health shall be the head of the Office. The Director of 

14 the Office of Minority Health shall be appointed by the 

15 Under Secretary for Health from among individuals quali16 fied to perform the duties of the position. 

17 ‘‘(c) FUNCTIONS.—The functions of the Office are as 

18 follows: 

19 ‘‘(1) To establish short-range and long-range 

20 goals and objectives and coordinate all other activi21 ties within the Veterans Health Administration that 

22 relate to disease prevention, health promotion, health 

23 care services delivery, health and health care edu24 cation, health care quality, and health care research 

25 concerning veterans who are members of a racial or 

26 ethnic minority group. 


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1 ‘‘(2) To support research, demonstrations, and 

2 evaluations to test new and innovative models for 

3 the discharge of activities described in paragraph 

4 (1). 

5 ‘‘(3) To increase knowledge and understanding 

6 of health risk factors for veterans who are members 

7 of a racial or ethnic minority group. 

8 ‘‘(4) To develop mechanisms that support bet9 ter health care information dissemination, education, 

10 prevention, and services delivery to veterans from 

11 disadvantaged backgrounds, including veterans who 

12 are members of a racial or ethnic minority group. 

13 ‘‘(5) To enter into contracts or agreements with 

14 appropriate public and nonprofit private entities to 

15 develop and carry out programs to provide bilingual 

16 or interpretive services to assist veterans who are 

17 members of a racial or ethnic minority group and 

18 who lack proficiency in speaking the English lan19 guage in accessing and receiving health care services 

20 through the Veterans Health Administration. 

21 ‘‘(6) To carry out programs to improve access 

22 to health care services through the Veterans Health 

23 Administration for veterans with limited proficiency 

24 in speaking the English language, including the deVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 velopment and evaluation of demonstration and pilot 

2 projects for that purpose. 

3 ‘‘(7) To advise the Under Secretary for Health 

4 on matters relating to the development, implementa5 tion, and evaluation of health professions education 

6 in decreasing disparities in health care outcomes be7 tween veterans who are members of a racial or eth8 nic minority group and other veterans, including cul9 tural competency as a method of eliminating such 

10 health disparities. 

11 ‘‘(8) To perform such other functions and du12 ties as the Secretary or the Under Secretary for 

13 Health considers appropriate. 

14 ‘‘(d) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘racial or ethnic minority group’ 

16 means any of the following: 

17 ‘‘(A) American Indians (including Alaska 

18 Natives, Eskimos, and Aleuts). 

19 ‘‘(B) Asian Americans. 

20 ‘‘(C) Native Hawaiians and Pacific Island21 ers. 

22 ‘‘(D) Blacks. 

23 ‘‘(E) Hispanics. 

24 ‘‘(2) The term ‘Hispanic’ means individuals 

25 whose origin is from Mexico, Puerto Rico, Cuba, 


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1 Central or South America, or any other Spanish2 speaking country.’’. 

3 (b) CLERICAL AMENDMENT.—The table of sections 

4 at the beginning of such subchapter is amended by insert5 ing after the item relating to section 7308 the following 

6 new item: 

‘‘7308A. Office of Minority Health.’’. 

7 SEC. 4211. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 

8 ACCESS FOR LOW-INCOME PATIENTS. 

9 (a) IN GENERAL.—Not later than January 1, 2023, 

10 the Comptroller General of the United States shall con11 duct a study on how amendments made by the Patient 

12 Protection and Affordable Care Act (Public Law 111– 

13 148) and the Health Care and Education Reconciliation 

14 Act of 2010 (Public Law 111–152) to titles XVIII and 

15 XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 

16 42 U.S.C. 1396 et seq.) relating to disproportionate share 

17 hospital adjustment payments under Medicare and Med18 icaid (and subsequent amendments made with respect to 

19 such payments) affect the timely access to health care 

20 services for low-income patients. Such study shall— 

21 (1) evaluate and examine whether States elect22 ing to make medical assistance available under sec23 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 

24 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 

25 States making such an election through a waiver of 


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1 the State plan) to individuals described in such sec2 tion mitigate the need for payments to dispropor3 tionate share hospitals under section 1886(d)(5)(F) 

4 of the Social Security Act (42 U.S.C. 

5 1395ww(d)(5)(F)) and section 1923 of such Act (42 

6 U.S.C. 1396r–4), including the impact of such 

7 States electing to make medical assistance available 

8 to such individuals on— 

9 (A) the number of individuals in the 

10 United States who are without health insurance 

11 and the distribution of such individuals in rela12 tion to areas primarily served by dispropor13 tionate share hospitals; and 

14 (B) the low-income utilization rate of such 

15 hospitals and the resulting fiscal sustainability 

16 of such hospitals; 

17 (2) evaluate the appropriate level and distribu18 tion of such payments among such disproportionate 

19 share hospitals for purposes of— 

20 (A) sufficiently accounting for the level of 

21 uncompensated care provided by such hospitals 

22 to low-income patients; and 

23 (B) providing timely access to health care 

24 services for individuals in medically underserved 

25 areas; and 


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1 (3) assess, with respect to such disproportionate 

2 share hospitals— 

3 (A) the role played by such hospitals in 

4 providing critical access to emergency, inpa5 tient, and outpatient health services, including 

6 end-of-life services, as well as the location of 

7 such hospitals in relation to medically under8 served areas; and 

9 (B) the extent to which such hospitals sat10 isfy the requirements established for charitable 

11 hospital organizations under section 501(r) of 

12 the Internal Revenue Code of 1986 with respect 

13 to community health needs assessments, finan14 cial assistance policy requirements, limitations 

15 on charges, and billing and collection require16 ments. 

17 (b) REPORTS.— 

18 (1) REPORT TO CONGRESS.—Not later than 

19 180 days after the date on which the study under 

20 subsection (a) is completed, the Comptroller General 

21 of the United States shall submit to the Committee 

22 on Energy and Commerce of the House of Rep23 resentatives and the Committee on Finance of the 

24 Senate a report that contains— 

25 (A) the results of the study; 


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1 (B) recommendations to Congress for any 

2 legislative changes to the payments to dis3 proportionate share hospitals under section 

4 1886(d)(5)(F) of the Social Security Act (42 

5 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 

6 such Act (42 U.S.C. 1396r–4) that are needed 

7 to ensure access to health services for low-in8 come patients that— 

9 (i) are based on the number of indi10 viduals without health insurance, the 

11 amount of uncompensated care provided by 

12 such hospitals, and the impact of reduced 

13 payment levels on low-income communities; 

14 and 

15 (ii) takes into account any reports 

16 submitted by the Secretary of the Treas17 ury, in consultation with the Secretary of 

18 Health and Human Services, to congres19 sional committees regarding the costs in20 curred by charitable hospital organizations 

21 for charity care, bad debt, nonreimbursed 

22 expenses for services provided to individ23 uals under the Medicare program under 

24 title XVIII of the Social Security Act and 

25 the Medicaid program under title XIX of 


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1 such Act, and any community benefit ac2 tivities provided by such organizations. 

3 (2) REPORT TO THE SECRETARY OF HEALTH

4 AND HUMAN SERVICES.—Not later than 180 days 

5 after the date on which the study under subsection 

6 (a) is completed, the Comptroller General of the 

7 United States shall submit to the Secretary of 

8 Health and Human Services a report that con9 tains— 

10 (A) the results of the study; and 

11 (B) any recommendations for purposes of 

12 assisting in the development of the methodology 

13 for the adjustment of payments to dispropor14 tionate share hospitals, as required under sec15 tion 1886(r) of the Social Security Act (42 

16 U.S.C. 1395ww(r)) and the reduction of such 

17 payments under section 1923(f)(7) of such Act 

18 (42 U.S.C. 1396r–4(f)(7)), taking into account 

19 the reports referred to in paragraph (1)(B)(ii). 

20 SEC. 4212. REAUTHORIZATION OF PROGRAMS UNDER THE 

21 NATIVE HAWAIIAN HEALTH CARE IMPROVE22 MENT ACT. 

23 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 

24 Section 6(h)(1) of the Native Hawaiian Health Care Im25 provement Act (42 U.S.C. 11705(h)(1)) is amended by 


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1 striking ‘‘may be necessary for fiscal years 1993 through 

2 2019’’ and inserting ‘‘are necessary’’. 

3 (b) ADMINISTRATIVE GRANT FOR PAPA OLA

4 LOKAHI.—Section 7(b) of the Native Hawaiian Health 

5 Care Improvement Act (42 U.S.C. 11706(b)) is amended 

6 by striking ‘‘may be necessary for fiscal years 1993 

7 through 2019’’ and inserting ‘‘are necessary’’. 

8 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 

9 Section 10(c) of the Native Hawaiian Health Care Im10 provement Act (42 U.S.C. 11709(c)) is amended by strik11 ing ‘‘may be necessary for fiscal years 1993 through 

12 2019’’ and inserting ‘‘are necessary’’. 

13 PART 2—RURAL 

14 SEC. 4221. ESTABLISHMENT OF RURAL COMMUNITY HOS15 PITAL (RCH) PROGRAM. 

16 (a) IN GENERAL.—Section 1861 of the Social Secu17 rity Act (42 U.S.C. 1395x), as amended by section 

18 2007(b)(1), is amended by adding at the end of the fol19 lowing new subsection: 

20 ‘‘Rural Community Hospital; Rural Community Hospital 

21 Services 

22 ‘‘(mmm)(1) The term ‘rural community hospital’ 

23 means a hospital (as defined in subsection (e)) that— 


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1 ‘‘(A) is located in a rural area (as defined in 

2 section 1886(d)(2)(D)) or treated as being so lo3 cated pursuant to section 1886(d)(8)(E); 

4 ‘‘(B) subject to paragraph (2), has less than 51 

5 acute care inpatient beds, as reported in its most re6 cent cost report; 

7 ‘‘(C) makes available 24-hour emergency care 

8 services; 

9 ‘‘(D) subject to paragraph (3), has a provider 

10 agreement in effect with the Secretary and is open 

11 to the public as of January 1, 2010; and 

12 ‘‘(E) applies to the Secretary for such designa13 tion. 

14 ‘‘(2) For purposes of paragraph (1)(B), beds in a 

15 psychiatric or rehabilitation unit of the hospital which is 

16 a distinct part of the hospital shall not be counted. 

17 ‘‘(3) Paragraph (1)(D) shall not be construed to pro18 hibit any of the following from qualifying as a rural com19 munity hospital: 

20 ‘‘(A) A replacement facility (as defined by the 

21 Secretary in regulations in effect on January 1, 

22 2012) with the same service area (as defined by the 

23 Secretary in regulations in effect on such date). 

24 ‘‘(B) A facility obtaining a new provider num25 ber pursuant to a change of ownership. 


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1 ‘‘(C) A facility which has a binding written 

2 agreement with an outside, unrelated party for the 

3 construction, reconstruction, lease, rental, or financ4 ing of a building as of January 1, 2012. 

5 ‘‘(4) Nothing in this subsection shall be construed as 

6 prohibiting a critical access hospital from qualifying as a 

7 rural community hospital if the critical access hospital 

8 meets the conditions otherwise applicable to hospitals 

9 under subsection (e) and section 1866. 

10 ‘‘(5) Nothing in this subsection shall be construed as 

11 prohibiting a rural community hospital participating in 

12 the demonstration program under section 410A of the 

13 Medicare Prescription Drug, Improvement, and Mod14 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

15 2313) from qualifying as a rural community hospital if 

16 the rural community hospital meets the conditions other17 wise applicable to hospitals under subsection (e) and sec18 tion 1866.’’. 

19 (b) PAYMENT.— 

20 (1) INPATIENT HOSPITAL SERVICES.—Section 

21 1814 of the Social Security Act (42 U.S.C. 1395f) 

22 is amended by adding at the end the following new 

23 subsection: 


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1 ‘‘Payment for Inpatient Services Furnished in Rural 

2 Community Hospitals 

3 ‘‘(m) The amount of payment under this part for in4 patient hospital services furnished in a rural community 

5 hospital, other than such services furnished in a psy6 chiatric or rehabilitation unit of the hospital which is a 

7 distinct part, is, at the election of the hospital in the appli8 cation referred to in section 1861(mmm)(1)(E)— 

9 ‘‘(1) 101 percent of the reasonable costs of pro10 viding such services, without regard to the amount 

11 of the customary or other charge, or 

12 ‘‘(2) the amount of payment provided for under 

13 the prospective payment system for inpatient hos14 pital services under section 1886(d).’’. 

15 (2) OUTPATIENT SERVICES.—Section 1834 of 

16 the Social Security Act (42 U.S.C. 1395m) is 

17 amended by adding at the end the following new 

18 subsection: 

19 ‘‘(z) PAYMENT FOR OUTPATIENT SERVICES FUR20 NISHED IN RURAL COMMUNITY HOSPITALS.—The 

21 amount of payment under this part for outpatient services 

22 furnished in a rural community hospital is, at the election 

23 of the hospital in the application referred to in section 

24 1861(mmm)(1)(E)— 


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1 ‘‘(1) 101 percent of the reasonable costs of pro2 viding such services, without regard to the amount 

3 of the customary or other charge and any limitation 

4 under section 1861(v)(1)(U), or 

5 ‘‘(2) the amount of payment provided for under 

6 the prospective payment system for covered OPD 

7 services under section 1833(t).’’. 

8 (3) EXEMPTION FROM 30-PERCENT REDUCTION

9 IN REIMBURSEMENT FOR BAD DEBT.—Section 

10 1861(v)(1)(T) of the Social Security Act (42 U.S.C. 

11 1395x(v)(1)(T)) is amended by inserting ‘‘(other 

12 than for a rural community hospital)’’ after ‘‘In de13 termining such reasonable costs for hospitals’’. 

14 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT

15 SERVICES.—Section 1834(z) of the Social Security Act (as 

16 added by subsection (b)(2)) is amended— 

17 (1) by redesignating paragraphs (1) and (2) as 

18 subparagraphs (A) and (B), respectively; 

19 (2) by inserting ‘‘(1)’’ after ‘‘(z)’’; and 

20 (3) by adding at the end the following: 

21 ‘‘(2) The amounts of beneficiary cost-sharing for out22 patient services furnished in a rural community hospital 

23 under this part shall be as follows: 

24 ‘‘(A) For items and services that would have 

25 been paid under section 1833(t) if furnished by a 


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1 hospital, the amount of cost-sharing determined 

2 under paragraph (8) of such section. 

3 ‘‘(B) For items and services that would have 

4 been paid under section 1833(h) if furnished by a 

5 provider of services or supplier, no cost-sharing shall 

6 apply. 

7 ‘‘(C) For all other items and services, the 

8 amount of cost-sharing that would apply to the item 

9 or service under the methodology that would be used 

10 to determine payment for such item or service if pro11 vided by a physician, provider of services, or sup12 plier, as the case may be.’’. 

13 (d) CONFORMING AMENDMENTS.— 

14 (1) PART A PAYMENT.—Section 1814(b) of the 

15 Social Security Act (42 U.S.C. 1395f(b)) is amended 

16 in the matter preceding paragraph (1) by inserting 

17 ‘‘other than inpatient hospital services furnished by 

18 a rural community hospital,’’ after ‘‘critical access 

19 hospital services,’’. 

20 (2) PART B PAYMENT.—Section 1833(a) of the 

21 Social Security Act (42 U.S.C. 1395l(a)), as amend22 ed by section 207(b)(3), is amended— 

23 (A) by striking ‘‘and’’ at the end of para24 graph (9); 


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1 (B) by striking the period at the end of 

2 paragraph (10) and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following: 

4 ‘‘(11) in the case of outpatient services fur5 nished by a rural community hospital, the amounts 

6 described in section 1834(z).’’. 

7 (3) TECHNICAL AMENDMENTS.— 

8 (A) CONSULTATION WITH STATE AGEN9 CIES.—Section 1863 of the Social Security Act 

10 (42 U.S.C. 1395z) is amended by striking ‘‘and 

11 (dd)(2)’’ and inserting ‘‘(dd)(2), and 

12 (mmm)(1)’’. 

13 (B) PROVIDER AGREEMENTS.—Section 

14 1866(a)(2)(A) of the Social Security Act (42 

15 U.S.C. 1395cc(a)(2)(A)) is amended by insert16 ing ‘‘section 1834(z)(2),’’ after ‘‘section 

17 1833(b),’’. 

18 (e) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply to items and services furnished on 

20 or after October 1, 2022. 

21 SEC. 4222. RURAL HEALTH QUALITY ADVISORY COMMIS22 SION AND DEMONSTRATION PROJECTS. 

23 (a) RURAL HEALTH QUALITY ADVISORY COMMIS24 SION.— 


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1 (1) ESTABLISHMENT.—Not later than 6 

2 months after the date of the enactment of this sec3 tion, the Secretary of Health and Human Services 

4 (in this section referred to as the ‘‘Secretary’’) shall 

5 establish a commission to be known as the Rural 

6 Health Quality Advisory Commission (in this section 

7 referred to as the ‘‘Commission’’). 

8 (2) DUTIES OF COMMISSION.— 

9 (A) NATIONAL PLAN.—The Commission 

10 shall develop, coordinate, and facilitate imple11 mentation of a national plan for rural health 

12 quality improvement. The national plan shall— 

13 (i) identify objectives for rural health 

14 quality improvement; 

15 (ii) identify strategies to eliminate 

16 known gaps in rural health system capacity 

17 and improve rural health quality; and 

18 (iii) provide recommendations for 

19 Federal programs to identify opportunities 

20 for strengthening and aligning policies and 

21 programs to improve rural health quality. 

22 (B) DEMONSTRATION PROJECTS.—The 

23 Commission shall design demonstration projects 

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1 ment, including with respect to both personal 

2 and population health. 

3 (C) MONITORING.—The Commission shall 

4 monitor progress toward the objectives identi5 fied pursuant to subparagraph (A)(i). 

6 (3) MEMBERSHIP.— 

7 (A) NUMBER.—The Commission shall be 

8 composed of 11 members appointed by the Sec9 retary. 

10 (B) SELECTION.—The Secretary shall se11 lect the members of the Commission from 

12 among individuals with significant rural health 

13 care and health care quality expertise, including 

14 expertise in clinical health care, health care 

15 quality research, end-of-life care, population or 

16 public health, or purchaser organizations. 

17 (4) CONTRACTING AUTHORITY.—Subject to the 

18 availability of funds, the Commission may enter into 

19 contracts and make other arrangements, as may be 

20 necessary to carry out the duties described in para21 graph (2). 

22 (5) STAFF.—Upon the request of the Commis23 sion, the Secretary may detail, on a reimbursable 

24 basis, any of the personnel of the Office of Rural 

25 Health Policy of the Health Resources and Services 


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1 Administration, the Agency for Healthcare Research 

2 and Quality, or the Centers for Medicare & Medicaid 

3 Services to the Commission to assist in carrying out 

4 this subsection. 

5 (6) REPORTS TO CONGRESS.—Not later than 1 

6 year after the establishment of the Commission, and 

7 annually thereafter, the Commission shall submit a 

8 report to the Congress on rural health quality. Each 

9 such report shall include the following: 

10 (A) An inventory of relevant programs and 

11 recommendations for improved coordination and 

12 integration of policy and programs. 

13 (B) An assessment of achievement of the 

14 objectives identified in the national plan devel15 oped under paragraph (2) and recommenda16 tions for realizing such objectives. 

17 (C) Recommendations on Federal legisla18 tion, regulations, or administrative policies to 

19 enhance rural health quality and outcomes. 

20 (b) RURAL HEALTH QUALITY DEMONSTRATION

21 PROJECTS.— 

22 (1) IN GENERAL.—Not later than 270 days 

23 after the date of the enactment of this section, the 

24 Secretary, in consultation with the Rural Health 

25 Quality Advisory Commission, the Office of Rural 


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1 Health Policy of the Health Resources and Services 

2 Administration, the Agency for Healthcare Research 

3 and Quality, and the Centers for Medicare & Med4 icaid Services, shall make grants to eligible entities 

5 for a total of 5 demonstration projects to implement 

6 and evaluate methods for improving the quality of 

7 health care in rural communities. Each such dem8 onstration project shall include— 

9 (A) alternative community models that— 

10 (i) will achieve greater integration of 

11 personal and population health services; 

12 and 

13 (ii) address safety, effectiveness, 

14 patient- or community-centeredness, timeli15 ness, efficiency, and equity (the 6 aims 

16 identified by the National Academy of 

17 Medicine (formerly known as the ‘‘Institute 

18 of Medicine’’) in its report entitled ‘‘Cross19 ing the Quality Chasm: A New Health Sys20 tem for the 21st Century’’ released on 

21 March 1, 2001); 

22 (B) innovative approaches to the financing 

23 and delivery of health care services to achieve 

24 rural health quality and accessibility goals for 

25 patients; and 


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1 (C) development of quality improvement 

2 support structures to assist rural health sys3 tems and professionals in the provision of 

4 health care (such as workforce support struc5 tures, quality monitoring and reporting, clinical 

6 care protocols, and information technology ap7 plications). 

8 (2) ELIGIBLE ENTITIES.—In this subsection, 

9 the term ‘‘eligible entity’’ means a consortium 

10 that— 

11 (A) shall include— 

12 (i) at least one health care provider or 

13 health care delivery system located in a 

14 rural area; and 

15 (ii) at least one organization rep16 resenting multiple community stakeholders; 

17 and 

18 (B) may include other partners such as 

19 rural research centers. 

20 (3) CONSULTATION.—In developing the pro21 gram for awarding grants under this subsection, the 

22 Secretary shall consult with the Administrator of the 

23 Agency for Healthcare Research and Quality, rural 

24 health care providers, rural health care researchers, 


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1 and private and nonprofit groups (including national 

2 associations) which are undertaking similar efforts. 

3 (4) EXPEDITED WAIVERS.—The Secretary shall 

4 expedite the processing of any waiver that— 

5 (A) is authorized under title XVIII or XIX 

6 of the Social Security Act (42 U.S.C. 1395 et 

7 seq.; 42 U.S.C. 1396 et seq.); and 

8 (B) is necessary to carry out a demonstra9 tion project under this subsection. 

10 (5) DEMONSTRATION PROJECT SITES.—The 

11 Secretary shall ensure that the 5 demonstration 

12 projects funded under this subsection are conducted 

13 at a variety of sites representing the diversity of 

14 rural communities in the United States. 

15 (6) DURATION.—Each demonstration project 

16 under this subsection shall be for a period of 4 

17 years. 

18 (7) INDEPENDENT EVALUATION.—The Sec19 retary shall enter into an arrangement with an enti20 ty that has experience working directly with rural 

21 health systems for the conduct of an independent 

22 evaluation of the program carried out under this 

23 subsection. 

24 (8) REPORT.—Not later than 1 year after the 

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1 ed under this subsection, the Secretary shall submit 

2 a report to the Congress on the results of such 

3 projects. The report shall include— 

4 (A) an evaluation of patient access to care, 

5 patient outcomes, and an analysis of the cost6 effectiveness of each such project; and 

7 (B) recommendations on Federal legisla8 tion, regulations, or administrative policies to 

9 enhance rural health quality and outcomes. 

10 (c) APPROPRIATION.— 

11 (1) IN GENERAL.—Out of funds in the Treas12 ury not otherwise appropriated, there are appro13 priated to the Secretary to carry out this section 

14 $30,000,000 for the period of fiscal years 2023 

15 through 2027. 

16 (2) AVAILABILITY.— 

17 (A) IN GENERAL.—Funds appropriated 

18 under paragraph (1) shall remain available for 

19 expenditure through fiscal year 2027. 

20 (B) REPORT.—For purposes of carrying 

21 out subsection (b)(8), funds appropriated under 

22 paragraph (1) shall remain available for ex23 penditure through fiscal year 2028. 


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1 (3) RESERVATION.—Of the amount appro2 priated under paragraph (1), the Secretary shall re3 serve— 

4 (A) $5,000,000 to carry out subsection (a); 

5 and 

6 (B) $25,000,000 to carry out subsection 

7 (b), of which— 

8 (i) 2 percent shall be for the provision 

9 of technical assistance to grant recipients; 

10 and 

11 (ii) 5 percent shall be for independent 

12 evaluation under subsection (b)(7). 

13 SEC. 4223. RURAL HEALTH CARE SERVICES. 

14 Section 330A of the Public Health Service Act (42 

15 U.S.C. 254c) is amended to read as follows: 

16 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 

17 RURAL HEALTH NETWORK DEVELOPMENT, 

18 DELTA RURAL DISPARITIES AND HEALTH 

19 SYSTEMS DEVELOPMENT, AND SMALL RURAL 

20 HEALTH CARE PROVIDER QUALITY IMPROVE21 MENT GRANT PROGRAMS. 

22 ‘‘(a) PURPOSE.—The purpose of this section is to 

23 provide for grants— 

24 ‘‘(1) under subsection (b), to promote rural 

25 health care services outreach; 


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1 ‘‘(2) under subsection (c), to provide for the 

2 planning and implementation of integrated health 

3 care networks in rural areas; 

4 ‘‘(3) under subsection (d), to assist rural com5 munities in the Delta Region to reduce health dis6 parities and to promote and enhance health system 

7 development; and 

8 ‘‘(4) under subsection (e), to provide for the 

9 planning and implementation of small rural health 

10 care provider quality improvement activities. 

11 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH

12 GRANTS.— 

13 ‘‘(1) GRANTS.—The Director of the Office of 

14 Rural Health Policy of the Health Resources and 

15 Services Administration (referred to in this section 

16 as the ‘Director’) may award grants to eligible enti17 ties to promote rural health care services outreach 

18 by expanding the delivery of health care services to 

19 include new and enhanced services in rural areas. 

20 The Director may award the grants for periods of 

21 not more than 3 years. 

22 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

23 grant under this subsection for a project, an enti24 ty— 


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1 ‘‘(A) shall be a rural public or rural non2 profit private entity, a facility that qualifies as 

3 a rural health clinic under title XVIII of the 

4 Social Security Act, a public or nonprofit entity 

5 existing exclusively to provide services to mi6 grant and seasonal farm workers in rural areas, 

7 or a Tribal government whose grant-funded ac8 tivities will be conducted within federally recog9 nized Tribal areas; 

10 ‘‘(B) shall represent a consortium com11 posed of members— 

12 ‘‘(i) that include 3 or more independ13 ently owned health care entities; and 

14 ‘‘(ii) that may be nonprofit or for15 profit entities; and 

16 ‘‘(C) shall not previously have received a 

17 grant under this subsection for the same or a 

18 similar project, unless the entity is proposing to 

19 expand the scope of the project or the area that 

20 will be served through the project. 

21 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

22 grant under this subsection, an eligible entity shall 

23 prepare and submit to the Director an application at 

24 such time, in such manner, and containing such in25 formation as the Director may require, including— 


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1 ‘‘(A) a description of the project that the 

2 eligible entity will carry out using the funds 

3 provided under the grant; 

4 ‘‘(B) a description of the manner in which 

5 the project funded under the grant will meet 

6 the health care needs of rural populations in 

7 the local community or region to be served; 

8 ‘‘(C) a plan for quantifying how health 

9 care needs will be met through identification of 

10 the target population and benchmarks of service 

11 delivery or health status, such as— 

12 ‘‘(i) quantifiable measurements of 

13 health and health care status improvement 

14 for projects focusing on health promotion; 

15 or 

16 ‘‘(ii) benchmarks of increased access 

17 to primary and end-of-life care, including 

18 tracking factors such as the number and 

19 type of primary and end-of-life care visits, 

20 identification of a medical home, or other 

21 general measures of such access; 

22 ‘‘(D) a description of how the local com23 munity or region to be served will be involved 

24 in the development and ongoing operations of 

25 the project; 


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1 ‘‘(E) a plan for sustaining the project after 

2 Federal support for the project has ended; 

3 ‘‘(F) a description of how the project will 

4 be evaluated; 

5 ‘‘(G) the administrative capacity to submit 

6 annual performance data electronically as speci7 fied by the Director; and 

8 ‘‘(H) other such information as the Direc9 tor determines to be appropriate. 

10 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT

11 GRANTS.— 

12 ‘‘(1) GRANTS.— 

13 ‘‘(A) IN GENERAL.—The Director may 

14 award rural health network development grants 

15 to eligible entities to promote, through planning 

16 and implementation, the development of inte17 grated health care networks that have combined 

18 the functions of the entities participating in the 

19 networks in order to— 

20 ‘‘(i) achieve efficiencies and economies 

21 of scale; 

22 ‘‘(ii) expand access to, coordinate, and 

23 improve the quality of the health care de24 livery system through development of orga25 nizational efficiencies; 


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1 ‘‘(iii) implement health information 

2 technology to achieve efficiencies, reduce 

3 medical errors, and improve quality; 

4 ‘‘(iv) coordinate care and manage 

5 chronic and terminal illness; and 

6 ‘‘(v) strengthen the rural health care 

7 system as a whole and across all facets of 

8 the health care delivery system, including 

9 end-of-life care, in such a manner as to 

10 show a quantifiable return on investment 

11 to the participants in the network. 

12 ‘‘(B) GRANT PERIODS.—The Director may 

13 award such a rural health network development 

14 grant— 

15 ‘‘(i) for a period of 3 years for imple16 mentation activities; or 

17 ‘‘(ii) for a period of 1 year for plan18 ning activities to assist in the initial devel19 opment of an integrated health care net20 work, if the proposed participants in the 

21 network do not have a history of collabo22 rative efforts and a 3-year grant would be 

23 inappropriate. 

24 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

25 grant under this subsection, an entity— 


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1 ‘‘(A) shall be a rural public or rural non2 profit private entity, a facility that qualifies as 

3 a rural health clinic under title XVIII of the 

4 Social Security Act, a public or nonprofit entity 

5 existing exclusively to provide services to mi6 grant and seasonal farm workers in rural areas, 

7 or a Tribal government whose grant-funded ac8 tivities will be conducted within federally recog9 nized Tribal areas; 

10 ‘‘(B) shall represent a network composed 

11 of participants— 

12 ‘‘(i) that include 3 or more independ13 ently owned health care entities; and 

14 ‘‘(ii) that may be nonprofit or for15 profit entities; and 

16 ‘‘(C) shall not previously have received a 

17 grant under this subsection (other than a 1- 

18 year grant for planning activities) for the same 

19 or a similar project. 

20 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

21 grant under this subsection, an eligible entity, in 

22 consultation with the appropriate State office of 

23 rural health or another appropriate State entity, 

24 shall prepare and submit to the Director an applica25 tion at such time, in such manner, and containing 


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1 such information as the Director may require, in2 cluding— 

3 ‘‘(A) a description of the project that the 

4 eligible entity will carry out using the funds 

5 provided under the grant; 

6 ‘‘(B) an explanation of the reasons why 

7 Federal assistance is required to carry out the 

8 project; 

9 ‘‘(C) a description of— 

10 ‘‘(i) the history of collaborative activi11 ties carried out by the participants in the 

12 network; 

13 ‘‘(ii) the degree to which the partici14 pants are ready to integrate their func15 tions; and 

16 ‘‘(iii) how the local community or re17 gion to be served will benefit from and be 

18 involved in the activities carried out by the 

19 network; 

20 ‘‘(D) a description of how the local com21 munity or region to be served will experience in22 creased access to quality health care services 

23 across the continuum of care as a result of the 

24 integration activities carried out by the net25 work, including a description of— 


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1 ‘‘(i) return on investment for the com2 munity and the network members; and 

3 ‘‘(ii) other quantifiable performance 

4 measures that show the benefit of the net5 work activities; 

6 ‘‘(E) a plan for sustaining the project after 

7 Federal support for the project has ended; 

8 ‘‘(F) a description of how the project will 

9 be evaluated; 

10 ‘‘(G) the administrative capacity to submit 

11 annual performance data electronically as speci12 fied by the Director; and 

13 ‘‘(H) other such information as the Direc14 tor determines to be appropriate. 

15 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS16 TEMS DEVELOPMENT GRANTS.— 

17 ‘‘(1) GRANTS.—The Director may award grants 

18 to eligible entities to support reduction of health dis19 parities, improve access to health care, and enhance 

20 rural health system development in the Delta Re21 gion. 

22 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

23 grant under this subsection, an entity shall be a 

24 rural public or rural nonprofit private entity, a facil25 ity that qualifies as a rural health clinic under title 


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1 XVIII of the Social Security Act, a public or non2 profit entity existing exclusively to provide services 

3 to migrant and seasonal farm workers in rural 

4 areas, or a Tribal government whose grant-funded 

5 activities will be conducted within federally recog6 nized Tribal areas. 

7 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

8 grant under this subsection, an eligible entity shall 

9 prepare and submit to the Director an application at 

10 such time, in such manner, and containing such in11 formation as the Director may require, including— 

12 ‘‘(A) a description of the project that the 

13 eligible entity will carry out using the funds 

14 provided under the grant; 

15 ‘‘(B) an explanation of the reasons why 

16 Federal assistance is required to carry out the 

17 project; 

18 ‘‘(C) a description of the manner in which 

19 the project funded under the grant will meet 

20 the health care needs of the Delta Region; 

21 ‘‘(D) a description of how the local com22 munity or region to be served will experience in23 creased access to quality health care services as 

24 a result of the activities carried out by the enti25 ty; 


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1 ‘‘(E) a description of how health dispari2 ties will be reduced or the health system will be 

3 improved; 

4 ‘‘(F) a plan for sustaining the project after 

5 Federal support for the project has ended; 

6 ‘‘(G) a description of how the project will 

7 be evaluated including process and outcome 

8 measures related to the quality of care provided 

9 or how the health care system improves its per10 formance; 

11 ‘‘(H) a description of how the grantee will 

12 develop an advisory group made up of rep13 resentatives of the communities to be served to 

14 provide guidance to the grantee to best meet 

15 community need; and 

16 ‘‘(I) other such information as the Director 

17 determines to be appropriate. 

18 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL19 ITY IMPROVEMENT GRANTS.— 

20 ‘‘(1) GRANTS.—The Director may award grants 

21 to provide for the planning and implementation of 

22 small rural health care provider quality improvement 

23 activities. The Director may award the grants for 

24 periods of 1 to 3 years. 


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1 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

2 under this subsection, an entity— 

3 ‘‘(A) shall be— 

4 ‘‘(i) a rural public or rural nonprofit 

5 private health care provider or provider of 

6 health care services, such as a rural health 

7 clinic; or 

8 ‘‘(ii) another rural provider or net9 work of small rural providers identified by 

10 the Director as a key source of local care; 

11 and 

12 ‘‘(B) shall not previously have received a 

13 grant under this subsection for the same or a 

14 similar project. 

15 ‘‘(3) PREFERENCE.—In awarding grants under 

16 this subsection, the Director shall give preference to 

17 facilities that qualify as rural health clinics under 

18 title XVIII of the Social Security Act. 

19 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

20 grant under this subsection, an eligible entity shall 

21 prepare and submit to the Director an application at 

22 such time, in such manner, and containing such in23 formation as the Director may require, including— 


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1 ‘‘(A) a description of the project that the 

2 eligible entity will carry out using the funds 

3 provided under the grant; 

4 ‘‘(B) an explanation of the reasons why 

5 Federal assistance is required to carry out the 

6 project; 

7 ‘‘(C) a description of the manner in which 

8 the project funded under the grant will assure 

9 continuous quality improvement in the provision 

10 of services by the entity; 

11 ‘‘(D) a description of how the local com12 munity or region to be served will experience in13 creased access to quality health care services as 

14 a result of the activities carried out by the enti15 ty; 

16 ‘‘(E) a plan for sustaining the project after 

17 Federal support for the project has ended; 

18 ‘‘(F) a description of how the project will 

19 be evaluated including process and outcome 

20 measures related to the quality of care pro21 vided; and 

22 ‘‘(G) other such information as the Direc23 tor determines to be appropriate. 

24 ‘‘(f) GENERAL REQUIREMENTS.— 


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1 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 

2 that receives a grant under this section may not use 

3 funds provided through the grant— 

4 ‘‘(A) to build or acquire real property; or 

5 ‘‘(B) for construction. 

6 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 

7 The Director shall coordinate activities carried out 

8 under grant programs described in this section, to 

9 the extent practicable, with Federal and State agen10 cies and nonprofit organizations that are operating 

11 similar grant programs, to maximize the effect of 

12 public dollars in funding meritorious proposals. 

13 ‘‘(g) REPORT.—Not later than September 30, 2024, 

14 the Secretary shall prepare and submit to the appropriate 

15 committees of Congress a report on the progress and ac16 complishments of the grant programs described in sub17 sections (b), (c), (d), and (e). 

18 ‘‘(h) DEFINITION OF DELTA REGION.—In this sec19 tion, the term ‘Delta Region’ has the meaning given to 

20 the term ‘region’ in section 382A of the Consolidated 

21 Farm and Rural Development Act (7 U.S.C. 2009aa). 

22 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section 

24 such sums as may be necessary for each of fiscal years 

25 2024 through 2027.’’. 


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1 PART 3—INDIAN COMMUNITIES 

2 SEC. 4231. ASSISTANT SECRETARY OF THE INDIAN HEALTH 

3 SERVICE. 

4 (a) REFERENCES.—Any reference in a law, regula5 tion, document, paper, or other record of the United 

6 States to the Director of the Indian Health Service shall 

7 be deemed to be a reference to the Assistant Secretary 

8 of the Indian Health Service. 

9 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 

10 United States Code, is amended, in the matter relating 

11 to the Assistant Secretaries of Health and Human Serv12 ices, by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall 

13 be the Assistant Secretary of the Indian Health Service’’. 

14 (c) CONFORMING AMENDMENT.—Section 5316 of 

15 title 5, United States Code, is amended by striking ‘‘Direc16 tor, Indian Health Service, Department of Health and 

17 Human Services.’’. 

18 SEC. 4232. EXTENSION OF FULL FEDERAL MEDICAL ASSIST19 ANCE PERCENTAGE TO INDIAN HEALTH 

20 CARE PROVIDERS. 

21 Section 1905 of the Social Security Act (42 U.S.C. 

22 1396d) is amended— 

23 (1) in subsection (a), by amending paragraph 

24 (9) to read as follows: 

25 ‘‘(9) clinic services furnished by or under the 

26 direction of a physician, without regard to whether 


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1 the clinic itself is administered by a physician, in2 cluding— 

3 ‘‘(A) such services furnished outside the 

4 clinic by clinic personnel to an eligible indi5 vidual who does not reside in a permanent 

6 dwelling or does not have a fixed home or mail7 ing address; and 

8 ‘‘(B) such services furnished outside the 

9 clinic by any Indian Health Service facility, a 

10 health program or facility operated by a tribe or 

11 tribal organization under the Indian Self-Deter12 mination Act (Public Law 93–638), or an 

13 urban Indian organization receiving funds 

14 under title V of the Indian Health Care Im15 provement Act;’’; and 

16 (2) in subsection (b), by inserting after ‘‘Papa 

17 Ola Lokahi under section 8 of such Act’’ the fol18 lowing: ‘‘; the Federal medical assistance percentage 

19 shall also be 100 per centum with respect to 

20 amounts expended as medical assistance for services 

21 which are received by an Indian Health Service facil22 ity, a health program or facility operated by a tribe 

23 or tribal organization under the Indian Self-Deter24 mination Act (Public Law 93–638), or an urban InVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 dian organization receiving funds under title V of 

2 the Indian Health Care Improvement Act’’. 

3 SEC. 4233. CONFERRING WITH URBAN INDIAN ORGANIZA4 TIONS. 

5 Section 514 of the Indian Health Care Improvement 

6 Act (25 U.S.C. 1660d) is amended by striking subsection 

7 (b) and inserting the following: 

8 ‘‘(b) REQUIREMENT.—The Secretary shall ensure 

9 that the Service and other agencies and offices of the De10 partment and the Department of Veterans Affairs confer, 

11 to the maximum extent practicable, with urban Indian or12 ganizations in carrying out— 

13 ‘‘(1) this Act; and 

14 ‘‘(2) other provisions of law relating to Indian 

15 health care.’’. 

16 PART 4—PROVIDERS 

17 SEC. 4241. AVAILABILITY OF NON-ENGLISH LANGUAGE 

18 SPEAKING PROVIDERS. 

19 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa20 tient Protection and Affordable Care Act (42 U.S.C. 

21 18031(c)(1)(B)) is amended by inserting before the semi22 colon the following: ‘‘and the ability of such provider to 

23 provide care in a language other than English either 

24 through the provider speaking such language or by the 

25 provider having a qualified interpreter for an individual 


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1 with limited English proficiency (as defined in section 

2 3400 of such Act) who speaks such language available 

3 during office hours’’. 

4 (b) EFFECTIVE DATE.—The amendment made by 

5 subsection (a) shall not apply to any plan beginning on 

6 or prior to the date that is 1 year after the date of the 

7 enactment of this Act. 

8 SEC. 4242. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 

9 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 

10 1311(c)(1)(C) of the Patient Protection and Affordable 

11 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 

12 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 

13 (2) by adding at the end the following new 

14 clauses: 

15 ‘‘(ii) not later than January 1, 2023, in16 crease the percentage of essential community 

17 providers as described in clause (i) included in 

18 its network by 10 percent annually (based on 

19 the level in the plan for 2016) until 90 percent 

20 of all federally qualified health centers and 75 

21 percent of all other such essential community 

22 providers in the contract service area are in-net23 work; and 

24 ‘‘(iii) include at least one essential commu25 nity provider in each of the essential community 


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1 provider categories described in section 

2 156.235(a)(2)(ii)(B) of title 45, Code of Fed3 eral Regulations (as in effect on the date of en4 actment of the Health Equity and Account5 ability Act of 2022), in each county in the serv6 ice area, where available;’’. 

7 (b) REPORTING REQUIREMENTS.—Section 

8 1311(e)(3) of the Patient Protection and Affordable Care 

9 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 

10 end the following new subparagraph: 

11 ‘‘(E) DATA ON ESSENTIAL COMMUNITY

12 PROVIDERS.—The Secretary shall require quali13 fied health plans to submit annually to the Sec14 retary data on the percentage of essential com15 munity providers as described in clause (ii) of 

16 subsection (c)(1)(C), by county, that contract 

17 with each qualified health plan offered in that 

18 county and the percentage of such essential 

19 community providers, by category as described 

20 in clause (iii) of such subsection, that contract 

21 with each qualified health plan offered in that 

22 county. Such data shall be made available to 

23 the general public.’’. 

24 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS

25 APPLIED UNDER MEDICARE AND MEDICAID.— 


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1 (1) MEDICARE.—Section 1852(d)(1) of the So2 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 

3 amended— 

4 (A) by striking ‘‘and’’ at the end of sub5 paragraph (D); 

6 (B) by striking the period at the end of 

7 subparagraph (E) and inserting ‘‘; and’’; and 

8 (C) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(F) the plan meets the requirements of 

11 clauses (ii) and (iii) of section 1311(c)(1)(C) of 

12 the Patient Protection and Affordable Care Act 

13 (relating to inclusion in networks of essential 

14 community providers).’’. 

15 (2) MEDICAID.—Section 1932(b)(5) of the So16 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 

17 amended— 

18 (A) by striking ‘‘and’’ at the end of sub19 paragraph (A); 

20 (B) by striking the period at the end of 

21 subparagraph (B) and inserting ‘‘; and’’; and 

22 (C) by adding at the end the following new 

23 subparagraph: 

24 ‘‘(C) meets the requirements of clauses (ii) 

25 and (iii) of section 1311(c)(1)(C) of the Patient 


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1 Protection and Affordable Care Act (relating to 

2 inclusion in networks of essential community 

3 providers) with respect to services offered in the 

4 service area involved.’’. 

5 SEC. 4243. PROVIDER NETWORK ADEQUACY IN COMMU6 NITIES OF COLOR. 

7 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa8 tient Protection and Affordable Care Act (42 U.S.C. 

9 18031(c)(1)(B)), as amended by section 4241(a), is fur10 ther amended— 

11 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 

12 (2) by adding at the end the following new 

13 clauses: 

14 ‘‘(ii) meet such network adequacy stand15 ards as the Secretary may establish with regard 

16 to— 

17 ‘‘(I) appointment wait time; 

18 ‘‘(II) travel time and distance to 

19 health care provider facilities and providers 

20 by public and private transit; 

21 ‘‘(III) hours of operation to accommo22 date individuals who cannot come to pro23 vider appointments during standard busi24 ness hours; 


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1 ‘‘(IV) availability of health care op2 tions for patients; and 

3 ‘‘(V) other network adequacy stand4 ards to ensure that care through these 

5 plans is accessible to diverse communities, 

6 including individuals with limited English 

7 proficiency as defined in section 3400 of 

8 such Act; and 

9 ‘‘(iii) provide coverage for services for en10 rollees through out-of-network providers at no 

11 additional cost to the enrollees in cases where 

12 in-network providers are unable to comply with 

13 the standards established under subclause (III) 

14 or (IV) of clause (ii) for such services and the 

15 out-of-network providers can deliver such serv16 ices in compliance with such standards;’’. 

17 (b) EFFECTIVE DATE.—The amendments made by 

18 subsection (a) shall not apply to plans beginning on or 

19 prior to the date that is 1 year after the date of the enact20 ment of the Health Equity and Accountability Act of 

21 2022. 

22 PART 5—DENTAL 

23 SEC. 4251. IMPROVING ACCESS TO DENTAL CARE. 

24 (a) REPORTS TO CONGRESS.— 


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1 (1) GAO REPORTS.—Not later than 1 year 

2 after the date of the enactment of this Act, the 

3 Comptroller General of the United States shall sub4 mit to Congress— 

5 (A) a report on the Alaska Dental Health 

6 Aide Therapists program and the Dental Ther7 apist and Advanced Dental Therapist programs 

8 in Minnesota, to assess the effectiveness of den9 tal therapists in— 

10 (i) improving access to timely dental 

11 care among communities of color; 

12 (ii) providing high-quality care; 

13 (iii) providing culturally competent 

14 care; and 

15 (iv) providing accessible care to people 

16 with disabilities; 

17 (B) a report on State variations in the use 

18 of dental hygienists and the effectiveness of ex19 panding the scope of practice for dental hygien20 ists in— 

21 (i) improving access to timely dental 

22 care among communities of color; 

23 (ii) providing high-quality care; 

24 (iii) providing culturally competent 

25 care; and 


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1 (iv) providing accessible care to people 

2 with disabilities; and 

3 (C) a report on the use of telehealth serv4 ices to enhance services provided by dental hy5 gienists and therapists, including recommenda6 tions for any modifications to the Medicare pro7 gram under title XVIII of the Social Security 

8 Act (42 U.S.C. 1395 et seq.) and the Medicaid 

9 program under title XIX of such Act (42 

10 U.S.C. 1396 et seq.) to better provide for tele11 health consultations in conjunction with thera12 pists’ and hygienists’ care. 

13 (2) HRSA REPORT ON DENTAL SHORTAGE

14 AREAS.—Not later than 1 year after the date of the 

15 enactment of this Act, the Secretary of Health and 

16 Human Services, acting through the Administrator 

17 of the Health Resources and Services Administra18 tion, shall submit to Congress a report which details 

19 geographic dental access shortages and the pre20 paredness of dental providers to offer culturally and 

21 linguistically appropriate, affordable, accessible, and 

22 timely services. 

23 (b) EXPANSION OF DENTAL HEALTH AID THERA24 PISTS IN TRIBAL AND URBAN INDIAN COMMUNITIES.— 


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1 Section 119 of the Indian Health Care Improvement Act 

2 (25 U.S.C. 1616l) is amended— 

3 (1) in subsection (d)— 

4 (A) by striking paragraph (2) and insert5 ing the following: 

6 ‘‘(2) REQUIREMENT; EXCLUSION.—Subject to 

7 paragraphs (3) and (4), in establishing a national 

8 program under paragraph (1), the Secretary— 

9 ‘‘(A) shall not reduce the amounts pro10 vided for the Community Health Aide Program 

11 described in subsections (a) and (b); 

12 ‘‘(B) shall exclude dental health aide thera13 pist services from services covered under such 

14 Program; and 

15 ‘‘(C) shall include urban Indian organiza16 tions.’’; and 

17 (B) in paragraph (3), by striking ‘‘or tribal 

18 organization’’ each place it appears and insert19 ing ‘‘, tribal organization, or urban Indian orga20 nization’’; and 

21 (2) in subsection (e), by striking ‘‘or a tribal or22 ganization’’ and inserting ‘‘a tribal organization, or 

23 an urban Indian organization’’. 

24 (c) COVERAGE OF DENTAL SERVICES UNDER THE

25 MEDICARE PROGRAM.— 


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1 (1) COVERAGE.—Section 1861(s)(2) of the So2 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend3 ed— 

4 (A) in subparagraph (GG), by striking 

5 ‘‘and’’ at the end; 

6 (B) in subparagraph (HH), by striking the 

7 period at the end and inserting ‘‘; and’’; and 

8 (C) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(II) dental and oral health services (as defined 

11 in subsection (nnn));’’. 

12 (2) DENTAL AND ORAL HEALTH SERVICES DE13 FINED.—Section 1861 of the Social Security Act (42 

14 U.S.C. 1395x), as amended by sections 2007(b) and 

15 4221(a), is amended by adding at the end the fol16 lowing new subsection: 

17 ‘‘Dental and Oral Health Services 

18 ‘‘(nnn)(1) The term ‘dental and oral health services’ 

19 means services (as defined by the Secretary) that are nec20 essary to prevent disease and promote oral health, restore 

21 oral structures to health and function, and treat emer22 gency conditions, including— 

23 ‘‘(A) routine diagnostic and preventive care 

24 such as dental cleanings, exams, and x-rays; 


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1 ‘‘(B) basic dental services such as fillings and 

2 extractions; 

3 ‘‘(C) major dental services such as root canals, 

4 crowns, and dentures; 

5 ‘‘(D) emergency dental care; and 

6 ‘‘(E) other necessary services related to dental 

7 and oral health (as defined by the Secretary). 

8 ‘‘(2) For purposes of paragraph (1), such term shall 

9 include mobile and portable oral health services (as de10 fined by the Secretary) that— 

11 ‘‘(A) are provided for the purpose of over12 coming mobility, transportation, and access barriers 

13 for individuals; and 

14 ‘‘(B) satisfy the standards and certification re15 quirements established under section 1902(a)(82)(B) 

16 for the State in which the services are provided.’’. 

17 (3) PAYMENT AND COINSURANCE.—Section 

18 1833(a)(1) of the Social Security Act (42 U.S.C. 

19 1395l(a)(1)) is amended— 

20 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 

21 (B) by inserting before the semicolon at 

22 the end the following: ‘‘and (EE) with respect 

23 to dental and oral health services (as defined in 

24 section 1861(nnn)), the amount paid shall be 

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1 tive, 100 percent of the lesser of the actual 

2 charge for the services or the amount deter3 mined under the payment basis determined 

4 under section 1848, and (ii) in the case of all 

5 other such services, 80 percent of the lesser of 

6 the actual charge for the services or the amount 

7 determined under the payment basis determined 

8 under section 1848’’. 

9 (4) PAYMENT UNDER PHYSICIAN FEE SCHED10 ULE.—Section 1848(j)(3) of the Social Security Act 

11 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

12 ‘‘, (2)(II),’’ after ‘‘(including administration of the 

13 health risk assessment)’’. 

14 (5) DENTURES.—Section 1861(s)(8) of the So15 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend16 ed— 

17 (A) by striking ‘‘(other than dental)’’ and 

18 inserting ‘‘(including dentures)’’; and 

19 (B) by striking ‘‘internal body’’. 

20 (6) REPEAL OF GROUND FOR EXCLUSION.— 

21 Section 1862(a) of the Social Security Act (42 

22 U.S.C. 1395y) is amended by striking paragraph 

23 (12). 


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1 (7) EFFECTIVE DATE.—The amendments made 

2 by this section shall apply to services furnished on 

3 or after January 1, 2023. 

4 (d) REQUIRING COVERAGE OF DENTAL SERVICES

5 FOR ADULTS UNDER THE MEDICAID PROGRAM.— 

6 (1) MANDATORY COVERAGE.— 

7 (A) IN GENERAL.— 

8 (i) REQUIREMENT.—Section 

9 1902(a)(10)(A) of the Social Security Act 

10 (42 U.S.C. 1396a(a)(10)(A)) is amended 

11 by inserting ‘‘, (10)’’ after ‘‘(5)’’. 

12 (ii) EFFECTIVE DATE.—The amend13 ment made by clause (i) shall apply with 

14 respect to medical assistance furnished in 

15 calendar quarters beginning on or after the 

16 date that is 1 year after the date of the en17 actment of this Act. 

18 (B) BENCHMARK COVERAGE.—Section 

19 1937(b)(5) of the Social Security Act (42 

20 U.S.C. 1396u–7(b)(5)) is amended by striking 

21 the period and inserting ‘‘, and, beginning with 

22 the first quarter beginning on or after the date 

23 of the enactment of the Health Equity and Ac24 countability Act of 2022, coverage of dental and 


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1 oral health services (as defined in section 

2 1905(kk)).’’. 

3 (2) DEFINITION OF SERVICES.—Section 1905 

4 of the Social Security Act (42 U.S.C. 1396d), as 

5 amended by section 4107, is further amended— 

6 (A) in subsection (a)(10), by striking ‘‘den7 tal services’’ and inserting ‘‘dental and oral 

8 health services (as defined in subsection 

9 (kk)(1))’’; and 

10 (B) by adding at the end the following new 

11 subsection: 

12 ‘‘(kk) DENTAL AND ORAL HEALTH SERVICES.—(1) 

13 For purposes of this title, the term ‘dental and oral health 

14 services’ means services necessary to prevent disease and 

15 promote oral health, restore oral structures to health and 

16 function, reduce oral pain, and treat emergency oral condi17 tions. Such term includes the services specified in para18 graph (2). 

19 ‘‘(2) For purposes of paragraph (1), the services 

20 specified in this paragraph are the following: 

21 ‘‘(A) Routine diagnostic and preventive care 

22 (such as dental cleanings, exams, and x-rays). 

23 ‘‘(B) Basic dental services (such as fillings and 

24 extractions) and major dental services (such as root 

25 canals, crowns, and dentures). 


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1 ‘‘(C) Emergency dental care. 

2 ‘‘(D) Temporomandibular (TMD) and orofacial 

3 pain disorder treatment. 

4 ‘‘(E) Other necessary services related to dental 

5 and oral health (as specified by the Secretary).’’. 

6 ‘‘(3) For purposes of paragraph (1), such term shall 

7 not include dental care or services provided to individuals 

8 under the age of 21 under subsection (r)(3).’’. 

9 (3) CONFORMING AMENDMENTS.— 

10 (A) STATE PLAN REQUIREMENTS.—Section 

11 1902(a) of the Social Security Act (42 U.S.C. 

12 1396a(a)) is amended— 

13 (i) in paragraph (10)(A), in the mat14 ter preceding clause (i), by inserting 

15 ‘‘(10),’’ after ‘‘(5),’’; 

16 (ii) in paragraph (86), by striking 

17 ‘‘and’’ at the end; 

18 (iii) in paragraph (87), by striking the 

19 period at the end and inserting ‘‘; and’’; 

20 and 

21 (iv) by inserting after paragraph (87) 

22 the following: 

23 ‘‘(88) provide for— 

24 ‘‘(A) informing, in writing, all individuals 

25 who have been determined to be eligible for 


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1 medical assistance of the availability of dental 

2 and oral health services (as defined in section 

3 1905(kk)); 

4 ‘‘(B) conducting targeted outreach to preg5 nant women who have been determined to be el6 igible for medical assistance about the avail7 ability of medical assistance for such dental 

8 services and the importance of receiving dental 

9 care while pregnant; and 

10 ‘‘(C) establishing and maintaining stand11 ards for and certification of mobile and portable 

12 oral health services (as described in section 

13 1905(r)(3)(C)).’’. 

14 (B) DEFINITION OF MEDICAL ASSIST15 ANCE.—Section 1905(a)(12) of the Social Secu16 rity Act (42 U.S.C. 1396d(a)(12)) is amended 

17 by striking ‘‘, dentures,’’. 

18 (4) MOBILE AND PORTABLE ORAL HEALTH

19 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 

20 Social Security Act (42 U.S.C. 1396d(r)(3)) is 

21 amended— 

22 (A) in subparagraph (A)(ii), by striking ‘‘; 

23 and’’ and inserting a semicolon; 

24 (B) in subparagraph (B), by striking the 

25 period at the end and inserting ‘‘; and’’; and 


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1 (C) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(C) which shall include mobile and port4 able oral health services (as defined by the Sec5 retary) that— 

6 ‘‘(i) are provided for the purpose of 

7 overcoming mobility, transportation, or ac8 cess barriers for children; and 

9 ‘‘(ii) satisfy the standards and certifi10 cation requirements established under sec11 tion 1902(a)(88)(C) for the State in which 

12 the services are provided.’’. 

13 (5) ENHANCED FMAP; MAINTENANCE OF EF14 FORT.— 

15 (A) MEDICAID.—Section 1905 of the So16 cial Security Act (42 U.S.C. 1396d), as amend17 ed by paragraph (2), is further amended— 

18 (i) in subsection (b), by striking ‘‘and 

19 (ii)’’ and inserting ‘‘(ii), and (ll)’’; and 

20 (ii) by adding at the end of the fol21 lowing new subsection: 

22 ‘‘(ll) INCREASED FMAP FOR EXPENDITURES FOR

23 DENTAL AND ORAL HEALTH SERVICES.— 

24 ‘‘(1) IN GENERAL.—The Federal medical assist25 ance percentage with respect to amounts expended 


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1 by such State for medical assistance consisting of 

2 dental and oral health services (as defined in sub3 section (kk)) furnished during the first calendar 

4 quarter beginning on or after the date that is 1 year 

5 after the date of the enactment of this subsection or 

6 during any subsequent quarter) to individuals 21 

7 years of age or older shall be equal to, in the case 

8 of such services furnished— 

9 ‘‘(A) during the 3-year period beginning on 

10 the first day of such first calendar year, 100 

11 percent; 

12 ‘‘(B) during the 1-year period immediately 

13 following the period described in subparagraph 

14 (A), 95 percent; 

15 ‘‘(C) during each subsequent 1-year period 

16 (through the third such subsequent period), the 

17 percentage specified under this paragraph for 

18 the preceding 1-year period, reduced by 5 per19 centage points; and 

20 ‘‘(D) during any quarter beginning after 

21 the 7-year period beginning on the first day de22 scribed in subparagraph (A), 80 percent. 

23 ‘‘(2) NO REDUCTION IN FMAP.—Paragraph (1) 

24 shall not apply with respect to amounts expended by 

25 a State if the Federal medical assistance percentage 


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1 otherwise applicable to such amounts without appli2 cation of such paragraph would be higher than such 

3 percentage available to such amounts with applica4 tion of such paragraph.’’. 

5 (6) EXCLUSION OF AMOUNTS ATTRIBUTABLE

6 TO INCREASED FMAP FROM TERRITORIAL CAPS.— 

7 Section 1108 of the Social Security Act (42 U.S.C. 

8 1308), as amended by section 4101(a), is amend9 ed— 

10 (A) in subsection (f), in the matter pre11 ceding paragraph (1), by striking ‘‘subsections 

12 (g), (h), and (i)’’; and 

13 (B) by adding at the end the following: 

14 ‘‘(j) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB15 UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN16 TAL AND ORAL SERVICES.—Any payment made to a terri17 tory for expenditures for medical assistance that are sub18 ject to an increase in the Federal medical assistance per19 centage applicable to such expenditures under section 

20 1905(ll) shall not be taken into account for purposes of 

21 applying payment limits under subsections (f) and (g) to 

22 the extent that such payment exceeds the amount of the 

23 payment that would have been made to the territory for 

24 such expenditures without regard to such section.’’. 


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1 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL

2 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro3 tection and Affordable Care Act (42 U.S.C. 18022(b)), as 

4 amended by section 2013(a), is further amended— 

5 (1) in paragraph (1)— 

6 (A) in subparagraph (J), by striking ‘‘oral 

7 and’’; and 

8 (B) by adding at the end the following: 

9 ‘‘(K) Oral health services for children and 

10 adults.’’; and 

11 (2) by adding at the end the following: 

12 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 

13 of paragraph (1)(K), the term ‘oral health services’ 

14 means services (as defined by the Secretary) that 

15 are necessary to prevent any oral disease and pro16 mote oral health, restore oral structures to health 

17 and function, and treat emergency oral conditions.’’. 

18 (f) DEMONSTRATION PROGRAM ON TRAINING AND

19 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

20 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

21 VETERANS IN RURAL AND OTHER UNDERSERVED COM22 MUNITIES.— 

23 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

24 The Secretary of Veterans Affairs may carry out a 

25 demonstration program to establish programs to 


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1 train and employ alternative dental health care pro2 viders in order to increase access to dental health 

3 care services for veterans who are entitled to such 

4 services from the Department of Veterans Affairs 

5 and reside in rural and other underserved commu6 nities. 

7 (2) TELEHEALTH.—For purposes of alternative 

8 dental health care providers and other dental care 

9 providers who are licensed to provide clinical care, 

10 dental services provided under the demonstration 

11 program under this subsection may be administered 

12 by such providers through telehealth-enabled collabo13 ration and supervision when appropriate and fea14 sible. 

15 (3) ALTERNATIVE DENTAL HEALTH CARE PRO16 VIDERS DEFINED.—In this subsection, the term ‘‘al17 ternative dental health care providers’’ has the 

18 meaning given that term in section 340G–1(a)(2) of 

19 the Public Health Service Act (42 U.S.C. 256g– 

20 1(a)(2)). 

21 (4) AUTHORIZATION OF APPROPRIATIONS.— 

22 There are authorized to be appropriated such sums 

23 as are necessary to carry out the demonstration pro24 gram under this subsection. 


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1 (g) DEMONSTRATION PROGRAM ON TRAINING AND

2 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

3 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

4 MEMBERS OF THE ARMED FORCES AND DEPENDENTS

5 LACKING READY ACCESS TO SUCH SERVICES.— 

6 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

7 The Secretary of Defense may carry out a dem8 onstration program to establish programs to train 

9 and employ alternative dental health care providers 

10 in order to increase access to dental health care 

11 services for members of the Armed Forces and their 

12 dependents who lack ready access to such services, 

13 including the following: 

14 (A) Members and dependents who reside in 

15 rural areas or areas otherwise underserved by 

16 dental health care providers. 

17 (B) Members of a reserve component of 

18 the Armed Forces in active status who are po19 tentially deployable. 

20 (2) TELEHEALTH.—For purposes of alternative 

21 dental health care providers and other dental care 

22 providers who are licensed to provide clinical care, 

23 dental services provided under the demonstration 

24 program under this subsection may be administered 

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1 ration and supervision when appropriate and fea2 sible. 

3 (3) DEFINITIONS.—In this subsection: 

4 (A) ACTIVE STATUS.—The term ‘‘active 

5 status’’ has the meaning given that term in sec6 tion 101(d) of title 10, United States Code. 

7 (B) ALTERNATIVE DENTAL HEALTH CARE

8 PROVIDERS.—The term ‘‘alternative dental 

9 health care providers’’ has the meaning given 

10 that term in section 340G–1(a)(2) of the Public 

11 Health Service Act (42 U.S.C. 256g–1(a)(2)). 

12 (4) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated such sums 

14 as are necessary to carry out the demonstration pro15 gram under this subsection. 

16 (h) DEMONSTRATION PROGRAM ON TRAINING AND

17 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

18 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

19 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF

20 PRISONS.— 

21 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

22 The Attorney General, acting through the Director 

23 of the Bureau of Prisons, may carry out a dem24 onstration program to establish programs to train 

25 and employ alternative dental health care providers 


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1 in order to increase access to dental health services 

2 for prisoners within the custody of the Bureau of 

3 Prisons. 

4 (2) TELEHEALTH.—For purposes of alternative 

5 dental health care providers and other dental care 

6 providers who are licensed to provide clinical care, 

7 dental services provided under the demonstration 

8 program under this subsection may be administered 

9 by such providers through telehealth-enabled collabo10 ration and supervision when appropriate and fea11 sible. 

12 (3) ALTERNATIVE DENTAL HEALTH CARE PRO13 VIDERS DEFINED.—In this subsection, the term ‘‘al14 ternative dental health care providers’’ has the 

15 meaning given that term in section 340G–1(a)(2) of 

16 the Public Health Service Act (42 U.S.C. 256g– 

17 1(a)(2)). 

18 (4) AUTHORIZATION OF APPROPRIATIONS.— 

19 There are authorized to be appropriated such sums 

20 as are necessary to carry out the demonstration pro21 gram under this subsection. 

22 (i) DEMONSTRATION PROGRAM ON TRAINING AND

23 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

24 PROVIDERS FOR DENTAL HEALTH CARE SERVICES

25 UNDER THE INDIAN HEALTH SERVICE.— 


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1 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

2 The Secretary of Health and Human Services, act3 ing through the Indian Health Service, may carry 

4 out a demonstration program to establish programs 

5 to train and employ alternative dental health care 

6 providers in order to help eliminate oral health dis7 parities and increase access to dental services 

8 through health programs operated by the Indian 

9 Health Service, Indian tribes, tribal organizations, 

10 and Urban Indian organizations. 

11 (2) TELEHEALTH.—For purposes of alternative 

12 dental health care providers and other dental care 

13 providers who are licensed to provide clinical care, 

14 dental services provided under the demonstration 

15 program under this subsection may be administered 

16 by such providers through telehealth-enabled collabo17 ration and supervision when appropriate and fea18 sible. 

19 (3) DEFINITIONS.—In this subsection: 

20 (A) ALTERNATIVE DENTAL HEALTH CARE

21 PROVIDERS DEFINED.—The term ‘‘alternative 

22 dental health care providers’’ has the meaning 

23 given that term in section 340G–1(a)(2) of the 

24 Public Health Service Act (42 U.S.C. 256g– 

25 1(a)(2)). 


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1 (B) INDIAN HEALTH CARE IMPROVEMENT

2 ACT.—The terms ‘‘Indian tribe’’, ‘‘tribal organi3 zation’’, and ‘‘Urban Indian organization’’ have 

4 the meaning given the terms in section 4 of the 

5 Indian Health Care Improvement Act (25 

6 U.S.C. 1603). 

7 (4) AUTHORIZATION OF APPROPRIATIONS.— 

8 There are authorized to be appropriated such sums 

9 as are necessary to carry out the demonstration pro10 gram under this subsection. 

11 SEC. 4252. ORAL HEALTH LITERACY AND AWARENESS CAM12 PAIGN. 

13 The Public Health Service Act is amended by insert14 ing after section 340G–1 of such Act (42 U.S.C. 256g– 

15 1) the following: 

16 ‘‘SEC. 340G–2. ORAL HEALTH LITERACY AND AWARENESS. 

17 ‘‘(a) CAMPAIGN.—The Secretary, acting through the 

18 Administrator of the Health Resources and Services Ad19 ministration, shall establish a public education campaign 

20 (referred to in this subsection as the ‘campaign’) across 

21 all relevant programs of the Health Resources and Serv22 ices Administration (including the health center program, 

23 oral health workforce programs, maternal and child health 

24 programs, the Ryan White HIV/AIDS Program, and rural 


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1 health programs) to increase oral health literacy and 

2 awareness. 

3 ‘‘(b) STRATEGIES.—In carrying out the campaign, 

4 the Secretary shall identify oral health literacy and aware5 ness strategies that are evidence based and focused on oral 

6 health care education, including education on prevention 

7 of oral disease such as early childhood and other caries, 

8 periodontal disease, and oral cancer. 

9 ‘‘(c) FOCUS.—The Secretary shall design the cam10 paign to communicate directly with specific populations, 

11 including children, pregnant women, parents, the elderly, 

12 individuals with disabilities, and ethnic and racial minority 

13 populations, including Indians, Alaska Natives, and Na14 tive Hawaiians, in a culturally and linguistically appro15 priate manner. 

16 ‘‘(d) OUTCOMES.—In carrying out the campaign, the 

17 Secretary shall include a process for measuring outcomes 

18 and effectiveness. 

19 ‘‘(e) REPORT TO CONGRESS.—Not later than 3 years 

20 after the date of enactment of this section, the Secretary 

21 shall submit to the Committee on Energy and Commerce 

22 of the House of Representatives and the Committee on 

23 Health, Education, Labor, and Pensions of the Senate a 

24 report on the outcomes and effectiveness of the campaign. 


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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 

2 carry out this section, there is authorized to be appro3 priated $750,000 for each of fiscal years 2023 through 

4 2027.’’. 

5 Subtitle D—Advancing Health Eq6 uity Through Payment and De7 livery Reform 

8 SEC. 4301. SENSE OF CONGRESS. 

9 It is the sense of Congress that— 

10 (1) the sustainability of the health care system 

11 in the United States hinges on restructuring how 

12 health care is paid for, shifting away from paying 

13 for the volume of services provided to the value the 

14 services provide; 

15 (2) high value care is care that provides higher 

16 quality care more efficiently, achieving greater 

17 health improvement and better health outcomes at 

18 lower cost (per patient and overall); 

19 (3) a high value health care system must deliver 

20 timely, accessible, well-coordinated, high-quality, cul21 turally centered, and language-appropriate care to 

22 everyone; 

23 (4) eliminating health and health care dispari24 ties and achieving health equity must be central to 


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1 and required in efforts to achieve a high value health 

2 care system; 

3 (5) eliminating such disparities and achieving 

4 such equity will require tailored interventions and 

5 targeted investments to address inequities in health 

6 and health care to make sure that health care deliv7 ery and payment efforts are responsive to and inclu8 sive of the needs of communities of color and other 

9 communities experiencing disparities; and 

10 (6) new models of value-based payment and 

11 care delivery should prioritize primary care and con12 sider the holistic needs of and other factors with re13 spect to the patient population, including with re14 spect to behavioral health, oral health, end-of-life 

15 care, history of adverse childhood experiences and 

16 adverse community environments, social deter17 minants of health, social risk factors, unmet social 

18 needs, and the burden of intergenerational racial 

19 and other inequities. 

20 SEC. 4302. CENTERS FOR MEDICARE & MEDICAID SERVICES 

21 REPORTING AND VALUE-BASED PROGRAMS. 

22 (a) ADVANCING HEALTH EQUITY IN REPORTING AND

23 VALUE-BASED PAYMENT PROGRAMS.— 

24 (1) IN GENERAL.—The Administrator of the 

25 Centers for Medicare & Medicaid Services (in this 


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1 section referred to as the ‘‘Administrator’’) shall re2 quire that a clinician or other professional partici3 pating in any pay-for-reporting or value-based pay4 ment program stratify clinical quality measures by 

5 disparity variables, including race, ethnicity, sex, pri6 mary language, disability status, sexual orientation, 

7 gender identity, and socioeconomic status. A clini8 cian or other professional may use existing demo9 graphic data collection fields in certified electronic 

10 health record technology (as defined in section 

11 1848(o)(4) of the Social Security Act (42 U.S.C. 

12 1395w–4(o)(4))) to carry out such data stratifica13 tion under the preceding sentence. Such stratified 

14 data will assist clinicians and other professionals in 

15 the identification of disparities obscured in aggre16 gated data and assist with the provision of interven17 tions that target reducing those disparities. 

18 (2) CLINICIAN.—In assessing performance in 

19 any value-based payment program, the Adminis20 trator shall incorporate a clinician or other profes21 sional’s performance in reducing disparities across 

22 race, ethnicity, sex, primary language, disability sta23 tus, sexual orientation, gender identity, and socio24 economic status. Linking performance payments to 

25 the reduction of health care disparities across such 


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1 variables will assist in holding clinicians and other 

2 professionals accountable for providing quality care 

3 that can lead to decreased health inequities. 

4 (3) REQUIREMENT OF ADOPTION OF CERT.—All 

5 entities, clinicians, or other professionals partici6 pating in the Quality Payment Program of the Cen7 ters for Medicare & Medicaid Services shall be re8 quired to adopt 2015 certified electronic health 

9 record technology (as so defined) as a condition of 

10 participating in such program. 

11 (b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad12 ministrator, upon yearly review of the Quality Payment 

13 Program, shall add quality improvement activities that im14 plement the Culturally and Linguistically Accessible 

15 Standards (CLAS) as Improvement Activities under the 

16 Quality Payment Program. 

17 SEC. 4303. DEVELOPMENT AND TESTING OF DISPARITY RE18 DUCING DELIVERY AND PAYMENT MODELS. 

19 (a) IN GENERAL.—The Center for Medicare and 

20 Medicaid Innovation established under section 1115A of 

21 the Social Security Act (42 U.S.C. 1315a) (in this section 

22 referred to as the ‘‘CMI’’) shall establish a dedicated fund 

23 to identify, test, evaluate, and scale delivery and payment 

24 models under the applicable titles (as defined in subsection 

25 (a)(4)(B) of such section) that target health disparities 


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1 among racial and ethnic minorities, including models that 

2 support high-value nonmedical services that address so3 cially determined barriers to health in all stages of the 

4 life cycle through end-of-life, including English proficiency 

5 status, low health and health care literacy, lack of access 

6 to health care planning, including end-of-life care plan7 ning, case management, transportation, enrollment assist8 ance needs, stable and affordable housing, utility assist9 ance, employment and career development, and nutrition 

10 and food security which will help to reduce disparities and 

11 impact the overall cost of care. 

12 (b) AMENDMENT TO SOCIAL SECURITY ACT.—The 

13 second sentence of section 1115A(a)(1) of the Social Secu14 rity Act (42 U.S.C. 1315a(a)(1)) is amended by inserting 

15 ‘‘and improve health equity’’ after ‘‘expenditures’’. 

16 (c) PILOT PROGRAMS.—The CMI shall prioritize the 

17 testing of models under such section 1115A that include 

18 partnerships with entities, including community-based or19 ganizations or other nonprofit entities, to help address so20 cially determined barriers to health and health care. 

21 (d) ALTERNATIVES.—Any model tested by the CMI 

22 under such 1115A shall include measures to assess and 

23 track the impact of the model on health disparities, using 

24 existing measures such as the Healthcare Disparities and 

25 Cultural Competency Measures endorsed by the entity 


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1 with a contract under section 1890(a) of the Social Secu2 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 

3 ethnicity, English proficiency, gender identity, sexual ori4 entation, and disability status. 

5 SEC. 4304. DIVERSITY IN CENTERS FOR MEDICARE AND 

6 MEDICAID CONSULTATION. 

7 (a) IN GENERAL.—In carrying out the duties under 

8 this section, the CMI shall consult representatives of rel9 evant Federal agencies, and clinical and analytical experts 

10 with expertise in medicine and health care management, 

11 specifically such experts with expertise in— 

12 (1) the health care needs of minority, rural, and 

13 underserved populations; and 

14 (2) the financial needs of safety net, commu15 nity-based, rural, and critical access providers, in16 cluding federally qualified health centers. 

17 (b) OPEN DOOR FORUMS.—The CMI shall use open 

18 door forums or other mechanisms to seek external feed19 back from interested parties and incorporate that feedback 

20 into the development of models. 

21 SEC. 4305. SUPPORTING SAFETY NET AND COMMUNITY22 BASED PROVIDERS TO COMPETE IN VALUE23 BASED PAYMENT SYSTEMS. 

24 (a) IN GENERAL.—Any pay-for-performance or alter25 native payment model that is developed and tested by the 


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1 Center for Medicare and Medicaid Innovation established 

2 under section 1115A of the Social Security Act (42 U.S.C. 

3 1315a), or any other agency of the Department of Health 

4 and Human Services with respect to the programs under 

5 titles XVIII, XIX, or XXI of such Act, shall be assessed 

6 for potential impact on safety net, community-based, and 

7 critical access providers, including Federally qualified 

8 health centers. 

9 (b) NEW MODELS.—The rollout of any such models 

10 shall include training and additional up front resources for 

11 community-based and safety net providers to enable those 

12 providers to participate in the model. 

13 Subtitle E—Health Empowerment 

14 Zones 

15 SEC. 4401. DESIGNATION OF HEALTH EMPOWERMENT 

16 ZONES. 

17 (a) IN GENERAL.—The Secretary may, at the request 

18 of an eligible community partnership described in sub19 section (b)(1), designate an eligible area described in sub20 section (b)(2) as a health empowerment zone for the pur21 pose of eligibility for a grant under section 4402. 

22 (b) ELIGIBILITY CRITERIA.— 

23 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 

24 community partnership is eligible to submit a re25 quest under this section if the partnership— 


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1 (A) demonstrates widespread public sup2 port from key individuals and entities in the eli3 gible area, including members of the target 

4 community, State and local governments, non5 profit organizations including national and re6 gional intermediaries with demonstrated capac7 ity to serve low-income urban communities, and 

8 community and industry leaders, for designa9 tion of the eligible area as a health empower10 ment zone; and 

11 (B) includes representatives of— 

12 (i) a broad cross-section of stake13 holders and residents from communities in 

14 the eligible area experiencing dispropor15 tionate disparities in health status and 

16 health care; and 

17 (ii) organizations, facilities, and insti18 tutions that have a history of working 

19 within and serving such communities. 

20 (2) ELIGIBLE AREA.—An area is eligible to be 

21 designated as a health empowerment zone under this 

22 section if one or more communities in the area expe23 rience disproportionate disparities in health status 

24 and health care. In determining whether a commu25 nity experiences such disparities, the Secretary shall 


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1 consider data collected by the Department of Health 

2 and Human Services focusing on the following areas: 

3 (A) Access to affordable, high-quality 

4 health care services. 

5 (B) The prevalence of disproportionate 

6 rates of certain illnesses or diseases including 

7 the following: 

8 (i) Arthritis, osteoporosis, chronic 

9 back conditions, and other musculoskeletal 

10 diseases. 

11 (ii) Cancer. 

12 (iii) Chronic kidney disease. 

13 (iv) Diabetes. 

14 (v) Injury (intentional and uninten15 tional). 

16 (vi) Violence (intimate and non17 intimate). 

18 (vii) Maternal and paternal illnesses 

19 and diseases. 

20 (viii) Infant mortality. 

21 (ix) Mental illness and other disabil22 ities. 

23 (x) Substance use disorder treatment 

24 and prevention, including underage drink25 ing. 


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1 (xi) Nutrition, obesity, and overweight 

2 conditions. 

3 (xii) Heart disease. 

4 (xiii) Hypertension. 

5 (xiv) Cerebrovascular disease or 

6 stroke. 

7 (xv) Tuberculosis. 

8 (xvi) HIV/AIDS and other sexually 

9 transmitted infections. 

10 (xvii) Viral hepatitis. 

11 (xviii) Asthma. 

12 (xix) Tooth decay and other oral 

13 health issues. 

14 (C) Within the community, the historical 

15 and persistent presence of conditions that have 

16 been found to contribute to health disparities 

17 including any such conditions respecting any of 

18 the following: 

19 (i) Poverty. 

20 (ii) Educational status and the quality 

21 of community schools. 

22 (iii) Income. 

23 (iv) Access to high-quality affordable 

24 health care. 

25 (v) Work and work environment. 


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1 (vi) Environmental conditions in the 

2 community, including with respect to clean 

3 water, clean air, and the presence or ab4 sence of pollutants. 

5 (vii) Language and English pro6 ficiency. 

7 (viii) Access to affordable healthy 

8 food. 

9 (ix) Access to ethnically and culturally 

10 diverse health and human service providers 

11 and practitioners. 

12 (x) Access to culturally and linguis13 tically competent health and human serv14 ices and health and human service pro15 viders. 

16 (xi) Health-supporting infrastructure. 

17 (xii) Health insurance that is ade18 quate and affordable. 

19 (xiii) Race, racism, and bigotry (con20 scious and unconscious). 

21 (xiv) Sexual orientation. 

22 (xv) Health and health care literacy. 

23 (xvi) Place of residence (such as 

24 urban areas, rural areas, and reservations 

25 of Indian Tribes). 


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1 (xvii) Stress. 

2 (c) PROCEDURE.— 

3 (1) REQUEST.—A request under subsection (a) 

4 shall— 

5 (A) describe the bounds of the area to be 

6 designated as a health empowerment zone and 

7 the process used to select those bounds; 

8 (B) demonstrate that the partnership sub9 mitting the request is an eligible community 

10 partnership described in subsection (b)(1); 

11 (C) demonstrate that the area is an eligible 

12 area described in subsection (b)(2); 

13 (D) include a comprehensive assessment of 

14 disparities in health status and health care ex15 perience by one or more communities in the 

16 area; 

17 (E) set forth— 

18 (i) a vision and a set of values for the 

19 area; and 

20 (ii) a comprehensive and holistic set of 

21 goals to be achieved in the area through 

22 designation as a health empowerment zone; 

23 and 


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1 (F) include a strategic plan and an action 

2 plan for achieving the goals described in sub3 paragraph (E)(ii). 

4 (2) APPROVAL.—Not later than 60 days after 

5 the receipt of a request for designation of an area 

6 as a health empowerment zone under this section, 

7 the Secretary shall approve or disapprove the re8 quest. 

9 (d) MINIMUM NUMBER.—The Secretary— 

10 (1) shall designate not more than 110 health 

11 empowerment zones under this section; and 

12 (2) of such zones designated under paragraph 

13 (1), shall designate at least one health empowerment 

14 zone in each of the several States, the District of 

15 Columbia, and each territory or possession of the 

16 United States. 

17 SEC. 4402. ASSISTANCE TO THOSE SEEKING DESIGNATION. 

18 At the request of any organization or entity seeking 

19 to submit a request under section 4401(a), the Secretary 

20 shall provide technical assistance, and may award a grant, 

21 to assist such organization or entity— 

22 (1) to form an eligible community partnership 

23 described in section 4401(b)(1); 


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1 (2) to complete a health assessment, including 

2 an assessment of health disparities under section 

3 4401(c)(1)(D); or 

4 (3) to prepare and submit a request, including 

5 a strategic plan, in accordance with section 4401. 

6 SEC. 4403. BENEFITS OF DESIGNATION. 

7 (a) PRIORITY.—In awarding a grant under sub8 section (b), a Federal official shall give priority to any ap9 plicant that— 

10 (1) meets the eligibility criteria for the grant; 

11 (2) proposes to use the grant for activities in a 

12 health empowerment zone; and 

13 (3) demonstrates that such activities will di14 rectly and significantly further the goals of the stra15 tegic plan approved for such zone under section 

16 4401. 

17 (b) GRANTS FOR INITIAL IMPLEMENTATION OF

18 STRATEGIC PLAN.— 

19 (1) IN GENERAL.—Upon designating an eligible 

20 area as a health empowerment zone at the request 

21 of an eligible community partnership, the Secretary 

22 shall, subject to the availability of appropriations, 

23 make a grant to the community partnership for im24 plementation of the strategic plan for such zone. 


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1 (2) GRANT PERIOD.—A grant under paragraph 

2 (1) for a health empowerment zone shall be for a pe3 riod of 2 years and may be renewed, except that the 

4 total period of grants under paragraph (1) for such 

5 zone may not exceed 10 years. 

6 (3) LIMITATION.—In awarding grants under 

7 this subsection, the Secretary shall not give less pri8 ority to an applicant or reduce the amount of a 

9 grant because the Secretary rendered technical as10 sistance or made a grant to the same applicant 

11 under section 4401. 

12 (4) REPORTING.—The Secretary shall establish 

13 metrics for measuring the progress of grantees 

14 under this subsection and, based on such metrics, 

15 require each such grantee to report to the Secretary 

16 not less than every 6 months on the progress in im17 plementing the strategic plan for the health em18 powerment zone. 

19 SEC. 4404. DEFINITION OF SECRETARY. 

20 In this subtitle, the term ‘‘Secretary’’ means the Sec21 retary of Health and Human Services, acting through the 

22 Administrator of the Health Resources and Services Ad23 ministration and the Deputy Assistant Secretary for Mi24 nority Health, and in cooperation with the Director of the 

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1 tional Institute on Minority Health and Health Dispari2 ties. 

3 SEC. 4405. AUTHORIZATION OF APPROPRIATIONS. 

4 To carry out this subtitle, there is authorized to be 

5 appropriated $100,000,000 for fiscal year 2023. 

6 Subtitle F—Equitable Health Care 

7 for All 

8 SEC. 4501. FINDINGS. 

9 Congress finds the following: 

10 (1) In 1966, Dr. Martin Luther King, Jr., said 

11 ‘‘Of all the forms of inequality, injustice in health 

12 care is the most shocking and inhuman because it 

13 often results in physical death.’’. 

14 (2) Inequity in health care remains a persistent 

15 and devastating reality for many communities, and, 

16 in particular, communities of color. 

17 (3) The provision of inequitable health care has 

18 complex causes, many stemming from systemic in19 equality in access to health care, housing, nutrition, 

20 economic opportunity, education, and other factors. 

21 (4) Health care outcomes for Black commu22 nities in particular lag far behind those of the popu23 lation as a whole. 

24 (5) Dr. Anthony Fauci, Director of the Na25 tional Institute of Allergy and Infectious Diseases, 


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1 said on April 7, 2020, the coronavirus outbreak is 

2 ‘‘shining a bright light’’ on ‘‘unacceptable’’ health 

3 disparities in the Black community. 

4 (6) A contributing factor in health disparities is 

5 explicit and implicit bias in the delivery of health 

6 care, resulting in inferior care and poorer outcomes 

7 for some patients on the basis of factors that include 

8 race, national origin, sex (including sexual orienta9 tion or gender identity), disability, age, and religion. 

10 (7) The National Academy of Medicine (for11 merly known as the ‘‘Institute of Medicine’’) issued 

12 a report in 2002 titled ‘‘Unequal Treatment’’, find13 ing that racial and ethnic minorities receive lower14 quality health care than Whites do, even when insur15 ance status, income, age, and severity of condition is 

16 comparable. 

17 (8) Just as Congress has sought to eliminate 

18 bias, both explicit and implicit, in employment, hous19 ing, and other parts of our society, the elimination 

20 of bias and the legacy of structural racism in health 

21 care is of paramount importance. 

22 SEC. 4502. DATA COLLECTION AND REPORTING. 

23 (a) REQUIRED REPORTING.— 

24 (1) IN GENERAL.—The Secretary of Health and 

25 Human Services, in consultation with the Director 


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1 for Civil Rights and Health Equity, the Director of 

2 the National Institutes of Health, the Administrator 

3 of the Centers for Medicare & Medicaid Services, the 

4 Director of the Agency for Healthcare Research and 

5 Quality, the Deputy Assistant Secretary for Minority 

6 Health, and the Director of the Centers for Disease 

7 Control and Prevention, shall by regulation require 

8 all health care providers and facilities that are re9 quired under other provisions of law to report data 

10 on specific health outcomes to the Department of 

11 Health and Human Services in aggregate form, to 

12 disaggregate such data by demographic characteris13 tics, including by race, national origin, sex (including 

14 sexual orientation and gender identity), disability, 

15 and age, as well as any other factor that the Sec16 retary of Health and Human Services determines 

17 would be useful for determining a pattern of provi18 sion of inequitable health care. 

19 (2) PROPOSED REGULATIONS.—Not later than 

20 90 days after the date of enactment of this Act, the 

21 Secretary of Health and Human Services shall issue 

22 proposed regulations to carry out paragraph (1). 

23 (b) REPOSITORY.—The Secretary of Health and 

24 Human Services shall— 


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1 (1) not later than 1 year after the date of en2 actment of this Act, establish a repository of the 

3 disaggregated data reported pursuant to subsection 

4 (a); 

5 (2) subject to paragraph (3), make the data in 

6 such repository publicly available; and 

7 (3) ensure that such repository does not contain 

8 any data that is individually identifiable. 

9 SEC. 4503. REQUIRING EQUITABLE HEALTH CARE IN THE 

10 HOSPITAL VALUE-BASED PURCHASING PRO11 GRAM. 

12 (a) EQUITABLE HEALTH CARE AS VALUE MEASURE13 MENT.—Section 1886(b)(3)(B)(viii) of the Social Security 

14 Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by 

15 adding at the end the following new subclause: 

16 ‘‘(XIII)(aa) Effective for payments beginning with 

17 fiscal year 2024, in expanding the number of measures 

18 under subclause (III), the Secretary shall adopt measures 

19 that relate to equitable health care furnished by hospitals 

20 in inpatient settings. 

21 ‘‘(bb) In carrying out this subclause, the Secretary 

22 shall solicit input and recommendations from individuals 

23 and groups representing communities of color and other 

24 protected classes and ensure measures adopted pursuant 

25 to this subclause account for social determinants of health, 


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1 as defined in section 4506(e)(10) of the Health Equity 

2 and Accountability Act of 2022. 

3 ‘‘(cc) For purposes of this subclause, the term ‘equi4 table health care’ refers to the principle that high-quality 

5 care should be provided to all individuals and health care 

6 treatment and services should not vary on account of the 

7 real or perceived race, national origin, sex (including sex8 ual orientation and gender identity), disability, or age of 

9 an individual, as well as any other factor that the Sec10 retary determines would be useful for determining a pat11 tern of provision of inequitable health care.’’. 

12 (b) INCLUSION OF EQUITABLE HEALTH CARE MEAS13 URES.—Section 1886(o)(2)(B) of the Social Security Act 

14 (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the 

15 end the following new clause: 

16 ‘‘(iv) INCLUSION OF EQUITABLE

17 HEALTH CARE MEASURES.—Beginning in 

18 fiscal year 2024, measures selected under 

19 subparagraph (A) shall include the equi20 table health care measures described in 

21 subsection (b)(3)(B)(viii)(XIII).’’. 


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1 SEC. 4504. PROVISION OF INEQUITABLE HEALTH CARE AS A 

2 BASIS FOR PERMISSIVE EXCLUSION FROM 

3 MEDICARE AND STATE HEALTH CARE PRO4 GRAMS. 

5 Section 1128(b) of the Social Security Act (42 U.S.C. 

6 1320a–7(b)) is amended by adding at the end the fol7 lowing new paragraph: 

8 ‘‘(18) PROVISION OF INEQUITABLE HEALTH

9 CARE.— 

10 ‘‘(A) IN GENERAL.—Subject to subpara11 graph (B), any health care provider that the 

12 Secretary determines has engaged in a pattern 

13 of providing inequitable health care (as defined 

14 in section 4506(e)(7) of the Health Equity and 

15 Accountability Act of 2022) on the basis of 

16 race, national origin, sex (including sexual ori17 entation and gender identity), disability, or age 

18 of an individual. 

19 ‘‘(B) EXCEPTION.—For purposes of car20 rying out subparagraph (A), the Secretary shall 

21 not exclude any health care provider from par22 ticipation in the Medicare program under title 

23 XVIII of the Social Security Act or the Med24 icaid program under title XIX of such Act if 

25 the exclusion of such health care provider would 

26 result in increased difficulty in access to health 


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1 care services for underserved or low-income 

2 communities.’’. 

3 SEC. 4505. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY 

4 OF THE DEPARTMENT OF HEALTH AND 

5 HUMAN SERVICES. 

6 (a) NAME OF OFFICE.—Beginning on the date of en7 actment of this Act, the Office for Civil Rights of the De8 partment of Health and Human Services shall be known 

9 as the ‘‘Office for Civil Rights and Health Equity’’ of the 

10 Department of Health and Human Services. Any ref11 erence to the Office for Civil Rights of the Department 

12 of Health and Human Services in any law, regulation, 

13 map, document, record, or other paper of the United 

14 States shall be deemed to be a reference to the Office for 

15 Civil Rights and Health Equity. 

16 (b) HEAD OF OFFICE.—The head of the Office for 

17 Civil Rights and Health Equity shall be the Director for 

18 Civil Rights and Health Equity, to be appointed by the 

19 President. Any reference to the Director of the Office for 

20 Civil Rights of the Department of Health and Human 

21 Services in any law, regulation, map, document, record, 

22 or other paper of the United States shall be deemed to 

23 be a reference to the Director for Civil Rights and Health 

24 Equity. 


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1 SEC. 4506. PROHIBITING DISCRIMINATION IN HEALTH 

2 CARE. 

3 (a) PROHIBITING DISCRIMINATION.— 

4 (1) IN GENERAL.—No health care provider 

5 may, on the basis, in whole or in part, of race, sex 

6 (including sexual orientation and gender identity), 

7 disability, age, or religion, subject an individual to 

8 the provision of inequitable health care. 

9 (2) NOTICE OF PATIENT RIGHTS.—The Sec10 retary shall provide to each patient a notice of a pa11 tient’s rights under this section. 

12 (b) ADMINISTRATIVE COMPLAINT AND CONCILIATION

13 PROCESS.— 

14 (1) COMPLAINTS AND ANSWERS.— 

15 (A) IN GENERAL.—An aggrieved person 

16 may, not later than 1 year after an alleged vio17 lation of subsection (a) has occurred or con18 cluded, file a complaint with the Director alleg19 ing provision of inequitable health care by a 

20 provider described in subsection (a). 

21 (B) COMPLAINT.—A complaint submitted 

22 pursuant to subparagraph (A) shall be in writ23 ing and shall contain such information and be 

24 in such form as the Director requires. 

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1 section shall be made under oath or affirmation, 

2 and may be reasonably and fairly modified at 

3 any time. 

4 (2) RESPONSE TO COMPLAINTS.— 

5 (A) IN GENERAL.—Upon the filing of a 

6 complaint under this subsection, the following 

7 procedures shall apply: 

8 (i) COMPLAINANT NOTICE.—The Di9 rector shall serve notice upon the com10 plainant acknowledging receipt of such fil11 ing and advising the complainant of the 

12 time limits and procedures provided under 

13 this section. 

14 (ii) RESPONDENT NOTICE.—The Di15 rector shall, not later than 30 days after 

16 receipt of such filing— 

17 (I) serve on the respondent a no18 tice of the complaint, together with a 

19 copy of the original complaint; and 

20 (II) advise the respondent of the 

21 procedural rights and obligations of 

22 respondents under this section. 

23 (iii) ANSWER.—The respondent may 

24 file, not later than 60 days after receipt of 


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1 the notice from the Director, an answer to 

2 such complaint. 

3 (iv) INVESTIGATIVE DUTIES.—The Di4 rector shall— 

5 (I) make an investigation of the 

6 alleged provision of inequitable health 

7 care; and 

8 (II) complete such investigation 

9 within 180 days (unless it is impracti10 cable to complete such investigation 

11 within 180 days) after the filing of 

12 the complaint. 

13 (B) INVESTIGATIONS.— 

14 (i) PATTERN OR PRACTICE.—In the 

15 course of investigating the complaint, the 

16 Director may seek records of care provided 

17 to patients other than the complainant if 

18 necessary to demonstrate or disprove an 

19 allegation of provision of inequitable health 

20 care or to determine whether there is a 

21 pattern or practice of such care. 

22 (ii) ACCOUNTING FOR SOCIAL DETER23 MINANTS OF HEALTH.—In investigating 

24 the complaint and reaching a determina25 tion on the validity of the complaint, the 


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1 Director shall account for social deter2 minants of health and the effect of such 

3 social determinants on health care out4 comes. 

5 (iii) INABILITY TO COMPLETE INVES6 TIGATION.—If the Director is unable to 

7 complete (or finds it is impracticable to 

8 complete) the investigation within 180 

9 days after the filing of the complaint (or, 

10 if the Secretary takes further action under 

11 paragraph (6)(B) with respect to a com12 plaint, within 180 days after the com13 mencement of such further action), the Di14 rector shall notify the complainant and re15 spondent in writing of the reasons in16 volved. 

17 (iv) REPORT TO STATE LICENSING

18 AUTHORITIES.—On concluding each inves19 tigation under this subparagraph, the Di20 rector shall provide to the appropriate 

21 State licensing authorities information 

22 specifying the results of the investigation. 

23 (C) REPORT.— 

24 (i) FINAL REPORT.—On completing 

25 each investigation under this paragraph, 


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1 the Director shall prepare a final investiga2 tive report. 

3 (ii) MODIFICATION OF REPORT.—A 

4 final report under this subparagraph may 

5 be modified if additional evidence is later 

6 discovered. 

7 (3) CONCILIATION.— 

8 (A) IN GENERAL.—During the period be9 ginning on the date on which a complaint is 

10 filed under this subsection and ending on the 

11 date of final disposition of such complaint (in12 cluding during an investigation under para13 graph (2)(B)), the Director shall, to the extent 

14 feasible, engage in conciliation with respect to 

15 such complaint. 

16 (B) CONCILIATION AGREEMENT.—A con17 ciliation agreement arising out of such concilia18 tion shall be an agreement between the re19 spondent and the complainant, and shall be 

20 subject to approval by the Director. 

21 (C) RIGHTS PROTECTED.—The Director 

22 shall approve a conciliation agreement only if 

23 the agreement protects the rights of the com24 plainant and other persons similarly situated. 

25 (D) PUBLICLY AVAILABLE AGREEMENT.— 


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1 (i) IN GENERAL.—Subject to clause 

2 (ii), the Secretary shall make available to 

3 the public a copy of a conciliation agree4 ment entered into pursuant to this sub5 section unless the complainant and re6 spondent otherwise agree, and the Sec7 retary determines, that disclosure is not re8 quired to further the purposes of this sub9 section. 

10 (ii) LIMITATION.—A conciliation 

11 agreement that is made available to the 

12 public pursuant to clause (i) may not dis13 close individually identifiable health infor14 mation. 

15 (4) FAILURE TO COMPLY WITH CONCILIATION

16 AGREEMENT.—Whenever the Director has reason17 able cause to believe that a respondent has breached 

18 a conciliation agreement, the Director shall refer the 

19 matter to the Attorney General to consider filing a 

20 civil action to enforce such agreement. 

21 (5) WRITTEN CONSENT FOR DISCLOSURE OF

22 INFORMATION.—Nothing said or done in the course 

23 of conciliation under this subsection may be made 

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1 ceeding under this subsection, without the written 

2 consent of the parties to the conciliation. 

3 (6) PROMPT JUDICIAL ACTION.— 

4 (A) IN GENERAL.—If the Director deter5 mines at any time following the filing of a com6 plaint under this subsection that prompt judi7 cial action is necessary to carry out the pur8 poses of this subsection, the Director may rec9 ommend that the Attorney General promptly 

10 commence a civil action under subsection (d). 

11 (B) IMMEDIATE SUIT.—If the Director de12 termines at any time following the filing of a 

13 complaint under this subsection that the public 

14 interest would be served by allowing the com15 plainant to bring a civil action under subsection 

16 (c) in a State or Federal court immediately, the 

17 Director shall certify that the administrative 

18 process has concluded and that the complainant 

19 may file such a suit immediately. 

20 (7) ANNUAL REPORT.—Not later than 1 year 

21 after the date of enactment of this Act, and annually 

22 thereafter, the Director shall make publicly available 

23 a report detailing the activities of the Office for Civil 

24 Rights and Health Equity under this subsection, in25 cluding— 


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1 (A) the number of complaints filed and the 

2 basis on which the complaints were filed; 

3 (B) the number of investigations under4 taken as a result of such complaints; and 

5 (C) the disposition of all such investiga6 tions. 

7 (c) ENFORCEMENT BY PRIVATE PERSONS.— 

8 (1) IN GENERAL.— 

9 (A) CIVIL ACTION.— 

10 (i) IN SUIT.—A complainant under 

11 subsection (b) may commence a civil action 

12 to obtain appropriate relief with respect to 

13 an alleged violation of subsection (a), or 

14 for breach of a conciliation agreement 

15 under subsection (b), in an appropriate 

16 district court of the United States or State 

17 court— 

18 (I) not sooner than the earliest 

19 of— 

20 (aa) the date a conciliation 

21 agreement is reached under sub22 section (b); 

23 (bb) the date of a final dis24 position of a complaint under 

25 subsection (b); or 


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1 (cc) 180 days after the first 

2 day of the alleged violation; and 

3 (II) not later than 2 years after 

4 the final day of the alleged violation. 

5 (ii) STATUTE OF LIMITATIONS.—The 

6 computation of such 2-year period shall 

7 not include any time during which an ad8 ministrative proceeding (including inves9 tigation or conciliation) under subsection 

10 (b) was pending with respect to a com11 plaint under such subsection. 

12 (B) BARRING SUIT.—If the Director has 

13 obtained a conciliation agreement under sub14 section (b) regarding an alleged violation of 

15 subsection (a), no action may be filed under 

16 this paragraph by the complainant involved 

17 with respect to the alleged violation except for 

18 the purpose of enforcing the terms of such an 

19 agreement. 

20 (2) RELIEF WHICH MAY BE GRANTED.— 

21 (A) IN GENERAL.—In a civil action under 

22 paragraph (1), if the court finds that a viola23 tion of subsection (a) or breach of a conciliation 

24 agreement has occurred, the court may award 

25 to the plaintiff actual and punitive damages, 


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1 and may grant as relief, as the court deter2 mines to be appropriate, any permanent or tem3 porary injunction, temporary restraining order, 

4 or other order (including an order enjoining the 

5 defendant from engaging in a practice violating 

6 subsection (a) or ordering such affirmative ac7 tion as may be appropriate). 

8 (B) FEES AND COSTS.—In a civil action 

9 under paragraph (1), the court, in its discre10 tion, may allow the prevailing party, other than 

11 the United States, a reasonable attorney’s fee 

12 and costs. The United States shall be liable for 

13 such fees and costs to the same extent as a pri14 vate person. 

15 (3) INTERVENTION BY ATTORNEY GENERAL.— 

16 Upon timely application, the Attorney General may 

17 intervene in a civil action under paragraph (1), if 

18 the Attorney General certifies that the case is of 

19 general public importance. 

20 (d) ENFORCEMENT BY THE ATTORNEY GENERAL.— 

21 (1) COMMENCEMENT OF ACTIONS.— 

22 (A) PATTERN OR PRACTICE CASES.—The 

23 Attorney General may commence a civil action 

24 in any appropriate district court of the United 

25 States if the Attorney General has reasonable 


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1 cause to believe that any health care provider 

2 covered by subsection (a)— 

3 (i) is engaged in a pattern or practice 

4 that violates such subsection; or 

5 (ii) is engaged in a violation of such 

6 subsection that raises an issue of signifi7 cant public importance. 

8 (B) CASES BY REFERRAL.—The Director 

9 may determine, based on a pattern of com10 plaints, a pattern of violations, a review of data 

11 reported by a health care provider covered by 

12 subsection (a), or any other means, that there 

13 is reasonable cause to believe a health care pro14 vider is engaged in a pattern or practice that 

15 violates subsection (a). If the Director makes 

16 such a determination, the Director shall refer 

17 the related findings to the Attorney General. If 

18 the Attorney General finds that such reasonable 

19 cause exists, the Attorney General may com20 mence a civil action in any appropriate district 

21 court of the United States. 

22 (2) ENFORCEMENT OF SUBPOENAS.—The At23 torney General, on behalf of the Director, or another 

24 party at whose request a subpoena is issued under 

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1 propriate proceedings in the district court of the 

2 United States for the district in which the person to 

3 whom the subpoena was addressed resides, was 

4 served, or transacts business. 

5 (3) RELIEF WHICH MAY BE GRANTED IN CIVIL

6 ACTIONS.— 

7 (A) IN GENERAL.—In a civil action under 

8 paragraph (1), the court— 

9 (i) may award such preventive relief, 

10 including a permanent or temporary in11 junction, temporary restraining order, or 

12 other order against the person responsible 

13 for a violation of subsection (a) as is nec14 essary to assure the full enjoyment of the 

15 rights granted by this subsection; 

16 (ii) may award such other relief as the 

17 court determines to be appropriate, includ18 ing monetary damages, to aggrieved per19 sons; and 

20 (iii) may, to vindicate the public inter21 est, assess punitive damages against the 

22 respondent— 

23 (I) in an amount not exceeding 

24 $500,000, for a first violation; and 


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1 (II) in an amount not exceeding 

2 $1,000,000, for any subsequent viola3 tion. 

4 (B) FEES AND COSTS.—In a civil action 

5 under this subsection, the court, in its discre6 tion, may allow the prevailing party, other than 

7 the United States, a reasonable attorney’s fee 

8 and costs. The United States shall be liable for 

9 such fees and costs to the extent provided by 

10 section 2412 of title 28, United States Code. 

11 (4) INTERVENTION IN CIVIL ACTIONS.—Upon 

12 timely application, any person may intervene in a 

13 civil action commenced by the Attorney General 

14 under paragraphs (1) and (2) if the action involves 

15 an alleged violation of subsection (a) with respect to 

16 which such person is an aggrieved person (including 

17 a person who is a complainant under subsection (b)) 

18 or a conciliation agreement to which such person is 

19 a party. 

20 (e) DEFINITIONS.—In this section: 

21 (1) AGGRIEVED PERSON.—The term ‘‘aggrieved 

22 person’’ means— 

23 (A) a person who believes that the person 

24 was or will be injured in violation of subsection 

25 (a); or 


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1 (B) the personal representative or estate of 

2 a deceased person who was injured in violation 

3 of subsection (a). 

4 (2) DIRECTOR.—The term ‘‘Director’’ means 

5 the Director for Civil Rights and Health Equity of 

6 the Department of Health and Human Services. 

7 (3) DISABILITY.—The term ‘‘disability’’ has the 

8 meaning given such term in section 3 of the Ameri9 cans with Disabilities Act of 1990 (42 U.S.C. 

10 12102). 

11 (4) CONCILIATION.—The term ‘‘conciliation’’ 

12 means the attempted resolution of issues raised by 

13 a complaint, or by the investigation of such com14 plaint, through informal negotiations involving the 

15 complainant, the respondent, and the Secretary. 

16 (5) CONCILIATION AGREEMENT.—The term 

17 ‘‘conciliation agreement’’ means a written agreement 

18 setting forth the resolution of the issues in concilia19 tion. 

20 (6) INDIVIDUALLY IDENTIFIABLE HEALTH IN21 FORMATION.—The term ‘‘individually identifiable 

22 health information’’ means any information, includ23 ing demographic information collected from an indi24 vidual— 


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1 (A) that is created or received by a health 

2 care provider covered by subsection (a), health 

3 plan, employer, or health care clearinghouse; 

4 (B) that relates to the past, present, or fu5 ture physical or mental health or condition of, 

6 the provision of health care to, or the past, 

7 present, or future payment for the provision of 

8 health care to, the individual; and 

9 (C)(i) that identifies the individual; or 

10 (ii) with respect to which there is a reason11 able basis to believe that the information can be 

12 used to identify the individual. 

13 (7) PROVISION OF INEQUITABLE HEALTH

14 CARE.—The term ‘‘provision of inequitable health 

15 care’’ means the provision of any health care service, 

16 by a health care provider in a manner that— 

17 (A) fails to meet a high-quality care stand18 ard, meaning the health care provider fails to— 

19 (i) avoid harm to patients as a result 

20 of the health services that are intended to 

21 help the patient; 

22 (ii) provide health services based on 

23 scientific knowledge to all and to all pa24 tients who benefit; 


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1 (iii) refrain from providing services to 

2 patients not likely to benefit; 

3 (iv) provide care that is responsive to 

4 patient preferences, needs, and values; and 

5 (v) avoids waits or delays in care; and 

6 (B) is discriminatory in intent or effect 

7 based at least in part on a basis specified in 

8 subsection (a). 

9 (8) RESPONDENT.—The term ‘‘respondent’’ 

10 means the person or other entity accused in a com11 plaint of a violation of subsection (a). 

12 (9) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Health and Human Services. 

14 (10) SOCIAL DETERMINANTS OF HEALTH.—The 

15 term ‘‘social determinants of health’’ means condi16 tions in the environments in which individuals live, 

17 work, attend school, and worship, that affect a wide 

18 range of health, functioning, and quality-of-life out19 comes and risks. 

20 (f) RULE OF CONSTRUCTION.—Nothing in this sec21 tion shall be construed as repealing or limiting the effect 

22 of title VI of the Civil Rights Act of 1964 (42 U.S.C. 

23 2000d et seq.), section 1557 of the Patient Protection and 

24 Affordable Care Act (42 U.S.C. 18116), section 504 of 


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1 the Rehabilitation Act of 1973 (29 U.S.C. 794), or the 

2 Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.). 

3 SEC. 4507. FEDERAL HEALTH EQUITY COMMISSION. 

4 (a) ESTABLISHMENT OF COMMISSION.— 

5 (1) IN GENERAL.—There is established the 

6 Federal Health Equity Commission (in this section 

7 referred to as the ‘‘Commission’’). 

8 (2) MEMBERSHIP.— 

9 (A) IN GENERAL.—The Commission shall 

10 be composed of— 

11 (i) 8 voting members appointed under 

12 subparagraph (B); and 

13 (ii) the nonvoting, ex officio members 

14 listed in subparagraph (C). 

15 (B) VOTING MEMBERS.—Not more than 4 

16 of the members described in subparagraph 

17 (A)(i) shall at any one time be of the same po18 litical party. Such members shall have recog19 nized expertise in and personal experience with 

20 racial and ethnic health inequities, health care 

21 needs of vulnerable and marginalized popu22 lations, and health equity as a vehicle for im23 proving health status and health outcomes. 

24 Such members shall be appointed to the Com25 mission as follows: 


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1 (i) 4 members of the Commission 

2 shall be appointed by the President. 

3 (ii) 2 members of the Commission 

4 shall be appointed by the President pro 

5 tempore of the Senate, upon the rec6 ommendations of the majority leader and 

7 the minority leader of the Senate. Each 

8 member appointed to the Commission 

9 under this clause shall be appointed from 

10 a different political party. 

11 (iii) 2 members of the Commission 

12 shall be appointed by the Speaker of the 

13 House of Representatives upon the rec14 ommendations of the majority leader and 

15 the minority leader of the House of Rep16 resentatives. Each member appointed to 

17 the Commission under this clause shall be 

18 appointed from a different political party. 

19 (C) EX OFFICIO MEMBER.—The Commis20 sion shall have the following nonvoting, ex offi21 cio members: 

22 (i) The Director for Civil Rights and 

23 Health Equity of the Department of 

24 Health and Human Services. 


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1 (ii) The Deputy Assistant Secretary 

2 for Minority Health of the Department of 

3 Health and Human Services. 

4 (iii) The Director of the National In5 stitute on Minority Health and Health Dis6 parities. 

7 (iv) The Chairperson of the Advisory 

8 Committee on Minority Health established 

9 under section 1707(c) of the Public Health 

10 Service Act (42 U.S.C. 300u–6(c)). 

11 (3) TERMS.—The term of office of each mem12 ber appointed under paragraph (2)(B) of the Com13 mission shall be 6 years. 

14 (4) CHAIRPERSON; VICE CHAIRPERSON.— 

15 (A) CHAIRPERSON.—The President shall, 

16 with the concurrence of a majority of the mem17 bers of the Commission appointed under para18 graph (2)(B), designate a Chairperson from 

19 among the members of the Commission ap20 pointed under such paragraph. 

21 (B) VICE CHAIRPERSON.— 

22 (i) DESIGNATION.—The Speaker of 

23 the House of Representatives shall, in con24 sultation with the majority leaders and the 

25 minority leaders of the Senate and the 


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1 House of Representatives and with the 

2 concurrence of a majority of the members 

3 of the Commission appointed under para4 graph (2)(B), designate a Vice Chairperson 

5 from among the members of the Commis6 sion appointed under such paragraph. The 

7 Vice Chairperson may not be a member of 

8 the same political party as the Chair9 person. 

10 (ii) DUTY.—The Vice Chairperson 

11 shall act in place of the Chairperson in the 

12 absence of the Chairperson. 

13 (5) REMOVAL OF MEMBERS.—The President 

14 may remove a member of the Commission only for 

15 neglect of duty or malfeasance in office. 

16 (6) QUORUM.—A majority of members of the 

17 Commission appointed under paragraph (2)(B) shall 

18 constitute a quorum of the Commission, but a lesser 

19 number of members may hold hearings. 

20 (b) DUTIES OF THE COMMISSION.— 

21 (1) IN GENERAL.—The Commission shall— 

22 (A) monitor and report on the implementa23 tion of this Act; and 


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1 (B) investigate, monitor, and report on 

2 progress towards health equity and the elimi3 nation of health disparities. 

4 (2) ANNUAL REPORT.—The Commission 

5 shall— 

6 (A) submit to the President and Congress 

7 at least one report annually on health equity 

8 and health disparities; and 

9 (B) include in such report— 

10 (i) a description of actions taken by 

11 the Department of Health and Human 

12 Services and any other Federal agency re13 lated to health equity or health disparities; 

14 and 

15 (ii) recommendations on ensuring eq16 uitable health care and eliminating health 

17 disparities. 

18 (c) POWERS.— 

19 (1) HEARINGS.— 

20 (A) IN GENERAL.—The Commission or, at 

21 the direction of the Commission, any sub22 committee or member of the Commission, may, 

23 for the purpose of carrying out this section, as 

24 the Commission or the subcommittee or mem25 ber considers advisable— 


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1 (i) hold such hearings, meet and act 

2 at such times and places, take such testi3 mony, receive such evidence, and admin4 ister such oaths; and 

5 (ii) require, by subpoena or otherwise, 

6 the attendance and testimony of such wit7 nesses and the production of such books, 

8 records, correspondence, memoranda, pa9 pers, documents, tapes, and materials. 

10 (B) LIMITATION ON HEARINGS.—The 

11 Commission may hold a hearing under subpara12 graph (A)(i) only if the hearing is approved— 

13 (i) by a majority of the members of 

14 the Commission appointed under sub15 section (a)(2)(B); or 

16 (ii) by a majority of such members 

17 present at a meeting when a quorum is 

18 present. 

19 (2) ISSUANCE AND ENFORCEMENT OF SUB20 POENAS.— 

21 (A) ISSUANCE.—A subpoena issued under 

22 paragraph (1) shall— 

23 (i) bear the signature of the Chair24 person of the Commission; and 


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1 (ii) be served by any person or class 

2 of persons designated by the Chairperson 

3 for that purpose. 

4 (B) ENFORCEMENT.—In the case of contu5 macy or failure to obey a subpoena issued 

6 under paragraph (1), the United States district 

7 court for the district in which the subpoenaed 

8 person resides, is served, or may be found may 

9 issue an order requiring the person to appear at 

10 any designated place to testify or to produce 

11 documentary or other evidence. 

12 (C) NONCOMPLIANCE.—Any failure to 

13 obey the order of the court may be punished by 

14 the court as a contempt of court. 

15 (3) WITNESS ALLOWANCES AND FEES.— 

16 (A) IN GENERAL.—Section 1821 of title 

17 28, United States Code, shall apply to a witness 

18 requested or subpoenaed to appear at a hearing 

19 of the Commission. 

20 (B) EXPENSES.—The per diem and mile21 age allowances for a witness shall be paid from 

22 funds available to pay the expenses of the Com23 mission. 

24 (4) POSTAL SERVICES.—The Commission may 

25 use the United States mails in the same manner and 


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1 under the same conditions as other agencies of the 

2 Federal Government. 

3 (5) GIFTS.—The Commission may accept, use, 

4 and dispose of gifts or donations of services or prop5 erty. 

6 (d) ADMINISTRATIVE PROVISIONS.— 

7 (1) STAFF.— 

8 (A) DIRECTOR.—There shall be a full-time 

9 staff director for the Commission who shall— 

10 (i) serve as the administrative head of 

11 the Commission; and 

12 (ii) be appointed by the Chairperson 

13 with the concurrence of the Vice Chair14 person. 

15 (B) OTHER PERSONNEL.—The Commis16 sion may— 

17 (i) appoint such other personnel as it 

18 considers advisable, subject to the provi19 sions of title 5, United States Code, gov20 erning appointments in the competitive 

21 service, and the provisions of chapter 51 

22 and subchapter III of chapter 53 of that 

23 title relating to classification and General 

24 Schedule pay rates; and 


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1 (ii) may procure temporary and inter2 mittent services under section 3109(b) of 

3 title 5, United States Code, at rates for in4 dividuals not in excess of the daily equiva5 lent paid for positions at the maximum 

6 rate for GS–15 of the General Schedule 

7 under section 5332 of title 5, United 

8 States Code. 

9 (2) COMPENSATION OF MEMBERS.— 

10 (A) NON-FEDERAL EMPLOYEES.—Each 

11 member of the Commission who is not an offi12 cer or employee of the Federal Government 

13 shall be compensated at a rate equal to the 

14 daily equivalent of the annual rate of basic pay 

15 prescribed for level IV of the Executive Sched16 ule under section 5315 of title 5, United States 

17 Code, for each day (including travel time) dur18 ing which the member is engaged in the per19 formance of the duties of the Commission. 

20 (B) FEDERAL EMPLOYEES.—Each member 

21 of the Commission who is an officer or em22 ployee of the Federal Government shall serve 

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1 ber as an office or employee of the Federal 

2 Government. 

3 (C) TRAVEL EXPENSES.—A member of the 

4 Commission shall be allowed travel expenses, in5 cluding per diem in lieu of subsistence, at rates 

6 authorized for an employee of an agency under 

7 subchapter I of chapter 57 of title 5, United 

8 States Code, while away from the home or reg9 ular place of business of the member in the per10 formance of the duties of the Commission. 

11 (3) COOPERATION.—The Commission may se12 cure directly from any Federal department or agency 

13 such information as the Commission considers nec14 essary to carry out this Act. Upon request of the 

15 Chairman of the Commission, the head of such de16 partment or agency shall furnish such information to 

17 the Commission. 

18 (e) PERMANENT COMMISSION.—Section 14 of the 

19 Federal Advisory Committee Act (5 U.S.C. App.) shall not 

20 apply to the Commission. 

21 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated for fiscal year 2022 and 

23 each fiscal year thereafter such sums as may be necessary 

24 to carry out the duties of the Commission. 


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1 SEC. 4508. GRANTS FOR HOSPITALS TO PROMOTE EQUI2 TABLE HEALTH CARE AND OUTCOMES. 

3 (a) IN GENERAL.—Not later than 180 days after the 

4 date of the enactment of this Act, the Secretary of Health 

5 and Human Services (in this section referred to as the 

6 ‘‘Secretary’’) shall award grants to hospitals to promote 

7 equitable health care treatment and services, and reduce 

8 disparities in care and outcomes. 

9 (b) CONSULTATION.—In establishing the criteria for 

10 grants under this section and evaluating applications for 

11 such grants, the Secretary shall consult with the Director 

12 for Civil Rights and Health Equity of the Department of 

13 Health and Human Services. 

14 (c) USE OF FUNDS.—A hospital shall use funds re15 ceived from a grant under this section to establish or ex16 pand programs to provide equitable health care to all pa17 tients and to ensure equitable health care outcomes. Such 

18 uses may include— 

19 (1) providing explicit and implicit bias training 

20 to medical providers and staff; 

21 (2) providing translation or interpretation serv22 ices for patients; 

23 (3) recruiting and training a diverse workforce; 

24 (4) tracking data related to care and outcomes; 

25 and 

26 (5) training on cultural sensitivity. 


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1 (d) PRIORITY.—In awarding grants under this sec2 tion, the Secretary shall give priority to hospitals that 

3 have received disproportionate share hospital payments 

4 under section 1886(r) of the Social Security Act (42 

5 U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 

6 1396r–4) with respect to fiscal year 2021. 

7 (e) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 

8 under this section shall be used to supplement, not sup9 plant, any nongovernment efforts, or other Federal, State, 

10 or local funds provided to a recipient. 

11 (f) EQUITABLE HEALTH CARE DEFINED.—The term 

12 ‘‘equitable health care’’ has the meaning given such term 

13 in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Secu14 rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as 

15 added by section 4503(a). 

16 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there are authorized to be appropriated 

18 such sums as may be necessary for each of fiscal years 

19 2022 through 2027. 

20 Subtitle G—Investing in Equity 

21 SEC. 4601. DEFINITIONS. 

22 In this subtitle: 

23 (1) ADVISORY COUNCIL.—The term ‘‘Advisory 

24 Council’’ means the Pay for Equity Council con25 vened under section 4603. 


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1 (2) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Health and Human Services. 

3 (3) STRATEGY.—The term ‘‘Strategy’’ means 

4 the Pay for Equity Strategy set forth under section 

5 4602. 

6 SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY. 

7 (a) IN GENERAL.—The Secretary, in consultation 

8 with the heads of other appropriate Federal agencies, shall 

9 develop jointly with the Advisory Council and submit to 

10 the Committee on Finance of the Senate and the Com11 mittee on Energy and Commerce and the Committee on 

12 Ways and Means of the House of Representatives, and 

13 make publicly available on the internet website of the De14 partment of Health and Human Services, a Pay for Eq15 uity Strategy. 

16 (b) CONTENTS.—The Strategy shall establish goals 

17 for Federal programs, including those authorized under ti18 tles XVIII and XIX of the Social Security Act, to 

19 incentivize health equity, which may include at least— 

20 (1) incorporating measures of equity into all 

21 payment models by 2025; 

22 (2) tying a percentage of reimbursement in 

23 value-based payment models to equity measure per24 formance by 2028; and 


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1 (3) increasing the number of safety net pro2 viders participating in value-based payment by a set 

3 percentage by 2030. 

4 (c) DUTIES OF THE SECRETARY.—The Secretary, in 

5 carrying out subsection (a), shall oversee the following: 

6 (1) Collecting and making publicly available in7 formation submitted by the Advisory Council. 

8 (2) Coordinating and assessing existing Federal 

9 Government programs and activities to assess capac10 ity to meet equity goals. 

11 (3) Providing technical assistance, as appro12 priate, such as disseminating identified best prac13 tices and information sharing based on reports de14 veloped as a result of this subtitle. 

15 (d) INITIAL STRATEGY; UPDATES.—The Secretary 

16 shall— 

17 (1) not later than 18 months after the date of 

18 enactment of this Act, develop, publish, and submit 

19 to the Committee on Finance of the Senate and the 

20 Committee on Energy and Commerce and the Com21 mittee on Ways and Means of the House of Rep22 resentatives the strategy outlined in subsection (a); 

23 and 

24 (2) biennially update, publish, and submit to 

25 Congress an updated strategy to— 


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1 (A) reflect new developments, challenges, 

2 opportunities, and solutions; and 

3 (B) review progress and, based on the re4 sults of such review, recommend priority actions 

5 for improving the implementation of such rec6 ommendations, as appropriate. 

7 (e) PROCESS FOR PUBLIC INPUT.—The Secretary 

8 shall establish a process for public input to inform the de9 velopment of, and updates to, the Strategy, including a 

10 process for the public to submit recommendations to the 

11 Advisory Council and an opportunity for public comment 

12 on the proposed Strategy. 

13 SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL. 

14 (a) CONVENING.—The Secretary shall convene a Pay 

15 for Equity Advisory Council to advise and provide rec16 ommendations, including identified best practices, to the 

17 Secretary on the Pay for Equity Strategy. 

18 (b) MEMBERSHIP.— 

19 (1) IN GENERAL.—The members of the Advi20 sory Council shall consist of— 

21 (A) the appointed members under para22 graph (2); and 

23 (B) the Federal members under paragraph 

24 (3). 


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1 (2) APPOINTED MEMBERS.—In addition to the 

2 Federal members under paragraph (3), the Sec3 retary shall appoint not more than 15 voting mem4 bers of the Advisory Council who are not representa5 tives of Federal departments or agencies and who 

6 shall include at least 1 representative of each of the 

7 following: 

8 (A) Beneficiaries of Medicare and Med9 icaid. 

10 (B) Safety net health care providers. 

11 (C) Value-based payment experts. 

12 (D) Other members with expertise and 

13 lived experience the Secretary deems appro14 priate. 

15 (3) FEDERAL MEMBERS.—The Federal mem16 bers of the Advisory Council, who shall be nonvoting 

17 members, shall consist of the following: 

18 (A) The Administrator of the Centers for 

19 Medicare & Medicaid Services (or the Adminis20 trator’s designee). 

21 (B) The Administrator of the Health Re22 sources and Services Administration. 

23 (4) DIVERSE REPRESENTATION.—The Sec24 retary shall ensure that the membership of the AdviVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 sory Council reflects the diversity of individuals im2 pacted by Federal health payment programs. 

3 (c) MEETINGS.—The Advisory Council shall meet 

4 quarterly during the 1-year period beginning on the date 

5 of enactment of this Act and at least 3 times during each 

6 year thereafter. Meetings of the Advisory Council shall be 

7 open to the public. 

8 TITLE V—IMPROVING HEALTH 

9 OUTCOMES FOR WOMEN, 

10 CHILDREN, AND FAMILIES 

11 Subtitle A—In General 

12 SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDER13 SERVED COMMUNITIES. 

14 Part Q of title III of the Public Health Service Act 

15 (42 U.S.C. 280h et seq.) is amended by adding at the end 

16 the following: 

17 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER18 SERVED COMMUNITIES. 

19 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col20 laboration with the Administrator of the Health Resources 

21 and Services Administration and other Federal officials 

22 determined appropriate by the Secretary, is authorized to 

23 award grants to eligible entities— 

24 ‘‘(1) to promote health for medically under25 served communities, with preference given to 


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1 projects that benefit racial and ethnic minority 

2 women, racial and ethnic minority children, adoles3 cents, and lesbian, gay, bisexual, transgender, queer, 

4 nonbinary, gender-nonconforming, or questioning 

5 communities; and 

6 ‘‘(2) to strengthen health outreach initiatives in 

7 medically underserved communities, including lin8 guistically isolated populations. 

9 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

10 subsection (a) may be used to support the activities of 

11 community health workers, including such activities— 

12 ‘‘(1) to educate and provide outreach regarding 

13 enrollment in health insurance including the State 

14 Children’s Health Insurance Program under title 

15 XXI of the Social Security Act, Medicare under title 

16 XVIII of such Act, and Medicaid under title XIX of 

17 such Act; 

18 ‘‘(2) to educate and provide outreach in a com19 munity setting regarding health problems prevalent 

20 among medically underserved communities, and es21 pecially among racial and ethnic minority women, 

22 racial and ethnic minority children, adolescents, and 

23 lesbian, gay, bisexual, transgender, queer, nonbinary, 

24 gender-nonconforming, or questioning communities; 


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1 ‘‘(3) to educate and provide experiential learn2 ing opportunities and target risk factors and healthy 

3 behaviors that impede or contribute to achieving 

4 positive health outcomes, including— 

5 ‘‘(A) healthy nutrition; 

6 ‘‘(B) physical activity; 

7 ‘‘(C) overweight or obesity; 

8 ‘‘(D) tobacco use, including the use of e9 cigarettes and vaping; 

10 ‘‘(E) alcohol and substance use; 

11 ‘‘(F) injury and violence; 

12 ‘‘(G) sexual health; 

13 ‘‘(H) mental health; 

14 ‘‘(I) musculoskeletal health and arthritis; 

15 ‘‘(J) prenatal and postnatal care; 

16 ‘‘(K) dental and oral health; 

17 ‘‘(L) understanding informed consent; 

18 ‘‘(M) stigma; and 

19 ‘‘(N) environmental hazards; 

20 ‘‘(4) to promote community wellness and aware21 ness; and 

22 ‘‘(5) to educate and refer target populations to 

23 appropriate health care agencies and community24 based programs and organizations in order to inVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 crease access to quality health care services, includ2 ing preventive health services. 

3 ‘‘(c) APPLICATION.— 

4 ‘‘(1) IN GENERAL.—Each eligible entity that 

5 desires to receive a grant under subsection (a) shall 

6 submit an application to the Secretary, at such time, 

7 in such manner, and accompanied by such additional 

8 information as the Secretary may require. 

9 ‘‘(2) CONTENTS.—Each application submitted 

10 pursuant to paragraph (1) shall— 

11 ‘‘(A) describe the activities for which as12 sistance under this section is sought; 

13 ‘‘(B) contain an assurance that, with re14 spect to each community health worker pro15 gram receiving funds under the grant awarded, 

16 such program provides in-language training and 

17 supervision to community health workers to en18 able such workers to provide authorized pro19 gram activities in (at least) the most commonly 

20 used languages within a particular geographic 

21 region; 

22 ‘‘(C) contain an assurance that the appli23 cant will evaluate the effectiveness of commu24 nity health worker programs receiving funds 

25 under the grant; 


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1 ‘‘(D) contain an assurance that each com2 munity health worker program receiving funds 

3 under the grant will provide culturally com4 petent services in the linguistic context most 

5 appropriate for the individuals served by the 

6 program; 

7 ‘‘(E) contain a plan to document and dis8 seminate project descriptions and results to 

9 other States and organizations as identified by 

10 the Secretary; and 

11 ‘‘(F) describe plans to enhance the capac12 ity of individuals to utilize health services and 

13 health-related social services under Federal, 

14 State, and local programs by— 

15 ‘‘(i) assisting individuals in estab16 lishing eligibility under the programs and 

17 in receiving the services or other benefits 

18 of the programs; and 

19 ‘‘(ii) providing other services, as the 

20 Secretary determines to be appropriate, 

21 which may include transportation and 

22 translation services. 

23 ‘‘(d) PRIORITY.—In awarding grants under sub24 section (a), the Secretary shall give priority to those appli25 cants— 


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1 ‘‘(1) who propose to target geographic areas 

2 that— 

3 ‘‘(A)(i) have a high percentage of residents 

4 who are uninsured or underinsured (if the tar5 geted geographic area is located in a State that 

6 has elected to make medical assistance available 

7 under section 1902(a)(10)(A)(i)(VIII) of the 

8 Social Security Act to individuals described in 

9 such section); 

10 ‘‘(ii) have a high percentage of under11 insured residents in a particular geographic 

12 area (if the targeted geographic area is located 

13 in a State that has not so elected); or 

14 ‘‘(iii) have a high number of households ex15 periencing extreme poverty; and 

16 ‘‘(B) have a high percentage of families for 

17 whom English is not their primary language or 

18 including smaller limited English-proficient 

19 communities within the region that are not oth20 erwise reached by linguistically appropriate 

21 health services; 

22 ‘‘(2) with experience in providing health or 

23 health-related social services to individuals who are 

24 underserved with respect to such services; and 


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1 ‘‘(3) with documented community activity and 

2 experience with community health workers. 

3 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU4 TIONS.—The Secretary shall encourage community health 

5 worker programs receiving funds under this section to col6 laborate with academic institutions, including minority7 serving institutions. Nothing in this section shall be con8 strued to require such collaboration. 

9 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE10 NESS.—The Secretary shall establish guidelines for ensur11 ing the quality of the training and supervision of commu12 nity health workers under the programs funded under this 

13 section and for ensuring the cost-effectiveness of such pro14 grams. 

15 ‘‘(g) MONITORING.—The Secretary shall monitor 

16 community health worker programs identified in approved 

17 applications and shall determine whether such programs 

18 are in compliance with the guidelines established under 

19 subsection (f). 

20 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

21 provide technical assistance to community health worker 

22 programs identified in approved applications with respect 

23 to planning, developing, and operating programs under the 

24 grant. 

25 ‘‘(i) REPORT TO CONGRESS.— 


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1 ‘‘(1) IN GENERAL.—Not later than 4 years 

2 after the date on which the Secretary first awards 

3 grants under subsection (a), the Secretary shall sub4 mit to Congress a report regarding the grant 

5 project. 

6 ‘‘(2) CONTENTS.—The report required under 

7 paragraph (1) shall include the following: 

8 ‘‘(A) A description of the programs for 

9 which grant funds were used. 

10 ‘‘(B) The number of individuals served. 

11 ‘‘(C) An evaluation of— 

12 ‘‘(i) the effectiveness of these pro13 grams; 

14 ‘‘(ii) the cost of these programs; and 

15 ‘‘(iii) the impact of these programs on 

16 the health outcomes of the community resi17 dents. 

18 ‘‘(D) Recommendations for sustaining the 

19 community health worker programs developed 

20 or assisted under this section. 

21 ‘‘(E) Recommendations regarding training 

22 to enhance career opportunities for community 

23 health workers. 

24 ‘‘(j) DEFINITIONS.—In this section: 


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1 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

2 ‘community health worker’ means an individual who 

3 promotes health or nutrition within the community 

4 in which the individual resides— 

5 ‘‘(A) by serving as a liaison between com6 munities and health care agencies; 

7 ‘‘(B) by providing guidance and social as8 sistance to community residents; 

9 ‘‘(C) by enhancing community residents’ 

10 ability to effectively communicate with health 

11 care providers; 

12 ‘‘(D) by providing culturally and linguis13 tically appropriate health or nutrition edu14 cation; 

15 ‘‘(E) by advocating for individual and com16 munity health, including dental, oral, mental, 

17 and environmental health, or nutrition needs; 

18 ‘‘(F) by taking into consideration the 

19 needs of the communities served, including the 

20 prevalence rates of risk factors that impede 

21 achieving positive healthy outcomes among 

22 pregnant, birthing, and postpartum people and 

23 children, especially among racial and ethnic mi24 nority pregnant, birthing, and postpartum peo25 ple and children; and 


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1 ‘‘(G) by providing referral and followup 

2 services. 

3 ‘‘(2) COMMUNITY SETTING.—The term ‘commu4 nity setting’ means a home or a community organi5 zation that serves a population. 

6 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en7 tity’ means— 

8 ‘‘(A) a unit of State, territorial, local, or 

9 Tribal government (including a federally recog10 nized Tribe or Alaska Native village); or 

11 ‘‘(B) a community-based organization. 

12 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

13 The term ‘medically underserved community’ means 

14 a community— 

15 ‘‘(A) that has a substantial number of in16 dividuals who are members of a medically un17 derserved population, as defined by section 

18 330(b)(3); 

19 ‘‘(B) a significant portion of which is a 

20 health professional shortage area as designated 

21 under section 332; and 

22 ‘‘(C) that includes populations that are lin23 guistically isolated, such as geographic areas 

24 with a shortage of health professionals able to 

25 provide linguistically appropriate services. 


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1 ‘‘(5) SUPPORT.—The term ‘support’ means the 

2 provision of training, supervision, and materials 

3 needed to effectively deliver the services described in 

4 subsection (b), reimbursement for services, and 

5 other benefits. 

6 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section 

8 $15,000,000 for each of fiscal years 2023 through 2027.’’. 

9 Subtitle B—Pregnancy Screening 

10 SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE 

11 DEMONSTRATION PROGRAM. 

12 Part P of title III of the Public Health Service Act 

13 (42 U.S.C. 280g et seq.) is amended by adding at the end 

14 the following: 

15 ‘‘SEC. 399V–7. PREGNANCY INTENTION SCREENING INITIA16 TIVE DEMONSTRATION PROGRAM. 

17 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 

18 acting through the Director of the Centers for Disease 

19 Control and Prevention, shall establish a demonstration 

20 program to facilitate the clinical adoption of pregnancy in21 tention screening initiatives by health care and social serv22 ices providers. 

23 ‘‘(b) GRANTS.—The Secretary may carry out the 

24 demonstration program through awarding grants to eligiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ble entities to implement pregnancy intention screening 

2 initiatives, collect data, and evaluate such initiatives. 

3 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible to seek a 

4 grant under this section, an entity shall— 

5 ‘‘(1) provide non-directive, comprehensive, 

6 medically accurate information; and 

7 ‘‘(2) be a community-based organization, vol8 untary health organization, public health depart9 ment, community health center, or other interested 

10 public or private primary, behavioral, or other health 

11 care or social service provider or organization. 

12 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA13 TIVE.—For purposes of this section, the term ‘pregnancy 

14 intention screening initiative’ means any initiative by an 

15 eligible entity to routinely screen people with respect to 

16 their pregnancy intentions and goals to either prevent un17 intended pregnancies or improve the likelihood of healthy 

18 pregnancies, in order to better provide health care that 

19 meets the contraceptive or pre-pregnancy needs and goals 

20 of such people. 

21 ‘‘(e) EVALUATION.— 

22 ‘‘(1) IN GENERAL.—The Secretary, acting 

23 through the Director of the Centers for Disease 

24 Control and Prevention, shall, by grant or contract, 

25 and after consultation as described in paragraph (2), 


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1 conduct an evaluation of the demonstration pro2 gram, with respect to pregnancy intention screening 

3 initiatives, conducted under this section. Such eval4 uation shall include: 

5 ‘‘(A) Assessment of the implementation of 

6 pregnancy intention screening protocols among 

7 a diverse group of patients and providers, in8 cluding collecting data on the experiences and 

9 outcomes for diverse patient populations in a 

10 variety of clinical settings. 

11 ‘‘(B) Analysis of outcome measures that 

12 will facilitate effective and widespread adoption 

13 of such protocols by health care providers for 

14 inquiring about and responding to pregnancy 

15 goals of people with both contraceptive and pre16 pregnancy care. 

17 ‘‘(C) Consideration of health inequities 

18 among the population served. 

19 ‘‘(D) Assessment of the equitable and vol20 untary application of such initiatives to minor21 ity and medically underserved communities. 

22 ‘‘(E) Assessment of the training, capacity, 

23 and ongoing technical assistance needed for 

24 providers to effectively implement such preg25 nancy intention screening protocols. 


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1 ‘‘(F) Assessment of whether referral sys2 tems for selected protocols follow evidence-based 

3 standards that ensure access to comprehensive 

4 health services and appropriate follow-up care. 

5 ‘‘(G) Measuring through rigorous methods 

6 the effect of such initiatives on key health out7 comes. 

8 ‘‘(2) CONSULTATION WITH INDEPENDENT, EX9 PERT ADVISORY PANEL.—In conducting the evalua10 tion under paragraph (1), the Director of the Cen11 ters for Disease Control and Prevention shall consult 

12 with physicians, physician assistants, advanced prac13 tice registered nurses, nurse midwives, and other 

14 health care providers who specialize in women’s 

15 health, and other experts in public health, clinical 

16 practice, program evaluation, and research. 

17 ‘‘(3) REPORT.—Not later than one year after 

18 the last day of the demonstration program under 

19 this section, the Director of the Centers for Disease 

20 Control and Prevention shall— 

21 ‘‘(A) submit to Congress a report on the 

22 results of the evaluation conducted under para23 graph (1); and 

24 ‘‘(B) make the report publicly available. 

25 ‘‘(f) FUNDING.— 


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1 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

2 To carry out this section, there is authorized to be 

3 appropriated $10,000,000 for each of fiscal years 

4 2023 through 2027. 

5 ‘‘(2) LIMITATION.—Not more than 20 percent 

6 of funds appropriated to carry out this section pur7 suant to paragraph (1) for a fiscal year may be used 

8 for purposes of the evaluation under subsection 

9 (e).’’. 

10 SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 

11 AND AWARENESS. 

12 (a) IN GENERAL.—The Secretary shall establish and 

13 implement a birth defects prevention and public awareness 

14 program, consisting of the activities described in sub15 sections (c) and (d). 

16 (b) DEFINITIONS.—In this section: 

17 (1) MATERNAL.—The term ‘‘maternal’’ refers 

18 to people who are pregnant or breastfeeding. 

19 (2) PREGNANCY AND BREASTFEEDING INFOR20 MATION SERVICES.—The term ‘‘pregnancy and 

21 breastfeeding information services’’ includes only— 

22 (A) information services to provide accu23 rate, evidence-based, clinical information re24 garding maternal exposures during pregnancy 

25 or breastfeeding that may be associated with 


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1 birth defects, health risks to a breastfed infant, 

2 or other health risks, such as exposures to 

3 medications, chemicals, infections, foodborne 

4 pathogens, illnesses, nutrition, lifestyle, or 

5 climate- and weather-related factors; 

6 (B) the provision of accurate, evidence7 based information weighing risks of exposures 

8 during breastfeeding against the benefits of 

9 breastfeeding; and 

10 (C) the provision of information described 

11 in subparagraph (A) or (B) through counselors, 

12 websites, fact sheets, telephonic or electronic 

13 communication, community outreach efforts, or 

14 other appropriate means. 

15 (3) SECRETARY.—The term ‘‘Secretary’’ means 

16 the Secretary of Health and Human Services, acting 

17 through the Director of the Centers for Disease 

18 Control and Prevention. 

19 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 

20 subsection (a), the Secretary shall conduct or support a 

21 nationwide media campaign to increase awareness among 

22 health care providers and at-risk populations about preg23 nancy and breastfeeding information services. 

24 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING

25 INFORMATION SERVICES.— 


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1 (1) IN GENERAL.—In carrying out subsection 

2 (a), the Secretary shall award grants to State or re3 gional agencies or organizations for any of the fol4 lowing: 

5 (A) INFORMATION SERVICES.—The provi6 sion of, or campaigns to increase awareness 

7 about, pregnancy and breastfeeding information 

8 services. 

9 (B) SURVEILLANCE AND RESEARCH.—The 

10 conduct or support of— 

11 (i) surveillance of or research on— 

12 (I) maternal exposures and ma13 ternal health conditions that may in14 fluence the risk of birth defects, pre15 maturity, or other adverse pregnancy 

16 outcomes; and 

17 (II) maternal exposures that may 

18 influence health risks to a breastfed 

19 infant; or 

20 (ii) networking to facilitate surveil21 lance or research described in this sub22 paragraph. 

23 (2) PREFERENCE FOR CERTAIN STATES.—The 

24 Secretary, in making any grant under this sub25 section, shall give preference to States, otherwise 


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1 equally qualified, that have pregnancy and 

2 breastfeeding information services in place. 

3 (3) MATCHING FUNDS.—The Secretary may 

4 only award a grant under this subsection to a State 

5 or regional agency or organization that agrees, with 

6 respect to the costs to be incurred in carrying out 

7 the grant activities, to make available (directly or 

8 through donations from public or private entities) 

9 non-Federal funds toward such costs in an amount 

10 equal to not less than 25 percent of the amount of 

11 the grant. 

12 (4) COORDINATION.—The Secretary shall en13 sure that activities funded through a grant under 

14 this subsection are coordinated, to the maximum ex15 tent practicable, with other birth defects prevention 

16 and environmental health activities of the Federal 

17 Government, including with respect to pediatric envi18 ronmental health specialty units and children’s envi19 ronmental health centers. 

20 (e) EVALUATION.—The Secretary shall provide for an 

21 evaluation of pregnancy and breastfeeding information 

22 services carried out by States to identify efficient and ef23 fective models of— 

24 (1) providing information; 


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1 (2) raising awareness and increasing knowledge 

2 about birth defects prevention measures and tar3 geting education to at-risk groups; 

4 (3) modifying risk behaviors; or 

5 (4) other outcome measures as determined ap6 propriate by the Secretary. 

7 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

8 out this section, there are authorized to be appropriated— 

9 (1) $5,000,000 for fiscal year 2023; 

10 (2) $6,000,000 for fiscal year 2024; 

11 (3) $7,000,000 for fiscal year 2025; 

12 (4) $8,000,000 for fiscal year 2026; and 

13 (5) $9,000,000 for fiscal year 2027. 

14 Subtitle C—Pregnancy-Related 

15 Care 

16 SEC. 5201. MOTHERS AND OFFSPRING MORTALITY AND 

17 MORBIDITY AWARENESS. 

18 (a) IMPROVING FEDERAL EFFORTS WITH RESPECT

19 TO PREVENTION OF MATERNAL MORTALITY.— 

20 (1) TECHNICAL ASSISTANCE FOR STATES WITH

21 RESPECT TO REPORTING MATERNAL MORTALITY.— 

22 Not later than one year after the date of enactment 

23 of this Act, the Director of the Centers for Disease 

24 Control and Prevention (referred to in this section 

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1 istrator of the Health Resources and Services Ad2 ministration, shall provide technical assistance to 

3 States that elect to report comprehensive data on 

4 maternal mortality and factors relating to such mor5 tality (including oral and mental health), intimate 

6 partner violence, and breastfeeding health informa7 tion, for the purpose of encouraging uniformity in 

8 the reporting of such data and to encourage the 

9 sharing of such data among the respective States. 

10 (2) BEST PRACTICES RELATING TO PREVEN11 TION OF MATERNAL MORTALITY.— 

12 (A) IN GENERAL.—Not later than one year 

13 after the date of enactment of this Act— 

14 (i) the Director, in consultation with 

15 relevant patient and provider groups, shall 

16 issue best practices to State maternal mor17 tality review committees on how best to 

18 identify and review maternal mortality 

19 cases, taking into account any data made 

20 available by States relating to maternal 

21 mortality, including data on oral, mental, 

22 and breastfeeding health, and utilization of 

23 any emergency services; and 

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1 ices Administration, shall issue best prac2 tices to hospitals, State professional society 

3 groups, and perinatal quality collaboratives 

4 on how best to prevent maternal mortality. 

5 (B) AUTHORIZATION OF APPROPRIA6 TIONS.—For purposes of carrying out this 

7 paragraph, there is authorized to be appro8 priated $5,000,000 for each of fiscal years 

9 2023 through 2027. 

10 (3) ALLIANCE FOR INNOVATION ON MATERNAL

11 HEALTH GRANT PROGRAM.— 

12 (A) IN GENERAL.—Not later than one year 

13 after the date of enactment of this Act, the Sec14 retary of Health and Human Services, acting 

15 through the Associate Administrator of the Ma16 ternal and Child Health Bureau of the Health 

17 Resources and Services Administration (re18 ferred to in this paragraph as the ‘‘Secretary’’), 

19 shall establish a grant program to be known as 

20 the Alliance for Innovation on Maternal Health 

21 Grant Program (referred to in this subsection 

22 as ‘‘AIM’’) under which the Secretary shall 

23 award grants to eligible entities for the purpose 

24 of— 


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1 (i) directing widespread adoption and 

2 implementation of maternal safety bundles 

3 through collaborative State-based teams; 

4 and 

5 (ii) collecting and analyzing process, 

6 structure, and outcome data to drive con7 tinuous improvement in the implementa8 tion of such safety bundles by such State9 based teams with the ultimate goal of 

10 eliminating preventable maternal mortality 

11 and severe maternal morbidity in the 

12 United States. 

13 (B) ELIGIBLE ENTITIES.—In order to be 

14 eligible for a grant under subparagraph (A), an 

15 entity shall— 

16 (i) submit to the Secretary an applica17 tion at such time, in such manner, and 

18 containing such information as the Sec19 retary may require; and 

20 (ii) demonstrate in such application 

21 that the entity is an interdisciplinary, 

22 multi-stakeholder, national organization 

23 with a national data-driven maternal safety 

24 and quality improvement initiative based 

25 on implementation approaches that have 


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1 been proven to improve maternal safety 

2 and outcomes in the United States. 

3 (C) USE OF FUNDS.—An eligible entity 

4 that receives a grant under subparagraph (A) 

5 shall use such grant funds— 

6 (i) to develop and implement, through 

7 a robust, multi-stakeholder process, mater8 nal safety bundles to assist States, 

9 perinatal quality collaboratives, and health 

10 care systems in aligning national, State, 

11 and hospital-level quality improvement ef12 forts to improve maternal health outcomes, 

13 specifically the reduction of maternal mor14 tality and severe maternal morbidity; 

15 (ii) to ensure, in developing and im16 plementing maternal safety bundles under 

17 clause (i), that such maternal safety bun18 dles— 

19 (I) satisfy the quality improve20 ment needs of a State, perinatal qual21 ity collaborative, or health care system 

22 by factoring in the results and find23 ings of relevant data reviews, such as 

24 reviews conducted by a State maternal 

25 mortality review committee; and 


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1 (II) address topics which may in2 clude— 

3 (aa) information on evi4 dence-based practices to improve 

5 the quality and safety of mater6 nal health care in hospitals and 

7 other health care settings of a 

8 State or health care system, in9 cluding by addressing topics com10 monly associated with health 

11 complications or risks related to 

12 prenatal care, labor care, birth13 ing, and postpartum care; 

14 (bb) best practices for im15 proving maternal health care 

16 based on data findings and re17 views conducted by a State ma18 ternal mortality review committee 

19 that address topics of relevance 

20 to common complications or 

21 health risks related to prenatal 

22 care, labor care, birthing, and 

23 postpartum care; 

24 (cc) information on address25 ing determinants of health that 


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1 impact maternal health outcomes 

2 for people before, during, and 

3 after pregnancy; 

4 (dd) obstetric hemorrhage; 

5 (ee) obstetric and 

6 postpartum care for people with 

7 substance use disorders, includ8 ing opioid use disorder; 

9 (ff) maternal cardiovascular 

10 system; 

11 (gg) maternal mental health; 

12 (hh) postpartum care basics 

13 for maternal safety; 

14 (ii) reduction of peripartum 

15 racial and ethnic inequities; 

16 (jj) reduction of primary ce17 sarean birth; 

18 (kk) severe hypertension in 

19 pregnancy; 

20 (ll) severe maternal mor21 bidity reviews; 

22 (mm) support after a severe 

23 maternal morbidity event; 

24 (nn) thromboembolism; 


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1 (oo) optimization of support 

2 for breastfeeding; 

3 (pp) maternal oral health; 

4 and 

5 (qq) intimate partner vio6 lence; and 

7 (iii) to provide ongoing technical as8 sistance at the national and State levels to 

9 support implementation of maternal safety 

10 bundles under clause (i). 

11 (D) MATERNAL SAFETY BUNDLE DE12 FINED.—For purposes of this paragraph, the 

13 term ‘‘maternal safety bundle’’ means standard14 ized, evidence-informed processes for maternal 

15 health care. 

16 (E) AUTHORIZATION OF APPROPRIA17 TIONS.—For purposes of carrying out this 

18 paragraph, there is authorized to be appro19 priated $10,000,000 for each of fiscal years 

20 2023 through 2027. 

21 (4) FUNDING FOR STATE-BASED PERINATAL

22 QUALITY COLLABORATIVES DEVELOPMENT AND SUS23 TAINABILITY.— 

24 (A) IN GENERAL.—Not later than one year 

25 after the date of enactment of this Act, the SecVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 retary of Health and Human Services (referred 

2 to in this paragraph as the ‘‘Secretary’’), acting 

3 through the Division of Reproductive Health of 

4 the Centers for Disease Control and Prevention, 

5 shall establish a grant program to be known as 

6 the State-Based Perinatal Quality Collaborative 

7 grant program under which the Secretary 

8 awards grants to eligible entities for the pur9 pose of development and sustainability of 

10 perinatal quality collaboratives in every State, 

11 the District of Columbia, and eligible terri12 tories, in order to measurably improve perinatal 

13 care and perinatal health outcomes for preg14 nant and postpartum people and their infants. 

15 (B) GRANT AMOUNTS.—Grants awarded 

16 under this paragraph shall be in amounts not to 

17 exceed $250,000 per year, for the duration of 

18 the grant period. 

19 (C) STATE-BASED PERINATAL QUALITY

20 COLLABORATIVE DEFINED.—For purposes of 

21 this paragraph, the term ‘‘State-based perinatal 

22 quality collaborative’’ means a network of teams 

23 that— 


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1 (i) is multidisciplinary in nature and 

2 includes the full range of perinatal and 

3 maternity care providers; 

4 (ii) works to improve measurable out5 comes for maternal and infant health by 

6 advancing evidence-informed clinical prac7 tices using quality improvement principles; 

8 (iii) works with hospital-based or out9 patient facility-based clinical teams, ex10 perts, and stakeholders, including patients 

11 and families, to spread best practices and 

12 optimize resources to improve perinatal 

13 care and outcomes; 

14 (iv) employs strategies that include 

15 the use of the collaborative learning model 

16 to provide opportunities for hospitals and 

17 clinical teams to collaborate on improve18 ment strategies, rapid-response data to 

19 provide timely feedback to hospital and 

20 other clinical teams to track progress, and 

21 quality improvement science to provide 

22 support and coaching to hospital and clin23 ical teams; 


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1 (v) has the goal of improving popu2 lation-level outcomes in maternal and in3 fant health; and 

4 (vi) has the goal of improving out5 comes of all birthing people, through the 

6 coordination, integration, and collaboration 

7 across birth settings. 

8 (D) AUTHORIZATION OF APPROPRIA9 TIONS.—For purposes of carrying out this 

10 paragraph, there is authorized to be appro11 priated $14,000,000 per year for each of fiscal 

12 years 2023 through 2027. 

13 (5) EXPANSION OF MEDICAID AND CHIP COV14 ERAGE FOR PREGNANT AND POSTPARTUM PEO15 PLE.— 

16 (A) REQUIRING COVERAGE OF ORAL

17 HEALTH SERVICES FOR PREGNANT AND

18 POSTPARTUM PEOPLE.— 

19 (i) MEDICAID.—Section 1905 of the 

20 Social Security Act (42 U.S.C. 1396d), as 

21 previously amended by this Act, is amend22 ed— 

23 (I) in subsection (a)(4), by in24 serting ‘‘; and (G) oral health services 

25 for pregnant and postpartum people 


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1 (as defined in subsection (mm))’’ be2 fore the semicolon at the end; and 

3 (II) by adding at the end the fol4 lowing new subsection: 

5 ‘‘(mm) ORAL HEALTH SERVICES FOR PREGNANT

6 AND POSTPARTUM PEOPLE.— 

7 ‘‘(1) IN GENERAL.—For purposes of this title, 

8 the term ‘oral health services for pregnant and 

9 postpartum people’ means dental services necessary 

10 to prevent disease and promote oral health, restore 

11 oral structures to health and function, and treat 

12 emergency conditions that are furnished to a person 

13 during pregnancy (or during the 1-year period be14 ginning on the last day of the pregnancy). 

15 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 

16 the requirement to provide oral health services for 

17 pregnant and postpartum people, a State shall pro18 vide coverage for preventive, diagnostic, periodontal, 

19 and restorative care consistent with recommenda20 tions for perinatal oral health care and dental care 

21 during pregnancy from the American Academy of 

22 Pediatric Dentistry and the American College of Ob23 stetricians and Gynecologists.’’. 

24 (ii) CHIP.—Section 2103(c)(6)(A) of 

25 the Social Security Act (42 U.S.C. 


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1 1397cc(c)(6)(A)) is amended by inserting 

2 ‘‘or a targeted low-income pregnant per3 son’’ after ‘‘targeted low-income child’’. 

4 (B) EXTENDING MEDICAID COVERAGE FOR

5 PREGNANT AND POSTPARTUM PEOPLE.—Sec6 tion 1902 of the Social Security Act (42 U.S.C. 

7 1396a) is amended— 

8 (i) in subsection (e)— 

9 (I) in paragraph (5)— 

10 (aa) by inserting ‘‘(including 

11 oral health services for pregnant 

12 and postpartum people (as de13 fined in section 1905(mm)))’’ 

14 after ‘‘postpartum medical assist15 ance under the plan’’; and 

16 (bb) by striking ‘‘60-day’’ 

17 and inserting ‘‘1-year’’; and 

18 (II) in paragraph (6), by striking 

19 ‘‘60-day’’ and inserting ‘‘1-year’’; and 

20 (ii) in subsection (l)(1)(A), by striking 

21 ‘‘60-day’’ and inserting ‘‘1-year’’. 

22 (C) EXTENDING CHIP COVERAGE FOR

23 PREGNANT AND POSTPARTUM PEOPLE.—Sec24 tion 2112(d)(2)(A) of the Social Security Act 


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1 (42 U.S.C. 1397ll(d)(2)(A)) is amended by 

2 striking ‘‘60-day’’ and inserting ‘‘1-year’’. 

3 (D) CONFORMING AMENDMENTS.— 

4 (i) Section 1902(e)(16) of the Social 

5 Security Act (42 U.S.C. 1396a(e)(16)) is 

6 amended— 

7 (I) in subparagraph (A), by strik8 ing ‘‘may provide’’ and all that follows 

9 through the period and inserting the 

10 following: ‘‘may provide that the State 

11 will provide the medical assistance de12 scribed in subparagraph (B) to an in13 dividual who, while pregnant, is eligi14 ble for and has received medical as15 sistance under the State plan ap16 proved under this title (or a waiver of 

17 such plan), including during a period 

18 of retroactive eligibility under sub19 section (a)(34) and through the end 

20 of the month in which the 1-year pe21 riod beginning on the last day of the 

22 individual’s pregnancy ends.’’; and 

23 (II) in subparagraph (B), by 

24 striking ‘‘12-month’’ each place it ap25 pears and inserting ‘‘1-year’’. 


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1 (ii) Section 1905(a) of the Social Se2 curity Act (42 U.S.C. 1396d(a)) is amend3 ed, in the fifth sentence, by striking ‘‘60- 

4 day’’ and inserting ‘‘1-year’’. 

5 (E) MAINTENANCE OF EFFORT.— 

6 (i) MEDICAID.—Section 1902(l) of the 

7 Social Security Act (42 U.S.C. 1396a(l)) is 

8 amended by adding at the end the fol9 lowing new paragraph: 

10 ‘‘(5) During the period that begins on the date of 

11 enactment of this paragraph and ends on the date that 

12 is 5 years after such date of enactment, as a condition 

13 for receiving any Federal payments under section 1903(a) 

14 for calendar quarters occurring during such period, a 

15 State shall not have in effect, with respect to people who 

16 are eligible for medical assistance under the State plan 

17 or under a waiver of such plan on the basis of being preg18 nant or having been pregnant, eligibility standards, meth19 odologies, or procedures under the State plan or waiver 

20 that are more restrictive than the eligibility standards, 

21 methodologies, or procedures, respectively, under such 

22 plan or waiver that are in effect on the date of enactment 

23 of this paragraph.’’. 

24 (ii) CHIP.—Section 2105(d) of the 

25 Social Security Act (42 U.S.C. 1397ee(d)) 


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1 is amended by adding at the end the fol2 lowing new paragraph: 

3 ‘‘(4) ELIGIBILITY STANDARDS FOR TARGETED

4 LOW-INCOME PREGNANT PEOPLE.—During the pe5 riod that begins on the date of enactment of this 

6 paragraph and ends on the date that is five years 

7 after such date of enactment, as a condition of re8 ceiving payments under subsection (a) and section 

9 1903(a), a State that elects to provide assistance to 

10 people on the basis of being pregnant (including 

11 pregnancy-related assistance provided to targeted 

12 low-income pregnant people (as defined in section 

13 2112(d)), pregnancy-related assistance provided to 

14 people who are eligible for such assistance through 

15 application of section 1902(v)(4)(A) under section 

16 2107(e)(1), or any other assistance under the State 

17 child health plan (or a waiver of such plan) which 

18 is provided to people on the basis of being pregnant) 

19 shall not have in effect, with respect to such people, 

20 eligibility standards, methodologies, or procedures 

21 under such plan (or waiver) that are more restrictive 

22 than the eligibility standards, methodologies, or pro23 cedures, respectively, under such plan (or waiver) 

24 that are in effect on the date of enactment of this 

25 paragraph.’’. 


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1 (F) INFORMATION ON BENEFITS.—The 

2 Secretary of Health and Human Services shall 

3 make publicly available on the internet website 

4 of the Department of Health and Human Serv5 ices, information regarding benefits available to 

6 pregnant and postpartum people and under the 

7 Medicaid program and the Children’s Health 

8 Insurance Program, including information on— 

9 (i) benefits that States are required to 

10 provide to pregnant and postpartum people 

11 under such programs; 

12 (ii) optional benefits that States may 

13 provide to pregnant and postpartum people 

14 under such programs; and 

15 (iii) the availability of different kinds 

16 of benefits for pregnant and postpartum 

17 people, including oral health and mental 

18 health benefits, under such programs. 

19 (G) FEDERAL FUNDING FOR COST OF EX20 TENDED MEDICAID AND CHIP COVERAGE FOR

21 POSTPARTUM PEOPLE.— 

22 (i) MEDICAID.—Section 1905 of the 

23 Social Security Act (42 U.S.C. 1396d), as 

24 previously amended by this Act, is further 

25 amended— 


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1 (I) in subsection (b), by striking 

2 ‘‘and (ll)’’ and inserting ‘‘(ll), and 

3 (nn)’’; and 

4 (II) by adding at the end the fol5 lowing: 

6 ‘‘(nn) INCREASED FMAP FOR EXTENDED MEDICAL

7 ASSISTANCE FOR POSTPARTUM PEOPLE.—Notwith8 standing subsection (b), the Federal medical assistance 

9 percentage for a State, with respect to amounts expended 

10 by such State for medical assistance for a person who is 

11 eligible for such assistance on the basis of being pregnant 

12 or having been pregnant that is provided during the 305- 

13 day period that begins on the 60th day after the last day 

14 of their pregnancy (including any such assistance provided 

15 during the month in which such period ends), shall be 

16 equal to— 

17 ‘‘(1) 100 percent for the first 20 calendar quar18 ters during which this subsection is in effect; and 

19 ‘‘(2) 90 percent for calendar quarters there20 after.’’. 

21 (ii) CHIP.—Section 2105(c) of the 

22 Social Security Act (42 U.S.C. 1397ee(c)) 

23 is amended by adding at the end the fol24 lowing new paragraph: 


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1 ‘‘(13) ENHANCED PAYMENT FOR EXTENDED

2 ASSISTANCE PROVIDED TO PREGNANT PEOPLE.— 

3 Notwithstanding subsection (b), the enhanced 

4 FMAP, with respect to payments under subsection 

5 (a) for expenditures under the State child health 

6 plan (or a waiver of such plan) for assistance pro7 vided under the plan (or waiver) to a person who is 

8 eligible for such assistance on the basis of being 

9 pregnant (including pregnancy-related assistance 

10 provided to a targeted low-income pregnant person 

11 (as defined in section 2112(d)), pregnancy-related 

12 assistance provided to a person who is eligible for 

13 such assistance through application of section 

14 1902(v)(4)(A) under section 2107(e)(1), or any 

15 other assistance under the plan (or waiver) provided 

16 to a person who is eligible for such assistance on the 

17 basis of being pregnant) during the 305-day period 

18 that begins on the 60th day after the last day of her 

19 pregnancy (including any such assistance provided 

20 during the month in which such period ends), shall 

21 be equal to— 

22 ‘‘(A) 100 percent for the first 20 calendar 

23 quarters during which this paragraph is in ef24 fect; and 


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1 ‘‘(B) 90 percent for calendar quarters 

2 thereafter.’’. 

3 (H) GUIDANCE ON STATE OPTIONS FOR

4 MEDICAID COVERAGE OF DOULA SERVICES.— 

5 Not later than 1 year after the date of the en6 actment of this Act, the Secretary of Health 

7 and Human Services, acting through the Ad8 ministrator of the Centers for Medicare & Med9 icaid Services, shall issue guidance for the 

10 States concerning options for Medicaid coverage 

11 and payment for support services provided by 

12 doulas. 

13 (I) EFFECTIVE DATE.— 

14 (i) IN GENERAL.—Subject to clause 

15 (ii), the amendments made by this para16 graph shall take effect on the first day of 

17 the first calendar quarter that begins on or 

18 after the date that is one year after the 

19 date of enactment of this Act. 

20 (ii) EXCEPTION FOR STATE LEGISLA21 TION.—In the case of a State plan under 

22 title XIX of the Social Security Act or a 

23 State child health plan under title XXI of 

24 such Act that the Secretary of Health and 

25 Human Services determines requires State 


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1 legislation in order for the respective plan 

2 to meet any requirement imposed by 

3 amendments made by this paragraph, the 

4 respective plan shall not be regarded as 

5 failing to comply with the requirements of 

6 such title solely on the basis of its failure 

7 to meet such an additional requirement be8 fore the first day of the first calendar 

9 quarter beginning after the close of the 

10 first regular session of the State legislature 

11 that begins after the date of enactment of 

12 this Act. For purposes of the previous sen13 tence, in the case of a State that has a 2- 

14 year legislative session, each year of the 

15 session shall be considered to be a separate 

16 regular session of the State legislature. 

17 (6) REGIONAL CENTERS OF EXCELLENCE.— 

18 Part P of title III of the Public Health Service Act 

19 (42 U.S.C. 280g et seq.), as amended by section 

20 5101, is further amended by adding at the end the 

21 following new section: 


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1 ‘‘SEC. 399V–8. REGIONAL CENTERS OF EXCELLENCE AD2 DRESSING IMPLICIT BIAS AND CULTURAL 

3 COMPETENCY IN PATIENT-PROVIDER INTER4 ACTIONS EDUCATION. 

5 ‘‘(a) IN GENERAL.—Not later than one year after the 

6 date of enactment of this section, the Secretary, in con7 sultation with such other agency heads as the Secretary 

8 determines appropriate, shall award cooperative agree9 ments for the establishment or support of regional centers 

10 of excellence addressing implicit bias, cultural competency, 

11 and respectful care practices in patient-provider inter12 actions education for the purpose of enhancing and im13 proving how health care professionals are educated in im14 plicit bias and delivering culturally competent health care. 

15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper16 ative agreement under subsection (a), an entity shall— 

17 ‘‘(1) be a public or other nonprofit entity speci18 fied by the Secretary that provides educational and 

19 training opportunities for students and health care 

20 professionals, which may be a health system, teach21 ing hospital, community health center, medical 

22 school, school of public health, school of nursing, 

23 dental school, social work school, school of profes24 sional psychology, or any other health professional 

25 school or program at an institution of higher edu26 cation (as defined in section 101 of the Higher EduVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 cation Act of 1965) focused on the prevention, treat2 ment, or recovery of health conditions that con3 tribute to maternal mortality and the prevention of 

4 maternal mortality and severe maternal morbidity; 

5 ‘‘(2) demonstrate community engagement and 

6 participation, such as through partnerships with 

7 home visiting and case management programs; 

8 ‘‘(3) demonstrate engagement with groups en9 gaged in the implementation of health care profes10 sional training in implicit bias and delivering cul11 turally competent care, such as departments of pub12 lic health, perinatal quality collaboratives, hospital 

13 systems, and health care professional groups, in 

14 order to obtain input on resources needed for effec15 tive implementation strategies; and 

16 ‘‘(4) provide to the Secretary such information, 

17 at such time and in such manner, as the Secretary 

18 may require. 

19 ‘‘(c) DIVERSITY.—In awarding a cooperative agree20 ment under subsection (a), the Secretary shall take into 

21 account any regional differences among eligible entities 

22 and make an effort to ensure geographic diversity among 

23 award recipients. 

24 ‘‘(d) DISSEMINATION OF INFORMATION.— 


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1 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 

2 shall make publicly available on the internet website 

3 of the Department of Health and Human Services 

4 information submitted to the Secretary under sub5 section (b)(4). 

6 ‘‘(2) EVALUATION.—The Secretary shall evalu7 ate each regional center of excellence established or 

8 supported pursuant to subsection (a) and dissemi9 nate the findings resulting from each such evalua10 tion to the appropriate public and private entities. 

11 ‘‘(3) DISTRIBUTION.—The Secretary shall share 

12 evaluations and overall findings with State depart13 ments of health and other relevant State level offices 

14 to inform State and local best practices. 

15 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec16 tion, the term ‘maternal mortality’ means death of a per17 son that occurs during pregnancy or within the one-year 

18 period following the end of such pregnancy. 

19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 

20 purposes of carrying out this section, there is authorized 

21 to be appropriated $5,000,000 for each of fiscal years 

22 2023 through 2027.’’. 

23 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO24 GRAM FOR PEOPLE, INFANTS, AND CHILDREN.—SecVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tion 17(d)(3)(A)(ii) of the Child Nutrition Act of 

2 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended— 

3 (A) by striking the clause designation and 

4 heading and all that follows through ‘‘A State’’ 

5 and inserting the following: 

6 ‘‘(ii) PREGNANT AND POSTPARTUM

7 PEOPLE.— 

8 ‘‘(I) BREASTFEEDING PEOPLE.— 

9 A State’’; 

10 (B) in subclause (I) (as so designated), by 

11 striking ‘‘1 year’’ and all that follows through 

12 ‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 

13 and 

14 (C) by adding at the end the following: 

15 ‘‘(II) POSTPARTUM PEOPLE.—A 

16 State may elect to certify a 

17 postpartum person for a period of 2 

18 years.’’. 

19 (8) DEFINITIONS.—In this subsection: 

20 (A) MATERNAL MORTALITY.—The term 

21 ‘‘maternal mortality’’ means death of a person 

22 that occurs during pregnancy or within the one23 year period following the end of such preg24 nancy. 


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1 (B) PREGNANCY RELATED DEATH.—The 

2 term ‘‘pregnancy related death’’ includes the 

3 death of a person during pregnancy or within 

4 one year of the end of pregnancy from a preg5 nancy complication, a chain of events initiated 

6 by pregnancy, or the aggravation of an unre7 lated condition by the physiologic effects of 

8 pregnancy. 

9 (C) SEVERE MATERNAL MORBIDITY.—The 

10 term ‘‘severe maternal morbidity’’ includes un11 expected outcomes of labor and delivery that re12 sult in significant short-term or long-term con13 sequences to a person’s health. 

14 (b) INCREASE IN TAX ON CERTAIN TOBACCO PROD15 UCTS AND IMPOSITION OF TAX ON NICOTINE.— 

16 (1) INCREASING TAX ON CIGARETTES.— 

17 (A) SMALL CIGARETTES.—Section 

18 5701(b)(1) of the Internal Revenue Code of 

19 1986 is amended by striking ‘‘$50.33’’ and in20 serting ‘‘$100.66’’. 

21 (B) LARGE CIGARETTES.—Section 

22 5701(b)(2) of such Code is amended by striking 

23 ‘‘$105.69’’ and inserting ‘‘$211.39’’. 


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1 (2) TAX PARITY FOR SMALL CIGARS.—Section 

2 5701(a)(1) of such Code is amended by striking 

3 ‘‘$50.33’’ and inserting ‘‘$100.66’’. 

4 (3) TAX PARITY FOR LARGE CIGARS.—Section 

5 5701(a)(2) of such Code is amended by striking 

6 ‘‘52.75 percent’’ and all that follows through the pe7 riod and inserting ‘‘$49.56 per pound and a propor8 tionate tax at the like rate on all fractional parts of 

9 a pound but not less than 10.06 cents per cigar.’’. 

10 (4) TAX PARITY FOR SMOKELESS TOBACCO.— 

11 (A) Section 5701(e) of such Code is 

12 amended— 

13 (i) in paragraph (1), by striking 

14 ‘‘$1.51’’ and inserting ‘‘$26.84’’, 

15 (ii) in paragraph (2), by striking 

16 ‘‘50.33 cents’’ and inserting ‘‘$10.70’’, and 

17 (iii) by adding at the end the fol18 lowing new paragraph: 

19 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE

20 SINGLE-USE UNITS.—On discrete single-use units, 

21 $100 per thousand.’’. 

22 (B) Section 5702(m) of such Code is 

23 amended— 


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1 (i) in paragraph (1), by striking ‘‘or 

2 chewing tobacco’’ and inserting ‘‘, chewing 

3 tobacco, or discrete single-use unit’’, 

4 (ii) in paragraphs (2) and (3), by in5 serting ‘‘and that is not a discrete single6 use unit’’ before the period at the end of 

7 each such paragraph, and 

8 (iii) by adding at the end the fol9 lowing new paragraph: 

10 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 

11 ‘discrete single-use unit’ means any product con12 taining tobacco that— 

13 ‘‘(A) is not intended to be smoked, and 

14 ‘‘(B) is in the form of a lozenge, tablet, 

15 pill, pouch, dissolvable strip, or other discrete 

16 single-use or single-dose unit.’’. 

17 (5) TAX PARITY FOR PIPE TOBACCO.—Section 

18 5701(f) of such Code is amended by striking 

19 ‘‘$2.8311 cents’’ and inserting ‘‘$49.56’’. 

20 (6) TAX PARITY FOR ROLL-YOUR-OWN TO21 BACCO.—Section 5701(g) of such Code is amended 

22 by striking ‘‘$24.78’’ and inserting ‘‘$49.56’’. 

23 (7) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO

24 AND CERTAIN PROCESSED TOBACCO.—Section 

25 5702(o) of such Code is amended by inserting ‘‘, 


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1 and includes processed tobacco that is removed for 

2 delivery or delivered to a person other than a person 

3 with a permit provided under section 5713, but does 

4 not include removals of processed tobacco for expor5 tation’’ after ‘‘wrappers thereof’’. 

6 (8) IMPOSITION OF TAX ON NICOTINE FOR USE

7 IN VAPING, ETC.— 

8 (A) IN GENERAL.—Section 5701 of such 

9 Code is amended by redesignating subsection 

10 (h) as subsection (i) and by inserting after sub11 section (g) the following new subsection: 

12 ‘‘(h) NICOTINE.—On taxable nicotine, manufactured 

13 in or imported into the United States, there shall be im14 posed a tax equal to the dollar amount specified in section 

15 5701(b)(1) per 1,810 milligrams of nicotine (and a pro16 portionate tax at the like rate on any fractional part there17 of).’’. 

18 (B) TAXABLE NICOTINE.—Section 5702 of 

19 such Code is amended by adding at the end the 

20 following new subsection: 

21 ‘‘(q) TAXABLE NICOTINE.— 

22 ‘‘(1) IN GENERAL.—Except as otherwise pro23 vided in this subsection, the term ‘taxable nicotine’ 

24 means any nicotine which has been extracted, con25 centrated, or synthesized. 


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1 ‘‘(2) EXCEPTION FOR PRODUCTS APPROVED BY

2 FOOD AND DRUG ADMINISTRATION.—Such term 

3 shall not include any nicotine if the manufacturer or 

4 importer thereof demonstrates to the satisfaction of 

5 the Secretary of Health and Human Services that 

6 such nicotine will be used in— 

7 ‘‘(A) a drug— 

8 ‘‘(i) that is approved under section 

9 505 of the Federal Food, Drug, and Cos10 metic Act or licensed under section 351 of 

11 the Public Health Service Act, or 

12 ‘‘(ii) for which an investigational use 

13 exemption has been authorized under sec14 tion 505(i) of the Federal Food, Drug, and 

15 Cosmetic Act or under section 351(a) of 

16 the Public Health Service Act, or 

17 ‘‘(B) a combination product (as described 

18 in section 503(g) of the Federal Food, Drug, 

19 and Cosmetic Act), the constituent parts of 

20 which were approved or cleared under section 

21 505, 510(k), or 515 of such Act. 

22 ‘‘(3) COORDINATION WITH TAXATION OF OTHER

23 TOBACCO PRODUCTS.—Tobacco products meeting 

24 the definition of cigars, cigarettes, smokeless to25 bacco, pipe tobacco, and roll-your-own tobacco in 


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1 this section shall be classified and taxed as such de2 spite any concentration of the nicotine inherent in 

3 those products or any addition of nicotine to those 

4 products during the manufacturing process. 

5 ‘‘(4) REGULATIONS.—The Secretary shall pre6 scribe such regulations or other guidance as is nec7 essary or appropriate to carry out the purposes of 

8 this subsection, including regulations or other guid9 ance for coordinating the taxation of tobacco prod10 ucts and taxable nicotine to protect revenue and pre11 vent double taxation.’’. 

12 (C) TAXABLE NICOTINE TREATED AS A TO13 BACCO PRODUCT.—Section 5702(c) of such 

14 Code is amended by striking ‘‘and roll-your-own 

15 tobacco’’ and inserting ‘‘roll-your-own tobacco, 

16 and taxable nicotine’’. 

17 (D) MANUFACTURER OF TAXABLE NICO18 TINE.—Section 5702 of such Code, as amended 

19 by subparagraph (B), is amended by adding at 

20 the end the following new subsection: 

21 ‘‘(r) MANUFACTURER OF TAXABLE NICOTINE.— 

22 ‘‘(1) IN GENERAL.—Any person who extracts, 

23 concentrates, or synthesizes nicotine shall be treated 

24 as a manufacturer of taxable nicotine (and as manu25 facturing such taxable nicotine). 


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1 ‘‘(2) APPLICATION OF RULES RELATED TO

2 MANUFACTURERS OF TOBACCO PRODUCTS.—Any 

3 reference to a manufacturer of tobacco products, or 

4 to manufacturing tobacco products, shall be treated 

5 as including a reference to a manufacturer of tax6 able nicotine, or to manufacturing taxable nicotine, 

7 respectively.’’. 

8 (9) REPEAL OF SPECIAL RULES FOR DETER9 MINING PRICE OF CIGARS.—Section 5702 of such 

10 Code is amended by striking subsection (l). 

11 (10) FLOOR STOCKS TAXES.— 

12 (A) IMPOSITION OF TAX.—On covered to13 bacco products, and cigarette papers and tubes, 

14 manufactured in or imported into the United 

15 States which are removed before the tax in16 crease date and held on such date for sale by 

17 any person, there is hereby imposed a tax in an 

18 amount equal to the excess of— 

19 (i) the tax which would be imposed 

20 under section 5701 of the Internal Rev21 enue Code of 1986 on the article if the ar22 ticle had been removed on such date, over 

23 (ii) the prior tax (if any) imposed 

24 under section 5701 of such Code on such 

25 article. 


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1 (B) COVERED TOBACCO PRODUCTS.—For 

2 purposes of this paragraph, the term ‘‘covered 

3 tobacco products’’ means any tobacco product 

4 other than— 

5 (i) cigars described in section 

6 5701(a)(2) of the Internal Revenue Code 

7 of 1986, 

8 (ii) discrete single-use units (as de9 fined in section 5702(m)(4) of such Code, 

10 as amended by this subsection), and 

11 (iii) taxable nicotine (as defined in 

12 section 5702(q) of such Code, as amended 

13 by this subsection). 

14 (C) CREDIT AGAINST TAX.—Each person 

15 shall be allowed as a credit against the taxes 

16 imposed by subparagraph (A) an amount equal 

17 to the lesser of $1,000 or the amount of such 

18 taxes. For purposes of the preceding sentence, 

19 all persons treated as a single employer under 

20 subsection (b), (c), (m), or (o) of section 414 of 

21 the Internal Revenue Code of 1986 shall be 

22 treated as 1 person for purposes of this sub23 paragraph. 

24 (D) LIABILITY FOR TAX AND METHOD OF

25 PAYMENT.— 


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1 (i) LIABILITY FOR TAX.—The person 

2 referred to in subparagraph (A) shall be 

3 liable for the tax imposed by such subpara4 graph. 

5 (ii) METHOD OF PAYMENT.—The tax 

6 imposed by subparagraph (A) shall be paid 

7 in such manner as the Secretary may pro8 vide. 

9 (E) ARTICLES IN FOREIGN TRADE

10 ZONES.— 

11 (i) IN GENERAL.—Notwithstanding 

12 the Act of June 18, 1934 (commonly 

13 known as the Foreign Trade Zone Act, 48 

14 Stat. 998, 19 U.S.C. 81a et seq.) or any 

15 other provision of law, any covered tobacco 

16 products, or cigarette papers and tubes, 

17 which are located in a foreign trade zone 

18 on the tax increase date, shall be subject 

19 to the tax imposed by subparagraph (A) 

20 if— 

21 (I) internal revenue taxes have 

22 been determined, or customs duties 

23 liquidated, with respect to such article 

24 before such date pursuant to a reVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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•S 4486 IS

1 quest made under the 1st proviso of 

2 section 3(a) of such Act, or 

3 (II) such article is held on such 

4 date under the supervision of an offi5 cer of the United States Customs and 

6 Border Protection of the Department 

7 of Homeland Security pursuant to the 

8 2d proviso of such section 3(a). 

9 (F) TAX INCREASE DATE.—For purposes 

10 of this paragraph, the term ‘‘tax increase date’’ 

11 means the first day of the first calendar quarter 

12 described in paragraph (11)(A). 

13 (G) CERTAIN OTHER DEFINITIONS.— 

14 Terms used in this paragraph which are also 

15 used in section 5702 of the Internal Revenue 

16 Code of 1986 shall have the same meaning as 

17 when used in such section. 

18 (11) EFFECTIVE DATE.— 

19 (A) IN GENERAL.—Except as otherwise 

20 provided in this paragraph, the amendments 

21 made by this subsection shall apply to articles 

22 removed in calendar quarters beginning after 

23 the date of the enactment of this Act. 

24 (B) DELAYED EFFECTIVE DATE FOR CER25 TAIN PRODUCTS.—The amendments made by 


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•S 4486 IS

1 paragraphs (3), (4)(A)(iii), (4)(B), and (8) 

2 shall apply to articles removed in calendar 

3 quarters beginning after the date which is 180 

4 days after the date of the enactment of this 

5 Act. 

6 (12) TRANSITION RULE FOR PERMIT AND BOND

7 REQUIREMENTS.—A person which is lawfully en8 gaged in business as a manufacturer or importer of 

9 taxable nicotine (within the meaning of subchapter 

10 A of chapter 52 of the Internal Revenue Code of 

11 1986, as amended by this subsection) on the date of 

12 the enactment of this Act, first becomes subject to 

13 the requirements of subchapter B of chapter 52 of 

14 such Code by reason of the amendments made by 

15 this subsection, and submits an application under 

16 such subchapter B to engage in such business not 

17 later than 90 days after the date of the enactment 

18 of this Act, shall not be denied the right to carry on 

19 such business by reason of such requirements before 

20 final action on such application. 

21 SEC. 5202. MOMMIES. 

22 (a) GAO STUDY AND REPORT.— 

23 (1) IN GENERAL.—Not later than 1 year after 

24 the date of the enactment of this Act, the Comp25 troller General of the United States shall submit to 


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•S 4486 IS

1 Congress a report on the gaps in coverage with re2 spect to— 

3 (A) pregnant individuals enrolled under a 

4 State plan (or waiver of such plan) under title 

5 XIX of the Social Security Act (42 U.S.C. 1396 

6 et seq.) and the Children’s Health Insurance 

7 Program under title XXI of the Social Security 

8 Act (42 U.S.C. 1397aa et seq.); and 

9 (B) postpartum individuals enrolled under 

10 a State plan (or waiver of such plan) under title 

11 XIX of the Social Security Act (42 U.S.C. 1396 

12 et seq.) and the Children’s Health Insurance 

13 Program under title XXI of the Social Security 

14 Act (42 U.S.C. 1397aa et seq.) who received as15 sistance under either such program during their 

16 pregnancy. 

17 (2) CONTENT OF REPORT.—The report re18 quired under this paragraph shall include the fol19 lowing: 

20 (A) Information about the abilities and 

21 successes of State Medicaid agencies in deter22 mining whether pregnant and postpartum indi23 viduals are eligible under another insurance af24 fordability program, and in transitioning any 

25 such individuals who are so eligible to coverage 


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1 under such a program at the end of their period 

2 of eligibility for medical assistance, pursuant to 

3 section 435.1200 of the title 42, Code of Fed4 eral Regulations (as in effect on September 1, 

5 2018). 

6 (B) Information on factors contributing to 

7 gaps in coverage that disproportionately impact 

8 underserved populations, including low-income 

9 individuals, Black, Indigenous, and other indi10 viduals of color, individuals who reside in a 

11 health professional shortage area (as defined in 

12 section 332(a)(1)(A) of the Public Health Serv13 ice Act (42 U.S.C. 254e(a)(1)(A))) or individ14 uals who are members of a medically under15 served population (as defined by section 

16 330(b)(3) of such Act (42 U.S.C. 

17 254b(b)(3)(A))). 

18 (C) Recommendations for addressing and 

19 reducing such gaps in coverage. 

20 (D) Such other information as the Comp21 troller General deems necessary. 

22 (3) DATA DISAGGREGATION.—To the greatest 

23 extent possible, the Comptroller General shall 

24 disaggregate data presented in the report, including 


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1 by age, gender identity, race, ethnicity, income level, 

2 and other demographic factors. 

3 (b) MATERNITY CARE HOME DEMONSTRATION

4 PROJECT.—Title XIX of the Social Security Act (42 

5 U.S.C. 1396 et seq.) is amended by inserting the following 

6 new section after section 1947: 

7 ‘‘SEC. 1948. MATERNITY CARE HOME DEMONSTRATION 

8 PROJECT. 

9 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

10 date of the enactment of this section, the Secretary shall 

11 establish a demonstration project (in this section referred 

12 to as the ‘demonstration project’) under which the Sec13 retary shall provide grants to States to enter into arrange14 ments with eligible entities to implement or expand a ma15 ternity care home model for eligible individuals. 

16 ‘‘(b) GOALS OF DEMONSTRATION PROJECT.—The 

17 goals of the demonstration project are the following: 

18 ‘‘(1) To improve— 

19 ‘‘(A) maternity and infant care outcomes; 

20 ‘‘(B) birth equity; 

21 ‘‘(C) health equity for— 

22 ‘‘(i) Black, Indigenous, and other peo23 ple of color; 


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1 ‘‘(ii) lesbian, gay, bisexual, 

2 transgender, queer, non-binary, and gender 

3 nonconfirming individuals; 

4 ‘‘(iii) people with disabilities; and 

5 ‘‘(iv) other underserved populations; 

6 ‘‘(D) communication by maternity, infant 

7 care, and social services providers; 

8 ‘‘(E) integration of perinatal support serv9 ices, including community health workers, 

10 doulas, social workers, public health nurses, 

11 peer lactation counselors, lactation consultants, 

12 childbirth educators, peer mental health work13 ers, and others, into health care entities and or14 ganizations; 

15 ‘‘(F) care coordination between maternity, 

16 infant care, oral health services, and social serv17 ices providers within the community; 

18 ‘‘(G) the quality and safety of maternity 

19 and infant care; 

20 ‘‘(H) the experience of individuals receiv21 ing maternity care, including by increasing the 

22 ability of an individual to develop and follow 

23 their own birthing plans; and 

24 ‘‘(I) access to adequate prenatal and 

25 postpartum care, including— 


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•S 4486 IS

1 ‘‘(i) prenatal care that is initiated in 

2 a timely manner; 

3 ‘‘(ii) not fewer than 5 post-pregnancy 

4 visits to a maternity care provider; and 

5 ‘‘(iii) interpregnancy care. 

6 ‘‘(2) To provide coordinated, evidence-based, re7 spectful, culturally and linguistically appropriate, 

8 and person-centered maternity care management. 

9 ‘‘(3) To decrease— 

10 ‘‘(A) severe and preventable maternal mor11 bidity and maternal mortality; 

12 ‘‘(B) overall health care spending; 

13 ‘‘(C) unnecessary emergency department 

14 visits; 

15 ‘‘(D) inequities in maternal and infant care 

16 outcomes, including racial, economic, disability, 

17 gender-based, and geographical inequities; 

18 ‘‘(E) racial, gender, economic, and other 

19 discrimination among health care professionals; 

20 ‘‘(F) racism, discrimination, disrespect, 

21 and abuse in maternity care settings; 

22 ‘‘(G) the rate of cesarean deliveries for 

23 low-risk pregnancies; 

24 ‘‘(H) the rate of pre-term births and in25 fants born with low birth weight; and 


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1 ‘‘(I) the rate of avoidable maternal and 

2 newborn hospitalizations and admissions to in3 tensive care units. 

4 ‘‘(c) CONSULTATION.—In designing and imple5 menting the demonstration project the Secretary shall 

6 consult with stakeholders, including— 

7 ‘‘(1) States; 

8 ‘‘(2) organizations representing relevant health 

9 care professionals, including oral health services pro10 fessionals; 

11 ‘‘(3) organizations, particularly reproductive 

12 justice and birth justice organizations led by people 

13 of color, that represent consumers of maternal 

14 health care, including consumers of maternal health 

15 care who are disproportionately impacted by poor 

16 maternal health outcomes; 

17 ‘‘(4) representatives with experience imple18 menting other maternity care home models, includ19 ing representatives from the Center for Medicare 

20 and Medicaid Innovation; 

21 ‘‘(5) community-based health care professionals, 

22 including doulas, lactation consultants, and other 

23 stakeholders; 

24 ‘‘(6) experts in promoting health equity and 

25 combating racial bias in health care settings; and 


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1 ‘‘(7) Black, Indigenous, and other maternal 

2 health care consumers of color who have experienced 

3 severe maternal morbidity. 

4 ‘‘(d) APPLICATION AND SELECTION OF STATES.— 

5 ‘‘(1) IN GENERAL.—A State seeking to partici6 pate in the demonstration project shall submit an 

7 application to the Secretary at such time and in 

8 such manner as the Secretary shall require. 

9 ‘‘(2) SELECTION OF STATES.— 

10 ‘‘(A) IN GENERAL.—The Secretary shall 

11 select at least 10 States to participate in the 

12 demonstration project. 

13 ‘‘(B) SELECTION REQUIREMENTS.—In se14 lecting States to participate in the demonstra15 tion project, the Secretary shall— 

16 ‘‘(i) ensure that there is geographic 

17 and regional diversity in the areas in which 

18 activities will be carried out under the 

19 project; 

20 ‘‘(ii) ensure that States with signifi21 cant inequities in maternal and infant 

22 health outcomes, including severe maternal 

23 morbidity, and other inequities based on 

24 race, income, or access to maternity care, 

25 are included; and 


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1 ‘‘(iii) ensure that at least 1 territory 

2 is included. 

3 ‘‘(e) GRANTS.— 

4 ‘‘(1) IN GENERAL.—From amounts appro5 priated under subsection (l), the Secretary shall 

6 award 1 grant for each year of the demonstration 

7 project to each State that is selected to participate 

8 in the demonstration project. 

9 ‘‘(2) USE OF GRANT FUNDS.—A State may use 

10 funds received under this section to— 

11 ‘‘(A) award grants or make payments to 

12 eligible entities as part of an arrangement de13 scribed in subsection (f)(2); 

14 ‘‘(B) provide financial incentives to health 

15 care professionals, including community-based 

16 health care workers and community-based 

17 doulas, who participate in the State’s maternity 

18 care home model; 

19 ‘‘(C) provide adequate training for health 

20 care professionals, including community-based 

21 health care workers, doulas, and care coordina22 tors, who participate in the State’s maternity 

23 care home model, which may include training 

24 for cultural humility and antiracism, racial bias, 

25 health equity, reproductive and birth justice, 


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1 trauma-informed care, home visiting skills, and 

2 respectful communication and listening skills, 

3 particularly in regards to maternal health; 

4 ‘‘(D) pay for personnel and administrative 

5 expenses associated with designing, imple6 menting, and operating the State’s maternity 

7 care home model; 

8 ‘‘(E) pay for items and services that are 

9 furnished under the State’s maternity care 

10 home model and for which payment is otherwise 

11 unavailable under this title; 

12 ‘‘(F) pay for services and materials to en13 sure culturally and linguistically appropriate 

14 communication, including— 

15 ‘‘(i) language services such as inter16 preters and translation of written mate17 rials; and 

18 ‘‘(ii) development of culturally and lin19 guistically appropriate materials; and aux20 iliary aids and services; and 

21 ‘‘(G) pay for other costs related to the 

22 State’s maternity care home model, as deter23 mined by the Secretary. 

24 ‘‘(3) GRANT FOR NATIONAL INDEPENDENT

25 EVALUATOR.— 


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1 ‘‘(A) IN GENERAL.—From the amounts 

2 appropriated under subsection (l), prior to 

3 awarding any grants under paragraph (1), the 

4 Secretary shall enter into a contract with a na5 tional external entity to create a single, uniform 

6 process to— 

7 ‘‘(i) ensure that States that receive 

8 grants under paragraph (1) comply with 

9 the requirements of this section; and 

10 ‘‘(ii) evaluate the outcomes of the 

11 demonstration project in each participating 

12 State. 

13 ‘‘(B) ANNUAL REPORT.—The contract de14 scribed in subparagraph (A) shall require the 

15 national external entity to submit to the Sec16 retary— 

17 ‘‘(i) a yearly evaluation report for 

18 each year of the demonstration project; 

19 and 

20 ‘‘(ii) a final impact report after the 

21 demonstration project has concluded. 

22 ‘‘(C) SECRETARY’S AUTHORITY.—Nothing 

23 in this paragraph shall prevent the Secretary 

24 from making a determination that a State is 

25 not in compliance with the requirements of this 


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1 section without the national external entity 

2 making such a determination. 

3 ‘‘(f) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 

4 ‘‘(1) IN GENERAL.—As a condition of receiving 

5 a grant under this section, a State shall enter into 

6 an arrangement with one or more eligible entities 

7 that meets the requirements of paragraph (2). 

8 ‘‘(2) ARRANGEMENTS WITH ELIGIBLE ENTI9 TIES.—Under an arrangement between a State and 

10 an eligible entity under this subsection, the eligible 

11 entity shall perform the following functions, with re12 spect to eligible individuals enrolled with the entity 

13 under the State’s maternity care home model— 

14 ‘‘(A) provide culturally and linguistically 

15 appropriate congruent care, which may include 

16 prenatal care, family planning services, medical 

17 care, mental and behavioral care, postpartum 

18 care, and oral health services to such eligible in19 dividuals through a team of health care profes20 sionals, which may include obstetrician-gyne21 cologists, maternal-fetal medicine specialists, 

22 family physicians, primary care providers, oral 

23 health providers, physician assistants, advanced 

24 practice registered nurses such as nurse practi25 tioners and certified nurse midwives, certified 


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1 midwives, certified professional midwives, phys2 ical therapists, social workers, traditional and 

3 community-based doulas, lactation consultants, 

4 childbirth educators, community health workers, 

5 peer mental health supporters, and other health 

6 care professionals; 

7 ‘‘(B) conduct a risk assessment of each 

8 such eligible individual to determine if their 

9 pregnancy is high or low risk, and establish a 

10 tailored pregnancy care plan, which takes into 

11 consideration the individual’s own preferences 

12 and pregnancy care and birthing plans and de13 termines the appropriate support services to re14 duce the individual’s medical, social, and envi15 ronmental risk factors, for each such eligible in16 dividual based on the results of such risk as17 sessment; 

18 ‘‘(C) assign each such eligible individual to 

19 a culturally and linguistically appropriate care 

20 coordinator, which may be a nurse, social work21 er, traditional or community-based doula, com22 munity health worker, midwife, or other health 

23 care provider, who is responsible for ensuring 

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1 essary medical care and connections to essential 

2 support services; 

3 ‘‘(D) provide, or arrange for the provision 

4 of, essential support services, such as services 

5 that address— 

6 ‘‘(i) food access, nutrition, and exer7 cise; 

8 ‘‘(ii) smoking cessation; 

9 ‘‘(iii) substance use disorder and ad10 diction treatment; 

11 ‘‘(iv) anxiety, depression, trauma, and 

12 other mental and behavioral health issues; 

13 ‘‘(v) breastfeeding, chestfeeding, or 

14 other infant feeding options supports, initi15 ation, continuation, and duration; 

16 ‘‘(vi) stable, affordable, safe, and 

17 healthy housing; 

18 ‘‘(vii) transportation; 

19 ‘‘(viii) intimate partner violence; 

20 ‘‘(ix) community and police violence; 

21 ‘‘(x) home visiting services; 

22 ‘‘(xi) childbirth and newborn care edu23 cation; 

24 ‘‘(xii) oral health education; 

25 ‘‘(xiii) continuous labor support; 


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1 ‘‘(xiv) group prenatal care; 

2 ‘‘(xv) family planning and contracep3 tive care and supplies; and 

4 ‘‘(xvi) affordable child care; 

5 ‘‘(E) as appropriate, facilitate connections 

6 to a usual primary care provider, which may be 

7 a reproductive health care provider; 

8 ‘‘(F) refer to guidelines and opinions of 

9 medical associations when determining whether 

10 an elective delivery should be performed on an 

11 eligible individual before 39 weeks of gestation; 

12 ‘‘(G) provide such eligible individual with 

13 evidence-based and culturally and linguistically 

14 appropriate education and resources to identify 

15 potential warning signs of pregnancy and 

16 postpartum complications and when and how to 

17 obtain medical attention; 

18 ‘‘(H) provide, or arrange for the provision 

19 of, culturally and linguistically appropriate 

20 pregnancy and postpartum health services, in21 cluding family planning counseling and services, 

22 to eligible individuals; 

23 ‘‘(I) track and report postpartum health 

24 and birth outcomes of such eligible individuals 

25 and their children; 


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1 ‘‘(J) ensure that care is person-centered, 

2 culturally and linguistically appropriate, and 

3 patient-led, including by engaging eligible indi4 viduals in their own care, including through 

5 communication and education; and 

6 ‘‘(K) ensure adequate training for appro7 priately serving the population of individuals el8 igible for medical assistance under the State 

9 plan (or waiver of such plan), including through 

10 reproductive justice, birth justice, birth equity, 

11 and anti-racist frameworks, home visiting skills, 

12 and knowledge of social services. 

13 ‘‘(g) TERM OF DEMONSTRATION PROJECT.—The 

14 Secretary shall conduct the demonstration project for a 

15 period of 5 years. 

16 ‘‘(h) REPORT.—Not later than 18 months after the 

17 date of the enactment of this section and annually there18 after for each year of the demonstration project term, the 

19 Secretary shall submit a report to Congress on the results 

20 of the demonstration project, including— 

21 ‘‘(1) the results of the final report of the na22 tional external entity required under subsection 

23 (e)(3)(B)(ii); and 

24 ‘‘(2) recommendations on whether the model 

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1 tinued or more widely adopted, including by private 

2 health plans. 

3 ‘‘(i) WAIVER AUTHORITY.—To the extent that the 

4 Secretary determines necessary in order to carry out the 

5 demonstration project, the Secretary may waive section 

6 1902(a)(1) (relating to statewideness) and section 

7 1902(a)(10)(B) (relating to comparability). 

8 ‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 

9 establish a process to provide technical assistance to 

10 States that are awarded grants under this section and to 

11 eligible entities and other providers participating in a 

12 State maternity care home model funded by such a grant. 

13 ‘‘(k) DEFINITIONS.—In this section: 

14 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en15 tity’ means an entity or organization that provides 

16 medically accurate, comprehensive maternity services 

17 to individuals who are eligible for medical assistance 

18 under a State plan under this title or a waiver of 

19 such a plan, and may include: 

20 ‘‘(A) A freestanding birth center. 

21 ‘‘(B) An entity or organization receiving 

22 assistance under section 330 of the Public 

23 Health Service Act. 

24 ‘‘(C) A federally qualified health center. 

25 ‘‘(D) A rural health clinic. 


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1 ‘‘(E) A health facility operated by an In2 dian tribe or tribal organization (as those terms 

3 are defined in section 4 of the Indian Health 

4 Care Improvement Act). 

5 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

6 individual’ means a pregnant individual or a for7 merly pregnant individual during the 1-year period 

8 beginning on the last day of the pregnancy, or such 

9 longer period beginning on such day as a State may 

10 elect, who is— 

11 ‘‘(A) enrolled in a State plan under this 

12 title, a waiver of such a plan, or a State child 

13 health plan under title XXI; and 

14 ‘‘(B) a patient of an eligible entity which 

15 has entered into an arrangement with a State 

16 under subsection (g). 

17 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to the Secretary, for 

19 each of fiscal years 2023 through 2030, such sums as may 

20 be necessary to carry out this section.’’. 

21 (c) REAPPLICATION OF MEDICARE PAYMENT RATE

22 FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER

23 MEDICAID AND INCLUSION OF ADDITIONAL PRO24 VIDERS.— 


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1 (1) REAPPLICATION OF PAYMENT FLOOR; ADDI2 TIONAL PROVIDERS.— 

3 (A) IN GENERAL.—Section 1902(a)(13) of 

4 the Social Security Act (42 U.S.C. 

5 1396a(a)(13)) is amended— 

6 (i) in subparagraph (B), by striking ‘‘; 

7 and’’ and inserting a semicolon; 

8 (ii) in subparagraph (C), by striking 

9 the semicolon and inserting ‘‘; and’’; and 

10 (iii) by adding at the end the fol11 lowing new subparagraph: 

12 ‘‘(D) payment for primary care services (as 

13 defined in subsection (jj)(1)) furnished in the 

14 period that begins on the first day of the first 

15 month that begins after the date of enactment 

16 of this subparagraph by a provider described in 

17 subsection (jj)(2)— 

18 ‘‘(i) at a rate that is not less than 100 

19 percent of the payment rate that applies to 

20 such services and the provider of such 

21 services under part B of title XVIII (or, if 

22 greater, the payment rate that would be 

23 applicable under such part if the conver24 sion factor under section 1848(d) for the 


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1 year were the conversion factor under such 

2 section for 2009); 

3 ‘‘(ii) in the case of items and services 

4 that are not items and services provided 

5 under such part, at a rate to be established 

6 by the Secretary; and 

7 ‘‘(iii) in the case of items and services 

8 that are furnished in rural areas (as de9 fined in section 1886(d)(2)(D)), health 

10 professional shortage areas (as defined in 

11 section 332(a)(1)(A) of the Public Health 

12 Service Act (42 U.S.C. 254e(a)(1)(A))), or 

13 medically underserved areas (according to 

14 a designation under section 330(b)(3)(A) 

15 of the Public Health Service Act (42 

16 U.S.C. 254b(b)(3)(A))), at the rate other17 wise applicable to such items or services 

18 under clause (i) or (ii) increased, at the 

19 Secretary’s discretion, by not more than 25 

20 percent;’’. 

21 (B) CONFORMING AMENDMENTS.— 

22 (i) Section 1902(a)(13)(C) of the So23 cial Security Act (42 U.S.C. 

24 1396a(a)(13)(C)) is amended by striking 


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1 ‘‘subsection (jj)’’ and inserting ‘‘subsection 

2 (jj)(1)’’. 

3 (ii) Section 1905(dd) of the Social Se4 curity Act (42 U.S.C. 1396d(dd)) is 

5 amended— 

6 (I) by striking ‘‘Notwith7 standing’’ and inserting the following: 

8 ‘‘(1) IN GENERAL.—Notwithstanding’’; 

9 (II) by striking ‘‘section 

10 1902(a)(13)(C)’’ and inserting ‘‘sub11 paragraph (C) of section 

12 1902(a)(13)’’; 

13 (III) by inserting ‘‘or for services 

14 described in subparagraph (D) of sec15 tion 1902(a)(13) furnished during an 

16 additional period specified in para17 graph (2),’’ after ‘‘2015,’’; 

18 (IV) by striking ‘‘under such sec19 tion’’ and inserting ‘‘under subpara20 graph (C) or (D) of section 

21 1902(a)(13), as applicable’’; and 

22 (V) by adding at the end the fol23 lowing: 

24 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 

25 paragraph (1), the following are additional periods: 


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1 ‘‘(A) The period that begins on the first 

2 day of the first month that begins after the 

3 date of enactment of this paragraph.’’. 

4 (2) IMPROVED TARGETING OF PRIMARY

5 CARE.—Section 1902(jj) of the Social Security Act 

6 (42 U.S.C. 1396a(jj)) is amended— 

7 (A) by redesignating paragraphs (1) and 

8 (2) as clauses (i) and (ii), respectively, and re9 aligning the left margins accordingly; 

10 (B) by striking ‘‘For purposes of sub11 section (a)(13)(C)’’ and inserting the following: 

12 ‘‘(1) IN GENERAL.— 

13 ‘‘(A) DEFINITION.—For purposes of sub14 paragraphs (C) and (D) of subsection (a)(13)’’; 

15 and 

16 (C) by inserting after clause (ii) (as so re17 designated) the following: 

18 ‘‘(B) EXCLUSIONS.—Such term does not 

19 include any services described in subparagraph 

20 (A) or (B) of paragraph (1) if such services are 

21 provided in an emergency department of a hos22 pital. 

23 ‘‘(2) ADDITIONAL PROVIDERS.—For purposes 

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•S 4486 IS

1 vider described in this paragraph is any of the fol2 lowing: 

3 ‘‘(A) A physician with a primary specialty 

4 designation of family medicine, general internal 

5 medicine, or pediatric medicine, or obstetrics 

6 and gynecology. 

7 ‘‘(B) An advanced practice clinician, as de8 fined by the Secretary, that works under the 

9 supervision of— 

10 ‘‘(i) a physician that satisfies the cri11 teria specified in subparagraph (A); 

12 ‘‘(ii) a nurse practitioner or a physi13 cian assistant (as such terms are defined 

14 in section 1861(aa)(5)(A)) who is working 

15 in accordance with State law; or 

16 ‘‘(iii) or a certified nurse-midwife (as 

17 defined in section 1861(gg)) or a certified 

18 professional midwife who is working in ac19 cordance with State law. 

20 ‘‘(C) A rural health clinic, federally quali21 fied health center, health center that receives 

22 funding under title X of the Public Health 

23 Service Act, or other health clinic that receives 

24 reimbursement on a fee schedule applicable to 

25 a physician. 


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1 ‘‘(D) An advanced practice clinician super2 vised by a physician described in subparagraph 

3 (A), another advanced practice clinician, or a 

4 certified nurse-midwife. 

5 ‘‘(E) A midwife who is working in accord6 ance with State law.’’. 

7 (3) ENSURING PAYMENT BY MANAGED CARE

8 ENTITIES.— 

9 (A) IN GENERAL.—Section 1903(m)(2)(A) 

10 of the Social Security Act (42 U.S.C. 

11 1396b(m)(2)(A)) is amended— 

12 (i) in clause (xii), by striking ‘‘and’’ 

13 after the semicolon; 

14 (ii) by realigning the left margin of 

15 clause (xiii) so as to align with the left 

16 margin of clause (xii) and by striking the 

17 period at the end of clause (xiii) and in18 serting ‘‘; and’’; and 

19 (iii) by inserting after clause (xiii) the 

20 following: 

21 ‘‘(xiv) such contract provides that (I) payments 

22 to providers specified in section 1902(a)(13)(D) for 

23 primary care services (as defined in section 1902(jj)) 

24 that are furnished during a year or period (as speci25 fied in section 1902(a)(13)(D) and section 


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•S 4486 IS

1 1905(dd)) are at least equal to the amounts set 

2 forth and required by the Secretary by regulation; 

3 (II) the entity shall, upon request, provide docu4 mentation to the State, sufficient to enable the State 

5 and the Secretary to ensure compliance with sub6 clause (I); and (III) the Secretary shall approve pay7 ments described in subclause (I) that are furnished 

8 through an agreed upon capitation, partial capita9 tion, or other value-based payment arrangement if 

10 the capitation, partial capitation, or other value11 based payment arrangement is based on a reason12 able methodology and the entity provides docu13 mentation to the State sufficient to enable the State 

14 and the Secretary to ensure compliance with sub15 clause (I).’’. 

16 (B) CONFORMING AMENDMENT.—Section 

17 1932(f) of the Social Security Act (42 U.S.C. 

18 1396u–2(f)) is amended— 

19 (i) by striking ‘‘section 

20 1902(a)(13)(C)’’ and inserting ‘‘sub21 sections (C) and (D) of section 

22 1902(a)(13)’’; and 

23 (ii) by inserting ‘‘, and clause (xiv) of 

24 section 1903(m)(2)(A)’’ before the period. 


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1 (d) MACPAC REPORT AND CMS GUIDANCE ON IN2 CREASING ACCESS TO DOULA SERVICES FOR MEDICAID

3 BENEFICIARIES.— 

4 (1) MACPAC REPORT.— 

5 (A) IN GENERAL.—Not later than 1 year 

6 after the date of the enactment of this Act, the 

7 Medicaid and CHIP Payment and Access Com8 mission (referred to in this subsection as 

9 ‘‘MACPAC’’) shall publish a report on the cov10 erage of doula services under State Medicaid 

11 programs, which shall at a minimum include 

12 the following: 

13 (i) Information about coverage for 

14 doula services under State Medicaid pro15 grams that currently provide coverage for 

16 such care, including the type of doula serv17 ices offered (such as prenatal, labor and 

18 delivery, postpartum support, and also 

19 community-based and traditional doula 

20 services). 

21 (ii) An analysis of barriers to covering 

22 doula services under State Medicaid pro23 grams. 

24 (iii) An identification of effective 

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1 ices in order to provide better care and 

2 achieve better maternal and infant health 

3 outcomes, including strategies that States 

4 may use to recruit, train, and certify a di5 verse doula workforce, particularly from 

6 underserved communities, communities of 

7 color, and communities facing linguistic or 

8 cultural barriers. 

9 (iv) Recommendations for legislative 

10 and administrative actions to increase ac11 cess to doula services in State Medicaid 

12 programs, including actions that ensure 

13 doulas may earn a living wage that ac14 counts for their time and costs associated 

15 with providing care and community-based 

16 doula program administration and oper17 ation. 

18 (B) STAKEHOLDER CONSULTATION.—In 

19 developing the report required under subpara20 graph (A), MACPAC shall consult with relevant 

21 stakeholders, including— 

22 (i) States; 

23 (ii) organizations, especially reproduc24 tive justice and birth justice organizations 

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1 sumers of maternal health care, including 

2 those that are disproportionately impacted 

3 by poor maternal health outcomes; 

4 (iii) organizations and individuals rep5 resenting doulas, including community6 based doula programs and those who serve 

7 underserved communities, including com8 munities of color, and communities facing 

9 linguistic or cultural barriers; 

10 (iv) organizations representing health 

11 care providers; and 

12 (v) Black, Indigenous, and other ma13 ternal health care consumers of color who 

14 have experienced severe maternal mor15 bidity. 

16 (2) CMS GUIDANCE.— 

17 (A) IN GENERAL.—Not later than 1 year 

18 after the date that MACPAC publishes the re19 port required under paragraph (1)(A), the Ad20 ministrator of the Centers for Medicare & Med21 icaid Services shall issue guidance to States on 

22 increasing access to doula services under Med23 icaid. Such guidance shall at a minimum in24 clude— 


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1 (i) options for States to provide med2 ical assistance for doula services under 

3 State Medicaid programs; 

4 (ii) best practices for ensuring that 

5 doulas, including community-based doulas, 

6 receive reimbursement for doula services 

7 provided under a State Medicaid program, 

8 at a level that allows doulas to earn a liv9 ing wage that accounts for their time and 

10 costs associated with providing care and 

11 community-based doula program adminis12 tration; and 

13 (iii) best practices for increasing ac14 cess to doula services, including services 

15 provided by community-based doulas, 

16 under State Medicaid programs. 

17 (B) STAKEHOLDER CONSULTATION.—In 

18 developing the guidance required under sub19 paragraph (A), the Administrator of the Cen20 ters for Medicare & Medicaid Services shall con21 sult with MACPAC and other relevant stake22 holders, including— 

23 (i) State Medicaid officials; 

24 (ii) organizations representing con25 sumers of maternal health care, including 


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1 those that are disproportionately impacted 

2 by poor maternal health outcomes; 

3 (iii) organizations representing doulas, 

4 including community-based doulas and 

5 those who serve underserved communities, 

6 such as communities of color and commu7 nities facing linguistic or cultural barriers; 

8 and 

9 (iv) organizations representing med10 ical professionals. 

11 (e) GAO REPORT ON STATE MEDICAID PROGRAMS’ 

12 USE OF TELEHEALTH TO INCREASE ACCESS TO MATER13 NITY CARE.—Not later than 1 year after the date of the 

14 enactment of this Act, the Comptroller General of the 

15 United States shall submit a report to Congress on State 

16 Medicaid programs’ use of telehealth to increase access to 

17 maternity care. Such report shall include the following: 

18 (1) The number of State Medicaid programs 

19 that utilize telehealth that increases access to mater20 nity care. 

21 (2) With respect to State Medicaid programs 

22 that utilize telehealth that increases access to mater23 nity care, information about— 


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1 (A) common characteristics of such pro2 grams’ approaches to utilizing telehealth that 

3 increases access to maternity care; 

4 (B) differences in States’ approaches to 

5 utilizing telehealth to improve access to mater6 nity care, and the resulting differences in State 

7 maternal health outcomes, as determined by 

8 factors described in subsection (C); and 

9 (C) when compared to patients who receive 

10 maternity care in person, what is known 

11 about— 

12 (i) the demographic characteristics, 

13 such as race, ethnicity, sex, sexual orienta14 tion, gender identity, disability status, age, 

15 and preferred language of the individuals 

16 enrolled in such programs who use tele17 health to access maternity care; 

18 (ii) health outcomes for such individ19 uals, including frequency of mortality and 

20 severe morbidity, as compared to individ21 uals with similar characteristics who did 

22 not use telehealth to access maternity care; 

23 (iii) the services provided to individ24 uals through telehealth, including family 


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1 planning services, mental health care serv2 ices, and oral health services; 

3 (iv) the devices and equipment pro4 vided to individuals for remote patient 

5 monitoring and telehealth, including blood 

6 pressure monitors and blood glucose mon7 itors; 

8 (v) the quality of maternity care pro9 vided through telehealth, including whether 

10 maternity care provided through telehealth 

11 is culturally and linguistically appropriate; 

12 (vi) the level of patient satisfaction 

13 with maternity care provided through tele14 health to individuals enrolled in State Med15 icaid programs; 

16 (vii) the impact of utilizing telehealth 

17 to increase access to maternity care on 

18 spending, cost savings, access to care, and 

19 utilization of care under State Medicaid 

20 programs; and 

21 (viii) the accessibility and effectiveness 

22 of telehealth for maternity care during the 

23 COVID–19 pandemic. 


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1 (3) An identification and analysis of the bar2 riers to using telehealth to increase access to mater3 nity care under State Medicaid programs. 

4 (4) Recommendations for such legislative and 

5 administrative actions related to increasing access to 

6 telehealth maternity services under Medicaid as the 

7 Comptroller General deems appropriate. 

8 SEC. 5203. JUSTICE FOR INCARCERATED MOMS. 

9 (a) SENSE OF CONGRESS.—It is the sense of Con10 gress that— 

11 (1) the respect and proper care that birthing 

12 people deserve is inclusive; and 

13 (2) regardless of race, ethnicity, gender iden14 tity, sexual orientation, religion, marital status, fa15 milial status, socioeconomic status, immigration sta16 tus, incarceration status, or disability, all deserve 

17 dignity. 

18 (b) ENDING THE SHACKLING OF PREGNANT INDI19 VIDUALS.— 

20 (1) IN GENERAL.—For each fiscal year that be21 gins on or after the date that is 180 days after the 

22 date of enactment of this Act, for each State that 

23 receives a grant under subpart 1 of part E of title 

24 I of the Omnibus Crime Control and Safe Streets 

25 Act of 1968 (34 U.S.C. 10151 et seq.) (commonly 


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1 referred to as the ‘‘Edward Byrne Memorial Justice 

2 Assistance Grant Program’’) and that does not have 

3 in effect throughout the State for such fiscal year 

4 laws restricting the use of restraints on pregnant in5 dividuals in correctional facilities that provide rights, 

6 procedures, requirements, effects, and penalties that 

7 are substantially similar to those set forth in section 

8 4322 of title 18, United States Code, the amount of 

9 such grant that would otherwise be allocated to such 

10 State under such subpart for the fiscal year shall be 

11 decreased by 25 percent. 

12 (2) REALLOCATION.—Amounts not allocated to 

13 a State for failure to comply with paragraph (1) 

14 shall be reallocated in accordance with subpart 1 of 

15 part E of title I of the Omnibus Crime Control and 

16 Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) 

17 to States that have complied with such paragraph. 

18 (c) CREATING MODEL PROGRAMS FOR THE CARE OF

19 INCARCERATED INDIVIDUALS IN THE PRENATAL AND

20 POSTPARTUM PERIODS.— 

21 (1) IN GENERAL.—Not later than 1 year after 

22 the date of enactment of this Act, the Attorney Gen23 eral, acting through the Director of the Bureau of 

24 Prisons (in this subsection referred to as the ‘‘Direc25 tor’’), shall establish, in not fewer than 6 Bureau of 


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1 Prisons facilities, programs to optimize maternal 

2 health outcomes for pregnant and postpartum indi3 viduals incarcerated in such facilities. The Attorney 

4 General shall establish such programs in consulta5 tion with stakeholders such as— 

6 (A) Federal Public Defenders and Execu7 tive Directors of Community Defender Organi8 zations; 

9 (B) relevant community-based organiza10 tions, particularly organizations that represent 

11 incarcerated and formerly incarcerated individ12 uals and organizations that seek to improve ma13 ternal health outcomes for pregnant and 

14 postpartum individuals from racial and ethnic 

15 minority groups; 

16 (C) relevant organizations representing pa17 tients, with a particular focus on patients from 

18 racial and ethnic minority groups; 

19 (D) organizations representing maternity 

20 care providers and maternal health care edu21 cation programs; 

22 (E) perinatal health workers; and 

23 (F) researchers and policy experts in fields 

24 related to maternal health care for incarcerated 

25 individuals. 


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1 (2) START DATE.—Each facility selected under 

2 paragraph (1) shall begin the programs to optimize 

3 maternal health outcomes for pregnant and 

4 postpartum individuals incarcerated in such facilities 

5 not later than 18 months after the date of enact6 ment of this Act. 

7 (3) FACILITY PRIORITY.—In carrying out para8 graph (1), the Director, in consultation with the 

9 stakeholders described in paragraph (1), shall give 

10 priority to a facility based on— 

11 (A) the number of pregnant and 

12 postpartum individuals incarcerated in such fa13 cility and, among such individuals, the number 

14 of pregnant and postpartum individuals from 

15 racial and ethnic minority groups; and 

16 (B) the extent to which the leaders of such 

17 facility have demonstrated a commitment to de18 veloping exemplary programs for pregnant and 

19 postpartum individuals incarcerated in such fa20 cility. 

21 (4) PROGRAM DURATION.—The programs es22 tablished under this subsection shall be carried out 

23 for a 5-year period. 

24 (5) PROGRAMS.—Bureau of Prisons facilities 

25 selected by the Director shall establish programs for 


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1 pregnant and postpartum incarcerated individuals, 

2 and such programs may— 

3 (A) provide access to perinatal health 

4 workers from pregnancy through the 

5 postpartum period; 

6 (B) provide access to healthy foods and 

7 counseling on nutrition, recommended activity 

8 levels, and safety measures throughout preg9 nancy; 

10 (C) train correctional officers to ensure 

11 that pregnant incarcerated individuals receive 

12 safe and respectful treatment; 

13 (D) train medical personnel to ensure that 

14 pregnant incarcerated individuals receive trau15 ma-informed, culturally congruent care that 

16 promotes the health and safety of the pregnant 

17 individuals; 

18 (E) provide counseling and treatment for 

19 individuals who have suffered from— 

20 (i) diagnosed mental or behavioral 

21 health conditions, including trauma and 

22 substance use disorders; 

23 (ii) trauma or violence, including do24 mestic violence; 

25 (iii) human immunodeficiency virus; 


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1 (iv) sexual abuse; 

2 (v) pregnancy or infant loss; or 

3 (vi) chronic conditions; 

4 (F) provide evidence-based pregnancy and 

5 childbirth education, parenting support, and 

6 other relevant forms of health literacy; 

7 (G) provide clinical education opportunities 

8 to maternity care providers in training to ex9 pand pathways into maternal health care ca10 reers serving incarcerated individuals; 

11 (H) offer opportunities for postpartum in12 dividuals to maintain contact with the individ13 ual’s newborn child to promote bonding, includ14 ing enhanced visitation policies, access to prison 

15 nursery programs, or breastfeeding support; 

16 (I) provide reentry assistance, particularly 

17 to— 

18 (i) ensure access to health insurance 

19 coverage and transfer of health records to 

20 community providers if an incarcerated in21 dividual exits the criminal justice system 

22 during such individual’s pregnancy or in 

23 the postpartum period; and 

24 (ii) connect individuals exiting the 

25 criminal justice system during pregnancy 


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1 or in the postpartum period to community2 based resources, such as referrals to health 

3 care providers, substance use disorder 

4 treatments, and social services that ad5 dress social determinants of maternal 

6 health; or 

7 (J) establish partnerships with local public 

8 entities, private community entities, community9 based organizations, Indian Tribes and tribal 

10 organizations (as such terms are defined in sec11 tion 4 of the Indian Self-Determination and 

12 Education Assistance Act (25 U.S.C. 5304)), 

13 and urban Indian organizations (as such term 

14 is defined in section 4 of the Indian Health 

15 Care Improvement Act (25 U.S.C. 1603)) to es16 tablish or expand pretrial diversion programs as 

17 an alternative to incarceration for pregnant and 

18 postpartum individuals, including— 

19 (i) evidence-based childbirth education 

20 or parenting classes; 

21 (ii) prenatal health coordination; 

22 (iii) family and individual counseling; 

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1 tal and behavioral health conditions, in2 cluding drug and alcohol treatments; 

3 (v) family case management services; 

4 (vi) domestic violence education and 

5 prevention; 

6 (vii) physical and sexual abuse coun7 seling; and 

8 (viii) programs to address social de9 terminants of health such as employment, 

10 housing, education, transportation, and nu11 trition. 

12 (6) IMPLEMENTATION AND REPORTING.—A fa13 cility selected under paragraph (1) shall be respon14 sible for— 

15 (A) implementing programs, which may in16 clude the programs described in paragraph (5); 

17 and 

18 (B) not later than 3 years after the date 

19 of enactment of this Act, and not later than 6 

20 years after the date of enactment of this Act, 

21 reporting results of the programs to the Direc22 tor, including information describing— 

23 (i) relevant quantitative indicators of 

24 success in improving the standard of care 

25 and health outcomes for pregnant and 


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•S 4486 IS

1 postpartum incarcerated individuals in the 

2 facility, including data stratified by race, 

3 ethnicity, sex, gender, age, geography, dis4 ability status, the category of the criminal 

5 charge against such individual, rates of 

6 pregnancy-related deaths, pregnancy-asso7 ciated deaths, cases of infant mortality and 

8 morbidity, rates of pre-term births and 

9 low-birthweight births, cases of severe ma10 ternal morbidity, cases of violence against 

11 pregnant or postpartum individuals, diag12 noses of maternal mental or behavioral 

13 health conditions, and other such informa14 tion as appropriate; 

15 (ii) relevant qualitative and quan16 titative evaluations from pregnant and 

17 postpartum incarcerated individuals who 

18 participated in such programs, including 

19 measures of patient-reported experience of 

20 care; and 

21 (iii) strategies to sustain such pro22 grams after fiscal year 2028 and expand 

23 such programs to other facilities. 

24 (7) REPORT.—Not later than 6 years after the 

25 date of enactment of this Act, the Director shall 


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1 submit to the Attorney General and Congress a re2 port describing the results of the programs carried 

3 out under this subsection. 

4 (8) OVERSIGHT.—Not later than 1 year after 

5 the date of enactment of this Act, the Attorney Gen6 eral shall award a contract to an independent orga7 nization or independent organizations to conduct 

8 oversight of the programs described in paragraph 

9 (5). 

10 (9) AUTHORIZATION OF APPROPRIATIONS.— 

11 There is authorized to be appropriated to carry out 

12 this subsection $10,000,000 for each of fiscal years 

13 2024 through 2028. 

14 (d) GRANT PROGRAM TO IMPROVE MATERNAL

15 HEALTH OUTCOMES FOR INDIVIDUALS IN STATE AND

16 LOCAL CORRECTIONAL FACILITIES.— 

17 (1) ESTABLISHMENT.—Not later than 1 year 

18 after the date of enactment of this Act, the Attorney 

19 General, acting through the Director of the Bureau 

20 of Justice Assistance (in this subsection referred to 

21 as the ‘‘Director’’), shall award Justice for Incarcer22 ated Moms grants to States to establish or expand 

23 programs in State and local correctional facilities for 

24 pregnant and postpartum incarcerated individuals. 


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1 The Attorney General shall award such grants in 

2 consultation with stakeholders such as— 

3 (A) Federal Public Defenders and Execu4 tive Directors of Community Defender Organi5 zations; 

6 (B) relevant community-based organiza7 tions, particularly organizations that represent 

8 incarcerated and formerly incarcerated individ9 uals and organizations that seek to improve ma10 ternal health outcomes for pregnant and 

11 postpartum individuals from racial and ethnic 

12 minority groups; 

13 (C) relevant organizations representing pa14 tients, with a particular focus on patients from 

15 racial and ethnic minority groups; 

16 (D) organizations representing maternity 

17 care providers and maternal health care edu18 cation programs; 

19 (E) perinatal health workers; and 

20 (F) researchers and policy experts in fields 

21 related to maternal health care for incarcerated 

22 individuals. 

23 (2) APPLICATIONS.—Each State desiring a 

24 grant under this subsection shall submit to the Di25 rector an application at such time, in such manner, 


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1 and containing such information as the Director 

2 may require. 

3 (3) USE OF FUNDS.—A State that is awarded 

4 a grant under this subsection shall use such grant 

5 to establish or expand programs for pregnant and 

6 postpartum incarcerated individuals, and such pro7 grams may— 

8 (A) provide access to perinatal health 

9 workers from pregnancy through the 

10 postpartum period; 

11 (B) provide access to healthy foods and 

12 counseling on nutrition, recommended activity 

13 levels, and safety measures throughout preg14 nancy; 

15 (C) train correctional officers to ensure 

16 that pregnant incarcerated individuals receive 

17 safe and respectful treatment; 

18 (D) train medical personnel to ensure that 

19 pregnant incarcerated individuals receive trau20 ma-informed, culturally congruent care that 

21 promotes the health and safety of the pregnant 

22 individuals; 

23 (E) provide counseling and treatment for 

24 individuals who have suffered from— 


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•S 4486 IS

1 (i) diagnosed mental or behavioral 

2 health conditions, including trauma and 

3 substance use disorders; 

4 (ii) trauma or violence, including do5 mestic violence; 

6 (iii) human immunodeficiency virus; 

7 (iv) sexual abuse; 

8 (v) pregnancy or infant loss; or 

9 (vi) chronic conditions; 

10 (F) provide evidence-based pregnancy and 

11 childbirth education, parenting support, and 

12 other relevant forms of health literacy; 

13 (G) provide clinical education opportunities 

14 to maternity care providers in training to ex15 pand pathways into maternal health care ca16 reers serving incarcerated individuals; 

17 (H) offer opportunities for postpartum in18 dividuals to maintain contact with the individ19 ual’s newborn child to promote bonding, includ20 ing enhanced visitation policies, access to prison 

21 nursery programs, or breastfeeding support; 

22 (I) provide reentry assistance, particularly 

23 to— 

24 (i) ensure access to health insurance 

25 coverage and transfer of health records to 


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•S 4486 IS

1 community providers if an incarcerated in2 dividual exits the criminal justice system 

3 during such individual’s pregnancy or in 

4 the postpartum period; and 

5 (ii) connect individuals exiting the 

6 criminal justice system during pregnancy 

7 or in the postpartum period to community8 based resources, such as referrals to health 

9 care providers, substance use disorder 

10 treatments, and social services that ad11 dress social determinants of maternal 

12 health; or 

13 (J) establish partnerships with local public 

14 entities, private community entities, community15 based organizations, Indian Tribes and tribal 

16 organizations (as such terms are defined in sec17 tion 4 of the Indian Self-Determination and 

18 Education Assistance Act (25 U.S.C. 5304)), 

19 and urban Indian organizations (as such term 

20 is defined in section 4 of the Indian Health 

21 Care Improvement Act (25 U.S.C. 1603)) to es22 tablish or expand pretrial diversion programs as 

23 an alternative to incarceration for pregnant and 

24 postpartum individuals, including— 


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•S 4486 IS

1 (i) evidence-based childbirth education 

2 or parenting classes; 

3 (ii) prenatal health coordination; 

4 (iii) family and individual counseling; 

5 (iv) evidence-based screenings, edu6 cation, and, as needed, treatment for men7 tal and behavioral health conditions, in8 cluding drug and alcohol treatments; 

9 (v) family case management services; 

10 (vi) domestic violence education and 

11 prevention; 

12 (vii) physical and sexual abuse coun13 seling; and 

14 (viii) programs to address social de15 terminants of health such as employment, 

16 housing, education, transportation, and nu17 trition. 

18 (4) PRIORITY.—In awarding grants under this 

19 subsection, the Director shall give priority to appli20 cants based on— 

21 (A) the number of pregnant and 

22 postpartum individuals incarcerated in the 

23 State and, among such individuals, the number 

24 of pregnant and postpartum individuals from 

25 racial and ethnic minority groups; and 


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1 (B) the extent to which the State has dem2 onstrated a commitment to developing exem3 plary programs for pregnant and postpartum 

4 individuals incarcerated in the correctional fa5 cilities in such State. 

6 (5) GRANT DURATION.—A grant awarded under 

7 this subsection shall be for a 5-year period. 

8 (6) IMPLEMENTING AND REPORTING.—A State 

9 that receives a grant under this subsection shall be 

10 responsible for— 

11 (A) implementing the program funded by 

12 the grant; and 

13 (B) not later than 3 years after the date 

14 of enactment of this Act, and not later than 6 

15 years after the date of enactment of this Act, 

16 reporting results of such program to the Attor17 ney General, including information describing— 

18 (i) relevant quantitative indicators of 

19 the program’s success in improving the 

20 standard of care and health outcomes for 

21 pregnant and postpartum incarcerated in22 dividuals in the facility, including data 

23 stratified by race, ethnicity, sex, gender, 

24 age, geography, disability status, category 

25 of the criminal charge against such indiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 vidual, incidence rates of pregnancy-related 

2 deaths, pregnancy-associated deaths, cases 

3 of infant mortality and morbidity, rates of 

4 pre-term births and low-birthweight births, 

5 cases of severe maternal morbidity, cases 

6 of violence against pregnant or postpartum 

7 individuals, diagnoses of maternal mental 

8 or behavioral health conditions, and other 

9 such information as appropriate; 

10 (ii) relevant qualitative and quan11 titative evaluations from pregnant and 

12 postpartum incarcerated individuals who 

13 participated in such programs, including 

14 measures of patient-reported experience of 

15 care; and 

16 (iii) strategies to sustain such pro17 grams beyond the duration of the grant 

18 and expand such programs to other facili19 ties. 

20 (7) REPORT.—Not later than 6 years after the 

21 date of enactment of this Act, the Attorney General 

22 shall submit to Congress a report describing the re23 sults of programs carried out using grants under 

24 this subsection. 


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1 (8) OVERSIGHT.—Not later than 1 year after 

2 the date of enactment of this Act, the Attorney Gen3 eral shall award a contract to an independent orga4 nization or independent organizations to conduct 

5 oversight of the programs described in paragraph 

6 (3). 

7 (9) AUTHORIZATION OF APPROPRIATIONS.— 

8 There is authorized to be appropriated to carry out 

9 this subsection $10,000,000 for each of fiscal years 

10 2024 through 2028. 

11 (e) GAO REPORT.— 

12 (1) IN GENERAL.—Not later than 2 years after 

13 the date of enactment of this Act, the Comptroller 

14 General of the United States shall submit to Con15 gress a report on adverse maternal and infant health 

16 outcomes among incarcerated individuals and infants 

17 born to such individuals, with a particular focus on 

18 racial and ethnic inequities in maternal and infant 

19 health outcomes for incarcerated individuals. 

20 (2) CONTENTS OF REPORT.—The report de21 scribed in this subsection shall include— 

22 (A) to the extent practicable— 

23 (i) the number of pregnant individuals 

24 who are incarcerated in Bureau of Prisons 

25 facilities; 


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1 (ii) the number of incarcerated indi2 viduals, including those incarcerated in 

3 Federal, State, and local correctional facili4 ties, who have experienced a pregnancy-re5 lated death, pregnancy-associated death, or 

6 the death of an infant in the most recent 

7 10 years of available data; 

8 (iii) the number of cases of severe ma9 ternal morbidity among incarcerated indi10 viduals, including those incarcerated in 

11 Federal, State, and local correctional facili12 ties, in the most recent 10 years of avail13 able data; 

14 (iv) the number of pre-term and low15 birthweight births of infants born to incar16 cerated individuals, including those incar17 cerated in Federal, State, and local correc18 tional facilities, in the most recent 10 

19 years of available data; and 

20 (v) statistics on the racial and ethnic 

21 inequities in maternal and infant health 

22 outcomes and severe maternal morbidity 

23 rates among incarcerated individuals, in24 cluding those incarcerated in Federal, 

25 State, and local correctional facilities; 


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1 (B) in the case that the Comptroller Gen2 eral of the United States is unable to determine 

3 the information required in clauses (i) through 

4 (v) of subparagraph (A), an assessment of the 

5 barriers to determining such information and 

6 recommendations for improvements in tracking 

7 maternal health outcomes among incarcerated 

8 individuals, including those incarcerated in Fed9 eral, State, and local correctional facilities; 

10 (C) a discussion of causes of adverse ma11 ternal health outcomes that are unique to incar12 cerated individuals, including those incarcerated 

13 in Federal, State, and local correctional facili14 ties; 

15 (D) a discussion of causes of adverse ma16 ternal health outcomes and severe maternal 

17 morbidity that are unique to incarcerated indi18 viduals from racial and ethnic minority groups; 

19 (E) recommendations to reduce maternal 

20 mortality and severe maternal morbidity among 

21 incarcerated individuals and to address racial 

22 and ethnic inequities in maternal health out23 comes for incarcerated individuals in Bureau of 

24 Prisons facilities and State and local correc25 tional facilities; and 


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1 (F) such other information as may be ap2 propriate to reduce the occurrence of adverse 

3 maternal health outcomes among incarcerated 

4 individuals and to address racial and ethnic in5 equities in maternal health outcomes for such 

6 individuals. 

7 (f) MACPAC REPORT.— 

8 (1) IN GENERAL.—Not later than 2 years after 

9 the date of enactment of this section, the Medicaid 

10 and CHIP Payment and Access Commission (re11 ferred to in this subsection as ‘‘MACPAC’’) shall 

12 publish a report on the implications of pregnant and 

13 postpartum incarcerated individuals being ineligible 

14 for medical assistance under a State plan under title 

15 XIX of the Social Security Act (42 U.S.C. 1396 et 

16 seq.) that contains the information described in 

17 paragraph (2). 

18 (2) INFORMATION DESCRIBED.—For purposes 

19 of paragraph (1), the information described in this 

20 paragraph includes— 

21 (A) information on the effect of ineligibility 

22 for medical assistance under a State plan under 

23 title XIX of the Social Security Act (42 U.S.C. 

24 1396 et seq.) on maternal health outcomes for 

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1 uals, concentrating on the effects of such ineli2 gibility for pregnant and postpartum individuals 

3 from racial and ethnic minority groups; and 

4 (B) the potential implications on maternal 

5 health outcomes resulting from suspending eli6 gibility for medical assistance under a State 

7 plan under such title of such Act when a preg8 nant or postpartum individual is incarcerated. 

9 (g) DEFINITIONS.—In this section: 

10 (1) CULTURALLY CONGRUENT.—The term ‘‘cul11 turally congruent’’ means that the care, maternity 

12 care, health care services, provider, or non-clinical 

13 support made available is in agreement with the pre14 ferred cultural values, beliefs, worldview, language, 

15 and practices of the health care consumer and other 

16 stakeholders. 

17 (2) MATERNITY CARE PROVIDER.—The term 

18 ‘‘maternity care provider’’ means a health care pro19 vider who— 

20 (A) is a physician, physician assistant, 

21 midwife who meets at a minimum the inter22 national definition of the midwife and global 

23 standards for midwifery education as estab24 lished by the International Confederation of 


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1 Midwives, nurse practitioner, or clinical nurse 

2 specialist; and 

3 (B) has a focus on maternal or perinatal 

4 health. 

5 (3) MATERNAL MORTALITY.—The term ‘‘mater6 nal mortality’’ means a death occurring during or 

7 within a one-year period after pregnancy that is 

8 caused by pregnancy-related or childbirth complica9 tions, including a suicide, overdose, or other death 

10 resulting from a mental health or substance use dis11 order attributed to or aggravated by pregnancy-re12 lated or childbirth complications. 

13 (4) PERINATAL HEALTH WORKER.—The term 

14 ‘‘perinatal health worker’’ means a doula, commu15 nity health worker, peer supporter, breastfeeding 

16 and lactation educator or counselor, nutritionist or 

17 dietitian, childbirth educator, social worker, home 

18 visitor, language interpreter, or navigator. 

19 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

20 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

21 refer to the 1-year period beginning on the last day 

22 of the pregnancy of an individual. 

23 (6) PREGNANCY-ASSOCIATED DEATH.—The 

24 term ‘‘pregnancy-associated death’’ means a death of 

25 a pregnant or postpartum individual, by any cause, 


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1 that occurs during, or within 1 year following, the 

2 individual’s pregnancy, regardless of the outcome, 

3 duration, or site of the pregnancy. 

4 (7) PREGNANCY-RELATED DEATH.—The term 

5 ‘‘pregnancy-related death’’ means a death of a preg6 nant or postpartum individual that occurs during, or 

7 within 1 year following, the individual’s pregnancy, 

8 from a pregnancy complication, a chain of events 

9 initiated by pregnancy, or the aggravation of an un10 related condition by the physiologic effects of preg11 nancy. 

12 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

13 The term ‘‘racial and ethnic minority group’’ has the 

14 meaning given such term in section 1707(g)(1) of 

15 the Public Health Service Act (42 U.S.C. 300u– 

16 6(g)(1)). 

17 (9) SEVERE MATERNAL MORBIDITY.—The term 

18 ‘‘severe maternal morbidity’’ means a health condi19 tion, including mental health conditions and sub20 stance use disorders, attributed to or aggravated by 

21 pregnancy or childbirth that results in significant 

22 short-term or long-term consequences to the health 

23 of the individual who was pregnant. 

24 (10) SOCIAL DETERMINANTS OF MATERNAL

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1 nal health’’ means non-clinical factors that impact 

2 maternal health outcomes, including— 

3 (A) economic factors, which may include 

4 poverty, employment, food security, support for 

5 and access to lactation and other infant feeding 

6 options, housing stability, and related factors; 

7 (B) neighborhood factors, which may in8 clude quality of housing, access to transpor9 tation, access to child care, availability of 

10 healthy foods and nutrition counseling, avail11 ability of clean water, air and water quality, 

12 ambient temperatures, neighborhood crime and 

13 violence, access to broadband, and related fac14 tors; 

15 (C) social and community factors, which 

16 may include systemic racism, gender discrimi17 nation or discrimination based on other pro18 tected classes, workplace conditions, incarcer19 ation, and related factors; 

20 (D) household factors, which may include 

21 ability to conduct lead testing and abatement, 

22 car seat installation, indoor air temperatures, 

23 and related factors; 


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1 (E) education access and quality factors, 

2 which may include educational attainment, lan3 guage and literacy, and related factors; and 

4 (F) health care access factors, including 

5 health insurance coverage, access to culturally 

6 congruent health care services, providers, and 

7 non-clinical support, access to home visiting 

8 services, access to wellness and stress manage9 ment programs, health literacy, access to tele10 health and items required to receive telehealth 

11 services, and related factors. 

12 (11) STATE.—The term ‘‘State’’ means any 

13 State of the United States, the District of Columbia, 

14 or any territory or possession of the United States. 

15 SEC. 5204. IMPACT TO SAVE MOMS ACT. 

16 (a) PERINATAL CARE ALTERNATIVE PAYMENT

17 MODEL DEMONSTRATION PROJECT.— 

18 (1) IN GENERAL.—For the period of fiscal 

19 years 2023 through 2027, the Secretary of Health 

20 and Human Services (referred to in this subsection 

21 as the ‘‘Secretary’’), acting through the Adminis22 trator of the Centers for Medicare & Medicaid Serv23 ices, shall establish and implement, in accordance 

24 with the requirements of this subsection, a dem25 onstration project, to be known as the Perinatal 


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1 Care Alternative Payment Model Demonstration 

2 Project (referred to in this subsection as the ‘‘Dem3 onstration Project’’), for purposes of allowing States 

4 to test payment models under their State plans 

5 under title XIX of the Social Security Act (42 

6 U.S.C. 1396 et seq.) and State child health plans 

7 under title XXI of such Act (42 U.S.C. 1397aa et 

8 seq.) with respect to maternity care provided to 

9 pregnant and postpartum individuals enrolled in 

10 such State plans and State child health plans. 

11 (2) COORDINATION.—In establishing the Dem12 onstration Project, the Secretary shall coordinate 

13 with stakeholders such as— 

14 (A) State Medicaid programs; 

15 (B) relevant organizations representing 

16 maternal health care providers; 

17 (C) relevant organizations representing pa18 tients, with a particular focus on individuals 

19 from demographic groups with disproportionate 

20 rates of adverse maternal health outcomes; 

21 (D) relevant community-based organiza22 tions, particularly organizations that seek to 

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1 tionate rates of adverse maternal health out2 comes; 

3 (E) non-clinical perinatal health workers 

4 such as doulas, community health workers, peer 

5 supporters, certified lactation consultants, nu6 tritionists and dieticians, social workers, home 

7 visitors, and navigators; 

8 (F) relevant health insurance issuers; 

9 (G) hospitals, health systems, freestanding 

10 birth centers (as such term is defined in para11 graph (3)(B) of section 1905(l) of the Social 

12 Security Act (42 U.S.C. 1396d(l))), Federally13 qualified health centers (as such term is defined 

14 in paragraph (2)(B) of such section), and rural 

15 health clinics (as such term is defined in section 

16 1861(aa) of such Act (42 U.S.C. 1395x(aa))); 

17 (H) researchers and policy experts in fields 

18 related to maternity care payment models; and 

19 (I) any other stakeholders as the Secretary 

20 determines appropriate, with a particular focus 

21 on stakeholders from demographic groups with 

22 disproportionate rates of adverse maternal 

23 health outcomes. 


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1 (3) CONSIDERATIONS.—In establishing the 

2 Demonstration Project, the Secretary shall consider 

3 each of the following: 

4 (A) Findings from any evaluations of the 

5 Strong Start for Mothers and Newborns initia6 tive carried out by the Centers for Medicare & 

7 Medicaid Services, the Health Resources and 

8 Services Administration, and the Administra9 tion on Children and Families. 

10 (B) Any alternative payment model that— 

11 (i) is designed to improve maternal 

12 health outcomes for racial and ethnic 

13 groups with disproportionate rates of ad14 verse maternal health outcomes; 

15 (ii) includes methods for stratifying 

16 patients by pregnancy risk level and, as 

17 appropriate, adjusting payments under 

18 such model to take into account pregnancy 

19 risk level; 

20 (iii) establishes evidence-based quality 

21 metrics for such payments; 

22 (iv) includes consideration of non-hos23 pital birth settings such as freestanding 

24 birth centers (as so defined); 


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1 (v) includes consideration of social de2 terminants of health that are relevant to 

3 maternal health outcomes such as housing, 

4 transportation, nutrition, and other non5 clinical factors that influence maternal 

6 health outcomes; or 

7 (vi) includes diverse maternity care 

8 teams that include— 

9 (I) maternity care providers, in10 cluding obstetrician-gynecologists, 

11 family physicians, physician assist12 ants, midwives who meet, at a min13 imum, the international definition of 

14 the term ‘‘midwife’’ and global stand15 ards for midwifery education (as es16 tablished by the International Confed17 eration of Midwives), and nurse prac18 titioners— 

19 (aa) from racially, eth20 nically, and professionally diverse 

21 backgrounds; 

22 (bb) with experience prac23 ticing in racially and ethnically 

24 diverse communities; or 


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1 (cc) who have undergone 

2 trainings on racism, implicit bias, 

3 and explicit bias; and 

4 (II) non-clinical perinatal health 

5 workers such as doulas, community 

6 health workers, peer supporters, cer7 tified lactation consultants, nutrition8 ists and dieticians, social workers, 

9 home visitors, and navigators. 

10 (4) ELIGIBILITY.—To be eligible to participate 

11 in the Demonstration Project, a State shall submit 

12 an application to the Secretary at such time, in such 

13 manner, and containing such information as the Sec14 retary may require. 

15 (5) EVALUATION.—The Secretary shall conduct 

16 an evaluation of the Demonstration Project to deter17 mine the impact of the Demonstration Project on— 

18 (A) maternal health outcomes, with data 

19 stratified by race, ethnicity, socioeconomic indi20 cators, and any other factors as the Secretary 

21 determines appropriate; 

22 (B) spending on maternity care by States 

23 participating in the Demonstration Project; 

24 (C) to the extent practicable, subjective 

25 measures of patient experience; and 


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1 (D) any other areas of assessment that the 

2 Secretary determines relevant. 

3 (6) REPORT.—Not later than one year after the 

4 completion or termination date of the Demonstration 

5 Project, the Secretary shall submit to the Committee 

6 on Energy and Commerce, the Committee on Ways 

7 and Means, and the Committee on Education and 

8 Labor of the House of Representatives and the Com9 mittee on Finance and the Committee on Health, 

10 Education, Labor, and Pensions of the Senate, and 

11 make publicly available, a report containing— 

12 (A) the results of any evaluation conducted 

13 under paragraph (5); and 

14 (B) a recommendation regarding whether 

15 the Demonstration Project should be continued 

16 after fiscal year 2026 and expanded on a na17 tional basis. 

18 (7) AUTHORIZATION OF APPROPRIATIONS.— 

19 There are authorized to be appropriated such sums 

20 as are necessary to carry out this subsection. 

21 (8) DEFINITIONS.—In this subsection: 

22 (A) ALTERNATIVE PAYMENT MODEL.—The 

23 term ‘‘alternative payment model’’ has the 

24 meaning given such term in section 


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1 1833(z)(3)(C) of the Social Security Act (42 

2 U.S.C. 1395l(z)(3)(C)). 

3 (B) PERINATAL.—The term ‘‘perinatal’’ 

4 means the period beginning on the day a person 

5 becomes pregnant and ending on the last day of 

6 the 1-year period beginning on the last day of 

7 such person’s pregnancy. 

8 (b) MACPAC REPORT.— 

9 (1) IN GENERAL.—Not later than two years 

10 after the date of the enactment of this section, the 

11 Medicaid and CHIP Payment and Access Commis12 sion shall publish a report on issues relating to the 

13 continuity of coverage under State plans under title 

14 XIX of the Social Security Act (42 U.S.C. 1396 et 

15 seq.) and State child health plans under title XXI of 

16 such Act (42 U.S.C. 1397aa et seq.) for pregnant 

17 and postpartum individuals. Such report shall, at a 

18 minimum, include the following: 

19 (A) An assessment of any existing policies 

20 under such State plans and such State child 

21 health plans regarding presumptive eligibility 

22 for pregnant individuals while their application 

23 for enrollment in such a State plan or such a 

24 State child health plan is being processed. 


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1 (B) An assessment of any existing policies 

2 under such State plans and such State child 

3 health plans regarding measures to ensure con4 tinuity of coverage under such a State plan or 

5 such a State child health plan for pregnant and 

6 postpartum individuals, including such individ7 uals who need to change their health insurance 

8 coverage during their pregnancy or the 

9 postpartum period following their pregnancy. 

10 (C) An assessment of any existing policies 

11 under such State plans and such State child 

12 health plans regarding measures to automati13 cally reenroll individuals who are eligible to en14 roll under such a State plan or such a State 

15 child health plan as a parent. 

16 (D) If determined appropriate by the Com17 mission, any recommendations for the Depart18 ment of Health and Human Services, or such 

19 State plans and such State child health plans, 

20 to ensure continuity of coverage under such a 

21 State plan or such a State child health plan for 

22 pregnant and postpartum people. 

23 (2) POSTPARTUM DEFINED.—In this sub24 section, the term ‘‘postpartum’’ means the 1-year 


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1 period beginning on the last day of a person’s preg2 nancy. 

3 SEC. 5205. PROTECTING MOMS AND BABIES AGAINST CLI4 MATE CHANGE. 

5 (a) GRANT PROGRAM TO PROTECT VULNERABLE

6 MOTHERS AND BABIES FROM CLIMATE CHANGE

7 RISKS.— 

8 (1) IN GENERAL.—Not later than 180 days 

9 after the date of the enactment of this section, the 

10 Secretary of Health and Human Services (in this 

11 section referred to as the ‘‘Secretary’’) shall estab12 lish a grant program (in this subsection referred to 

13 as the ‘‘Program’’) to protect vulnerable individuals 

14 from risks associated with climate change. 

15 (2) GRANT AUTHORITY.—In carrying out the 

16 Program, the Secretary may award, on a competitive 

17 basis, grants to 10 covered entities. 

18 (3) APPLICATIONS.—To be eligible for a grant 

19 under the Program, a covered entity shall submit to 

20 the Secretary an application at such time, in such 

21 form, and containing such information as the Sec22 retary may require, which shall include, at a min23 imum, a description of the following: 

24 (A) Plans for the use of grant funds 

25 awarded under the Program and how patients 


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1 and stakeholder organizations were involved in 

2 the development of such plans. 

3 (B) How such grant funds will be targeted 

4 to geographic areas that have disproportionately 

5 high levels of risks associated with climate 

6 change for vulnerable individuals. 

7 (C) How such grant funds will be used to 

8 address racial and ethnic inequities in— 

9 (i) adverse maternal and infant health 

10 outcomes; and 

11 (ii) exposure to risks associated with 

12 climate change for vulnerable individuals. 

13 (D) Strategies to prevent an initiative as14 sisted with such grant funds from causing— 

15 (i) adverse environmental impacts; 

16 (ii) displacement of residents and 

17 businesses; 

18 (iii) rent and housing price increases; 

19 or 

20 (iv) disproportionate adverse impacts 

21 on racial and ethnic minority groups and 

22 other underserved populations. 

23 (4) SELECTION OF GRANT RECIPIENTS.— 

24 (A) TIMING.—Not later than 270 days 

25 after the date of the enactment of this Act, the 


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1 Secretary shall select the recipients of grants 

2 under the Program. 

3 (B) CONSULTATION.—In selecting covered 

4 entities for grants under the Program, the Sec5 retary shall consult with— 

6 (i) representatives of stakeholder or7 ganizations; 

8 (ii) the Administrator of the Environ9 mental Protection Agency; 

10 (iii) the Administrator of the National 

11 Oceanic and Atmospheric Administration; 

12 and 

13 (iv) from the Department of Health 

14 and Human Services— 

15 (I) the Deputy Assistant Sec16 retary for Minority Health; 

17 (II) the Administrator of the 

18 Centers for Medicare & Medicaid 

19 Services; 

20 (III) the Administrator of the 

21 Health Resources and Services Ad22 ministration; 

23 (IV) the Director of the National 

24 Institutes of Health; and 


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1 (V) the Director of the Centers 

2 for Disease Control and Prevention. 

3 (C) PRIORITY.—In selecting a covered en4 tity to be awarded a grant under the Program, 

5 the Secretary shall give priority to covered enti6 ties that serve a county— 

7 (i) designated, or located in an area 

8 designated, as a nonattainment area pur9 suant to section 107 of the Clean Air Act 

10 (42 U.S.C. 7407) for any air pollutant for 

11 which air quality criteria have been issued 

12 under section 108(a) of such Act (42 

13 U.S.C. 7408(a)); 

14 (ii) with a level of vulnerability of 

15 moderate-to-high or higher, according to 

16 the Social Vulnerability Index of the Cen17 ters for Disease Control and Prevention; or 

18 (iii) with temperatures that pose a 

19 risk to human health, as determined by the 

20 Secretary, in consultation with the Admin21 istrator of the National Oceanic and At22 mospheric Administration and the Chair of 

23 the United States Global Change Research 

24 Program, based on the best available 

25 science. 


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1 (D) LIMITATION.—A recipient of grant 

2 funds under the Program may not use such 

3 grant funds to serve a county that is served by 

4 any other recipient of a grant under the Pro5 gram. 

6 (5) USE OF FUNDS.—A covered entity awarded 

7 grant funds under the Program may only use such 

8 grant funds for the following: 

9 (A) Initiatives to identify risks associated 

10 with climate change for vulnerable individuals 

11 and to provide services and support to such in12 dividuals that address such risks, which may in13 clude— 

14 (i) training for health care providers, 

15 doulas, and other employees in hospitals, 

16 birth centers, midwifery practices, and 

17 other health care practices that provide 

18 prenatal or labor and delivery services to 

19 vulnerable individuals on the identification 

20 of, and patient counseling relating to, risks 

21 associated with climate change for vulner22 able individuals; 

23 (ii) hiring, training, or providing re24 sources to community health workers and 

25 perinatal health workers who can help 


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1 identify risks associated with climate 

2 change for vulnerable individuals, provide 

3 patient counseling about such risks, and 

4 carry out the distribution of relevant serv5 ices and support; 

6 (iii) enhancing the monitoring of risks 

7 associated with climate change for vulner8 able individuals, including by— 

9 (I) collecting data on such risks 

10 in specific census tracts, neighbor11 hoods, or other geographic areas; and 

12 (II) sharing such data with local 

13 health care providers, doulas, and 

14 other employees in hospitals, birth 

15 centers, midwifery practices, and 

16 other health care practices that pro17 vide prenatal or labor and delivery 

18 services to local vulnerable individuals; 

19 and 

20 (iv) providing vulnerable individuals— 

21 (I) air conditioning units, resi22 dential weatherization support, filtra23 tion systems, household appliances, or 

24 related items; 


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1 (II) direct financial assistance; 

2 and 

3 (III) services and support, in4 cluding housing and transportation 

5 assistance, to prepare for or recover 

6 from extreme weather events, which 

7 may include floods, hurricanes, 

8 wildfires, droughts, and related 

9 events. 

10 (B) Initiatives to mitigate levels of and ex11 posure to risks associated with climate change 

12 for vulnerable individuals, which shall be based 

13 on the best available science and which may in14 clude initiatives to— 

15 (i) develop, maintain, or expand urban 

16 or community forestry initiatives and tree 

17 canopy coverage initiatives; 

18 (ii) improve infrastructure, including 

19 buildings and paved surfaces; 

20 (iii) develop or improve community 

21 outreach networks to provide culturally 

22 and linguistically appropriate information 

23 and notifications about risks associated 

24 with climate change for vulnerable individ25 uals; and 


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1 (iv) provide enhanced services to ra2 cial and ethnic minority groups and other 

3 underserved populations. 

4 (6) LENGTH OF AWARD.—A grant under this 

5 subsection shall be disbursed over 4 fiscal years. 

6 (7) TECHNICAL ASSISTANCE.—The Secretary 

7 shall provide technical assistance to a covered entity 

8 awarded a grant under the Program to support the 

9 development, implementation, and evaluation of ac10 tivities funded with such grant. 

11 (8) REPORTS TO SECRETARY.— 

12 (A) ANNUAL REPORT.—For each fiscal 

13 year during which a covered entity is disbursed 

14 grant funds under the Program, such covered 

15 entity shall submit to the Secretary a report 

16 that summarizes the activities carried out by 

17 such covered entity with such grant funds dur18 ing such fiscal year, which shall include a de19 scription of the following: 

20 (i) The involvement of stakeholder or21 ganizations in the implementation of initia22 tives assisted with such grant funds. 

23 (ii) Relevant health and environmental 

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1 ticable, by race, ethnicity, gender, and 

2 pregnancy status. 

3 (iii) Qualitative feedback received 

4 from vulnerable individuals with respect to 

5 initiatives assisted with such grant funds. 

6 (iv) Criteria used in selecting the geo7 graphic areas assisted with such grant 

8 funds. 

9 (v) Efforts to address racial and eth10 nic inequities in adverse maternal and in11 fant health outcomes and in exposure to 

12 risks associated with climate change for 

13 vulnerable individuals. 

14 (vi) Any negative and unintended im15 pacts of initiatives assisted with such grant 

16 funds, including— 

17 (I) adverse environmental im18 pacts; 

19 (II) displacement of residents 

20 and businesses; 

21 (III) rent and housing price in22 creases; and 

23 (IV) disproportionate adverse im24 pacts on racial and ethnic minority 


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1 groups and other underserved popu2 lations. 

3 (vii) How the covered entity will ad4 dress and prevent any impacts described in 

5 clause (vi). 

6 (B) PUBLICATION.—Not later than 30 

7 days after the date on which a report is sub8 mitted under subparagraph (A), the Secretary 

9 shall publish such report on a public website of 

10 the Department of Health and Human Services. 

11 (9) REPORT TO CONGRESS.—Not later than the 

12 date that is 5 years after the date on which the Pro13 gram is established, the Secretary shall submit to 

14 Congress and publish on a public website of the De15 partment of Health and Human Services a report on 

16 the results of the Program, including the following: 

17 (A) Summaries of the annual reports sub18 mitted under paragraph (8). 

19 (B) Evaluations of the initiatives assisted 

20 with grant funds under the Program. 

21 (C) An assessment of the effectiveness of 

22 the Program in— 

23 (i) identifying risks associated with 

24 climate change for vulnerable individuals; 


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1 (ii) providing services and support to 

2 such individuals; 

3 (iii) mitigating levels of and exposure 

4 to such risks; and 

5 (iv) addressing racial and ethnic in6 equities in adverse maternal and infant 

7 health outcomes and in exposure to such 

8 risks. 

9 (D) A description of how the Program 

10 could be expanded, including— 

11 (i) monitoring efforts or data collec12 tion that would be required to identify 

13 areas with high levels of risks associated 

14 with climate change for vulnerable individ15 uals; 

16 (ii) how such areas could be identified 

17 using the strategy developed under sub18 section (d); and 

19 (iii) recommendations for additional 

20 funding. 

21 (10) COVERED ENTITY DEFINED.—In this sub22 section, the term ‘‘covered entity’’ means a consor23 tium of organizations serving a county that— 

24 (A) shall include a community-based orga25 nization; and 


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1 (B) may include— 

2 (i) another stakeholder organization; 

3 (ii) the government of such county; 

4 (iii) the governments of one or more 

5 municipalities within such county; 

6 (iv) a State or local public health de7 partment or emergency management agen8 cy; 

9 (v) a local health care practice, which 

10 may include a licensed and accredited hos11 pital, birth center, midwifery practice, or 

12 other health care practice that provides 

13 prenatal or labor and delivery services to 

14 vulnerable individuals; 

15 (vi) an Indian tribe or tribal organiza16 tion (as such terms are defined in section 

17 4 of the Indian Self-Determination and 

18 Education Assistance Act (25 U.S.C. 

19 5304)); 

20 (vii) an Urban Indian organization (as 

21 defined in section 4 of the Indian Health 

22 Care Improvement Act (25 U.S.C. 1603)); 

23 and 

24 (viii) an institution of higher edu25 cation. 


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1 (11) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated to carry out 

3 this subsection $100,000,000 for fiscal years 2023 

4 through 2026. 

5 (b) GRANT PROGRAM FOR EDUCATION AND TRAIN6 ING AT HEALTH PROFESSION SCHOOLS.— 

7 (1) IN GENERAL.—Not later than 1 year after 

8 the date of the enactment of this Act, the Secretary 

9 shall establish a grant program (in this subsection 

10 referred to as the ‘‘Program’’) to provide funds to 

11 health profession schools to support the development 

12 and integration of education and training programs 

13 for identifying and addressing risks associated with 

14 climate change for vulnerable individuals. 

15 (2) GRANT AUTHORITY.—In carrying out the 

16 Program, the Secretary may award, on a competitive 

17 basis, grants to health profession schools. 

18 (3) APPLICATION.—To be eligible for a grant 

19 under the Program, a health profession school shall 

20 submit to the Secretary an application at such time, 

21 in such form, and containing such information as 

22 the Secretary may require, which shall include, at a 

23 minimum, a description of the following: 

24 (A) How such health profession school will 

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1 holder organizations representing such individ2 uals, in developing and implementing the edu3 cation and training programs supported by 

4 grant funds awarded under the Program. 

5 (B) How such health profession school will 

6 ensure that such education and training pro7 grams will address racial and ethnic inequities 

8 in exposure to, and the effects of, risks associ9 ated with climate change for vulnerable individ10 uals. 

11 (4) USE OF FUNDS.—A health profession school 

12 awarded a grant under the Program shall use the 

13 grant funds to develop, and integrate into the cur14 riculum and continuing education of such health 

15 profession school, education and training on each of 

16 the following: 

17 (A) Identifying risks associated with cli18 mate change for vulnerable individuals and indi19 viduals with the intent to become pregnant. 

20 (B) How risks associated with climate 

21 change affect vulnerable individuals and individ22 uals with the intent to become pregnant. 

23 (C) Racial and ethnic inequities in expo24 sure to, and the effects of, risks associated with 


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1 climate change for vulnerable individuals and 

2 individuals with the intent to become pregnant. 

3 (D) Patient counseling and mitigation 

4 strategies relating to risks associated with cli5 mate change for vulnerable individuals. 

6 (E) Relevant services and support for vul7 nerable individuals relating to risks associated 

8 with climate change and strategies for ensuring 

9 vulnerable individuals have access to such serv10 ices and support. 

11 (F) Implicit and explicit bias, racism, and 

12 discrimination. 

13 (G) Related topics identified by such 

14 health profession school based on the engage15 ment of such health profession school with vul16 nerable individuals and stakeholder organiza17 tions representing such individuals. 

18 (5) PARTNERSHIPS.—In carrying out activities 

19 with grant funds, a health profession school awarded 

20 a grant under the Program may partner with one or 

21 more of the following: 

22 (A) A State or local public health depart23 ment. 

24 (B) A health care professional membership 

25 organization. 


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1 (C) A stakeholder organization. 

2 (D) A health profession school. 

3 (E) An institution of higher education. 

4 (6) REPORTS TO SECRETARY.— 

5 (A) ANNUAL REPORT.—For each fiscal 

6 year during which a health profession school is 

7 disbursed grant funds under the Program, such 

8 health profession school shall submit to the Sec9 retary a report that describes the activities car10 ried out with such grant funds during such fis11 cal year. 

12 (B) FINAL REPORT.—Not later than the 

13 date that is 1 year after the end of the last fis14 cal year during which a health profession school 

15 is disbursed grant funds under the Program, 

16 the health profession school shall submit to the 

17 Secretary a final report that summarizes the 

18 activities carried out with such grant funds. 

19 (7) REPORT TO CONGRESS.—Not later than the 

20 date that is 6 years after the date on which the Pro21 gram is established, the Secretary shall submit to 

22 Congress and publish on a public website of the De23 partment of Health and Human Services a report 

24 that includes the following: 


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1 (A) A summary of the reports submitted 

2 under paragraph (6). 

3 (B) Recommendations to improve edu4 cation and training programs at health profes5 sion schools with respect to identifying and ad6 dressing risks associated with climate change 

7 for vulnerable individuals. 

8 (8) HEALTH PROFESSION SCHOOL DEFINED.— 

9 In this subsection, the term ‘‘health profession 

10 school’’ means an accredited— 

11 (A) medical school; 

12 (B) school of nursing; 

13 (C) midwifery program; 

14 (D) physician assistant education program; 

15 (E) teaching hospital; 

16 (F) residency or fellowship program; or 

17 (G) other school or program determined 

18 appropriate by the Secretary. 

19 (9) AUTHORIZATION OF APPROPRIATIONS.— 

20 There is authorized to be appropriated to carry out 

21 this subsection $5,000,000 for fiscal years 2023 

22 through 2026. 

23 (c) NIH CONSORTIUM ON BIRTH AND CLIMATE

24 CHANGE RESEARCH.— 


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1 (1) ESTABLISHMENT.—Not later than 1 year 

2 after the date of the enactment of this Act, the Di3 rector of the National Institutes of Health (in this 

4 subsection referred to as the ‘‘Director of NIH’’) 

5 shall establish the Consortium on Birth and Climate 

6 Change Research (in this subsection referred to as 

7 the ‘‘Consortium’’). 

8 (2) DUTIES.— 

9 (A) IN GENERAL.—The Consortium shall 

10 coordinate, across the institutes, centers, and 

11 offices of the National Institutes of Health, re12 search on the risks associated with climate 

13 change for vulnerable individuals. 

14 (B) REQUIRED ACTIVITIES.—In carrying 

15 out subparagraph (A), the Consortium shall— 

16 (i) establish research priorities, in17 cluding by prioritizing research that— 

18 (I) identifies the risks associated 

19 with climate change for vulnerable in20 dividuals with a particular focus on 

21 inequities in such risks among racial 

22 and ethnic minority groups and other 

23 underserved populations; and 

24 (II) identifies strategies to reduce 

25 levels of, and exposure to, such risks, 


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1 with a particular focus on risks 

2 among racial and ethnic minority 

3 groups and other underserved popu4 lations; 

5 (ii) identify gaps in available data re6 lated to such risks; 

7 (iii) identify gaps in, and opportuni8 ties for, research collaborations; 

9 (iv) identify funding opportunities for 

10 community-based organizations and re11 searchers from racially, ethnically, and 

12 geographically diverse backgrounds; and 

13 (v) publish annual reports on the 

14 work and findings of the Consortium on a 

15 public website of the National Institutes of 

16 Health. 

17 (3) MEMBERSHIP.—The Director of NIH shall 

18 appoint to the Consortium representatives of such 

19 institutes, centers, and offices of the National Insti20 tutes of Health as the Director of NIH considers ap21 propriate, including, at a minimum, representatives 

22 of— 

23 (A) the National Institute of Environ24 mental Health Sciences; 


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1 (B) the National Institute on Minority 

2 Health and Health Disparities; 

3 (C) the Eunice Kennedy Shriver National 

4 Institute of Child Health and Human Develop5 ment; 

6 (D) the National Institute of Nursing Re7 search; and 

8 (E) the Office of Research on Women’s 

9 Health. 

10 (4) CHAIRPERSON.—The Chairperson of the 

11 Consortium shall be designated by the Director of 

12 NIH and selected from among the representatives 

13 appointed under paragraph (3). 

14 (5) CONSULTATION.—In carrying out the duties 

15 described in paragraph (2), the Consortium shall 

16 consult with— 

17 (A) the heads of relevant Federal agencies, 

18 including— 

19 (i) the Environmental Protection 

20 Agency; 

21 (ii) the National Oceanic and Atmos22 pheric Administration; 

23 (iii) the Occupational Safety and 

24 Health Administration; and 


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1 (iv) from the Department of Health 

2 and Human Services— 

3 (I) the Office of Minority Health 

4 in the Office of the Secretary; 

5 (II) the Centers for Medicare & 

6 Medicaid Services; 

7 (III) the Health Resources and 

8 Services Administration; 

9 (IV) the Centers for Disease 

10 Control and Prevention; 

11 (V) the Indian Health Service; 

12 and 

13 (VI) the Administration for Chil14 dren and Families; and 

15 (B) representatives of— 

16 (i) stakeholder organizations; 

17 (ii) health care providers and profes18 sional membership organizations with ex19 pertise in maternal health or environ20 mental justice; 

21 (iii) State and local public health de22 partments; 

23 (iv) licensed and accredited hospitals, 

24 birth centers, midwifery practices, or other 

25 health care practices that provide prenatal 


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1 or labor and delivery services to vulnerable 

2 individuals; and 

3 (v) institutions of higher education, 

4 including such institutions that are minor5 ity-serving institutions or have expertise in 

6 maternal health or environmental justice. 

7 (d) STRATEGY FOR IDENTIFYING CLIMATE CHANGE

8 RISK ZONES FOR VULNERABLE MOTHERS AND BABIES.— 

9 (1) IN GENERAL.—The Secretary, acting 

10 through the Director of the Centers for Disease 

11 Control and Prevention, shall develop a strategy (in 

12 this subsection referred to as the ‘‘Strategy’’) for 

13 designating areas that the Secretary determines to 

14 have a high risk of adverse maternal and infant 

15 health outcomes among vulnerable individuals as a 

16 result of risks associated with climate change. 

17 (2) STRATEGY REQUIREMENTS.— 

18 (A) IN GENERAL.—In developing the 

19 Strategy, the Secretary shall establish a process 

20 to identify areas where vulnerable individuals 

21 are exposed to a high risk of adverse maternal 

22 and infant health outcomes as a result of risks 

23 associated with climate change in conjunction 

24 with other factors that can impact such health 

25 outcomes, including— 


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1 (i) the incidence of diseases associated 

2 with air pollution, extreme heat, and other 

3 environmental factors; 

4 (ii) the availability and accessibility of 

5 maternal and infant health care providers; 

6 (iii) English-language proficiency 

7 among people of reproductive age; 

8 (iv) the health insurance status of 

9 people of reproductive age; 

10 (v) the number of people of reproduc11 tive age who are members of racial or eth12 nic groups with disproportionately high 

13 rates of adverse maternal and infant 

14 health outcomes; 

15 (vi) the socioeconomic status of people 

16 of reproductive age, including with respect 

17 to— 

18 (I) poverty; 

19 (II) unemployment; 

20 (III) household income; and 

21 (IV) educational attainment; and 

22 (vii) access to quality housing, trans23 portation, and nutrition. 


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1 (B) RESOURCES.—In developing the Strat2 egy, the Secretary shall identify, and incor3 porate a description of, the following: 

4 (i) Existing mapping tools or Federal 

5 programs that identify— 

6 (I) risks associated with climate 

7 change for vulnerable individuals; and 

8 (II) other factors that can influ9 ence maternal and infant health out10 comes, including the factors described 

11 in subparagraph (A). 

12 (ii) Environmental, health, socio13 economic, and demographic data relevant 

14 to identifying risks associated with climate 

15 change for vulnerable individuals. 

16 (iii) Existing monitoring networks 

17 that collect data described in clause (ii), 

18 and any gaps in such networks. 

19 (iv) Federal, State, and local stake20 holders involved in maintaining monitoring 

21 networks identified under clause (iii), and 

22 how such stakeholders are coordinating 

23 their monitoring efforts. 

24 (v) Additional monitoring networks, 

25 and enhancements to existing monitoring 


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1 networks, that would be required to ad2 dress gaps identified under clause (iii), in3 cluding at the subcounty and census tract 

4 level. 

5 (vi) Funding amounts required to es6 tablish the monitoring networks identified 

7 under clause (v) and recommendations for 

8 Federal, State, and local coordination with 

9 respect to such networks. 

10 (vii) Potential uses for data collected 

11 and generated as a result of the Strategy, 

12 including how such data may be used in 

13 determining recipients of grants under the 

14 program established by subsection (a) or 

15 other similar programs. 

16 (viii) Other information the Secretary 

17 considers relevant for the development of 

18 the Strategy. 

19 (3) COORDINATION AND CONSULTATION.—In 

20 developing the Strategy, the Secretary shall— 

21 (A) coordinate with the Administrator of 

22 the Environmental Protection Agency and the 

23 Administrator of the National Oceanic and At24 mospheric Administration; and 

25 (B) consult with— 


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1 (i) stakeholder organizations; 

2 (ii) health care providers and profes3 sional membership organizations with ex4 pertise in maternal health or environ5 mental justice; 

6 (iii) State and local public health de7 partments; 

8 (iv) licensed and accredited hospitals, 

9 birth centers, midwifery practices, or other 

10 health care providers that provide prenatal 

11 or labor and delivery services to vulnerable 

12 individuals; and 

13 (v) institutions of higher education, 

14 including such institutions that are minor15 ity-serving institutions or have expertise in 

16 maternal health or environmental justice. 

17 (4) NOTICE AND COMMENT.—At least 240 days 

18 before the date on which the Strategy is published 

19 in accordance with paragraph (5), the Secretary 

20 shall provide— 

21 (A) notice of the Strategy on a public 

22 website of the Department of Health and 

23 Human Services; and 

24 (B) an opportunity for public comment of 

25 at least 90 days. 


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1 (5) PUBLICATION.—Not later than 18 months 

2 after the date of the enactment of this Act, the Sec3 retary shall publish on a public website of the De4 partment of Health and Human Services— 

5 (A) the Strategy; 

6 (B) the public comments received under 

7 paragraph (4); and 

8 (C) the responses of the Secretary to such 

9 public comments. 

10 (e) DEFINITIONS.—In this section, the following defi11 nitions apply: 

12 (1) ADVERSE MATERNAL AND INFANT HEALTH

13 OUTCOMES.—The term ‘‘adverse maternal and in14 fant health outcomes’’ includes the outcomes of pre15 term birth, low birth weight, stillbirth, infant or ma16 ternal mortality, and severe maternal morbidity. 

17 (2) INSTITUTION OF HIGHER EDUCATION.—The 

18 term ‘‘institution of higher education’’ has the 

19 meaning given such term in section 101 of the High20 er Education Act of 1965 (20 U.S.C. 1001). 

21 (3) MINORITY-SERVING INSTITUTION.—The 

22 term ‘‘minority-serving institution’’ means an entity 

23 specified in any of paragraphs (1) through (7) of 

24 section 371(a) of the Higher Education Act of 1965 

25 (20 U.S.C. 1067q(a)). 


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1 (4) RACIAL AND ETHNIC MINORITY GROUP.— 

2 The term ‘‘racial and ethnic minority group’’ has the 

3 meaning given such term in section 1707(g) of the 

4 Public Health Service Act (42 U.S.C. 300u–6(g)). 

5 (5) RISKS ASSOCIATED WITH CLIMATE

6 CHANGE.—The term ‘‘risks associated with climate 

7 change’’ includes risks associated with extreme heat, 

8 air pollution, extreme weather events, and other en9 vironmental issues associated with climate change 

10 that can result in adverse maternal and infant 

11 health outcomes. 

12 (6) STAKEHOLDER ORGANIZATION.—The term 

13 ‘‘stakeholder organization’’ means— 

14 (A) a community-based organization with 

15 expertise in providing assistance to vulnerable 

16 individuals; 

17 (B) a nonprofit organization with expertise 

18 in maternal or infant health or environmental 

19 justice; and 

20 (C) a patient advocacy organization rep21 resenting vulnerable individuals. 

22 (7) VULNERABLE INDIVIDUAL.—The term ‘‘vul23 nerable individual’’ means— 

24 (A) an individual who is pregnant; 


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1 (B) an individual who was pregnant during 

2 any portion of the preceding 1-year period; and 

3 (C) an individual under 3 years of age. 

4 SEC. 5206. TECH TO SAVE MOMS. 

5 (a) DEFINITIONS.—In this section: 

6 (1) POSTPARTUM AND POSTPARTUM PERIOD.— 

7 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

8 refer to the 1-year period beginning on the last day 

9 of the pregnancy of an individual. 

10 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

11 The term ‘‘racial and ethnic minority group’’ has the 

12 meaning given such term in section 1707(g)(1) of 

13 the Public Health Service Act (42 U.S.C. 300u– 

14 6(g)(1)). 

15 (3) SEVERE MATERNAL MORBIDITY.—The term 

16 ‘‘severe maternal morbidity’’ means a health condi17 tion, including mental health conditions and sub18 stance use disorders, attributed to or aggravated by 

19 pregnancy or childbirth that results in significant 

20 short-term or long-term consequences to the health 

21 of the individual who was pregnant. 

22 (4) SOCIAL DETERMINANTS OF MATERNAL

23 HEALTH.—The term ‘‘social determinants of mater24 nal health’’ means non-clinical factors that impact 

25 maternal health outcomes, including— 


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1 (A) economic factors, which may include 

2 poverty, employment, food security, support for 

3 and access to lactation and other infant feeding 

4 options, housing stability, and related factors; 

5 (B) neighborhood factors, which may in6 clude quality of housing, access to transpor7 tation, access to child care, availability of 

8 healthy foods and nutrition counseling, avail9 ability of clean water, air and water quality, 

10 ambient temperatures, neighborhood crime and 

11 violence, access to broadband, and related fac12 tors; 

13 (C) social and community factors, which 

14 may include systemic racism, gender discrimi15 nation or discrimination based on other pro16 tected classes, workplace conditions, incarcer17 ation, and related factors; 

18 (D) household factors, which may include 

19 ability to conduct lead testing and abatement, 

20 car seat installation, indoor air temperatures, 

21 and related factors; 

22 (E) education access and quality factors, 

23 which may include educational attainment, lan24 guage and literacy, and related factors; and 


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1 (F) health care access factors, including 

2 health insurance coverage, access to culturally 

3 congruent health care services, providers, and 

4 non-clinical support, access to home visiting 

5 services, access to wellness and stress manage6 ment programs, health literacy, access to tele7 health and items required to receive telehealth 

8 services, and related factors. 

9 (b) INTEGRATED TELEHEALTH MODELS IN MATER10 NITY CARE SERVICES.— 

11 (1) IN GENERAL.—Section 1115A(b)(2)(B) of 

12 the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) 

13 is amended by adding at the end the following: 

14 ‘‘(xxviii) Focusing on title XIX, pro15 viding for the adoption of and use of tele16 health tools that allow for screening, moni17 toring, and management of common health 

18 complications with respect to an individual 

19 receiving medical assistance during such 

20 individual’s pregnancy and for not more 

21 than a 1-year period beginning on the last 

22 day of the pregnancy.’’. 

23 (2) EFFECTIVE DATE.—The amendment made 

24 by paragraph (1) shall take effect 1 year after the 

25 date of the enactment of this section. 


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1 (c) GRANTS TO EXPAND THE USE OF TECHNOLOGY2 ENABLED COLLABORATIVE LEARNING AND CAPACITY

3 MODELS FOR PREGNANT AND POSTPARTUM INDIVID4 UALS.—Title III of the Public Health Service Act is 

5 amended by inserting after section 330N (42 U.S.C. 

6 254c–20) the following new section: 

7 ‘‘SEC. 330N–1. EXPANDING CAPACITY FOR MATERNAL 

8 HEALTH OUTCOMES. 

9 ‘‘(a) ESTABLISHMENT.—Beginning not later than 1 

10 year after the date of enactment of this section, the Sec11 retary shall award grants to eligible entities to evaluate, 

12 develop, and expand the use of technology-enabled collabo13 rative learning and capacity building models and improve 

14 maternal health outcomes— 

15 ‘‘(1) in health professional shortage areas; 

16 ‘‘(2) in areas with high rates of maternal mor17 tality and severe maternal morbidity; 

18 ‘‘(3) in areas with significant racial and ethnic 

19 inequities in maternal health outcomes; and 

20 ‘‘(4) for medically underserved populations and 

21 American Indians and Alaska Natives, including In22 dian Tribes, Tribal organizations, and Urban Indian 

23 organizations. 

24 ‘‘(b) USE OF FUNDS.— 


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1 ‘‘(1) REQUIRED USES.—Recipients of grants 

2 under this section shall use the grants to— 

3 ‘‘(A) train maternal health care providers, 

4 students, and other similar professionals 

5 through models that include— 

6 ‘‘(i) methods to increase safety and 

7 health care quality; 

8 ‘‘(ii) training to increase awareness of, 

9 and eliminate implicit bias, racism, and 

10 discrimination in, the provision of health 

11 care; 

12 ‘‘(iii) best practices in screening for 

13 and, as needed, evaluating and treating 

14 maternal mental health conditions and 

15 substance use disorders; 

16 ‘‘(iv) training on best practices in ma17 ternity care for pregnant and postpartum 

18 individuals during the COVID–19 public 

19 health emergency or future public health 

20 emergencies; 

21 ‘‘(v) methods to screen for social de22 terminants of maternal health risks in the 

23 prenatal and postpartum periods; and 

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1 plications described in section 

2 1115A(b)(2)(B)(xxviii) of the Social Secu3 rity Act; 

4 ‘‘(B) evaluate and collect information on 

5 the effect of such models on— 

6 ‘‘(i) access to, and quality of, care; 

7 ‘‘(ii) outcomes with respect to the 

8 health of an individual; and 

9 ‘‘(iii) the experience of individuals who 

10 receive pregnancy-related health care; 

11 ‘‘(C) develop qualitative and quantitative 

12 measures to identify best practices for the ex13 pansion and use of such models; 

14 ‘‘(D) study the effect of such models on 

15 patient outcomes and maternity care providers; 

16 and 

17 ‘‘(E) conduct any other activity, as deter18 mined by the Secretary. 

19 ‘‘(2) PERMISSIBLE USES.—Recipients of grants 

20 under this section may use grants to support— 

21 ‘‘(A) the use and expansion of technology22 enabled collaborative learning and capacity 

23 building models, including hardware and soft24 ware that— 


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1 ‘‘(i) enable distance learning and tech2 nical support; and 

3 ‘‘(ii) support the secure exchange of 

4 electronic health information; and 

5 ‘‘(B) maternity care providers, students, 

6 and other similar professionals in the provision 

7 of maternity care through such models. 

8 ‘‘(c) APPLICATION.— 

9 ‘‘(1) IN GENERAL.—An eligible entity seeking a 

10 grant under subsection (a) shall submit to the Sec11 retary an application, at such time, in such manner, 

12 and containing such information as the Secretary 

13 may require. 

14 ‘‘(2) ASSURANCE.—An application under para15 graph (1) shall include an assurance that such entity 

16 shall collect information on, and assess the effect of, 

17 the use of technology-enabled collaborative learning 

18 and capacity building models, including with respect 

19 to— 

20 ‘‘(A) maternal health outcomes; 

21 ‘‘(B) access to maternal health care serv22 ices; 

23 ‘‘(C) quality of maternal health care; and 


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1 ‘‘(D) retention of maternity care providers 

2 serving areas and populations described in sub3 section (a). 

4 ‘‘(d) LIMITATIONS.— 

5 ‘‘(1) NUMBER.—The Secretary may not award 

6 more than 1 grant under this section to an eligible 

7 entity. 

8 ‘‘(2) DURATION.—A grant awarded under this 

9 section shall be for a 5-year period. 

10 ‘‘(e) ACCESS TO BROADBAND.—In administering 

11 grants under this section, the Secretary may coordinate 

12 with other agencies to ensure that funding opportunities 

13 are available to support access to reliable, high-speed 

14 internet for grantees. 

15 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary shall 

16 provide (either directly or by contract) technical assistance 

17 to eligible entities, including recipients of grants under 

18 subsection (a), on the development, use, and sustainability 

19 of technology-enabled collaborative learning and capacity 

20 building models to expand access to maternal health care 

21 services provided by such entities, including— 

22 ‘‘(1) in health professional shortage areas; 

23 ‘‘(2) in areas with high rates of maternal mor24 tality and severe maternal morbidity or significant 


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1 racial and ethnic inequities in maternal health out2 comes; and 

3 ‘‘(3) for medically underserved populations or 

4 American Indians and Alaska Natives. 

5 ‘‘(g) RESEARCH AND EVALUATION.—The Secretary, 

6 in consultation with experts, shall develop a strategic plan 

7 to research and evaluate the evidence for such models. 

8 ‘‘(h) REPORTING.— 

9 ‘‘(1) ELIGIBLE ENTITIES.—An eligible entity 

10 that receives a grant under subsection (a) shall sub11 mit to the Secretary a report, at such time, in such 

12 manner, and containing such information as the Sec13 retary may require. 

14 ‘‘(2) SECRETARY.—Not later than 4 years after 

15 the date of enactment of this section, the Secretary 

16 shall submit to the Congress, and make available on 

17 the website of the Department of Health and 

18 Human Services, a report that includes— 

19 ‘‘(A) a description of grants awarded 

20 under subsection (a) and the purpose and 

21 amounts of such grants; 

22 ‘‘(B) a summary of— 

23 ‘‘(i) the evaluations conducted under 

24 subsection (b)(1)(B); 


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1 ‘‘(ii) any technical assistance provided 

2 under subsection (f); and 

3 ‘‘(iii) the activities conducted under 

4 subsection (a); and 

5 ‘‘(C) a description of any significant find6 ings with respect to— 

7 ‘‘(i) patient outcomes; and 

8 ‘‘(ii) best practices for expanding, 

9 using, or evaluating technology-enabled col10 laborative learning and capacity building 

11 models. 

12 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to carry out this section, 

14 $6,000,000 for each of fiscal years 2023 through 2027. 

15 ‘‘(j) DEFINITIONS.—In this section: 

16 ‘‘(1) ELIGIBLE ENTITY.— 

17 ‘‘(A) IN GENERAL.—The term ‘eligible en18 tity’ means an entity that provides, or supports 

19 the provision of, maternal health care services 

20 or other evidence-based services for pregnant 

21 and postpartum individuals— 

22 ‘‘(i) in health professional shortage 

23 areas; 

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1 cant racial and ethnic inequities in mater2 nal health outcomes; or 

3 ‘‘(iii) who are— 

4 ‘‘(I) members of medically under5 served populations; or 

6 ‘‘(II) American Indians and Alas7 ka Natives, including Indian Tribes, 

8 Tribal organizations, and Urban In9 dian organizations. 

10 ‘‘(B) INCLUSIONS.—An eligible entity may 

11 include entities that lead, or are capable of 

12 leading, a technology-enabled collaborative 

13 learning and capacity building model. 

14 ‘‘(2) HEALTH PROFESSIONAL SHORTAGE

15 AREA.—The term ‘health professional shortage area’ 

16 means a health professional shortage area des17 ignated under section 332. 

18 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 

19 has the meaning given such term in section 4 of the 

20 Indian Self-Determination and Education Assistance 

21 Act. 

22 ‘‘(4) MATERNAL MORTALITY.—The term ‘ma23 ternal mortality’ means a death occurring during or 

24 within the 1-year period after pregnancy caused by 

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1 cluding a suicide, overdose, or other death resulting 

2 from a mental health or substance use disorder at3 tributed to or aggravated by pregnancy or childbirth 

4 complications. 

5 ‘‘(5) MEDICALLY UNDERSERVED POPU6 LATION.—The term ‘medically underserved popu7 lation’ has the meaning given such term in section 

8 330(b)(3). 

9 ‘‘(6) POSTPARTUM.—The term ‘postpartum’ 

10 means the 1-year period beginning on the last date 

11 of an individual’s pregnancy. 

12 ‘‘(7) SEVERE MATERNAL MORBIDITY.—The 

13 term ‘severe maternal morbidity’ means a health 

14 condition, including a mental health or substance 

15 use disorder, attributed to or aggravated by preg16 nancy or childbirth that results in significant short17 term or long-term consequences to the health of the 

18 individual who was pregnant. 

19 ‘‘(8) TECHNOLOGY-ENABLED COLLABORATIVE

20 LEARNING AND CAPACITY BUILDING MODEL.—The 

21 term ‘technology-enabled collaborative learning and 

22 capacity building model’ means a distance health 

23 education model that connects health care profes24 sionals, and other specialists, through simultaneous 

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1 cilitating case-based learning, disseminating best 

2 practices, and evaluating outcomes in the context of 

3 maternal health care. 

4 ‘‘(9) TRIBAL ORGANIZATION.—The term ‘Tribal 

5 organization’ has the meaning given such term in 

6 section 4 of the Indian Self-Determination and Edu7 cation Assistance Act. 

8 ‘‘(10) URBAN INDIAN ORGANIZATION.—The 

9 term ‘Urban Indian organization’ has the meaning 

10 given such term in section 4 of the Indian Health 

11 Care Improvement Act.’’. 

12 (d) GRANTS TO PROMOTE EQUITY IN MATERNAL

13 HEALTH OUTCOMES THROUGH DIGITAL TOOLS.— 

14 (1) IN GENERAL.—Beginning not later than 1 

15 year after the date of the enactment of this Act, the 

16 Secretary of Health and Human Services shall make 

17 grants to eligible entities to reduce racial and ethnic 

18 inequities in maternal health outcomes by increasing 

19 access to digital tools related to maternal health 

20 care. 

21 (2) APPLICATIONS.—To be eligible to receive a 

22 grant under this subsection, an eligible entity shall 

23 submit to the Secretary an application at such time, 

24 in such manner, and containing such information as 

25 the Secretary may require. 


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1 (3) PRIORITIZATION.—In awarding grants 

2 under this subsection, the Secretary shall prioritize 

3 an eligible entity— 

4 (A) in an area with high rates of adverse 

5 maternal health outcomes or significant racial 

6 and ethnic inequities in maternal health out7 comes; 

8 (B) in a health professional shortage area 

9 designated under section 332 of the Public 

10 Health Service Act (42 U.S.C. 254e); and 

11 (C) that promotes technology that address12 es racial and ethnic inequities in maternal 

13 health outcomes. 

14 (4) LIMITATIONS.— 

15 (A) NUMBER.—The Secretary may award 

16 not more than 1 grant under this subsection to 

17 an eligible entity. 

18 (B) DURATION.—A grant awarded under 

19 this subsection shall be for a 5-year period. 

20 (5) TECHNICAL ASSISTANCE.—The Secretary 

21 shall provide technical assistance to an eligible entity 

22 on the development, use, evaluation, and post-grant 

23 sustainability of digital tools for purposes of pro24 moting equity in maternal health outcomes. 

25 (6) REPORTING.— 


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1 (A) ELIGIBLE ENTITIES.—An eligible enti2 ty that receives a grant under paragraph (1) 

3 shall submit to the Secretary a report, at such 

4 time, in such manner, and containing such in5 formation as the Secretary may require. 

6 (B) SECRETARY.—Not later than 4 years 

7 after the date of the enactment of this Act, the 

8 Secretary shall submit to Congress a report 

9 that includes— 

10 (i) an evaluation on the effectiveness 

11 of grants awarded under this subsection to 

12 improve health outcomes for pregnant and 

13 postpartum individuals from racial and 

14 ethnic minority groups; 

15 (ii) recommendations on new grant 

16 programs that promote the use of tech17 nology to improve such maternal health 

18 outcomes; and 

19 (iii) recommendations with respect 

20 to— 

21 (I) technology-based privacy and 

22 security safeguards in maternal health 

23 care; 

24 (II) reimbursement rates for ma25 ternal telehealth services; 


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1 (III) the use of digital tools to 

2 analyze large data sets to identify po3 tential pregnancy-related complica4 tions; 

5 (IV) barriers that prevent mater6 nity care providers from providing 

7 telehealth services across States; 

8 (V) the use of consumer digital 

9 tools such as mobile phone applica10 tions, patient portals, and wearable 

11 technologies to improve maternal 

12 health outcomes; 

13 (VI) barriers that prevent access 

14 to telehealth services, including a lack 

15 of access to reliable, high-speed inter16 net or electronic devices; 

17 (VII) barriers to data sharing be18 tween the Special Supplemental Nu19 trition Program for Women, Infants, 

20 and Children program and maternity 

21 care providers, and recommendations 

22 for addressing such barriers; and 

23 (VIII) lessons learned from ex24 panded access to telehealth related to 


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1 maternity care during the COVID–19 

2 public health emergency. 

3 (7) AUTHORIZATION OF APPROPRIATIONS.— 

4 There is authorized to be appropriated to carry out 

5 this subsection $6,000,000 for each of fiscal years 

6 2023 through 2027. 

7 (e) REPORT ON THE USE OF TECHNOLOGY IN MA8 TERNITY CARE.— 

9 (1) IN GENERAL.—Not later than 60 days after 

10 the date of enactment of this Act, the Secretary of 

11 Health and Human Services shall enter into an 

12 agreement with the National Academies of Sciences, 

13 Engineering, and Medicine (referred to in this sec14 tion as the ‘‘National Academies’’) under which the 

15 National Academies shall conduct a study on the use 

16 of technology and patient monitoring devices in ma17 ternity care. 

18 (2) CONTENT.—The agreement entered into 

19 pursuant to paragraph (1) shall provide for the 

20 study of the following: 

21 (A) The use of innovative technology (in22 cluding artificial intelligence) in maternal 

23 health care, including the extent to which such 

24 technology has affected racial or ethnic biases 

25 in maternal health care. 


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1 (B) The use of patient monitoring devices 

2 (including pulse oximeter devices) in maternal 

3 health care, including the extent to which such 

4 devices have affected racial or ethnic biases in 

5 maternal health care. 

6 (C) Best practices for reducing and pre7 venting racial or ethnic biases in the use of in8 novative technology and patient monitoring de9 vices in maternity care. 

10 (D) Best practices in the use of innovative 

11 technology and patient monitoring devices for 

12 pregnant and postpartum individuals from ra13 cial and ethnic minority groups. 

14 (E) Best practices with respect to privacy 

15 and security safeguards in such use. 

16 (3) REPORT.—Not later than 24 months after 

17 the date of enactment of this Act, the National 

18 Academies shall complete the study under this sub19 section, and transmit a report of the results of such 

20 study to Congress. 

21 SEC. 5207. SOCIAL DETERMINANTS FOR MOMS. 

22 (a) TASK FORCE TO DEVELOP A STRATEGY TO AD23 DRESS SOCIAL DETERMINANTS OF MATERNAL

24 HEALTH.— 


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1 (1) IN GENERAL.—The Secretary of Health and 

2 Human Services shall convene a task force (in this 

3 subsection referred to as the ‘‘Task Force’’) to de4 velop a strategy to coordinate efforts between Fed5 eral agencies to address social determinants of ma6 ternal health with respect to pregnant and 

7 postpartum individuals. 

8 (2) EX OFFICIO MEMBERS.—The ex officio 

9 members of the Task Force shall consist of the fol10 lowing: 

11 (A) The Secretary of Health and Human 

12 Services (or a designee thereof). 

13 (B) The Secretary of Housing and Urban 

14 Development (or a designee thereof). 

15 (C) The Secretary of Transportation (or a 

16 designee thereof). 

17 (D) The Secretary of Agriculture (or a 

18 designee thereof). 

19 (E) The Secretary of Labor (or a designee 

20 thereof). 

21 (F) The Administrator of the Environ22 mental Protection Agency (or a designee there23 of). 


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1 (G) The Assistant Secretary for the Ad2 ministration for Children and Families (or a 

3 designee thereof). 

4 (H) The Administrator of the Centers for 

5 Medicare & Medicaid Services (or a designee 

6 thereof). 

7 (I) The Director of the Indian Health 

8 Service (or a designee thereof). 

9 (J) The Director of the National Institutes 

10 of Health (or a designee thereof). 

11 (K) The Administrator of the Health Re12 sources and Services Administration (or a des13 ignee thereof). 

14 (L) The Deputy Assistant Secretary for 

15 Minority Health of the Department of Health 

16 and Human Services (or a designee thereof). 

17 (M) The Deputy Assistant Secretary for 

18 Women’s Health of the Department of Health 

19 and Human Services (or a designee thereof). 

20 (N) The Director of the Centers for Dis21 ease Control and Prevention (or a designee 

22 thereof). 

23 (O) The Director of the Office on Violence 

24 Against Women of the Department of Justice 

25 (or a designee thereof). 


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1 (3) APPOINTED MEMBERS.—In addition to the 

2 ex officio members of the Task Force, the Secretary 

3 of Health and Human Services shall appoint the fol4 lowing members of the Task Force: 

5 (A) At least two representatives of pa6 tients, to include— 

7 (i) a representative of patients who 

8 have suffered from severe maternal mor9 bidity; or 

10 (ii) a representative of patients who is 

11 a family member of an individual who suf12 fered a pregnancy-related death. 

13 (B) At least two leaders of community14 based organizations that address maternal mor15 tality and severe maternal morbidity with a spe16 cific focus on racial and ethnic inequities. In 

17 appointing such leaders under this subpara18 graph, the Secretary of Health and Human 

19 Services shall give priority to individuals who 

20 are leaders of organizations led by individuals 

21 from racial and ethnic minority groups. 

22 (C) At least two perinatal health workers. 

23 (D) A professionally diverse panel of ma24 ternity care providers. 


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1 (4) CHAIR.—The Secretary of Health and 

2 Human Services shall select the chair of the Task 

3 Force from among the members of the Task Force. 

4 (5) REPORT.—Not later than 2 years after the 

5 date of the enactment of this Act, the Task Force 

6 shall submit to Congress a report on— 

7 (A) the strategy developed under para8 graph (1); 

9 (B) recommendations on funding amounts 

10 with respect to implementing such strategy; and 

11 (C) recommendations for how to expand 

12 coverage of social services to address social de13 terminants of maternal health under Medicaid 

14 managed care organizations and State Medicaid 

15 programs. 

16 (6) TERMINATION.—Section 14 of the Federal 

17 Advisory Committee Act (5 U.S.C. App.) shall not 

18 apply to the Task Force with respect to termination. 

19 (b) HOUSING FOR MOMS GRANT PROGRAM.— 

20 (1) DEFINITIONS.—In this subsection: 

21 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 

22 entity’’ means— 

23 (i) a community-based organization; 


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1 (ii) a State or local governmental enti2 ty, including a State or local public health 

3 department; 

4 (iii) an Indian tribe or Tribal organi5 zation (as such terms are defined in sec6 tion 4 of the Indian Self-Determination 

7 and Education Assistance Act (25 U.S.C. 

8 5304)); or 

9 (iv) an Urban Indian organization (as 

10 such term is defined in section 4 of the In11 dian Health Care Improvement Act (25 

12 U.S.C. 1603)). 

13 (B) SECRETARY.—The term ‘‘Secretary’’ 

14 means the Secretary of Housing and Urban De15 velopment. 

16 (2) ESTABLISHMENT.—The Secretary shall es17 tablish a Housing for Moms grant program to make 

18 grants to eligible entities to increase access to safe, 

19 stable, affordable, and adequate housing for preg20 nant and postpartum individuals and their families. 

21 (3) APPLICATION.—To be eligible to receive a 

22 grant under this subsection, an eligible entity shall 

23 submit to the Secretary an application at such time, 

24 in such manner, and containing such information as 

25 the Secretary may provide. 


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1 (4) PRIORITY.—In awarding grants under this 

2 subsection, the Secretary shall give priority to an eli3 gible entity that— 

4 (A) is a community-based organization or 

5 will partner with a community-based organiza6 tion to implement initiatives to increase access 

7 to safe, stable, affordable, and adequate hous8 ing for pregnant and postpartum individuals 

9 and their families; 

10 (B) is operating in an area with high rates 

11 of adverse maternal health outcomes or signifi12 cant racial or ethnic inequities in maternal 

13 health outcomes, to the extent such data are 

14 available; and 

15 (C) is operating in an area with a high 

16 poverty rate or a significant number of individ17 uals who lack consistent access to safe, stable, 

18 affordable, and adequate housing. 

19 (5) USE OF FUNDS.—An eligible entity that re20 ceives a grant under this subsection shall use funds 

21 from the grant for the purposes of— 

22 (A) identifying and conducting outreach to 

23 pregnant and postpartum individuals who are 

24 low-income and lack consistent access to safe, 

25 stable, affordable, and adequate housing; 


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1 (B) providing safe, stable, affordable, and 

2 adequate housing options to such individuals; 

3 (C) connecting such individuals with local 

4 organizations offering safe, stable, affordable, 

5 and adequate housing options; 

6 (D) providing application assistance to 

7 such individuals seeking to enroll in programs 

8 offering safe, stable, affordable, and adequate 

9 housing options; 

10 (E) providing direct financial assistance to 

11 such individuals for the purposes of maintaining 

12 safe, stable, and adequate housing for the dura13 tion of the individual’s pregnancy and 

14 postpartum periods; and 

15 (F) working with relevant stakeholders to 

16 ensure that local housing and homeless shelter 

17 infrastructure is supportive to pregnant and 

18 postpartum individuals, including through— 

19 (i) health-promoting housing codes; 

20 (ii) enforcement of housing codes; 

21 (iii) proactive rental inspection pro22 grams; 

23 (iv) code enforcement officer training; 

24 and 


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1 (v) partnerships between regional of2 fices of the Department of Housing and 

3 Urban Development and community-based 

4 organizations to ensure housing laws are 

5 understood and violations are discovered. 

6 (6) REPORTING.— 

7 (A) ELIGIBLE ENTITIES.—The Secretary 

8 shall require each eligible entity receiving a 

9 grant under this subsection to annually submit 

10 to the Secretary and make publicly available a 

11 report on the status of activities conducted 

12 using the grant. 

13 (B) SECRETARY.—Not later than the end 

14 of each fiscal year in which grants are made 

15 under this subsection, the Secretary shall sub16 mit to Congress and make publicly available a 

17 report that— 

18 (i) summarizes the reports received 

19 under subparagraph (A); 

20 (ii) evaluates the effectiveness of 

21 grants awarded under this subsection in 

22 increasing access to safe, stable, afford23 able, and adequate housing for pregnant 

24 and postpartum individuals and their fami25 lies; and 


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1 (iii) makes recommendations with re2 spect to ensuring activities described in 

3 paragraph (5) continue after grant 

4 amounts made available under this sub5 section are expended. 

6 (7) AUTHORIZATION OF APPROPRIATIONS.— 

7 There is authorized to be appropriated to carry out 

8 this subsection $10,000,000 for fiscal year 2023, 

9 which shall remain available until expended. 

10 (c) DEPARTMENT OF TRANSPORTATION.— 

11 (1) REPORT.—Not later than 1 year after the 

12 date of enactment of this Act, the Secretary of 

13 Transportation shall submit to Congress and make 

14 publicly available a report containing— 

15 (A) an assessment of transportation bar16 riers preventing individuals from attending pre17 natal and postpartum appointments, accessing 

18 maternal health care services, or accessing serv19 ices and resources related to social deter20 minants of maternal health; 

21 (B) recommendations on how to overcome 

22 the barriers assessed under subparagraph (A); 

23 and 


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1 (C) an assessment of transportation safety 

2 risks for pregnant individuals and recommenda3 tions on how to mitigate those risks. 

4 (2) CONSIDERATIONS.—In carrying out para5 graph (1), the Secretary of Transportation shall give 

6 special consideration to solutions for— 

7 (A) pregnant and postpartum individuals 

8 living in a health professional shortage area 

9 designated under section 332 of the Public 

10 Health Service Act (42 U.S.C. 254e); 

11 (B) pregnant and postpartum individuals 

12 living in areas with high maternal mortality or 

13 severe morbidity rates or significant racial or 

14 ethnic inequities in maternal health outcomes; 

15 and 

16 (C) pregnant and postpartum individuals 

17 with a disability that impacts mobility. 

18 (d) DEPARTMENT OF AGRICULTURE.— 

19 (1) SPECIAL SUPPLEMENTAL NUTRITION PRO20 GRAM FOR WOMEN, INFANTS, AND CHILDREN.— 

21 (A) EXTENSION OF POSTPARTUM PE22 RIOD.—Section 17(b)(10) of the Child Nutri23 tion Act of 1966 (42 U.S.C. 1786(b)(10)) is 

24 amended by striking ‘‘six’’ and inserting ‘‘24’’. 


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1 (B) REPORT.—Not later than 2 years after 

2 the date of enactment of this Act, the Secretary 

3 shall submit to Congress a report that evaluates 

4 the effect of the amendment made by subpara5 graph (A) on— 

6 (i) maternal and infant health out7 comes, including racial and ethnic inequi8 ties with respect to those outcomes; 

9 (ii) breastfeeding rates among 

10 postpartum individuals; 

11 (iii) qualitative evaluations of family 

12 experiences under the special supplemental 

13 nutrition program for women, infants, and 

14 children established under section 17 of 

15 the Child Nutrition Act of 1966 (42 

16 U.S.C. 1786); and 

17 (iv) other relevant information as de18 termined by the Secretary. 

19 (2) GRANT PROGRAM FOR HEALTHY FOOD AND

20 CLEAN WATER FOR PREGNANT AND POSTPARTUM

21 INDIVIDUALS.— 

22 (A) IN GENERAL.—The Secretary shall es23 tablish a program (referred to in this paragraph 

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1 petitive basis, to eligible entities to carry out 

2 the activities described in subparagraph (D). 

3 (B) APPLICATION.—To be eligible for a 

4 grant under the program, an eligible entity 

5 shall submit to the Secretary an application at 

6 such time, in such manner, and containing such 

7 information as the Secretary determines appro8 priate. 

9 (C) PRIORITY.—In awarding grants under 

10 the program, the Secretary shall give priority to 

11 an eligible entity that— 

12 (i) is, or will partner with, an eligible 

13 entity described in paragraph (3)(A)(i); 

14 and 

15 (ii) is operating in an area with a high 

16 rate of— 

17 (I) adverse maternal health out18 comes; or 

19 (II) significant racial or ethnic 

20 inequities in maternal health out21 comes. 

22 (D) USE OF FUNDS.—An eligible entity 

23 shall use a grant awarded under the program to 

24 deliver healthy food, infant formula, clean 

25 water, or diapers to pregnant and postpartum 


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1 individuals located in areas that are food 

2 deserts, as determined by the Secretary using 

3 data from the Food Access Research Atlas of 

4 the Department of Agriculture. 

5 (E) REPORTS.— 

6 (i) ELIGIBLE ENTITIES.—Not later 

7 than 1 year after the date on which an eli8 gible entity receives a grant under the pro9 gram, and annually thereafter, the eligible 

10 entity shall submit to the Secretary a re11 port on the status of activities conducted 

12 using the grant, which shall contain such 

13 information as the Secretary may require. 

14 (ii) SECRETARY.— 

15 (I) IN GENERAL.—Not later than 

16 2 years after the date on which the 

17 first grant is awarded under the pro18 gram, the Secretary shall submit to 

19 Congress a report that includes— 

20 (aa) a summary of the re21 ports submitted by eligible enti22 ties under clause (i); 

23 (bb) an assessment of the 

24 extent to which food distributed 

25 using grants awarded under the 


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1 program was purchased from 

2 local and regional food systems; 

3 (cc) an evaluation of the ef4 fect of the program on maternal 

5 and infant health outcomes, in6 cluding racial and ethnic inequi7 ties with respect to those out8 comes; and 

9 (dd) recommendations with 

10 respect to ensuring the activities 

11 described in subparagraph (D) 

12 continue after the grant period 

13 funding those activities expires. 

14 (II) PUBLICATION.—The Sec15 retary shall make the report sub16 mitted under subclause (I) publicly 

17 available on the website of the De18 partment of Agriculture. 

19 (F) AUTHORIZATION OF APPROPRIA20 TIONS.—There is authorized to be appropriated 

21 to carry out the program $5,000,000 for the 

22 period of fiscal years 2022 through 2024. 

23 (3) DEFINITIONS.—In this subsection: 

24 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 

25 entity’’ means— 


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1 (i) a community-based organization; 

2 (ii) a State or local governmental enti3 ty, including a State or local public health 

4 department; 

5 (iii) an Indian Tribe or Tribal organi6 zation (as those terms are defined in sec7 tion 4 of the Indian Self-Determination 

8 and Education Assistance Act (25 U.S.C. 

9 5304)); and 

10 (iv) an Urban Indian organization (as 

11 defined in section 4 of the Indian Health 

12 Care Improvement Act (25 U.S.C. 1603)). 

13 (B) SECRETARY.—The term ‘‘Secretary’’ 

14 means the Secretary of Agriculture. 

15 (e) ENVIRONMENTAL STUDY THROUGH NATIONAL

16 ACADEMIES.— 

17 (1) IN GENERAL.—Not later than 60 days after 

18 the date of enactment of this Act, the Administrator 

19 of the Environmental Protection Agency shall seek 

20 to enter into an agreement with the National Acad21 emies of Sciences, Engineering, and Medicine (re22 ferred to in this subsection as the ‘‘National Acad23 emies’’) under which the National Academies agree 

24 to conduct a study on the impacts of, with respect 

25 to maternal and infant health incomes, water and 


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1 air quality, exposure to extreme temperatures, envi2 ronmental chemicals, environmental risks in the 

3 workplace and the home, and pollution levels. 

4 (2) STUDY REQUIREMENTS.—The agreement 

5 under paragraph (1) shall direct the National Acad6 emies to make recommendations for— 

7 (A) improving environmental conditions to 

8 improve maternal and infant health outcomes; 

9 and 

10 (B) reducing or eliminating racial and eth11 nic inequities in those outcomes. 

12 (3) REPORT.—The agreement under paragraph 

13 (1) shall direct the National Academies to complete 

14 the study under this subsection, and submit to Con15 gress and make publicly available a report on the re16 sults of the study, not later than 1 year after the 

17 date of enactment of this Act. 

18 (f) CHILD CARE ACCESS.— 

19 (1) GRANT PROGRAM.—The Secretary of 

20 Health and Human Services (in this subsection re21 ferred to as the ‘‘Secretary’’) shall award grants to 

22 eligible organizations to carry out programs to pro23 vide pregnant and postpartum individuals with free 

24 and accessible drop-in child care services during pre25 natal and postpartum appointments. 


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1 (2) APPLICATION.—To be eligible to receive a 

2 grant under this subsection, an eligible entity shall 

3 submit to the Secretary an application at such time, 

4 in such manner, and containing such information as 

5 the Secretary may require. 

6 (3) ELIGIBLE ORGANIZATIONS.— 

7 (A) ELIGIBILITY.—To be eligible to receive 

8 a grant under this subsection, an organization 

9 shall be an organization that— 

10 (i) provides child care services; and 

11 (ii) can carry out a program providing 

12 pregnant and postpartum individuals with 

13 free and accessible drop-in child care serv14 ices during prenatal and postpartum ap15 pointments. 

16 (B) PRIORITIZATION.—In selecting grant 

17 recipients under this subsection, the Secretary 

18 shall give priority to eligible organizations that 

19 operate in an area that has, to the extent data 

20 with respect to such an area are available— 

21 (i) high rates of adverse maternal 

22 health outcomes; or 

23 (ii) significant racial or ethnic inequi24 ties in maternal health outcomes. 


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1 (4) TIMING.—The Secretary shall commence 

2 the grant program under paragraph (1) not later 

3 than 1 year after the date of enactment of this Act. 

4 (5) REPORTING.— 

5 (A) GRANTEES.—Each recipient of a grant 

6 under this subsection shall annually submit to 

7 the Secretary and make publicly available a re8 port on the status of activities conducted using 

9 the grant. Each such report shall include— 

10 (i) an analysis of the effect of the 

11 funded program on prenatal and 

12 postpartum appointment attendance rates; 

13 (ii) summaries of qualitative assess14 ments of the funded program from— 

15 (I) pregnant and postpartum in16 dividuals participating in the pro17 gram; and 

18 (II) the families of such individ19 uals; and 

20 (iii) such additional information as 

21 the Secretary may require. 

22 (B) SECRETARY.—Not later than the end 

23 of fiscal year 2024, the Secretary shall submit 

24 to the Congress, and make publicly available, a 

25 report containing each of the following: 


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1 (i) A summary of the reports received 

2 under subparagraph (A). 

3 (ii) An assessment of the effects, if 

4 any, of the funded programs on maternal 

5 health outcomes, with a specific focus on 

6 racial and ethnic inequities in such out7 comes. 

8 (iii) A description of actions the Sec9 retary can take to ensure that pregnant 

10 and postpartum individuals eligible for 

11 medical assistance under a State plan 

12 under title XIX of the Social Security Act 

13 (42 U.S.C. 1936 et seq.) have access to 

14 free and accessible drop-in child care serv15 ices during prenatal and postpartum ap16 pointments, including identification of the 

17 funding necessary to carry out such ac18 tions. 

19 (6) DROP-IN CHILD CARE SERVICES DE20 FINED.—In this subsection, the term ‘‘drop-in child 

21 care services’’ means child care (including early 

22 childhood education) services that are— 

23 (A) delivered at a facility that meets the 

24 requirements of all applicable laws and regula25 tions of the State or local government in which 


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1 it is located, including the requirements for li2 censing of the facility as a child care facility; 

3 and 

4 (B) provided in single encounters without 

5 requiring full-time enrollment of a person in a 

6 child care program. 

7 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

8 carry out this subsection, there is authorized to be 

9 appropriated $5,000,000 for the period of fiscal 

10 years 2023 through 2025. 

11 (g) GRANTS TO LOCAL ENTITIES ADDRESSING SO12 CIAL DETERMINANTS OF MATERNAL HEALTH.— 

13 (1) IN GENERAL.—The Secretary of Health and 

14 Human Services (in this subsection referred to as 

15 the ‘‘Secretary’’) shall award grants to eligible enti16 ties to— 

17 (A) address social determinants of mater18 nal health for pregnant and postpartum individ19 uals; and 

20 (B) eliminate racial and ethnic inequities 

21 in maternal health outcomes. 

22 (2) APPLICATION.—To be eligible to receive a 

23 grant under this subsection an eligible entity shall 

24 submit to the Secretary an application at such time, 


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1 in such manner, and containing such information as 

2 the Secretary may provide. 

3 (3) PRIORITIZATION.—In awarding grants 

4 under paragraph (1), the Secretary shall give pri5 ority to an eligible entity that— 

6 (A) is a community-based organization, or 

7 will partner with a community-based organiza8 tion to carry out the activities under paragraph 

9 (4); 

10 (B) is operating in an area with high rates 

11 of adverse maternal health outcomes or signifi12 cant racial or ethnic inequities in maternal 

13 health outcomes; and 

14 (C) is operating in an area with a high 

15 poverty rate. 

16 (4) ACTIVITIES.—An eligible entity that re17 ceives a grant under this subsection may use funds 

18 received through the grant to— 

19 (A) hire and retain staff; 

20 (B) develop and distribute a list of avail21 able resources with respect to social service pro22 grams in a community; 

23 (C) establish a resource center that pro24 vides multiple social service programs in a sin25 gle location; 


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1 (D) offer programs and resources in the 

2 communities in which the respective eligible en3 tities are located to address social determinants 

4 of health for pregnant and postpartum individ5 uals; and 

6 (E) consult with such pregnant and 

7 postpartum individuals to conduct an assess8 ment of the activities under this paragraph. 

9 (5) TECHNICAL ASSISTANCE.—The Secretary 

10 shall provide to grant recipients under this sub11 section technical assistance to plan for sustaining 

12 programs to address social determinants of maternal 

13 health among pregnant and postpartum individuals 

14 after the period of the grant. 

15 (6) REPORTING.— 

16 (A) GRANTEES.—Not later than 1 year 

17 after the date on which an eligible entity first 

18 receives a grant under this subsection, and an19 nually thereafter, an eligible entity shall submit 

20 to the Secretary, and make publicly available, a 

21 report on the status of activities conducted 

22 using the grant. Each such report shall include 

23 data on the effects of such activities, 

24 disaggregated by race, ethnicity, gender, and 

25 other relevant factors. 


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1 (B) SECRETARY.—Not later than the end 

2 of fiscal year 2026, the Secretary shall submit 

3 to Congress a report that includes— 

4 (i) a summary of the reports received 

5 under subparagraph (A); and 

6 (ii) recommendations for— 

7 (I) improving maternal health 

8 outcomes; and 

9 (II) reducing or eliminating ra10 cial and ethnic inequities in maternal 

11 health outcomes. 

12 (7) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to carry out 

14 this subsection $15,000,000 for each of fiscal years 

15 2023 through 2027. 

16 (h) DEFINITIONS.—In this section: 

17 (1) CULTURALLY CONGRUENT.—The term ‘‘cul18 turally congruent’’, with respect to care or maternity 

19 care provided to a health care consumer, means care 

20 that is in agreement with the preferred cultural val21 ues, beliefs, worldview, language, and practices of 

22 the health care consumer and other relevant stake23 holders. 


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1 (2) MATERNITY CARE PROVIDER.—The term 

2 ‘‘maternity care provider’’ means a health care pro3 vider who— 

4 (A) is a physician, physician assistant, 

5 midwife who meets at a minimum the inter6 national definition of the midwife and global 

7 standards for midwifery education as estab8 lished by the International Confederation of 

9 Midwives, nurse practitioner, or clinical nurse 

10 specialist; and 

11 (B) has a focus on maternal or perinatal 

12 health. 

13 (3) MATERNAL MORTALITY.—The term ‘‘mater14 nal mortality’’ means a death occurring during or 

15 within a one-year period after pregnancy, caused by 

16 pregnancy-related or childbirth complications, in17 cluding a suicide, overdose, or other death resulting 

18 from a mental health or substance use disorder at19 tributed to or aggravated by pregnancy-related or 

20 childbirth complications. 

21 (4) PERINATAL HEALTH WORKER.—The term 

22 ‘‘perinatal health worker’’ means a doula, commu23 nity health worker, peer supporter, breastfeeding 

24 and lactation educator or counselor, nutritionist or 


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1 dietitian, childbirth educator, social worker, home 

2 visitor, language interpreter, or navigator. 

3 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

4 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

5 refer to the 1-year period beginning on the last day 

6 of the pregnancy of an individual. 

7 (6) RACIAL AND ETHNIC MINORITY GROUP.— 

8 The term ‘‘racial and ethnic minority group’’ has the 

9 meaning given such term in section 1707(g)(1) of 

10 the Public Health Service Act (42 U.S.C. 300u– 

11 6(g)(1)). 

12 (7) SEVERE MATERNAL MORBIDITY.—The term 

13 ‘‘severe maternal morbidity’’ means a health condi14 tion, including mental health conditions and sub15 stance use disorders, attributed to or aggravated by 

16 pregnancy or childbirth that results in significant 

17 short-term or long-term consequences to the health 

18 of the individual who was pregnant. 

19 (8) SOCIAL DETERMINANTS OF MATERNAL

20 HEALTH DEFINED.—The term ‘‘social determinants 

21 of maternal health’’ means non-clinical factors that 

22 impact maternal health outcomes, including— 

23 (A) economic factors, which may include 

24 poverty, employment, food security, support for 


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1 and access to lactation and other infant feeding 

2 options, housing stability, and related factors; 

3 (B) neighborhood factors, which may in4 clude quality of housing, access to transpor5 tation, access to child care, availability of 

6 healthy foods and nutrition counseling, avail7 ability of clean water, air and water quality, 

8 ambient temperatures, neighborhood crime and 

9 violence, access to broadband, and related fac10 tors; 

11 (C) social and community factors, which 

12 may include systemic racism, gender discrimi13 nation or discrimination based on other pro14 tected classes, workplace conditions, incarcer15 ation, and related factors; 

16 (D) household factors, which may include 

17 ability to conduct lead testing and abatement, 

18 car seat installation, indoor air temperatures, 

19 and related factors; 

20 (E) education access and quality factors, 

21 which may include educational attainment, lan22 guage and literacy, and related factors; and 

23 (F) health care access factors, including 

24 health insurance coverage, access to culturally 

25 congruent health care services, providers, and 


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1 non-clinical support, access to home visiting 

2 services, access to wellness and stress manage3 ment programs, health literacy, access to tele4 health and items required to receive telehealth 

5 services, and related factors. 

6 SEC. 5208. DATA TO SAVE MOMS. 

7 (a) SHORT TITLE.—This section may be cited as the 

8 ‘‘Data To Save Moms Act’’. 

9 (b) FUNDING FOR MATERNAL MORTALITY REVIEW

10 COMMITTEES TO PROMOTE REPRESENTATIVE COMMU11 NITY ENGAGEMENT.— 

12 (1) IN GENERAL.—Section 317K(d) of the Pub13 lic Health Service Act (42 U.S.C. 247b–12(d)) is 

14 amended by adding at the end the following: 

15 ‘‘(9) GRANTS TO PROMOTE REPRESENTATIVE

16 COMMUNITY ENGAGEMENT IN MATERNAL MOR17 TALITY REVIEW COMMITTEES.— 

18 ‘‘(A) IN GENERAL.—The Secretary may, 

19 using funds made available pursuant to sub20 paragraph (C), provide assistance to an applica21 ble maternal mortality review committee of a 

22 State, Indian tribe, tribal organization, or 

23 Urban Indian organization (as such term is de24 fined in section 4 of the Indian Health Care 

25 Improvement Act (25 U.S.C. 1603))— 


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1 ‘‘(i) to select for inclusion in the mem2 bership of such a committee community 

3 members from the State, Indian tribe, trib4 al organization, or Urban Indian organiza5 tion by— 

6 ‘‘(I) prioritizing community mem7 bers who can increase the diversity of 

8 the committee’s membership with re9 spect to race and ethnicity, location, 

10 and professional background, includ11 ing members with non-clinical experi12 ences; and 

13 ‘‘(II) to the extent applicable, 

14 using funds reserved under subsection 

15 (f), to address barriers to maternal 

16 mortality review committee participa17 tion for community members, includ18 ing through providing required train19 ing, reducing transportation barriers, 

20 providing compensation, and providing 

21 other supports as may be necessary; 

22 ‘‘(ii) to establish initiatives to conduct 

23 outreach and community engagement ef24 forts within communities throughout the 

25 State or Indian tribe to seek input from 


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1 community members on the work of such 

2 maternal mortality review committee, with 

3 a particular focus on outreach to people 

4 who are members of minority groups; and 

5 ‘‘(iii) to release public reports assess6 ing— 

7 ‘‘(I) the pregnancy-related death 

8 and pregnancy-associated death review 

9 processes of the maternal mortality 

10 review committee, with a particular 

11 focus on the maternal mortality re12 view committee’s sensitivity to the 

13 unique circumstances of pregnant and 

14 postpartum individuals from racial 

15 and ethnic minority groups (as such 

16 term is defined in section 1707(g)(1)) 

17 who have suffered pregnancy-related 

18 deaths; and 

19 ‘‘(II) the impact of the use of 

20 funds made available pursuant to 

21 paragraph (C) on increasing the diver22 sity of the maternal mortality review 

23 committee membership and promoting 

24 community engagement efforts 

25 throughout the State or Indian tribe. 


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1 ‘‘(B) TECHNICAL ASSISTANCE.—The Sec2 retary shall provide (either directly through the 

3 Department of Health and Human Services or 

4 by contract) technical assistance to any mater5 nal mortality review committee receiving a 

6 grant under this paragraph on best practices 

7 for increasing the diversity of the maternal 

8 mortality review committee’s membership and 

9 for conducting effective community engagement 

10 throughout the State or Indian tribe. 

11 ‘‘(C) AUTHORIZATION OF APPROPRIA12 TIONS.—In addition to any funds made avail13 able under subsection (f), there are authorized 

14 to be appropriated to carry out this paragraph 

15 $10,000,000 for each of fiscal years 2023 

16 through 2027.’’. 

17 (2) RESERVATION OF FUNDS.—Section 317K(f) 

18 of the Public Health Service Act (42 U.S.C. 247b– 

19 12(f)) is amended by adding at the end the fol20 lowing: ‘‘Of the amount made available under the 

21 preceding sentence for a fiscal year, not less than 

22 $1,500,000 shall be reserved for grants awarded 

23 under subsection (d)(9) to Indian tribes, tribal orga24 nizations, or Urban Indian organizations (as those 


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1 terms are defined in section 4 of the Indian Health 

2 Care Improvement Act (25 U.S.C. 1603)).’’. 

3 (c) DATA COLLECTION AND REVIEW.—Section 

4 317K(d)(3)(A)(i) of the Public Health Service Act (42 

5 U.S.C. 247b–12(d)(3)(A)(i)) is amended— 

6 (1) by redesignating subclauses (II) and (III) 

7 as subclauses (V) and (VI), respectively; and 

8 (2) by inserting after subclause (I) the fol9 lowing: 

10 ‘‘(II) to the extent practicable, 

11 reviewing cases of severe maternal 

12 morbidity, according to the most up13 to-date indicators; 

14 ‘‘(III) to the extent practicable, 

15 reviewing deaths during pregnancy or 

16 up to 1 year after the end of a preg17 nancy from suicide, overdose, or other 

18 death from a mental health condition 

19 or substance use disorder attributed 

20 to, or aggravated by, pregnancy or 

21 childbirth complications; 

22 ‘‘(IV) to the extent practicable, 

23 consulting with local community-based 

24 organizations representing pregnant 

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1 mographic groups disproportionately 

2 impacted by poor maternal health out3 comes to ensure that, in addition to 

4 clinical factors, non-clinical factors 

5 that might have contributed to a preg6 nancy-related death are appropriately 

7 considered;’’. 

8 (d) REVIEW OF MATERNAL HEALTH DATA COLLEC9 TION PROCESSES AND QUALITY MEASURES.— 

10 (1) IN GENERAL.—The Secretary of Health and 

11 Human Services, acting through the Administrator 

12 for the Centers for Medicare & Medicaid Services 

13 and the Director of the Agency for Healthcare Re14 search and Quality, shall consult with relevant stake15 holders— 

16 (A) to review existing maternal health data 

17 collection processes and quality measures; and 

18 (B) to make recommendations to improve 

19 such processes and measures, including topics 

20 described under paragraph (3). 

21 (2) COLLABORATION.—In carrying out this sub22 section, the Secretary shall consult with a diverse 

23 group of maternal health stakeholders, which may 

24 include— 


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1 (A) pregnant and postpartum individuals 

2 and their family members, and nonprofit orga3 nizations representing such individuals, with a 

4 particular focus on patients from racial and 

5 ethnic minority groups; 

6 (B) community-based organizations that 

7 provide support for pregnant and postpartum 

8 individuals, with a particular focus on patients 

9 from racial and ethnic minority groups; 

10 (C) membership organizations for mater11 nity care providers; 

12 (D) organizations representing perinatal 

13 health workers; 

14 (E) organizations that focus on maternal 

15 mental or behavioral health; 

16 (F) organizations that focus on intimate 

17 partner violence; 

18 (G) institutions of higher education, with a 

19 particular focus on minority-serving institu20 tions; 

21 (H) licensed and accredited hospitals, birth 

22 centers, midwifery practices, or other medical 

23 practices that provide maternal health care 

24 services to pregnant and postpartum patients; 


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1 (I) relevant State and local public agencies, 

2 including State maternal mortality review com3 mittees; and 

4 (J) the National Quality Forum, or such 

5 other standard-setting organizations specified 

6 by the Secretary. 

7 (3) TOPICS.—The review of maternal health 

8 data collection processes and recommendations to 

9 improve such processes and measures required under 

10 paragraph (1) shall assess all available relevant in11 formation, including information from State-level 

12 sources, and shall consider at least the following: 

13 (A) Current State and Tribal practices for 

14 maternal health, maternal mortality, and severe 

15 maternal morbidity data collection and dissemi16 nation, including consideration of— 

17 (i) the timeliness of processes for 

18 amending a death certificate when new in19 formation pertaining to the death becomes 

20 available to reflect whether the death was 

21 a pregnancy-related death; 

22 (ii) relevant data collected with elec23 tronic health records, including data on 

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1 ance type, and other relevant demographic 

2 information; 

3 (iii) maternal health data collected 

4 and publicly reported by hospitals, health 

5 systems, midwifery practices, and birth 

6 centers; 

7 (iv) the barriers preventing States 

8 from correlating maternal outcome data 

9 with race and ethnicity data; 

10 (v) processes for determining the 

11 cause of a pregnancy-associated death in 

12 States that do not have a maternal mor13 tality review committee; 

14 (vi) whether maternal mortality review 

15 committees include multidisciplinary and 

16 diverse membership (as described in sec17 tion 317K(d)(1)(A) of the Public Health 

18 Service Act (42 U.S.C. 247b– 

19 12(d)(1)(A))); 

20 (vii) whether members of maternal 

21 mortality review committees participate in 

22 trainings on bias, racism, or discrimina23 tion, and the quality of such trainings; 

24 (viii) the extent to which States have 

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1 ing to the stories of pregnant and 

2 postpartum individuals and their family 

3 members, with a particular focus on preg4 nant and postpartum individuals from ra5 cial and ethnic minority groups and their 

6 family members, to fully understand the 

7 causes of, and inform potential solutions 

8 to, the maternal mortality and severe ma9 ternal morbidity crisis within their respec10 tive States; 

11 (ix) the extent to which maternal mor12 tality review committees are considering 

13 social determinants of maternal health 

14 when examining the causes of pregnancy15 associated and pregnancy-related deaths; 

16 (x) the extent to which maternal mor17 tality review committees are making ac18 tionable recommendations based on their 

19 reviews of adverse maternal health out20 comes and the extent to which such rec21 ommendations are being implemented by 

22 appropriate stakeholders; 

23 (xi) the legal and administrative bar24 riers preventing the collection, collation, 


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1 and dissemination of State maternity care 

2 data; 

3 (xii) the effectiveness of data collec4 tion and reporting processes in separating 

5 pregnancy-associated deaths from preg6 nancy-related deaths; and 

7 (xiii) the current Federal, State, local, 

8 and Tribal funding support for the activi9 ties referred to in clauses (i) through (xii). 

10 (B) Whether the funding support referred 

11 to in subparagraph (A)(xiii) is adequate for 

12 States to carry out optimal data collection and 

13 dissemination processes with respect to mater14 nal health, maternal mortality, and severe ma15 ternal morbidity. 

16 (C) Current quality measures for mater17 nity care, including prenatal measures, labor 

18 and delivery measures, and postpartum meas19 ures, including topics such as— 

20 (i) effective quality measures for ma21 ternity care used by hospitals, health sys22 tems, midwifery practices, birth centers, 

23 health plans, and other relevant entities; 

24 (ii) the sufficiency of current outcome 

25 measures used to evaluate maternity care 


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1 for driving improved care, experiences, and 

2 outcomes in maternity care payment and 

3 delivery system models; 

4 (iii) maternal health quality measures 

5 that other countries effectively use; 

6 (iv) validated measures that have been 

7 used for research purposes that could be 

8 tested, refined, and submitted for national 

9 endorsement; 

10 (v) barriers preventing maternity care 

11 providers and insurers from implementing 

12 quality measures that are aligned with best 

13 practices; 

14 (vi) the frequency with which mater15 nity care quality measures are reviewed 

16 and revised; 

17 (vii) the strengths and weaknesses of 

18 the Prenatal and Postpartum Care meas19 ures of the Health Plan Employer Data 

20 and Information Set measures established 

21 by the National Committee for Quality As22 surance; 

23 (viii) the strengths and weaknesses of 

24 maternity care quality measures under the 

25 Medicaid program under title XIX of the 


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1 Social Security Act (42 U.S.C. 1396 et 

2 seq.) and the Children’s Health Insurance 

3 Program under title XXI of such Act (42 

4 U.S.C. 1397aa et seq.), including the ex5 tent to which States voluntarily report rel6 evant measures; 

7 (ix) the extent to which maternity 

8 care quality measures are informed by pa9 tient experiences that include measures of 

10 patient-reported experience of care; 

11 (x) the current processes for collecting 

12 stratified data on the race and ethnicity of 

13 pregnant and postpartum individuals in 

14 hospitals, health systems, midwifery prac15 tices, and birth centers, and for incor16 porating such racially and ethnically strati17 fied data in maternity care quality meas18 ures; 

19 (xi) the extent to which maternity 

20 care quality measures account for the 

21 unique experiences of pregnant and 

22 postpartum individuals from racial and 

23 ethnic minority groups; and 

24 (xii) the extent to which hospitals, 

25 health systems, midwifery practices, and 


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1 birth centers are implementing existing 

2 maternity care quality measures. 

3 (D) Recommendations on authorizing addi4 tional funds and providing additional technical 

5 assistance to improve maternal mortality review 

6 committees and State and Tribal maternal 

7 health data collection and reporting processes. 

8 (E) Recommendations for new authorities 

9 that may be granted to maternal mortality re10 view committees to be able to— 

11 (i) access records from other Federal 

12 and State agencies and departments that 

13 may be necessary to identify causes of 

14 pregnancy-associated and pregnancy-re15 lated deaths that are unique to pregnant 

16 and postpartum individuals from specific 

17 populations, such as veterans and individ18 uals who are incarcerated; and 

19 (ii) work with relevant experts who 

20 are not members of the maternal mortality 

21 review committee to assist in the review of 

22 pregnancy-associated deaths of pregnant 

23 and postpartum individuals from specific 

24 populations, such as veterans and individ25 uals who are incarcerated. 


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1 (F) Recommendations to improve and 

2 standardize current quality measures for mater3 nity care, with a particular focus on racial and 

4 ethnic inequities in maternal health outcomes. 

5 (G) Recommendations to improve the co6 ordination by the Department of Health and 

7 Human Services of the efforts undertaken by 

8 the agencies and organizations within the De9 partment related to maternal health data and 

10 quality measures. 

11 (4) REPORT.—Not later than 1 year after the 

12 date of the enactment of this Act, the Secretary 

13 shall submit to the Congress, and make publicly 

14 available, a report on the results of the review of 

15 maternal health data collection processes and quality 

16 measures and recommendations to improve such 

17 processes and measures required under paragraph 

18 (1). 

19 (5) DEFINITIONS.—In this subsection: 

20 (A) MATERNAL MORTALITY REVIEW COM21 MITTEE.—The term ‘‘maternal mortality review 

22 committee’’ means a maternal mortality review 

23 committee duly authorized by a State and re24 ceiving funding under section 317K(a)(2)(D) of 


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1 the Public Health Service Act (42 U.S.C. 247b– 

2 12(a)(2)(D)). 

3 (B) PREGNANCY-ASSOCIATED DEATH.— 

4 The term ‘‘pregnancy-associated’’, with respect 

5 to a death, means a death of a pregnant or 

6 postpartum individual, by any cause, that oc7 curs during, or within 1 year following, the in8 dividual’s pregnancy, regardless of the outcome, 

9 duration, or site of the pregnancy. 

10 (C) PREGNANCY-RELATED DEATH.—The 

11 term ‘‘pregnancy-related’’, with respect to a 

12 death, means a death of a pregnant or 

13 postpartum individual that occurs during, or 

14 within 1 year following, the individual’s preg15 nancy, from a pregnancy complication, a chain 

16 of events initiated by pregnancy, or the aggra17 vation of an unrelated condition by the physio18 logic effects of pregnancy. 

19 (6) AUTHORIZATION OF APPROPRIATIONS.— 

20 There are authorized to be appropriated such sums 

21 as may be necessary to carry out this subsection for 

22 each of fiscal years 2023 through 2027. 

23 (e) INDIAN HEALTH SERVICE STUDY ON MATERNAL

24 MORTALITY AND SEVERE MATERNAL MORBIDITY.— 


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1 (1) IN GENERAL.—The Director of the Indian 

2 Health Service (referred to in this subsection as the 

3 ‘‘Director’’) shall, in coordination with entities de4 scribed in paragraph (2)— 

5 (A) not later than 90 days after the date 

6 of enactment of this Act, enter into a contract 

7 with an independent research organization or 

8 Tribal Epidemiology Center to conduct a com9 prehensive study on maternal mortality and se10 vere maternal morbidity in the populations of 

11 American Indian and Alaska Native individuals; 

12 and 

13 (B) not later than 3 years after the date 

14 of the enactment of this Act, submit to Con15 gress a report on such study that contains rec16 ommendations for policies and practices that 

17 can be adopted to improve maternal health out18 comes for pregnant and postpartum American 

19 Indian and Alaska Native individuals. 

20 (2) PARTICIPATING ENTITIES.—The entities de21 scribed in this paragraph shall consist of 12 mem22 bers, selected by the Director from among individ23 uals nominated by Indian Tribes and Tribal organi24 zations (as such terms are defined in section 4 of 

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1 ance Act (25 U.S.C. 5304)), and Urban Indian or2 ganizations (as such term is defined in section 4 of 

3 the Indian Health Care Improvement Act (25 U.S.C. 

4 1603)). In selecting such members, the Director 

5 shall ensure that each of the 12 service areas of the 

6 Indian Health Service is represented. 

7 (3) CONTENTS OF STUDY.—The study con8 ducted pursuant to paragraph (1) shall— 

9 (A) examine the causes of maternal mor10 tality and severe maternal morbidity that are 

11 unique to American Indian and Alaska Native 

12 individuals; 

13 (B) include a systematic process of listen14 ing to the stories of American Indian and Alas15 ka Native pregnant and postpartum individuals 

16 to fully understand the causes of, and inform 

17 potential solutions to, the maternal mortality 

18 and severe maternal morbidity crisis within 

19 their respective communities; 

20 (C) distinguish between the causes of, 

21 landscape of maternity care at, and rec22 ommendations to improve maternal health out23 comes within, the different settings in which 

24 American Indian and Alaska Native pregnant 


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•S 4486 IS

1 and postpartum individuals receive maternity 

2 care, such as— 

3 (i) facilities operated by the Indian 

4 Health Service; 

5 (ii) an Indian health program oper6 ated by an Indian Tribe or Tribal organi7 zation pursuant to a contract, grant, coop8 erative agreement, or compact with the In9 dian Health Service pursuant to the Indian 

10 Self-Determination Act; and 

11 (iii) an Urban Indian health program 

12 operated by an Urban Indian organization 

13 pursuant to a grant or contract with the 

14 Indian Health Service pursuant to title V 

15 of the Indian Health Care Improvement 

16 Act; 

17 (D) review processes for coordinating pro18 grams of the Indian Health Service with social 

19 services provided through other programs ad20 ministered by the Secretary of Health and 

21 Human Services (other than the Medicare pro22 gram under title XVIII of the Social Security 

23 Act (42 U.S.C. 1395 et seq.), the Medicaid pro24 gram under title XIX of such Act (42 U.S.C. 

25 1396 et seq.), and the Children’s Health InsurVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ance Program under title XXI of such Act (42 

2 U.S.C. 1397aa et seq.)); 

3 (E) review current data collection and 

4 quality measurement processes and practices; 

5 (F) assess causes and frequency of mater6 nal mental health conditions and substance use 

7 disorders; 

8 (G) consider social determinants of health, 

9 including poverty, lack of health insurance, un10 employment, sexual violence, and environmental 

11 conditions in Tribal areas; 

12 (H) consider the role that historical mis13 treatment of American Indian and Alaska Na14 tive people has played in causing currently high 

15 rates of maternal mortality and severe maternal 

16 morbidity; 

17 (I) consider how current funding of the In18 dian Health Service affects the ability of the 

19 Service to deliver quality maternity care; 

20 (J) consider the extent to which the deliv21 ery of maternity care services is culturally ap22 propriate for American Indian and Alaska Na23 tive pregnant and postpartum individuals; 

24 (K) make recommendations to reduce 

25 misclassification of American Indian and Alaska 


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•S 4486 IS

1 Native pregnant and postpartum individuals, 

2 including consideration of best practices in 

3 training for maternal mortality review com4 mittee members to be able to correctly classify 

5 American Indian and Alaska Native individuals; 

6 and 

7 (L) make recommendations informed by 

8 the stories shared by American Indian and 

9 Alaska Native pregnant and postpartum indi10 viduals pursuant to subparagraph (B) to im11 prove maternal health outcomes for such indi12 viduals. 

13 (4) REPORT.—The agreement entered into 

14 under paragraph (1) with an independent research 

15 organization or Tribal Epidemiology Center shall re16 quire that the organization or center transmit to 

17 Congress a report on the results of the study con18 ducted pursuant to that agreement not later than 36 

19 months after the date of the enactment of this Act. 

20 (5) AUTHORIZATION OF APPROPRIATIONS.— 

21 There is authorized to be appropriated to carry out 

22 this subsection $2,000,000 for each of fiscal years 

23 2023 through 2025. 

24 (f) GRANTS TO MINORITY-SERVING INSTITUTIONS

25 TO STUDY MATERNAL MORTALITY, SEVERE MATERNAL


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1 MORBIDITY, AND OTHER ADVERSE MATERNAL HEALTH

2 OUTCOMES.— 

3 (1) IN GENERAL.—The Secretary of Health and 

4 Human Services shall establish a program under 

5 which the Secretary shall award grants to research 

6 centers, health professions schools and programs, 

7 and other entities at minority-serving institutions to 

8 study specific aspects of the maternal health crisis 

9 among pregnant and postpartum individuals from 

10 racial and ethnic minority groups. Such research 

11 may— 

12 (A) include the development and imple13 mentation of systematic processes of listening 

14 to the stories of pregnant and postpartum indi15 viduals from racial and ethnic minority groups, 

16 and perinatal health workers supporting such 

17 individuals, to fully understand the causes of, 

18 and inform potential solutions to, the maternal 

19 mortality and severe maternal morbidity crisis 

20 within their respective communities; 

21 (B) assess the potential causes of relatively 

22 low rates of maternal mortality among Hispanic 

23 individuals, including potential racial 

24 misclassification and other data collection and 

25 reporting issues that might be misrepresenting 


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•S 4486 IS

1 maternal mortality rates among Hispanic indi2 viduals in the United States; and 

3 (C) assess differences in rates of adverse 

4 maternal health outcomes among subgroups 

5 identifying as Hispanic. 

6 (2) APPLICATION.—To be eligible to receive a 

7 grant under paragraph (1), an entity described in 

8 such paragraph shall submit to the Secretary an ap9 plication at such time, in such manner, and con10 taining such information as the Secretary may re11 quire. 

12 (3) TECHNICAL ASSISTANCE.—The Secretary 

13 may use not more than 10 percent of the funds 

14 made available under paragraph (7)— 

15 (A) to conduct outreach to minority-serv16 ing institutions to raise awareness of the avail17 ability of grants under paragraph (1); 

18 (B) to provide technical assistance in the 

19 application process for such a grant; and 

20 (C) to promote capacity building, as need21 ed to enable entities described in such para22 graph to submit such an application. 

23 (4) REPORTING REQUIREMENT.—Each entity 

24 awarded a grant under this subsection shall periodiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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•S 4486 IS

1 cally submit to the Secretary a report on the status 

2 of activities conducted using the grant. 

3 (5) EVALUATION.—Beginning one year after 

4 the date on which the first grant is awarded under 

5 this subsection, the Secretary shall submit to Con6 gress an annual report summarizing the findings of 

7 research conducted using funds made available 

8 under this subsection. 

9 (6) MINORITY-SERVING INSTITUTIONS DE10 FINED.—In this subsection, the term ‘‘minority-serv11 ing institution’’ means an eligible institution de12 scribed in section 371(a) of the Higher Education 

13 Act of 1965 (20 U.S.C. 1067q(a)). 

14 (7) AUTHORIZATION OF APPROPRIATIONS.— 

15 There are authorized to be appropriated to carry out 

16 this subsection $10,000,000 for each of fiscal years 

17 2023 through 2027. 

18 (g) DEFINITIONS.—In this section: 

19 (1) CULTURALLY CONGRUENT.—The term ‘‘cul20 turally congruent’’, with respect to care or maternity 

21 care, means care that is in agreement with the pre22 ferred cultural values, beliefs, worldview, language, 

23 and practices of the health care consumer and other 

24 stakeholders. 


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1 (2) MATERNITY CARE PROVIDER.—The term 

2 ‘‘maternity care provider’’ means a health care pro3 vider who— 

4 (A) is a physician, physician assistant, 

5 midwife who meets at a minimum the inter6 national definition of the midwife and global 

7 standards for midwifery education as estab8 lished by the International Confederation of 

9 Midwives, nurse practitioner, or clinical nurse 

10 specialist; and 

11 (B) has a focus on maternal or perinatal 

12 health. 

13 (3) MATERNAL MORTALITY.—The term ‘‘mater14 nal mortality’’ means a death occurring during or 

15 within a one-year period after pregnancy, caused by 

16 pregnancy-related or childbirth complications, in17 cluding a suicide, overdose, or other death resulting 

18 from a mental health or substance use disorder at19 tributed to or aggravated by pregnancy-related or 

20 childbirth complications. 

21 (4) PERINATAL HEALTH WORKER.—The term 

22 ‘‘perinatal health worker’’ means a doula, commu23 nity health worker, peer supporter, breastfeeding 

24 and lactation educator or counselor, nutritionist or 


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•S 4486 IS

1 dietitian, childbirth educator, social worker, home 

2 visitor, language interpreter, or navigator. 

3 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

4 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

5 refer to the 1-year period beginning on the last day 

6 of the pregnancy of an individual. 

7 (6) PREGNANCY-ASSOCIATED DEATH.—The 

8 term ‘‘pregnancy-associated death’’ means a death of 

9 a pregnant or postpartum individual, by any cause, 

10 that occurs during, or within 1 year following, the 

11 individual’s pregnancy, regardless of the outcome, 

12 duration, or site of the pregnancy. 

13 (7) PREGNANCY-RELATED DEATH.—The term 

14 ‘‘pregnancy-related death’’ means a death of a preg15 nant or postpartum individual that occurs during, or 

16 within 1 year following, the individual’s pregnancy, 

17 from a pregnancy complication, a chain of events 

18 initiated by pregnancy, or the aggravation of an un19 related condition by the physiologic effects of preg20 nancy. 

21 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

22 The term ‘‘racial and ethnic minority group’’ has the 

23 meaning given such term in section 1707(g)(1) of 

24 the Public Health Service Act (42 U.S.C. 300u– 

25 6(g)(1)). 


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•S 4486 IS

1 (9) SEVERE MATERNAL MORBIDITY.—The term 

2 ‘‘severe maternal morbidity’’ means a health condi3 tion, including mental health conditions and sub4 stance use disorders, attributed to or aggravated by 

5 pregnancy or childbirth that results in significant 

6 short-term or long-term consequences to the health 

7 of the individual who was pregnant. 

8 (10) SOCIAL DETERMINANTS OF MATERNAL

9 HEALTH DEFINED.—The term ‘‘social determinants 

10 of maternal health’’ means non-clinical factors that 

11 impact maternal health outcomes, including— 

12 (A) economic factors, which may include 

13 poverty, employment, food security, support for 

14 and access to lactation and other infant feeding 

15 options, housing stability, and related factors; 

16 (B) neighborhood factors, which may in17 clude quality of housing, access to transpor18 tation, access to child care, availability of 

19 healthy foods and nutrition counseling, avail20 ability of clean water, air and water quality, 

21 ambient temperatures, neighborhood crime and 

22 violence, access to broadband, and related fac23 tors; 

24 (C) social and community factors, which 

25 may include systemic racism, gender discrimiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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•S 4486 IS

1 nation or discrimination based on other pro2 tected classes, workplace conditions, incarcer3 ation, and related factors; 

4 (D) household factors, which may include 

5 ability to conduct lead testing and abatement, 

6 car seat installation, indoor air temperatures, 

7 and related factors; 

8 (E) education access and quality factors, 

9 which may include educational attainment, lan10 guage and literacy, and related factors; and 

11 (F) health care access factors, including 

12 health insurance coverage, access to culturally 

13 congruent health care services, providers, and 

14 non-clinical support, access to home visiting 

15 services, access to wellness and stress manage16 ment programs, health literacy, access to tele17 health and items required to receive telehealth 

18 services, and related factors. 

19 SEC. 5209. KIRA JOHNSON ACT. 

20 (a) INVESTMENTS IN COMMUNITY-BASED ORGANIZA21 TIONS TO IMPROVE BLACK MATERNAL HEALTH OUT22 COMES.— 

23 (1) AWARDS.—Following the 1-year period de24 scribed in paragraph (3), the Secretary of Health 

25 and Human Services (in this subsection referred to 


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•S 4486 IS

1 as the ‘‘Secretary’’) shall award grants to eligible 

2 entities to establish or expand programs to prevent 

3 maternal mortality and severe maternal morbidity 

4 among Black pregnant and postpartum individuals. 

5 (2) ELIGIBILITY.—To be eligible to seek a 

6 grant under this subsection, an entity shall be a 

7 community-based organization offering programs 

8 and resources aligned with evidence-based practices 

9 for improving maternal health outcomes for Black 

10 pregnant and postpartum individuals. 

11 (3) OUTREACH AND TECHNICAL ASSISTANCE

12 PERIOD.—During the 1-year period beginning on the 

13 date of enactment of this Act, the Secretary shall— 

14 (A) conduct outreach to encourage eligible 

15 entities to apply for grants under this sub16 section; and 

17 (B) provide technical assistance to eligible 

18 entities on best practices for applying for grants 

19 under this subsection. 

20 (4) SPECIAL CONSIDERATION.— 

21 (A) OUTREACH.—In conducting outreach 

22 under paragraph (3), the Secretary shall give 

23 special consideration to eligible entities that— 

24 (i) are based in, and provide support 

25 for, communities with high rates of adverse 


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•S 4486 IS

1 maternal health outcomes or significant ra2 cial and ethnic inequities in maternal 

3 health outcomes, to the extent such data 

4 are available; 

5 (ii) are led by Black people; and 

6 (iii) offer programs and resources that 

7 are aligned with evidence-based practices 

8 for improving maternal health outcomes 

9 for Black pregnant and postpartum indi10 viduals. 

11 (B) AWARDS.—In awarding grants under 

12 this subsection, the Secretary shall give special 

13 consideration to eligible entities that— 

14 (i) are described in clauses (i), (ii), 

15 and (iii) of subparagraph (A); 

16 (ii) offer programs and resources de17 signed in consultation with and intended 

18 for Black pregnant and postpartum indi19 viduals; and 

20 (iii) offer programs and resources in 

21 the communities in which the respective el22 igible entities are located that— 

23 (I) promote maternal mental 

24 health and maternal substance use 

25 disorder treatments and supports that 


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•S 4486 IS

1 are aligned with evidence-based prac2 tices for improving maternal mental 

3 and behavioral health outcomes for 

4 Black pregnant and postpartum indi5 viduals; 

6 (II) address social determinants 

7 of maternal health for pregnant and 

8 postpartum individuals; 

9 (III) promote evidence-based 

10 health literacy and pregnancy, child11 birth, and parenting education for 

12 pregnant and postpartum individuals; 

13 (IV) provide support from 

14 perinatal health workers to pregnant 

15 and postpartum individuals; 

16 (V) provide culturally congruent 

17 training to perinatal health workers; 

18 (VI) conduct or support research 

19 on maternal health issues dispropor20 tionately impacting Black pregnant 

21 and postpartum individuals; 

22 (VII) provide support to family 

23 members of individuals who suffered a 

24 pregnancy-associated death or preg25 nancy-related death; 


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•S 4486 IS

1 (VIII) operate midwifery prac2 tices that provide culturally congruent 

3 maternal health care and support, in4 cluding for the purposes of— 

5 (aa) supporting additional 

6 education, training, and certifi7 cation programs, including sup8 port for distance learning; 

9 (bb) providing financial sup10 port to current and future mid11 wives to address education costs, 

12 debts, and other needs; 

13 (cc) clinical site investments; 

14 (dd) supporting preceptor 

15 development trainings; 

16 (ee) expanding the mid17 wifery practice; or 

18 (ff) related needs identified 

19 by the midwifery practice and de20 scribed in the practice’s applica21 tion; or 

22 (IX) have developed other pro23 grams and resources that address 

24 community-specific needs for pregnant 

25 and postpartum individuals and are 


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•S 4486 IS

1 aligned with evidence-based practices 

2 for improving maternal health out3 comes for Black pregnant and 

4 postpartum individuals. 

5 (5) TECHNICAL ASSISTANCE.—The Secretary 

6 shall provide to grant recipients under this sub7 section technical assistance on— 

8 (A) capacity building to establish or ex9 pand programs to prevent adverse maternal 

10 health outcomes among Black pregnant and 

11 postpartum individuals; 

12 (B) best practices in data collection, meas13 urement, evaluation, and reporting; and 

14 (C) planning for sustaining programs to 

15 prevent maternal mortality and severe maternal 

16 morbidity among Black pregnant and 

17 postpartum individuals after the period of the 

18 grant. 

19 (6) EVALUATION.—Not later than the end of 

20 fiscal year 2026, the Secretary shall submit to the 

21 Congress an evaluation of the grant program under 

22 this subsection that— 

23 (A) assesses the effectiveness of outreach 

24 efforts during the application process in diversi25 fying the pool of grant recipients; 


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•S 4486 IS

1 (B) makes recommendations for future 

2 outreach efforts to diversify the pool of grant 

3 recipients for Department of Health and 

4 Human Services grant programs and funding 

5 opportunities related to maternal health; 

6 (C) assesses the effectiveness of programs 

7 funded by grants under this subsection in im8 proving maternal health outcomes for Black 

9 pregnant and postpartum individuals, to the ex10 tent practicable; and 

11 (D) makes recommendations for future 

12 Department of Health and Human Services 

13 grant programs and funding opportunities that 

14 deliver funding to community-based organiza15 tions that provide programs and resources that 

16 are aligned with evidence-based practices for 

17 improving maternal health outcomes for Black 

18 pregnant and postpartum individuals. 

19 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

20 carry out this subsection, there is authorized to be 

21 appropriated $10,000,000 for each of fiscal years 

22 2023 through 2027. 

23 (b) INVESTMENTS IN COMMUNITY-BASED ORGANIZA24 TIONS TO IMPROVE MATERNAL HEALTH OUTCOMES IN

25 UNDERSERVED COMMUNITIES.— 


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•S 4486 IS

1 (1) AWARDS.—Following the 1-year period de2 scribed in paragraph (3), the Secretary of Health 

3 and Human Services (in this subsection referred to 

4 as the ‘‘Secretary’’) shall award grants to eligible 

5 entities to establish or expand programs to prevent 

6 maternal mortality and severe maternal morbidity 

7 among underserved groups. 

8 (2) ELIGIBILITY.—To be eligible to seek a 

9 grant under this subsection, an entity shall be a 

10 community-based organization offering programs 

11 and resources aligned with evidence-based practices 

12 for improving maternal health outcomes for preg13 nant and postpartum individuals. 

14 (3) OUTREACH AND TECHNICAL ASSISTANCE

15 PERIOD.—During the 1-year period beginning on the 

16 date of enactment of this Act, the Secretary shall— 

17 (A) conduct outreach to encourage eligible 

18 entities to apply for grants under this sub19 section; and 

20 (B) provide technical assistance to eligible 

21 entities on best practices for applying for grants 

22 under this subsection. 

23 (4) SPECIAL CONSIDERATION.— 


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•S 4486 IS

1 (A) OUTREACH.—In conducting outreach 

2 under paragraph (3), the Secretary shall give 

3 special consideration to eligible entities that— 

4 (i) are based in, and provide support 

5 for, communities with high rates of adverse 

6 maternal health outcomes or significant ra7 cial and ethnic inequities in maternal 

8 health outcomes, to the extent such data 

9 are available; 

10 (ii) are led by individuals from ra11 cially, ethnically, and geographically di12 verse backgrounds; and 

13 (iii) offer programs and resources that 

14 are aligned with evidence-based practices 

15 for improving maternal health outcomes 

16 for pregnant and postpartum individuals. 

17 (B) AWARDS.—In awarding grants under 

18 this subsection, the Secretary shall give special 

19 consideration to eligible entities that— 

20 (i) are described in clauses (i), (ii), 

21 and (iii) of subparagraph (A); 

22 (ii) offer programs and resources de23 signed in consultation with and intended 

24 for pregnant and postpartum individuals 

25 from underserved groups; and 


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•S 4486 IS

1 (iii) offer programs and resources in 

2 the communities in which the respective el3 igible entities are located that— 

4 (I) promote maternal mental 

5 health and maternal substance use 

6 disorder treatments and support that 

7 are aligned with evidence-based prac8 tices for improving maternal mental 

9 and behavioral health outcomes for 

10 pregnant and postpartum individuals; 

11 (II) address social determinants 

12 of maternal health for pregnant and 

13 postpartum individuals; 

14 (III) promote evidence-based 

15 health literacy and pregnancy, child16 birth, and parenting education for 

17 pregnant and postpartum individuals; 

18 (IV) provide support from 

19 perinatal health workers to pregnant 

20 and postpartum individuals; 

21 (V) provide culturally congruent 

22 training to perinatal health workers; 

23 (VI) conduct or support research 

24 on maternal health outcomes and in25 equities; 


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•S 4486 IS

1 (VII) provide support to family 

2 members of individuals who suffered a 

3 pregnancy-associated death or preg4 nancy-related death; or 

5 (VIII) operate midwifery prac6 tices that provide culturally congruent 

7 maternal health care and support, in8 cluding for the purposes of— 

9 (aa) supporting additional 

10 education, training, and certifi11 cation programs, including sup12 port for distance learning; 

13 (bb) providing financial sup14 port to current and future mid15 wives to address education costs, 

16 debts, and other needs; 

17 (cc) clinical site investments; 

18 (dd) supporting preceptor 

19 development trainings; 

20 (ee) expanding the mid21 wifery practice; or 

22 (ff) related needs identified 

23 by the midwifery practice and de24 scribed in the practice’s applica25 tion; or 


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•S 4486 IS

1 (iv) have developed other programs 

2 and resources that address community-spe3 cific needs for pregnant and postpartum 

4 individuals and are aligned with evidence5 based practices for improving maternal 

6 health outcomes for pregnant and 

7 postpartum individuals. 

8 (5) TECHNICAL ASSISTANCE.—The Secretary 

9 shall provide to grant recipients under this sub10 section technical assistance on— 

11 (A) capacity building to establish or ex12 pand programs to prevent adverse maternal 

13 health outcomes among pregnant and 

14 postpartum individuals from underserved 

15 groups; 

16 (B) best practices in data collection, meas17 urement, evaluation, and reporting; and 

18 (C) planning for sustaining programs to 

19 prevent maternal mortality and severe maternal 

20 morbidity among pregnant and postpartum in21 dividuals from underserved groups after the pe22 riod of the grant. 

23 (6) EVALUATION.—Not later than the end of 

24 fiscal year 2026, the Secretary shall submit to the 


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•S 4486 IS

1 Congress an evaluation of the grant program under 

2 this subsection that— 

3 (A) assesses the effectiveness of outreach 

4 efforts during the application process in diversi5 fying the pool of grant recipients; 

6 (B) makes recommendations for future 

7 outreach efforts to diversify the pool of grant 

8 recipients for Department of Health and 

9 Human Services grant programs and funding 

10 opportunities related to maternal health; 

11 (C) assesses the effectiveness of programs 

12 funded by grants under this subsection in im13 proving maternal health outcomes for pregnant 

14 and postpartum individuals from underserved 

15 groups, to the extent practicable; and 

16 (D) makes recommendations for future 

17 Department of Health and Human Services 

18 grant programs and funding opportunities that 

19 deliver funding to community-based organiza20 tions that provide programs and resources that 

21 are aligned with evidence-based practices for 

22 improving maternal health outcomes for preg23 nant and postpartum individuals. 


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1 (7) DEFINITION.—In this subsection, the term 

2 ‘‘underserved groups’’ refers to pregnant and 

3 postpartum individuals— 

4 (A) from racial and ethnic minority 

5 groups; 

6 (B) whose household income is equal to or 

7 less than 150 percent of the Federal poverty 

8 line; 

9 (C) who live in health professional shortage 

10 areas (as such term is defined in section 332 of 

11 the Public Health Service Act (42 U.S.C. 

12 254e)); 

13 (D) who live in counties with no hospital 

14 offering obstetric care, no birth center, and no 

15 obstetric provider; or 

16 (E) who live in counties with a level of vul17 nerability of moderate-to-high or higher, accord18 ing to the Social Vulnerability Index of the Cen19 ters for Disease Control and Prevention. 

20 (8) AUTHORIZATION OF APPROPRIATIONS.—To 

21 carry out this subsection, there is authorized to be 

22 appropriated $10,000,000 for each of fiscal years 

23 2023 through 2027. 

24 (c) RESPECTFUL MATERNITY CARE TRAINING FOR

25 ALL EMPLOYEES IN MATERNITY CARE SETTINGS.—Part 


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1 B of title VII of the Public Health Service Act (42 U.S.C. 

2 293 et seq.), as amended by section 3002, is further 

3 amended by adding at the end the following new section: 

4 ‘‘SEC. 743. RESPECTFUL MATERNITY CARE TRAINING FOR 

5 ALL EMPLOYEES IN MATERNITY CARE SET6 TINGS. 

7 ‘‘(a) GRANTS.—The Secretary shall award grants for 

8 programs to reduce and prevent bias, racism, and dis9 crimination in maternity care settings and to advance re10 spectful, culturally congruent, trauma-informed care. 

11 ‘‘(b) SPECIAL CONSIDERATION.—In awarding grants 

12 under subsection (a), the Secretary shall give special con13 sideration to applications for programs that would— 

14 ‘‘(1) apply to all maternity care providers and 

15 any employees who interact with pregnant and 

16 postpartum individuals in the provider setting, in17 cluding front desk employees, sonographers, sched18 ulers, health care professionals, hospital or health 

19 system administrators, security staff, and other em20 ployees; 

21 ‘‘(2) emphasize periodic, as opposed to one22 time, trainings for all birthing professionals and em23 ployees described in paragraph (1); 

24 ‘‘(3) address implicit bias, racism, and cultural 

25 humility; 


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1 ‘‘(4) be delivered in ongoing education settings 

2 for providers maintaining their licenses, with a pref3 erence for trainings that provide continuing edu4 cation units; 

5 ‘‘(5) include trauma-informed care best prac6 tices and an emphasis on shared decision making be7 tween providers and patients; 

8 ‘‘(6) include antiracism training and programs; 

9 ‘‘(7) be delivered in undergraduate programs 

10 that funnel into health professions schools; 

11 ‘‘(8) be delivered in settings that apply to pro12 viders of the special supplemental nutrition program 

13 for women, infants, and children under section 17 of 

14 the Child Nutrition Act of 1966; 

15 ‘‘(9) integrate bias training in obstetric emer16 gency simulation trainings or related trainings; 

17 ‘‘(10) include training for emergency depart18 ment employees and emergency medical technicians 

19 on recognizing warning signs for severe pregnancy20 related complications; 

21 ‘‘(11) offer training to all maternity care pro22 viders on the value of racially, ethnically, and profes23 sionally diverse maternity care teams to provide cul24 turally congruent care; or 


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1 ‘‘(12) be based on one or more programs de2 signed by a historically Black college or university or 

3 other minority-serving institution. 

4 ‘‘(c) APPLICATION.—To seek a grant under sub5 section (a), an entity shall submit an application at such 

6 time, in such manner, and containing such information as 

7 the Secretary may require. 

8 ‘‘(d) REPORTING TO SECRETARY.—Each recipient of 

9 a grant under this section shall annually submit to the 

10 Secretary a report on the status of activities conducted 

11 using the grant, including, as applicable, a description of 

12 the impact of training provided through the grant on pa13 tient outcomes and patient experience for pregnant and 

14 postpartum individuals from racial and ethnic minority 

15 groups and their families. 

16 ‘‘(e) DISSEMINATION OF FINDINGS.—Based on the 

17 annual reports submitted pursuant to subsection (d), the 

18 Secretary— 

19 ‘‘(1) shall produce an annual report on the find20 ings resulting from programs funded through this 

21 section; 

22 ‘‘(2) shall disseminate such report to all recipi23 ents of grants under this section and to the public; 

24 and 


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1 ‘‘(3) may include in such report findings on 

2 best practices for improving patient outcomes and 

3 patient experience for pregnant and postpartum in4 dividuals from racial and ethnic minority groups and 

5 their families in maternity care settings. 

6 ‘‘(f) DEFINITIONS.—In this section: 

7 ‘‘(1) The term ‘postpartum’ means the one-year 

8 period beginning on the last day of an individual’s 

9 pregnancy. 

10 ‘‘(2) The term ‘culturally congruent’ means in 

11 agreement with the preferred cultural values, beliefs, 

12 world view, language, and practices of the health 

13 care consumer and other stakeholders. 

14 ‘‘(3) The term ‘maternity care provider’ means 

15 a health care provider who— 

16 ‘‘(A) is a physician, physician assistant, 

17 midwife who meets at a minimum the inter18 national definition of the midwife and global 

19 standards for midwifery education as estab20 lished by the International Confederation of 

21 Midwives, nurse practitioner, or clinical nurse 

22 specialist; and 

23 ‘‘(B) has a focus on maternal or perinatal 

24 health. 


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1 ‘‘(4) The term ‘racial and ethnic minority 

2 group’ has the meaning given such term in section 

3 1707(g)(1). 

4 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

5 carry out this section, there is authorized to be appro6 priated $5,000,000 for each of fiscal years 2023 through 

7 2027.’’. 

8 (d) STUDY ON REDUCING AND PREVENTING BIAS, 

9 RACISM, AND DISCRIMINATION IN MATERNITY CARE SET10 TINGS.— 

11 (1) IN GENERAL.—The Secretary of Health and 

12 Human Services shall seek to enter into an agree13 ment, not later than 90 days after the date of enact14 ment of this Act, with the National Academies of 

15 Sciences, Engineering, and Medicine (referred to in 

16 this subsection as the ‘‘National Academies’’) under 

17 which the National Academies agree to— 

18 (A) conduct a study on the design and im19 plementation of programs to reduce and prevent 

20 bias, racism, and discrimination in maternity 

21 care settings and to advance respectful, cul22 turally congruent, trauma-informed care; and 

23 (B) not later than 24 months after the 

24 date of the enactment of this Act— 

25 (i) complete the study; and 


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•S 4486 IS

1 (ii) transmit a report on the results of 

2 the study to the Congress. 

3 (2) POSSIBLE TOPICS.—The agreement entered 

4 into pursuant to paragraph (1) may provide for the 

5 study of any of the following: 

6 (A) The development of a scorecard or 

7 other evaluation standards for programs de8 signed to reduce and prevent bias, racism, and 

9 discrimination in maternity care settings to as10 sess the effectiveness of such programs in im11 proving patient outcomes and patient experi12 ence for pregnant and postpartum individuals 

13 from racial and ethnic minority groups and 

14 their families. 

15 (B) Determination of the types and fre16 quency of training to reduce and prevent bias, 

17 racism, and discrimination in maternity care 

18 settings that are demonstrated to improve pa19 tient outcomes or patient experience for preg20 nant and postpartum individuals from racial 

21 and ethnic minority groups and their families. 

22 (e) RESPECTFUL MATERNITY CARE COMPLIANCE

23 PROGRAM.— 

24 (1) IN GENERAL.—The Secretary of Health and 

25 Human Services (referred to in this subsection as 


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1 the ‘‘Secretary’’) shall award grants to accredited 

2 hospitals, health systems, and other maternity care 

3 settings to establish as an integral part of quality 

4 implementation initiatives within one or more hos5 pitals or other birth settings a respectful maternity 

6 care compliance program. 

7 (2) PROGRAM REQUIREMENTS.—A respectful 

8 maternity care compliance program funded through 

9 a grant under this subsection shall— 

10 (A) institutionalize mechanisms to allow 

11 patients receiving maternity care services, the 

12 families of such patients, or perinatal health 

13 workers supporting such patients to report in14 stances of racism or evidence of bias on the 

15 basis of race, ethnicity, or another protected 

16 class; 

17 (B) institutionalize response mechanisms 

18 through which representatives of the program 

19 can directly follow up with the patient, if pos20 sible, and the patient’s family in a timely man21 ner; 

22 (C) prepare, and make publicly available, a 

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1 other protected class in the delivery of mater2 nity care that includes— 

3 (i) information on the training pro4 grams to reduce and prevent bias, racism, 

5 and discrimination on the basis of race, 

6 ethnicity, or another protected class for all 

7 employees in maternity care settings; 

8 (ii) information on the number of 

9 cases reported to the compliance program; 

10 and 

11 (iii) the development of methods to 

12 routinely assess the extent to which bias, 

13 racism, or discrimination on the basis of 

14 race, ethnicity, or another protected class 

15 are present in the delivery of maternity 

16 care to patients from racial and ethnic mi17 nority groups; 

18 (D) develop mechanisms to routinely col19 lect and publicly report hospital-level data re20 lated to patient-reported experience of care; and 

21 (E) provide annual reports to the Sec22 retary with information about each case re23 ported to the compliance program over the 

24 course of the year containing such information 

25 as the Secretary may require, such as— 


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1 (i) de-identified demographic informa2 tion on the patient in the case, such as 

3 race, ethnicity, gender identity, and pri4 mary language; 

5 (ii) the content of the report from the 

6 patient or the family of the patient to the 

7 compliance program; 

8 (iii) the response from the compliance 

9 program; and 

10 (iv) to the extent applicable, institu11 tional changes made as a result of the 

12 case. 

13 (3) SECRETARY REQUIREMENTS.— 

14 (A) PROCESSES.—Not later than 180 days 

15 after the date of the enactment of this Act, the 

16 Secretary shall establish processes for— 

17 (i) disseminating best practices for es18 tablishing and implementing a respectful 

19 maternity care compliance program within 

20 a hospital or other birth setting; 

21 (ii) promoting coordination and col22 laboration between hospitals, health sys23 tems, and other maternity care delivery 

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1 mentation of respectful maternity care 

2 compliance programs; and 

3 (iii) evaluating the effectiveness of re4 spectful maternity care compliance pro5 grams on maternal health outcomes and 

6 patient and family experiences, especially 

7 for patients from racial and ethnic minor8 ity groups and their families. 

9 (B) STUDY.— 

10 (i) IN GENERAL.—Not later than 2 

11 years after the date of the enactment of 

12 this Act, the Secretary shall, through a 

13 contract with an independent research or14 ganization, conduct a study on strategies 

15 to address— 

16 (I) racism or bias on the basis of 

17 race, ethnicity, or another protected 

18 class in the delivery of maternity care 

19 services; and 

20 (II) successful implementation of 

21 respectful care initiatives. 

22 (ii) COMPONENTS OF STUDY.—The 

23 study shall include the following: 

24 (I) An assessment of the reports 

25 submitted to the Secretary from the 


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•S 4486 IS

1 respectful maternity care compliance 

2 programs pursuant to paragraph 

3 (2)(E). 

4 (II) Based on such assessment, 

5 recommendations for potential ac6 countability mechanisms related to 

7 cases of racism or bias on the basis of 

8 race, ethnicity, or another protected 

9 class in the delivery of maternity care 

10 services at hospitals and other birth 

11 settings. Such recommendations shall 

12 take into consideration medical and 

13 non-medical factors that contribute to 

14 adverse patient experiences and ma15 ternal health outcomes. 

16 (iii) REPORT.—The Secretary shall 

17 submit to the Congress, and make publicly 

18 available, a report on the results of the 

19 study under this subparagraph. 

20 (4) AUTHORIZATION OF APPROPRIATIONS.—To 

21 carry out this subsection, there is authorized to be 

22 appropriated such sums as may be necessary for fis23 cal years 2023 through 2028. 

24 (f) GAO REPORT.— 


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1 (1) IN GENERAL.—Not later than 2 years after 

2 the date of enactment of this Act and annually 

3 thereafter, the Comptroller General of the United 

4 States shall submit to the Congress, and make pub5 licly available, a report on the establishment of re6 spectful maternity care compliance programs within 

7 hospitals, health systems, and other maternity care 

8 settings. 

9 (2) MATTERS INCLUDED.—The report under 

10 paragraph (1) shall include the following: 

11 (A) Information regarding the extent to 

12 which hospitals, health systems, and other ma13 ternity care settings have elected to establish 

14 respectful maternity care compliance programs, 

15 including— 

16 (i) which hospitals and other birth 

17 settings elect to establish compliance pro18 grams and when such programs are estab19 lished; 

20 (ii) to the extent practicable, impacts 

21 of the establishment of such programs on 

22 maternal health outcomes and patient and 

23 family experiences in the hospitals and 

24 other birth settings that have established 

25 such programs, especially for patients from 


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•S 4486 IS

1 racial and ethnic minority groups and their 

2 families; 

3 (iii) information on geographic areas, 

4 and types of hospitals or other birth set5 tings, where respectful maternity care com6 pliance programs are not being established 

7 and information on factors contributing to 

8 decisions to not establish such programs; 

9 and 

10 (iv) recommendations for establishing 

11 respectful maternity care compliance pro12 grams in geographic areas, and types of 

13 hospitals or other birth settings, where 

14 such programs are not being established. 

15 (B) Whether the funding made available to 

16 carry out this subsection has been sufficient 

17 and, if applicable, recommendations for addi18 tional appropriations to carry out this sub19 section. 

20 (C) Such other information as the Comp21 troller General determines appropriate. 

22 (g) DEFINITIONS.—In this section: 

23 (1) CULTURALLY CONGRUENT.—The term ‘‘cul24 turally congruent’’, with respect to care or maternity 

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•S 4486 IS

1 ferred cultural values, beliefs, worldview, language, 

2 and practices of the health care consumer and other 

3 stakeholders. 

4 (2) MATERNITY CARE PROVIDER.—The term 

5 ‘‘maternity care provider’’ means a health care pro6 vider who— 

7 (A) is a physician, physician assistant, 

8 midwife who meets at a minimum the inter9 national definition of the midwife and global 

10 standards for midwifery education as estab11 lished by the International Confederation of 

12 Midwives, nurse practitioner, or clinical nurse 

13 specialist; and 

14 (B) has a focus on maternal or perinatal 

15 health. 

16 (3) MATERNAL MORTALITY.—The term ‘‘mater17 nal mortality’’ means a death occurring during or 

18 within a one-year period after pregnancy, caused by 

19 pregnancy-related or childbirth complications, in20 cluding a suicide, overdose, or other death resulting 

21 from a mental health or substance use disorder at22 tributed to or aggravated by pregnancy-related or 

23 childbirth complications. 

24 (4) PERINATAL HEALTH WORKER.—The term 

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•S 4486 IS

1 nity health worker, peer supporter, breastfeeding 

2 and lactation educator or counselor, nutritionist or 

3 dietitian, childbirth educator, social worker, home 

4 visitor, language interpreter, or navigator. 

5 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

6 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

7 refer to the 1-year period beginning on the last day 

8 of the pregnancy of an individual. 

9 (6) PREGNANCY-ASSOCIATED DEATH.—The 

10 term ‘‘pregnancy-associated death’’ means a death of 

11 a pregnant or postpartum individual, by any cause, 

12 that occurs during, or within 1 year following, the 

13 individual’s pregnancy, regardless of the outcome, 

14 duration, or site of the pregnancy. 

15 (7) PREGNANCY-RELATED DEATH.—The term 

16 ‘‘pregnancy-related death’’ means a death of a preg17 nant or postpartum individual that occurs during, or 

18 within 1 year following, the individual’s pregnancy, 

19 from a pregnancy complication, a chain of events 

20 initiated by pregnancy, or the aggravation of an un21 related condition by the physiologic effects of preg22 nancy. 

23 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

24 The term ‘‘racial and ethnic minority group’’ has the 

25 meaning given such term in section 1707(g)(1) of 


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•S 4486 IS

1 the Public Health Service Act (42 U.S.C. 300u– 

2 6(g)(1)). 

3 (9) SEVERE MATERNAL MORBIDITY.—The term 

4 ‘‘severe maternal morbidity’’ means a health condi5 tion, including mental health conditions and sub6 stance use disorders, attributed to or aggravated by 

7 pregnancy or childbirth that results in significant 

8 short-term or long-term consequences to the health 

9 of the individual who was pregnant. 

10 (10) SOCIAL DETERMINANTS OF MATERNAL

11 HEALTH DEFINED.—The term ‘‘social determinants 

12 of maternal health’’ means non-clinical factors that 

13 impact maternal health outcomes, including— 

14 (A) economic factors, which may include 

15 poverty, employment, food security, support for 

16 and access to lactation and other infant feeding 

17 options, housing stability, and related factors; 

18 (B) neighborhood factors, which may in19 clude quality of housing, access to transpor20 tation, access to child care, availability of 

21 healthy foods and nutrition counseling, avail22 ability of clean water, air and water quality, 

23 ambient temperatures, neighborhood crime and 

24 violence, access to broadband, and related fac25 tors; 


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1 (C) social and community factors, which 

2 may include systemic racism, gender discrimi3 nation or discrimination based on other pro4 tected classes, workplace conditions, incarcer5 ation, and related factors; 

6 (D) household factors, which may include 

7 ability to conduct lead testing and abatement, 

8 car seat installation, indoor air temperatures, 

9 and related factors; 

10 (E) education access and quality factors, 

11 which may include educational attainment, lan12 guage and literacy, and related factors; and 

13 (F) health care access factors, including 

14 health insurance coverage, access to culturally 

15 congruent health care services, providers, and 

16 non-clinical support, access to home visiting 

17 services, access to wellness and stress manage18 ment programs, health literacy, access to tele19 health and items required to receive telehealth 

20 services, and related factors. 

21 SEC. 5210. MOMS MATTER. 

22 (a) MATERNAL MENTAL HEALTH EQUITY GRANT

23 PROGRAM.— 

24 (1) IN GENERAL.—The Secretary of Health and 

25 Human Services, acting through the Assistant SecVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 retary for Mental Health and Substance Use, shall 

2 establish a program to award grants to eligible enti3 ties to address maternal mental health conditions 

4 and substance use disorders with respect to preg5 nant and postpartum individuals, with a focus on ra6 cial and ethnic minority groups. 

7 (2) APPLICATION.—To be eligible to receive a 

8 grant under this subsection, an eligible entity shall 

9 submit to the Secretary an application at such time, 

10 in such manner, and containing such information as 

11 the Secretary may provide, including how such entity 

12 will use funds for activities described in paragraph 

13 (4) that are culturally congruent. 

14 (3) PRIORITY.—In awarding grants under this 

15 subsection, the Secretary shall give priority to an eli16 gible entity that— 

17 (A) is, or will partner with, a community18 based organization to address maternal mental 

19 health conditions and substance use disorders 

20 described in paragraph (1); 

21 (B) is operating in an area with high rates 

22 of— 

23 (i) adverse maternal health outcomes; 

24 or 


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1 (ii) significant racial or ethnic inequi2 ties in maternal health outcomes; and 

3 (C) is operating in a health professional 

4 shortage area designated under section 332 of 

5 the Public Health Service Act (42 U.S.C. 

6 254e). 

7 (4) USE OF FUNDS.—An eligible entity that re8 ceives a grant under this subsection shall use funds 

9 for the following: 

10 (A) Establishing or expanding maternity 

11 care programs to improve the integration of 

12 maternal health and behavioral health care 

13 services into primary care settings where preg14 nant individuals regularly receive health care 

15 services. 

16 (B) Establishing or expanding group pre17 natal care programs or postpartum care pro18 grams. 

19 (C) Expanding existing programs that im20 prove maternal mental and behavioral health 

21 during the prenatal and postpartum periods, 

22 with a focus on individuals from racial and eth23 nic minority groups. 

24 (D) Providing services and support for 

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1 ternal mental health conditions and substance 

2 use disorders, including referrals to addiction 

3 treatment centers that offer evidence-based 

4 treatment options. 

5 (E) Addressing stigma associated with ma6 ternal mental health conditions and substance 

7 use disorders, with a focus on racial and ethnic 

8 minority groups. 

9 (F) Raising awareness of warning signs of 

10 maternal mental health conditions and sub11 stance use disorders, with a focus on pregnant 

12 and postpartum individuals from racial and eth13 nic minority groups. 

14 (G) Establishing or expanding programs to 

15 prevent suicide or self-harm among pregnant 

16 and postpartum individuals. 

17 (H) Offering evidence-aligned programs at 

18 freestanding birth centers that provide maternal 

19 mental and behavioral health care education, 

20 treatments, and services, and other services for 

21 individuals throughout the prenatal and 

22 postpartum period. 

23 (I) Establishing or expanding programs to 

24 provide education and training to maternity 

25 care providers with respect to— 


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1 (i) identifying potential warning signs 

2 for maternal mental health conditions or 

3 substance use disorders in pregnant and 

4 postpartum individuals, with a focus on in5 dividuals from racial and ethnic minority 

6 groups; and 

7 (ii) in the case where such providers 

8 identify such warning signs, offering refer9 rals to mental and behavioral health care 

10 professionals. 

11 (J) Developing a website, or other source, 

12 that includes information on health care pro13 viders who treat maternal mental health condi14 tions and substance use disorders. 

15 (K) Establishing or expanding programs in 

16 communities to improve coordination between 

17 maternity care providers and mental and behav18 ioral health care providers who treat maternal 

19 mental health conditions and substance use dis20 orders, including through the use of toll-free 

21 hotlines. 

22 (L) Carrying out other programs aligned 

23 with evidence-based practices for addressing 

24 maternal mental health conditions and sub25 stance use disorders for pregnant and 


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1 postpartum individuals from racial and ethnic 

2 minority groups. 

3 (5) REPORTING.— 

4 (A) ELIGIBLE ENTITIES.—An eligible enti5 ty that receives a grant under paragraph (1) 

6 shall submit annually to the Secretary, and 

7 make publicly available, a report on the activi8 ties conducted using funds received through a 

9 grant under this subsection. Such reports shall 

10 include quantitative and qualitative evaluations 

11 of such activities, including the experience of in12 dividuals who received health care through such 

13 grant. 

14 (B) SECRETARY.—Not later than the end 

15 of fiscal year 2024, the Secretary shall submit 

16 to Congress a report that includes— 

17 (i) a summary of the reports received 

18 under subparagraph (A); 

19 (ii) an evaluation of the effectiveness 

20 of grants awarded under this subsection; 

21 (iii) recommendations with respect to 

22 expanding coverage of evidence-based 

23 screenings and treatments for maternal 

24 mental health conditions and substance use 

25 disorders; and 


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1 (iv) recommendations with respect to 

2 ensuring activities described under para3 graph (4) continue after the end of a grant 

4 period. 

5 (6) DEFINITIONS.—In this subsection: 

6 (A) CULTURALLY CONGRUENT.—The term 

7 ‘‘culturally congruent’’, with respect to care or 

8 maternity care, means care that is in agreement 

9 with the preferred cultural values, beliefs, 

10 worldview, language, and practices of the health 

11 care consumer and other stakeholders. 

12 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

13 entity’’ means— 

14 (i) a community-based organization 

15 serving pregnant and postpartum individ16 uals, including such organizations serving 

17 individuals from racial and ethnic minority 

18 groups and other underserved populations; 

19 (ii) a nonprofit or patient advocacy 

20 organization with expertise in maternal 

21 mental and behavioral health; 

22 (iii) a maternity care provider; 

23 (iv) a mental or behavioral health care 

24 provider who treats maternal mental health 

25 conditions or substance use disorders; 


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1 (v) a State or local governmental enti2 ty, including a State or local public health 

3 department; 

4 (vi) an Indian Tribe or Tribal organi5 zation (as such terms are defined in sec6 tion 4 of the Indian Self-Determination 

7 and Education Assistance Act (25 U.S.C. 

8 5304)); and 

9 (vii) an Urban Indian organization (as 

10 such term is defined in section 4 of the In11 dian Health Care Improvement Act (25 

12 U.S.C. 1603)). 

13 (C) FREESTANDING BIRTH CENTER.—The 

14 term ‘‘freestanding birth center’’ has the mean15 ing given that term under section 1905(l) of the 

16 Social Security Act (42 U.S.C. 1396d(1)). 

17 (D) MATERNITY CARE PROVIDER.—The 

18 term ‘‘maternity care provider’’ means a health 

19 care provider who— 

20 (i) is a physician, physician assistant, 

21 midwife who meets at a minimum the 

22 international definition of the midwife and 

23 global standards for midwifery education 

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1 eration of Midwives, nurse practitioner, or 

2 clinical nurse specialist; and 

3 (ii) has a focus on maternal or 

4 perinatal health. 

5 (E) SECRETARY.—The term ‘‘Secretary’’ 

6 means the Secretary of Health and Human 

7 Services. 

8 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

9 carry out this subsection, there is authorized to be 

10 appropriated $25,000,000 for each of fiscal years 

11 2023 through 2026. 

12 (b) GRANTS TO GROW AND DIVERSIFY THE MATER13 NAL MENTAL AND BEHAVIORAL HEALTH CARE WORK14 FORCE.—Title VII of the Public Health Service Act is 

15 amended by inserting after section 757 of such Act (42 

16 U.S.C. 294f) the following new section: 

17 ‘‘SEC. 758. MATERNAL MENTAL AND BEHAVIORAL HEALTH 

18 CARE WORKFORCE GRANTS. 

19 ‘‘(a) IN GENERAL.—The Secretary may award grants 

20 to entities to establish or expand programs described in 

21 subsection (b) to grow and diversify the maternal mental 

22 and behavioral health care workforce. 

23 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

24 this section shall use the grants to grow and diversify the 


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1 maternal mental and behavioral health care workforce 

2 by— 

3 ‘‘(1) establishing schools or programs that pro4 vide education and training to individuals seeking 

5 appropriate licensing or certification as mental or 

6 behavioral health care providers who will specialize 

7 in maternal mental health conditions or substance 

8 use disorders; or 

9 ‘‘(2) expanding the capacity of existing schools 

10 or programs described in paragraph (1), for the pur11 poses of increasing the number of students enrolled 

12 in such schools or programs, including by awarding 

13 scholarships for students. 

14 ‘‘(c) PRIORITIZATION.—In awarding grants under 

15 this section, the Secretary shall give priority to any entity 

16 that— 

17 ‘‘(1) has demonstrated a commitment to re18 cruiting and retaining students and faculty from ra19 cial and ethnic minority groups; 

20 ‘‘(2) has developed a strategy to recruit and re21 tain a diverse pool of students into the maternal 

22 mental or behavioral health care workforce program 

23 or school supported by funds received through the 

24 grant, particularly from racial and ethnic minority 

25 groups and other underserved populations; 


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1 ‘‘(3) has developed a strategy to recruit and re2 tain students who plan to practice in a health pro3 fessional shortage area designated under section 

4 332; 

5 ‘‘(4) has developed a strategy to recruit and re6 tain students who plan to practice in an area with 

7 significant racial and ethnic inequities in maternal 

8 health outcomes, to the extent practicable; and 

9 ‘‘(5) includes in the standard curriculum for all 

10 students within the maternal mental or behavioral 

11 health care workforce program or school a bias, rac12 ism, or discrimination training program that in13 cludes training on implicit bias and racism. 

14 ‘‘(d) REPORTING.—As a condition on receipt of a 

15 grant under this section for a maternal mental or behav16 ioral health care workforce program or school, an entity 

17 shall agree to submit to the Secretary an annual report 

18 on the activities conducted through the grant, including— 

19 ‘‘(1) the number and demographics of students 

20 participating in the program or school; 

21 ‘‘(2) the extent to which students in the pro22 gram or school are entering careers in— 

23 ‘‘(A) health professional shortage areas 

24 designated under section 332; and 


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1 ‘‘(B) areas with significant racial and eth2 nic inequities in maternal health outcomes, to 

3 the extent such data are available; and 

4 ‘‘(3) whether the program or school has in5 cluded in the standard curriculum for all students a 

6 bias, racism, or discrimination training program that 

7 includes training on implicit bias and racism, and if 

8 so the effectiveness of such training program. 

9 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

10 under this section shall be up to 5 years. 

11 ‘‘(f) APPLICATION.—To seek a grant under this sec12 tion, an entity shall submit to the Secretary an application 

13 at such time, in such manner, and containing such infor14 mation as the Secretary may require, including any infor15 mation necessary for prioritization under subsection (c). 

16 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

17 provide, directly or by contract, technical assistance to en18 tities seeking or receiving a grant under this section on 

19 the development, use, evaluation, and post-grant period 

20 sustainability of the maternal mental or behavioral health 

21 care workforce programs or schools proposed to be, or 

22 being, established or expanded through the grant. 

23 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

24 4 years after the date of enactment of this section, the 

25 Secretary shall prepare and submit to the Congress, and 


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1 post on the internet website of the Department of Health 

2 and Human Services, a report on the effectiveness of the 

3 grant program under this section at— 

4 ‘‘(1) recruiting students from racial and ethnic 

5 minority groups and other underserved populations; 

6 ‘‘(2) increasing the number of mental or behav7 ioral health care providers specializing in maternal 

8 mental health conditions or substance use disorders 

9 from racial and ethnic minority groups and other 

10 underserved populations; 

11 ‘‘(3) increasing the number of mental or behav12 ioral health care providers specializing in maternal 

13 mental health conditions or substance use disorders 

14 working in health professional shortage areas des15 ignated under section 332; and 

16 ‘‘(4) increasing the number of mental or behav17 ioral health care providers specializing in maternal 

18 mental health conditions or substance use disorders 

19 working in areas with significant racial and ethnic 

20 inequities in maternal health outcomes, to the extent 

21 such data are available. 

22 ‘‘(i) DEFINITIONS.—In this section: 

23 ‘‘(1) RACIAL AND ETHNIC MINORITY GROUP.— 

24 The term ‘racial and ethnic minority group’ has the 

25 meaning given such term in section 1707(g)(1). 


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1 ‘‘(2) MENTAL OR BEHAVIORAL HEALTH CARE

2 PROVIDER.—The term ‘mental or behavioral health 

3 care provider’ refers to a health care provider in the 

4 field of mental and behavioral health, including sub5 stance use disorders, acting in accordance with State 

6 law. 

7 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 

8 carry out this section, there is authorized to be appro9 priated $15,000,000 for each of fiscal years 2023 through 

10 2027.’’. 

11 SEC. 5211. TASKFORCE RECOMMENDING IMPROVEMENTS 

12 FOR UNADDRESSED MENTAL PERINATAL & 

13 POSTPARTUM HEALTH (TRIUMPH) FOR NEW 

14 MOMS. 

15 Part B of title III of the Public Health Service Act 

16 (42 U.S.C. 243 et seq.) is amended by inserting after sec17 tion 317L–1 (42 U.S.C. 247b–13a) the following: 

18 ‘‘SEC. 317L–2. TASK FORCE ON MATERNAL MENTAL 

19 HEALTH. 

20 ‘‘(a) ESTABLISHMENT.—Not later than 90 days after 

21 the date of enactment of this section, the Secretary shall 

22 establish a task force, to be known as the Task Force on 

23 Maternal Mental Health (in this section referred to as the 

24 ‘Task Force’) to identify, evaluate, and make recVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ommendations to coordinate and improve, Federal re2 sponses to maternal mental health conditions. 

3 ‘‘(b) MEMBERSHIP.— 

4 ‘‘(1) COMPOSITION.—The Task Force shall be 

5 composed of— 

6 ‘‘(A) the Assistant Secretary for Health of 

7 the Department of Health and Human Services 

8 (or the Assistant Secretary’s designee) who 

9 shall serve as the Chair of the Task Force; 

10 ‘‘(B) the Federal members under para11 graph (2); and 

12 ‘‘(C) the non-Federal members under para13 graph (3). 

14 ‘‘(2) FEDERAL MEMBERS.—In addition to the 

15 Assistant Secretary for Health, the Federal mem16 bers of the Task Force shall consist of the heads of 

17 the following Federal departments and agencies (or 

18 their designees): 

19 ‘‘(A) The Administration for Children and 

20 Families. 

21 ‘‘(B) The Agency for Healthcare Research 

22 and Quality. 

23 ‘‘(C) The Centers for Disease Control and 

24 Prevention. 


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1 ‘‘(D) The Centers for Medicare & Medicaid 

2 Services. 

3 ‘‘(E) The Health Resources and Services 

4 Administration. 

5 ‘‘(F) The Food and Drug Administration. 

6 ‘‘(G) The Indian Health Service. 

7 ‘‘(H) The Office of the Assistant Secretary 

8 for Planning and Evaluation of the Department 

9 of Health and Human Services. 

10 ‘‘(I) The Office of Minority Health of the 

11 Department of Health and Human Services. 

12 ‘‘(J) The Office of the Surgeon General of 

13 the Department of Health and Human Services. 

14 ‘‘(K) The Office on Women’s Health of the 

15 Department of Health and Human Services. 

16 ‘‘(L) The National Institutes of Health. 

17 ‘‘(M) The Substance Abuse and Mental 

18 Health Services Administration. 

19 ‘‘(N) Such other Federal departments and 

20 agencies as the Secretary determines that serve 

21 individuals with maternal mental health condi22 tions, such as the Department of Veterans Af23 fairs, the Department of Justice, the Depart24 ment of Labor, the Department of Housing and 


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1 Urban Development, and the Department of 

2 Defense. 

3 ‘‘(3) NON-FEDERAL MEMBERS.—The non-Fed4 eral members of the Task Force shall— 

5 ‘‘(A) compose not more than one-half, and 

6 not less than one-third, of the total membership 

7 of the Task Force; 

8 ‘‘(B) be appointed by the Secretary; and 

9 ‘‘(C) include— 

10 ‘‘(i) representatives of medical soci11 eties with expertise in maternal or mental 

12 health; 

13 ‘‘(ii) representatives of nonprofit orga14 nizations with expertise in maternal or 

15 mental health; 

16 ‘‘(iii) relevant industry representa17 tives; and 

18 ‘‘(iv) other representatives, as appro19 priate. 

20 ‘‘(4) DEADLINE FOR DESIGNATING DES21 IGNEES.—If the Assistant Secretary for Health, or 

22 the head of a Federal department or agency serving 

23 as a member of the Task Force under paragraph 

24 (2), chooses to be represented on the Task Force by 

25 a designee, the Assistant Secretary or head shall 


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•S 4486 IS

1 designate such designee not later than 90 days after 

2 the date of the enactment of this section. 

3 ‘‘(c) DUTIES.—The Task Force shall— 

4 ‘‘(1) create and regularly update a report that 

5 identifies, analyzes, and evaluates the state of na6 tional maternal mental health policy and programs 

7 at the Federal, State, and local levels, and identifies 

8 best practices including— 

9 ‘‘(A) a set of evidence-based, evidence-in10 formed, and promising practices with respect 

11 to— 

12 ‘‘(i) prevention strategies for individ13 uals at risk of experiencing a maternal 

14 mental health condition, including strate15 gies and recommendations to address so16 cial determinants of health; 

17 ‘‘(ii) the identification, screening, di18 agnosis, intervention, and treatment of in19 dividuals and families affected by a mater20 nal mental health condition; 

21 ‘‘(iii) the expeditious referral to, and 

22 implementation of, practices and supports 

23 that prevent and mitigate the effects of a 

24 maternal mental health condition, includ25 ing strategies and recommendations to 


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1 eliminate the racial and ethnic inequities 

2 that exist in maternal mental health; and 

3 ‘‘(iv) community-based or 

4 multigenerational practices that support 

5 individuals and families affected by a ma6 ternal mental health condition; and 

7 ‘‘(B) Federal and State programs and ac8 tivities to prevent, screen, diagnose, intervene, 

9 and treat maternal mental health conditions; 

10 ‘‘(2) develop and regularly update a national 

11 strategy for maternal mental health, taking into con12 sideration the findings of the reports under para13 graph (1), on how the Task Force and Federal de14 partments and agencies represented on the Task 

15 Force will prioritize options for, and implement a co16 ordinated approach to, addressing maternal mental 

17 health conditions, including by— 

18 ‘‘(A) increasing prevention, screening, di19 agnosis, intervention, treatment, and access to 

20 care, including clinical and nonclinical care such 

21 as peer-support and community health workers, 

22 through the public and private sectors; 

23 ‘‘(B) providing support for pregnant or 

24 postpartum individuals who are at risk for or 


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•S 4486 IS

1 experiencing a maternal mental health condi2 tion, and their families as appropriate; 

3 ‘‘(C) reducing racial, ethnic, geographic, 

4 and other health inequities for prevention, diag5 nosis, intervention, treatment, and access to 

6 care; 

7 ‘‘(D) identifying opportunities for local8 and State-level partnerships; 

9 ‘‘(E) identifying options for modifying, 

10 strengthening, and coordinating Federal pro11 grams and activities, including existing infant 

12 and maternity programs, such as the Medicaid 

13 program under title XIX of the Social Security 

14 Act and the State Children’s Health Insurance 

15 Program under title XXI of such Act, in order 

16 to increase research, prevention, identification, 

17 intervention, and treatment with respect to ma18 ternal mental health; 

19 ‘‘(F) providing recommendations to ensure 

20 research, services, supports, and prevention ac21 tivities are not unnecessarily duplicative; and 

22 ‘‘(G) planning, data sharing, and commu23 nication within and across Federal depart24 ments, agencies, offices, and programs; 


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1 ‘‘(3) solicit public comments from stakeholders 

2 for the report under paragraph (1) and the national 

3 strategy under paragraph (2), including comments 

4 from frontline service providers, mental health pro5 fessionals, researchers, experts in maternal mental 

6 health, institutions of higher education, public health 

7 agencies (including maternal and child health pro8 grams), and industry representatives, in order to in9 form the activities and reports of the Task Force; 

10 and 

11 ‘‘(4) disaggregate any data collected under this 

12 section by race, ethnicity, geographical location, age, 

13 marital status, socioeconomic level, and other factors 

14 as determined appropriate by the Secretary. 

15 ‘‘(d) MEETINGS.—The Task Force shall— 

16 ‘‘(1) meet not less than two times each year; 

17 and 

18 ‘‘(2) convene public meetings, as appropriate, to 

19 fulfill its duties under this section. 

20 ‘‘(e) REPORTS TO PUBLIC AND FEDERAL LEAD21 ERS.—The Task Force shall make publicly available and 

22 submit to the heads of relevant Federal departments and 

23 agencies, the Committee on Energy and Commerce of the 

24 House of Representatives, the Committee on Health, EduVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 cation, Labor, and Pensions of the Senate, and other rel2 evant congressional committees, the following: 

3 ‘‘(1) Not later than 1 year after the first meet4 ing of the Task Force, an initial report under sub5 section (c)(1). 

6 ‘‘(2) Not later than 2 years after the first meet7 ing of the Task Force, an initial national strategy 

8 under subsection (c)(2). 

9 ‘‘(3) Each year thereafter— 

10 ‘‘(A) an updated report under subsection 

11 (c)(1); 

12 ‘‘(B) an updated national strategy under 

13 subsection (c)(2); or 

14 ‘‘(C) if no such update is made, a report 

15 summarizing the activities of the Task Force. 

16 ‘‘(f) REPORTS TO GOVERNORS.—Upon finalizing the 

17 initial national strategy under subsection (c)(2), and upon 

18 making relevant updates to such strategy, the Task Force 

19 shall submit a report to the Governors of all States de20 scribing opportunities for local- and State-level partner21 ships identified under subsection (c)(2)(D). 

22 ‘‘(g) SUNSET.—The Task Force shall terminate on 

23 the date that is 6 years after the date on which the Task 

24 Force is established under subsection (a).’’. 


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1 SEC. 5212. PROTECT MOMS FROM DOMESTIC VIOLENCE. 

2 (a) STUDY BY DEPARTMENT OF HEALTH AND

3 HUMAN SERVICES.— 

4 (1) STUDY.—The Secretary, in collaboration 

5 with the Health Resources and Services Administra6 tion, the Substance Abuse and Mental Health Serv7 ices Administration, and the Administration for 

8 Children and Families, and in consultation with the 

9 Attorney General of the United States, the Director 

10 of the Indian Health Service, and stakeholders (in11 cluding community-based organizations, culturally 

12 specific organizations, and Tribal public health au13 thorities), shall conduct a study on the extent to 

14 which individuals are more at risk of maternal mor15 tality or severe maternal morbidity as a result of 

16 being a victim of domestic violence, dating violence, 

17 sexual assault, stalking, human trafficking, sex traf18 ficking, child sexual abuse, or forced marriage. 

19 (2) REPORTS.—Not later than 2 years after the 

20 date of enactment of this Act, the Secretary shall 

21 complete the study under paragraph (1) and submit 

22 a report to the Congress on the results of such 

23 study. Such report shall include— 

24 (A) an analysis of the extent to which do25 mestic violence, dating violence, sexual assault, 

26 stalking, human trafficking, sex trafficking, 


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1 child sexual abuse, and forced marriage con2 tribute to, or result in, maternal mortality; 

3 (B) an analysis of the impact of domestic 

4 violence, dating violence, sexual assault, stalk5 ing, human trafficking, sex trafficking, child 

6 sexual abuse, and forced marriage on access to 

7 health care (including mental health care) and 

8 substance use disorder treatment and recovery 

9 support; 

10 (C) a breakdown (including by race and 

11 ethnicity) of categories of individuals who are 

12 disproportionately victims of domestic violence, 

13 dating violence, sexual assault, stalking, human 

14 trafficking, sex trafficking, child sexual abuse, 

15 or forced marriage that contributes to, or re16 sults in, pregnancy-related death; 

17 (D) an analysis of the impact on health, 

18 mental health, and substance use resulting from 

19 domestic violence, dating violence, sexual as20 sault, stalking, human trafficking, sex traf21 ficking, child sexual abuse, and forced marriage 

22 among Alaskan Natives, Native Hawaiians, and 

23 American Indians during the prenatal and 

24 postpartum period; 


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1 (E) an assessment of the factors that in2 crease or decrease risks for maternal mortality 

3 or severe maternal morbidity among victims of 

4 domestic violence, dating violence, sexual as5 sault, stalking, human trafficking, sex traf6 ficking, child sexual abuse, or forced marriage; 

7 (F) an assessment of increased risk of ma8 ternal mortality or severe maternal morbidity 

9 stemming from suicide, substance use disorders, 

10 or drug overdose due to domestic violence, dat11 ing violence, sexual assault, stalking, human 

12 trafficking, sex trafficking, child sexual abuse, 

13 or forced marriage; 

14 (G) recommendations for legislative or pol15 icy changes— 

16 (i) to reduce maternal mortality rates; 

17 and 

18 (ii) to address health inequities that 

19 contribute to inequities in such rates and 

20 deaths; 

21 (H) best practices to reduce maternal mor22 tality and severe maternal morbidity among vic23 tims of domestic violence, dating violence, sex24 ual assault, stalking, human trafficking, sex 


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1 trafficking, child sexual abuse, and forced mar2 riage, including— 

3 (i) reducing reproductive coercion, 

4 mental health conditions, and substance 

5 use coercion; and 

6 (ii) routinely assessing pregnant peo7 ple for domestic violence and other forms 

8 of reproductive violence; and 

9 (I) any other information on maternal 

10 mortality or severe maternal morbidity the Sec11 retary determines appropriate to include in the 

12 report. 

13 (b) STUDY BY NATIONAL ACADEMY OF MEDICINE.— 

14 (1) IN GENERAL.—The Secretary shall seek to 

15 enter into an arrangement with the National Acad16 emy of Medicine (or, if the Academy declines to 

17 enter into such arrangement, another appropriate 

18 entity) to study— 

19 (A) the impact of domestic violence, dating 

20 violence, sexual assault, stalking, human traf21 ficking, sex trafficking, child sexual abuse, and 

22 forced marriage on an individual’s health; rel23 ative to 

24 (B) maternal mortality and severe mater25 nal morbidity. 


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1 (2) TOPICS.—The study under paragraph (1) 

2 shall— 

3 (A) examine— 

4 (i) whether domestic violence, dating 

5 violence, sexual assault, stalking, human 

6 trafficking, sex trafficking, child sexual 

7 abuse, or forced marriage, or generational 

8 intimate partner violence, trauma, and psy9 chiatric disorders, increase the risk of sui10 cide, substance use, and drug overdose 

11 among pregnant and postpartum persons; 

12 and 

13 (ii) the intersection of domestic vio14 lence, dating violence, sexual assault, stalk15 ing, human trafficking, sex trafficking, 

16 child sexual abuse, and forced marriage as 

17 a social determinant of health; and 

18 (B) give particular focus to impacts among 

19 African American, American Indian, Native Ha20 waiian, Alaskan Native, and LGBTQ birthing 

21 persons. 

22 (c) GRANTS FOR INNOVATIVE APPROACHES.— 

23 (1) IN GENERAL.—The Secretary, acting 

24 through the Administrator of the Health Resources 

25 and Services Administration, and in collaboration 


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1 with the Administration for Children and Families, 

2 the Indian Health Service, and the Substance Abuse 

3 and Mental Health Services Administration, shall 

4 award grants to eligible entities for developing and 

5 implementing innovative approaches to improve ma6 ternal and child health outcomes of victims of do7 mestic violence, dating violence, sexual assault, 

8 stalking, human trafficking, sex trafficking, child 

9 sexual abuse, or forced marriage. 

10 (2) ELIGIBLE ENTITY.—To seek a grant under 

11 this subsection, an entity shall be— 

12 (A) a State, local, or federally recognized 

13 Tribal government; 

14 (B) a nonprofit organization or commu15 nity-based organization that provides prevention 

16 or intervention services related to domestic vio17 lence, dating violence, sexual assault, stalking, 

18 human trafficking, sex trafficking, child sexual 

19 abuse, or forced marriage; 

20 (C) a tribal organization or Urban Indian 

21 organization (as such terms are defined in sec22 tion 4 of the Indian Health Care Improvement 

23 Act (25 U.S.C. 1603)); 

24 (D) an entity, the principal purpose of 

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1 pital, clinic, health department, freestanding 

2 birthing center, perinatal health worker, or ma3 ternity care provider; 

4 (E) an institution of higher education; or 

5 (F) a comprehensive substance use dis6 order parenting program. 

7 (3) PRIORITY.—In awarding grants under this 

8 subsection, the Secretary shall give priority to appli9 cants proposing to address— 

10 (A) mental health and substance use dis11 orders among pregnant persons; or 

12 (B) pregnant and postpartum persons ex13 periencing intimate partner violence. 

14 (4) FREESTANDING BIRTH CENTER DEFINED.— 

15 In this subsection, the term ‘‘freestanding birth cen16 ter’’ has the meaning given that term in section 

17 1905(l) of the Social Security Act (42 U.S.C. 

18 1396d(1)). 

19 (5) AUTHORIZATION OF APPROPRIATIONS.—To 

20 carry out this subsection, there is authorized to be 

21 appropriated $25,000,000 for the period of fiscal 

22 years 2023 through 2025. 

23 (d) GUIDANCE.—Not later than 2 years after the 

24 date of enactment of this Act, the Secretary shall issue 


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1 and disseminate guidance to States, Tribes, territories, 

2 maternity care providers, and managed care entities on— 

3 (1) providing universal education on healthy re4 lationships and intimate partner violence; 

5 (2) developing protocols on— 

6 (A) routine assessment of intimate partner 

7 violence; and 

8 (B) health promotion and strategies for 

9 trauma-informed care plans; and 

10 (3) creating sustainable partnerships with com11 munity-based organizations that address domestic vi12 olence, dating violence, sexual assault, stalking, 

13 human trafficking, sex trafficking, child sexual 

14 abuse, or forced marriage. 

15 (e) DEFINITIONS.—In this section: 

16 (1) The term ‘‘maternal mortality’’— 

17 (A) means death that— 

18 (i) occurs during, or within the 1-year 

19 period after, pregnancy; and 

20 (ii) is attributed to or aggravated by 

21 pregnancy-related or childbirth complica22 tions; and 

23 (B) includes a suicide, drug overdose 

24 death, homicide (including a domestic violence25 related homicide), or other death resulting from 


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1 a mental health or substance use disorder at2 tributed to or aggravated by pregnancy-related 

3 or childbirth complications. 

4 (2) The term ‘‘maternity care provider’’ means 

5 a health care provider who— 

6 (A) is a physician, physician assistant, 

7 nurse, midwife who meets at a minimum the 

8 international definition of the midwife and glob9 al standards for midwifery education as estab10 lished by the International Confederation of 

11 Midwives, nurse practitioner, or clinical nurse 

12 specialist; and 

13 (B) has a focus on maternal or perinatal 

14 health. 

15 (3) The term ‘‘perinatal health worker’’ means 

16 a worker who— 

17 (A) is a doula, community health worker, 

18 peer supporter, breastfeeding and lactation edu19 cator or counselor, nutritionist or dietitian, 

20 childbirth educator, social worker, home visitor, 

21 language interpreter, or navigator; and 

22 (B) provides assistance with perinatal 

23 health. 

24 (4) The term ‘‘postpartum’’ refers to the 12- 

25 month period following childbirth. 


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1 (5) The term ‘‘Secretary’’ means the Secretary 

2 of Health and Human Services. 

3 (6) The term ‘‘severe maternal morbidity’’ 

4 means a health condition, including a mental health 

5 condition or substance use disorder, that— 

6 (A) is attributed to or aggravated by preg7 nancy or childbirth; and 

8 (B) results in significant short-term or 

9 long-term consequences to the health of the in10 dividual who was pregnant. 

11 SEC. 5213. PERINATAL WORKFORCE. 

12 (a) HHS AGENCY DIRECTIVES.— 

13 (1) GUIDANCE TO STATES.— 

14 (A) IN GENERAL.—Not later than 2 years 

15 after the date of enactment of this Act, the Sec16 retary of Health and Human Services shall 

17 issue and disseminate guidance to States to 

18 educate providers, managed care entities, and 

19 other insurers about the value and process of 

20 delivering respectful maternal health care 

21 through diverse and multidisciplinary care pro22 vider models. 

23 (B) CONTENTS.—The guidance required 

24 by subparagraph (A) shall address how States 

25 can encourage and incentivize hospitals, health 


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1 systems, midwifery practices, freestanding birth 

2 centers, other maternity care provider groups, 

3 managed care entities, and other insurers— 

4 (i) to recruit and retain maternity 

5 care providers, mental and behavioral 

6 health care providers acting in accordance 

7 with State law, registered dietitians or nu8 trition professionals (as such term is de9 fined in section 1861(vv)(2) of the Social 

10 Security Act (42 U.S.C. 1395x(vv)(2))), 

11 and lactation consultants certified by the 

12 International Board of Lactation Consult13 ants Examiners— 

14 (I) from racially, ethnically, and 

15 linguistically diverse backgrounds; 

16 (II) with experience practicing in 

17 racially and ethnically diverse commu18 nities; and 

19 (III) who have undergone train20 ing on implicit bias and racism; 

21 (ii) to incorporate into maternity care 

22 teams— 

23 (I) midwives who meet, at a min24 imum, the international definition of 

25 the midwife and global standards for 


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•S 4486 IS

1 midwifery education, as established by 

2 the International Confederation of 

3 Midwives; and 

4 (II) perinatal health workers; 

5 (iii) to provide collaborative, culturally 

6 congruent care; and 

7 (iv) to provide opportunities for indi8 viduals enrolled in accredited midwifery 

9 education programs to participate in job 

10 shadowing with maternity care teams in 

11 hospitals, health systems, midwifery prac12 tices, and freestanding birth centers. 

13 (2) STUDY ON RESPECTFUL AND CULTURALLY

14 CONGRUENT MATERNITY CARE.— 

15 (A) STUDY.—The Secretary of Health and 

16 Human Services, acting through the Director of 

17 the National Institutes of Health (in this para18 graph referred to as the ‘‘Secretary’’), shall 

19 conduct a study on best practices in respectful 

20 and culturally congruent maternity care. 

21 (B) REPORT.—Not later than 2 years after 

22 the date of enactment of this Act, the Secretary 

23 shall— 

24 (i) complete the study required by 

25 subparagraph (A); 


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1 (ii) submit to the Congress, and make 

2 publicly available, a report on the results 

3 of such study; and 

4 (iii) include in such report— 

5 (I) a compendium of examples of 

6 hospitals, health systems, midwifery 

7 practices, freestanding birth centers, 

8 other maternity care provider groups, 

9 managed care entities, and other in10 surers that are delivering respectful 

11 and culturally congruent maternal 

12 health care; 

13 (II) a compendium of examples 

14 of hospitals, health systems, midwifery 

15 practices, freestanding birth centers, 

16 other maternity care provider groups, 

17 managed care entities, and other in18 surers that have made progress in re19 ducing inequities in maternal health 

20 outcomes and improving birthing ex21 periences for pregnant and 

22 postpartum individuals from racial 

23 and ethnic minority groups; and 

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•S 4486 IS

1 tices, freestanding birth centers, other 

2 maternity care provider groups, man3 aged care entities, and other insurers, 

4 for best practices in respectful and 

5 culturally congruent maternity care. 

6 (b) GRANTS TO GROW AND DIVERSIFY THE

7 PERINATAL WORKFORCE.—Title VII of the Public Health 

8 Service Act is amended by inserting after section 758, as 

9 added by section 5210(b), the following new section: 

10 ‘‘SEC. 758A. PERINATAL WORKFORCE GRANTS. 

11 ‘‘(a) IN GENERAL.—The Secretary shall award 

12 grants to entities to establish or expand programs de13 scribed in subsection (b) to grow and diversify the 

14 perinatal workforce. 

15 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

16 this section shall use the grants to grow and diversify the 

17 perinatal workforce by— 

18 ‘‘(1) establishing schools or programs that pro19 vide education and training to individuals seeking 

20 appropriate licensing or certification as— 

21 ‘‘(A) physician assistants who will complete 

22 clinical training in the field of maternal and 

23 perinatal health; or 

24 ‘‘(B) perinatal health workers; and 


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•S 4486 IS

1 ‘‘(2) expanding the capacity of existing schools 

2 or programs described in paragraph (1), for the pur3 poses of increasing the number of students enrolled 

4 in such schools or programs, including by awarding 

5 scholarships for students. 

6 ‘‘(c) PRIORITIZATION.—In awarding grants under 

7 this section, the Secretary shall give priority to any entity 

8 that— 

9 ‘‘(1) has demonstrated a commitment to re10 cruiting and retaining students and faculty from ra11 cial and ethnic minority groups; 

12 ‘‘(2) has developed a strategy to recruit and re13 tain a diverse pool of students into the perinatal 

14 workforce program or school supported by funds re15 ceived through the grant, particularly from racial 

16 and ethnic minority groups and other underserved 

17 populations; 

18 ‘‘(3) has developed a strategy to recruit and re19 tain students who plan to practice in a health pro20 fessional shortage area designated under section 

21 332; 

22 ‘‘(4) has developed a strategy to recruit and re23 tain students who plan to practice in an area with 

24 significant racial and ethnic inequities in maternal 

25 health outcomes, to the extent practicable; and 


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1 ‘‘(5) includes in the standard curriculum for all 

2 students within the perinatal workforce program or 

3 school a bias, racism, or discrimination training pro4 gram that includes training on implicit bias and rac5 ism. 

6 ‘‘(d) REPORTING.—As a condition on receipt of a 

7 grant under this section for a perinatal workforce program 

8 or school, an entity shall agree to submit to the Secretary 

9 an annual report on the activities conducted through the 

10 grant, including— 

11 ‘‘(1) the number and demographics of students 

12 participating in the program or school; 

13 ‘‘(2) the extent to which students in the pro14 gram or school are entering careers in— 

15 ‘‘(A) health professional shortage areas 

16 designated under section 332; and 

17 ‘‘(B) areas with significant racial and eth18 nic inequities in maternal health outcomes, to 

19 the extent such data are available; and 

20 ‘‘(3) whether the program or school has in21 cluded in the standard curriculum for all students a 

22 bias, racism, or discrimination training program that 

23 includes explicit and implicit bias, and if so the ef24 fectiveness of such training program. 


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1 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

2 under this section shall not exceed 5 years. 

3 ‘‘(f) APPLICATION.—To seek a grant under this sec4 tion, an entity shall submit to the Secretary an application 

5 at such time, in such manner, and containing such infor6 mation as the Secretary may require, including any infor7 mation necessary for prioritization under subsection (c). 

8 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

9 provide, directly or by contract, technical assistance to en10 tities seeking or receiving a grant under this section on 

11 the development, use, evaluation, and post-grant period 

12 sustainability of the perinatal workforce programs or 

13 schools proposed to be, or being, established or expanded 

14 through the grant. 

15 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

16 4 years after the date of enactment of this section, the 

17 Secretary shall prepare and submit to the Congress, and 

18 post on the internet website of the Department of Health 

19 and Human Services, a report on the effectiveness of the 

20 grant program under this section at— 

21 ‘‘(1) recruiting students from racial and ethnic 

22 minority groups; 

23 ‘‘(2) increasing the number of physician assist24 ants who will complete clinical training in the field 

25 of maternal and perinatal health, and perinatal 


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1 health workers, from racial and ethnic minority 

2 groups and other underserved populations; 

3 ‘‘(3) increasing the number of physician assist4 ants who will complete clinical training in the field 

5 of maternal and perinatal health, and perinatal 

6 health workers, working in health professional short7 age areas designated under section 332; and 

8 ‘‘(4) increasing the number of physician assist9 ants who will complete clinical training in the field 

10 of maternal and perinatal health, and perinatal 

11 health workers, working in areas with significant ra12 cial and ethnic inequities in maternal health out13 comes, to the extent such data are available. 

14 ‘‘(i) DEFINITION.—In this section, the term ‘racial 

15 and ethnic minority group’ has the meaning given such 

16 term in section 1707(g). 

17 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 

18 carry out this section, there is authorized to be appro19 priated $15,000,000 for each of fiscal years 2023 through 

20 2027.’’. 

21 (c) GRANTS TO GROW AND DIVERSIFY THE NURSING

22 WORKFORCE IN MATERNAL AND PERINATAL HEALTH.— 

23 Title VIII of the Public Health Service Act is amended 

24 by inserting after section 811 of that Act (42 U.S.C. 296j) 

25 the following: 


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1 ‘‘SEC. 812. PERINATAL NURSING WORKFORCE GRANTS. 

2 ‘‘(a) IN GENERAL.—The Secretary shall award 

3 grants to schools of nursing to grow and diversify the 

4 perinatal nursing workforce. 

5 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

6 this section shall use the grants to grow and diversify the 

7 perinatal nursing workforce by providing scholarships to 

8 students seeking to become— 

9 ‘‘(1) nurse practitioners whose education in10 cludes a focus on maternal and perinatal health; or 

11 ‘‘(2) clinical nurse specialists whose education 

12 includes a focus on maternal and perinatal health. 

13 ‘‘(c) PRIORITIZATION.—In awarding grants under 

14 this section, the Secretary shall give priority to any school 

15 of nursing that— 

16 ‘‘(1) has developed a strategy to recruit and re17 tain a diverse pool of students seeking to enter ca18 reers focused on maternal and perinatal health, par19 ticularly students from racial and ethnic minority 

20 groups and other underserved populations; 

21 ‘‘(2) has developed a partnership with a prac22 tice setting in a health professional shortage area 

23 designated under section 332 for the clinical place24 ments of the school’s students; 

25 ‘‘(3) has developed a strategy to recruit and re26 tain students who plan to practice in an area with 


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1 significant racial and ethnic inequities in maternal 

2 health outcomes, to the extent practicable; and 

3 ‘‘(4) includes in the standard curriculum for all 

4 students seeking to enter careers focused on mater5 nal and perinatal health a bias, racism, or discrimi6 nation training program that includes education on 

7 implicit bias and racism. 

8 ‘‘(d) REPORTING.—As a condition on receipt of a 

9 grant under this section, a school of nursing shall agree 

10 to submit to the Secretary an annual report on the activi11 ties conducted through the grant, including, to the extent 

12 practicable— 

13 ‘‘(1) the number and demographics of students 

14 in the school of nursing seeking to enter careers fo15 cused on maternal and perinatal health; 

16 ‘‘(2) the extent to which such students are pre17 paring to enter careers in— 

18 ‘‘(A) health professional shortage areas 

19 designated under section 332; and 

20 ‘‘(B) areas with significant racial and eth21 nic inequities in maternal health outcomes, to 

22 the extent such data are available; and 

23 ‘‘(3) whether the standard curriculum for all 

24 students seeking to enter careers focused on mater25 nal and perinatal health includes a bias, racism, or 


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1 discrimination training program that includes edu2 cation on implicit bias and racism. 

3 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

4 under this section shall be up to 5 years. 

5 ‘‘(f) APPLICATION.—To seek a grant under this sec6 tion, an entity shall submit to the Secretary an applica7 tion, at such time, in such manner, and containing such 

8 information as the Secretary may require, including any 

9 information necessary for prioritization under subsection 

10 (c). 

11 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

12 provide, directly or by contract, technical assistance to 

13 schools of nursing seeking or receiving a grant under this 

14 section on the processes of awarding and evaluating schol15 arships through the grant. 

16 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

17 4 years after the date of enactment of this section, the 

18 Secretary shall prepare and submit to the Congress, and 

19 post on the internet website of the Department of Health 

20 and Human Services, a report on the effectiveness of the 

21 grant program under this section at— 

22 ‘‘(1) recruiting students from racial and ethnic 

23 minority groups and other underserved populations; 

24 ‘‘(2) increasing the number of nurse practi25 tioners and clinical nurse specialists entering careers 


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•S 4486 IS

1 focused on maternal and perinatal health from racial 

2 and ethnic minority groups and other underserved 

3 populations; 

4 ‘‘(3) increasing the number of nurse practi5 tioners and clinical nurse specialists entering careers 

6 focused on maternal and perinatal health working in 

7 health professional shortage areas designated under 

8 section 332; and 

9 ‘‘(4) increasing the number of nurse practi10 tioners and clinical nurse specialists entering careers 

11 focused on maternal and perinatal health working in 

12 areas with significant racial and ethnic inequities in 

13 maternal health outcomes, to the extent such data 

14 are available. 

15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—To 

16 carry out this section, there is authorized to be appro17 priated $15,000,000 for each of fiscal years 2023 through 

18 2027.’’. 

19 (d) GAO REPORT.— 

20 (1) IN GENERAL.—Not later than 2 years after 

21 the date of enactment of this Act, and every 5 years 

22 thereafter, the Comptroller General of the United 

23 States shall submit to Congress a report on barriers 

24 to maternal health education and access to care in 

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1 formation and recommendations described in para2 graph (2). 

3 (2) CONTENT OF REPORT.—The report under 

4 paragraph (1) shall include— 

5 (A) an assessment of current barriers to 

6 entering accredited midwifery education pro7 grams, and recommendations for addressing 

8 such barriers, particularly for low-income people 

9 and people from racial and ethnic minority 

10 groups; 

11 (B) an assessment of current barriers to 

12 entering and successfully completing accredited 

13 education programs for other health profes14 sional careers related to maternity care, includ15 ing maternity care providers, mental and behav16 ioral health care providers acting in accordance 

17 with State law, registered dietitians or nutrition 

18 professionals (as such term is defined in section 

19 1861(vv)(2) of the Social Security Act (42 

20 U.S.C. 1395x(vv)(2))), and lactation consult21 ants certified by the International Board of 

22 Lactation Consultants Examiners, particularly 

23 for low-income people and people from racial 

24 and ethnic minority groups; 


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1 (C) an assessment of current barriers that 

2 prevent midwives from meeting the inter3 national definition of the midwife and global 

4 standards for midwifery education as estab5 lished by the International Confederation of 

6 Midwives, and recommendations for addressing 

7 such barriers, particularly for low-income people 

8 and people from racial and ethnic minority 

9 groups; 

10 (D) an assessment of inequities in access 

11 to maternity care providers, mental or behav12 ioral health care providers acting in accordance 

13 with State law, registered dietitians or nutrition 

14 professionals (as such term is defined in section 

15 1861(vv)(2) of the Social Security Act (42 

16 U.S.C. 1395x(vv)(2))), lactation consultants 

17 certified by the International Board of Lacta18 tion Consultants Examiners, and perinatal 

19 health workers, stratified by race, ethnicity, 

20 gender identity, geographic location, and insur21 ance type and recommendations to promote 

22 greater access equity; and 

23 (E) recommendations to promote greater 

24 equity in compensation for perinatal health 

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1 ticularly for such individuals from racially and 

2 ethnically diverse backgrounds. 

3 (e) DEFINITIONS.—In this section: 

4 (1) CULTURALLY CONGRUENT.—The term ‘‘cul5 turally congruent’’, with respect to care or maternity 

6 care, means care that is in agreement with the pre7 ferred cultural values, beliefs, worldview, language, 

8 and practices of the health care consumer and other 

9 stakeholders. 

10 (2) MATERNITY CARE PROVIDER.—The term 

11 ‘‘maternity care provider’’ means a health care pro12 vider who— 

13 (A) is a physician, physician assistant, 

14 midwife who meets at a minimum the inter15 national definition of the midwife and global 

16 standards for midwifery education as estab17 lished by the International Confederation of 

18 Midwives, nurse practitioner, or clinical nurse 

19 specialist; and 

20 (B) has a focus on maternal or perinatal 

21 health. 

22 (3) PERINATAL HEALTH WORKER.—The term 

23 ‘‘perinatal health worker’’ means a doula, commu24 nity health worker, peer supporter, breastfeeding 

25 and lactation educator or counselor, nutritionist or 


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1 dietitian, childbirth educator, social worker, home 

2 visitor, language interpreter, or navigator. 

3 (4) POSTPARTUM AND POSTPARTUM PERIOD.— 

4 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

5 refer to the 1-year period beginning on the last day 

6 of the pregnancy of an individual. 

7 (5) RACIAL AND ETHNIC MINORITY GROUP.— 

8 The term ‘‘racial and ethnic minority group’’ has the 

9 meaning given such term in section 1707(g)(1) of 

10 the Public Health Service Act (42 U.S.C. 300u– 

11 6(g)(1)). 

12 SEC. 5214. MIDWIVES SCHOOLS AND PROGRAMS EXPAN13 SION. 

14 (a) MIDWIFERY SCHOOLS AND PROGRAMS.— 

15 (1) IN GENERAL.—Title VII of the Public 

16 Health Service Act is amended by inserting after 

17 section 760 of such Act (42 U.S.C. 294k) the fol18 lowing: 

19 ‘‘SEC. 760A. MIDWIFERY SCHOOLS AND PROGRAMS. 

20 ‘‘(a) IN GENERAL.—The Secretary may award grants 

21 to institutions of higher education (as defined in sub22 sections (a) and (b) of section 101 of the Higher Edu23 cation Act of 1965) for the following: 

24 ‘‘(1) Direct support of students in an accredited 

25 midwifery school or program. 


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1 ‘‘(2) Establishment or expansion of an accred2 ited midwifery school or program. 

3 ‘‘(3) Securing, preparing, or providing support 

4 for increasing the number of, qualified preceptors 

5 for training the students of an accredited midwifery 

6 school or program. 

7 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 

8 grants under subsection (a), the Secretary shall give spe9 cial consideration to any institution of higher education 

10 that— 

11 ‘‘(1) agrees to prioritize students who plan to 

12 practice in a health professional shortage area des13 ignated under section 332; and 

14 ‘‘(2) demonstrates a focus on increasing racial 

15 and ethnic minority representation in midwifery edu16 cation. 

17 ‘‘(c) RESTRICTION.—The Secretary shall not provide 

18 any assistance under this section to be used with respect 

19 to a midwifery school or program within a school of nurs20 ing (as defined in section 801). 

21 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 

22 ‘‘(1) IN GENERAL.—There is authorized to be 

23 appropriated to carry out this section $15,000,000 

24 for the period of fiscal years 2023 through 2027. 


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1 ‘‘(2) ALLOCATION.—Of the amounts made 

2 available to carry out this section for any fiscal year, 

3 the Secretary shall use— 

4 ‘‘(A) 50 percent to award grants for pur5 poses specified in subsection (a)(1); 

6 ‘‘(B) 25 percent to award grants for pur7 poses specified in subsection (a)(2); and 

8 ‘‘(C) 25 percent to award grants for pur9 poses specified in subsection (a)(3).’’. 

10 (2) DEFINITIONS.— 

11 (A) MIDWIFERY SCHOOL OR PROGRAM.— 

12 Section 799B(1)(A) of the Public Health Serv13 ice Act (42 U.S.C. 295p(1)(A)) is amended— 

14 (i) by inserting ‘‘ ‘midwifery school or 

15 program’,’’ before ‘‘and ‘school of chiro16 practic’ ’’; 

17 (ii) by inserting ‘‘a degree or certifi18 cate in midwifery or an equivalent degree 

19 or certificate,’’ before ‘‘and a degree of 

20 doctor of chiropractic or an equivalent de21 gree’’; and 

22 (iii) by striking ‘‘any such school’’ and 

23 inserting ‘‘any such school or program’’. 

24 (B) ACCREDITED.—Section 799B(1)(E) of 

25 the Public Health Service Act (42 U.S.C. 


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1 295p(1)(E)) is amended by inserting ‘‘a mid2 wifery school or program,’’ before ‘‘or a grad3 uate program in health administration’’. 

4 (b) NURSE-MIDWIVES.—Title VIII of the Public 

5 Health Service Act, as amended by section 5213, is fur6 ther amended by inserting after section 812 of that Act, 

7 as added by section 5213, the following: 

8 ‘‘SEC. 812A. MIDWIFERY EXPANSION PROGRAM. 

9 ‘‘(a) IN GENERAL.—The Secretary may award grants 

10 to schools of nursing for the following: 

11 ‘‘(1) Direct support of students in an accredited 

12 nurse-midwifery school or program. 

13 ‘‘(2) Establishment or expansion of an accred14 ited nurse-midwifery school or program. 

15 ‘‘(3) Securing, preparing, or providing support 

16 for increasing the numbers of, preceptors at clinical 

17 training sites to precept students training to become 

18 certified nurse-midwives. 

19 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 

20 grants under subsection (a), the Secretary shall give spe21 cial consideration to any school of nursing that— 

22 ‘‘(1) agrees to prioritize students who choose to 

23 pursue an advanced education degree in nurse-mid24 wifery to practice in a health professional shortage 

25 area designated under section 332; and 


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1 ‘‘(2) demonstrates a focus on increasing racial 

2 and ethnic minority representation in nurse-mid3 wifery education. 

4 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 

5 ‘‘(1) IN GENERAL.—To carry out this section, 

6 there is authorized to be appropriated $20,000,000 

7 for the period of fiscal years 2023 through 2027. 

8 ‘‘(2) ALLOCATION.—Of the amounts made 

9 available to carry out this section for any fiscal year, 

10 the Secretary shall use— 

11 ‘‘(A) 50 percent to award grants for pur12 poses specified in subsection (a)(1); 

13 ‘‘(B) 25 percent to award grants for pur14 poses specified in subsection (a)(2); and 

15 ‘‘(C) 25 percent to award grants for pur16 poses specified in subsection (a)(3).’’. 

17 SEC. 5215. GESTATIONAL DIABETES. 

18 Part B of title III of the Public Health Service Act 

19 (42 U.S.C. 243 et seq.) is amended by adding after section 

20 317H the following: 

21 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 

22 ‘‘(a) UNDERSTANDING AND MONITORING GESTA23 TIONAL DIABETES.— 

24 ‘‘(1) IN GENERAL.—The Secretary, acting 

25 through the Director of the Centers for Disease 


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1 Control and Prevention, in consultation with the Di2 abetes Mellitus Interagency Coordinating Committee 

3 established under section 429 and representatives of 

4 appropriate national health organizations, shall de5 velop a multisite gestational diabetes research 

6 project within the diabetes program of the Centers 

7 for Disease Control and Prevention to expand and 

8 enhance surveillance data and public health research 

9 on gestational diabetes. 

10 ‘‘(2) AREAS TO BE ADDRESSED.—The research 

11 project developed under paragraph (1) shall ad12 dress— 

13 ‘‘(A) procedures to establish accurate and 

14 efficient systems for the collection of gestational 

15 diabetes data within each State and common16 wealth, territory, or possession of the United 

17 States; 

18 ‘‘(B) the progress of collaborative activities 

19 with the National Vital Statistics System, the 

20 National Center for Health Statistics, and 

21 State health departments with respect to the 

22 standard birth certificate, in order to improve 

23 surveillance of gestational diabetes; 

24 ‘‘(C) postpartum methods of tracking indi25 viduals with gestational diabetes after delivery 


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1 as well as targeted interventions proven to 

2 lower the incidence of type 2 diabetes in that 

3 population; 

4 ‘‘(D) variations in the distribution of diag5 nosed and undiagnosed gestational diabetes, 

6 and of impaired fasting glucose tolerance and 

7 impaired fasting glucose, within and among 

8 groups of pregnant individuals; and 

9 ‘‘(E) factors and culturally sensitive inter10 ventions that influence risks and reduce the in11 cidence of gestational diabetes and related com12 plications during childbirth, including cultural, 

13 behavioral, racial, ethnic, geographic, demo14 graphic, socioeconomic, and genetic factors. 

15 ‘‘(3) REPORT.—Not later than 2 years after the 

16 date of the enactment of this section, and annually 

17 thereafter, the Secretary shall generate a report on 

18 the findings and recommendations of the research 

19 project including prevalence of gestational diabetes 

20 in the multisite area and disseminate the report to 

21 the appropriate Federal and non-Federal agencies. 

22 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE23 SEARCH.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall expand 

2 and intensify public health research regarding gesta3 tional diabetes. Such research may include— 

4 ‘‘(A) developing and testing novel ap5 proaches for improving postpartum diabetes 

6 testing or screening and for preventing type 2 

7 diabetes in individuals who can become preg8 nant with a history of gestational diabetes; and 

9 ‘‘(B) conducting public health research to 

10 further understanding of the epidemiologic, 

11 socioenvironmental, behavioral, translation, and 

12 biomedical factors and health systems that in13 fluence the risk of gestational diabetes and the 

14 development of type 2 diabetes in individuals 

15 who can become pregnant with a history of ges16 tational diabetes. 

17 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

18 There is authorized to be appropriated to carry out 

19 this subsection $5,000,000 for each of fiscal years 

20 2023 through 2027. 

21 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE

22 RATE OF GESTATIONAL DIABETES.— 

23 ‘‘(1) IN GENERAL.—The Secretary, acting 

24 through the Director of the Centers for Disease 

25 Control and Prevention, shall award grants, on a 


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1 competitive basis, to eligible entities for demonstra2 tion projects that implement evidence-based inter3 ventions to reduce the incidence of gestational diabe4 tes, the recurrence of gestational diabetes in subse5 quent pregnancies, and the development of type 2 di6 abetes in individuals who can become pregnant with 

7 a history of gestational diabetes. 

8 ‘‘(2) PRIORITY.—In making grants under this 

9 subsection, the Secretary shall give priority to 

10 projects focusing on— 

11 ‘‘(A) helping individuals who can become 

12 pregnant who have 1 or more risk factors for 

13 developing gestational diabetes; 

14 ‘‘(B) working with individuals who can be15 come pregnant with a history of gestational dia16 betes during a previous pregnancy; 

17 ‘‘(C) providing postpartum care for indi18 viduals who can become pregnant with gesta19 tional diabetes; 

20 ‘‘(D) tracking cases where individuals who 

21 can become pregnant with a history of gesta22 tional diabetes developed type 2 diabetes; 

23 ‘‘(E) educating mothers with a history of 

24 gestational diabetes about the increased risk of 

25 their child developing diabetes; 


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1 ‘‘(F) working to prevent gestational diabe2 tes and prevent or delay the development of 

3 type 2 diabetes in individuals who can become 

4 pregnant with a history of gestational diabetes; 

5 and 

6 ‘‘(G) achieving outcomes designed to assess 

7 the efficacy and cost-effectiveness of interven8 tions that can inform decisions on long-term 

9 sustainability, including third-party reimburse10 ment. 

11 ‘‘(3) APPLICATION.—An eligible entity desiring 

12 to receive a grant under this subsection shall submit 

13 to the Secretary— 

14 ‘‘(A) an application at such time, in such 

15 manner, and containing such information as the 

16 Secretary may require; and 

17 ‘‘(B) a plan to— 

18 ‘‘(i) lower the rate of gestational dia19 betes during pregnancy; or 

20 ‘‘(ii) develop methods of tracking indi21 viduals who can become pregnant with a 

22 history of gestational diabetes and develop 

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1 betes in subsequent pregnancies and the 

2 development of type 2 diabetes. 

3 ‘‘(4) USES OF FUNDS.—An eligible entity re4 ceiving a grant under this subsection shall use the 

5 grant funds to carry out demonstration projects de6 scribed in paragraph (1), including— 

7 ‘‘(A) expanding community-based health 

8 promotion education, activities, and incentives 

9 focused on the prevention of gestational diabe10 tes and development of type 2 diabetes in indi11 viduals who can become pregnant with a history 

12 of gestational diabetes; 

13 ‘‘(B) aiding State- and Tribal-based diabe14 tes prevention and control programs to collect, 

15 analyze, disseminate, and report surveillance 

16 data on individuals who can become pregnant 

17 with, and at risk for, gestational diabetes, the 

18 recurrence of gestational diabetes in subsequent 

19 pregnancies, and, for individuals who can be20 come pregnant with a history of gestational dia21 betes, the development of type 2 diabetes; and 

22 ‘‘(C) training and encouraging health care 

23 providers— 

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1 tational diabetes and the recurrence of ges2 tational diabetes in subsequent preg3 nancies; and 

4 ‘‘(ii) to prevent the development of 

5 type 2 diabetes in individuals who can be6 come pregnant with a history of gesta7 tional diabetes, and its complications in the 

8 practice settings of the health care pro9 viders. 

10 ‘‘(5) REPORT.—Not later than 4 years after the 

11 date of the enactment of this section, the Secretary 

12 shall prepare and submit to the Congress a report 

13 concerning the results of the demonstration projects 

14 conducted through the grants awarded under this 

15 subsection. 

16 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 

17 this subsection, the term ‘eligible entity’ means a 

18 nonprofit organization (such as a nonprofit academic 

19 center or community health center) or a State, Trib20 al, or local health agency. 

21 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

22 There is authorized to be appropriated to carry out 

23 this subsection $5,000,000 for each of fiscal years 

24 2023 through 2027. 


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1 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA2 TIONAL DIABETES.—The Secretary, acting through the 

3 Director of the Centers for Disease Control and Preven4 tion, shall work with the State- and Tribal-based diabetes 

5 prevention and control programs assisted by the Centers 

6 to encourage postpartum followup after gestational diabe7 tes, as medically appropriate, for the purpose of reducing 

8 the incidence of gestational diabetes, the recurrence of 

9 gestational diabetes in subsequent pregnancies, the devel10 opment of type 2 diabetes in individuals with a history 

11 of gestational diabetes, and related complications.’’. 

12 SEC. 5216. CONSUMER EDUCATION CAMPAIGN. 

13 Section 229(b) of the Public Health Service Act (42 

14 U.S.C. 237a(b)), as amended— 

15 (1) in paragraph (6), at the end, by striking 

16 ‘‘and’’; 

17 (2) in paragraph (7), at the end, by striking the 

18 period and inserting a semicolon; and 

19 (3) by adding at the end the following: 

20 ‘‘(8) not later than one year after the date of 

21 the enactment of this paragraph, develop and imple22 ment a 4-year culturally and linguistically appro23 priate multimedia consumer education campaign 

24 that is designed to promote understanding and ac25 ceptance of evidence-based maternity practices and 


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1 models of care for optimal maternity outcomes 

2 among individuals of childbearing ages and families 

3 of such individuals and that— 

4 ‘‘(A) highlights the importance of pro5 tecting, promoting, and supporting the innate 

6 capacities of childbearing individuals and their 

7 newborns for childbirth, breastfeeding, and at8 tachment; 

9 ‘‘(B) promotes understanding of the impor10 tance of using obstetric interventions when 

11 medically necessary and when supported by 

12 strong, high-quality evidence; 

13 ‘‘(C) highlights the widespread overuse of 

14 maternity practices that have been shown to 

15 have benefit when used appropriately in situa16 tions of medical necessity, but which can expose 

17 pregnant individuals, infants, or both to risk of 

18 harm if used routinely and indiscriminately; 

19 ‘‘(D) emphasizes the noninvasive maternity 

20 practices that have proven correlation or may 

21 be associated with improvement in outcomes 

22 with no detrimental side effects, and are signifi23 cantly underused in the United States, includ24 ing smoking cessation programs in pregnancy, 

25 group model prenatal care, continuous labor 


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1 support, nonsupine positions for birth, and ex2 ternal version to turn breech babies at term; 

3 ‘‘(E) educates consumers about— 

4 ‘‘(i) the qualifications of licensed pro5 viders of maternity care, including obstetri6 cian-gynecologists, family physicians, cer7 tified nurse-midwives, certified midwives, 

8 and certified professional midwives; and 

9 ‘‘(ii) the best evidence about the safe10 ty, satisfaction, outcomes, and costs of 

11 such providers; 

12 ‘‘(F) informs consumers about the best 

13 available research comparing birth center 

14 births, planned home births, and hospital 

15 births, including information about each set16 ting’s safety, satisfaction, outcomes, and costs; 

17 ‘‘(G) fosters participation in high-quality, 

18 evidence-based childbirth education that pro19 motes a healthy and safe approach to preg20 nancy, childbirth, and early parenting; is taught 

21 by certified educators, peer counselors, and 

22 health professionals; and promotes informed de23 cision making by childbearing individuals; 

24 ‘‘(H) informs consumers about— 


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1 ‘‘(i) the effects of systemic, institu2 tional, and interpersonal racism on the 

3 health, well-being, and outcomes of birth4 ing people; 

5 ‘‘(ii) the importance of respectful, cul6 turally and linguistically appropriate, and 

7 culturally congruent care; and 

8 ‘‘(iii) the value of community-based 

9 and community-led maternal care and sup10 port; and 

11 ‘‘(I) is pilot tested for consumer com12 prehension, cultural sensitivity, and acceptance 

13 of the messages across geographically, racially, 

14 ethnically, and linguistically diverse popu15 lations;’’. 

16 SEC. 5217. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE17 VIEWS FOR CARE OF CHILDBEARING INDI18 VIDUALS AND NEWBORNS. 

19 (a) IN GENERAL.—Not later than one year after the 

20 date of the enactment of this Act, the Secretary of Health 

21 and Human Services, acting through the Director of the 

22 Agency for Healthcare Research and Quality, shall— 

23 (1) make publicly available an online biblio24 graphic database identifying systematic reviews, in25 cluding an explanation of the level and quality of 


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1 evidence, for care of childbearing individuals and 

2 newborns; and 

3 (2) initiate regular updates that incorporate 

4 newly issued and updated systematic reviews. 

5 (b) SOURCES.—To aim for a comprehensive inventory 

6 of systematic reviews relevant to maternal and newborn 

7 care, the database shall identify reviews from diverse 

8 sources, including— 

9 (1) scientific peer-reviewed journals; 

10 (2) databases, including the Cochrane Database 

11 of Systematic Reviews; and 

12 (3) internet websites of agencies and organiza13 tions throughout the world that produce such sys14 tematic reviews. 

15 (c) FEATURES.—The database shall— 

16 (1) provide bibliographic citations for each 

17 record within the database, and for each such cita18 tion include an explanation of the level and quality 

19 of evidence; 

20 (2) include abstracts, as available; 

21 (3) provide reference to companion documents 

22 as may exist for each review, such as evidence tables 

23 and guidelines or consumer educational materials de24 veloped from the review; 


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1 (4) provide links to the source of the full review 

2 and to any companion documents; 

3 (5) provide links to the source of a previous 

4 version or update of the review; 

5 (6) be searchable by intervention or other topic 

6 of the review, reported outcomes, author, title, and 

7 source; and 

8 (7) offer to users periodic electronic notification 

9 of database updates relating to users’ topics of inter10 est. 

11 (d) OUTREACH.—Not later than the first date the 

12 database is made publicly available and periodically there13 after, the Secretary of Health and Human Services shall 

14 publicize the availability, features, and uses of the data15 base under this section to the stakeholders described in 

16 subsection (e). 

17 (e) CONSULTATION.—For purposes of developing the 

18 database under this section and maintaining and updating 

19 such database, the Secretary of Health and Human Serv20 ices shall convene and consult with an advisory committee 

21 composed of relevant stakeholders, including— 

22 (1) Federal Medicaid administrators and State 

23 agencies administrating State plans under title XIX 

24 of the Social Security Act pursuant to section 

25 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 


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1 (2) providers of maternity and newborn care 

2 from both academic and community-based settings, 

3 including obstetrician-gynecologists, family physi4 cians, certified nurse midwives, certified midwives, 

5 certified professional midwives, physician assistants, 

6 perinatal nurses, pediatricians, and nurse practi7 tioners; 

8 (3) maternal-fetal medicine specialists; 

9 (4) neonatologists; 

10 (5) childbearing individuals and advocates for 

11 such individuals, including childbirth educators cer12 tified by a nationally accredited program, rep13 resenting communities that are diverse in terms of 

14 race, ethnicity, indigenous status, and geographic 

15 area; 

16 (6) employers and purchasers; 

17 (7) health facility and system leaders, including 

18 both hospital and birth center facilities; 

19 (8) journalists; and 

20 (9) bibliographic informatics specialists. 

21 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated $2,500,000 for each of the 

23 fiscal years 2023 through 2025 for the purpose of devel24 oping the database and such sums as may be necessary 

25 for each subsequent fiscal year for updating the database 


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1 and providing outreach and notification to users, as de2 scribed in this section. 

3 SEC. 5218. DEVELOPMENT OF INTERPROFESSIONAL MA4 TERNITY CARE EDUCATIONAL MODELS AND 

5 TOOLS. 

6 (a) IN GENERAL.—Not later than 6 months after the 

7 date of the enactment of this Act, the Secretary of Health 

8 and Human Services, acting in conjunction with the Ad9 ministrator of Health Resources and Services Administra10 tion, shall convene, for a 1-year period, an Interprofes11 sional Maternity Provider Education Commission (re12 ferred to in this section as the ‘‘Commission’’) to discuss 

13 and make recommendations for— 

14 (1) a consensus standard physiologic maternity 

15 care curriculum that takes into account the core 

16 competencies for basic midwifery practice such as 

17 those developed by the American College of Nurse18 Midwives and the North American Registry of Mid19 wives, and the educational objectives for physicians 

20 practicing in obstetrics and gynecology as deter21 mined by the Council on Resident Education in Ob22 stetrics and Gynecology; 

23 (2) suggestions for multidisciplinary use of the 

24 consensus physiologic curriculum; 


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1 (3) strategies to integrate and coordinate edu2 cation across maternity care disciplines, including 

3 recommendations to increase medical and midwifery 

4 student exposure to out-of-hospital birth; 

5 (4) curriculum and strategies for continuing 

6 education of practicing perinatal professionals who 

7 have completed their undergraduate and graduate 

8 education; and 

9 (5) pilot demonstrations of interprofessional 

10 educational models. 

11 (b) PARTICIPANTS.— 

12 (1) PROFESSIONS.—The Commission shall in13 clude maternity care educators, curriculum devel14 opers, service leaders, certification leaders, and ac15 creditation leaders from the various professions that 

16 provide or support maternity care in the United 

17 States. Such professions shall include obstetrician 

18 gynecologists, certified nurse midwives or certified 

19 midwives, family practice physicians, nurse practi20 tioners, physician assistants, certified professional 

21 midwives, perinatal nurses, doulas, lactation per22 sonnel, and community health workers. 

23 (2) CONSUMER ADVOCATES.—The Commission 

24 shall also include representation from maternity care 

25 consumer advocates. 


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1 (c) CURRICULUM.—The consensus standard physio2 logic maternity care curriculum described in subsection 

3 (a)(1) shall— 

4 (1) have a public health focus with a foundation 

5 in health promotion and disease prevention; 

6 (2) foster physiologic childbearing and person 

7 and family centered care; 

8 (3) reflect the extensive, growing research evi9 dence about— 

10 (A) the innate abilities and processes of 

11 the birthing person and the fetus or newborn 

12 for labor, birth, postpartum transition, 

13 breastfeeding, and attachment, when promoted, 

14 supported, and protected; and 

15 (B) the effects of factors that disturb and 

16 disrupt these processes; 

17 (4) integrate strategies to reduce maternal and 

18 infant morbidity and mortality; 

19 (5) incorporate recommendations to ensure re20 spectful, safe, and seamless consultation, referral, 

21 transport, and transfer of care when necessary; 

22 (6) include cultural sensitivity and strategies to 

23 decrease inequities in maternity outcomes; and 

24 (7) include implicit bias training. 


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1 (d) REPORT.—Not later than 6 months after the final 

2 meeting of the Commission, the Secretary of Health and 

3 Human Services shall— 

4 (1) submit to Congress a report containing the 

5 recommendations made by the Commission under 

6 this section; and 

7 (2) make such report publicly available. 

8 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated to carry out this section 

10 $1,000,000 for each of the fiscal years 2023 and 2024, 

11 and such sums as are necessary for each of the fiscal years 

12 2025 through 2027. 

13 SEC. 5219. DISSEMINATION OF THE QUALITY FAMILY PLAN14 NING GUIDELINES. 

15 (a) IN GENERAL.—Not later than 180 days after the 

16 date of enactment of this Act, the Secretary of Health and 

17 Human Services and the Director of the Centers for Dis18 ease Control and Prevention shall— 

19 (1) develop a plan for outreach to publicly fund20 ed health care providers, including federally qualified 

21 health centers (as defined in section 1861(aa)(4) of 

22 the Social Security Act (42 U.S.C. 1395x(aa)(4))) 

23 and branches of the Indian Health Service, about 

24 the quality family planning guidelines referred to in 

25 section 5304; and 


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1 (2) award grants to eligible entities to imple2 ment such guidelines for all patients seeking family 

3 planning services. 

4 (b) DEFINITION.—In this section, the term ‘‘eligible 

5 entity’’ means a publicly funded health care provider that 

6 serves persons of reproductive age. 

7 Subtitle D—Federal Agency 

8 Coordination on Maternal Health 

9 SEC. 5301. INTERAGENCY COORDINATING COMMITTEE ON 

10 THE PROMOTION OF OPTIMAL MATERNITY 

11 OUTCOMES. 

12 (a) IN GENERAL.—Part A of title II of the Public 

13 Health Service Act (42 U.S.C. 202 et seq.) is amended 

14 by adding at the end the following: 

15 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 

16 THE PROMOTION OF OPTIMAL MATERNITY 

17 OUTCOMES. 

18 ‘‘(a) IN GENERAL.—The Secretary, acting through 

19 the Deputy Assistant Secretary for Women’s Health under 

20 section 229 and in collaboration with the Federal officials 

21 specified in subsection (b), shall establish the Interagency 

22 Coordinating Committee on the Promotion of Optimal Ma23 ternity Outcomes (referred to in this section as the 

24 ‘ICCPOM’). 


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1 ‘‘(b) OTHER AGENCIES.—The officials specified in 

2 this subsection are the Secretary of Labor, the Secretary 

3 of Defense, the Secretary of Veterans Affairs, the Surgeon 

4 General, the Director of the Centers for Disease Control 

5 and Prevention, the Administrator of the Health Re6 sources and Services Administration, the Administrator of 

7 the Centers for Medicare & Medicaid Services, the Direc8 tor of the Indian Health Service, the Administrator of the 

9 Substance Abuse and Mental Health Services Administra10 tion, the Director of the National Institute of Child Health 

11 and Human Development, the Director of the Agency for 

12 Healthcare Research and Quality, the Assistant Secretary 

13 for Children and Families, the Deputy Assistant Secretary 

14 for Minority Health, the Director of the Office of Per15 sonnel Management, and such other Federal officials as 

16 the Secretary of Health and Human Services determines 

17 to be appropriate. 

18 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 

19 Women’s Health shall serve as the chair of the ICCPOM. 

20 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 

21 program development across the Federal Government with 

22 respect to promotion of optimal maternity care, provided, 

23 however, that nothing in this section shall be construed 

24 as transferring regulatory or program authority from an 

25 agency to the ICCPOM. 


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1 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 

2 seek the input of, and shall consult with, all appropriate 

3 and interested stakeholders, including State health depart4 ments, public health research and interest groups, founda5 tions, childbearing individuals and their advocates, and 

6 maternity care professional associations and organiza7 tions, reflecting racially, ethnically, demographically, and 

8 geographically diverse communities. 

9 ‘‘(f) ANNUAL REPORT.— 

10 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 

11 the ICCPOM, shall annually submit to Congress a 

12 report that summarizes— 

13 ‘‘(A) all programs and policies of Federal 

14 agencies (including the Medicare Program 

15 under title XVIII of the Social Security Act and 

16 the Medicaid program under title XIX of such 

17 Act) designed to promote optimal maternity 

18 care, focusing particularly on programs and 

19 policies that support the adoption of evidence20 based maternity care, as defined by timely, sci21 entifically sound systematic reviews; 

22 ‘‘(B) all programs and policies of Federal 

23 agencies (including the Medicare Program 

24 under title XVIII of the Social Security Act and 

25 the Medicaid program under title XIX of such 


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1 Act) designed to address the problems of mater2 nal mortality and morbidity, infant mortality, 

3 prematurity, and low birth weight, including 

4 such programs and policies designed to address 

5 racial and ethnic inequities with respect to each 

6 of such problems; 

7 ‘‘(C) the extent of progress in reducing 

8 maternal mortality and infant mortality, low 

9 birth weight, and prematurity at State and na10 tional levels; and 

11 ‘‘(D) such other information regarding op12 timal maternity care (such as quality and per13 formance measures) as the Secretary deter14 mines to be appropriate. 

15 ‘‘(2) REDUCING INEQUITIES WITH RESPECT TO

16 INDIGENOUS STATUS.—The information specified in 

17 paragraph (1)(C) shall be included in each such re18 port in a manner that disaggregates such informa19 tion by race, ethnicity, and indigenous status in 

20 order to determine the extent of progress in reduc21 ing racial and ethnic inequities and inequities related 

22 to indigenous status. 

23 ‘‘(3) CERTAIN INFORMATION.—Each report 

24 under paragraph (1) shall include information 

25 (disaggregated by race, ethnicity, and indigenous 


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1 status, as applicable) on the following rates, trends, 

2 and costs by State: 

3 ‘‘(A) The rate and trend of primary cesar4 ean deliveries and repeat cesarean deliveries. 

5 ‘‘(B) The rate and trend of vaginal births 

6 after cesarean. 

7 ‘‘(C) The rate and trend of vaginal breech 

8 births. 

9 ‘‘(D) The rate and trend of induction of 

10 labor. 

11 ‘‘(E) The rate and trend of freestanding 

12 birth center births. 

13 ‘‘(F) The rate and trend of planned and 

14 unplanned home birth. 

15 ‘‘(G) The rate and trends of attended 

16 births by different types of maternity care pro17 viders, including by an obstetrician-gyne18 cologist, family practice physician, obstetrician19 gynecologist physician assistant, certified nurse20 midwife, certified midwife, and certified profes21 sional midwife. 

22 ‘‘(H) The rate and trend of severe mater23 nal morbidity. 

24 ‘‘(I) The rates and trends of prenatal and 

25 postpartum anxiety and depression. 


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1 ‘‘(J) The rate and trend of pre-term birth. 

2 ‘‘(K) The rate and trend of low birth 

3 weight. 

4 ‘‘(L) The cost of maternity care 

5 disaggregated by place of birth and provider of 

6 care, including— 

7 ‘‘(i) uncomplicated vaginal birth; 

8 ‘‘(ii) complicated vaginal birth; 

9 ‘‘(iii) uncomplicated cesarean birth; 

10 and 

11 ‘‘(iv) complicated cesarean birth. 

12 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated, in addition to amounts 

14 authorized to be appropriated under section 229(e), to 

15 carry out this section $1,000,000 for each of the fiscal 

16 years 2023 through 2027.’’. 

17 (b) CONFORMING AMENDMENTS.— 

18 (1) INCLUSION AS DUTY OF HHS OFFICE ON

19 WOMEN’S HEALTH.—Section 229(b) of such Act (42 

20 U.S.C. 237a(b)), as amended by section 5216, is 

21 further amended by adding at the end the following 

22 new paragraph: 

23 ‘‘(9) establish the Interagency Coordinating 

24 Committee on the Promotion of Optimal Maternity 

25 Outcomes in accordance with section 229A; and’’. 


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1 (2) TREATMENT OF BIENNIAL REPORTS.—Sec2 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 

3 amended by inserting ‘‘(other than under subsection 

4 (b)(9))’’ after ‘‘under this section’’. 

5 SEC. 5302. EXPANSION OF CDC PREVENTION RESEARCH 

6 CENTERS PROGRAM TO INCLUDE CENTERS 

7 ON OPTIMAL MATERNITY OUTCOMES. 

8 (a) IN GENERAL.—Not later than one year after the 

9 date of the enactment of this Act, the Secretary of Health 

10 and Human Services shall support the establishment of 

11 additional Prevention Research Centers under the Preven12 tion Research Center Program administered by the Cen13 ters for Disease Control and Prevention. Such additional 

14 centers shall each be known as a Center for Excellence 

15 on Optimal Maternity Outcomes. 

16 (b) RESEARCH.—Each Center for Excellence on Opti17 mal Maternity Outcomes shall— 

18 (1) conduct at least one focused program of re19 search to improve maternity outcomes, including the 

20 reduction of cesarean birth rates, early elective in21 ductions, prematurity rates, and low birth weight 

22 rates within an underserved population that has a 

23 disproportionately large burden of suboptimal mater24 nity outcomes, including maternal mortality and 

25 morbidity, infant mortality, prematurity, or low 


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1 birth weight, which such program shall include de2 veloping performance and quality measures for ac3 countability; 

4 (2) work with partners on special interest 

5 projects, as specified by the Centers for Disease 

6 Control and Prevention and other relevant agencies 

7 within the Department of Health and Human Serv8 ices, and on projects funded by other sources; and 

9 (3) involve a minimum of two distinct birth set10 ting models, such as— 

11 (A) a hospital labor and delivery model 

12 and freestanding birth center model; or 

13 (B) a hospital labor and delivery model 

14 and planned home birth model. 

15 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 

16 for Excellence on Optimal Maternity Outcomes shall in17 clude the following interdisciplinary providers of maternity 

18 care: 

19 (1) Obstetrician-gynecologists. 

20 (2) At least two of the following providers: 

21 (A) Family practice physicians. 

22 (B) Nurse practitioners. 

23 (C) Physician assistants. 

24 (D) Certified professional midwives, cer25 tified nurse-midwives, or certified midwives. 


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1 (d) SERVICES.—Research conducted by each Center 

2 for Excellence on Optimal Maternity Outcomes shall in3 clude at least 2 (and preferably more) of the following sup4 portive provider services: 

5 (1) Mental health. 

6 (2) Doula labor support. 

7 (3) Nutrition education. 

8 (4) Childbirth education. 

9 (5) Social work. 

10 (6) Physical therapy or occupation therapy. 

11 (7) Substance use disorder services. 

12 (8) Home visiting. 

13 (e) COORDINATION.—The programs of research at 

14 each of the Centers of Excellence on Optimal Maternity 

15 Outcomes shall complement and not replicate the work of 

16 the other. 

17 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $2,000,000 for each of the fiscal years 2023 through 

20 2027. 


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1 SEC. 5303. EXPANDING MODELS TO BE TESTED BY CENTER 

2 FOR MEDICARE AND MEDICAID INNOVATION 

3 TO EXPLICITLY INCLUDE MATERNITY CARE 

4 AND CHILDREN’S HEALTH MODELS. 

5 Section 1115A(b)(2) of the Social Security Act (42 

6 U.S.C. 1315a(b)(2)), as amended by section 5206(b), is 

7 amended— 

8 (1) in subparagraph (B), by adding at the end 

9 the following: 

10 ‘‘(xxix) Promoting evidence-based 

11 models of care that have been associated 

12 with reductions in pregnancy-related and 

13 infant health inequities, including incor14 porating the use of and payment for 

15 doulas, particularly community-based 

16 doulas, and promoting support for people 

17 during pregnancy and for the one-year pe18 riod after the last day of such person’s 

19 pregnancy, through evidence-based models 

20 of antepartum, birth, postpartum care, and 

21 two-generation birthing person and new22 born care models, and supporting the risk23 appropriate use of out-of-hospital birth 

24 models, including births at home and in 

25 freestanding birth centers. Such models 

26 shall be selected and evaluated based on 


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1 their impact on quality, equity, and devel2 opmental outcomes, notwithstanding any 

3 other provision of this section.’’; 

4 (2) in subparagraph (C), by adding at the end 

5 the following: 

6 ‘‘(ix) Whether the model includes a 

7 regular process for ensuring the provision 

8 of culturally and linguistically appropriate 

9 services. 

10 ‘‘(x) Whether health care services and 

11 supportive services included in the model 

12 are tailored to community health and 

13 health-related social needs and provided by 

14 community-based and community-led pro15 viders. 

16 ‘‘(xi) Whether the model is designed 

17 to mitigate harmful effects of discrimina18 tion on the basis of race, sex, disability, 

19 ethnicity, language, and age.’’; and 

20 (3) by adding at the end the following: 

21 ‘‘(D) MANDATORY HEALTH EQUITY MOD22 ELS TO BE TESTED.—The Secretary shall se23 lect— 

24 ‘‘(i) Medicaid global and episode-based 

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1 tically appropriate antepartum, labor and 

2 delivery, and postpartum doula services, in3 cluding community-based doula services, 

4 that are— 

5 ‘‘(I) structured to provide pay6 ment to doulas as individuals, health 

7 care entity staff, or members of a 

8 doula group or collective, or through a 

9 third-party administrator; 

10 ‘‘(II) designed to reduce racial 

11 and intersecting health inequities; 

12 ‘‘(III) designed to provide doulas 

13 providing support with an equitable 

14 and sustainable reimbursement rate; 

15 ‘‘(IV) designed to reduce barriers 

16 to workforce entry for culturally and 

17 linguistically competent and racially 

18 congruent doulas to provide services 

19 to Medicaid enrollees; and 

20 ‘‘(V) designed with input from 

21 community-based doulas, maternal 

22 health advocates, reproductive justice 

23 advocates, and Medicaid beneficiaries; 

24 ‘‘(ii) a Medicaid episode-based pay25 ment model for pregnancy-related services, 


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1 including health care services and sup2 portive services to address health-related 

3 social needs, during the prenatal, 

4 intrapartum, and postpartum periods, to 

5 improve health outcomes and reduce racial 

6 health inequities, and to be designed with 

7 input from maternity care providers, ma8 ternal health advocates, reproductive jus9 tice advocates, and Medicaid beneficiaries; 

10 ‘‘(iii) a Medicaid alternative payment 

11 model for a pregnancy-related health home 

12 service to improve health outcomes during 

13 and for one year after pregnancy and dur14 ing the newborn period, and to reduce ra15 cial health inequities, designed with input 

16 from maternity care providers, maternal 

17 health advocates, reproductive justice advo18 cates, and Medicaid beneficiaries; 

19 ‘‘(iv) a Medicaid perinatal health 

20 worker service delivery model for culturally 

21 and linguistically appropriate and respect22 ful health care and supportive services that 

23 are tailored to community health and 

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1 ful effects of racism and other forms of 

2 discrimination, and provided by commu3 nity-based and community-led providers; 

4 and 

5 ‘‘(v) one or more models exclusively 

6 focused on early intervention and preven7 tion for children enrolled in a State plan 

8 (or waiver of such plan) under title XIX or 

9 a State child health plan under title XXI 

10 using evidence-based interventions includ11 ing parenting support programs, home-vis12 iting services, and dyadic therapy treat13 ment for children and adolescents at risk. 

14 Such models shall be selected and evaluated 

15 based on their impact on quality, equity, and 

16 developmental outcomes, notwithstanding any 

17 other provision of this section.’’. 

18 SEC. 5304. INTERAGENCY UPDATE TO THE QUALITY FAMILY 

19 PLANNING GUIDELINES. 

20 (a) IN GENERAL.—Not later than six months after 

21 the date of enactment of this Act, the Director of the Cen22 ters for Disease Control and Prevention and the Office 

23 of Population Affairs shall review and expand the 2014 

24 Quality Family Planning Guidelines to address— 

25 (1) health inequities; and 


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1 (2) the importance of patient-directed contra2 ceptive decision making. 

3 (b) CONSULTATION.—In carrying out subsection (a), 

4 the Director of the Centers for Disease Control and Pre5 vention and the Office of Population Affairs shall convene 

6 a meeting, and solicit the views of, stakeholders including 

7 experts on health inequities, experts on reproductive coer8 cion, representatives of provider organizations, patient ad9 vocates, reproductive justice organizations, organizations 

10 that represent racial and ethnic minority communities, or11 ganizations that represent people with disabilities, organi12 zations that represent LGBTQ persons, and organizations 

13 that represent people with limited English proficiency. 

14 Subtitle E—Reproductive and 

15 Sexual Health 

16 SEC. 5401. FINDINGS; SENSE OF CONGRESS ON URGENT 

17 BARRIERS TO ABORTION ACCESS AND VITAL 

18 SOLUTIONS. 

19 (a) FINDINGS.—Congress finds the following: 

20 (1) Affordable, comprehensive health insurance 

21 that includes coverage for a full range of pregnancy22 related care, including abortion, is critical to the 

23 health of every person regardless of actual or per24 ceived race, color, national origin, immigration sta25 tus, sex (including sexual orientation, gender idenVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00842 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tity, pregnancy, childbirth, a medical condition relat2 ing to pregnancy or childbirth, or sex stereotyping), 

3 age, or disability status. 

4 (2) Abortion services are essential to health 

5 care and access to those services is central to peo6 ple’s ability to participate equally in the economic 

7 and social life of the United States. Abortion access 

8 allows people who are pregnant to make their own 

9 decisions about their pregnancies, their families, and 

10 their lives. 

11 (3) Reproductive justice seeks to address re12 strictions on reproductive health, including abortion, 

13 that perpetuate systems of oppression, lack of bodily 

14 autonomy, White supremacy, and anti-Black racism. 

15 The violent legacy of these systems of oppression has 

16 manifested in policies including enslavement, rape, 

17 and experimentation on Black people, forced steri18 lizations, medical experimentation on low-income 

19 people’s reproductive systems, and the forcible re20 moval of Indigenous children. Access to equitable re21 productive health care, including abortion services, 

22 has always been deficient in the United States for 

23 Black, Indigenous, and other People of Color 

24 (BIPOC) and their families. Transgender, non25 binary, and gender expansive individuals, and speVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00843 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 cifically those who are Black, disabled, and at the 

2 intersections of multiple forms of oppression, also 

3 experience inequitable access to abortion services due 

4 to systemic violence. Centering abortion rights and 

5 access as a ‘‘women’s health’’ issue restricts access 

6 to those with reproductive needs who do not identify 

7 as cisgender women. In order to work towards repro8 ductive justice for all communities, transgender, 

9 nonbinary, and gender expansive individuals must be 

10 centered in conversations of abortion access. Improv11 ing abortion access for this community requires a 

12 gender-neutral approach to abortion care, rights, 

13 and justice policy. 

14 (4) The legacy of restrictions on reproductive 

15 health, rights, and justice is not a dated vestige of 

16 a dark history. Access to abortion services is ob17 structed across the United States in various ways, 

18 including blockades of health care facilities and asso19 ciated violence, prohibitions of, and restrictions on, 

20 insurance coverage, parental involvement laws (noti21 fication and consent), restrictions that shame and 

22 stigmatize people seeking abortion services, and 

23 medically unnecessary regulations that neither con24 fer any health benefit nor further the safety of abor25 tion services, but which harm people by delaying, 


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1 complicating access to, and reducing the availability 

2 of, abortion services. As of December 2, 2021, 19 

3 States have enacted 106 restrictions, including 12 

4 new abortion bans, making 2021 the year with the 

5 highest number of restrictions passed since Roe v. 

6 Wade was decided in 1973. Additionally, 21 States 

7 are poised to immediately ban or significantly re8 strict access to abortion services if the Supreme 

9 Court chooses to overturn or weaken Roe v. Wade. 

10 These unprecedented attacks on abortion rights and 

11 access fall especially heavily on people with low in12 comes, BIPOC, immigrants, young people, people 

13 with disabilities, those living in rural and other 

14 medically underserved areas, and transgender, non15 binary, and gender expansive individuals. 

16 (5) Since 1976, the Federal Government has 

17 withheld funds for abortion coverage in most cir18 cumstances through the Hyde amendment and simi19 lar coverage restrictions, affecting individuals of re20 productive age in the United States who are insured 

21 through the Medicaid program, as well as individuals 

22 who receive insurance or care through other Federal 

23 health plans and programs. Of women aged 15 to 44 

24 enrolled in Medicaid in 2017, 55 percent lived in the 

25 35 States and the District of Columbia that do not 


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1 cover abortion, except in limited circumstances. This 

2 amounts to roughly 7,300,000 women of reproduc3 tive age, including 3,100,000 women living below the 

4 Federal poverty level. Women of color are dispropor5 tionately likely to be insured by the Medicaid pro6 gram, and nationwide, 32 percent of Black women 

7 and 27 percent of Hispanic women aged 15 to 44 

8 were enrolled in Medicaid in 2017, compared with 

9 16 percent of White women. 

10 (6) Abortion-specific restrictions are even more 

11 compounded by the ongoing criminalization of people 

12 who are pregnant, including those who are incarcer13 ated, living with HIV, or with substance use dis14 orders. These communities already experience health 

15 inequities due to social, political, and environmental 

16 inequities, and restrictions on abortion services exac17 erbate these harms. Removing medically unjustified 

18 restrictions on abortion services would constitute one 

19 important step on the path toward realizing repro20 ductive justice by ensuring that the full range of re21 productive health care is accessible to all who need 

22 it. 

23 (7) Abortion-specific restrictions are a tool of 

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1 productive needs. These paternalistic restrictions 

2 rely on and reinforce harmful stereotypes about gen3 der roles, people’s decision making, and people’s 

4 need for protection instead of support, undermining 

5 their ability to control their own lives and well-being. 

6 These restrictions harm the basic autonomy, dignity, 

7 and equality of individuals with reproductive health 

8 needs, and their ability to participate in the social 

9 and economic life of the Nation. 

10 (8) Many abortion-specific restrictions do not 

11 confer any health or safety benefits on the patient. 

12 Instead, these restrictions have the purpose and ef13 fect of unduly burdening people’s personal and pri14 vate medical decisions to end their pregnancies by 

15 making access to abortion services more difficult, 

16 invasive, and costly, often forcing people to travel 

17 significant distances and make multiple unnecessary 

18 visits to the provider, and in some cases, foreclosing 

19 the option altogether. 

20 (9) Congress has used its authority in the past 

21 to protect access to abortion services and health care 

22 providers’ ability to provide abortion services. In the 

23 early 1990s, protests and blockades at health care 

24 facilities where abortion services were provided, and 

25 associated violence, increased dramatically and 


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1 reached crisis level, requiring congressional action. 

2 Congress passed the Freedom of Access to Clinic 

3 Entrances Act (Public Law 103–259; 108 Stat. 694) 

4 to address that situation and protect physical access 

5 to abortion services. 

6 (10) Congressional action is necessary to put an 

7 end to harmful restrictions, to federally protect ac8 cess to abortion services for everyone regardless of 

9 where they live, and to protect the ability of health 

10 care providers to provide these services in a safe and 

11 accessible manner. 

12 (11) The Equal Access to Abortion Coverage in 

13 Health Insurance Act of 2021 or the EACH Act of 

14 2021 (H.R. 2234, S. 1021) introduced in the 117th 

15 Congress, would reverse the Hyde amendment and 

16 related abortion coverage restrictions. It would cre17 ate an enforceable statutory right for people who re18 ceive health coverage or care through enumerated 

19 Federal programs (including Medicaid, the Chil20 dren’s Health Insurance Program, Medicare, and the 

21 Indian Health Service, among others) and plans (in22 cluding government-sponsored health insurance due 

23 to a current or former employment relationship) to 

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1 dividuals eligible to receive health care in Federal fa2 cilities or in facilities with which it contracts to pro3 vide health care, such as immigration detention cen4 ters. It also prohibits the Federal Government from 

5 prohibiting, restricting, or otherwise inhibiting State 

6 or local governments or private health insurance 

7 issuers from providing abortion coverage. 

8 (12) The Women’s Health Protection Act of 

9 2021 (H.R. 3755, S. 1975) introduced in the 117th 

10 Congress, would establish an enforceable statutory 

11 right for health care providers to provide, and abor12 tion patients to receive, abortions free from medi13 cally unnecessary restrictions, limitations, and bans 

14 that delay, and at times, completely obstruct, access 

15 to abortion. 

16 (b) SENSE OF CONGRESS.—It is the sense of Con17 gress that eliminating the Hyde amendment, enacting the 

18 Equal Access to Abortion Coverage in Health Insurance 

19 Act of 2021, and enacting the Women’s Health Protection 

20 Act of 2021, are critical to— 

21 (1) promoting equitable abortion access, includ22 ing coverage, for all who seek care; 

23 (2) creating enforceable rights to receive, and 

24 receive coverage for, such care; 


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1 (3) advancing equitable access to comprehensive 

2 health coverage, which cannot be achieved without 

3 abortion coverage; and 

4 (4) alleviating urgent racial, gender, and other 

5 inequities in health and health care and cor6 responding reproductive injustices. 

7 SEC. 5402. EMERGENCY CONTRACEPTION EDUCATION AND 

8 INFORMATION PROGRAMS. 

9 (a) EMERGENCY CONTRACEPTION PUBLIC EDU10 CATION PROGRAM.— 

11 (1) IN GENERAL.—The Secretary, acting 

12 through the Director of the Centers for Disease 

13 Control and Prevention, shall develop and dissemi14 nate to the public medically accurate and complete 

15 information on emergency contraceptives. 

16 (2) DISSEMINATION.—The Secretary may dis17 seminate medically accurate and complete informa18 tion under paragraph (1) directly or through ar19 rangements with nonprofit organizations, community 

20 health workers, including promotores, consumer 

21 groups, institutions of higher education, clinics, the 

22 media, and Federal, State, and local agencies. 

23 (3) INFORMATION.—The information dissemi24 nated under paragraph (1) shall— 


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1 (A) include, at a minimum, a description 

2 of emergency contraceptives and an explanation 

3 of the use, safety, efficacy, affordability, and 

4 availability, including over-the-counter access, 

5 of such contraceptives and options for access to 

6 such contraceptives without cost-sharing 

7 through insurance and other programs; and 

8 (B) be pilot tested for consumer com9 prehension, cultural and linguistic appropriate10 ness, and acceptance of the messages across 

11 geographically, racially, ethnically, and linguis12 tically diverse populations. 

13 (b) EMERGENCY CONTRACEPTION INFORMATION

14 PROGRAM FOR HEALTH CARE PROVIDERS.— 

15 (1) IN GENERAL.—The Secretary, acting 

16 through the Administrator of the Health Resources 

17 and Services Administration and in consultation 

18 with major medical and public health organizations, 

19 shall develop and disseminate to health care pro20 viders, including pharmacists, information on emer21 gency contraceptives. 

22 (2) INFORMATION.—The information dissemi23 nated under paragraph (1) shall include, at a min24 imum— 


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1 (A) information describing the use, safety, 

2 efficacy, and availability of emergency contra3 ceptives, and options for access without cost4 sharing through insurance and other programs; 

5 (B) a recommendation regarding the use of 

6 such contraceptives; and 

7 (C) information explaining how to obtain 

8 copies of the information developed under sub9 section (a) for distribution to the patients of 

10 the providers. 

11 (c) DEFINITIONS.—In this section: 

12 (1) HEALTH CARE PROVIDER.—The term 

13 ‘‘health care provider’’ means an individual who is li14 censed or certified under State law to provide health 

15 care services and who is operating within the scope 

16 of such license. Such term shall include a phar17 macist. 

18 (2) INSTITUTION OF HIGHER EDUCATION.—The 

19 term ‘‘institution of higher education’’ has the same 

20 meaning given such term in section 101(a) of the 

21 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 

22 (3) SECRETARY.—The term ‘‘Secretary’’ means 

23 the Secretary of Health and Human Services. 

24 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section 


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1 such sums as may be necessary for each of the fiscal years 

2 2023 through 2027. 

3 SEC. 5403. DUTIES OF PHARMACIES TO ENSURE PROVISION 

4 OF FDA-APPROVED CONTRACEPTION. 

5 Part B of title II of the Public Health Service Act 

6 (42 U.S.C. 238 et seq.) is amended by adding at the end 

7 the following: 

8 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 

9 OF FDA-APPROVED CONTRACEPTION. 

10 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 

11 pharmacy that receives Food and Drug Administration12 approved drugs or devices in interstate commerce shall 

13 maintain compliance with the following: 

14 ‘‘(1) If a customer requests a contraceptive or 

15 a medication related to a contraceptive, including 

16 emergency contraception, that is in stock, the phar17 macy shall ensure that the contraceptive is provided 

18 to the customer without delay. 

19 ‘‘(2) If a customer requests a contraceptive or 

20 a medication related to a contraceptive that is not 

21 in stock and the pharmacy in the normal course of 

22 business stocks contraception, the pharmacy shall 

23 immediately inform the customer that the contracep24 tive is not in stock and without delay offer the cus25 tomer the following options: 


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1 ‘‘(A) If the customer prefers to obtain the 

2 contraceptive or a medication related to a con3 traceptive through a referral or transfer, the 

4 pharmacy shall— 

5 ‘‘(i) locate a pharmacy of the cus6 tomer’s choice or the closest pharmacy 

7 confirmed to have the contraceptive or a 

8 medication related to a contraceptive in 

9 stock; and 

10 ‘‘(ii) refer the customer or transfer 

11 the prescription to that pharmacy. 

12 ‘‘(B) If the customer prefers for the phar13 macy to order the contraceptive or a medication 

14 related to a contraceptive, the pharmacy shall 

15 obtain the contraceptive or medication under 

16 the pharmacy’s standard procedure for expe17 dited ordering of medication and notify the cus18 tomer when the contraceptive or medication ar19 rives. 

20 ‘‘(3) The pharmacy shall ensure that— 

21 ‘‘(A) the pharmacy does not operate an en22 vironment in which customers are intimidated, 

23 threatened, or harassed in the delivery of serv24 ices relating to a request for contraception or a 

25 medication related to a contraceptive; 


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1 ‘‘(B) the pharmacy’s employees do not 

2 interfere with or obstruct the delivery of serv3 ices relating to a request for contraception or a 

4 medication related to a contraceptive; 

5 ‘‘(C) the pharmacy’s employees do not in6 tentionally misrepresent or deceive customers 

7 about the availability of a contraceptive or a 

8 medication related to a contraceptive, or the 

9 mechanism of action of such contraceptive or 

10 medication; 

11 ‘‘(D) the pharmacy’s employees do not 

12 breach medical confidentiality with respect to a 

13 request for a contraceptive or a medication re14 lated to a contraceptive or threaten to breach 

15 such confidentiality; or 

16 ‘‘(E) the pharmacy’s employees do not 

17 refuse to return a valid, lawful prescription for 

18 a contraceptive or a medication related to a 

19 contraceptive upon customer request. 

20 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY

21 STOCKED.—Nothing in subsection (a)(2) shall be con22 strued to require any pharmacy to comply with such sub23 section if the pharmacy does not ordinarily stock contra24 ceptives or a medication related to a contraceptive in the 

25 normal course of business. 


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1 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR2 MACY PRACTICE.—This section does not prohibit a phar3 macy from refusing to provide a contraceptive or a medi4 cation related to a contraceptive to a customer in accord5 ance with any of the following: 

6 ‘‘(1) If it is unlawful to dispense the contracep7 tive or a medication related to a contraceptive to the 

8 customer without a valid, lawful prescription and no 

9 such prescription is presented. 

10 ‘‘(2) If the customer is unable to pay for the 

11 contraceptive or the medication related to a contra12 ceptive. 

13 ‘‘(3) If the employee of the pharmacy refuses to 

14 provide the contraceptive or a medication related to 

15 a contraceptive on the basis of a professional clinical 

16 judgment. 

17 ‘‘(d) RELATION TO OTHER LAW.— 

18 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 

19 this section shall be construed to invalidate or limit 

20 rights, remedies, procedures, or legal standards 

21 under title VII of the Civil Rights Act of 1964. 

22 ‘‘(2) CERTAIN CLAIMS.—The Religious Free23 dom Restoration Act of 1993 shall not provide a 

24 basis for a claim concerning, or a defense to a claim 


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1 under, this section, or provide a basis for challenging 

2 the application or enforcement of this section. 

3 ‘‘(e) PREEMPTION.—This section does not preempt 

4 any provision of State law or any professional obligation 

5 made applicable by a State board or other entity respon6 sible for licensing or discipline of pharmacies or phar7 macists, to the extent that such State law or professional 

8 obligation provides protections for customers that are 

9 greater than the protections provided by this section. 

10 ‘‘(f) ENFORCEMENT.— 

11 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio12 lates a requirement of subsection (a) is liable to the 

13 United States for a civil penalty in an amount not 

14 exceeding $1,000 per day of violation, not to exceed 

15 $100,000 for all violations adjudicated in a single 

16 proceeding. 

17 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 

18 aggrieved as a result of a violation of a requirement 

19 of subsection (a) may, in any court of competent ju20 risdiction, commence a civil action against the phar21 macy involved to obtain appropriate relief, including 

22 actual and punitive damages, injunctive relief, and a 

23 reasonable attorney’s fee and cost. 

24 ‘‘(3) LIMITATIONS.—A civil action under para25 graph (1) or (2) may not be commenced against a 


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1 pharmacy after the expiration of the 5-year period 

2 beginning on the date on which the pharmacy alleg3 edly engaged in the violation involved. 

4 ‘‘(g) DEFINITIONS.—In this section: 

5 ‘‘(1) CONTRACEPTION.—The term ‘contracep6 tion’ or ‘contraceptive’ means any drug or device ap7 proved by the Food and Drug Administration to pre8 vent pregnancy. 

9 ‘‘(2) EMPLOYEE.—The term ‘employee’ means 

10 a person hired, by contract or any other form of an 

11 agreement, by a pharmacy. 

12 ‘‘(3) MEDICATION RELATED TO A CONTRACEP13 TIVE.—The term ‘medication related to a contracep14 tive’ means any drug or device approved by the Food 

15 and Drug Administration that a medical professional 

16 determines necessary to use before or in conjunction 

17 with a contraceptive. 

18 ‘‘(4) PHARMACY.—The term ‘pharmacy’ means 

19 an entity that— 

20 ‘‘(A) is authorized by a State to engage in 

21 the business of selling prescription drugs at re22 tail; and 

23 ‘‘(B) employs one or more employees. 


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1 ‘‘(5) PRODUCT.—The term ‘product’ means a 

2 Food and Drug Administration-approved drug or de3 vice. 

4 ‘‘(6) PROFESSIONAL CLINICAL JUDGMENT.— 

5 The term ‘professional clinical judgment’ means the 

6 use of professional knowledge and skills to form a 

7 clinical judgment, in accordance with prevailing 

8 medical standards. 

9 ‘‘(7) WITHOUT DELAY.—The term ‘without 

10 delay’, with respect to a pharmacy providing, pro11 viding a referral for, or ordering contraception, or 

12 transferring the prescription for contraception, 

13 means within the usual and customary timeframe at 

14 the pharmacy for providing, providing a referral for, 

15 or ordering other products, or transferring the pre16 scription for other products, respectively. 

17 ‘‘(h) EFFECTIVE DATE.—This section shall take ef18 fect on the 31st day after the date of the enactment of 

19 this section, without regard to whether the Secretary has 

20 issued any guidance or final rule regarding this section.’’. 

21 SEC. 5404. REAL EDUCATION AND ACCESS FOR HEALTHY 

22 YOUTH. 

23 (a) PURPOSE.—The purpose of this section is to pro24 vide young people with sex education and sexual health 

25 services that— 


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1 (1) promote and uphold the rights of young 

2 people to information and services that empower 

3 them to make decisions about their bodies, health, 

4 sexuality, families, and communities in all areas of 

5 life; 

6 (2) are evidence-informed, comprehensive in 

7 scope, confidential, equitable, accessible, medically 

8 accurate and complete, age and developmentally ap9 propriate, culturally responsive, and trauma-in10 formed and resilience-oriented; 

11 (3) provide information about the prevention, 

12 treatment, and care of pregnancy, sexually trans13 mitted infections, and interpersonal violence; 

14 (4) provide information about the importance of 

15 consent as a basis for healthy relationships and for 

16 autonomy in health care; 

17 (5) provide information on gender roles and 

18 gender discrimination; 

19 (6) provide information on the historical and 

20 current condition in which education and health sys21 tems, policies, programs, services, and practices have 

22 uniquely and adversely impacted Black, Indigenous, 

23 Latinx, Asian, Asian American and Pacific Islander, 

24 and other People of Color; and 


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1 (7) redress inequities in the delivery of sex edu2 cation and sexual health services to marginalized 

3 young people. 

4 (b) DEFINITIONS.—In this section: 

5 (1) AGE AND DEVELOPMENTALLY APPRO6 PRIATE.—The term ‘‘age and developmentally appro7 priate’’ means topics, messages, and teaching meth8 ods suitable to particular ages, age groups, or devel9 opmental levels, based on cognitive, emotional, so10 cial, and behavioral capacity of most young people at 

11 that age level. 

12 (2) CHARACTERISTICS OF EFFECTIVE PRO13 GRAMS.—The term ‘‘characteristics of effective pro14 grams’’ means the aspects of evidence-informed pro15 grams, including development, content, and imple16 mentation of such programs, that— 

17 (A) have been shown to be effective in 

18 terms of increasing knowledge, clarifying values 

19 and attitudes, increasing skills, and impacting 

20 behavior; and 

21 (B) are widely recognized by leading med22 ical and public health agencies to be effective in 

23 changing sexual behaviors that lead to sexually 

24 transmitted infections, unintended pregnancy, 

25 and interpersonal violence among young people. 


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1 (3) CONSENT.—The term ‘‘consent’’ means af2 firmative, conscious, and voluntary agreement to en3 gage in interpersonal, physical, or sexual activity. 

4 (4) CULTURALLY RESPONSIVE.—The term ‘‘cul5 turally responsive’’ means education and services 

6 that— 

7 (A) embrace and actively engage and ad8 just to young people and their various cultural 

9 identities; 

10 (B) recognize the ways in which many 

11 marginalized young people face unique barriers 

12 in our society that result in increased adverse 

13 health outcomes and associated stereotypes; and 

14 (C) may address the ways in which racism 

15 has shaped national health care policy, the last16 ing historical trauma associated with reproduc17 tive health experiments and forced sterilizations 

18 of Black, Latinx, and Indigenous communities, 

19 or sexual stereotypes assigned to young People 

20 of Color or LGBTQ+ people. 

21 (5) EVIDENCE-INFORMED.—The term ‘‘evi22 dence-informed’’ means incorporates characteristics, 

23 content, or skills that have been proven to be effec24 tive through evaluation in changing sexual behavior. 


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1 (6) GENDER EXPRESSION.—The term ‘‘gender 

2 expression’’ means the expression of one’s gender, 

3 such as through behavior, clothing, haircut, or voice, 

4 and which may or may not conform to socially de5 fined behaviors and characteristics typically associ6 ated with being either masculine or feminine. 

7 (7) GENDER IDENTITY.—The term ‘‘gender 

8 identity’’ means the gender-related identity, appear9 ance, mannerisms, or other gender-related character10 istics of an individual, regardless of the individual’s 

11 designated sex at birth. 

12 (8) INCLUSIVE.—The term ‘‘inclusive’’ means 

13 content and skills that ensure marginalized young 

14 people are valued, respected, centered, and sup15 ported in sex education instruction and materials. 

16 (9) INSTITUTION OF HIGHER EDUCATION.—The 

17 term ‘‘institution of higher education’’ has the 

18 meaning given the term in section 101 of the Higher 

19 Education Act of 1965 (20 U.S.C. 1001). 

20 (10) INTERPERSONAL VIOLENCE.—The term 

21 ‘‘interpersonal violence’’ means abuse, assault, bul22 lying, dating violence, domestic violence, harassment, 

23 intimate partner violence, or stalking. 

24 (11) MARGINALIZED YOUNG PEOPLE.—The 

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1 ple who are disadvantaged by underlying structural 

2 barriers and social inequities, including young people 

3 who are— 

4 (A) Black, Indigenous, and other People of 

5 Color; 

6 (B) immigrants; 

7 (C) in contact with the foster care system; 

8 (D) in contact with the juvenile justice sys9 tem; 

10 (E) experiencing homelessness; 

11 (F) pregnant or parenting; 

12 (G) lesbian, gay, bisexual, transgender, or 

13 queer; 

14 (H) living with HIV; 

15 (I) living with disabilities; 

16 (J) from families with low incomes; or 

17 (K) living in rural areas. 

18 (12) MEDICALLY ACCURATE AND COMPLETE.— 

19 The term ‘‘medically accurate and complete’’ means 

20 that— 

21 (A) the information provided through the 

22 education is verified or supported by the weight 

23 of research conducted in compliance with ac24 cepted scientific methods and is published in 

25 peer-reviewed journals, where applicable; or 


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1 (B) the education contains information 

2 that leading professional organizations and 

3 agencies with relevant expertise in the field rec4 ognize as accurate, objective, and complete. 

5 (13) RESILIENCE.—The term ‘‘resilience’’ 

6 means the ability to adapt to trauma and tragedy. 

7 (14) SECRETARY.—The term ‘‘Secretary’’ 

8 means the Secretary of Health and Human Services. 

9 (15) SEX EDUCATION.—The term ‘‘sex edu10 cation’’ means high-quality teaching and learning 

11 that— 

12 (A) is delivered, to the maximum extent 

13 practicable, following the National Sexuality 

14 Education Standards of the Future of Sex Edu15 cation Initiative; 

16 (B) is about a broad variety of topics re17 lated to sex and sexuality, including— 

18 (i) puberty and adolescent develop19 ment; 

20 (ii) sexual and reproductive anatomy 

21 and physiology; 

22 (iii) sexual orientation, gender iden23 tity, and gender expression; 

24 (iv) contraception, pregnancy, and re25 production; 


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1 (v) HIV and other STIs; 

2 (vi) consent and healthy relationships; 

3 and 

4 (vii) interpersonal violence; 

5 (C) explores values and beliefs about such 

6 topics; and 

7 (D) helps young people in gaining the 

8 skills that are needed to navigate relationships 

9 and manage one’s own sexual health. 

10 (16) SEXUAL DEVELOPMENT.—The term ‘‘sex11 ual development’’ means the lifelong process of phys12 ical, behavioral, cognitive, and emotional growth and 

13 change as it relates to an individual’s sexuality and 

14 sexual maturation, including puberty, identity devel15 opment, socio-cultural influences, and sexual behav16 iors. 

17 (17) SEXUAL HEALTH SERVICES.—The term 

18 ‘‘sexual health services’’ includes— 

19 (A) sexual health information, education, 

20 and counseling; 

21 (B) all methods of contraception approved 

22 by the Food and Drug Administration; 

23 (C) routine gynecological care, including 

24 human papillomavirus (HPV) vaccines and can25 cer screenings; 


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1 (D) pre-exposure prophylaxis or post-expo2 sure prophylaxis; 

3 (E) substance use and mental health serv4 ices; 

5 (F) interpersonal violence survivor services; 

6 and 

7 (G) other prevention, care, or treatment 

8 services. 

9 (18) SEXUAL ORIENTATION.—The term ‘‘sexual 

10 orientation’’ means an individual’s romantic, emo11 tional, or sexual attraction to other people. 

12 (19) TRAUMA.—The term ‘‘trauma’’ means a 

13 response to an event, series of events, or set of cir14 cumstances that is experienced or witnessed by an 

15 individual or group of people as physically or emo16 tionally harmful or life-threatening with lasting ad17 verse effects on their functioning and mental, phys18 ical, social, emotional, or spiritual well-being. 

19 (20) TRAUMA-INFORMED AND RESILIENCE-ORI20 ENTED.—The term ‘‘trauma-informed and resil21 ience-oriented’’ means an approach that realizes the 

22 prevalence of trauma, recognizes the various ways 

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1 ience can be built, and responds by putting this 

2 knowledge into practice. 

3 (21) YOUNG PEOPLE.—The term ‘‘young peo4 ple’’ means individuals who are ages 10 through 29 

5 at the time of commencement of participation in a 

6 project supported under this section. 

7 (22) YOUTH-FRIENDLY SEXUAL HEALTH SERV8 ICES.—The term ‘‘youth-friendly sexual health serv9 ices’’ means sexual health services that are provided 

10 in a confidential, equitable, and accessible manner 

11 that makes it easy and comfortable for young people 

12 to seek out and receive services. 

13 (c) GRANTS FOR SEX EDUCATION AT ELEMENTARY

14 AND SECONDARY SCHOOLS AND YOUTH-SERVING ORGA15 NIZATIONS.— 

16 (1) PROGRAM AUTHORIZED.—The Secretary, in 

17 coordination with the Secretary of Education, shall 

18 award grants, on a competitive basis, to eligible enti19 ties to enable such eligible entities to carry out 

20 projects that provide young people with sex edu21 cation. 

22 (2) DURATION.—Grants awarded under this 

23 subsection shall be for a period of 5 years. 


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1 (3) ELIGIBLE ENTITY.—In this subsection, the 

2 term ‘‘eligible entity’’ means a public or private enti3 ty that delivers health education to young people. 

4 (4) APPLICATIONS.—An eligible entity desiring 

5 a grant under this subsection shall submit an appli6 cation to the Secretary at such time, in such man7 ner, and containing such information as the Sec8 retary may require. 

9 (5) PRIORITY.—In awarding grants under this 

10 subsection, the Secretary shall give priority to eligi11 ble entities that are— 

12 (A) State educational agencies or local 

13 educational agencies; or 

14 (B) Indian Tribes or Tribal organizations, 

15 as defined in section 4 of the Indian Self-Deter16 mination and Education Assistance Act (25 

17 U.S.C. 5304). 

18 (6) USE OF FUNDS.—Each eligible entity that 

19 receives a grant under this subsection shall use the 

20 grant funds to carry out a project that provides 

21 young people with sex education. 

22 (d) GRANTS FOR SEX EDUCATION AT INSTITUTIONS

23 OF HIGHER EDUCATION.— 

24 (1) PROGRAM AUTHORIZED.—The Secretary, in 

25 coordination with the Secretary of Education, shall 


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1 award grants, on a competitive basis, to institutions 

2 of higher education or consortia of such institutions 

3 to enable such institutions to provide students with 

4 age and developmentally appropriate sex education. 

5 (2) DURATION.—Grants awarded under this 

6 subsection shall be for a period of 5 years. 

7 (3) APPLICATIONS.—An institution of higher 

8 education or consortium of such institutions desiring 

9 a grant under this subsection shall submit an appli10 cation to the Secretary at such time, in such man11 ner, and containing such information as the Sec12 retary may require. 

13 (4) PRIORITY.—In awarding grants under this 

14 subsection, the Secretary shall give priority to an in15 stitution of higher education that— 

16 (A) has an enrollment of needy students, 

17 as defined in section 318(b) of the Higher Edu18 cation Act of 1965 (20 U.S.C. 1059e(b)); 

19 (B) is a Hispanic-serving institution, as 

20 defined in section 502(a) of such Act (20 

21 U.S.C. 1101a(a)); 

22 (C) is a Tribal College or University, as 

23 defined in section 316(b) of such Act (20 

24 U.S.C. 1059c(b)); 


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1 (D) is an Alaska Native-serving institution, 

2 as defined in section 317(b) of such Act (20 

3 U.S.C. 1059d(b)); 

4 (E) is a Native Hawaiian-serving institu5 tion, as defined in section 317(b) of such Act 

6 (20 U.S.C. 1059d(b)); 

7 (F) is a Predominantly Black Institution, 

8 as defined in section 318(b) of such Act (20 

9 U.S.C. 1059e(b)); 

10 (G) is a Native American-serving, non11 tribal institution, as defined in section 319(b) 

12 of such Act (20 U.S.C. 1059f(b)); 

13 (H) is an Asian American and Native 

14 American Pacific Islander-serving institution, as 

15 defined in section 320(b) of such Act (20 

16 U.S.C. 1059g(b)); or 

17 (I) is a minority institution, as defined in 

18 section 365 of such Act (20 U.S.C. 1067k), 

19 with an enrollment of needy students, as de20 fined in section 312 of such Act (20 U.S.C. 

21 1058). 

22 (5) USES OF FUNDS.—An institution of higher 

23 education or consortium of such institutions receiv24 ing a grant under this subsection shall use grant 

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1 grate sex education into the institution of higher 

2 education in order to reach a large number of stu3 dents, by carrying out 1 or more of the following ac4 tivities: 

5 (A) Adopting and incorporating age and 

6 developmentally appropriate sex education into 

7 student orientation, general education, or 

8 courses. 

9 (B) Developing or adopting and imple10 menting educational programming outside of 

11 class that delivers age and developmentally ap12 propriate sex education to students. 

13 (C) Developing or adopting and imple14 menting innovative technology-based approaches 

15 to deliver age and developmentally appropriate 

16 sex education to students. 

17 (D) Developing or adopting and imple18 menting peer-led activities to generate discus19 sion, educate, and raise awareness among stu20 dents about age and developmentally appro21 priate sex education. 

22 (E) Developing or adopting and imple23 menting policies and practices to link students 

24 to sexual health services. 

25 (e) GRANTS FOR EDUCATOR TRAINING.— 


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1 (1) PROGRAM AUTHORIZED.—The Secretary, in 

2 coordination with the Secretary of Education, shall 

3 award grants, on a competitive basis, to eligible enti4 ties to enable such eligible entities to carry out the 

5 activities described in paragraph (5). 

6 (2) DURATION.—Grants awarded under this 

7 subsection shall be for a period of 5 years. 

8 (3) ELIGIBLE ENTITY.—In this subsection, the 

9 term ‘‘eligible entity’’ means— 

10 (A) a State educational agency or local 

11 educational agency; 

12 (B) an Indian Tribe or Tribal organiza13 tion, as defined in section 4 of the Indian Self14 Determination and Education Assistance Act 

15 (25 U.S.C. 5304); 

16 (C) a State or local department of health; 

17 (D) an educational service agency; 

18 (E) a nonprofit institution of higher edu19 cation or a consortium of such institutions; or 

20 (F) a national or statewide nonprofit orga21 nization or consortium of nonprofit organiza22 tions that has as its primary purpose the im23 provement of provision of sex education through 

24 training and effective teaching of sex education. 


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1 (4) APPLICATION.—An eligible entity desiring a 

2 grant under this subsection shall submit an applica3 tion to the Secretary at such time, in such manner, 

4 and containing such information as the Secretary 

5 may require. 

6 (5) AUTHORIZED ACTIVITIES.— 

7 (A) REQUIRED ACTIVITY.—Each eligible 

8 entity receiving a grant under this subsection 

9 shall use grant funds for professional develop10 ment and training of relevant teachers, health 

11 educators, faculty, administrators, and staff, in 

12 order to increase effective teaching of sex edu13 cation to young people. 

14 (B) PERMISSIBLE ACTIVITIES.—Each eligi15 ble entity receiving a grant under this sub16 section may use grant funds to— 

17 (i) provide training and support for 

18 educators about the content, skills, and 

19 professional disposition needed to imple20 ment sex education effectively; 

21 (ii) develop and provide training and 

22 support to educators on incorporating anti23 racist and gender-inclusive policies and 

24 practices in sex education; 


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1 (iii) support the dissemination of in2 formation on effective practices and re3 search findings concerning the teaching of 

4 sex education; 

5 (iv) support research on— 

6 (I) effective sex education teach7 ing practices; and 

8 (II) the development of assess9 ment instruments and strategies to 

10 document— 

11 (aa) young people’s under12 standing of sex education; and 

13 (bb) the effects of sex edu14 cation; 

15 (v) convene conferences on sex edu16 cation, in order to effectively train edu17 cators in the provision of sex education; 

18 and 

19 (vi) develop and disseminate appro20 priate research-based materials to foster 

21 sex education. 

22 (C) SUBGRANTS.—Each eligible entity re23 ceiving a grant under this subsection may 

24 award subgrants to nonprofit organizations that 

25 possess a demonstrated record of providing 


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1 training to teachers, health educators, faculty, 

2 administrators, and staff on sex education to— 

3 (i) train educators in sex education; 

4 (ii) support internet or distance learn5 ing related to sex education; 

6 (iii) promote rigorous academic stand7 ards and assessment techniques to guide 

8 and measure student performance in sex 

9 education; 

10 (iv) encourage replication of best 

11 practices and model programs to promote 

12 sex education; 

13 (v) develop and disseminate effective, 

14 research-based sex education learning ma15 terials; or 

16 (vi) develop academic courses on the 

17 pedagogy of sex education at institutions 

18 of higher education. 

19 (f) AUTHORIZATION OF GRANTS TO SUPPORT THE

20 DELIVERY OF SEXUAL HEALTH SERVICES TO

21 MARGINALIZED YOUNG PEOPLE.— 

22 (1) PROGRAM AUTHORIZED.—The Secretary 

23 shall award grants, on a competitive basis, to eligible 

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1 friendly sexual health services to marginalized young 

2 people. 

3 (2) DURATION.—Grants awarded under this 

4 subsection shall be for a period of 5 years. 

5 (3) ELIGIBLE ENTITY.—In this subsection, the 

6 term ‘‘eligible entity’’ means— 

7 (A) a public or private youth-serving orga8 nization; or 

9 (B) a covered entity, as defined in section 

10 340B of the Public Health Service Act (42 

11 U.S.C. 256b). 

12 (4) APPLICATIONS.—An eligible entity desiring 

13 a grant under this subsection shall submit an appli14 cation to the Secretary at such time, in such man15 ner, and containing such information as the Sec16 retary may require. 

17 (5) USES OF FUNDS.—Each eligible entity that 

18 receives a grant under this subsection may use the 

19 grant funds to— 

20 (A) develop and implement an evidence-in21 formed project to deliver sexual health services 

22 to marginalized young people; 

23 (B) establish, alter, or modify staff posi24 tions, service delivery policies and practices, 

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1 ronments, service delivery schedules, or other 

2 services components in order to increase youth3 friendly sexual health services to marginalized 

4 young people; 

5 (C) conduct outreach to marginalized 

6 young people to invite them to participate in 

7 the eligible entity’s sexual health services and to 

8 provide feedback to inform improvements in the 

9 delivery of such services; 

10 (D) establish and refine systems of referral 

11 to connect marginalized young people to other 

12 sexual health services and supportive services; 

13 (E) establish partnerships and collabora14 tions with entities providing services to 

15 marginalized young people to link such young 

16 people to sexual health services, such as by de17 livering health services at locations where they 

18 congregate, providing transportation to loca19 tions where sexual health services are provided, 

20 or other linkages to services approaches; 

21 (F) provide evidence-informed, comprehen22 sive in scope, confidential, equitable, accessible, 

23 medically accurate and complete, age and devel24 opmentally appropriate, culturally responsive, 

25 and trauma-informed and resilience-oriented 


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1 sexual health information to marginalized 

2 young people in the languages and cultural con3 texts that are most appropriate for the 

4 marginalized young people to be served by the 

5 eligible entity; 

6 (G) promote effective communication re7 garding sexual health among marginalized 

8 young people; and 

9 (H) provide training and support for eligi10 ble entity personnel and community members 

11 who work with marginalized young people about 

12 the content, skills, and professional disposition 

13 needed to provide youth-friendly sex education 

14 and youth-friendly sexual health services. 

15 (g) REPORTING AND IMPACT EVALUATION.— 

16 (1) GRANTEE REPORT TO SECRETARY.—For 

17 each year an eligible entity receives grant funds 

18 under subsection (c), (d), (e), or (f), the eligible enti19 ty shall submit to the Secretary a report that in20 cludes— 

21 (A) the use of grant funds by the eligible 

22 entity; 

23 (B) how the use of grant funds has in24 creased the access of young people to sex edu25 cation or sexual health services; and 


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1 (C) such other information as the Sec2 retary may require. 

3 (2) SECRETARY’S REPORT TO CONGRESS.—Not 

4 later than 1 year after the date of the enactment of 

5 this Act, and annually thereafter for a period of 5 

6 years, the Secretary shall prepare and submit to 

7 Congress a report on the activities funded under this 

8 section. The Secretary’s report to Congress shall in9 clude— 

10 (A) a statement of how grants awarded by 

11 the Secretary meet the purposes described in 

12 subsection (a); and 

13 (B) information about— 

14 (i) the number of eligible entities that 

15 are receiving grant funds under sub16 sections (c), (d), (e), and (f); 

17 (ii) the specific activities supported by 

18 grant funds awarded under subsections (c), 

19 (d), (e), and (f); 

20 (iii) the number of young people 

21 served by projects funded under sub22 sections (c), (d), (e), and (f), in the aggre23 gate and disaggregated and cross-tabulated 

24 by grant program, race and ethnicity, sex, 

25 sexual orientation, gender identity, and 


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1 other characteristics determined by the 

2 Secretary (except that such disaggregation 

3 or cross-tabulation shall not be required in 

4 a case in which the results would reveal 

5 personally identifiable information about 

6 an individual young person); 

7 (iv) the number of teachers, health 

8 educators, faculty, school administrators, 

9 and staff trained under subsection (e); and 

10 (v) the status of the evaluation re11 quired under paragraph (3). 

12 (3) MULTI-YEAR EVALUATION.— 

13 (A) IN GENERAL.—Not later than 6 

14 months after the date of the enactment of this 

15 Act, the Secretary shall enter into a contract 

16 with a nonprofit organization with experience in 

17 conducting impact evaluations to conduct a 

18 multi-year evaluation on the impact of the 

19 projects funded under subsections (c), (d), (e), 

20 and (f) and to report to Congress and the Sec21 retary on the findings of such evaluation. 

22 (B) EVALUATION.—The evaluation con23 ducted under this paragraph shall— 

24 (i) be conducted in a manner con25 sistent with relevant, nationally recognized 


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1 professional and technical evaluation 

2 standards; 

3 (ii) use sound statistical methods and 

4 techniques relating to the behavioral 

5 sciences, including quasi-experimental de6 signs, inferential statistics, and other 

7 methodologies and techniques that allow 

8 for conclusions to be reached; 

9 (iii) be carried out by an independent 

10 organization that has not received a grant 

11 under subsection (c), (d), (e), or (f); and 

12 (iv) be designed to provide informa13 tion on output measures and outcome 

14 measures to be determined by the Sec15 retary. 

16 (C) REPORT.—Not later than 6 years after 

17 the date of enactment of this Act, the organiza18 tion conducting the evaluation under this para19 graph shall prepare and submit to the appro20 priate committees of Congress and the Sec21 retary a report on such evaluation. Such report 

22 shall be made publicly available, including on 

23 the website of the Department of Health and 

24 Human Services. 


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1 (h) NONDISCRIMINATION.—Activities funded under 

2 this section shall not discriminate on the basis of actual 

3 or perceived sex (including sexual orientation and gender 

4 identity), age, parental status, race, color, ethnicity, na5 tional origin, disability, or religion. Nothing in this section 

6 shall be construed to invalidate or limit rights, remedies, 

7 procedures, or legal standards available under any other 

8 Federal law or any law of a State or a political subdivision 

9 of a State, including the Civil Rights Act of 1964 (42 

10 U.S.C. 2000a et seq.), title IX of the Education Amend11 ments of 1972 (20 U.S.C. 1681 et seq.), section 504 of 

12 the Rehabilitation Act of 1973 (29 U.S.C. 794), the Amer13 icans with Disabilities Act of 1990 (42 U.S.C. 12101 et 

14 seq.), and section 1557 of the Patient Protection and Af15 fordable Care Act (42 U.S.C. 18116). 

16 (i) LIMITATION.—No Federal funds provided under 

17 this section may be used for sex education or sexual health 

18 services that— 

19 (1) withhold health-promoting or life-saving in20 formation about sexuality-related topics, including 

21 HIV; 

22 (2) are medically inaccurate or incomplete; 

23 (3) promote gender or racial stereotypes or are 

24 unresponsive to gender or racial inequities; 


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1 (4) fail to address the needs of sexually active 

2 young people; 

3 (5) fail to address the needs of pregnant or par4 enting young people; 

5 (6) fail to address the needs of survivors of 

6 interpersonal violence; 

7 (7) fail to address the needs of young people of 

8 all physical, developmental, or mental abilities; 

9 (8) fail to be inclusive of individuals with vary10 ing gender identities, gender expressions, and sexual 

11 orientations; or 

12 (9) are inconsistent with the ethical imperatives 

13 of medicine and public health. 

14 (j) AMENDMENTS TO OTHER LAWS.— 

15 (1) AMENDMENT TO THE PUBLIC HEALTH

16 SERVICE ACT.—Section 2500 of the Public Health 

17 Service Act (42 U.S.C. 300ee) is amended by strik18 ing subsections (b) through (d) and inserting the fol19 lowing: 

20 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 

21 education and information receiving funds under this title 

22 shall include information about the potential effects of in23 travenous substance use.’’. 

24 (2) AMENDMENTS TO THE ELEMENTARY AND

25 SECONDARY EDUCATION ACT OF 1965.—Section 8526 


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1 of the Elementary and Secondary Education Act of 

2 1965 (20 U.S.C. 7906) is amended— 

3 (A) by striking paragraphs (3), (5), and 

4 (6); 

5 (B) in paragraph (2), by inserting ‘‘or’’ 

6 after the semicolon; 

7 (C) by redesignating paragraph (4) as 

8 paragraph (3); and 

9 (D) in paragraph (3), as redesignated by 

10 subparagraph (C), by striking the semicolon 

11 and inserting a period. 

12 (k) FUNDING.— 

13 (1) AUTHORIZATION.—For the purpose of car14 rying out this section, there is authorized to be ap15 propriated $100,000,000 for each of fiscal years 

16 2022 through 2027. Amounts appropriated under 

17 this paragraph shall remain available until expended. 

18 (2) RESERVATIONS OF FUNDS.— 

19 (A) IN GENERAL.—Of the amount author20 ized under paragraph (1), the Secretary shall 

21 reserve— 

22 (i) not more than 30 percent for the 

23 purposes of awarding grants for sex edu24 cation at elementary and secondary schools 


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1 and youth-serving organizations under sub2 section (c); 

3 (ii) not more than 10 percent for the 

4 purpose of awarding grants for sex edu5 cation at institutions of higher education 

6 under subsection (d); 

7 (iii) not more than 15 percent for the 

8 purpose of awarding grants for educator 

9 training under subsection (e); 

10 (iv) not more than 30 percent for the 

11 purpose of awarding grants for sexual 

12 health services for marginalized youth 

13 under subsection (f); and 

14 (v) not less than 5 percent for the 

15 purpose of carrying out the reporting and 

16 impact evaluation required under sub17 section (g). 

18 (B) RESEARCH, TRAINING AND TECHNICAL

19 ASSISTANCE.—The Secretary shall reserve not 

20 less than 10 percent of the amount authorized 

21 under paragraph (1) for expenditures by the 

22 Secretary to provide, directly or through a com23 petitive grant process, research, training, and 

24 technical assistance, including dissemination of 

25 research and information regarding effective 


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1 and promising practices, providing consultation 

2 and resources, and developing resources and 

3 materials to support the activities of recipients 

4 of grants. In carrying out such functions, the 

5 Secretary shall collaborate with a variety of en6 tities that have expertise in sex education and 

7 sexual health services standards setting, design, 

8 development, delivery, research, monitoring, and 

9 evaluation. 

10 (3) REPROGRAMMING OF ABSTINENCE ONLY

11 UNTIL MARRIAGE PROGRAM FUNDING.—The unobli12 gated balance of funds made available to carry out 

13 section 510 of the Social Security Act (42 U.S.C. 

14 710) (as in effect on the day before the date of en15 actment of this Act) are hereby transferred and shall 

16 be used by the Secretary to carry out this section. 

17 The amounts transferred and made available to 

18 carry out this section shall remain available until ex19 pended. 

20 (4) REPEAL OF ABSTINENCE ONLY UNTIL MAR21 RIAGE PROGRAM.—Section 510 of the Social Secu22 rity Act (42 U.S.C. 710 et seq.) is repealed. 

23 SEC. 5405. COMPASSIONATE ASSISTANCE FOR RAPE EMER24 GENCIES. 

25 (a) MEDICARE.— 


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1 (1) LIMITATION ON PAYMENT.—Section 

2 1866(a)(1) of the Social Security Act (42 U.S.C. 

3 1395cc(a)(1)) is amended— 

4 (A) by moving the indentation of subpara5 graph (W) 2 ems to the left; 

6 (B) in subparagraph (X)— 

7 (i) by moving the indentation 2 ems 

8 to the left; and 

9 (ii) by striking ‘‘and’’ at the end; 

10 (C) in subparagraph (Y), by striking the 

11 period at the end and inserting ‘‘; and’’; and 

12 (D) by inserting after subparagraph (Y) 

13 the following new subparagraph: 

14 ‘‘(Z) in the case of a hospital or critical access 

15 hospital, to adopt and enforce a policy to ensure 

16 compliance with the requirements of subsection (l) 

17 and to meet the requirements of such subsection.’’. 

18 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 

19 the Social Security Act (42 U.S.C. 1395cc) is 

20 amended by adding at the end the following new 

21 subsection: 

22 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER23 GENCIES.— 

24 ‘‘(1) IN GENERAL.—For purposes of subsection 

25 (a)(1)(Z), a hospital meets the requirements of this 


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1 subsection if the hospital provides each of the serv2 ices described in paragraph (2) to each individual, 

3 whether or not eligible for benefits under this title 

4 or under any other form of health insurance, who 

5 comes to the hospital on or after January 1, 2022, 

6 and— 

7 ‘‘(A) who states to hospital personnel that 

8 they are victims of sexual assault; 

9 ‘‘(B) who is accompanied by an individual 

10 who states to hospital personnel that the indi11 vidual is a victim of sexual assault; or 

12 ‘‘(C) whom hospital personnel, during the 

13 course of treatment and care for the individual, 

14 have reason to believe is a victim of sexual as15 sault. 

16 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 

17 purposes of paragraph (1), the services described in 

18 this subparagraph are the following: 

19 ‘‘(A) Provision of medically and factually 

20 accurate and unbiased written and oral infor21 mation about emergency contraception that— 

22 ‘‘(i) is written in clear and concise 

23 language; 

24 ‘‘(ii) is readily comprehensible; 


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1 ‘‘(iii) includes an explanation that 

2 emergency contraceptives— 

3 ‘‘(I) have been approved by the 

4 Food and Drug Administration for in5 dividuals and are a safe and effective 

6 way to prevent pregnancy after unpro7 tected intercourse or contraceptive 

8 failure if taken in a timely manner; 

9 ‘‘(II) are more effective the soon10 er it is taken; and 

11 ‘‘(III) do not cause an abortion 

12 and cannot interrupt an established 

13 pregnancy; 

14 ‘‘(iv) meet such conditions regarding 

15 the provision of such information in lan16 guages other than English as the Secretary 

17 may establish; and 

18 ‘‘(v) are provided without regard to 

19 the ability of the individual or their family 

20 to pay costs associated with the provision 

21 of such information to the individual. 

22 ‘‘(B) Immediate offer to provide emergency 

23 contraception to the individual at the hospital 

24 and, in the case that such individual accepts 

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1 vidual of such contraception on the same day it 

2 is requested without regard to the inability of 

3 the individual or their family to pay costs asso4 ciated with the offer and provision of such con5 traception. 

6 ‘‘(C) Development and implementation of a 

7 written policy to ensure that an individual is 

8 present at the hospital, or on-call, who— 

9 ‘‘(i) has authority to dispense or pre10 scribe emergency contraception, independ11 ently, or under a protocol prepared by a 

12 physician for the administration of emer13 gency contraception at the hospital to a 

14 victim of sexual assault; and 

15 ‘‘(ii) is trained to comply with the re16 quirements of this section. 

17 ‘‘(D) Provision of medically and factually 

18 accurate and unbiased written and oral infor19 mation and counseling about post-exposure pro20 phylaxis (PEP) protocol for the prevention of 

21 HIV. 

22 ‘‘(E) Immediate offer to begin PEP to the 

23 individual at the hospital except in cases where 

24 the medical professional’s best judgement is 

25 that further evaluation is required or that such 


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1 a regimen will be substantially detrimental to 

2 the health of such individual. Such provision 

3 shall be offered regardless of the individual’s 

4 ability to pay. Hospitals shall be responsible for 

5 ensuring adequate supply of PEP medications 

6 to provide to patients. 

7 ‘‘(3) HOSPITAL DEFINED.—For purposes of 

8 this paragraph, the term ‘hospital’ includes a critical 

9 access hospital, as defined in section 

10 1861(mm)(1).’’. 

11 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 

12 Section 1903(i) of the Social Security Act (42 U.S.C. 

13 1396b(i)), as amended by section 4106(b)(2), is further 

14 amended— 

15 (1) in paragraph (27), by striking ‘‘or’’ after 

16 the semicolon; 

17 (2) in paragraph (28), by striking the period 

18 and inserting ‘‘; or’’; and 

19 (3) by inserting after paragraph (28) the fol20 lowing new paragraph: 

21 ‘‘(29) with respect to any amount expended for 

22 care or services furnished under the plan by a hos23 pital on or after January 1, 2023, unless such hos24 pital meets the requirements specified in section 

25 1866(l) for purposes of title XVIII.’’. 


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1 SEC. 5406. MENSTRUAL EQUITY FOR ALL ACT OF 2022. 

2 (a) SHORT TITLE.—This section may be cited as the 

3 ‘‘Menstrual Equity for All Act of 2022’’. 

4 (b) MENSTRUAL PRODUCTS FOR STUDENTS AT ELE5 MENTARY AND SECONDARY SCHOOLS.— 

6 (1) IN GENERAL.—Section 4108(5)(C) of the 

7 Elementary and Secondary Education Act of 1965 

8 (20 U.S.C. 7118(5)(C)) is amended— 

9 (A) in clause (vi), by striking ‘‘or’’ after 

10 the semicolon; 

11 (B) in clause (vii), by inserting ‘‘or’’ after 

12 the semicolon; and 

13 (C) by adding at the end the following: 

14 ‘‘(viii) provide free menstrual products 

15 to students who use menstrual products;’’. 

16 (2) DEFINITIONS.—Section 4102 of the Ele17 mentary and Secondary Education Act of 1965 (20 

18 U.S.C. 7112) is amended— 

19 (A) by redesignating paragraphs (6) 

20 through (8) as paragraphs (7) through (9), re21 spectively; and 

22 (B) by inserting after paragraph (5) the 

23 following: 

24 ‘‘(6) MENSTRUAL PRODUCTS.—The term ‘men25 strual products’ means sanitary napkins and tamVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00893 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 pons that conform to applicable industry stand2 ards.’’. 

3 (3) RULEMAKING.—Not later than 1 year after 

4 the date of enactment of this section, the Secretary 

5 of Education, in consultation with the Secretary of 

6 Health and Human Services, shall promulgate rules 

7 with respect to the definition of ‘‘menstrual prod8 ucts’’ in paragraph (6) of section 4102 of the Ele9 mentary and Secondary Education Act of 1965 (20 

10 U.S.C. 7112), as amended by paragraph (2). 

11 (c) MENSTRUAL PRODUCTS FOR STUDENTS AT IN12 STITUTIONS OF HIGHER EDUCATION.— 

13 (1) PURPOSE.—The purpose of this section is 

14 to alleviate— 

15 (A) the barriers to academic success faced 

16 by many college and graduate students due to 

17 the inability of such students to afford to pur18 chase menstrual products; and 

19 (B) the unique set of burdens that college 

20 and graduate students experiencing period pov21 erty face that can be compounded by lack of ac22 cess to basic needs such as housing, food, trans23 portation, and access to physical and mental 

24 health services. 


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1 (2) IN GENERAL.—The Secretary of Education 

2 shall establish a program to award grants, on a com3 petitive basis, to at least 4 institutions of higher 

4 education, to— 

5 (A) support programs that provide free 

6 menstrual products to students; and 

7 (B) report on best practices of such pro8 grams. 

9 (3) APPLICATION.—To apply for a grant under 

10 this subsection, an institution of higher education 

11 shall submit to the Secretary an application in such 

12 form, at such time, and containing such information 

13 as the Secretary determines appropriate, including 

14 an assurance that such grant will be used to carry 

15 out the activities described in paragraph (5). 

16 (4) COMMUNITY COLLEGES.—At least 50 per17 cent of the grants awarded under this subsection 

18 shall be awarded to community colleges. 

19 (5) GRANT USES.—A grant awarded under this 

20 subsection may only be used to— 

21 (A) carry out or expand activities that 

22 fund programs that support direct provision of 

23 free menstrual products to students in appro24 priate campus locations, including— 

25 (i) campus restroom facilities; 


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1 (ii) wellness centers; and 

2 (iii) on-campus residential buildings; 

3 (B) report on best practices of such pro4 grams; 

5 (C) conduct outreach to students to en6 courage participation in menstrual equity pro7 grams and services; 

8 (D) help eligible students apply for and en9 roll in local, State, and Federal public assist10 ance programs; and 

11 (E) coordinate and collaborate with gov12 ernment or community-based organizations to 

13 carry out the activities described in subpara14 graphs (A) through (D). 

15 (6) PRIORITY.—In awarding grants under this 

16 subsection, the Secretary shall prioritize— 

17 (A) institutions with Federal Pell Grant 

18 enrollment that is at least 25 percent of the 

19 total enrollment of such institution; and 

20 (B) historically Black colleges and univer21 sities, Hispanic-serving institutions, Asian 

22 American and Native American Pacific Is23 lander-serving institutions, and other minority 

24 serving institutions. 


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1 (7) MENSTRUAL PRODUCT DEFINED.—In this 

2 subsection, the term ‘‘menstrual product’’ means a 

3 sanitary napkin or tampon that conforms to industry 

4 standards. 

5 (8) AUTHORIZATION OF APPROPRIATIONS.— 

6 There are authorized to be appropriated, out of 

7 funds appropriated for a fiscal year to the Fund for 

8 the Improvement of Postsecondary Education under 

9 section 741 of the Higher Education Act of 1965 

10 (20 U.S.C. 1138), $5,000,000 to carry out the grant 

11 program under this subsection. 

12 (d) MENSTRUAL PRODUCTS FOR INCARCERATED IN13 DIVIDUALS AND DETAINEES.— 

14 (1) REQUIREMENT FOR STATES.—Not later 

15 than 180 days after the date of enactment of this 

16 section, and annually thereafter, the chief executive 

17 officer of each State that receives a grant under sub18 part 1 of part E of title I of the Omnibus Crime 

19 Control and Safe Streets Act of 1968 (34 U.S.C. 

20 10151 et seq.) (commonly referred to as the ‘‘Ed21 ward Byrne Memorial Justice Assistance Grant Pro22 gram’’) shall submit to the Attorney General a cer23 tification, in such form and containing such informa24 tion as the Attorney General may require, that— 


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1 (A) all incarcerated individuals and detain2 ees in the custody of that State, a political sub3 division thereof, or an agent of that State or a 

4 political subdivision thereof have access to men5 strual products— 

6 (i) on demand; and 

7 (ii) at no cost to such individuals and 

8 detainees; and 

9 (B) no visitor is prohibited from visiting an 

10 incarcerated individual due to the visitor’s use 

11 of menstrual products. 

12 (2) REDUCTION IN GRANT FUNDING.—If the 

13 chief executive officer of a State fails to submit a 

14 certification required under paragraph (1) during a 

15 fiscal year, the Attorney General shall reduce the 

16 amount that the State would have otherwise received 

17 under section 505 of title I of the Omnibus Crime 

18 Control and Safe Streets Act of 1968 (34 U.S.C. 

19 10156) by 20 percent for the following fiscal year. 

20 (3) REALLOCATION.—Amounts not allocated to 

21 a State under section 505 of title I of the Omnibus 

22 Crime Control and Safe Streets Act of 1968 (34 

23 U.S.C. 10156) for a fiscal year pursuant to para24 graph (2) shall be reallocated under such section to 

25 States that submit such certifications. 


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1 (4) MENSTRUAL PRODUCTS.—For the purposes 

2 of paragraph (1), the term ‘‘menstrual products’’ 

3 means sanitary napkins and tampons that conform 

4 to applicable industry standards. 

5 (5) AVAILABILITY FOR FEDERAL PRISONERS.— 

6 The Attorney General shall issue rules requiring, 

7 and the Director of the Bureau of Prisons shall take 

8 such actions as may be necessary to ensure— 

9 (A) the distribution and accessibility (with10 out charge) of menstrual products to prisoners 

11 in the custody of the Bureau of Prisons, includ12 ing any prisoner in a Federal penal or correc13 tional institution, any Federal prisoner in a 

14 State penal or correctional institution, and any 

15 Federal prisoner in a facility administered by a 

16 private detention entity; and 

17 (B) that each prisoner described in sub18 paragraph (A) who requires menstrual products 

19 may receive them in sufficient quantity. 

20 (6) AVAILABILITY FOR DETAINEES.—The Sec21 retary of Homeland Security shall take such actions 

22 as may be necessary to ensure that menstrual prod23 ucts are distributed and made accessible to each 

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1 rity, including any alien in a facility administered by 

2 a private detention entity, at no expense to the alien. 

3 (e) MENSTRUAL PRODUCTS AVAILABILITY FOR

4 HOMELESS INDIVIDUALS UNDER EMERGENCY FOOD AND

5 SHELTER GRANT PROGRAM.—Section 316(a) of the 

6 McKinney-Vento Homeless Assistance Act (42 U.S.C. 

7 11346(a)) is amended— 

8 (1) in paragraph (5), by striking ‘‘and’’ at the 

9 end; 

10 (2) in paragraph (6), by striking the period at 

11 the end and inserting ‘‘; and’’; and 

12 (3) by adding at the end the following new 

13 paragraph: 

14 ‘‘(7) guidelines that ensure that amounts pro15 vided under the program to private nonprofit organi16 zations and local governments may be used to pro17 vide sanitary napkins and tampons that conform to 

18 applicable industry standards.’’. 

19 (f) MENSTRUAL PRODUCTS COVERED BY MED20 ICAID.— 

21 (1) IN GENERAL.—Section 1905 of the Social 

22 Security Act (42 U.S.C. 1396d), as amended by sec23 tions 2007(d)(3) and 5201(a)(5)(G)(i), is amend24 ed— 

25 (A) in subsection (a)— 


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1 (i) by redesignating paragraph (32) as 

2 paragraph (33); 

3 (ii) in paragraph (31), by striking 

4 ‘‘and’’ after the semicolon; and 

5 (iii) by inserting after paragraph (31) 

6 the following new paragraph: 

7 ‘‘(32) menstrual products (as defined in sub8 section (oo)); and’’; and 

9 (B) by adding at the end the following: 

10 ‘‘(oo) MENSTRUAL PRODUCTS.—For purposes of 

11 subsection (a)(32), the term ‘menstrual products’ means 

12 sanitary napkins, tampons, liners, cups, and similar items 

13 used by individuals with respect to menstruation and that 

14 conform to industry standards.’’. 

15 (2) EFFECTIVE DATE.— 

16 (A) IN GENERAL.—Subject to subpara17 graph (B), the amendments made by this sub18 section shall apply with respect to medical as19 sistance furnished during or after the first cal20 endar quarter beginning on or after the date 

21 that is 1 year after the date of the enactment 

22 of this section. 

23 (B) EXCEPTION FOR STATE LEGISLA24 TION.—In the case of a State plan under title 

25 XIX of the Social Security Act (42 U.S.C. 1396 


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1 et seq.) that the Secretary of Health and 

2 Human Services determines requires State leg3 islation in order for the respective plan to meet 

4 any requirement imposed by amendments made 

5 by this section, the respective plan shall not be 

6 regarded as failing to comply with the require7 ments of such title solely on the basis of its fail8 ure to meet such an additional requirement be9 fore the first day of the first calendar quarter 

10 beginning after the close of the first regular 

11 session of the State legislature that begins after 

12 the date of the enactment of this section. For 

13 purposes of the previous sentence, in the case 

14 of a State that has a 2-year legislative session, 

15 each year of the session shall be considered to 

16 be a separate regular session of the State legis17 lature. 

18 (g) MENSTRUAL PRODUCTS FOR EMPLOYEES.—Sec19 tion 6 of the Occupational Safety and Health Act of 1970 

20 (29 U.S.C. 655) is amended by adding at the end the fol21 lowing: 

22 ‘‘(h) The Secretary shall by rule promulgate a re23 quirement that each employer with not less than 100 em24 ployees provide menstrual products free of charge for em25 ployees of the employer. For purposes of the preceding 


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1 sentence, ‘menstrual products’ means sanitary napkins 

2 and tampons that conform to applicable industry stand3 ards.’’. 

4 (h) MENSTRUAL PRODUCTS IN FEDERAL BUILD5 INGS.— 

6 (1) DEFINITIONS.—In this subsection: 

7 (A) APPROPRIATE AUTHORITY.—The term 

8 ‘‘appropriate authority’’ means the head of a 

9 Federal agency, the Architect of the Capitol, or 

10 any other official authority responsible for the 

11 operation of a covered public building. 

12 (B) COVERED PUBLIC BUILDING.— 

13 (i) IN GENERAL.—The term ‘‘covered 

14 public building’’ means a public building 

15 (as defined in section 3301(a) of title 40, 

16 United States Code) that is open to the 

17 public and contains a public restroom. 

18 (ii) INCLUSIONS.—The term ‘‘covered 

19 public building’’ includes specified build20 ings and grounds (as defined in section 

21 6301 of title 40, United States Code) and 

22 the Capitol Buildings (as defined in section 

23 5101 of that title). 


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1 (C) COVERED RESTROOM.—The term ‘‘cov2 ered restroom’’ means a public restroom in a 

3 covered public building. 

4 (D) MENSTRUAL PRODUCTS.—The term 

5 ‘‘menstrual products’’ means sanitary napkins 

6 and tampons that conform to applicable indus7 try standards. 

8 (2) REQUIREMENT.—Each appropriate author9 ity shall ensure that menstrual products are stocked 

10 in, and available free of charge in, each covered rest11 room in each covered public building under the juris12 diction of that authority. 

13 SEC. 5407. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 

14 WOMEN’S HEALTH. 

15 Section 229(b) of the Public Health Service Act (42 

16 U.S.C. 237a(b)), as amended by sections 5216 and 5301, 

17 is further amended by adding at the end the following: 

18 ‘‘(10) facilitate policymakers, health system 

19 leaders and providers, consumers, and other stake20 holders in understanding optimal maternity care and 

21 support for the provision of such care, including the 

22 priorities of— 

23 ‘‘(A) protecting, promoting, and supporting 

24 the innate capacities of childbearing individuals 


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1 and their newborns for childbirth, 

2 breastfeeding, and attachment; 

3 ‘‘(B) using obstetric interventions only 

4 when such interventions are supported by 

5 strong, high-quality evidence, and minimizing 

6 overuse of maternity practices that have been 

7 shown to have benefit in limited situations and 

8 that can expose people, infants, or both to risk 

9 of harm if used routinely and indiscriminately, 

10 including continuous electronic fetal monitoring, 

11 labor induction, epidural analgesia, primary ce12 sarean section, and routine repeat cesarean 

13 birth; 

14 ‘‘(C) reliably incorporating noninvasive, 

15 evidence-based practices that have a docu16 mented correlation with considerable improve17 ment in outcomes with no detrimental side ef18 fects, such as smoking cessation programs in 

19 pregnancy, maternal immunizations, and proven 

20 models (including group prenatal care, mid21 wifery care, and doula support) that integrate 

22 health assessment, education, and support into 

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1 spect for a breastfeeding individual’s personal 

2 decision making; 

3 ‘‘(D) a shared understanding of the quali4 fications of licensed providers of maternity care 

5 and the best evidence about the safety, satisfac6 tion, outcomes, and costs of maternity care, and 

7 appropriate deployment of such caregivers with8 in the maternity care workforce to address the 

9 needs of childbearing individuals and newborns 

10 and the growing shortage of maternity care11 givers; 

12 ‘‘(E) a shared understanding of the results 

13 of the best available research comparing hos14 pital, birth center, and planned home births, in15 cluding information about each setting’s safety, 

16 satisfaction, outcomes, and costs; 

17 ‘‘(F) a shared understanding of the impor18 tance for the safety and choices of birthing 

19 families of an integrated maternity care system 

20 with seamless processes for consultation, shared 

21 care, transfer and transport across maternity 

22 care settings, and providers when birthing peo23 ple and their newborns require a higher level of 

24 care; 


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1 ‘‘(G) high-quality, evidence-based child2 birth education that— 

3 ‘‘(i) promotes a healthy and safe ap4 proach to pregnancy, childbirth, and early 

5 parenting; 

6 ‘‘(ii) is taught by certified educators, 

7 peer counselors, and health professionals; 

8 and 

9 ‘‘(iii) promotes informed decision 

10 making by childbearing individuals; and 

11 ‘‘(H) developing measures that enable a 

12 more robust, balanced set of standardized ma13 ternity care measures, including performance 

14 and quality measures.’’. 

15 SEC. 5408. INCLUDING SERVICES FURNISHED BY CERTAIN 

16 STUDENTS, INTERNS, AND RESIDENTS SU17 PERVISED BY CERTIFIED NURSE MIDWIVES 

18 OR CERTIFIED MIDWIVES WITHIN INPATIENT 

19 HOSPITAL SERVICES UNDER MEDICARE. 

20 (a) IN GENERAL.—Section 1861(b) of the Social Se21 curity Act (42 U.S.C. 1395x(b)) is amended— 

22 (1) in paragraph (6), by striking ‘‘; or’’ at the 

23 end and inserting ‘‘, or in the case of services in a 

24 hospital or osteopathic hospital by a student midwife 

25 or an intern or resident-in-training under a teaching 


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1 program previously described in this paragraph who 

2 is in the field of obstetrics and gynecology, if such 

3 student midwife, intern, or resident-in-training is su4 pervised by a certified nurse-midwife or certified 

5 midwife to the extent permitted under applicable 

6 State law and as may be authorized by the hos7 pital;’’; 

8 (2) in paragraph (7), by striking the period at 

9 the end and inserting ‘‘; or’’; and 

10 (3) by adding at the end the following new 

11 paragraph: 

12 ‘‘(8) a certified nurse-midwife or certified mid13 wife where the hospital has a teaching program ap14 proved as specified in paragraph (6), if— 

15 ‘‘(A) the hospital elects to receive any pay16 ment due under this title for reasonable costs of 

17 such services; and 

18 ‘‘(B) all certified nurse-midwives or cer19 tified midwives in such hospital agree not to bill 

20 charges for professional services rendered in 

21 such hospital to individuals covered under the 

22 insurance program established by this title.’’. 

23 (b) EFFECTIVE DATE.—The amendments made by 

24 subsection (a) shall apply to services furnished on or after 

25 the date of the enactment of this Act. 


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1 SEC. 5409. GRANTS TO PROFESSIONAL ORGANIZATIONS 

2 AND MINORITY-SERVING INSTITUTIONS TO 

3 INCREASE DIVERSITY IN MATERNAL, REPRO4 DUCTIVE, AND SEXUAL HEALTH PROFES5 SIONALS. 

6 (a) GRANTS TO HEALTH PROFESSIONAL ORGANIZA7 TIONS.— 

8 (1) IN GENERAL.—The Secretary of Health and 

9 Human Services, acting through the Administrator 

10 of the Health Resources and Services Administra11 tion, shall carry out a grant program under which 

12 the Secretary may make to eligible organizations— 

13 (A) for fiscal year 2023, planning grants 

14 described in paragraph (2); and 

15 (B) for the subsequent 4-year period, im16 plementation grants described in paragraph (3). 

17 (2) PLANNING GRANTS.— 

18 (A) IN GENERAL.—Planning grants de19 scribed in this paragraph are grants for the fol20 lowing purposes: 

21 (i) To collect data and identify any 

22 workforce inequalities, with respect to a 

23 health profession, at each of the following 

24 areas along the health professional con25 tinuum: 


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1 (I) Pipeline availability, with re2 spect to students at the high school 

3 and college or university levels consid4 ering, and working toward, entrance 

5 in the profession, including barriers 

6 triggered by criminal records. 

7 (II) Entrance into the training 

8 program for the profession. 

9 (III) Graduation from such train10 ing program. 

11 (IV) Entrance into practice, in12 cluding barriers triggered by criminal 

13 records. 

14 (V) Retention in practice for 

15 more than a 5-year period. 

16 (ii) To develop one or more strategies 

17 to address the workforce inequalities with18 in the health profession, as identified 

19 under (and in response to the findings pur20 suant to) clause (i). 

21 (B) APPLICATION.—To be eligible to re22 ceive a grant under this paragraph, an eligible 

23 health professional organization shall submit to 

24 the Secretary an application in such form and 


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1 manner and containing such information as 

2 specified by the Secretary. 

3 (C) AMOUNT.—Each grant awarded under 

4 this paragraph shall be for an amount not to 

5 exceed $300,000. 

6 (D) REPORT.—Each recipient of a grant 

7 under this paragraph shall submit to the Sec8 retary a report containing— 

9 (i) information on the extent and dis10 tribution of workforce inequities identified 

11 through the grant; and 

12 (ii) reasonable objectives and strate13 gies developed to address such inequalities 

14 within a 5-, 10-, and 25-year period. 

15 (3) IMPLEMENTATION GRANTS.— 

16 (A) IN GENERAL.—Implementation grants 

17 described in this paragraph are grants to imple18 ment one or more of the strategies developed 

19 pursuant to a planning grant awarded under 

20 paragraph (2). 

21 (B) APPLICATION.—To be eligible to re22 ceive a grant under this paragraph, an eligible 

23 health professional organization shall submit to 

24 the Secretary an application in such form and 


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1 manner as specified by the Secretary. Each 

2 such application shall contain information on— 

3 (i) the capability of the organization 

4 to carry out a strategy described in sub5 paragraph (A); 

6 (ii) the involvement of partners or 

7 coalitions; and 

8 (iii) the organization’s plans for devel9 oping sustainability of the efforts after the 

10 culmination of the grant cycle, and any 

11 other information specified by the Sec12 retary. 

13 (C) AMOUNT; DURATION.—Each grant 

14 awarded under this paragraph shall be for an 

15 amount not to exceed $500,000 each year of 

16 the grant. The term of a grant under this sub17 section shall not exceed 4 years. 

18 (D) REPORTS.—For each of the first 3 

19 years for which an eligible health professional 

20 organization is awarded a grant under this 

21 paragraph, the organization shall submit to the 

22 Secretary of Health and Human Services a re23 port on the activities carried out by such orga24 nization through the grant during such year 

25 and objectives for the subsequent year. For the 


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1 fourth year for which an eligible health profes2 sional organization is awarded a grant under 

3 this paragraph, the organization shall submit to 

4 the Secretary a report that includes an analysis 

5 of all the activities carried out by the organiza6 tion through the grant and a detailed plan for 

7 the continuation of the organization’s outreach 

8 efforts. 

9 (4) ELIGIBLE HEALTH PROFESSIONAL ORGANI10 ZATION DEFINED.—For purposes of this subsection, 

11 the term ‘‘eligible health professional organization’’ 

12 means a professional organization representing ob13 stetrician-gynecologists, certified nurse midwives, 

14 certified midwives, family practice physicians, nurse 

15 practitioners whose scope of practice includes mater16 nity or sexual and reproductive health care, physi17 cian assistants whose scope of practice includes ob18 stetrical or sexual and reproductive health care, or 

19 certified professional midwives, adolescent medicine 

20 specialists, and pediatricians who provide sexual and 

21 reproductive health care. 

22 (b) GRANTS TO MINORITY-SERVING INSTITU23 TIONS.— 

24 (1) IN GENERAL.—The Secretary of Health and 

25 Human Services, acting through the Administrator 


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1 of the Health Resources and Services Administration 

2 (referred to in this section as the ‘‘Secretary’’), shall 

3 carry out a grant program under which the Sec4 retary may make to eligible minority-serving institu5 tions— 

6 (A) for fiscal years 2023 and 2024, plan7 ning grants described in paragraph (2); and 

8 (B) for the subsequent ten-year period, im9 plementation grants described in paragraph (3). 

10 (2) PLANNING GRANTS.— 

11 (A) IN GENERAL.—Planning grants de12 scribed in this paragraph are grants for plans 

13 relating to the following purposes: 

14 (i) To develop or expand academic 

15 programs to educate maternity care clini16 cians and maternity care support per17 sonnel, including— 

18 (I) nurses with the intention of 

19 providing maternity, newborn, or sex20 ual and reproductive health care; 

21 (II) nurse-practitioners whose 

22 scope of practice includes maternity, 

23 newborn, or sexual and reproductive 

24 health care; and 


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1 (III) maternity care support per2 sonnel, such as doulas and lactation 

3 counselors. 

4 (ii) To develop or expand academic 

5 programs to educate obstetrician-gyne6 cologists. 

7 (B) APPLICATION.—To be eligible to re8 ceive a grant under this paragraph, an eligible 

9 minority-serving institution shall submit to the 

10 Secretary an application in such form and man11 ner and containing such information as speci12 fied by the Secretary. 

13 (C) AMOUNT.—Each grant awarded under 

14 this paragraph shall be for an amount not to 

15 exceed $400,000 for each of two years. 

16 (D) REPORT.—Each recipient of a grant 

17 under this paragraph shall submit to the Sec18 retary an annual report describing the planned 

19 development or expansion of educational pro20 grams, including— 

21 (i) the types of clinical or support per22 sonnel and the degrees or certificates to be 

23 conferred; 

24 (ii) the associated curricula; 


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1 (iii) the faculty and their capabilities 

2 and commitments, including any plans for 

3 recruitment; 

4 (iv) the anticipated number of stu5 dents to be enrolled and plans for their re6 cruitment and social, emotional, and finan7 cial support; and 

8 (v) the objectives and strategies for 

9 addressing inequities and preparing stu10 dents to provide high-quality culturally 

11 congruent care. 

12 (3) IMPLEMENTATION GRANTS.— 

13 (A) IN GENERAL.—Implementation grants 

14 described in this paragraph are grants to imple15 ment the strategies developed under paragraph 

16 (2). 

17 (B) APPLICATION.—To be eligible to re18 ceive a grant under this paragraph, an eligible 

19 minority-serving institution shall submit to the 

20 Secretary of Health and Human Services an 

21 application in such form and manner as speci22 fied by the Secretary. Each such application 

23 shall contain information on the capability of 

24 the institution to carry out a strategy described 

25 in paragraph (2), plans for sustainability of the 


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1 program after the culmination of the grant 

2 cycle, and any other information specified by 

3 the Secretary. 

4 (C) AMOUNT.—Each grant under this 

5 paragraph shall be for an amount not to exceed 

6 $1,000,000 each year during the 10-year period 

7 of the grant. 

8 (D) REPORTS.— 

9 (i) INITIAL PERIOD.—For each of the 

10 first 9 years for which an eligible minority11 serving institution is awarded a grant 

12 under this paragraph, the institution shall 

13 submit a report to the Secretary on the ac14 tivities carried out by such institution 

15 through the grant during such year and 

16 objectives for the subsequent year. 

17 (ii) FINAL YEAR.—For the tenth year 

18 for which an eligible minority-serving insti19 tution is awarded a grant under this para20 graph, the organization shall submit to the 

21 Secretary a report that includes an anal22 ysis of all the activities carried out by the 

23 institution through the grant and a de24 tailed plan for continuation of the edu25 cational program. 


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1 (4) ELIGIBLE MINORITY-SERVING INSTITUTIONS

2 DEFINED.—For the purposes of this subsection, the 

3 term ‘‘minority-serving institution’’ means a histori4 cally Black college or university, Tribal college or 

5 university, Latino-serving institution, Asian Amer6 ican and Pacific Islander serving institution, or 

7 other minority-serving institution of higher edu8 cation. 

9 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

10 authorized to be appropriated to carry out— 

11 (1) subsection (a), $2,000,000 for fiscal year 

12 2023 and $3,000,000 for each of the fiscal years 

13 2024 through 2027; and 

14 (2) subsection (b), $4,000,000 for each of fiscal 

15 years 2023 and 2024 and $10,000,000 for each of 

16 fiscal years 2025 through 2034. 

17 Subtitle F—Children’s Health 

18 SEC. 5501. CARING FOR KIDS ACT. 

19 (a) PERMANENT EXTENSION OF CHILDREN’S

20 HEALTH INSURANCE PROGRAM.— 

21 (1) IN GENERAL.—Section 2104(a)(28) of the 

22 Social Security Act (42 U.S.C. 1397dd(a)(28)) is 

23 amended to read as follows: 


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1 ‘‘(28) for fiscal year 2027 and each subsequent 

2 year, such sums as are necessary to fund allotments 

3 to States under subsections (c) and (m).’’. 

4 (2) ALLOTMENTS.— 

5 (A) IN GENERAL.—Section 2104(m) of the 

6 Social Security Act (42 U.S.C. 1397dd(m)) is 

7 amended— 

8 (i) in paragraph (2)(B)(i), by striking 

9 ‘‘,, 2023, and 2027’’ and inserting ‘‘and 

10 2023’’; 

11 (ii) in paragraph (7)— 

12 (I) in subparagraph (A), by strik13 ing ‘‘and ending with fiscal year 

14 2027,’’; and 

15 (II) in the flush left matter at 

16 the end, by striking ‘‘or fiscal year 

17 2026’’ and inserting ‘‘fiscal year 

18 2026, or a subsequent even-numbered 

19 fiscal year’’; 

20 (iii) in paragraph (9)— 

21 (I) by striking ‘‘(10), or (11)’’ 

22 and inserting ‘‘or (10)’’; and 

23 (II) by striking ‘‘2023, or 2027,’’ 

24 and inserting ‘‘or 2023’’; and 

25 (iv) by striking paragraph (11). 


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1 (B) CONFORMING AMENDMENT.—Section 

2 50101(b)(2) of the Bipartisan Budget Act of 

3 2018 (Public Law 115–123) is repealed. 

4 (b) PERMANENT EXTENSIONS OF OTHER PROGRAMS

5 AND DEMONSTRATION PROJECTS.— 

6 (1) PEDIATRIC QUALITY MEASURES PRO7 GRAM.—Section 1139A(i)(1) of the Social Security 

8 Act (42 U.S.C. 1320b–9a(i)(1)) is amended— 

9 (A) in subparagraph (C), by striking at the 

10 end ‘‘and’’; 

11 (B) in subparagraph (D), by striking the 

12 period at the end and insert a semicolon; and 

13 (C) by adding at the end the following new 

14 subparagraphs: 

15 ‘‘(E) for fiscal year 2028, $15,000,000 for 

16 the purpose of carrying out this section (other 

17 than subsections (e), (f), and (g)); and 

18 ‘‘(F) for a subsequent fiscal year, the 

19 amount appropriated under this paragraph for 

20 the previous fiscal year, increased by the per21 centage increase in the consumer price index for 

22 all urban consumers (all items; United States 

23 city average) over such previous fiscal year, for 

24 the purpose of carrying out this section (other 

25 than subsections (e), (f), and (g)).’’. 


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1 (2) EXPRESS LANE ELIGIBILITY OPTION.—Sec2 tion 1902(e)(13) of the Social Security Act (42 

3 U.S.C. 1396a(e)(13)) is amended by striking sub4 paragraph (I). 

5 (3) ASSURANCE OF AFFORDABILITY STANDARD

6 FOR CHILDREN AND FAMILIES.— 

7 (A) IN GENERAL.—Section 2105(d)(3) of 

8 the Social Security Act (42 U.S.C. 

9 1397ee(d)(3)) is amended— 

10 (i) in the paragraph heading, by strik11 ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 

12 (ii) in subparagraph (A), in the mat13 ter preceding clause (i)— 

14 (I) by striking ‘‘During the pe15 riod that begins on the date of enact16 ment of the Patient Protection and 

17 Affordable Care Act and ends on Sep18 tember 30, 2027’’ and inserting ‘‘Be19 ginning on the date of the enactment 

20 of the Patient Protection and Afford21 able Care Act’’; 

22 (II) by striking ‘‘During the pe23 riod that begins on October 1, 2019, 

24 and ends on September 30, 2027’’ 


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1 and inserting ‘‘Beginning on October 

2 1, 2019’’; and 

3 (III) by striking ‘‘The preceding 

4 sentences shall not be construed as 

5 preventing a State during any such 

6 periods from’’ and inserting ‘‘The pre7 ceding sentences shall not be con8 strued as preventing a State from’’. 

9 (B) CONFORMING AMENDMENTS.—Section 

10 1902(gg)(2) of the Social Security Act (42 

11 U.S.C. 1396a(gg)(2)) is amended— 

12 (i) in the paragraph heading, by strik13 ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 

14 (ii) by striking ‘‘through September 

15 30’’ and all that follows through ‘‘ends on 

16 September 30, 2027’’ and inserting ‘‘(but 

17 beginning on October 1, 2019,’’. 

18 (4) QUALIFYING STATES OPTION.—Section 

19 2105(g)(4) of the Social Security Act (42 U.S.C. 

20 1397ee(g)(4)) is amended— 

21 (A) in the paragraph heading, by striking 

22 ‘‘FOR FISCAL YEARS 2009 THROUGH 2027’’ and 

23 inserting ‘‘AFTER FISCAL YEAR 2008’’; and 

24 (B) in subparagraph (A), by striking ‘‘for 

25 any of fiscal years 2009 through 2027’’ and inVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00922 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 serting ‘‘for any fiscal year after fiscal year 

2 2008’’. 

3 (5) OUTREACH AND ENROLLMENT PROGRAM.— 

4 Section 2113 of the Social Security Act (42 U.S.C. 

5 1397mm) is amended— 

6 (A) in subsection (a)— 

7 (i) in paragraph (1), by striking ‘‘dur8 ing the period of fiscal years 2009 through 

9 2027’’ and inserting ‘‘, beginning with fis10 cal year 2009,’’; 

11 (ii) in paragraph (2)— 

12 (I) by striking ‘‘10 percent of 

13 such amounts’’ and inserting ‘‘10 per14 cent of such amounts for the period or 

15 the fiscal year for which such amounts 

16 are appropriated’’; and 

17 (II) by striking ‘‘during such pe18 riod’’ and inserting ‘‘, during such pe19 riod or such fiscal year,’’; and 

20 (iii) in paragraph (3), by striking 

21 ‘‘For the period of fiscal years 2024 

22 through 2027, an amount equal to 10 per23 cent of such amounts’’ and inserting ‘‘Be24 ginning with fiscal year 2024, an amount 

25 equal to 10 percent of such amounts for 


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1 the period or the fiscal year for which such 

2 amounts are appropriated’’; and 

3 (B) in subsection (g)— 

4 (i) by striking ‘‘2017,,’’ and inserting 

5 ‘‘2017,’’; 

6 (ii) by striking ‘‘and $48,000,000’’ 

7 and inserting ‘‘$48,000,000’’; and 

8 (iii) by inserting after ‘‘through 

9 2027’’ the following: ‘‘, $12,000,000 for 

10 fiscal year 2028, and, for each fiscal year 

11 after fiscal year 2028, the amount appro12 priated under this subsection for the pre13 vious fiscal year, increased by the percent14 age increase in the consumer price index 

15 for all urban consumers (all items; United 

16 States city average) over such previous fis17 cal year’’. 

18 (6) CHILD ENROLLMENT CONTINGENCY

19 FUND.—Section 2104(n) of the Social Security Act 

20 (42 U.S.C. 1397dd(n)) is amended— 

21 (A) in paragraph (2)— 

22 (i) in subparagraph (A)(ii)— 

23 (I) by striking ‘‘and 2024 

24 through 2026’’ and inserting ‘‘begin25 ning with fiscal year 2024’’; and 


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1 (II) by striking ‘‘2023, and 

2 2027’’ and inserting ‘‘, and 2023’’; 

3 and 

4 (ii) in subparagraph (B)— 

5 (I) by striking ‘‘2024 through 

6 2026’’ and inserting ‘‘beginning with 

7 fiscal year 2024’’; and 

8 (II) by striking ‘‘2023, and 

9 2027’’ and inserting ‘‘, and 2023’’; 

10 and 

11 (B) in paragraph (3)(A)— 

12 (i) by striking ‘‘fiscal years 2024 

13 through 2026’’ and inserting ‘‘beginning 

14 with fiscal year 2024’’; and 

15 (ii) by striking ‘‘2023, or 2027’’ and 

16 inserting ‘‘, or 2023’’. 

17 SEC. 5502. END DIAPER NEED ACT OF 2022. 

18 (a) TARGETED FUNDING FOR DIAPER ASSISTANCE

19 (INCLUDING DIAPERING SUPPLIES AND ADULT INCONTI20 NENCE MATERIALS AND SUPPLIES) THROUGH THE SO21 CIAL SERVICES BLOCK GRANT PROGRAM.— 

22 (1) INCREASE IN FUNDING FOR SOCIAL SERV23 ICES BLOCK GRANT PROGRAM.— 

24 (A) IN GENERAL.—The amount specified 

25 in subsection (c) of section 2003 of the Social 


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1 Security Act (42 U.S.C. 1397b) for purposes of 

2 subsections (a) and (b) of such section is 

3 deemed to be $1,900,000,000 for each of fiscal 

4 years 2023 through 2026, of which, the amount 

5 equal to $200,000,000, reduced by the amounts 

6 reserved under subparagraph (B)(ii) for each 

7 such fiscal year, shall be obligated by States in 

8 accordance with paragraph (2). 

9 (B) APPROPRIATION.— 

10 (i) IN GENERAL.—Out of any money 

11 in the Treasury of the United States not 

12 otherwise appropriated, there is appro13 priated $200,000,000 for each of fiscal 

14 years 2023 through 2026, to carry out this 

15 subsection. 

16 (ii) RESERVATIONS.— 

17 (I) PURPOSES.—The Secretary 

18 shall reserve, from the amount appro19 priated under clause (i) to carry out 

20 this subsection— 

21 (aa) for each of fiscal years 

22 2023 through 2026, not more 

23 than 2 percent of the amount ap24 propriated for the fiscal year for 

25 purposes of entering into an 


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1 agreement with a national entity 

2 described in clause (iii) to assist 

3 in providing technical assistance 

4 and training, to support effective 

5 policy, practice, research, and 

6 cross-system collaboration among 

7 grantees and subgrantees, and to 

8 assist in the administration of 

9 the program described in this 

10 subsection; and 

11 (bb) for fiscal year 2023, an 

12 amount, not to exceed 

13 $2,000,000, for purposes of con14 ducting an evaluation under 

15 paragraph (4). 

16 (II) NO STATE ENTITLEMENT TO

17 RESERVED FUNDS.—The State enti18 tlement under section 2002(a) of the 

19 Social Security Act (42 U.S.C. 

20 1397a(a)) shall not apply to the 

21 amounts reserved under subclause (I). 

22 (iii) NATIONAL ENTITY DESCRIBED.— 

23 A national entity described in this clause is 

24 a nonprofit organization described in sec25 tion 501(c)(3) of the Internal Revenue 


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1 Code of 1986 and exempt from taxation 

2 under section 501(a) of such Code, that— 

3 (I) has experience in more than 1 

4 State in the area of— 

5 (aa) community distribu6 tions of basic need services, in7 cluding experience collecting, 

8 warehousing, and distributing 

9 basic necessities such as diapers, 

10 food, or menstrual products; 

11 (bb) child care; 

12 (cc) child development ac13 tivities in low-income commu14 nities; or 

15 (dd) motherhood, father16 hood, or parent education efforts 

17 serving low-income parents of 

18 young children; 

19 (II) demonstrates competency to 

20 implement a project, provide fiscal ac21 countability, collect data, and prepare 

22 reports and other necessary docu23 mentation; and 

24 (III) demonstrates a willingness 

25 to share information with researchers, 


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1 practitioners, and other interested 

2 parties. 

3 (2) RULES GOVERNING USE OF ADDITIONAL

4 FUNDS.— 

5 (A) IN GENERAL.—Funds are used in ac6 cordance with this paragraph if— 

7 (i) the State, in consultation with rel8 evant stakeholders, including agencies, pro9 fessional associations, and nonprofit orga10 nizations, distributes the funds to eligible 

11 entities to— 

12 (I) decrease the need for diapers 

13 and diapering supplies and adult in14 continence materials and supplies in 

15 low-income families and meet such 

16 unmet needs of infants and toddlers, 

17 medically complex children, and low18 income adults and adults with disabil19 ities in such families through— 

20 (aa) the distribution of free 

21 diapers and diapering supplies, 

22 medically necessary diapers, and 

23 adult incontinence materials and 

24 supplies; 


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1 (bb) community outreach to 

2 assist in participation in existing 

3 diaper distribution programs or 

4 programs that distribute medi5 cally necessary diapers or adult 

6 incontinence materials and sup7 plies; or 

8 (cc) improving access to dia9 pers and diapering supplies, 

10 medically necessary diapers, and 

11 adult incontinence materials and 

12 supplies; and 

13 (II) increase the ability of com14 munities and low-income families in 

15 such communities to provide for the 

16 need for diapers and diapering sup17 plies, medically necessary diapers, and 

18 adult incontinence materials and sup19 plies, of infants and toddlers, medi20 cally complex children, and low-income 

21 adults and adults with disabilities; 

22 (ii) the funds are used subject to the 

23 limitations in section 2005 of the Social 

24 Security Act (42 U.S.C. 1397d); 


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1 (iii) the funds are used to supplement, 

2 not supplant, State general revenue funds 

3 provided for the purposes described in 

4 clause (i); and 

5 (iv) the funds are not used for costs 

6 that are reimbursable by the Federal 

7 Emergency Management Agency, under a 

8 contract for insurance, or by self-insur9 ance. 

10 (B) ALLOWABLE USES BY ELIGIBLE ENTI11 TIES.—An eligible entity receiving funds made 

12 available under paragraph (1) shall use the 

13 funds for any of the following: 

14 (i) To pay for the purchase and dis15 tribution of diapers and diapering supplies, 

16 medically necessary diapers, and funding 

17 diaper (including medically necessary dia18 pers) distribution that serves low-income 

19 families with— 

20 (I) 1 or more children 3 years of 

21 age or younger; or 

22 (II) 1 or more medically complex 

23 children. 

24 (ii) To pay for the purchase and dis25 tribution of adult incontinence materials 


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1 and supplies and funding distribution of 

2 such materials and supplies that serves 

3 low-income families with 1 or more low-in4 come adults or adults with disabilities who 

5 rely on adult incontinence materials and 

6 supplies. 

7 (iii) To integrate activities carried out 

8 under clause (i) with other basic needs as9 sistance programs serving eligible children 

10 and their families, including the following: 

11 (I) Programs funded by the tem12 porary assistance for needy families 

13 program under part A of title IV of 

14 the Social Security Act (42 U.S.C. 

15 601 et seq.), including the State 

16 maintenance of effort provisions of 

17 such program. 

18 (II) Programs designed to sup19 port the health of eligible children, 

20 such as the Children’s Health Insur21 ance Program under title XXI of the 

22 Social Security Act, the Medicaid pro23 gram under title XIX of such Act, or 

24 State-funded health care programs. 


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1 (III) Programs funded through 

2 the special supplemental nutrition 

3 program for women, infants, and chil4 dren under section 17 of the Child 

5 Nutrition Act of 1966. 

6 (IV) Programs that offer early 

7 home visiting services, including the 

8 maternal, infant, and early childhood 

9 home visiting program (including the 

10 Tribal home visiting program) under 

11 section 511 of the Social Security Act 

12 (42 U.S.C. 711). 

13 (V) Programs to provide im14 proved and affordable access to child 

15 care, including programs funded 

16 through the Child Care and Develop17 ment Fund, the temporary assistance 

18 for needy families program under part 

19 A of title IV of the Social Security 

20 Act (42 U.S.C. 601 et seq.), or a 

21 State-funded program. 

22 (C) AVAILABILITY OF FUNDS.— 

23 (i) FUNDS DISTRIBUTED TO ELIGIBLE

24 ENTITIES.—Funds made available under 

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1 igible entity by a State for a fiscal year 

2 may be expended by the eligible entity only 

3 in such fiscal year or the succeeding fiscal 

4 year. 

5 (ii) EVALUATION.—Funds reserved 

6 under paragraph (1)(B)(ii)(I)(aa) to carry 

7 out the evaluation under paragraph (4) 

8 shall be available for expenditure during 

9 the 3-year period that begins on the date 

10 of enactment of this Act. 

11 (D) NO EFFECT ON OTHER PROGRAMS.— 

12 Any assistance or benefits received by a family 

13 through funds made available under paragraph 

14 (1) shall be disregarded for purposes of deter15 mining the family’s eligibility for, or amount of, 

16 benefits under any other Federal needs-based 

17 programs. 

18 (3) ANNUAL REPORTS.—A State shall include 

19 in the annual report required under section 2006 of 

20 the Social Security Act (42 U.S.C. 1397e) covering 

21 each of fiscal years 2022 through 2025, information 

22 detailing how eligible entities, including subgrantees, 

23 used funds made available under paragraph (1) to 

24 distribute diapers and diapering supplies and adult 


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1 incontinence materials and supplies to families in 

2 need. Each such report shall include the following: 

3 (A) The number and age of infants, tod4 dlers, medically complex children, and low-in5 come adults and adults with disabilities who re6 ceived assistance or benefits through such 

7 funds. 

8 (B) The number of families that have re9 ceived assistance or benefits through such 

10 funds. 

11 (C) The number of diapers, medically nec12 essary diapers, or adult incontinence materials 

13 and supplies (such as adult diapers, briefs, pro14 tective underwear, pull-ons, pull-ups, liners, 

15 shields, guards, pads, undergarments), and the 

16 number of each type of diapering or adult in17 continence supply, distributed through the use 

18 of such funds. 

19 (D) The ZIP Code or ZIP Codes where the 

20 eligible entity (or subgrantee) distributed dia21 pers and diapering supplies and adult inconti22 nence materials and supplies. 

23 (E) The method or methods the eligible en24 tity (or subgrantee) uses to distribute diapers 


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1 and diapering supplies and, adult incontinence 

2 materials and supplies. 

3 (F) Such other information as the Sec4 retary may specify. 

5 (4) EVALUATION.—The Secretary, in consulta6 tion with States, the national entity described in 

7 paragraph (1)(B)(iii), and eligible entities receiving 

8 funds made available under this subsection, shall— 

9 (A) not later than 2 years after the date 

10 of enactment of this Act— 

11 (i) complete an evaluation of the effec12 tiveness of the assistance program carried 

13 out pursuant to this subsection, such as 

14 the effect of activities carried out under 

15 this section on mitigating the health and 

16 developmental risks of unmet diaper need 

17 among infants, toddlers, medically complex 

18 children, and other family members in low19 income families, including the risks of dia20 per dermatitis, urinary tract infections, 

21 and parental and child depression and anx22 iety; 

23 (ii) submit to the relevant congres24 sional committees a report on the results 

25 of such evaluation; and 


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1 (iii) publish the results of the evalua2 tion on the internet website of the Depart3 ment of Health and Human Services; 

4 (B) not later than 3 years after the date 

5 of enactment of this Act, update the evaluation 

6 required by subparagraph (A)(i); and 

7 (C) not later than 90 days after completion 

8 of the updated evaluation under subparagraph 

9 (B)— 

10 (i) submit to the relevant congres11 sional committees a report describing the 

12 results of such updated evaluation; and 

13 (ii) publish the results of such evalua14 tion on the internet website of the Depart15 ment of Health and Human Services. 

16 (5) GUIDANCE.—Not later than 180 days after 

17 enactment of this Act, the Secretary shall issue 

18 guidance regarding how the provisions of this sub19 section should be carried out, including information 

20 regarding eligible entities, allowable use of funds, 

21 and reporting requirements. 

22 (6) DEFINITIONS.—In this subsection: 

23 (A) ADULT INCONTINENCE MATERIALS

24 AND SUPPLIES.—The term ‘‘adult incontinence 

25 materials and supplies’’ means those supplies 


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1 that are used to assist low-income adults or 

2 adults with disabilities and includes adult dia3 pers, briefs, protective underwear, pull-ons, 

4 pull-ups, liners, shields, guards, pads, undergar5 ments, disposable wipes, over-the-counter adult 

6 diaper rash cream products, intermittent cath7 eterization, indwelling catheters, condom cath8 eters, urinary drainage bags, external collection 

9 devices, wearable urinals, and penile clamps. 

10 (B) ADULTS WITH DISABILITIES.—The 

11 term ‘‘adults with disabilities’’ means individ12 uals who— 

13 (i) have attained age 18; and 

14 (ii) have a disability (as such term is 

15 defined, with respect to an individual, in 

16 section 3 of the Americans with Disabil17 ities Act of 1990 (42 U.S.C. 12102)). 

18 (C) DIAPER.—The term ‘‘diaper’’ means 

19 an absorbent garment that— 

20 (i) is washable or disposable that may 

21 be worn by an infant or toddler who is not 

22 toilet-trained; and 

23 (ii) if disposable— 

24 (I) does not use any latex or 

25 common allergens; and 


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1 (II) meets or exceeds the quality 

2 standards for diapers commercially 

3 available through retail sale in the fol4 lowing categories: 

5 (aa) Absorbency (with ac6 ceptable rates for first and sec7 ond wetting). 

8 (bb) Waterproof outer cover. 

9 (cc) Flexible leg openings. 

10 (dd) Refastening closures. 

11 (D) DIAPERING SUPPLIES.—The term 

12 ‘‘diapering supplies’’ means items, including di13 aper wipes and diaper cream, necessary to en14 sure that— 

15 (i) an eligible child using a diaper is 

16 properly cleaned and protected from diaper 

17 rash; or 

18 (ii) a medically complex child who 

19 uses a medically necessary diaper is prop20 erly cleaned and protected from diaper 

21 rash. 

22 (E) ELIGIBLE CHILD.—The term ‘‘eligible 

23 child’’ means a child who— 

24 (i) has not attained 4 years of age; 

25 and 


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1 (ii) is a member of a low-income fam2 ily. 

3 (F) ELIGIBLE ENTITIES.—The term ‘‘eligi4 ble entity’’ means a State or local governmental 

5 entity, an Indian tribe or tribal organization (as 

6 defined in section 4 of the Indian Self-Deter7 mination and Education Assistance Act), or a 

8 nonprofit organization described in section 

9 501(c)(3) of the Internal Revenue Code of 1986 

10 and exempt from taxation under section 501(a) 

11 of such Code that— 

12 (i) has experience in the area of— 

13 (I) community distributions of 

14 basic need services, including experi15 ence collecting, warehousing, and dis16 tributing basic necessities such as dia17 pers, food, or menstrual products; 

18 (II) child care; 

19 (III) child development activities 

20 in low-income communities; or 

21 (IV) motherhood, fatherhood, or 

22 parent education efforts serving low23 income parents of young children; 

24 (ii) demonstrates competency to im25 plement a project, provide fiscal accountVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00940 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ability, collect data, and prepare reports 

2 and other necessary documentation; and 

3 (iii) demonstrates a willingness to 

4 share information with researchers, practi5 tioners, and other interested parties. 

6 (G) FEDERAL POVERTY LINE.—The term 

7 ‘‘Federal poverty line’’ means the Federal pov8 erty line as defined by the Office of Manage9 ment and Budget and revised annually in ac10 cordance with section 673(2) of the Omnibus 

11 Budget Reconciliation Act of 1981 applicable to 

12 a family of the size involved. 

13 (H) LOW-INCOME.—The term ‘‘low-in14 come’’, with respect to a family, means a family 

15 whose self-certified income is not more than 

16 200 percent of the Federal poverty line. 

17 (I) MEDICALLY COMPLEX CHILD.—The 

18 term ‘‘medically complex child’’ means an indi19 vidual who has attained age 3 and for whom a 

20 licensed health care provider has provided a di21 agnosis of bowel or bladder incontinence, a 

22 bowel or bladder condition that causes excess 

23 urine or stool (such as short gut syndrome or 

24 diabetes insipidus), or a severe skin condition 


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1 that causes skin erosions (such as epidermolysis 

2 bullosa). 

3 (J) MEDICALLY NECESSARY DIAPER.—The 

4 term ‘‘medically necessary diaper’’ means an 

5 absorbent garment that is— 

6 (i) washable or disposable; 

7 (ii) worn by a medically complex child 

8 who has been diagnosed with bowel or 

9 bladder incontinence, a bowel or bladder 

10 condition that causes excess urine or stool 

11 (such as short gut syndrome or diabetes 

12 insipidus), or a severe skin condition that 

13 causes skin erosions (such as epidermolysis 

14 bullosa) and needs such garment to correct 

15 or ameliorate such condition; and 

16 (iii) if disposable— 

17 (I) does not use any latex or 

18 common allergens; and 

19 (II) meets or exceeds the quality 

20 standards for diapers commercially 

21 available through retail sale in the fol22 lowing categories: 

23 (aa) Absorbency (with ac24 ceptable rates for first and sec25 ond wetting). 


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1 (bb) Waterproof outer cover. 

2 (cc) Flexible leg openings. 

3 (dd) Refastening closures. 

4 (7) EXEMPTION OF PROGRAM FROM SEQUES5 TRATION.— 

6 (A) IN GENERAL.—Section 255(h) of the 

7 Balanced Budget and Emergency Deficit Con8 trol Act of 1985 (2 U.S.C. 905(h)) is amended 

9 by inserting after ‘‘Supplemental Security In10 come Program (28–0406–0–1–609).’’ the fol11 lowing: 

12 ‘‘Targeted funding for States for diaper assist13 ance (including diapering supplies and adult inconti14 nence materials and supplies) through the Social 

15 Services Block Grant Program.’’. 

16 (B) APPLICABILITY.—The amendment 

17 made by this paragraph shall apply to any se18 questration order issued under the Balanced 

19 Budget and Emergency Deficit Control Act of 

20 1985 (2 U.S.C. 900 et seq.) on or after the 

21 date of enactment of this Act. 

22 (b) IMPROVING ACCESS TO DIAPERS FOR MEDICALLY

23 COMPLEX CHILDREN.—Section 1915(c) of the Social Se24 curity Act (42 U.S.C. 1396n(c)) is amended by adding at 

25 the end the following new paragraph: 


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1 ‘‘(11)(A) In the case of any waiver under this sub2 section that provides medical assistance to a medically 

3 complex child who has been diagnosed with bowel or blad4 der incontinence, a bowel or bladder condition that causes 

5 excess urine or stool (such as short gut syndrome or diabe6 tes insipidus), or a severe skin condition that causes skin 

7 erosions (such as epidermolysis bullosa), such medical as8 sistance shall include, for the duration of the waiver, the 

9 provision of 200 medically necessary diapers per month 

10 and diapering supplies. Such medical assistance may in11 clude the provision of medically necessary diapers in 

12 amounts greater than 200 if a licensed health care pro13 vider (such as a physician, nurse practitioner, or physician 

14 assistant) specifies that such greater amounts are nec15 essary for such medically complex child. 

16 ‘‘(B) For purposes of this paragraph: 

17 ‘‘(i) The term ‘medically complex child’ means 

18 an individual who has attained age 3 and for whom 

19 a licensed health care provider has provided a diag20 nosis of 1 or more significant chronic conditions. 

21 ‘‘(ii) The term ‘medically necessary diaper’ 

22 means an absorbent garment that is— 

23 ‘‘(I) washable or disposable; 

24 ‘‘(II) worn by a medically complex child 

25 who has been diagnosed with a condition deVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00944 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 scribed in subparagraph (A) and needs such 

2 garment to correct or ameliorate such condition; 

3 and 

4 ‘‘(III) if disposable— 

5 ‘‘(aa) does not use any latex or com6 mon allergens; and 

7 ‘‘(bb) meets or exceeds the quality 

8 standards for diapers commercially avail9 able through retail sale in the following 

10 categories: 

11 ‘‘(AA) Absorbency (with accept12 able rates for first and second wet13 ting). 

14 ‘‘(BB) Waterproof outer cover. 

15 ‘‘(CC) Flexible leg openings. 

16 ‘‘(DD) Refastening closures. 

17 ‘‘(iii) The term ‘diapering supplies’ means 

18 items, including diaper wipes and diaper creams, 

19 necessary to ensure that a medically complex child 

20 who has been diagnosed with a condition described 

21 in subparagraph (A) and uses a medically necessary 

22 diaper is properly cleaned and protected from diaper 

23 rash.’’. 

24 (c) INCLUSION OF DIAPERS AND DIAPERING SUP25 PLIES AS QUALIFIED MEDICAL EXPENSES.— 


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1 (1) HEALTH SAVINGS ACCOUNTS.—Section 

2 223(d)(2) of the Internal Revenue Code of 1986 is 

3 amended— 

4 (A) by inserting ‘‘, medically necessary dia5 pers, and diapering supplies’’ after ‘‘menstrual 

6 care products’’ in the last sentence of subpara7 graph (A); and 

8 (B) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(E) MEDICALLY NECESSARY DIAPERS

11 AND DIAPERING SUPPLIES.—For purposes of 

12 this paragraph— 

13 ‘‘(i) MEDICALLY NECESSARY DIA14 PERS.—The term ‘medically necessary dia15 per’ means an absorbent garment which is 

16 washable or disposable and which is worn 

17 by an individual who has attained 3 years 

18 of age because of medical necessity, such 

19 as someone who has been diagnosed with 

20 bowel or bladder incontinence, a bowel or 

21 bladder condition that causes excess urine 

22 or stool (such as short gut syndrome or di23 abetes insipidus), or a severe skin condi24 tion that causes skin erosions (such as 

25 epidermolysis bullosa) and needs such garVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00946 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ment to correct or ameliorate such condi2 tion, to serve a preventative medical pur3 pose, or to correct or ameliorate defects or 

4 physical or mental illnesses or conditions 

5 diagnosed by a licensed health care pro6 vider, and, if disposable— 

7 ‘‘(I) does not use any latex or 

8 common allergens; and 

9 ‘‘(II) meets or exceeds the quality 

10 standards for diapers commercially 

11 available through retail sale in the fol12 lowing categories: 

13 ‘‘(aa) Absorbency (with ac14 ceptable rates for first and sec15 ond wetting). 

16 ‘‘(bb) Waterproof outer 

17 cover. 

18 ‘‘(cc) Flexible leg openings. 

19 ‘‘(dd) Refastening closures. 

20 ‘‘(ii) DIAPERING SUPPLIES.—The 

21 term ‘diapering supplies’ means items, in22 cluding diaper wipes and diaper creams, 

23 necessary to ensure that an individual 

24 wearing medically necessary diapers is 


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1 properly cleaned and protected from diaper 

2 rash.’’. 

3 (2) ARCHER MSAS.—The last sentence of sec4 tion 220(d)(2)(A) of such Code is amended by in5 serting ‘‘, medically necessary diapers (as defined in 

6 section 223(d)(2)(E)), and diapering supplies (as de7 fined in section 223(d)(2)(E))’’ after ‘‘menstrual 

8 care products (as defined in section 223(d)(2)(D))’’. 

9 (3) HEALTH FLEXIBLE SPENDING ARRANGE10 MENTS AND HEALTH REIMBURSEMENT ARRANGE11 MENTS.—Section 106(f) of such Code is amended— 

12 (A) by inserting ‘‘, medically necessary dia13 pers (as defined in section 223(d)(2)(E)), and 

14 diapering supplies (as defined in section 

15 223(d)(2)(E))’’ after ‘‘menstrual care products 

16 (as defined in section 223(d)(2)(D))’’; and 

17 (B) in the heading, by inserting ‘‘, MEDI18 CALLY NECESSARY DIAPERS, AND DIAPERING

19 SUPPLIES’’ after ‘‘MENSTRUAL CARE PROD20 UCTS’’. 

21 (4) EFFECTIVE DATES.— 

22 (A) DISTRIBUTIONS FROM CERTAIN AC23 COUNTS.—The amendments made by para24 graphs (1) and (2) shall apply to amounts paid 

25 after December 31, 2023. 


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1 (B) REIMBURSEMENTS.—The amendment 

2 made by paragraph (3) shall apply to expenses 

3 incurred after December 31, 2023. 

4 SEC. 5503. DECREASING THE RISK FACTORS FOR SUDDEN 

5 UNEXPECTED INFANT DEATH AND SUDDEN 

6 UNEXPLAINED DEATH IN CHILDHOOD. 

7 (a) ESTABLISHMENT.—The Secretary of Health and 

8 Human Services, acting through the Administrator of the 

9 Health Resources and Services Administration and in con10 sultation with the Director of the Centers for Disease Con11 trol and Prevention and the Director of the National Insti12 tutes of Health (in this section referred to as the ‘‘Sec13 retary’’), shall establish and implement a culturally and 

14 linguistically competent public health awareness and edu15 cation campaign to provide information that is focused on 

16 decreasing the risk factors for sudden unexpected infant 

17 death and sudden unexplained death in childhood, includ18 ing educating individuals about safe sleep environments, 

19 sleep positions, and reducing exposure to smoking during 

20 pregnancy and after birth. 

21 (b) TARGETED POPULATIONS.—The campaign under 

22 subsection (a) shall be designed to reduce health inequities 

23 through the targeting of populations with high rates of 

24 sudden unexpected infant death and sudden unexplained 

25 death in childhood. 


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1 (c) CONSULTATION.—In establishing and imple2 menting the campaign under subsection (a), the Secretary 

3 shall consult with national organizations representing 

4 health care providers, including nurses and physicians, 

5 parents, child care providers, children’s advocacy and safe6 ty organizations, maternal and child health programs, nu7 trition professionals focusing on people, infants, and chil8 dren, and other individuals and groups determined nec9 essary by the Secretary for such establishment and imple10 mentation. 

11 (d) GRANTS.— 

12 (1) IN GENERAL.—In carrying out the cam13 paign under subsection (a), the Secretary shall 

14 award grants to national organizations, State and 

15 local health departments, and community-based or16 ganizations for the conduct of education and out17 reach programs for nurses, parents, child care pro18 viders, public health agencies, and community orga19 nizations. 

20 (2) APPLICATION.—To be eligible to receive a 

21 grant under paragraph (1), an entity shall submit to 

22 the Secretary an application at such time, in such 

23 manner, and containing such information as the Sec24 retary may require. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section 

3 such sums as may be necessary for each of fiscal years 

4 2023 through 2027. 

5 Subtitle G—Nutrition for Women, 

6 Children, Families 

7 SEC. 5601. CLOSING THE MEAL GAP. 

8 (a) ELIMINATION OF TIME LIMIT.— 

9 (1) IN GENERAL.—Section 6 of the Food and 

10 Nutrition Act of 2008 (7 U.S.C. 2015) is amend11 ed— 

12 (A) by striking subsection (o); and 

13 (B) by redesignating subsections (p) 

14 through (s) as subsections (o) through (r), re15 spectively. 

16 (2) ADDITIONAL ALLOCATIONS FOR STATES

17 THAT ENSURE AVAILABILITY OF WORK OPPORTUNI18 TIES.—Section 16(h) of the Food and Nutrition Act 

19 of 2008 (7 U.S.C. 2025(h)) is amended— 

20 (A) in paragraph (1)— 

21 (i) in subparagraph (C)(iv)(I)— 

22 (I) by striking ‘‘(F)(viii)’’ each 

23 place it appears and inserting 

24 ‘‘(E)(viii)’’; 


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1 (II) by striking ‘‘(F)(vii)(I)’’ each 

2 place it appears and inserting 

3 ‘‘(E)(vii)(I)’’; 

4 (III) in item (bb)(BB), by strik5 ing ‘‘(F)(vii)(II)’’ and inserting 

6 ‘‘(E)(vii)(II)’’; and 

7 (IV) in item (cc), by striking 

8 ‘‘(F)(vii)’’ and inserting ‘‘(E)(vii)’’; 

9 (ii) by striking subparagraph (E); and 

10 (iii) by redesignating subparagraph 

11 (F) as subparagraph (E); 

12 (B) in paragraphs (3) and (4), by striking 

13 ‘‘(1)(F)’’ each place it appears and inserting 

14 ‘‘(1)(E)’’; and 

15 (C) in paragraph (5)(C)— 

16 (i) in clause (ii), by adding ‘‘and’’ at 

17 the end; 

18 (ii) in clause (iii), by striking ‘‘; and’’ 

19 and inserting a period; and 

20 (iii) by striking clause (iv). 

21 (3) CONFORMING AMENDMENTS.— 

22 (A) Section 5 of the Food and Nutrition 

23 Act of 2008 (7 U.S.C. 2014) is amended— 


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1 (i) in subsection (a), in the second 

2 sentence, by striking ‘‘(r)’’ and inserting 

3 ‘‘(q)’’; and 

4 (ii) in subsection (g)(3), in the first 

5 sentence, by striking ‘‘16(h)(1)(F)’’ and 

6 inserting ‘‘16(h)(1)(E)’’. 

7 (B) Section 6(d)(4) of the Food and Nutri8 tion Act of 2008 (7 U.S.C. 2015(d)(4)) is 

9 amended— 

10 (i) in subparagraph 

11 (B)(ii)(I)(bb)(DD), by striking ‘‘or sub12 section (o)’’; and 

13 (ii) in subparagraph (N), by striking 

14 ‘‘or subsection (o)’’ each place it appears. 

15 (C) Section 7 of the Food and Nutrition 

16 Act of 2008 (7 U.S.C. 2016) is amended— 

17 (i) in subsection (a), by striking ‘‘Ex18 cept as provided in subsection (i), EBT’’ 

19 and inserting ‘‘EBT’’; 

20 (ii) in subsection (f)(3)— 

21 (I) by striking subparagraph (B); 

22 and 

23 (II) by redesignating subpara24 graph (C) as subparagraph (B); 

25 (iii) in subsection (h)— 


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1 (I) in paragraph (13)(B), by 

2 striking ‘‘subsection (j)(1)(H)’’ and 

3 inserting ‘‘subsection (i)(1)’’; and 

4 (II) in paragraph 

5 (14)(B)(ii)(III), by striking ‘‘section 

6 7(f)(2)(B)’’ and inserting ‘‘subsection 

7 (f)(2)(B)’’; 

8 (iv) by striking subsection (i); and 

9 (v) by redesignating subsections (j) 

10 and (k) as subsections (i) and (j), respec11 tively. 

12 (D) Section 16(h)(1) of the Food and Nu13 trition Act of 2008 (7 U.S.C. 2025(h)) is 

14 amended— 

15 (i) in subparagraph (B), in the matter 

16 preceding clause (i), by striking ‘‘that—’’ 

17 and all that follows through the period at 

18 the end of clause (ii) and inserting ‘‘that 

19 is determined and adjusted by the Sec20 retary.’’; and 

21 (ii) in clause (ii)(III)(ee)(AA) of sub22 paragraph (E) (as redesignated by para23 graph (2)(A)(iii)), by striking ‘‘, individ24 uals subject to the requirements under sec25 tion 6(o),’’. 


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1 (E) Section 17(b)(1)(B)(iv) of the Food 

2 and Nutrition Act of 2008 (7 U.S.C. 

3 2026(b)(1)(B)(iv)) is amended— 

4 (i) in subclause (V), by adding ‘‘or’’ 

5 at the end after the semicolon; 

6 (ii) in subclause (VI), by striking ‘‘; 

7 or’’ and inserting a period; and 

8 (iii) by striking subclause (VII). 

9 (F) Section 51(d)(8)(A)(ii) of the Internal 

10 Revenue Code of 1986 is amended— 

11 (i) in subclause (I), by striking ‘‘, or’’ 

12 at the end and inserting a period; 

13 (ii) in the matter preceding subclause 

14 (I), by striking ‘‘family—’’ and all that fol15 lows through ‘‘receiving’’ in subclause (I) 

16 and inserting ‘‘family receiving’’; and 

17 (iii) by striking subclause (II). 

18 (G) Section 103(a)(2) of the Workforce In19 novation and Opportunity Act (29 U.S.C. 3113) 

20 is amended— 

21 (i) by striking subparagraph (D); and 

22 (ii) by redesignating subparagraphs 

23 (E) through (K) as subparagraphs (D) 

24 through (J), respectively. 


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1 (H) Section 121(b)(2)(B) of the Workforce 

2 Innovation and Opportunity Act (29 U.S.C. 

3 3151) is amended— 

4 (i) by striking clause (iv); and 

5 (ii) by redesignating clauses (v) 

6 through (vii) as clauses (iv) through (vi), 

7 respectively. 

8 (4) Section 703(c)(1) of division N of the Con9 solidated Appropriations Act, 2021 (7 U.S.C. 2016 

10 note; Public Law 116–260), is amended by striking 

11 ‘‘section 7(k)(14) of the Food and Nutrition Act of 

12 2008’’ and inserting ‘‘section 7(j)(4) of the Food 

13 and Nutrition Act of 2008 (7 U.S.C. 2016(j)(4))’’. 

14 (b) PARTICIPATION OF PUERTO RICO, AMERICAN

15 SAMOA, AND THE NORTHERN MARIANA ISLANDS IN SUP16 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 

17 (1) DEFINITIONS.— 

18 (A) STATE.—Section 3(r) of the Food and 

19 Nutrition Act of 2008 (7 U.S.C. 2012(r)) is 

20 amended by inserting ‘‘the Commonwealth of 

21 Puerto Rico, American Samoa, the Common22 wealth of the Northern Mariana Islands,’’ after 

23 ‘‘Guam,’’. 

24 (B) THRIFTY FOOD PLAN.—Section 

25 3(u)(3) of the Food and Nutrition Act of 2008 


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1 (7 U.S.C. 2012(u)(3)) is amended by inserting 

2 ‘‘the Commonwealth of Puerto Rico, American 

3 Samoa, the Commonwealth of the Northern 

4 Mariana Islands,’’ after ‘‘Guam,’’. 

5 (2) ELIGIBLE HOUSEHOLDS.—Section 5 of the 

6 Food and Nutrition Act of 2008 (7 U.S.C. 2014) (as 

7 amended by section 4003(g)(1)(A)(iv)) is amended— 

8 (A) in subsection (c), in the undesignated 

9 matter at the end, by striking ‘‘States or 

10 Guam’’ and inserting ‘‘States, Guam, the Com11 monwealth of Puerto Rico, American Samoa, or 

12 the Commonwealth of the Northern Mariana Is13 lands’’; 

14 (B) in subsection (e)(1)(B)— 

15 (i) in the subparagraph heading, by 

16 striking ‘‘GUAM’’ and inserting ‘‘GUAM, 

17 THE COMMONWEALTH OF THE NORTHERN

18 MARIANA ISLANDS, AND AMERICAN

19 SAMOA’’; 

20 (ii) in clause (i), in the matter pre21 ceding subclause (I), by inserting ‘‘, the 

22 Commonwealth of the Northern Mariana 

23 Islands, and American Samoa’’ after 

24 ‘‘Guam’’; and 


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1 (iii) in clause (ii), in the matter pre2 ceding subclause (I), by inserting ‘‘, the 

3 Commonwealth of the Northern Mariana 

4 Islands, and American Samoa’’ after 

5 ‘‘Guam’’; and 

6 (C) by adding at the end the following: 

7 ‘‘(n) PUERTO RICO, AMERICAN SAMOA, AND THE

8 NORTHERN MARIANA ISLANDS.—Notwithstanding any 

9 other provision of this Act, including the requirements 

10 under this section, the Commonwealth of Puerto Rico, 

11 American Samoa, and the Commonwealth of the Northern 

12 Mariana Islands shall each establish their own standards 

13 of eligibility for participation by households in the supple14 mental nutrition assistance program.’’. 

15 (3) EFFECTIVE DATE.— 

16 (A) IN GENERAL.—The amendments made 

17 by paragraphs (1) and (2) shall be effective 

18 with respect to the Commonwealth of Puerto 

19 Rico, American Samoa, and the Commonwealth 

20 of the Northern Mariana Islands, as applicable, 

21 on the date described in subparagraph (B) if 

22 the Secretary of Agriculture submits to Con23 gress a certification under subsection (f)(2)(B) 

24 of section 19 of the Food and Nutrition Act of 

25 2008 (7 U.S.C. 2028). 


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1 (B) DATE DESCRIBED.—The date referred 

2 to in subparagraph (A) is, with respect to the 

3 Commonwealth of Puerto Rico, American 

4 Samoa, and the Commonwealth of the Northern 

5 Mariana Islands, the date established by the 

6 Commonwealth of Puerto Rico, American 

7 Samoa, or the Commonwealth of the Northern 

8 Mariana Islands, respectively, in the applicable 

9 plan of operation submitted to the Secretary of 

10 Agriculture under subsection (f)(1) of section 

11 19 of the Food and Nutrition Act of 2008 (7 

12 U.S.C. 2028). 

13 (c) TRANSITION OF PUERTO RICO, AMERICAN

14 SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP15 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.—Section 

16 19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) 

17 is amended— 

18 (1) in subsection (a)(1)— 

19 (A) in subparagraph (A), by striking 

20 ‘‘and’’ at the end; 

21 (B) in subparagraph (B), by striking the 

22 period at the end and inserting ‘‘; and’’; and 

23 (C) by adding at the end the following: 

24 ‘‘(C) the Commonwealth of the Northern 

25 Mariana Islands.’’; and 


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1 (2) by adding at the end the following: 

2 ‘‘(f) TRANSITION OF PUERTO RICO, AMERICAN

3 SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP4 PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 

5 ‘‘(1) REQUEST FOR PARTICIPATION.—A govern6 mental entity may submit to the Secretary a request 

7 to participate in the supplemental nutrition assist8 ance program, which shall include a plan of oper9 ation described in section 11(d), which shall include 

10 the date on which the governmental entity intends to 

11 begin participation in the program. 

12 ‘‘(2) CERTIFICATION BY SECRETARY.— 

13 ‘‘(A) IN GENERAL.—The Secretary shall 

14 certify a governmental entity that submits a re15 quest under paragraph (1) as qualified to par16 ticipate in the supplemental nutrition assistance 

17 program if the Secretary— 

18 ‘‘(i) approves the plan of operation 

19 submitted with the request, in accordance 

20 with this subsection; and 

21 ‘‘(ii) approves the applications de22 scribed in paragraph (4) in accordance 

23 with that paragraph. 

24 ‘‘(B) SUBMISSION OF CERTIFICATION TO

25 CONGRESS.—The Secretary shall submit each 


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1 certification under subparagraph (A) to Con2 gress. 

3 ‘‘(3) DETERMINATION OF PLAN OF OPER4 ATION.— 

5 ‘‘(A) APPROVAL.—The Secretary shall ap6 prove a plan of operation submitted with a re7 quest under paragraph (1) if the plan satisfies 

8 the requirements under this Act for a plan of 

9 operation. 

10 ‘‘(B) DISAPPROVAL.—If the Secretary does 

11 not approve a plan of operation submitted with 

12 a request under paragraph (1), the Secretary 

13 shall provide to the governmental entity a state14 ment that describes each requirement under 

15 this Act that is not satisfied by the plan. 

16 ‘‘(4) APPROVAL OF RETAIL FOOD STORES.— 

17 ‘‘(A) SOLICITATION OF APPLICATIONS.—If 

18 the Secretary approves a plan of operation 

19 under paragraph (3)(A) for a governmental en20 tity, the Secretary shall accept applications 

21 from retail food stores located in that govern22 mental entity to be authorized under section 9 

23 to participate in the supplemental nutrition as24 sistance program. 


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1 ‘‘(B) DETERMINATION.—The Secretary 

2 shall authorize a retail food store applying to 

3 participate in the supplemental nutrition assist4 ance program under subparagraph (A) if the 

5 application satisfies the requirements under this 

6 Act for authorization of a retail food store. 

7 ‘‘(5) PUERTO RICO.—In the case of a request 

8 under paragraph (1) by the Commonwealth of Puer9 to Rico, notwithstanding subsection (g), the Sec10 retary shall allow the Commonwealth of Puerto Rico 

11 to continue to carry out under the supplemental nu12 trition assistance program the Family Market Pro13 gram established pursuant to this section. 

14 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.— 

15 There are authorized to be appropriated to the Sec16 retary to carry out this subsection such sums as are 

17 necessary for fiscal year 2023, to remain available 

18 until expended. 

19 ‘‘(g) TERMINATION OF EFFECTIVENESS.— 

20 ‘‘(1) IN GENERAL.—Subsections (a) through (e) 

21 shall cease to be effective with respect to the Com22 monwealth of Puerto Rico, American Samoa, and 

23 the Commonwealth of the Northern Mariana Is24 lands, as applicable, on the date described in para25 graph (2) if the Secretary submits to Congress a 


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1 certification under subsection (f)(2)(B) for that gov2 ernmental entity. 

3 ‘‘(2) DATE DESCRIBED.—The date referred to 

4 in paragraph (1) is, with respect to the Common5 wealth of Puerto Rico, American Samoa, and the 

6 Commonwealth of the Northern Mariana Islands, 

7 the date established by the Commonwealth of Puerto 

8 Rico, American Samoa, or the Commonwealth of the 

9 Northern Mariana Islands, respectively, in the appli10 cable plan of operation submitted to the Secretary 

11 under subsection (f)(1).’’. 

12 SEC. 5602. REPEAL OF DENIAL OF SUPPLEMENTAL NUTRI13 TION ASSISTANCE PROGRAM BENEFITS. 

14 Section 115 of the Personal Responsibility and Work 

15 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 

16 is amended— 

17 (1) in subsection (a)— 

18 (A) by striking paragraph (2); 

19 (B) in paragraph (1), by striking ‘‘, or’’ 

20 and inserting a period; and 

21 (C) in the matter preceding paragraph (1), 

22 by striking ‘‘for—’’ and all that follows through 

23 ‘‘assistance’’ in paragraph (1) and inserting 

24 ‘‘for assistance’’; 

25 (2) in subsection (b)— 


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1 (A) by striking paragraph (2); 

2 (B) in paragraph (1), by striking the para3 graph designation and heading and all that fol4 lows through ‘‘The amount’’ and inserting ‘‘The 

5 amount’’; and 

6 (3) in subsection (e)— 

7 (A) by striking paragraph (2); 

8 (B) in paragraph (1), by striking ‘‘, and’’ 

9 and inserting a period; and 

10 (C) in the matter preceding paragraph (1), 

11 by striking ‘‘it—’’ and all that follows through 

12 ‘‘in section 419(5)’’ in paragraph (1) and in13 serting ‘‘the term in section 419(5)’’. 

14 Subtitle H—Universal School Meals 

15 Program 

16 SEC. 5701. SHORT TITLE. 

17 This subtitle may be cited as the ‘‘Universal School 

18 Meals Program Act of 2022’’. 

19 SEC. 5702. EFFECTIVE DATE. 

20 Unless otherwise provided, this subtitle, and the 

21 amendments made by this subtitle, shall take effect 1 year 

22 after the date of enactment of this Act. 


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1 SEC. 5703. FREE SCHOOL BREAKFAST PROGRAM. 

2 (a) IN GENERAL.—Section 4(a) of the Child Nutri3 tion Act of 1966 (42 U.S.C. 1773(a)) is amended, in the 

4 first sentence— 

5 (1) by striking ‘‘is hereby’’ and inserting ‘‘are’’; 

6 and 

7 (2) by inserting ‘‘to provide free breakfast to all 

8 children enrolled at those schools’’ before ‘‘in accord9 ance’’. 

10 (b) APPORTIONMENT TO STATES.—Section 4(b) of 

11 the Child Nutrition Act of 1966 (42 U.S.C. 1773(b)) is 

12 amended— 

13 (1) in paragraph (1)— 

14 (A) in subparagraph (A)(i), by striking 

15 subclause (II) and inserting the following: 

16 ‘‘(II) the national average pay17 ment for free breakfasts, as specified 

18 in subparagraph (B).’’; 

19 (B) by striking subparagraph (B) and in20 serting the following: 

21 ‘‘(B) PAYMENT AMOUNTS.— 

22 ‘‘(i) IN GENERAL.—The national aver23 age payment for each free breakfast shall 

24 be $2.72, adjusted annually for inflation in 

25 accordance with clause (ii) and rounded in 

26 accordance with clause (iii). 


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1 ‘‘(ii) INFLATION ADJUSTMENT.— 

2 ‘‘(I) IN GENERAL.—The annual 

3 inflation adjustment under clause (i) 

4 shall reflect changes in the cost of op5 erating the free breakfast program 

6 under this section, as indicated by the 

7 change in the Consumer Price Index 

8 for food away from home for all urban 

9 consumers. 

10 ‘‘(II) BASIS.—Each inflation an11 nual adjustment under clause (i) shall 

12 reflect the changes in the Consumer 

13 Price Index for food away from home 

14 for the most recent 12-month period 

15 for which that data is available. 

16 ‘‘(iii) ROUNDING.—On July 1, 2022, 

17 and annually thereafter, the national aver18 age payment rate for free breakfast shall 

19 be— 

20 ‘‘(I) adjusted to the nearest 

21 lower-cent increment; and 

22 ‘‘(II) based on the unrounded 

23 amounts for the preceding 12-month 

24 period.’’; 


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1 (C) by striking subparagraphs (C) and 

2 (E); and 

3 (D) by redesignating subparagraph (D) as 

4 subparagraph (C); 

5 (2) by striking paragraphs (2) and (3); 

6 (3) by redesignating paragraphs (4) and (5) as 

7 paragraphs (2) and (3), respectively; and 

8 (4) in paragraph (3) (as so redesignated), by 

9 striking ‘‘paragraph (3) or (4)’’ and inserting ‘‘para10 graph (2)’’. 

11 (c) STATE DISBURSEMENT TO SCHOOLS.—Section 4 

12 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) is 

13 amended by striking subsection (c) and inserting the fol14 lowing: 

15 ‘‘(c) STATE DISBURSEMENT TO SCHOOLS.—Funds 

16 apportioned and paid to any State for the purpose of this 

17 section shall be disbursed by the State educational agency 

18 to schools selected by the State educational agency to as19 sist those schools in operating a breakfast program.’’. 

20 (d) NO COLLECTION OF DEBT.— 

21 (1) IN GENERAL.—Notwithstanding any other 

22 provision of the Child Nutrition Act of 1966 (42 

23 U.S.C. 1771 et seq.) or any other provision of law, 

24 effective beginning on the date of enactment of this 

25 Act, as a condition of participation in the breakfast 


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1 program under section 4 of that Act (42 U.S.C. 

2 1773), a school— 

3 (A) shall not collect any debt owed to the 

4 school for unpaid meal charges; and 

5 (B) shall continue to accrue debt for un6 paid meal charges— 

7 (i) for the purpose of receiving reim8 bursement under section 5715; and 

9 (ii) until the effective date specified in 

10 section 5702. 

11 (2) CHILD NUTRITION ACT OF 1966.— 

12 (A) IN GENERAL.—Section 4 of the Child 

13 Nutrition Act of 1966 (42 U.S.C. 1773) is 

14 amended by striking subsection (d) and insert15 ing the following: 

16 ‘‘(d) NO COLLECTION OF DEBT.—A school partici17 pating in the free breakfast program under this section 

18 shall not collect any debt owed to the school for unpaid 

19 meal charges.’’. 

20 (B) CONFORMING AMENDMENT.—Section 

21 23(a) of the Child Nutrition Act of 1966 (42 

22 U.S.C. 1793(a)) is amended by striking ‘‘school 

23 in severe need, as described in section 4(d)(1)’’ 

24 and inserting the following: ‘‘school— 


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1 ‘‘(1) that has a free breakfast program under 

2 section 4 or seeks to initiate a free breakfast pro3 gram under that section; and 

4 ‘‘(2) of which not less than 40 percent of the 

5 students are identified students (as defined in para6 graph (8) of section 1113(a) of the Elementary and 

7 Secondary Education Act of 1965 (20 U.S.C. 

8 6313(a)))’’. 

9 (e) NUTRITIONAL AND OTHER PROGRAM REQUIRE10 MENTS.—Section 4(e) of the Child Nutrition Act of 1966 

11 (42 U.S.C. 1773(e)) is amended— 

12 (1) in paragraph (1)(A), in the second sentence, 

13 by striking ‘‘free or’’ and all that follows through 

14 the period at the end and inserting ‘‘free to all chil15 dren enrolled at a school participating in the school 

16 breakfast program.’’; and 

17 (2) in paragraph (2), in the second sentence, by 

18 striking ‘‘the full charge to the student for a break19 fast meeting the requirements of this section or’’. 

20 (f) PROHIBITION ON BREAKFAST SHAMING, MEAL

21 DENIAL.— 

22 (1) IN GENERAL.—Effective beginning on the 

23 date of enactment of this Act, a school or school 

24 food authority— 

25 (A) shall not— 


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1 (i) physically segregate or otherwise 

2 discriminate against any child participating 

3 in the breakfast program under section 4 

4 of the Child Nutrition Act of 1966 (42 

5 U.S.C. 1773); or 

6 (ii) overtly identify a child described 

7 in clause (i) by a special token or ticket, 

8 an announced or published list of names, 

9 or any other means; and 

10 (B) shall provide the program meal to any 

11 child eligible under the program. 

12 (2) CHILD NUTRITION ACT OF 1966.—Section 4 

13 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) 

14 is amended by adding at the end the following: 

15 ‘‘(f) PROHIBITION ON BREAKFAST SHAMING.—A 

16 school or school food authority shall not— 

17 ‘‘(1) physically segregate or otherwise discrimi18 nate against any child participating in the free 

19 breakfast program under this section; or 

20 ‘‘(2) overtly identify a child described in para21 graph (1) by a special token or ticket, an announced 

22 or published list of names, or any other means.’’. 

23 (g) DEPARTMENT OF DEFENSE OVERSEAS DEPEND24 ENTS’ SCHOOLS.—Section 20(b) of the Child Nutrition 

25 Act of 1966 (42 U.S.C. 1789(b)) is amended— 


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1 (1) by striking ‘‘and reduced-price’’; and 

2 (2) by striking ‘‘and shall’’ and all that follows 

3 through ‘‘section’’. 

4 (h) CONFORMING AMENDMENTS.—The Child Nutri5 tion Act of 1966 (42 U.S.C. 1771 et seq.) is amended— 

6 (1) by striking ‘‘or reduced price’’ each place it 

7 appears; 

8 (2) by striking ‘‘and reduced price’’ each place 

9 it appears; and 

10 (3) by striking ‘‘a reduced price’’ each place it 

11 appears. 

12 SEC. 5704. APPORTIONMENT TO STATES. 

13 Section 4(b) of the Richard B. Russell National 

14 School Lunch Act (42 U.S.C. 1753(b)) is amended— 

15 (1) by striking paragraph (2) and inserting the 

16 following: 

17 ‘‘(2) PAYMENT AMOUNTS.— 

18 ‘‘(A) IN GENERAL.—The national average 

19 payment for each free lunch shall be $3.81, ad20 justed annually for inflation in accordance with 

21 subparagraph (C) and rounded in accordance 

22 with subparagraph (D). 

23 ‘‘(B) ADDITIONAL PAYMENT FOR LOCAL

24 FOOD.— 


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1 ‘‘(i) DEFINITION OF LOCALLY

2 SOURCED FARM PRODUCT.—In this sub3 paragraph, the term ‘locally sourced farm 

4 product’ means a farm product that— 

5 ‘‘(I) is marketed to consumers— 

6 ‘‘(aa) directly; or 

7 ‘‘(bb) through intermediated 

8 channels (such as food hubs and 

9 cooperatives); and 

10 ‘‘(II) with respect to the school 

11 food authority purchasing the farm 

12 product, is produced and distrib13 uted— 

14 ‘‘(aa) in the State in which 

15 the school food authority is lo16 cated; or 

17 ‘‘(bb) not more than 250 

18 miles from the location of the 

19 school food authority. 

20 ‘‘(ii) ADDITIONAL PAYMENT ELIGI21 BILITY.—During a school year, a school 

22 food authority shall receive an additional 

23 payment described in clause (iii) if the 

24 State certifies that the school food author25 ity served meals (including breakfasts, 


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1 lunches, suppers, and supplements) during 

2 the last school year of which not less than 

3 25 percent were made with locally sourced 

4 farm products. 

5 ‘‘(iii) PAYMENT AMOUNT.— 

6 ‘‘(I) IN GENERAL.—The addi7 tional payment amount under this 

8 subparagraph shall be— 

9 ‘‘(aa) $0.30 for each free 

10 lunch and supper; 

11 ‘‘(bb) $0.21 for each free 

12 breakfast; and 

13 ‘‘(cc) $0.08 for each free 

14 supplement. 

15 ‘‘(II) ADJUSTMENTS.—Each ad16 ditional payment amount under sub17 clause (I) shall be adjusted annually 

18 in accordance with subparagraph (C) 

19 and rounded in accordance with sub20 paragraph (D). 

21 ‘‘(iv) DISBURSEMENT.—The State 

22 agency shall disburse funds made available 

23 under this clause to school food authorities 

24 eligible to receive additional reimburse25 ment. 


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1 ‘‘(C) INFLATION ADJUSTMENT.— 

2 ‘‘(i) IN GENERAL.—The annual infla3 tion adjustment under subparagraphs (A) 

4 and (B)(iii) shall reflect changes in the 

5 cost of operating the free lunch program 

6 under this Act, as indicated by the change 

7 in the Consumer Price Index for food away 

8 from home for all urban consumers. 

9 ‘‘(ii) BASIS.—Each annual inflation 

10 adjustment under subparagraphs (A) and 

11 (B)(iii) shall reflect the changes in the 

12 Consumer Price Index for food away from 

13 home for the most recent 12-month period 

14 for which that data is available. 

15 ‘‘(D) ROUNDING.—On July 1, 2022, and 

16 annually thereafter, the national average pay17 ment rate for free lunch and the additional pay18 ment amount for free breakfast, lunch, supper, 

19 and supplement under subparagraph (B) shall 

20 be— 

21 ‘‘(i) adjusted to the nearest lower-cent 

22 increment; and 

23 ‘‘(ii) based on the unrounded amounts 

24 for the preceding 12-month period.’’; and 

25 (2) by striking paragraph (3). 


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1 SEC. 5705. NUTRITIONAL AND OTHER PROGRAM REQUIRE2 MENTS. 

3 (a) ELIMINATION OF FREE LUNCH ELIGIBILITY RE4 QUIREMENTS.— 

5 (1) IN GENERAL.—Section 9 of the Richard B. 

6 Russell National School Lunch Act (42 U.S.C. 

7 1758) is amended by striking subsection (b) and in8 serting the following: 

9 ‘‘(b) ELIGIBILITY.—All children enrolled in a school 

10 that participates in the school lunch program under this 

11 Act shall be eligible to receive free lunch under this Act.’’. 

12 (2) CONFORMING AMENDMENTS.— 

13 (A) Section 9 of the Richard B. Russell 

14 National School Lunch Act (42 U.S.C. 1758) is 

15 amended— 

16 (i) in subsection (c), in the third sen17 tence, by striking ‘‘or at a reduced cost’’; 

18 and 

19 (ii) in subsection (e), by striking ‘‘, re20 duced price,’’. 

21 (B) Section 18 of the Richard B. Russell 

22 National School Lunch Act (42 U.S.C. 1769) is 

23 amended— 

24 (i) by striking subsection (j); and 

25 (ii) by redesignating subsection (k) as 

26 subsection (j). 


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1 (C) Section 28(b)(4) of the Richard B. 

2 Russell National School Lunch Act (42 U.S.C. 

3 1769i(b)(4)) is amended— 

4 (i) by striking subparagraph (B); and 

5 (ii) in subparagraph (A), by striking 

6 the subparagraph designation and heading 

7 and all that follows through ‘‘the Sec8 retary’’ and inserting ‘‘The Secretary’’. 

9 (D) Section 17 of the Child Nutrition Act 

10 of 1966 (42 U.S.C. 1786) is amended— 

11 (i) in subsection (d)(2)(A)— 

12 (I) by striking clause (i); and 

13 (II) by redesignating clauses (ii) 

14 and (iii) as clauses (i) and (ii), respec15 tively; and 

16 (ii) in subsection (f)(17), by striking 

17 ‘‘Notwithstanding subsection (d)(2)(A)(i), 

18 not later’’ and inserting ‘‘Not later’’. 

19 (E) Section 1902(a) of the Social Security 

20 Act (42 U.S.C. 1396a(a)) is amended by strik21 ing paragraph (7) and inserting the following: 

22 ‘‘(7) provide safeguards which restrict the use 

23 or disclosure of information concerning applicants 

24 and recipients to purposes directly connected with 

25 the administration of the plan;’’. 


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1 (F) Section 1154(a)(2)(A)(i) of title 10, 

2 United States Code, is amended by striking ‘‘in 

3 accordance with section 9(b)(1) of the Richard 

4 B. Russell National School Lunch Act (42 

5 U.S.C. 1758(b)(1)’’. 

6 (G) Section 4301 of the Food, Conserva7 tion, and Energy Act of 2008 (42 U.S.C. 

8 1758a) is repealed. 

9 (b) NO COLLECTION OF DEBT.— 

10 (1) IN GENERAL.—Notwithstanding any other 

11 provision of the Richard B. Russell National School 

12 Lunch Act (42 U.S.C. 1751 et seq.) or any other 

13 provision of law, effective beginning on the date of 

14 enactment of this Act, as a condition of participation 

15 in the school lunch program under that Act, a 

16 school— 

17 (A) shall not collect any debt owed to the 

18 school for unpaid meal charges; and 

19 (B) shall continue to accrue debt for un20 paid meal charges— 

21 (i) for the purpose of receiving reim22 bursement under section 5715; and 

23 (ii) until the effective date specified in 

24 section 5702. 


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1 (2) NATIONAL SCHOOL LUNCH ACT.—Section 9 

2 of the Richard B. Russell National School Lunch 

3 Act (42 U.S.C. 1758) is amended by striking sub4 section (d) and inserting the following: 

5 ‘‘(d) NO COLLECTION OF DEBT.—A school partici6 pating in the school lunch program under this Act shall 

7 not collect any debt owed to the school for unpaid meal 

8 charges.’’. 

9 SEC. 5706. SPECIAL ASSISTANCE PROGRAM. 

10 (a) IN GENERAL.—Section 11 of the Richard B. Rus11 sell National School Lunch Act (42 U.S.C. 1759a) is re12 pealed. 

13 (b) CONFORMING AMENDMENTS.— 

14 (1) Section 6 of the Richard B. Russell Na15 tional School Lunch Act (42 U.S.C. 1755) is amend16 ed— 

17 (A) in subsection (a)(2), by striking ‘‘sec18 tions 11 and 13’’ and inserting ‘‘section 13’’; 

19 and 

20 (B) in subsection (e)(1), in the matter pre21 ceding subparagraph (A), by striking ‘‘section 

22 4, this section, and section 11’’ and inserting 

23 ‘‘this section and section 4’’. 


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1 (2) Section 7(d) of the Richard B. Russell Na2 tional School Lunch Act (42 U.S.C. 1756(d)) is 

3 amended by striking ‘‘or 11’’. 

4 (3) Section 8(g) of the Richard B. Russell Na5 tional School Lunch Act (42 U.S.C. 1757(g)) is 

6 amended by striking ‘‘and under section 11 of this 

7 Act’’. 

8 (4) Section 12(f) of the Richard B. Russell Na9 tional School Lunch Act (42 U.S.C. 1760(f)) is 

10 amended by striking ‘‘11,’’. 

11 (5) Section 7(a) of the Child Nutrition Act of 

12 1966 (42 U.S.C. 1766(a)) is amended— 

13 (A) in paragraph (1)(A), by striking ‘‘4, 

14 11, and 17’’ and inserting ‘‘4 and 17’’; and 

15 (B) in paragraph (2)(A), by striking ‘‘sec16 tions 4 and 11’’ and inserting ‘‘section 4’’. 

17 SEC. 5707. PRICE FOR A PAID LUNCH. 

18 Section 12 of the Richard B. Russell National School 

19 Lunch Act (42 U.S.C. 1760) is amended— 

20 (1) by striking subsection (p); and 

21 (2) by redesignating subsections (q) and (r) as 

22 subsections (p) and (q), respectively. 


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1 SEC. 5708. SUMMER FOOD SERVICE PROGRAM FOR CHIL2 DREN. 

3 Section 13 of the Richard B. Russell National School 

4 Lunch Act (42 U.S.C. 1761) is amended— 

5 (1) in subsection (a)— 

6 (A) in paragraph (2), by adding at the end 

7 the following: 

8 ‘‘(C) WAIVER.—If the Secretary deter9 mines that a program requirement under this 

10 section limits the access of children to meals 

11 served under this section, the Secretary may 

12 waive that program requirement. 

13 ‘‘(D) ELIGIBILITY.—All children shall be 

14 eligible to participate in the program under this 

15 section.’’; and 

16 (B) in paragraph (5), by striking ‘‘only 

17 for’’ and all that follows through the period at 

18 the end and inserting ‘‘for meals served to all 

19 children.’’; 

20 (2) in subsection (b)(2), by striking ‘‘may only 

21 serve’’ and all that follows through ‘‘migrant chil22 dren’’; 

23 (3) by striking subsection (c) and inserting the 

24 following: 

25 ‘‘(c) PAYMENTS.— 


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1 ‘‘(1) IN GENERAL.—Payments shall be made to 

2 service institutions for meals served— 

3 ‘‘(A) during the months of May through 

4 September; 

5 ‘‘(B) during school vacation at any time 

6 during an academic school year; 

7 ‘‘(C) during a teacher in-service day; and 

8 ‘‘(D) on days that school is closed during 

9 the months of October through April due to a 

10 natural disaster, building repair, court order, or 

11 similar cause, as determined by the Secretary. 

12 ‘‘(2) LIMITATION ON PAYMENTS.—A service in13 stitution shall receive payments under this section 

14 for not more than 3 meals and 1 supplement per 

15 child per day.’’; and 

16 (4) in subsection (f)(3), by striking ‘‘, except 

17 that’’ and all that follows through ‘‘section’’. 

18 SEC. 5709. SUMMER ELECTRONIC BENEFIT TRANSFER FOR 

19 CHILDREN PROGRAM. 

20 Section 13(a) of the Richard B. Russell National 

21 School Lunch Act (42 U.S.C. 1761(a)) is amended by add22 ing at the end the following: 

23 ‘‘(13) SUMMER ELECTRONIC BENEFIT TRANS24 FER FOR CHILDREN PROGRAM.— 

25 ‘‘(A) DEFINITIONS.—In this paragraph: 


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1 ‘‘(i) EBT CARD.—The term ‘EBT 

2 card’ means an electronic benefit transfer 

3 card. 

4 ‘‘(ii) ELIGIBLE HOUSEHOLD.—The 

5 term ‘eligible household’ means a house6 hold with— 

7 ‘‘(I) an income that does not ex8 ceed 200 percent of the poverty line 

9 (as defined in section 673 of the Com10 munity Services Block Grant Act (42 

11 U.S.C. 9902)); and 

12 ‘‘(II) 1 or more children. 

13 ‘‘(iii) PROGRAM.—The term ‘Program’ 

14 means the Summer Electronic Benefit 

15 Transfer for Children Program established 

16 under subparagraph (B). 

17 ‘‘(B) ESTABLISHMENT.—The Secretary 

18 shall establish a national program, to be known 

19 as the ‘Summer Electronic Benefit Transfer for 

20 Children Program’, under which the Secretary 

21 shall issue EBT cards to eligible households to 

22 provide food assistance during the summer 

23 months. 

24 ‘‘(C) EBT AMOUNT.— 


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1 ‘‘(i) IN GENERAL.—The value of an 

2 EBT card provided under the Program to 

3 an eligible household shall be $60 per 

4 month per child (adjusted for inflation). 

5 ‘‘(ii) ANNUAL LIMITATION.—No eligi6 ble household shall receive benefits under 

7 the Program for more than 3 months in a 

8 calendar year. 

9 ‘‘(D) ADMINISTRATION.— 

10 ‘‘(i) IN GENERAL.—Except as pro11 vided under this paragraph, the Program 

12 shall be based on the summer electronic 

13 benefit transfer for children demonstration 

14 program carried out pursuant to section 

15 749(g) of the Agriculture, Rural Develop16 ment, Food and Drug Administration, and 

17 Related Agencies Appropriations Act, 2010 

18 (Public Law 111–80; 123 Stat. 2132). 

19 ‘‘(ii) SNAP OR WIC.— 

20 ‘‘(I) IN GENERAL.—Subject to 

21 subclause (II), a State shall admin22 ister the Program through the supple23 mental nutrition assistance program 

24 established under the Food and NutriVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 00983 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tion Act of 2008 (7 U.S.C. 2011 et 

2 seq.). 

3 ‘‘(II) WIC OPTION.—If a State 

4 has participated in the demonstration 

5 program described in clause (i) before 

6 the effective date specified in section 

7 5702 of the Universal School Meals 

8 Program Act of 2022, the State may 

9 elect to administer the Program 

10 through the special supplemental nu11 trition program for women, infants, 

12 and children established by section 17 

13 of the Child Nutrition Act of 1966 

14 (42 U.S.C. 1786). 

15 ‘‘(E) AUTHORIZATION OF APPROPRIA16 TIONS.—There are authorized to be appro17 priated to the Secretary to carry out this para18 graph such sums as are necessary for fiscal 

19 year 2022 and each fiscal year thereafter.’’. 

20 SEC. 5710. CHILD AND ADULT CARE FOOD PROGRAM. 

21 Section 17 of the Richard B. Russell National School 

22 Lunch Act (42 U.S.C. 1766) is amended— 

23 (1) in subsection (a)(2), by striking subpara24 graph (B) and inserting the following: 


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1 ‘‘(B) any other private organization pro2 viding nonresidential child care or day care out3 side school hours for school children;’’; 

4 (2) by striking subsection (c) and inserting the 

5 following: 

6 ‘‘(c) FREE MEALS.—Notwithstanding any other pro7 vision of law— 

8 ‘‘(1) all meals and supplements served under 

9 the program authorized under this section shall be 

10 provided for free to participants of the program; and 

11 ‘‘(2) an institution that serves those meals and 

12 supplements shall be reimbursed— 

13 ‘‘(A) in the case of breakfast, at the rate 

14 established for free breakfast under section 

15 4(b)(1)(B)(i) of the Child Nutrition Act of 

16 1966 (42 U.S.C. 1773(b)(1)(B)(i)); 

17 ‘‘(B) in the case of lunch, at the rate es18 tablished for free lunch under section 

19 4(b)(2)(A); and 

20 ‘‘(C) in the case of a supplemental meal, 

21 $0.96, adjusted for inflation in accordance with 

22 section 4(b)(2)(C).’’; 

23 (3) in subsection (f)— 

24 (A) in paragraph (2), by striking subpara25 graph (B) and inserting the following: 


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1 ‘‘(B) LIMITATION TO REIMBURSEMENTS.— 

2 An institution may claim reimbursement under 

3 this paragraph for not more than 3 meals and 

4 1 supplement per day per child.’’; 

5 (B) by striking paragraph (3); and 

6 (C) by redesignating paragraph (4) as 

7 paragraph (3); and 

8 (4) in subsection (r)— 

9 (A) in the subsection heading, by striking 

10 ‘‘PROGRAM FOR AT-RISK SCHOOL CHILDREN’’ 

11 and inserting ‘‘AFTERSCHOOL MEAL AND

12 SNACK PROGRAM’’; 

13 (B) by striking ‘‘at-risk school’’ each place 

14 it appears and inserting ‘‘eligible’’; 

15 (C) in paragraph (1)— 

16 (i) in the paragraph heading, by strik17 ing ‘‘AT-RISK SCHOOL’’ and inserting ‘‘ELI18 GIBLE’’; and 

19 (ii) in subparagraph (B), by striking 

20 ‘‘operated’’ and all that follows through 

21 the period at the end and inserting a pe22 riod; and 

23 (D) in paragraph (4)(A), by striking ‘‘only 

24 for’’ and all that follows through the period at 

25 the end and inserting the following: ‘‘for— 


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1 ‘‘(i) not more than 1 meal and 1 sup2 plement per child per day served on a reg3 ular school day; and 

4 ‘‘(ii) not more than 3 meals and 1 

5 supplement per child per day served on 

6 any day other than a regular school day.’’. 

7 SEC. 5711. MEALS AND SUPPLEMENTS FOR CHILDREN IN 

8 AFTERSCHOOL CARE. 

9 Section 17A of the Richard B. Russell National 

10 School Lunch Act (42 U.S.C. 1766a) is amended— 

11 (1) in the section heading, by striking ‘‘MEAL

12 SUPPLEMENTS’’ and inserting ‘‘MEALS AND SUP13 PLEMENTS’’; 

14 (2) in subsection (a)(1), by striking ‘‘meal sup15 plements’’ and inserting ‘‘free meals and supple16 ments’’; 

17 (3) in subsection (b), by inserting ‘‘meals and’’ 

18 before ‘‘supplements’’; and 

19 (4) by striking subsection (c) and inserting the 

20 following: 

21 ‘‘(c) REIMBURSEMENT.— 

22 ‘‘(1) IN GENERAL.— 

23 ‘‘(A) MEALS.—A free meal provided under 

24 this section to a child shall be reimbursed at a 

25 rate of $3.81, adjusted annually for inflation in 


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1 accordance with paragraph (3)(A) and rounded 

2 in accordance with paragraph (3)(B). 

3 ‘‘(B) SUPPLEMENTS.—A free supplement 

4 provided under this section to a child shall be 

5 reimbursed at the rate at which free supple6 ments are reimbursed under section 

7 17(c)(2)(C). 

8 ‘‘(2) LIMITATION TO REIMBURSEMENTS.—An 

9 institution may claim reimbursement under this sec10 tion for not more than 1 meal and 1 supplement per 

11 day per child served on a regular school day. 

12 ‘‘(3) INFLATION; ROUNDING.— 

13 ‘‘(A) INFLATION ADJUSTMENT.— 

14 ‘‘(i) IN GENERAL.—The annual infla15 tion adjustment under paragraph (1)(A) 

16 shall reflect changes in the cost of oper17 ating the program under this section, as 

18 indicated by the change in the Consumer 

19 Price Index for food away from home for 

20 all urban consumers. 

21 ‘‘(ii) BASIS.—Each inflation annual 

22 adjustment under paragraph (1)(A) shall 

23 reflect the changes in the Consumer Price 

24 Index for food away from home for the 


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1 most recent 12-month period for which 

2 that data is available. 

3 ‘‘(B) ROUNDING.—On July 1, 2022, and 

4 annually thereafter, the reimbursement rate for 

5 a free meal under this section shall be— 

6 ‘‘(i) adjusted to the nearest lower-cent 

7 increment; and 

8 ‘‘(ii) based on the unrounded amounts 

9 for the preceding 12-month period.’’. 

10 SEC. 5712. ACCESS TO LOCAL FOODS: FARM TO SCHOOL 

11 PROGRAM. 

12 Section 18(g)(5) of the Richard B. Russell National 

13 School Lunch Act (42 U.S.C. 1769(g)(5)) is amended by 

14 striking subparagraph (B) and inserting the following: 

15 ‘‘(B) serve a high proportion of identified 

16 students (as defined in paragraph (8) of section 

17 1113(a) of the Elementary and Secondary Edu18 cation Act of 1965 (20 U.S.C. 6313(a)));’’. 

19 SEC. 5713. FRESH FRUIT AND VEGETABLE PROGRAM. 

20 Section 19(d) of the Richard B. Russell National 

21 School Lunch Act (42 U.S.C. 1769a(d)) is amended— 

22 (1) in paragraph (1)— 

23 (A) in the matter preceding subparagraph 

24 (A), by striking ‘‘paragraph (2) of this sub25 section and’’; 


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1 (B) in subparagraph (A), in the matter 

2 preceding clause (i), by striking ‘‘school—’’ and 

3 all that follows through ‘‘submits’’ in clause (ii) 

4 and inserting ‘‘school that submits’’; 

5 (C) in subparagraph (B), by striking 

6 ‘‘schools’’ and all that follows through ‘‘Act’’ 

7 and inserting ‘‘high-need schools (as defined in 

8 section 2211(b) of the Elementary and Sec9 ondary Education Act of 1965 (20 U.S.C. 

10 6631(b)))’’; and 

11 (D) in subparagraph (D)— 

12 (i) by striking clause (i); and 

13 (ii) by redesignating clauses (ii) 

14 through (iv) as clauses (i) through (iii), re15 spectively; and 

16 (2) by striking paragraphs (2) and (3) and in17 serting the following: 

18 ‘‘(2) OUTREACH TO HIGH-NEED SCHOOLS.— 

19 Prior to making decisions regarding school participa20 tion in the program, a State agency shall inform 

21 high-need schools (as defined in section 2211(b) of 

22 the Elementary and Secondary Education Act of 

23 1965 (20 U.S.C. 6631(b))), including Tribal schools, 

24 of the eligibility of the schools for the program.’’. 


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•S 4486 IS

1 SEC. 5714. TRAINING, TECHNICAL ASSISTANCE, AND FOOD 

2 SERVICE MANAGEMENT INSTITUTE. 

3 Section 21(a)(1)(B) of the Richard B. Russell Na4 tional School Lunch Act (42 U.S.C. 1769b–1(a)(1)(B)) is 

5 amended in the matter preceding clause (i) by striking 

6 ‘‘certified to receive free or reduced price meals’’ and in7 serting ‘‘who are identified students (as defined in para8 graph (8) of section 1113(a) of the Elementary and Sec9 ondary Education Act of 1965 (20 U.S.C. 6313(a))’’. 

10 SEC. 5715. REIMBURSEMENT OF SCHOOL MEAL DELIN11 QUENT DEBT PROGRAM. 

12 (a) DEFINITIONS.—In this section: 

13 (1) DELINQUENT DEBT.—The term ‘‘delinquent 

14 debt’’ means the debt owed by a parent or guardian 

15 of a child to a school— 

16 (A) as of the effective date specified in sec17 tion 5702; and 

18 (B) for meals served by the school under— 

19 (i) the school breakfast program 

20 under section 4 of the Child Nutrition Act 

21 of 1966 (42 U.S.C. 1773); 

22 (ii) the school lunch program estab23 lished under the Richard B. Russell Na24 tional School Lunch Act (42 U.S.C. 1751 

25 et seq.); or 


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•S 4486 IS

1 (iii) both of the programs described in 

2 clauses (i) and (ii). 

3 (2) PROGRAM.—The term ‘‘program’’ means 

4 the program established under subsection (b)(1). 

5 (3) SECRETARY.—The term ‘‘Secretary’’ means 

6 the Secretary of Agriculture. 

7 (b) REIMBURSEMENT PROGRAM.— 

8 (1) ESTABLISHMENT.—Not later than 60 days 

9 after the effective date specified in section 5702, the 

10 Secretary shall establish a program under which the 

11 Secretary shall reimburse each school participating 

12 in a program described in clause (i) or (ii) of sub13 section (a)(1)(B) for all delinquent debt. 

14 (2) FORM FOR REIMBURSEMENT.—To carry out 

15 the program, the Secretary shall design and dis16 tribute a form to State agencies to collect data on 

17 all delinquent debt in applicable schools in the State, 

18 grouped by school food authority. 

19 (3) COMPLETION DATE.—The Secretary shall 

20 provide all reimbursements under the program not 

21 later than 180 days after the effective date specified 

22 in section 5702. 

23 (c) REPORT.—Not later than 2 years after the effec24 tive date specified in section 5702, the Comptroller Gen25 eral of the United States shall submit to Congress and 


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•S 4486 IS

1 make publicly available a report that describes the suc2 cesses and challenges of the program. 

3 SEC. 5716. CONFORMING AMENDMENTS. 

4 The Richard B. Russell National School Lunch Act 

5 (42 U.S.C. 1751 et seq.) is amended— 

6 (1) by striking ‘‘or reduced price’’ each place it 

7 appears; 

8 (2) by striking ‘‘or a reduced price’’ each place 

9 it appears; 

10 (3) by striking ‘‘and reduced price’’ each place 

11 it appears; and 

12 (4) by striking ‘‘a reduced price’’ each place it 

13 appears. 

14 SEC. 5717. MEASURE OF POVERTY. 

15 Section 1113(a) of the Elementary and Secondary 

16 Education Act of 1965 (20 U.S.C. 6313(a)) is amended— 

17 (1) in paragraph (5)(A), by striking ‘‘the num18 ber of children eligible for a free or reduced price 

19 lunch under the Richard B. Russell National School 

20 Lunch Act (42 U.S.C. 1751 et seq.)’’ and inserting 

21 ‘‘the number of identified students’’; and 

22 (2) by adding at the end the following: 

23 ‘‘(8) IDENTIFIED STUDENTS DEFINED.— 


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1 ‘‘(A) IN GENERAL.—In this subsection, the 

2 term ‘identified students’ means the number of 

3 students— 

4 ‘‘(i) who are— 

5 ‘‘(I) homeless children and 

6 youths, as defined under section 

7 725(2) of the McKinney-Vento Home8 less Assistance Act (42 U.S.C. 

9 11434a(2)); 

10 ‘‘(II) runaway and homeless 

11 youth served by programs established 

12 under the Runaway and Homeless 

13 Youth Act (34 U.S.C. 11201 et seq.); 

14 ‘‘(III) migratory children, as de15 fined under section 1309; or 

16 ‘‘(IV) foster children; 

17 ‘‘(ii) who are eligible for and receiving 

18 medical assistance under the program of 

19 medical assistance established under title 

20 XIX of the Social Security Act (42 U.S.C. 

21 1396 et seq.); or 

22 ‘‘(iii) who participate (or who are part 

23 of a household that participates) in at least 

24 one of the following: 


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•S 4486 IS

1 ‘‘(I) The supplemental nutrition 

2 assistance program established under 

3 the Food and Nutrition Act of 2008 

4 (7 U.S.C. 2011 et seq.). 

5 ‘‘(II) A State program funded 

6 under the program of block grants to 

7 States for temporary assistance for 

8 needy families established under part 

9 A of title IV of the Social Security 

10 Act (42 U.S.C. 601 et seq.). 

11 ‘‘(III) The food distribution pro12 gram on Indian reservations estab13 lished under section 4(b) of the Food 

14 and Nutrition Act of 2008 (7 U.S.C. 

15 2013(b)). 

16 ‘‘(IV) A Head Start program au17 thorized under the Head Start Act 

18 (42 U.S.C. 9831 et seq.) or a com19 parable State-funded Head Start or 

20 pre-kindergarten program. 

21 ‘‘(B) MULTIPLIER.—In determining the 

22 number of identified students under subpara23 graph (A), the local educational agency shall 

24 multiply the number determined under such 

25 subparagraph by 1.6.’’. 


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•S 4486 IS

1 SEC. 5718. SUPPLEMENTAL NUTRITION ASSISTANCE PRO2 GRAM. 

3 (a) AGREEMENT FOR DIRECT CERTIFICATION.— 

4 (1) IN GENERAL.—Section 11 of the Food and 

5 Nutrition Act of 2008 (7 U.S.C. 2020) is amend6 ed— 

7 (A) by striking subsection (u); and 

8 (B) by redesignating subsections (v) 

9 through (x) as subsections (u) through (w), re10 spectively. 

11 (2) CONFORMING AMENDMENTS.—Section 11(e) 

12 of the Food and Nutrition Act of 2008 (7 U.S.C. 

13 2020(e)) is amended— 

14 (A) in paragraph (8)(F), by striking ‘‘or 

15 subsection (u)’’; and 

16 (B) in paragraph (26)(B), by striking 

17 ‘‘(x)’’ and inserting ‘‘(w)’’. 

18 (b) NUTRITION EDUCATION AND OBESITY PREVEN19 TION GRANT PROGRAM.—Section 28(a) of the Food and 

20 Nutrition Act of 2008 (7 U.S.C. 2036a(a)) is amended 

21 by striking paragraph (1) and inserting the following: 

22 ‘‘(1) an individual eligible for benefits under 

23 this Act;’’. 

24 SEC. 5719. HIGHER EDUCATION ACT OF 1965. 

25 (a) TEACHER QUALITY ENHANCEMENT.—Subpara26 graph (A) of section 200(11) of the Higher Education Act 


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1 of 1965 (20 U.S.C. 1021(11)) is amended to read as fol2 lows: 

3 ‘‘(A) IN GENERAL.—The term ‘high-need 

4 school’ means a school that is in the highest 

5 quartile of schools in a ranking of all schools 

6 served by a local educational agency, ranked in 

7 descending order by percentage of students 

8 from low-income families enrolled in such 

9 schools, as determined by the local educational 

10 agency based on one of the following measures 

11 of poverty: 

12 ‘‘(i) The percentage of students aged 

13 5 through 17 in poverty counted in the 

14 most recent census data approved by the 

15 Secretary. 

16 ‘‘(ii) The percentage of students in 

17 families receiving assistance under the 

18 State program funded under the program 

19 of block grants to States for temporary as20 sistance for needy families established 

21 under part A of title IV of the Social Secu22 rity Act (42 U.S.C. 601 et seq.). 

23 ‘‘(iii) The percentage of students eligi24 ble to receive medical assistance under the 

25 program of medical assistance established 


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•S 4486 IS

1 under title XIX of the Social Security Act 

2 (42 U.S.C. 1396 et seq.). 

3 ‘‘(iv) A composite of two or more of 

4 the measures described in clauses (i) 

5 through (iii).’’. 

6 (b) GEAR UP.—Subparagraph (A) of section 

7 404B(d)(1) of the Higher Education Act of 1965 (20 

8 U.S.C. 1070a–22(d)(1)) is amended to read as follows: 

9 ‘‘(A) provide services under this chapter to 

10 at least one grade level of students, beginning 

11 not later than 7th grade, in a participating 

12 school— 

13 ‘‘(i) that has a 7th grade; and 

14 ‘‘(ii) in which— 

15 ‘‘(I) at least 50 percent of the 

16 students enrolled are identified stu17 dents (as described in clause (i), (ii), 

18 or (iii) of section 1113(a)(8)(A) of the 

19 Elementary and Secondary Education 

20 Act of 1965); or 

21 ‘‘(II) if an eligible entity deter22 mines that it would promote the effec23 tiveness of a program, an entire grade 

24 level of students, beginning not later 

25 than the 7th grade, reside in public 


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•S 4486 IS

1 housing, as defined in section 3(b)(1) 

2 of the United States Housing Act of 

3 1937 (42 U.S.C. 1437a(b)(1)).’’. 

4 (c) SIMPLIFIED NEEDS TEST.—Section 479(d)(2) of 

5 the Higher Education Act of 1965 (20 U.S.C. 

6 1087ss(d)(2)) is amended— 

7 (1) by striking subparagraph (C); and 

8 (2) by redesignating subparagraphs (D) 

9 through (F) as subparagraphs (C) through (E), re10 spectively. 

11 (d) EARLY FEDERAL PELL GRANT COMMITMENT

12 DEMONSTRATION PROGRAM.—Section 894(b) of the 

13 Higher Education Act of 1965 (20 U.S.C. 1161y(b)) is 

14 amended— 

15 (1) in paragraph (1)(B), by striking ‘‘qualify 

16 for a free or reduced price school lunch under the 

17 Richard B. Russell National School Lunch Act (42 

18 U.S.C. 1751 et seq.) or the Child Nutrition Act of 

19 1966 (42 U.S.C. 1771 et seq.)’’ and inserting ‘‘are 

20 identified students (as described in clause (i), (ii), or 

21 (iii) of section 1113(a)(8)(A) of the Elementary and 

22 Secondary Education Act of 1965)’’; and 

23 (2) in paragraph (5), by striking ‘‘eligible for a 

24 free or reduced price school lunch under the Richard 

25 B. Russell National School Lunch Act (42 U.S.C. 


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•S 4486 IS

1 1751 et seq.) or the Child Nutrition Act of 1966 (42 

2 U.S.C. 1771 et seq.)’’ and inserting ‘‘identified stu3 dents (as described in clause (i), (ii), or (iii) of sec4 tion 1113(a)(8)(A) of the Elementary and Sec5 ondary Education Act of 1965)’’. 

6 SEC. 5720. ELEMENTARY AND SECONDARY EDUCATION ACT 

7 OF 1965. 

8 (a) LITERACY EDUCATION FOR ALL.—Section 

9 2221(b)(3)(B) of the Elementary and Secondary Edu10 cation Act of 1965 (20 U.S.C. 6641(b)(3)(B)) is amend11 ed— 

12 (1) by striking clause (i); and 

13 (2) by redesignating clauses (ii) and (iii) as 

14 clauses (i) and (ii), respectively. 

15 (b) GRANTS FOR EDUCATION INNOVATION AND RE16 SEARCH.—Section 4611(d)(2) of the Elementary and Sec17 ondary Education Act of 1965 (20 U.S.C. 7261(d)(2)) is 

18 amended— 

19 (1) by striking subparagraph (B); and 

20 (2) by redesignating subparagraphs (C) and 

21 (D) as subparagraphs (B) and (C), respectively. 

22 (c) ELIGIBILITY FOR HEAVILY IMPACTED LOCAL

23 EDUCATIONAL AGENCIES.—Item (bb) of section 

24 7003(b)(2)(B)(i)(III) of the Elementary and Secondary 


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•S 4486 IS

1 Education Act of 1965 (20 U.S.C. 7703(b)(2)(B)(i)(III)) 

2 is amended to read as follows: 

3 ‘‘(bb) has an enrollment of 

4 children described in subsection 

5 (a)(1) that constitutes a percent6 age of the total student enroll7 ment of the agency that is not 

8 less than 30 percent; or’’. 

9 SEC. 5721. AMERICA COMPETES ACT. 

10 Section 6122(3) of the America COMPETES Act (20 

11 U.S.C. 9832(3)) is amended by striking ‘‘data on children 

12 eligible for free or reduced-price lunches under the Rich13 ard B. Russell National School Lunch Act,’’. 

14 SEC. 5722. WORKFORCE INNOVATION AND OPPORTUNITY 

15 ACT. 

16 Section 3(36)(A) of the Workforce Innovation and 

17 Opportunity Act (29 U.S.C. 3102(36)(A)) is amended— 

18 (1) by striking clause (iv); and 

19 (2) by redesignating clauses (v) and (vi) as 

20 clauses (iv) and (v), respectively. 

21 SEC. 5723. NATIONAL SCIENCE FOUNDATION AUTHORIZA22 TION ACT OF 2002. 

23 Section 4(8) of the National Science Foundation Au24 thorization Act of 2002 (42 U.S.C. 1862n note) is amend25 ed— 


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•S 4486 IS

1 (1) by striking subparagraph (A); and 

2 (2) by redesignating subparagraphs (B) and 

3 (C) as subparagraphs (A) and (B), respectively. 

4 SEC. 5724. CHILD CARE AND DEVELOPMENT BLOCK GRANT. 

5 Section 658O(b) of the Child Care and Development 

6 Block Grant Act of 1990 (42 U.S.C. 9858m(b)) is amend7 ed— 

8 (1) in paragraph (1)(B), by striking ‘‘school 

9 lunch factor’’ and inserting ‘‘identified students fac10 tor’’; and 

11 (2) by striking paragraph (3) and inserting the 

12 following: 

13 ‘‘(3) IDENTIFIED STUDENTS FACTOR.—The 

14 term ‘identified students factor’ means the ratio of 

15 the number of children who are identified students 

16 (as determined under paragraph (8) of section 

17 1113(a) of the Elementary and Secondary Edu18 cation Act of 1965 (20 U.S.C. 6313(a))) in the 

19 State to the number of such children in all the 

20 States as determined annually by the Secretary of 

21 Education.’’. 

22 SEC. 5725. CHILDREN’S HEALTH ACT OF 2000. 

23 Section 1404(b) of the Children’s Health Act of 2000 

24 (42 U.S.C. 9859c(b)) is amended— 


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•S 4486 IS

1 (1) in paragraph (1)(B), by striking ‘‘school 

2 lunch factor’’ and inserting ‘‘identified students fac3 tor’’; and 

4 (2) by amending paragraph (3) to read as fol5 lows: 

6 ‘‘(3) IDENTIFIED STUDENTS FACTOR.—In this 

7 subsection, the term ‘identified students factor’ 

8 means the ratio of the number of children who are 

9 identified students (as determined under paragraph 

10 (8) of section 1113(a) of the Elementary and Sec11 ondary Education Act of 1965 (20 U.S.C. 6313(a))) 

12 in the State to the number of such children in all 

13 the States as determined annually by the Secretary 

14 of Education.’’. 

15 SEC. 5726. JUVENILE JUSTICE AND DELINQUENCY PREVEN16 TION. 

17 Section 252(i) of the Juvenile Justice and Delin18 quency Prevention Act of 1974 (34 U.S.C. 11162(i)) is 

19 amended to read as follows: 

20 ‘‘(i) FREE SCHOOL LUNCHES FOR INCARCERATED

21 JUVENILES.— 

22 ‘‘(1) ELIGIBLE JUVENILE DETENTION CENTER

23 DEFINED.—In this subsection, the term ‘eligible ju24 venile detention center’ does not include any private, 

25 for-profit detention center. 


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•S 4486 IS

1 ‘‘(2) ELIGIBILITY FOR FREE LUNCH.—A juve2 nile who is incarcerated in an eligible juvenile deten3 tion center is eligible to receive free lunch under the 

4 Richard B. Russell National School Lunch Act (42 

5 U.S.C. 1751 et seq.). 

6 ‘‘(3) GUIDANCE.—Not later than 1 year after 

7 the date of enactment of the Universal School Meals 

8 Program Act of 2022, the Attorney General, in con9 sultation with the Secretary of Agriculture, shall 

10 provide guidance to States relating to the options for 

11 school food authorities in the States to apply for re12 imbursement for free lunches under the Richard B. 

13 Russell National School Lunch Act (42 U.S.C. 1751 

14 et seq.) for juveniles who are incarcerated.’’. 

15 Subtitle I—Elder Care 

16 SEC. 5801. EXPENSES FOR HOUSEHOLD AND ELDER CARE 

17 SERVICES NECESSARY FOR GAINFUL EM18 PLOYMENT. 

19 (a) IN GENERAL.—Subpart A of part IV of sub20 chapter A of chapter 1 of the Internal Revenue Code of 

21 1986 is amended by inserting after section 25D the fol22 lowing new section: 


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•S 4486 IS

1 ‘‘SEC. 25E. EXPENSES FOR HOUSEHOLD AND ELDER CARE 

2 SERVICES NECESSARY FOR GAINFUL EM3 PLOYMENT. 

4 ‘‘(a) ALLOWANCE OF CREDIT.— 

5 ‘‘(1) IN GENERAL.—In the case of an individual 

6 for which there are one or more qualifying individ7 uals (as defined in subsection (b)(1)) with respect to 

8 such individual, there shall be allowed as a credit 

9 against the tax imposed by this chapter for the tax10 able year an amount equal to the applicable percent11 age of the employment-related expenses (as defined 

12 in subsection (b)(3)) paid by such individual during 

13 the taxable year. 

14 ‘‘(2) APPLICABLE PERCENTAGE DEFINED.—For 

15 purposes of paragraph (1), the term ‘applicable per16 centage’ means 35 percent reduced (but not below 

17 20 percent) by 1 percentage point for each $2,000 

18 (or fraction thereof) by which the taxpayer’s ad19 justed gross income for the taxable year exceeds 

20 $15,000. 

21 ‘‘(b) DEFINITIONS OF QUALIFYING INDIVIDUAL AND

22 EMPLOYMENT-RELATED EXPENSES.—For purposes of 

23 this section— 

24 ‘‘(1) QUALIFYING INDIVIDUAL.—The term 

25 ‘qualifying individual’ means an individual who— 

26 ‘‘(A) has attained age 50, and 


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•S 4486 IS

1 ‘‘(B) satisfies the requirements of any of 

2 the following clauses: 

3 ‘‘(i) An individual who bears a rela4 tionship to the taxpayer described in sub5 paragraph (C) or (D) of section 152(d)(2) 

6 (relating to fathers, mothers, and ances7 tors). 

8 ‘‘(ii) An individual who would be a de9 pendent of the taxpayer (as defined in sec10 tion 152, determined without regard to 

11 subsections (b)(1) and (b)(2)) as a quali12 fying relative described in section 

13 152(d)(1) if— 

14 ‘‘(I) in lieu of the requirements 

15 under subparagraphs (B) and (C) of 

16 such section, with respect to such in17 dividual— 

18 ‘‘(aa) the taxpayer has pro19 vided over one-half of the individ20 ual’s support for the calendar 

21 year in which such taxable year 

22 begins and each of the preceding 

23 4 taxable years, and 

24 ‘‘(bb) the individual’s modi25 fied adjusted gross income for 


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•S 4486 IS

1 the calendar year in which such 

2 taxable year begins is less than 

3 the exemption amount (as de4 fined in section 151(d)), 

5 ‘‘(II) the individual is physically 

6 or mentally incapable of caring for 

7 himself or herself, and 

8 ‘‘(III) the individual has the 

9 same principal place of abode as the 

10 taxpayer for more than one-half of 

11 such taxable year. 

12 ‘‘(iii) The spouse of the taxpayer, if 

13 such spouse is physically or mentally in14 capable of caring for himself or herself. 

15 ‘‘(2) MODIFIED ADJUSTED GROSS INCOME.— 

16 The term ‘modified adjusted gross income’ means 

17 adjusted gross income determined without regard to 

18 section 86. 

19 ‘‘(3) EMPLOYMENT-RELATED EXPENSES.— 

20 ‘‘(A) IN GENERAL.—The term ‘employ21 ment-related expenses’ means amounts paid for 

22 the following expenses, but only if such ex23 penses are incurred to enable the taxpayer to be 

24 gainfully employed for any period for which 


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•S 4486 IS

1 there are one or more qualifying individuals 

2 with respect to the taxpayer: 

3 ‘‘(i) Expenses for household services 

4 with respect to the qualifying individual. 

5 ‘‘(ii) Expenses for the care of a quali6 fying individual, including expenses for res7 pite care and hospice care. 

8 ‘‘(B) EXCEPTION.—The term ‘employ9 ment-related expenses’ shall not include services 

10 provided outside the taxpayer’s household un11 less such expenses are incurred for the care 

12 of— 

13 ‘‘(i) a qualifying individual described 

14 in paragraph (1)(A), or 

15 ‘‘(ii) a qualifying individual (not de16 scribed in paragraph (1)(A)) who regularly 

17 spends at least 8 hours each day in the 

18 taxpayer’s household. 

19 ‘‘(C) DEPENDENT CARE CENTERS.—The 

20 term ‘employment-related expenses’ shall not 

21 include services provided outside the taxpayer’s 

22 household by a dependent care center (as de23 fined in subparagraph (D)) unless— 

24 ‘‘(i) such center complies with all ap25 plicable laws and regulations of the State 


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•S 4486 IS

1 and local government in which such center 

2 is located, and 

3 ‘‘(ii) the requirements of subpara4 graph (B) are met. 

5 ‘‘(D) DEPENDENT CARE CENTER DE6 FINED.—For purposes of this paragraph, the 

7 term ‘dependent care center’ means any facility 

8 which— 

9 ‘‘(i) provides care for more than 6 in10 dividuals (other than individuals who re11 side at the facility), and 

12 ‘‘(ii) receives a fee, payment, or grant 

13 for providing services for any of the indi14 viduals (regardless of whether such facility 

15 is operated for profit). 

16 ‘‘(c) DOLLAR LIMIT ON AMOUNT CREDITABLE.—The 

17 amount of the employment-related expenses incurred dur18 ing any taxable year which may be taken into account 

19 under subsection (a) shall not exceed— 

20 ‘‘(1) if there is 1 qualifying individual with re21 spect to the taxpayer for such taxable year, $3,000, 

22 or 

23 ‘‘(2) if there are 2 or more qualifying individ24 uals with respect to the taxpayer for such taxable 

25 year, $6,000. 


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1 The amount determined under this subsection shall be re2 duced by the aggregate amount excludable from gross in3 come under section 129 for the taxable year. 

4 ‘‘(d) EARNED INCOME LIMITATION.—The amount of 

5 the employment-related expenses incurred during any tax6 able year which may be taken into account under sub7 section (a) shall not exceed— 

8 ‘‘(1) in the case of an individual who is not 

9 married at the close of such year, such individual’s 

10 earned income for such year, or 

11 ‘‘(2) in the case of an individual who is married 

12 at the close of such year, the lesser of such individ13 ual’s earned income or the earned income of his 

14 spouse for such year. 

15 ‘‘(e) SPECIAL RULES.—For purposes of this sec16 tion— 

17 ‘‘(1) PLACE OF ABODE.—An individual shall 

18 not be treated as having the same principal place of 

19 abode of the taxpayer if at any time during the tax20 able year of the taxpayer the relationship between 

21 the individual and the taxpayer is in violation of 

22 local law. 

23 ‘‘(2) MARRIED COUPLES MUST FILE JOINT RE24 TURN.—In the case of an individual who is married 

25 as of the close of the taxable year, the credit shall 


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•S 4486 IS

1 be allowed under subsection (a) only if a joint return 

2 is filed for the taxable year under section 6013. 

3 ‘‘(3) MARITAL STATUS.—An individual legally 

4 separated from his or her spouse under a decree of 

5 divorce or of separate maintenance shall not be con6 sidered as married. 

7 ‘‘(4) CERTAIN MARRIED INDIVIDUALS LIVING

8 APART.—In the case of an individual who is married 

9 and does not file a joint return for the taxable year, 

10 if— 

11 ‘‘(A) such individual— 

12 ‘‘(i) maintains as his or her home a 

13 household which constitutes for more than 

14 one-half of the taxable year the principal 

15 place of abode of a qualifying individual, 

16 ‘‘(ii) furnishes over half of the cost of 

17 maintaining such household during the 

18 taxable year, and 

19 ‘‘(B) during the last 6 months of such tax20 able year, such individual’s spouse is not a 

21 member of such household, 

22 such individual shall not be considered as married. 

23 ‘‘(5) PAYMENTS TO RELATED INDIVIDUALS.— 

24 No credit shall be allowed under subsection (a) for 

25 any amount paid by the taxpayer to an individual— 


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1 ‘‘(A) with respect to whom, for the taxable 

2 year, a deduction under section 151(c) (relating 

3 to deduction for personal exemptions for de4 pendents) is allowable either to the taxpayer or 

5 the taxpayer’s spouse, or 

6 ‘‘(B) who— 

7 ‘‘(i) is a child of the taxpayer (within 

8 the meaning of section 152(f)(1)), and 

9 ‘‘(ii) has not attained the age of 19 at 

10 the close of the taxable year. 

11 For purposes of this paragraph, the term ‘taxable 

12 year’ means the taxable year of the taxpayer in 

13 which the service (as described in clause (i) of sub14 section (b)(3)(A)) is performed or the care (as de15 scribed in clause (ii) of such subsection) is provided. 

16 ‘‘(6) IDENTIFYING INFORMATION REQUIRED

17 WITH RESPECT TO SERVICE PROVIDER.—No credit 

18 shall be allowed under subsection (a) for any amount 

19 paid to any person unless— 

20 ‘‘(A) the name, address, and taxpayer 

21 identification number of such person are in22 cluded on the return of tax for the taxable year 

23 in which the credit under this section is being 

24 claimed, or 


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1 ‘‘(B) if such person is an organization de2 scribed in section 501(c)(3) and exempt from 

3 tax under section 501(a), the name and address 

4 of such person are included on the return of tax 

5 for the taxable year in which the credit under 

6 this section is being claimed. 

7 In the case of a failure to provide the information 

8 required under the preceding sentence, the preceding 

9 sentence shall not apply if it is shown that the tax10 payer exercised due diligence in attempting to pro11 vide the information so required. 

12 ‘‘(7) IDENTIFYING INFORMATION REQUIRED

13 WITH RESPECT TO QUALIFYING INDIVIDUALS.—No 

14 credit shall be allowed under this section with re15 spect to any qualifying individual unless the TIN of 

16 such individual is included on the return of tax for 

17 the taxable year in which the credit under this sec18 tion is being claimed. 

19 ‘‘(f) REGULATIONS.—The Secretary shall prescribe 

20 such regulations as may be necessary to carry out the pur21 poses of this section.’’. 

22 (b) CLERICAL AMENDMENT.—The table of sections 

23 for subpart A of part IV of subchapter A of chapter 1 

24 of the Internal Revenue Code of 1986 is amended by inVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01013 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 serting after the item relating to section 25D the following 

2 new item: 

‘‘Sec. 25E. Expenses for household and elder care services necessary for gainful 

employment.’’. 

3 (c) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply to taxable years beginning after 

5 the date of the enactment of this Act. 

6 Subtitle J—Miscellaneous 

7 Provisions 

8 SEC. 5901. CLARIFICATION SUPPORTING PERMISSIBLE USE 

9 OF FUNDS FOR STILLBIRTH PREVENTION AC10 TIVITIES. 

11 Section 501(a) of the Social Security Act (42 U.S.C. 

12 701(a)) is amended— 

13 (1) in paragraph (1)(B), by inserting ‘‘to re14 duce the incidence of stillbirth,’’ after ‘‘among chil15 dren,’’; and 

16 (2) in paragraph (2), by inserting after ‘‘follow17 up services’’ the following: ‘‘, and for evidence-based 

18 programs and activities and outcome research to re19 duce the incidence of stillbirth (including tracking 

20 and awareness of fetal movements, improvement of 

21 birth timing for pregnancies with risk factors, initia22 tives that encourage safe sleeping positions during 

23 pregnancy, screening and surveillance for fetal 

24 growth restriction, efforts to achieve smoking cesVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01014 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 sation during pregnancy, community-based programs 

2 that provide home visits or other types of support, 

3 and any other research or evidence-based program4 ming to prevent stillbirths)’’. 

5 TITLE VI—MENTAL HEALTH AND 

6 SUBSTANCE USE DISORDERS 

7 SEC. 6001. MENTAL HEALTH FINDINGS. 

8 Congress finds the following: 

9 (1) Despite the existence of effective treat10 ments, inequities lie in the availability, accessibility, 

11 and quality of mental health services for racial and 

12 ethnic minorities and people with disabilities. 

13 (2) These inequities have powerful significance 

14 for minority groups and for society as a whole. 

15 (3) Racial and ethnic minorities bear a greater 

16 burden from unmet mental health needs and thus 

17 suffer a greater loss to their overall health and pro18 ductivity. 

19 (4) Improving community conditions and one’s 

20 home environment, paired with high-quality, acces21 sible, and culturally and linguistically tailored men22 tal health services, can reduce the likelihood, fre23 quency, and intensity of challenges to one’s mental 

24 health. 


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1 (5) The presence of strong social connections 

2 and trust, opportunities to experience and share cul3 tural identity, safe gathering places, and economic 

4 opportunity are community factors that benefit men5 tal health. 

6 (6) The social, physical, economic, and other 

7 conditions, otherwise known as social determinants 

8 of health, in communities can have tremendous in9 fluence on daily stressors that shape mental health 

10 outcomes. 

11 (7) Significant barriers include the cost of and 

12 access to quality care, societal stigma, mental health 

13 workforce shortages, the fragmented organization of 

14 services and needed social supports, and the history 

15 of racism and discrimination in the mental health 

16 system. 

17 (8) People with severe and persistent mental ill18 ness who are racial or ethnic minorities often have 

19 co-occurring health and mental health conditions 

20 and experience direct inequities in access to nec21 essary supports, resources, and services which, with22 out proper accommodations and support, further 

23 stigmatize them and limit their participation in soci24 ety. 


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1 (9) African-American, Latinx, Asian American, 

2 Pacific Islander, Native, Middle Eastern and North 

3 African (MENA), and other people of color commu4 nities are more likely to experience systemic dis5 crimination by health care and social service pro6 viders and may be reluctant to seek mental health 

7 care and other health interventions. 

8 (10) Mental health conditions and substance 

9 abuse disorders retain considerable stigma in many 

10 communities of color and seeking treatment is not 

11 always encouraged. 

12 (11) Addressing mental health stigma and in13 creasing access to culturally and linguistically appro14 priate treatments and supports in communities will 

15 help to increase utilization of mental health services 

16 for people who have functional difficulties because of 

17 mental health challenges. 

18 (12) There is a link between a mental health di19 agnosis and the likelihood of an individual commit20 ting suicide. 

21 (13) A comprehensive public health approach to 

22 behavioral health is one that fosters and finances 

23 protective factors in racial and ethnic communities 

24 that support mental health. 


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1 (14) Approaches to mental health and trauma 

2 must keep in mind the historical and present day 

3 and cultural trauma that impacts many communities 

4 of color, including trauma and loss caused by ad5 verse weather events and structural violence. 

6 (15) Culturally and linguistically appropriate 

7 treatments and supports must keep approaches of 

8 individual communities to mental health in mind, in9 cluding by considering— 

10 (A) approaches to cultural healing prac11 tices; and 

12 (B) the diverse mental health professionals 

13 needed for such practices, such as peer support 

14 specialists. 

15 (16) Approaches to mental health and address16 ing trauma must keep in mind the concept of 

17 intersectionality of individuals; that individuals may 

18 experience many inequities that shape the way they 

19 process and experience everyday life. 

20 SEC. 6002. SENSE OF CONGRESS. 

21 It is the sense of the Congress that it is imperative 

22 that a comprehensive public health approach to addressing 

23 trauma and mental health care be focused on care delivery 

24 that is culturally and linguistically appropriate. 


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1 Subtitle A—Access to Care and 

2 Funding Streams 

3 SEC. 6011. COVERAGE OF MARRIAGE AND FAMILY THERA4 PIST SERVICES, MENTAL HEALTH COUN5 SELOR SERVICES, SUBSTANCE ABUSE COUN6 SELOR SERVICES, AND PEER SUPPORT SPE7 CIALIST SERVICES UNDER PART B OF THE 

8 MEDICARE PROGRAM. 

9 (a) COVERAGE OF SERVICES.— 

10 (1) IN GENERAL.—Section 1861(s)(2) of the 

11 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

12 amended by section 4251(c)(1), is amended— 

13 (A) in subparagraph (HH), by striking 

14 ‘‘and’’ at the end; 

15 (B) in subparagraph (II), by adding ‘‘and’’ 

16 at the end; and 

17 (C) by adding at the end the following new 

18 subparagraph: 

19 ‘‘(JJ) marriage and family therapist services 

20 (as defined in subsection (ooo)(1)), mental health 

21 counselor services (as defined in subsection 

22 (ooo)(3)), substance abuse counselor services (as de23 fined in subsection (ooo)(5)), and peer support spe24 cialist services (as defined in subsection (ooo)(7));’’. 


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1 (2) DEFINITIONS.—Section 1861 of the Social 

2 Security Act (42 U.S.C. 1395x), as amended by sec3 tions 2007(b), 4221(a), and 4251(c)(2), is amended 

4 by adding at the end the following new subsection: 

5 ‘‘Marriage and Family Therapist Services; Marriage and 

6 Family Therapist; Mental Health Counselor Serv7 ices; Mental Health Counselor; Substance Abuse 

8 Counselor Services; Substance Abuse Counselor; 

9 Peer Support Specialist Services; Peer Support Spe10 cialist 

11 ‘‘(ooo)(1) The term ‘marriage and family therapist 

12 services’ means services performed by a marriage and 

13 family therapist (as defined in paragraph (2)) for the diag14 nosis and treatment of mental illnesses, which the mar15 riage and family therapist is legally authorized to perform 

16 under State law (or the State regulatory mechanism pro17 vided by State law) of the State in which such services 

18 are performed, as would otherwise be covered if furnished 

19 by a physician or as an incident to a physician’s profes20 sional service, but only if no facility or other provider 

21 charges or is paid any amounts with respect to the fur22 nishing of such services. 

23 ‘‘(2) The term ‘marriage and family therapist’ means 

24 an individual who— 


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1 ‘‘(A) possesses a master’s or doctoral degree 

2 that qualifies for licensure or certification as a mar3 riage and family therapist pursuant to State law, in4 cluding but not limited to, clinical social workers and 

5 occupational therapists; 

6 ‘‘(B) after obtaining such degree has performed 

7 at least 2 years of clinical supervised experience in 

8 marriage and family therapy; and 

9 ‘‘(C) in the case of an individual performing 

10 services in a State that provides for licensure or cer11 tification of marriage and family therapists, is li12 censed or certified as a marriage and family thera13 pist in such State. 

14 ‘‘(3) The term ‘mental health counselor services’ 

15 means services performed by a mental health counselor (as 

16 defined in paragraph (4)) for the diagnosis and treatment 

17 of mental health conditions and disabilities that the men18 tal health counselor is legally authorized to perform under 

19 State law (or the State regulatory mechanism provided by 

20 the State law) of the State in which such services are per21 formed, as would otherwise be covered if furnished by a 

22 physician or as incident to a physician’s professional serv23 ice, but only if no facility or other provider charges or is 

24 paid any amounts with respect to the furnishing of such 

25 services. 


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1 ‘‘(4) The term ‘mental health counselor’ means an 

2 individual who— 

3 ‘‘(A) possesses a master’s or doctor’s degree in 

4 mental health counseling or a related field, including 

5 clinical social workers and occupational therapists; 

6 ‘‘(B) after obtaining such a degree has per7 formed at least 2 years of supervised mental health 

8 counselor practice; and 

9 ‘‘(C) in the case of an individual performing 

10 services in a State that provides for licensure or cer11 tification of mental health counselors or professional 

12 counselors, is licensed or certified as a mental health 

13 counselor or professional counselor in such State. 

14 ‘‘(5) The term ‘substance abuse counselor services’ 

15 means services performed by a substance abuse counselor 

16 (as defined in paragraph (6)) for the diagnosis and treat17 ment of substance abuse and addiction that the substance 

18 abuse counselor is legally authorized to perform under 

19 State law (or the State regulatory mechanism provided by 

20 the State law) of the State in which such services are per21 formed, as would otherwise be covered if furnished by a 

22 physician or as incident to a physician’s professional serv23 ice, but only if no facility or other provider charges or is 

24 paid any amounts with respect to the furnishing of such 

25 services. 


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1 ‘‘(6) The term ‘substance abuse counselor’ means an 

2 individual who— 

3 ‘‘(A) has performed at least 2 years of super4 vised substance abuse counselor practice; 

5 ‘‘(B) in the case of an individual performing 

6 services in a State that provides for licensure or cer7 tification of substance abuse counselors or profes8 sional counselors, is licensed or certified as a sub9 stance abuse counselor or professional counselor in 

10 such State; or 

11 ‘‘(C) is a drug and alcohol counselor as defined 

12 in section 40.281 of title 49, Code of Federal Regu13 lations. 

14 ‘‘(7) The term ‘peer support specialist services’ 

15 means services performed by a peer support specialist (as 

16 defined in paragraph (8)) for the well-being of individuals 

17 needing mental health support that the peer support spe18 cialist is legally authorized to perform under State law (or 

19 the State regulatory mechanism provided by the State 

20 law) of the State in which such services are performed, 

21 as would otherwise be covered if furnished by a physician 

22 or as incident to a physician’s professional service, but 

23 only if no facility or other provider charges or is paid any 

24 amounts with respect to the furnishing of such services. 


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1 ‘‘(8) The term ‘peer support specialist’ means an in2 dividual who— 

3 ‘‘(A) is an individual living in recovery with 

4 mental illness, addiction, or systems involvement; 

5 ‘‘(B) has skills learned in formal training; 

6 ‘‘(C) uses assets-based framing in speaking 

7 about mental health, recovery, and well-being; and 

8 ‘‘(D) delivers services in behavioral health set9 tings to promote mind-body recovery and resil10 iency.’’. 

11 (3) PROVISION FOR PAYMENT UNDER PART

12 B.—Section 1832(a)(2)(B) of the Social Security 

13 Act (42 U.S.C. 1395k(a)(2)(B)) is amended— 

14 (A) by striking ‘‘and’’ at the end of clause 

15 (iv); and 

16 (B) by adding at the end the following new 

17 clause: 

18 ‘‘(v) marriage and family therapist 

19 services, mental health counselor services, 

20 substance abuse counselor services, and 

21 peer support specialist services; and’’. 

22 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

23 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 

24 as amended by section 4251(c)(3), is amended— 

25 (A) by striking ‘‘and’’ before ‘‘(EE)’’; and 


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1 (B) by inserting before the semicolon at 

2 the end the following: ‘‘, and (FF) with respect 

3 to marriage and family therapist services, men4 tal health counselor services, substance abuse 

5 counselor services, and peer support specialist 

6 services under section 1861(s)(2)(JJ), the 

7 amounts paid shall be 80 percent of the lesser 

8 of the actual charge for the services or 75 per9 cent of the amount determined for payment of 

10 a psychologist under subparagraph (L)’’. 

11 (5) EXCLUSION OF MARRIAGE AND FAMILY

12 THERAPIST SERVICES, MENTAL HEALTH COUNSELOR

13 SERVICES, AND PEER SUPPORT SPECIALIST SERV14 ICES FROM SKILLED NURSING FACILITY PROSPEC15 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 

16 of the Social Security Act (42 U.S.C. 

17 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar18 riage and family therapist services (as defined in 

19 section 1861(nnn)(1)), mental health counselor serv20 ices (as defined in section 1861(nnn)(3)), and peer 

21 support specialist services (as defined in section 

22 1861(nnn)(7)),’’ after ‘‘qualified psychologist serv23 ices,’’. 

24 (6) INCLUSION OF MARRIAGE AND FAMILY

25 THERAPISTS, MENTAL HEALTH COUNSELORS, AND


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1 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS

2 FOR ASSIGNMENT OF CLAIMS.—Section 

3 1842(b)(18)(C) of the Social Security Act (42 

4 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

5 the end the following new clauses: 

6 ‘‘(vii) A marriage and family therapist (as de7 fined in section 1861(nnn)(2)). 

8 ‘‘(viii) A mental health counselor (as defined in 

9 section 1861(nnn)(4)). 

10 ‘‘(ix) A substance abuse counselor (as defined 

11 in section 1861(nnn)(6)). 

12 ‘‘(x) A peer support specialist (as defined in 

13 section 1861(nnn)(8)).’’. 

14 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV15 ICES PROVIDED IN CERTAIN SETTINGS.— 

16 (1) RURAL HEALTH CLINICS AND FEDERALLY

17 QUALIFIED HEALTH CENTERS.—Section 

18 1861(aa)(1)(B) of the Social Security Act (42 

19 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

20 by a clinical social worker (as defined in subsection 

21 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 

22 (as defined in subsection (hh)(1)), by a marriage 

23 and family therapist (as defined in subsection 

24 (nnn)(2)), or by a mental health counselor (as de25 fined in subsection (nnn)(4)), or by a substance 


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1 abuse counselor (as defined in section 1861 

2 (nnn)(6)), or by a peer support specialist (as defined 

3 in section 1861(nnn)(8)).’’. 

4 (2) HOSPICE PROGRAMS.—Section 

5 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 

6 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in7 serting ‘‘or one marriage and family therapist (as 

8 defined in subsection (nnn)(2))’’ after ‘‘social work9 er’’. 

10 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

11 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR

12 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 

13 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 

14 amended by inserting ‘‘marriage and family therapist (as 

15 defined in subsection (nnn)(2)),’’ after ‘‘social worker,’’. 

16 (d) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply with respect to services furnished 

18 on or after January 1, 2023. 

19 SEC. 6012. REAUTHORIZATION OF MINORITY FELLOWSHIP 

20 PROGRAM. 

21 Section 597(c) of the Public Health Service Act (42 

22 U.S.C. 297ll(c)) is amended by striking ‘‘$12,669,000 for 

23 each of fiscal years 2018 through 2022’’ and inserting 

24 ‘‘$25,000,000 for each of fiscal years 2023 through 

25 2027’’. 


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1 SEC. 6013. ADDITIONAL FUNDS FOR NATIONAL INSTITUTES 

2 OF HEALTH. 

3 (a) IN GENERAL.—In addition to amounts otherwise 

4 authorized to be appropriated to the National Institutes 

5 of Health, there is authorized to be appropriated to such 

6 Institutes $100,000,000 for each of fiscal years 2023 

7 through 2027 to build relations with communities and con8 duct or support clinical research, including clinical re9 search on racial or ethnic disparities in physical and men10 tal health. 

11 (b) DEFINITION.—In this section, the term ‘‘clinical 

12 research’’ has the meaning given to such term in section 

13 409 of the Public Health Service Act (42 U.S.C. 284d). 

14 SEC. 6014. ADDITIONAL FUNDS FOR NATIONAL INSTITUTE 

15 ON MINORITY HEALTH AND HEALTH DISPARI16 TIES. 

17 In addition to amounts otherwise authorized to be ap18 propriated to the National Institute on Minority Health 

19 and Health Disparities, there is authorized to be appro20 priated to such Institute $650,000,000 for each of fiscal 

21 years 2023 through 2027. 


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1 SEC. 6015. GRANTS FOR INCREASING RACIAL AND ETHNIC 

2 MINORITY ACCESS TO HIGH-QUALITY TRAU3 MA SUPPORT SERVICES AND MENTAL 

4 HEALTH CARE. 

5 (a) IN GENERAL.—The Secretary of Health and 

6 Human Services (in this section referred to as the ‘‘Sec7 retary’’), acting through the Assistant Secretary for Men8 tal Health and Substance Use, shall award grants to eligi9 ble entities to establish or expand programs for the pur10 pose of increasing racial and ethnic minority access to 

11 high-quality trauma support services and mental health 

12 care. 

13 (b) ELIGIBLE ENTITIES.—To seek a grant under this 

14 section, an entity shall be a community-based program or 

15 organization that— 

16 (1) provides culturally and linguistically appro17 priate programs and resources that are aligned with 

18 evidence-based practices for trauma-informed care; 

19 and 

20 (2) has demonstrated expertise in serving com21 munities of color or can partner with a program that 

22 has such demonstrated expertise. 

23 (c) USE OF FUNDS.—As a condition on receipt of a 

24 grant under this section, a grantee shall agree to use the 

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1 quality trauma support services and mental health care, 

2 such as by— 

3 (1) establishing and maintaining community4 based programs providing evidence-based services in 

5 trauma-informed care and culturally specific services 

6 and other resources; 

7 (2) developing innovative, culturally specific 

8 strategies and projects to enhance access to trauma9 informed care and resources for racial and ethnic 

10 minorities who face obstacles to using more tradi11 tional services and resources (such as obstacles in 

12 geographic access to providers, insurance coverage, 

13 and access to audio and video technologies); 

14 (3) working with State and local governments 

15 and social service agencies to develop and enhance 

16 effective strategies to provide culturally specific serv17 ices to racial and ethnic minorities; 

18 (4) increasing communities’ capacity to provide 

19 culturally specific resources and support for commu20 nities of color; 

21 (5) working in cooperation with the community 

22 to develop education and prevention strategies high23 lighting culturally specific issues and resources re24 garding racial and ethnic minorities; 


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1 (6) providing culturally specific programs for 

2 racial and ethnic minorities exposed to law enforce3 ment violence; and 

4 (7) examining the dynamics of culture and its 

5 impact on victimization and healing. 

6 (d) PRIORITY.—In awarding grants under this sec7 tion, the Secretary shall give priority to eligible entities 

8 proposing to serve communities that have faced high rates 

9 of community trauma, including from exposure to law en10 forcement violence, intergenerational poverty, civil unrest, 

11 discrimination, or oppression. 

12 (e) GRANT PERIOD.—The period of a grant under 

13 this section shall be 4 years. 

14 (f) EVALUATION.—Not later than 6 months after the 

15 end of the period of all grants under this section, the Sec16 retary shall— 

17 (1) conduct an evaluation of the programs 

18 funded by a grant under this section; 

19 (2) include in such evaluation an assessment of 

20 the outcomes of each such program; and 

21 (3) submit a report on the results of such eval22 uation to the Congress. 

23 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

24 out this section, there is authorized to be appropriated 

25 $20,000,000 for each of fiscal years 2023 through 2027. 


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1 SEC. 6016. GRANTS FOR UNARMED 9–1–1 RESPONSE PRO2 GRAMS. 

3 Part D of title V of the Public Health Service Act, 

4 as amended by sections 6022, 6023, and 6052, is further 

5 amended by adding at the end the following new section: 

6 ‘‘SEC. 556. GRANTS FOR UNARMED 9–1–1 RESPONSE PRO7 GRAMS. 

8 ‘‘(a) IN GENERAL.—The Secretary, acting through 

9 the Assistant Secretary for Mental Health and Substance 

10 Use, may award grants to States, territories, political sub11 divisions of States and territories, Tribal governments, 

12 and consortia of Tribal governments to establish an un13 armed 9–1–1 response program under which nonviolent 9– 

14 1–1 calls are referred to unarmed professional service pro15 viders for response, instead of to a law enforcement agen16 cy. 

17 ‘‘(b) PROGRAM REQUIREMENTS.—An unarmed 9–1– 

18 1 response program funded under this section shall— 

19 ‘‘(1) dispatch unarmed professional service pro20 viders in groups of two or more in a timely manner; 

21 ‘‘(2) be capable of providing screening, assess22 ment, de-escalation, trauma-informed culturally and 

23 linguistically appropriate services, referrals to treat24 ment providers, and transportation to immediately 

25 necessary treatment; 


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1 ‘‘(3) when necessary, coordinate with health or 

2 social services; 

3 ‘‘(4) not be subject to oversight of State or local 

4 law enforcement agencies; and 

5 ‘‘(5) clearly outline the scope of calls that must 

6 or may be referred to the unarmed 9–1–1 response 

7 program. 

8 ‘‘(c) USES OF FUNDS.—A grant under this section 

9 may be used for— 

10 ‘‘(1) hiring unarmed professional service pro11 viders and 9–1–1 dispatchers; 

12 ‘‘(2) training unarmed professional service pro13 viders to respond to 9–1–1 calls by identifying, un14 derstanding, and responding to signs of mental ill15 nesses, developmental or intellectual disabilities, and 

16 substance use disorders, including by means of— 

17 ‘‘(A) de-escalation; 

18 ‘‘(B) crisis intervention; and 

19 ‘‘(C) connecting individuals to local social 

20 service providers, health care providers, commu21 nity-based organizations, and the full range of 

22 other available providers and resources, with a 

23 focus on culturally and linguistically appro24 priate service providers; 


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1 ‘‘(3) updating 9–1–1 response systems to en2 able triage between nonviolent 9–1–1 calls and those 

3 that require a response from law enforcement; 

4 ‘‘(4) training 9–1–1 dispatchers on call diver5 sion; 

6 ‘‘(5) building the capacity— 

7 ‘‘(A) to coordinate with local social service 

8 providers, health care providers, suicide hotline 

9 operators, and community-based organizations; 

10 and 

11 ‘‘(B) to provide multilingual and culturally 

12 and linguistically appropriate services; and 

13 ‘‘(6) collecting data for reports to the Sec14 retary. 

15 ‘‘(d) APPLICATION.—An applicant seeking a grant 

16 under this section shall submit to the Secretary an appli17 cation at such time, in such manner, and containing such 

18 information as the Secretary may reasonably require, in19 cluding the applicant’s plan to train 9–1–1 dispatchers to 

20 determine when a call should be diverted to the unarmed 

21 9–1–1 response program. 

22 ‘‘(e) REPORTS TO SECRETARY.—A recipient of a 

23 grant under this section shall submit to the Secretary, on 

24 a biannual basis, a report on the following: 


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1 ‘‘(1) The number of calls placed to 9–1–1 that 

2 were diverted to the grantee’s unarmed 9–1–1 re3 sponse program. 

4 ‘‘(2) Demographic information on the individ5 uals served by the grantee’s unarmed 9–1–1 re6 sponse program, disaggregated by race, ethnicity, 

7 age, sex, sexual orientation, gender identity, and lo8 cation. 

9 ‘‘(3) The effects of the grantee’s unarmed 9–1– 

10 1 response program on emergency room visits, hos11 pitalizations, use of ambulances, and involvement of 

12 law enforcement in mental health or substance use 

13 disorder crises. 

14 ‘‘(4) An assessment of the types of events and 

15 crises to which the grantee’s unarmed 9–1–1 re16 sponse program responded and the services provided, 

17 including— 

18 ‘‘(A) the number of individuals to whom 

19 services were provided who were involuntarily 

20 committed for treatment; 

21 ‘‘(B) the number of individuals successfully 

22 transferred to an alternative destination; 

23 ‘‘(C) the time between notification by a 9– 

24 1–1 dispatcher and arrival at the scene by a 

25 provider; and 


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1 ‘‘(D) the time spent by providers at scene. 

2 ‘‘(5) A cost analysis of the grantee’s unarmed 

3 9–1–1 response program. 

4 ‘‘(6) An assessment of data sharing limitations 

5 or problems associated with adherence to— 

6 ‘‘(A) Federal regulations (concerning the 

7 privacy of individually identifiable health infor8 mation) promulgated under section 264(c) of 

9 the Health Insurance Portability and Account10 ability Act of 1996; and 

11 ‘‘(B) part 2 of title 42, Code of Federal 

12 Regulations. 

13 ‘‘(f) REPORTS TO CONGRESS.—The Secretary shall 

14 submit to the Congress, on a biannual basis, a report on 

15 the program under this section, including a summary of 

16 the reports submitted by grantees pursuant to subsection 

17 (e). 

18 ‘‘(g) GRANT AMOUNT.—The Secretary may make 

19 grants to applicants that do not meet all of the criteria 

20 under subsection (b), but applicants that do not meet all 

21 such criteria may not receive the full grant amount. 

22 ‘‘(h) DEFINITIONS.—In this section: 

23 ‘‘(1) The term ‘alternative destination’— 


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1 ‘‘(A) means any service- or care-providing 

2 site other than a hospital emergency depart3 ment or jail; and 

4 ‘‘(B) includes a clinic, primary care office, 

5 crisis center, and community care center. 

6 ‘‘(2) The term ‘nonviolent 9–1–1 call’ means a 

7 9–1–1 call that— 

8 ‘‘(A) relates to mental health, homeless9 ness, addiction problems, social services, tru10 ancy, intellectual and developmental disabilities, 

11 or public intoxication; and 

12 ‘‘(B) does not involve obvious violent be13 havior. 

14 ‘‘(3) The term ‘unarmed professional service 

15 provider’ means a professional (which may include a 

16 nurse, social worker, emergency medical technician, 

17 counselor, community health worker, trauma-in18 formed personnel, social service provider, or peer 

19 support specialist) who— 

20 ‘‘(A) is trained to deal with mental health 

21 or substance abuse crises or intellectual and de22 velopmental disabilities; and 

23 ‘‘(B) does not carry a firearm.’’. 


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1 Subtitle B—Interprofessional Care 

2 SEC. 6021. HEALTH PROFESSIONS COMPETENCIES TO AD3 DRESS RACIAL AND ETHNIC MENTAL HEALTH 

4 INEQUITIES. 

5 (a) IN GENERAL.—The Secretary of Health and 

6 Human Services, acting through the Assistant Secretary 

7 for Mental Health and Substance Use, shall award grants 

8 to qualified national organizations for the purposes of— 

9 (1) developing, and disseminating to health pro10 fessional educational programs, culturally and lin11 guistically appropriate curricula or core com12 petencies addressing mental health inequities among 

13 racial and ethnic minority groups for use in the 

14 training of students in the professions of social 

15 work, psychology, psychiatry, marriage and family 

16 therapy, mental health counseling, peer support, and 

17 substance abuse counseling; and 

18 (2) certifying community health workers and 

19 peer wellness specialists with respect to such cur20 ricula and core competencies and integrating and ex21 panding the use of such workers and specialists into 

22 health care and community-based settings to address 

23 mental health inequities among racial and ethnic mi24 nority groups. 


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1 (b) CURRICULA; CORE COMPETENCIES.—Organiza2 tions receiving funds under subsection (a) may use the 

3 funds to engage in the following activities related to the 

4 development and dissemination of curricula or core com5 petencies described in subsection (a)(1): 

6 (1) Formation of committees or working groups 

7 composed of experts from accredited health profes8 sions schools to identify core competencies relating 

9 to mental health inequities among racial and ethnic 

10 minority groups. 

11 (2) Planning of workshops in collaboration with 

12 community-based organizations and communities of 

13 color in national fora to directly facilitate public 

14 input, including input from communities of color 

15 with lived experience, into the educational needs as16 sociated with mental health inequities among racial 

17 and ethnic minority groups. 

18 (3) Dissemination and promotion of the use of 

19 curricula or core competencies in undergraduate and 

20 graduate health professions training programs na21 tionwide. 

22 (4) Establishing external stakeholder advisory 

23 boards to provide meaningful input into policy and 

24 program development and best practices to reduce 

25 mental health inequities among racial and ethnic 


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1 groups, including participation and leadership from 

2 communities of color with lived experience of the im3 pacts of mental health inequities. 

4 (c) DEFINITIONS.—In this section: 

5 (1) QUALIFIED NATIONAL ORGANIZATION.—The 

6 term ‘‘qualified national organization’’ means a na7 tional organization that focuses on the education of 

8 students in programs of social work, occupational 

9 therapy, psychology, psychiatry, substance use coun10 seling, and marriage and family therapy. 

11 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

12 The term ‘‘racial and ethnic minority group’’ has the 

13 meaning given to such term in section 1707(g) of 

14 the Public Health Service Act (42 U.S.C. 300u– 

15 6(g)), as amended by title I of this Act. 

16 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 such sums as may be necessary for each of fiscal years 

19 2023 through 2027. 

20 SEC. 6022. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

21 BEHAVIORAL HEALTH CARE. 

22 Part D of title V of the Public Health Service Act 

23 (42 U.S.C. 290dd et seq.) is amended by adding at the 

24 end the following: 


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1 ‘‘SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

2 PROVISION OF BEHAVIORAL HEALTH CARE 

3 IN PRIMARY CARE SETTINGS. 

4 ‘‘(a) GRANTS.—The Secretary, acting through the 

5 Assistant Secretary, shall award grants to eligible entities 

6 for the purpose of establishing interprofessional health 

7 care teams that provide behavioral health care. 

8 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

9 a grant under this section, an entity shall be a Federally 

10 qualified health center (as defined in section 1861(aa) of 

11 the Social Security Act), rural health clinic, women’s 

12 health clinic, or behavioral health program (including any 

13 such program operated by a community-based organiza14 tion) serving a high proportion of individuals from racial 

15 and ethnic minority groups (as defined in section 

16 1707(g)). 

17 ‘‘(c) LOAN FORGIVENESS.—To encourage qualified 

18 and diverse allied health professionals to enter the mental 

19 health field, an eligible entity receiving a grant under this 

20 section shall agree to use not less than $10,000 of the 

21 grant funds on a loan forgiveness program for practi22 tioners who commit to working in the mental health field 

23 for a period of 2 years. 

24 ‘‘(d) SCIENTIFICALLY AND CULTURALLY BASED.— 

25 Integrated health care funded through this section shall 

26 be scientifically and culturally based, taking into considerVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01041 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ation the results of the most recent peer-reviewed research 

2 available, including information on language accessibility, 

3 cultural humility, diversity of practitioners, and consider4 ation of social determinants of health. 

5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

6 carry out this section, there is authorized to be appro7 priated $20,000,000 for each of fiscal years 2023 through 

8 2027.’’. 

9 SEC. 6023. INTEGRATED HEALTH CARE DEMONSTRATION 

10 PROGRAM. 

11 Part D of title V of the Public Health Service Act 

12 (42 U.S.C. 290dd et seq.), as amended by sections 6022 

13 and 6052, is further amended by adding at the end the 

14 following: 

15 ‘‘SEC. 555. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

16 PROVISION OF BEHAVIORAL HEALTH CARE 

17 IN PRIMARY CARE SETTINGS. 

18 ‘‘(a) GRANTS.—The Secretary shall award grants to 

19 eligible entities for the purpose of establishing interprofes20 sional health care teams that provide behavioral health 

21 care. 

22 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

23 a grant under this section, an entity shall be a Federally 

24 qualified health center (as defined in section 1861(aa) of 

25 the Social Security Act), rural health clinic, or behavioral 


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1 health program, serving a high proportion of individuals 

2 from racial and ethnic minority groups (as defined in sec3 tion 1707(g)). 

4 ‘‘(c) SCIENTIFICALLY BASED.—Integrated health 

5 care funded through this section shall be scientifically 

6 based, taking into consideration the results of the most 

7 recent peer-reviewed research available. 

8 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 

9 carry out this section, there is authorized to be appro10 priated $20,000,000 for each of the first 5 fiscal years 

11 following the date of enactment of the Health Equity and 

12 Accountability Act.’’. 

13 Subtitle C—Workforce 

14 Development 

15 SEC. 6031. BUILDING AN EFFECTIVE WORKFORCE IN MEN16 TAL HEALTH. 

17 (a) IN GENERAL.—The Secretary of Health and 

18 Human Services, in coordination with the Assistant Sec19 retary for Mental Health and Substance Use, the Adminis20 trator of the Health Resources and Services Administra21 tion, the Secretary of Labor, and advocacy and behavioral 

22 and mental health organizations serving vulnerable popu23 lations, including youth and young adults, people with low 

24 incomes, and people of color, shall— 


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1 (1) develop, strengthen, and implement strate2 gies to bolster career pathways for diverse mental 

3 health professionals; 

4 (2) identify the breadth of settings where men5 tal health care and behavioral health care can take 

6 place; and 

7 (3) identify current mental health professional 

8 workforce shortages, inclusive of shortages of diverse 

9 mental health professionals. 

10 (b) CONTENTS.—Strategies under subsection (a) 

11 shall include— 

12 (1) the variety of settings where mental health 

13 professionals are needed, including community-based 

14 organizations, women’s centers, shelters, organiza15 tions focused on youth development, workforce agen16 cies, job placement and development centers, emer17 gency rooms, the special supplemental nutrition pro18 gram for women, infants, and children under section 

19 17 of the Child Nutrition Act of 1966 (42 U.S.C. 

20 1786), food banks, legal aid, and benefit issuers as 

21 defined in section 3 of the Food and Nutrition Act 

22 of 2008 (7 U.S.C. 2012); 

23 (2) defining career pathways in mental and be24 havioral health, to help diverse communities underVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01044 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 stand the variety of careers in mental and behavioral 

2 health that are available; 

3 (3) building career pathways in mental and be4 havioral health as part of the curriculum at the 

5 postsecondary education level; 

6 (4) providing accessible training and certifi7 cation pathways for diverse lay health workers such 

8 as community health workers and other peer support 

9 specialists to ensure that careers pay a living wage; 

10 (5) creating incentives for students in the fields 

11 of occupational therapy, social work, psychology, 

12 medicine, and nursing to learn more about mental 

13 health, and to include a mental health rotation, with 

14 a particular focus in racially and ethnically diverse 

15 communities, as a part of the health professional 

16 curricula; 

17 (6) including training and education for teach18 ers about the basics of section 504 of the Rehabilita19 tion Act of 1973 (29 U.S.C. 794) and individualized 

20 education programs (as defined in section 614(d) of 

21 the Individuals with Disabilities Education Act (20 

22 U.S.C. 1414(d))); 

23 (7) researching, developing, and implementing 

24 programs for mental and behavioral health profes25 sionals to prevent burnout; and 


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1 (8) finding better and increased avenues to en2 sure equity by providing better loan forgiveness pro3 grams, including a focus area within the National 

4 Health Service Corps focused on community trauma. 

5 (c) USE OF FUNDS.—Programs and activities funded 

6 under this section shall be consistent with subsection 

7 (a)(1) and shall include the following: 

8 (1) Subgrants to entities serving youth and 

9 young adults which demonstrate a need for an in10 creased mental health workforce, using strategies 

11 mentioned in subsection (a)(1). 

12 (2) Funding towards the Health Resources and 

13 Services Administration’s Behavioral Health Work14 force Education and Training Program. 

15 (3) Funding towards the development and im16 plementation of a National Health Service Corps 

17 program focused on community trauma. 

18 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section, 

20 $50,000,000 for each of fiscal years 2023 through 2033. 

21 SEC. 6032. PILOT PROGRAM TO INCREASE LANGUAGE AC22 CESS AT FEDERALLY QUALIFIED HEALTH 

23 CENTERS. 

24 (a) LOAN REPAYMENTS TO QUALIFIED HEALTH

25 CARE PROFESSIONALS.— 


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1 (1) IN GENERAL.—For the purpose of increas2 ing language access to mental health services, the 

3 Secretary shall carry out a demonstration project 

4 under which— 

5 (A) the Secretary matches qualified mental 

6 health professionals with Federally qualified 

7 health centers; 

8 (B) the qualified mental health profes9 sionals each agree to a period of obligated serv10 ice at a Federally qualified health center with 

11 which they are so matched; and 

12 (C) the Secretary agrees to make loan re13 payments under section 338B of the Public 

14 Health Service Act (42 U.S.C. 254l–1) on be15 half of such qualified mental health profes16 sionals. 

17 (2) PREFERENCE.—In matching qualified men18 tal health professionals with Federally qualified 

19 health centers under paragraph (1), the Secretary 

20 shall give preference to placement at Federally quali21 fied health centers at which at least 20 percent of 

22 the patients are best served in a language other than 

23 English, as indicated by data in the Uniform Data 

24 System (or any successor database). 


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1 (3) ENHANCED COMPENSATION.—For each 

2 year of obligated service that a qualified mental 

3 health professional contracts to serve under para4 graph (1) at a Federally qualified health center at 

5 which at least 20 percent of the patients are best 

6 served in a language other than English, as indi7 cated by data in the Uniform Data System (or any 

8 successor database), the Secretary may pay the 

9 higher of— 

10 (A) $10,000 above the maximum amount 

11 otherwise applicable under section 

12 338B(g)(2)(A) of the Public Health Service Act 

13 (42 U.S.C. 254l–1(g)(2)(A)); or 

14 (B) if the qualified health professional is 

15 fluent in a language other than English that is 

16 needed by such Federally qualified health cen17 ter, $15,000 above such maximum amount. 

18 (4) ACHIEVING FLUENCY.—A qualified mental 

19 health professional eligible to receive the enhanced 

20 pay amount specified in paragraph (3)(A) at the be21 ginning of the professional’s period of obligated serv22 ice may transition to being eligible to receive the en23 hanced higher pay amount specified in paragraph 

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1 sional serves to have achieved fluency in a language 

2 other than English needed by that health center. 

3 (b) GRANTS TO HEALTH CENTERS.— 

4 (1) IN GENERAL.—The Secretary shall carry 

5 out a demonstration program consisting of awarding 

6 grants under section 330 of the Public Health Serv7 ice Act (42 U.S.C. 254b) to Federally qualified 

8 health centers to recruit, hire, employ, and supervise 

9 qualified mental health professionals who are fluent 

10 in a language other than English to provide mental 

11 health services in such other language. 

12 (2) PREFERENCE.—In selecting grant recipi13 ents under paragraph (1), the Secretary shall give 

14 preference to Federally qualified health centers at 

15 which at least 20 percent of the patients are best 

16 served in a language other than English, as indi17 cated by data in the Uniform Data System (or any 

18 successor database). 

19 (3) MARKETING.—A Federally qualified health 

20 center receiving a grant under this subsection shall 

21 use a portion of the grant funds to disseminate in22 formation about, and otherwise market, the mental 

23 health services supported through the grant. 

24 (c) REPORTS.— 


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1 (1) INITIAL REPORT.—Not later than 6 months 

2 after awarding loan repayment agreements under 

3 subsection (a) and grants under subsection (b), the 

4 Secretary shall submit to the Committees on Appro5 priations of the House of Representatives and the 

6 Senate, and to other appropriate congressional com7 mittees, a report on the implementation of the pro8 grams under this section. Such report shall in9 clude— 

10 (A) the languages spoken by the qualified 

11 mental health professionals receiving loan re12 payments pursuant to subsection (a) or re13 cruited pursuant to a grant under subsection 

14 (b); 

15 (B) the Federally qualified health centers 

16 at which such professionals were placed; 

17 (C) how many Federally qualified health 

18 centers received funding through the grant pro19 gram under subsection (b); 

20 (D) an analysis, conducted in consultation 

21 with the Federally qualified health centers re22 ceiving grants under section (b), of the effec23 tiveness of such grants at increasing language 

24 access to mental health services; and 


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1 (E) best practices, developed in consulta2 tion with Federally qualified health centers re3 ceiving grants under section (b), for the recruit4 ment and retention of mental health profes5 sionals at Federally qualified health centers. 

6 (2) FINAL REPORT.—Not later than the end of 

7 fiscal year 2027, the Secretary shall submit to the 

8 Committees on Appropriations of the House of Rep9 resentatives and the Senate, and to other appro10 priate congressional committees, a final report on 

11 the implementation of the programs under this sec12 tion, including the information, analysis, and best 

13 practices listed in subparagraphs (A) through (E) of 

14 paragraph (1). 

15 (d) DEFINITIONS.—In this section: 

16 (1) The term ‘‘Federally qualified health cen17 ter’’ has the meaning given the term in section 

18 1861(aa) of the Social Security Act (42 U.S.C. 

19 1395x(aa)). 

20 (2) The term ‘‘qualified mental health profes21 sional’’ means— 

22 (A) physicians, allopathic physicians, osteo23 pathic physicians, nurse practitioners, and phy24 sician assistants with a specialty in mental 

25 health and psychiatry; 


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1 (B) health service psychologists; 

2 (C) licensed clinical social workers; 

3 (D) psychiatric nurse specialists; 

4 (E) marriage and family therapists; 

5 (F) licensed professional counselors; 

6 (G) substance use disorder counselors; 

7 (H) occupational therapists; and 

8 (I) other individuals who— 

9 (i) have not yet been licensed or cer10 tified to serve as a professional listed in 

11 any of subparagraphs (A) through (H); 

12 and 

13 (ii) will serve at the Federally quali14 fied health center under the supervision of 

15 a licensed individual or certified profes16 sional so listed. 

17 (3) The term ‘‘Secretary’’ means the Secretary 

18 of Health and Human Services. 

19 (e) AUTHORIZATION OF APPROPRIATIONS.— 

20 (1) IN GENERAL.—To carry out this section, 

21 there is authorized to be appropriated $75,000,000 

22 for each of fiscal years 2023 through 2027. 

23 (2) SUPPLEMENT, NOT SUPPLANT.—Amounts 

24 made available to carry out this section shall be in 

25 addition to amounts otherwise available to provide 


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1 mental health services at Federally qualified health 

2 centers pursuant to sections 338B and 330 of the 

3 Public Health Service Act (42 U.S.C. 254l–1, 254b). 

4 SEC. 6033. HEALTH PROFESSIONS COMPETENCIES TO AD5 DRESS RACIAL AND ETHNIC MINORITY MEN6 TAL HEALTH DISPARITIES. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services may award grants to qualified national 

9 organizations for the purposes of— 

10 (1) developing, and disseminating to health pro11 fessional educational programs, best practices or 

12 core competencies addressing mental health dispari13 ties among racial and ethnic minority groups for use 

14 in the training of students in the professions of so15 cial work, psychology, psychiatry, marriage and fam16 ily therapy, mental health counseling, and substance 

17 abuse counseling; and 

18 (2) certifying community health workers and 

19 peer wellness specialists with respect to such best 

20 practices and core competencies and integrating and 

21 expanding the use of such workers and specialists 

22 into health care to address mental health disparities 

23 among racial and ethnic minority groups. 

24 (b) BEST PRACTICES; CORE COMPETENCIES.—Orga25 nizations receiving funds under subsection (a) may use the 


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1 funds to engage in the following activities related to the 

2 development and dissemination of best practices or core 

3 competencies described in subsection (a)(1): 

4 (1) Formation of committees or working groups 

5 composed of experts from accredited health profes6 sions schools to identify best practices and core com7 petencies relating to mental health disparities among 

8 racial and ethnic minority groups. 

9 (2) Planning of workshops at the national level 

10 to allow for public input into the educational needs 

11 associated with mental health disparities among ra12 cial and ethnic minority groups. 

13 (3) Dissemination and promotion of the use of 

14 best practices or core competencies for culturally 

15 and linguistically appropriate mental health services 

16 in undergraduate and graduate health professions 

17 training programs nationwide. 

18 (4) Establishing external stakeholder advisory 

19 boards to provide meaningful input into policy and 

20 program development and best practices to reduce 

21 mental health disparities among racial and ethnic 

22 minority groups. 

23 (c) DEFINITIONS.—In this section: 

24 (1) QUALIFIED NATIONAL ORGANIZATION.—The 

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1 tional organization that focuses on the education of 

2 students in one or more of the professions of social 

3 work, psychology, psychiatry, marriage and family 

4 therapy, mental health counseling, and substance 

5 misuse counseling. 

6 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

7 The term ‘‘racial and ethnic minority group’’ has the 

8 meaning given to such term in section 1707(g) of 

9 the Public Health Service Act (42 U.S.C. 300u– 

10 6(g)). 

11 Subtitle D—Children’s Mental 

12 Health 

13 SEC. 6041. PEDIATRIC BEHAVIORAL HEALTH CARE. 

14 Subpart V of part D of title III of the Public Health 

15 Service Act (42 U.S.C. 256 et seq.) is amended by adding 

16 at the end the following: 

17 ‘‘SEC. 340A–1. GRANTS TO SUPPORT PEDIATRIC BEHAV18 IORAL HEALTH CARE INTEGRATION AND CO19 ORDINATION. 

20 ‘‘(a) IN GENERAL.—The Secretary, acting through 

21 the Administrator of the Health Resources and Services 

22 Administration, shall award grants to eligible entities for 

23 the purpose of supporting pediatric behavioral health care 

24 integration and coordination within communities to meet 

25 local community needs. 


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1 ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 

2 grants under subsection (a) include— 

3 ‘‘(1) pediatricians; 

4 ‘‘(2) children’s hospitals; 

5 ‘‘(3) pediatric behavioral health providers with 

6 the capacity to organize and implement activities 

7 working with community organizations and pro8 viders; and 

9 ‘‘(4) other entities as determined appropriate by 

10 the Secretary. 

11 ‘‘(c) PRIORITIZATION.—In awarding grants under 

12 subsection (a), the Secretary shall prioritize applicants 

13 that demonstrate the highest needs at the local level along 

14 the care continuum for strengthening children’s behavioral 

15 health crisis care and access. 

16 ‘‘(d) USE OF FUNDS.—Activities that may be funded 

17 through a grant under subsection (a) include— 

18 ‘‘(1) the recruitment and retention of commu19 nity health workers or navigators to coordinate fam20 ily access to pediatric mental, emotional, and behav21 ioral health services; 

22 ‘‘(2) training the pediatric mental, emotional, 

23 and behavioral health care workforce, relevant stake24 holders, and community members; 


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1 ‘‘(3) expanding evidence-based, integrated mod2 els of care for pediatric mental, emotional, and be3 havioral health services; 

4 ‘‘(4) pediatric practice integration for the provi5 sion of pediatric mental, emotional, and behavioral 

6 health services; 

7 ‘‘(5) addressing surge capacity for pediatric 

8 mental, emotional, and behavioral health needs; 

9 ‘‘(6) providing pediatric mental, emotional, and 

10 behavioral health services to children as delivered by 

11 behavioral, emotional, and mental health profes12 sionals utilizing telehealth services; 

13 ‘‘(7) establishing or maintaining initiatives to 

14 decompress emergency departments, including par15 tial hospitalization, step down residency programs, 

16 and intensive outpatient programs; 

17 ‘‘(8) supporting, enhancing, or expanding pedi18 atric mental, emotional, and behavioral health pre19 ventive and crisis intervention services; 

20 ‘‘(9) establishing or maintaining pediatric men21 tal, emotional, and behavioral health urgent care; 

22 ‘‘(10) establishing or maintaining community23 based initiatives, such as school-based partnerships; 

24 and 


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1 ‘‘(11) addressing other access and coordination 

2 gaps to mental, emotional, and behavioral health 

3 services in the community for children. 

4 ‘‘(e) FUNDING.—To carry out this section, there is 

5 hereby appropriated, out of amounts in the Treasury not 

6 otherwise obligated, $500,000,000 for each of fiscal years 

7 2023 through 2027. 

8 ‘‘SEC. 340A–2. PEDIATRIC BEHAVIORAL HEALTH WORK9 FORCE TRAINING PROGRAM. 

10 ‘‘(a) IN GENERAL.—The Secretary, acting through 

11 the Administrator of the Health Resources and Services 

12 Administration, shall award grants to eligible entities for 

13 the purpose of supporting evidence-based pediatric behav14 ioral health workforce training. 

15 ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 

16 grants under subsection (a) include— 

17 ‘‘(1) children’s hospitals; and 

18 ‘‘(2) other pediatric health care providers as de19 termined appropriate by the Secretary. 

20 ‘‘(c) USE OF FUNDS.—The training that may be sup21 ported through a grant under subsection (a) includes ex22 panded training in pediatric behavioral health for physi23 cians and nonphysician practitioners, including the fol24 lowing practitioner types: 

25 ‘‘(1) Child and adolescent psychiatrists. 


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1 ‘‘(2) Psychiatric nurses. 

2 ‘‘(3) Psychologists. 

3 ‘‘(4) Advanced practice nurses. 

4 ‘‘(5) Family therapists. 

5 ‘‘(6) Social workers. 

6 ‘‘(7) Mental health counselors. 

7 ‘‘(8) Other practitioner types as determined ap8 propriate by the Secretary. 

9 ‘‘(d) FUNDING.—To carry out this section, there is 

10 hereby appropriated, out of amounts in the Treasury not 

11 otherwise obligated, $100,000,000 for each of fiscal years 

12 2023 through 2027.’’. 

13 SEC. 6042. MENTAL HEALTH IN SCHOOLS. 

14 (a) PURPOSE.— It is the purpose of this section to— 

15 (1) revise, increase funding for, and expand the 

16 scope of the Project AWARE State Educational 

17 Agency Grant Program carried out by the Secretary 

18 of Health and Human Services, in order to provide 

19 access to more comprehensive school-based mental 

20 health services and supports; 

21 (2) provide for comprehensive staff development 

22 for school and community service personnel working 

23 in the school; 

24 (3) provide for comprehensive training to im25 prove health and academic outcomes for children 


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1 with, or who have a high likelihood of developing, 

2 mental health conditions, for parents or guardians, 

3 siblings, and other family members of such children, 

4 and for concerned members of the community; 

5 (4) provide for comprehensive, universal, evi6 dence-based screening to identify children and ado7 lescents with potential mental health conditions or 

8 unmet emotional health needs; 

9 (5) recognize best practices for the delivery of 

10 mental health care in school-based settings, includ11 ing school-based health centers; 

12 (6) provide for comprehensive training for par13 ents or guardians, siblings, other family members, 

14 and concerned members of the community on behalf 

15 of children and adolescents experiencing mental 

16 health trauma, disorders, co-occurring conditions, or 

17 disabilities; and 

18 (7) establish formal working relationships 

19 among health, human service, and educational enti20 ties that support the mental and emotional health of 

21 children and adolescents in the school setting or that 

22 have a child or youth focus. 

23 (b) TECHNICAL AMENDMENTS.—The second part G 

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1 tions) of title V of the Public Health Service Act (42 

2 U.S.C. 290kk et seq.) is amended— 

3 (1) by redesignating such part as part J; and 

4 (2) by redesignating sections 581 through 584 

5 as sections 596 through 596C, respectively. 

6 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL7 DREN AND VIOLENCE.—Section 581 of the Public Health 

8 Service Act (42 U.S.C. 290hh) (relating to children and 

9 violence) is amended to read as follows: 

10 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 

11 AND ADOLESCENTS. 

12 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

13 with the Secretary of Education, shall, through grants, 

14 contracts, or cooperative agreements awarded to eligible 

15 entities described in subsection (b), provide comprehensive 

16 school-based mental health services and supports to assist 

17 children in local communities and schools (including 

18 schools funded by the Bureau of Indian Education) deal19 ing with traumatic experiences, grief, bereavement, risk of 

20 suicide, and the risk of experiencing community or inter21 personal violence, such as abuse or neglect. All services 

22 and supports provided under such a grant, contract, or 

23 cooperative agreement shall— 

24 ‘‘(1) be developmentally, linguistically, and cul25 turally appropriate; 


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1 ‘‘(2) be trauma-informed; and 

2 ‘‘(3) incorporate positive behavioral interven3 tions and supports. 

4 ‘‘(b) ACTIVITIES.—Grants, contracts, or cooperative 

5 agreements awarded under subsection (a), shall, as appro6 priate, be used for— 

7 ‘‘(1) implementation of school and community8 based mental health programs that— 

9 ‘‘(A) build awareness of individual trauma 

10 and the intergenerational continuum of impacts 

11 of trauma on populations; 

12 ‘‘(B) train appropriate staff to identify, 

13 and screen for, signs of trauma exposure, men14 tal health and co-occurring conditions, or risk 

15 of suicide; and 

16 ‘‘(C) incorporate positive behavioral inter17 ventions, family engagement, student treatment, 

18 and multigenerational supports to foster the 

19 health and development of children, prevent 

20 mental health disorders, and ameliorate the im21 pact of trauma; 

22 ‘‘(2) technical assistance to local communities 

23 with respect to the development of programs de24 scribed in paragraph (1); 


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1 ‘‘(3) facilitating diverse community partnerships 

2 among families, students, educational agencies, men3 tal health and substance use disorder service sys4 tems, family-based mental health service systems, 

5 child welfare agencies, health care providers (includ6 ing primary care physicians, mental health profes7 sionals, and other professionals who specialize in 

8 children’s mental health such as child and adolescent 

9 psychiatrists), institutions of higher education, faith10 based programs, trauma networks, and other com11 munity-based systems to address child and adoles12 cent trauma, as well as unmet mental health needs; 

13 and 

14 ‘‘(4) establishing and promoting best practices 

15 that are either evidence based or culturally based for 

16 children and adolescents to share their experiences 

17 of individual and community trauma, including their 

18 exposure to community and domestic violence, with 

19 trusted adults. 

20 ‘‘(c) REQUIREMENTS.— 

21 ‘‘(1) IN GENERAL.—To be eligible for a grant, 

22 contract, or cooperative agreement under subsection 

23 (a), an entity shall be a partnership that includes— 

24 ‘‘(A) a State educational agency, as de25 fined in section 8101 of the Elementary and 


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1 Secondary Education Act of 1965, in coordina2 tion with one or more local educational agen3 cies, as defined in section 8101 of the Elemen4 tary and Secondary Education Act of 1965, or 

5 a consortium of any entities described in sub6 paragraph (B), (C), (D), or (E) of section 

7 8101(30) of such Act; and 

8 ‘‘(B) at least 1 community-based mental 

9 health provider, including a public or private 

10 mental health entity, health care entity, family11 based mental health entity, trauma network, or 

12 other community-based entity, as determined by 

13 the Secretary (and which may include addi14 tional entities such as a human services agency, 

15 child welfare agency, an institution of higher 

16 education, or another entity, as determined by 

17 the Secretary). 

18 ‘‘(2) COMPLIANCE WITH HIPAA.—Any patient 

19 records developed by covered entities through activi20 ties under the grant shall meet the regulations pro21 mulgated under section 264(c) of the Health Insur22 ance Portability and Accountability Act of 1996. 

23 ‘‘(3) COMPLIANCE WITH FERPA.—Section 444 

24 of the General Education Provisions Act (commonly 

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1 vacy Act of 1974’) shall apply to any entity that is 

2 a member of the partnership in the same manner 

3 that such section applies to an educational agency or 

4 institution (as that term is defined in such section). 

5 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 

6 shall ensure that grants, contracts, or cooperative agree7 ments under subsection (a) will be distributed equitably 

8 among the regions of the country and among urban and 

9 rural areas. 

10 ‘‘(e) DURATION OF AWARDS.—With respect to a 

11 grant, contract, or cooperative agreement under sub12 section (a), the period during which payments under such 

13 an award will be made to the recipient shall be 5 years, 

14 with options for renewal. 

15 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 

16 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist17 ant Secretary shall develop a fiscally appropriate 

18 process for evaluating activities carried out under 

19 this section. Such process shall include— 

20 ‘‘(A) the development of guidelines for the 

21 submission of program data by grant, contract, 

22 or cooperative agreement recipients; 

23 ‘‘(B) the development of measures of out24 comes (in accordance with paragraph (2)) to be 


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1 applied by such recipients in evaluating pro2 grams carried out under this section; and 

3 ‘‘(C) the submission of annual reports by 

4 such recipients concerning the effectiveness of 

5 programs carried out under this section. 

6 ‘‘(2) MEASURES OF OUTCOMES.—The Assistant 

7 Secretary shall develop measures of outcomes to be 

8 applied by recipients of assistance under this section 

9 to evaluate the effectiveness of programs carried out 

10 under this section, including outcomes related to the 

11 student, family, and local educational systems sup12 ported by this section. 

13 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi14 ble entity described in subsection (c) that receives a 

15 grant, contract, or cooperative agreement under this 

16 section shall annually submit to the Assistant Sec17 retary a report that includes data to evaluate the 

18 success of the program carried out by the entity 

19 based on whether such program is achieving the pur20 poses of the program. Such reports shall utilize the 

21 measures of outcomes under paragraph (2) in a rea22 sonable manner to demonstrate the progress of the 

23 program in achieving such purposes. 

24 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 

25 Based on the data submitted under paragraph (3), 


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1 the Assistant Secretary shall annually submit to 

2 Congress a report concerning the results and effec3 tiveness of the programs carried out with assistance 

4 received under this section. 

5 ‘‘(5) LIMITATION.—An eligible entity shall use 

6 not more than 20 percent of amounts received under 

7 a grant under this section to carry out evaluation 

8 activities under this subsection. 

9 ‘‘(g) INFORMATION AND EDUCATION.—The Sec10 retary shall disseminate best practices based on findings 

11 made pursuant to this section. 

12 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF

13 APPROPRIATIONS.— 

14 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 

15 section shall be in an amount that is not more than 

16 $2,000,000 for each of the first 5 fiscal years fol17 lowing the date of enactment of this section. The 

18 Secretary shall determine the amount of each such 

19 grant based on the population of children up to age 

20 21 of the area to be served under the grant. 

21 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

22 There is authorized to be appropriated to carry out 

23 this section, $130,000,000 for each of fiscal years 

24 2023 through 2026.’’. 


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1 (d) CONFORMING AMENDMENT.—Part G of title V 

2 of the Public Health Service Act (42 U.S.C. 290hh et 

3 seq.), as amended by this section, is further amended, in 

4 the part heading by striking ‘‘PROJECTS FOR CHIL5 DREN AND VIOLENCE’’ and inserting the following: 

6 ‘‘SCHOOL-BASED MENTAL HEALTH’’. 

7 (e) SCHOOL-BASED MENTAL HEALTH SERVICES.— 

8 (1) IN GENERAL.—The Secretary of Education 

9 shall award grants to State educational agencies to 

10 support services provided by school-based mental 

11 health services providers at schools receiving funds 

12 under part A of title I of the Elementary and Sec13 ondary Education Act of 1965 (20 U.S.C. 6311 et 

14 seq.). 

15 (2) USE OF FUNDS.—Grants under this sub16 section shall be used to help meet the recommended 

17 ratios of— 

18 (A) 250 students per school counselor; 

19 (B) 500 students per school psychologist; 

20 and 

21 (C) 250 students per school social worker. 

22 (3) CONDITION.—The Secretary shall ensure 

23 that funds made available under this subsection are 

24 used to provide services that are developmentally, 

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1 ma-informed, and incorporate positive behavioral 

2 interventions and supports. 

3 (4) DEFINITIONS.—For purposes of this sub4 section: 

5 (A) The term ‘‘school-based mental health 

6 services provider’’ has the meaning given such 

7 term in section 4102 of the Elementary and 

8 Secondary Education Act of 1965 (20 U.S.C. 

9 7112). 

10 (B) The term ‘‘State educational agency’’ 

11 has the meaning given such term in section 

12 8101 of the Elementary and Secondary Edu13 cation Act of 1965 (20 U.S.C. 7801). 

14 SEC. 6043. ADDITIONAL SUPPORT FOR YOUTH AND YOUNG 

15 ADULT MENTAL HEALTH SERVICE PROVI16 SION. 

17 Section 1903 of the Social Security Act (42 U.S.C. 

18 1396b) is amended by adding at the end the following new 

19 subsection: 

20 ‘‘(cc) YOUTH AND YOUNG ADULT INTERVENTION

21 SERVICES.— 

22 ‘‘(1) IN GENERAL.—Notwithstanding section 

23 1902(a)(1) (relating to Statewideness), section 

24 1902(a)(10)(B) (relating to comparability), section 

25 1902(a)(23)(A) (relating to freedom of choice of 


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1 providers), or section 1902(a)(27) (relating to pro2 vider agreements), a State may, during the 5-year 

3 period beginning on the first day of the fiscal year 

4 quarter that begins on or after January 1, 2024, 

5 provide medical assistance for qualifying youth and 

6 young adult mental health and substance use inter7 vention services (as defined in paragraph (2)(C)) 

8 under a State plan amendment or waiver approved 

9 under section 1115 or 1915(c). 

10 ‘‘(2) DEFINITIONS.—For the purposes of this 

11 subsection: 

12 ‘‘(A) PRIORITY SERVICE.—The term ‘pri13 ority service’ means any of the following if vol14 untarily received and provided in a manner that 

15 maintains the privacy and confidentiality of pa16 tient information consistent with Federal and 

17 State requirements: 

18 ‘‘(i) Community-based mobile crisis 

19 intervention services, as defined in section 

20 1947. 

21 ‘‘(ii) Telehealth. 

22 ‘‘(iii) Youth peer support. 

23 ‘‘(iv) Screening for adverse childhood 

24 experiences. 

25 ‘‘(v) Trauma responsive care. 


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1 ‘‘(vi) Other priority services for youth, 

2 as defined by the Secretary. 

3 ‘‘(B) QUALIFIED MENTAL HEALTH PRO4 VIDERS.—The term ‘qualified mental health 

5 providers’ means a behavioral health care pro6 fessional who is capable of conducting an as7 sessment of the individual, in accordance with 

8 the professional’s permitted scope of practice 

9 under State law, and other professionals or 

10 paraprofessionals with appropriate expertise in 

11 youth and young adult behavioral health or 

12 mental health, including social workers, peer 

13 support specialists, recovery coaches, commu14 nity health workers, mental health clinicians, 

15 and others, as designated by the State and ap16 proved by the Secretary. 

17 ‘‘(C) QUALIFYING YOUTH AND YOUNG

18 ADULT MENTAL HEALTH AND SUBSTANCE USE

19 INTERVENTION SERVICES DEFINED.—The term 

20 ‘qualifying youth and young adult mental health 

21 and substance use intervention services’ means, 

22 with respect to a State, items and services for 

23 which medical assistance is available under the 

24 State plan under this title or a waiver of such 

25 plan, that are— 


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1 ‘‘(i) furnished to an individual 16 to 

2 25 years of age who is— 

3 ‘‘(I) experiencing a mental health 

4 or substance use disorder crisis; 

5 ‘‘(II) subject to the juvenile or 

6 adult justice system as defined in sec7 tion 3102 of title 29, United States 

8 Code; 

9 ‘‘(III)(aa) experiencing homeless10 ness (as defined in section 41403(6) 

11 of the Violence Against Women Act of 

12 1994 (42 U.S.C. 14043e–2(6))); 

13 ‘‘(bb) a homeless child or youth 

14 (as defined in section 725(2) of the 

15 McKinney-Vento Homeless Assistance 

16 Act (42 U.S.C. 11434a(2))); 

17 ‘‘(cc) a runaway, in foster care, 

18 or has aged out of the foster care sys19 tem; 

20 ‘‘(dd) a child eligible for assist21 ance under section 477 of the Social 

22 Security Act (42 U.S.C. 677); or 

23 ‘‘(ee) in an out-of-home place24 ment; 


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1 ‘‘(IV) pregnant or parenting as 

2 defined in section 3102 of title 29, 

3 United States Code; 

4 ‘‘(V) a youth who is an individual 

5 with a disability as defined in section 

6 3102 of title 29, United States Code; 

7 ‘‘(VI) a low-income youth requir8 ing additional assistance to enter or 

9 complete an educational program or 

10 to secure or hold employment as de11 fined in section 3102 of title 29, 

12 United States Code; or 

13 ‘‘(VII) living in a community that 

14 has faced acute or long-term exposure 

15 to substantial discrimination, histor16 ical oppression, intergenerational pov17 erty, civil unrest, or a high rate of vio18 lence or drug overdose deaths; 

19 ‘‘(ii) furnished by qualified mental 

20 health providers; and 

21 ‘‘(iii) a priority service. 

22 ‘‘(D) TELEHEALTH.—The term ‘telehealth’ 

23 means use of electronic information and tele24 communications technologies, including voice 

25 only audio, text, remote patient monitoring, and 


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1 mHealth via applications, to support clinical 

2 mental health care, patient and professional 

3 health-related education, public health, and 

4 health administration. 

5 ‘‘(3) PAYMENTS.—Notwithstanding section 

6 1905(b), beginning January 1, 2024, during each of 

7 the first 20 fiscal quarters that a State meets the 

8 requirements described in paragraph (4), the Fed9 eral medical assistance percentage applicable to 

10 amounts expended by the State for medical assist11 ance for qualifying youth and young adult mental 

12 health and substance use intervention services fur13 nished during such quarter shall be equal to 100 

14 percent. 

15 ‘‘(4) REQUIREMENTS.—The requirements de16 scribed in this paragraph are the following: 

17 ‘‘(A) The State demonstrates, to the satis18 faction of the Secretary— 

19 ‘‘(i) that it will be able to support the 

20 provision of qualifying youth and young 

21 adult mental health and substance use 

22 intervention services that meet the condi23 tions specified in paragraphs (1) and (2); 

24 and 


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1 ‘‘(ii) how it will support coordination 

2 between qualified mental health providers 

3 and substance use teams and community 

4 partners, including health care providers, 

5 to enable the provision of services, needed 

6 referrals, and other activities identified by 

7 the Secretary. 

8 ‘‘(B) The State provides assurances satis9 factory to the Secretary that— 

10 ‘‘(i) any additional Federal funds re11 ceived by the State for qualifying youth 

12 and young adult mental health and sub13 stance use intervention services provided 

14 under this subsection that are attributable 

15 to the increased Federal medical assistance 

16 percentage under paragraph (3)(A) will be 

17 used to supplement, and not supplant, the 

18 level of State funds expended for such 

19 services for fiscal year 2024; 

20 ‘‘(ii) if the State made qualifying 

21 youth and young adult mental health and 

22 substance use intervention services avail23 able in a region of the State in fiscal year 

24 2023 the State will continue to make such 

25 services available in such region under this 


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1 subsection at the same level that the State 

2 made such services available in such fiscal 

3 year; and 

4 ‘‘(iii) the State will conduct the eval5 uation and assessment, and submit the re6 port required under paragraph (5). 

7 ‘‘(5) STATE EVALUATION AND REPORT.— 

8 ‘‘(A) STATE EVALUATION.—Not later than 

9 4 fiscal quarters after a State begins providing 

10 qualifying youth and young adult mental health 

11 and substance use intervention services in ac12 cordance with this subsection, the State shall 

13 enter into a contract with an independent entity 

14 or organization to conduct an evaluation for the 

15 purposes of— 

16 ‘‘(i) determining the effect of the pro17 vision of such services on— 

18 ‘‘(I) emergency room visits; 

19 ‘‘(II) use of ambulatory services; 

20 ‘‘(III) hospitalizations; 

21 ‘‘(IV) the involvement of law en22 forcement in mental health or sub23 stance use disorder crisis events; and 

24 ‘‘(V) the diversion of individuals 

25 from jails or similar settings; and 


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1 ‘‘(ii) assessing— 

2 ‘‘(I) the types of services pro3 vided to individuals; 

4 ‘‘(II) the types of events re5 sponded to; 

6 ‘‘(III) cost savings or cost-effec7 tiveness attributable to such services; 

8 ‘‘(IV) the experiences of individ9 uals who receive qualifying youth and 

10 young adult mental health and sub11 stance use intervention services; 

12 ‘‘(V) the successful connection of 

13 individuals with follow-up services; 

14 and 

15 ‘‘(VI) other relevant outcomes 

16 identified by the Secretary. 

17 ‘‘(B) COMPARISON TO HISTORICAL MEAS18 URES.—The contract described in subparagraph 

19 (A) shall specify that the evaluation is based on 

20 a comparison of the historical measures of 

21 State performance with respect to the outcomes 

22 specified under such subparagraph to the 

23 State’s performance with respect to such out24 comes during the period beginning with the 

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1 viding qualifying youth and young adult mental 

2 health and substance use intervention services 

3 in accordance with this subsection. 

4 ‘‘(C) REPORT.—Not later than 2 years 

5 after a State begins to provide qualifying youth 

6 and young adult mental health and substance 

7 use intervention services in accordance with this 

8 subsection, the State shall submit a report to 

9 the Secretary on the following: 

10 ‘‘(i) The results of the evaluation car11 ried out under subparagraph (A). 

12 ‘‘(ii) The number of individuals who 

13 received qualifying youth and young adult 

14 mental health and substance use interven15 tion services. 

16 ‘‘(iii) Demographic information re17 garding such individuals when available, 

18 including the race and ethnicity, age, sex, 

19 sexual orientation, gender identity, and ge20 ographic location of such individuals. 

21 ‘‘(iv) The processes and models devel22 oped by the State to provide qualifying 

23 youth and young adult mental health and 

24 substance use intervention services under 

25 such the State plan or waiver, including 


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1 the processes developed to provide referrals 

2 for, or coordination with, follow-up care 

3 and services. 

4 ‘‘(v) Lessons learned regarding the 

5 provision of such services. 

6 ‘‘(D) PUBLIC AVAILABILITY.—The State 

7 shall make the report required under subpara8 graph (C) publicly available, including on the 

9 website of the appropriate State agency, upon 

10 submission of such report to the Secretary. 

11 ‘‘(6) BEST PRACTICES REPORT.— 

12 ‘‘(A) IN GENERAL.—Not later than 3 years 

13 after the first State begins to provide qualifying 

14 youth and young adult mental health and sub15 stance use intervention services in accordance 

16 with this subsection, the Secretary shall submit 

17 a report to Congress that— 

18 ‘‘(i) identifies the States that elected 

19 to provide services in accordance with this 

20 subsection; 

21 ‘‘(ii) summarizes the information re22 ported by such States under paragraph 

23 (5)(C); and 

24 ‘‘(iii) identifies best practices for the 

25 effective delivery of youth and young adult 


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1 mental health and substance use interven2 tion services. 

3 ‘‘(B) PUBLIC AVAILABILITY.—The report 

4 required under subparagraph (A) shall be made 

5 publicly available, including on the website of 

6 the Department of Health and Human Services, 

7 upon submission to Congress. 

8 ‘‘(7) NONDISCRIMINATION.— 

9 ‘‘(A) FEDERALLY FUNDED ACTIVITIES.— 

10 (i) For the purpose of applying the prohibitions 

11 against discrimination on the basis of age under 

12 the Age Discrimination Act of 1975 (42 U.S.C. 

13 6101 et seq.), on the basis of handicap under 

14 section 504 of the Rehabilitation Act of 1973 

15 (29 U.S.C. 794), on the basis of sex under title 

16 IX of the Education Amendments of 1972 (20 

17 U.S.C. 1681 et seq.), or on the basis of race, 

18 color, or national origin under title VI of the 

19 Civil Rights Act of 1964 (42 U.S.C. 2000d et 

20 seq.), programs and activities funded in whole 

21 or in part with funds made available under this 

22 subchapter are considered to be programs and 

23 activities receiving Federal financial assistance. 

24 ‘‘(ii) No person shall on the ground of sex 

25 or religion be excluded from participation in, be 


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1 denied the benefits of, or be subjected to dis2 crimination under, any program or activity 

3 funded in whole or in part with funds made 

4 available under this title. 

5 ‘‘(B) COMPLIANCE.—Whenever the Sec6 retary finds that a State, or an entity that has 

7 received a payment from an allotment to a 

8 State under section 702(c) of this title, has 

9 failed to comply with a provision of law referred 

10 to in subsection (a)(1), with subsection (a)(2), 

11 or with an applicable regulation (including one 

12 prescribed to carry out subsection (a)(2)), he 

13 shall notify the chief executive officer of the 

14 State and shall request him to secure compli15 ance. If within a reasonable period of time, not 

16 to exceed 60 days, the chief executive officer 

17 fails or refuses to secure compliance, the Sec18 retary may— 

19 ‘‘(i) refer the matter to the Attorney 

20 General with a recommendation that an 

21 appropriate civil action be instituted; 

22 ‘‘(ii) exercise the powers and functions 

23 provided by title VI of the Civil Rights Act 

24 of 1964 (42 U.S.C. 2000d et seq.), the 

25 Age Discrimination Act of 1975 (42 


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1 U.S.C. 6101 et seq.), or section 504 of the 

2 Rehabilitation Act of 1973 (29 U.S.C. 

3 794), as may be applicable; or 

4 ‘‘(iii) take such other action as may 

5 be provided by law. 

6 ‘‘(C) AUTHORITY OF ATTORNEY GENERAL; 

7 CIVIL ACTIONS.—When a matter is referred to 

8 the Attorney General pursuant to subsection 

9 (b)(1), or whenever he has reason to believe 

10 that the entity is engaged in a pattern or prac11 tice in violation of a provision of law referred 

12 to in subsection (a)(1) or in violation of sub13 section (a)(2), the Attorney General may bring 

14 a civil action in any appropriate district court 

15 of the United States for such relief as may be 

16 appropriate, including injunctive relief.’’. 

17 SEC. 6044. EARLY INTERVENTION AND PREVENTION PRO18 GRAMS FOR TRANSITION-AGE YOUTH. 

19 (a) IN GENERAL.—Section 1912(b)(1) of the Public 

20 Health Service Act (42 U.S.C. 300x–1(b)(1)) is amend21 ed— 

22 (1) by redesignating subparagraph (E) as sub23 paragraph (F); and 

24 (2) by inserting after subparagraph (D) the fol25 lowing: 


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1 ‘‘(E) EARLY INTERVENTION AND PREVEN2 TION PROGRAMS FOR TRANSITION-AGE

3 YOUTH.—The plan shall describe the State’s 

4 plans to carry out demonstration grants or con5 tracts for early intervention and prevention pro6 grams for transition-age youth of 16 to 25 

7 years of age who meet one or more of the cri8 teria specified in section 129(a)(1)(B) of the 

9 Workforce Innovation and Opportunity Act to 

10 be considered out-of-school youth.’’. 

11 (b) SET-ASIDE.—Section 1920 of the Public Health 

12 Service Act (42 U.S.C. 300x–9) is amended by adding at 

13 the end the following: 

14 ‘‘(d) EARLY INTERVENTION AND PREVENTION PRO15 GRAMS FOR TRANSITION-AGE YOUTH.— 

16 ‘‘(1) IN GENERAL.—Except as provided in para17 graph (2), a State shall expend at least 15 percent 

18 of the amount of the allotment of the State pursuant 

19 to a funding agreement under section 1911 for each 

20 fiscal year to support programs described in section 

21 1912(b)(1)(E). 

22 ‘‘(2) STATE FLEXIBILITY.—In lieu of expending 

23 15 percent of the amount of the allotment for a fis24 cal year as required by paragraph (1), a State may 

25 elect to expend not less than 30 percent of such 


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1 amount to support such programs by the end of two 

2 consecutive fiscal years.’’. 

3 SEC. 6045. STRATEGIES TO INCREASE ACCESS TO TELE4 HEALTH UNDER MEDICAID AND CHILDREN’S 

5 HEALTH INSURANCE PROGRAM. 

6 (a) GUIDANCE.—Not later than 1 year after the date 

7 of the enactment of this Act, the Secretary of Health and 

8 Human Services shall issue and disseminate guidance to 

9 States to clarify strategies to overcome existing barriers 

10 and increase access to telehealth under the Medicaid pro11 gram under title XIX of the Social Security Act (42 

12 U.S.C. 1396 et seq.) and the Children’s Health Insurance 

13 Program under title XXI of such Act (42 U.S.C. 1397aa 

14 et seq.). Such guidance shall include technical assistance 

15 and best practices regarding— 

16 (1) telehealth delivery of covered services; 

17 (2) recommended voluntary billing codes, modi18 fiers, and place-of-service designations for telehealth 

19 and other virtual health care services; 

20 (3) the simplification or alignment (including 

21 through reciprocity) of provider licensing, 

22 credentialing, and enrollment protocols with respect 

23 to telehealth across States, State Medicaid plans 

24 under such title XIX, and Medicaid managed care 


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1 organizations, including during national public 

2 health emergencies; 

3 (4) existing strategies States can use to inte4 grate telehealth and other virtual health care serv5 ices into value-based health care models; and 

6 (5) examples of States that have used waivers 

7 under the Medicaid program to test expanded access 

8 to telehealth, including during the emergency period 

9 described in section 1135(g)(1)(B) of the Social Se10 curity Act (42 U.S.C. 1320b–5(g)(1)(B)). 

11 (b) STUDIES.— 

12 (1) TELEHEALTH IMPACT ON HEALTH CARE

13 ACCESS.—Not later than 1 year after the date of the 

14 enactment of this Act, the Medicaid and CHIP Pay15 ment and Access Commission shall conduct a study, 

16 with respect to a minimum of 10 States across geo17 graphic regions of the United States, and submit to 

18 Congress a report, on the impact of telehealth on 

19 health care access, utilization, cost, and outcomes, 

20 broken down by race, ethnicity, sex, age, disability 

21 status, and ZIP Code. Such report shall— 

22 (A) evaluate cost, access, utilization, out23 comes, and patient experience data from across 

24 the health care field, including States, Medicaid 

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1 tions, and other organizations that provide or 

2 pay for telehealth under the Medicaid program 

3 and Children’s Health Insurance Program; 

4 (B) identify barriers and potential solu5 tions to provider entry and participation in tele6 health that States are experiencing, as well as 

7 barriers to providing telehealth across State 

8 lines, including during times of public health 

9 crisis or public health emergency; 

10 (C) determine the frequency at which out11 of-State telehealth is provided to patients en12 rolled in the Medicaid program and the poten13 tial impact on access to telehealth if State Med14 icaid policies were more aligned; and 

15 (D) identify and evaluate opportunities for 

16 more alignment among such policies to promote 

17 access to telehealth across all States, State 

18 Medicaid plans under title XIX of the Social 

19 Security Act (42 U.S.C. 1396 et seq.), State 

20 child health plans under title XXI of such Act 

21 (42 U.S.C. 1397aa et seq.), and Medicaid man22 aged care organizations, including the potential 

23 for regional compacts or reciprocity agreements. 

24 (2) FEDERAL AGENCY TELEHEALTH COLLABO25 RATION.—Not later than 1 year after the date of the 


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1 enactment of this Act, the Comptroller General of 

2 the United States shall conduct a study and submit 

3 to Congress a report evaluating collaboration be4 tween Federal agencies with respect to telehealth 

5 services furnished under the Medicaid or CHIP pro6 gram to individuals under the age of 18, including 

7 such services furnished to such individuals in early 

8 care and education settings. Such report shall in9 clude recommendations on— 

10 (A) opportunities for Federal agencies to 

11 improve collaboration with respect to such tele12 health services; and 

13 (B) opportunities for collaboration between 

14 Federal agencies to expand telehealth access to 

15 such individuals enrolled under the Medicaid or 

16 CHIP program, including in early care and 

17 education settings. 

18 SEC. 6046. YOUTH AND YOUNG ADULT MENTAL HEALTH 

19 PROMOTION, PREVENTION, INTERVENTION, 

20 AND TREATMENT. 

21 Title III of the Public Health Service Act is amended 

22 by inserting after section 399Z–3, as added by section 

23 5001, the following: 


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1 ‘‘SEC. 399Z–4. YOUTH AND YOUNG ADULT MENTAL HEALTH 

2 PROMOTION, PREVENTION, INTERVENTION, 

3 AND TREATMENT. 

4 ‘‘(a) GRANTS.—The Secretary shall— 

5 ‘‘(1) award grants to eligible entities to develop, 

6 maintain, or enhance youth and young adult mental 

7 health promotion, prevention, intervention, and 

8 treatment programs, including— 

9 ‘‘(A) programs for youth and young adults 

10 who may be likely to develop, are showing early 

11 signs of, or have been diagnosed with a mental 

12 health condition, including a serious emotional 

13 disturbance; and 

14 ‘‘(B) infrastructure and organization 

15 change at a State, tribal, or territorial level to 

16 improve cross-system collaboration, service ca17 pacity, and expertise related to youth and 

18 young adults; and 

19 ‘‘(2) ensure that programs funded through 

20 grants under this section use community-driven, evi21 dence-informed, or evidence-based models, practices, 

22 and methods that are, as appropriate, culturally and 

23 linguistically appropriate, and can be replicated in 

24 other appropriate settings. 

25 ‘‘(b) ELIGIBLE TRANSITION AGE YOUTH AND ENTI26 TIES.—In this section: 


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1 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en2 tity’ means— 

3 ‘‘(A) a local educational agency; 

4 ‘‘(B) a State educational agency; 

5 ‘‘(C) an institution of higher education (or 

6 consortium of such institutions), which may in7 clude a recovery program at an institution of 

8 higher education; 

9 ‘‘(D) a local board, or a one-stop operator, 

10 as defined in section 3 of the Workforce Inno11 vation and Opportunity Act; 

12 ‘‘(E) a nonprofit organization with appro13 priate expertise in providing services or pro14 grams for children, adolescents, or young 

15 adults, excluding a school; 

16 ‘‘(F) a State, political subdivision of a 

17 State, Indian tribe, or tribal organization; or 

18 ‘‘(G) a high school or dormitory serving 

19 high school students that receives funding from 

20 the Bureau of Indian Education. 

21 ‘‘(2) ELIGIBLE TRANSITION AGE YOUTH.—The 

22 term ‘eligible transition age youth’ means a youth or 

23 young adult from age 16 to not more than 25 years 

24 of age who is— 


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1 ‘‘(A) an out-of-school youth as defined in 

2 section 129(a)(1)(B) of the Workforce Innova3 tion and Opportunity Act; 

4 ‘‘(B) a homeless individual (as defined in 

5 section 41403(6) of the Violence Against 

6 Women Act of 1994), a homeless child or youth 

7 (as defined in section 725(2) of the McKinney8 Vento Homeless Assistance Act) a runaway, in 

9 foster care or has aged out of the foster care 

10 system, a child eligible for assistance under sec11 tion 477 of the Social Security Act, or in an 

12 out-of-home placement; 

13 ‘‘(C) an individual who is pregnant or par14 enting, as referred to in section 129(a)(1)(B) of 

15 the Workforce Innovation and Opportunity Act; 

16 ‘‘(D) a youth who is an individual with a 

17 disability, as referred to in section 129(a)(1)(B) 

18 of the Workforce Innovation and Opportunity 

19 Act; 

20 ‘‘(E) a low-income individual who requires 

21 additional assistance to enter or complete an 

22 educational program or to secure or hold em23 ployment, as referred to in section 129(a)(1)(B) 

24 of the Workforce Innovation and Opportunity 

25 Act; or 


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1 ‘‘(F) living in a community that has faced 

2 acute or long-term exposure to substantial dis3 crimination, historical oppression, intergenera4 tional poverty, civil unrest, a high rate of vio5 lence, or drug overdose deaths. 

6 ‘‘(c) APPLICATION.—An eligible entity seeking a 

7 grant under subsection (a) shall submit to the Secretary 

8 an application at such time, in such manner, and con9 taining such information as the Secretary may require. 

10 ‘‘(d) USE OF FUNDS FOR MENTAL HEALTH PRO11 MOTION, PREVENTION, INTERVENTION AND TREATMENT

12 PROGRAMS.—An eligible entity may use amounts awarded 

13 under a grant under subsection (a)(1) to carry out the 

14 following: 

15 ‘‘(1) Creation, implementation, and expansion 

16 of services and supports that are culturally and lin17 guistically appropriate and youth guided, involve and 

18 include family and community members (including 

19 business leaders and faith-based organizations), and 

20 provide for continuity of care between child- and 

21 adult-serving systems to ensure seamless transition. 

22 ‘‘(2) Infrastructure and organization change at 

23 a State, Tribal, or territorial level to improve cross24 system collaboration, service capacity, and expertise 

25 related to youth and young adults with, or at risk 


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1 of, mental health conditions and substance use dis2 orders as they transition into adult roles and respon3 sibilities. 

4 ‘‘(3) Public awareness and cross-system pro5 vider training for individuals employed at institu6 tions of higher education and community colleges, 

7 behavioral health providers, individuals working in 

8 the criminal justice system, primary care providers, 

9 vocational service providers, and child welfare work10 ers. 

11 ‘‘(e) MATCHING FUNDS.—The Secretary may not 

12 award a grant under this section to an eligible entity un13 less the eligible entity agrees, with respect to the costs to 

14 be incurred by the eligible entity in carrying out the activi15 ties described in subsection (d), to make available non16 Federal contributions (in cash or in kind) toward such 

17 costs in an amount that is not less than 10 percent of 

18 the total amount of Federal funds provided in the grant. 

19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 

20 carry out this section, there are authorized to be appro21 priated $25,000,000 for each of fiscal years 2024 through 

22 2033.’’. 


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1 SEC. 6047. STUDY ON THE EFFECTS OF SMARTPHONE AND 

2 SOCIAL MEDIA USE ON ADOLESCENTS. 

3 (a) IN GENERAL.—Not later than 1 year after the 

4 date of enactment of this Act, the Secretary of Health and 

5 Human Services shall conduct or support research on— 

6 (1) smartphone and social media use by adoles7 cents; and 

8 (2) the effects of such use on— 

9 (A) emotional, behavioral, and physical 

10 health and development; and 

11 (B) disparities in minority and under12 served populations. 

13 (b) REPORT.—Not later than 5 years after the date 

14 of the enactment of this Act, the Secretary shall submit 

15 to the Congress, and make publicly available, a report on 

16 the findings of research described in this section. 

17 Subtitle E—Community-Based Care 

18 SEC. 6051. MENTAL HEALTH AT THE BORDER. 

19 (a) SHORT TITLE.—This section may be cited as the 

20 ‘‘Immigrants’ Mental Health Act of 2022’’. 

21 (b) DEFINITIONS.—In this section: 

22 (1) FORWARD OPERATING BASE.—The term 

23 ‘‘forward operating base’’ means a permanent facil24 ity— 


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1 (A) established by U.S. Customs and Bor2 der Protection in forward or remote locations; 

3 and 

4 (B) designated as such by U.S. Customs 

5 and Border Protection. 

6 (2) The term ‘‘U.S. Customs and Border Pro7 tection facility’’ means any of the following facilities 

8 that typically detain migrants on behalf of U.S. Cus9 toms and Border Protection: 

10 (A) U.S. Border Patrol stations. 

11 (B) Ports of entry. 

12 (C) Checkpoints. 

13 (D) Forward operating bases. 

14 (E) Secondary inspection areas. 

15 (F) Short-term custody facilities. 

16 (c) TRAINING FOR CERTAIN CBP PERSONNEL IN

17 MENTAL HEALTH ISSUES.— 

18 (1) TRAINING TO IDENTIFY RISK FACTORS AND

19 WARNING SIGNS IN IMMIGRANTS AND REFUGEES.— 

20 (A) IN GENERAL.—The Commissioner of 

21 U.S. Customs and Border Protection, in con22 sultation with the Assistant Secretary for Men23 tal Health and Substance Use, the Adminis24 trator of the Health Resources and Services Ad25 ministration, and nongovernmental experts in 


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1 the delivery of health care in humanitarian cri2 ses and in the delivery of health care to chil3 dren, shall develop and implement a training 

4 curriculum for U.S. Customs and Border Pro5 tection agents and officers to enable such 

6 agents and officers to identify the risk factors 

7 and warning signs in immigrants and refugees 

8 of mental health issues relating to trauma. 

9 (B) REQUIREMENTS.—The training cur10 riculum required under subparagraph (A) 

11 shall— 

12 (i) be offered to all U.S. Customs and 

13 Border Protection agents and officers 

14 working at U.S. Customs and Border Pro15 tection facilities; 

16 (ii) provide for crisis intervention 

17 using a trauma-informed approach; and 

18 (iii) provide for mental health 

19 screenings for immigrants and refugees ar20 riving at the border in their preferred lan21 guage or with appropriate language assist22 ance. 

23 (2) TRAINING TO ADDRESS MENTAL HEALTH

24 AND WELLNESS OF CBP AGENTS AND OFFICERS.— 


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1 (A) IN GENERAL.—The Commissioner of 

2 U.S. Customs and Border Protection, in con3 sultation with the Assistant Secretary for Men4 tal Health and Substance Use, the Adminis5 trator of the Health Resources and Services Ad6 ministration, and nongovernmental experts in 

7 the delivery of mental health care, shall develop 

8 and implement a training curriculum for U.S. 

9 Customs and Border Protection agents and offi10 cers assigned to U.S. Customs and Border Pro11 tection facilities to address the mental health 

12 and wellness of individuals working at such fa13 cilities. 

14 (B) REQUIREMENT.—The training cur15 riculum described in subparagraph (A) shall be 

16 designed to help the agents and officers de17 scribed in such subparagraph— 

18 (i) to better manage their own stress 

19 and the stress of their coworkers; and 

20 (ii) to be more aware of the psycho21 logical pressures experienced during their 

22 jobs. 

23 (3) ANNUAL REVIEW OF TRAINING.—Beginning 

24 in fiscal year 2023, the Assistant Secretary for Men25 tal Health and Substance Use shall— 


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1 (A) conduct an annual review of the train2 ing required under paragraphs (1) and (2); and 

3 (B) submit the results of each such review, 

4 including any recommendations for improve5 ment of such training, to— 

6 (i) the Commissioner of U.S. Customs 

7 and Border Protection; 

8 (ii) the Committee on Appropriations 

9 of the Senate; 

10 (iii) the Committee on Health, Edu11 cation, Labor, and Pensions of the Senate; 

12 (iv) the Committee on Homeland Se13 curity and Governmental Affairs of the 

14 Senate; 

15 (v) the Committee on the Judiciary of 

16 the Senate; 

17 (vi) the Committee on Appropriations 

18 of the House of Representatives; 

19 (vii) the Committee on Energy and 

20 Commerce of the House of Representa21 tives; 

22 (viii) the Committee on Homeland Se23 curity of the House of Representatives; 

24 and 


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1 (ix) the Committee on the Judiciary 

2 of the House of Representatives. 

3 (4) AUTHORIZATION OF APPROPRIATIONS.— 

4 There is authorized to be appropriated— 

5 (A) $50,000 for fiscal year 2023 to develop 

6 the training curriculum required under para7 graphs (1) and (2); and 

8 (B) for each of the fiscal years 2024 

9 through 2028— 

10 (i) $20,000 to provide the training re11 quired under paragraphs (1) and (2); and 

12 (ii) such sums as may be necessary to 

13 conduct the annual review of training pur14 suant to paragraph (3). 

15 (d) STAFFING BORDER FACILITIES AND DETENTION

16 CENTERS.— 

17 (1) IN GENERAL.—The Commissioner of U.S. 

18 Customs and Border Protection shall assign at least 

19 1 qualified mental or behavioral health expert to 

20 each U.S. Customs and Border Protection facility to 

21 adequately evaluate the mental health needs of im22 migrants, refugees, border patrol agents, and staff. 

23 (2) QUALIFICATIONS.—Each mental or behav24 ioral health expert assigned pursuant to paragraph 

25 (1)— 


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1 (A) shall be bilingual; 

2 (B) shall be well-versed in culturally and 

3 linguistically appropriate and trauma-informed 

4 interventions; and 

5 (C) shall have particular expertise in child 

6 or adolescent mental health or family mental 

7 health. 

8 (3) AUTHORIZATION OF APPROPRIATIONS.— 

9 There is authorized to be appropriated $3,000,000 

10 for each of the fiscal years 2023 through 2027 to 

11 carry out this subsection. 

12 (e) CONFIDENTIALITY OF DEPARTMENT OF HEALTH

13 AND HUMAN SERVICES MENTAL HEALTH INFORMATION

14 FOR ASYLUM DETERMINATIONS, IMMIGRATION HEAR15 INGS, OR DEPORTATION PROCEEDINGS.—The officers, 

16 employees, and agents of the Department of Health and 

17 Human Services, including the Office of Refugee Resettle18 ment, may not share with the Department of Homeland 

19 Security, and the officers, employees, and agents of the 

20 Department of Homeland Security may not request or re21 ceive from the Department of Health and Human Serv22 ices, for the purposes of an asylum determination, immi23 gration hearing, or deportation proceeding, any informa24 tion or record that— 

25 (1) concerns the mental health of an alien; and 


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1 (2) was obtained or produced by a mental or 

2 behavioral health professional while the alien was in 

3 a shelter or otherwise in the custody of the Federal 

4 Government. 

5 SEC. 6052. ASIAN AMERICAN, AFRICAN AMERICAN, NATIVE 

6 HAWAIIAN, PACIFIC ISLANDER, INDIGENOUS, 

7 MIDDLE EASTERN AND NORTH AFRICAN, AND 

8 HISPANIC AND LATINO BEHAVIORAL AND 

9 MENTAL HEALTH OUTREACH AND EDU10 CATION STRATEGY. 

11 Part D of title V of the Public Health Service Act 

12 (42 U.S.C. 290dd et seq.), as amended by section 6022, 

13 is further amended by adding at the end the following new 

14 section: 

15 ‘‘SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH 

16 AND EDUCATION STRATEGY. 

17 ‘‘(a) IN GENERAL.—The Secretary, acting through 

18 the Assistant Secretary for Mental Health and Substance 

19 Use, shall, in coordination with advocacy and behavioral 

20 and mental health organizations serving populations of 

21 Asian American, African American, Native Hawaiian, Pa22 cific Islander, Indigenous, Middle Eastern and North Afri23 can (in this section referred to as ‘MENA’), and Hispanic 

24 and Latino/a/x individuals or communities, develop and 

25 implement an outreach and education strategy to promote 


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1 behavioral and mental health, emphasize that behavioral 

2 and mental health conditions are treatable and that rea3 sonable accommodations under section 504 of the Reha4 bilitation Act of 1973 and titles II and III of the Ameri5 cans with Disabilities Act of 1990 are necessary and may 

6 help, as well as reduce stigma associated with mental 

7 health conditions and substance abuse among the Asian 

8 American, African American, Native Hawaiian, Pacific Is9 lander, Indigenous, MENA, and Hispanic and Latino/a/ 

10 x populations. Such strategy shall— 

11 ‘‘(1) be designed to— 

12 ‘‘(A) meet the diverse cultural and lan13 guage needs of the various Asian American, Af14 rican American, Indigenous, MENA, Native 

15 Hawaiian, Pacific Islander, and Hispanic and 

16 Latino/a/x populations; and 

17 ‘‘(B) ensure that approaches recommended 

18 in the strategy are developmentally (with re19 spect to the beneficiary’s relative age and expe20 rience) and age appropriate, as well as cog21 nitively accessible to persons with cognitive dis22 abilities; 

23 ‘‘(2) increase awareness of symptoms of mental 

24 illnesses common among such populations, taking 

25 into account differences within subgroups (such as 


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1 gender, gender identity, age, sexual orientation, dis2 ability, and ethnicity) of such populations; 

3 ‘‘(3) provide information on evidence-based, cul4 turally and linguistically appropriate and adapted 

5 interventions and treatments; 

6 ‘‘(4) ensure full participation of, and engage, 

7 both consumers and community members rep8 resenting the communities of focus in the develop9 ment and implementation of materials; and 

10 ‘‘(5) seek to broaden the perspective among 

11 both individuals in such communities and stake12 holders serving such communities to use a com13 prehensive public health approach to promoting be14 havioral and mental health that addresses a holistic 

15 view of health by focusing on the intersection be16 tween behavioral and physical health. 

17 ‘‘(b) REPORTS.—Beginning not later than 1 year 

18 after the date of the enactment of this section and annu19 ally thereafter, the Secretary, acting through the Assistant 

20 Secretary, shall submit to the Congress, and make publicly 

21 available, a report on the extent to which the strategy de22 veloped and implemented under subsection (a) increased 

23 behavioral and mental health outcomes associated with 

24 mental health conditions and substance abuse among 

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1 cific Islander, Indigenous, MENA, and Hispanic and 

2 Latino/a/x populations. 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section 

5 $10,000,000 for each of fiscal years 2024 through 2028.’’. 

6 Subtitle F—Reports 

7 SEC. 6061. ADDRESSING RACIAL AND ETHNIC MENTAL 

8 HEALTH INEQUITIES RESEARCH GAPS. 

9 (a) IN GENERAL.—Not later than 6 months after the 

10 date of the enactment of this Act— 

11 (1) the Director of the National Institute on 

12 Minority Health and Health Disparities shall enter 

13 into an arrangement with the National Academy of 

14 Sciences to carry out the activities under subsection 

15 (b); or 

16 (2) if the National Academy of Sciences de17 clines to enter into such an arrangement, the Direc18 tor of the National Institute on Minority Health and 

19 Health Disparities, in cooperation with the Agency 

20 for Healthcare Research and Quality, shall carry out 

21 the activities under subsection (b). 

22 (b) ACTIVITIES.—The applicable entity under sub23 section (a) shall— 

24 (1) conduct a study with respect to mental 

25 health inequities in racial and ethnic minority 


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1 groups (as defined in section 1707(g) of the Public 

2 Health Service Act (42 U.S.C. 300u–6(g)), as 

3 amended by title I of this Act); and 

4 (2) submit to the Congress a report on the re5 sults of such study, including— 

6 (A) a compilation of information on the dy7 namics of mental health outcomes in such racial 

8 and ethnic minority groups; 

9 (B) the degree and impacts of the co-oc10 currence of mental conditions with other dis11 abilities in such racial and ethnic groups, in12 cluding physical disabilities, mental disabilities, 

13 substance use disorders, severe and persistent 

14 mental illness, and mental disorders or mental 

15 health conditions which co-occur with one an16 other; 

17 (C) a compilation of information on the 

18 impact of community violence, community trau19 ma, adverse childhood experiences, weather ex20 tremes worsened by climate change (such as 

21 heat waves, flooding, hurricanes, and wildfires), 

22 substance use, and other psychological traumas, 

23 on mental disorders in such racial and ethnic 

24 minority groups, stratified by household income 

25 level; 


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1 (D) a compilation of information on the 

2 impact of the intersectionality of transgender 

3 individuals, gender nonbinary individuals, sex4 ual orientation, and age in racial and ethnic mi5 nority groups; and 

6 (E) a description of how protective factors 

7 contrast and compare among different commu8 nities of color, identifying cultural strengths. 

9 SEC. 6062. RESEARCH ON ADVERSE HEALTH EFFECTS AS10 SOCIATED WITH INTERACTIONS WITH LAW 

11 ENFORCEMENT. 

12 (a) IN GENERAL.—The Secretary of Health and 

13 Human Services (in this section referred to as the ‘‘Sec14 retary’’), acting through the Director of the Office of Mi15 nority Health of the Centers for Disease Control and Pre16 vention (established pursuant to section 1707A of the 

17 Public Health Service Act (42 U.S.C. 300u–6a)), shall 

18 conduct research on the adverse health effects associated 

19 with interactions with law enforcement. 

20 (b) EFFECTS AMONG RACIAL AND ETHNIC MINORI21 TIES.—The research under subsection (a) shall include re22 search on— 

23 (1) the health consequences, both individual 

24 and community-wide, of trauma related to violence 


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1 committed by law enforcement among racial and 

2 ethnic minorities; and 

3 (2) the disproportionate burden of morbidity 

4 and mortality associated with such trauma. 

5 (c) REPORT.—Not later than 1 year after the date 

6 of enactment of this Act, the Secretary shall— 

7 (1) complete the research under this section; 

8 and 

9 (2) submit to the Congress a report on the find10 ings, conclusions, and recommendations resulting 

11 from such research. 

12 SEC. 6063. GEOACCESS STUDY. 

13 The Assistant Secretary for Mental Health and Sub14 stance Use shall— 

15 (1) conduct a study to— 

16 (A) determine which geographic areas of 

17 the United States have shortages of racially and 

18 ethnically diverse mental health providers, as 

19 well as mental health providers trained to work 

20 with racially and ethnically diverse clients and 

21 clients with multiple mental health, cognitive, 

22 and developmental disabilities; and 

23 (B) assess the preparedness of mental 

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1 guistically appropriate, affordable, and acces2 sible services; and 

3 (2) submit a report to Congress on the results 

4 of such study. 

5 SEC. 6064. CO-OCCURRING CONDITIONS. 

6 (a) GAO REPORT.—Not later than two years after 

7 the date of enactment of this Act, the Comptroller General 

8 of the United States shall submit to Congress a report 

9 on barriers to care for persons with co-occurring condi10 tions and access to care in the United States. Such report 

11 shall include the information and recommendations de12 scribed in subsection (b). 

13 (b) CONTENT OF REPORT.—The report under sub14 section (a) shall include— 

15 (1) an assessment of current barriers to behav16 ioral health and substance use disorder treatment 

17 for low-income, uninsured, and Medicaid-enrolled 

18 adults, and recommendations for addressing such 

19 barriers, particularly for women and diverse racial 

20 and ethnic groups; 

21 (2) an assessment of— 

22 (A) how many adults have a behavioral 

23 health condition and options for adults to re24 ceive behavioral health and substance use dis25 order treatment in nonexpansion States; 


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1 (B) Medicaid expansion States who provide 

2 behavioral health coverage for newly eligible en3 rollees; 

4 (C) how enrollment in coverage affects 

5 treatment availability; and 

6 (D) the impacts of COVID–19 to receiving 

7 and accessing treatment for behavioral health, 

8 substance use disorders, and diverse racial and 

9 ethnic groups, and recommendations for ad10 dressing such barriers; 

11 (3) an assessment of current barriers, inclusive 

12 of social determinants of health and cultural bar13 riers, that prevent adults from receiving behavioral 

14 health and substance use disorder treatment, and 

15 recommendations for addressing such barriers, par16 ticularly for low-income women and adults from ra17 cial and ethnic groups; 

18 (4) an assessment of disparities in access to ad19 diction counselors and mental or behavioral health 

20 care providers acting in accordance with State law, 

21 stratified by race, ethnicity, gender identity, geo22 graphic location, and insurance type, and rec23 ommendations to promote greater access equity; and 

24 (5) recommendations to promote greater equity 

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1 stance use disorders, particularly for low-income 

2 women and adults from diverse racial and ethnic 

3 groups. 

4 SEC. 6065. TECHNICAL CORRECTION. 

5 Title V of the Public Health Service Act (42 U.S.C. 

6 290aa et seq.) is amended— 

7 (1) by redesignating the second section 550 (42 

8 U.S.C. 290ee–10) (relating to Sobriety Treatment 

9 And Recovery Teams) as section 552A; and 

10 (2) by moving such section, as so redesignated, 

11 so as to appear after section 552 (42 U.S.C. 290ee– 

12 7). 

13 Subtitle G—Miscellaneous 

14 Provisions 

15 SEC. 6071. CHILDREN’S MENTAL HEALTH INFRASTRUC16 TURE ACT. 

17 Part D of title III of the Public Health Service Act 

18 (42 U.S.C. 254b et seq.) is amended by inserting after 

19 subpart V, as amended by section 6041, the following new 

20 subpart: 

21 ‘‘Subpart VI—Increasing Investment in Pediatric 

22 Behavioral Health Services 

23 ‘‘SEC. 340AA–1. GRANTS TO CHILDREN’S HOSPITALS. 

24 ‘‘(a) IN GENERAL.—The Secretary, acting through 

25 the Administrator of the Health Resources and Services 


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1 Administration, shall make grants to eligible entities for 

2 the purpose of improving their ability to provide pediatric 

3 behavioral health services, including by— 

4 ‘‘(1) constructing or modernizing sites of care 

5 for pediatric behavioral health services; 

6 ‘‘(2) expanding capacity to provide pediatric be7 havioral health services, including enhancements to 

8 digital infrastructure, telehealth capabilities, or other 

9 improvements to patient care infrastructure; and 

10 ‘‘(3) supporting the reallocation of existing re11 sources to accommodate pediatric behavioral health 

12 patients, including by— 

13 ‘‘(A) converting or adding a sufficient 

14 number of beds to establish or increase the hos15 pital’s inventory of licensed and operational, 

16 short-term psychiatric and substance use inpa17 tient beds; and 

18 ‘‘(B) ensuring compliance with safety 

19 standards. 

20 ‘‘(b) ELIGIBILITY.—To be eligible to seek a grant 

21 under this section, an entity shall be a hospital that pre22 dominantly treats individuals under the age of 21, includ23 ing any hospital that receives funds under section 340E. 

24 ‘‘(c) FUNDING.—To carry out this section, there is 

25 hereby appropriated, out of amounts in the Treasury not 


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1 otherwise obligated, $2,000,000,000 for each of fiscal 

2 years 2022 through 2026.’’. 

3 SEC. 6072. MENTAL HEALTH FOR LATINOS. 

4 Part D of title V of the Public Health Service Act 

5 (42 U.S.C. 290dd et seq.), as amended by sections 6022, 

6 6023, 6052, and 6016, is further amended by adding at 

7 the end the following new section: 

8 ‘‘SEC. 557. BEHAVIORAL AND MENTAL HEALTH OUTREACH 

9 AND EDUCATION STRATEGY. 

10 ‘‘(a) IN GENERAL.—The Secretary, acting through 

11 the Assistant Secretary, shall, in coordination with advo12 cacy and behavioral and mental health organizations serv13 ing populations of Hispanic and Latino individuals or 

14 communities, develop and implement an outreach and edu15 cation strategy to promote behavioral and mental health 

16 and reduce stigma associated with mental health condi17 tions and substance abuse among the Hispanic and Latino 

18 populations. Such strategy shall— 

19 ‘‘(1) be designed to— 

20 ‘‘(A) meet the diverse cultural and lan21 guage needs of the various Hispanic and Latino 

22 populations; and 

23 ‘‘(B) be developmentally and age appro24 priate; 


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1 ‘‘(2) increase awareness of symptoms of mental 

2 illnesses common among such populations, taking 

3 into account differences within subgroups, such as 

4 gender, gender identity, age, sexual orientation, or 

5 ethnicity, of such populations; 

6 ‘‘(3) provide information on evidence-based, cul7 turally and linguistically appropriate and adapted 

8 interventions and treatments; 

9 ‘‘(4) ensure full participation of, and engage, 

10 both consumers and community members in the de11 velopment and implementation of materials; 

12 ‘‘(5) seek to broaden the perspective among 

13 both individuals in these communities and stake14 holders serving these communities to use a com15 prehensive public health approach to promoting be16 havioral health that addresses a holistic view of 

17 health by focusing on the intersection between be18 havioral and physical health; and 

19 ‘‘(6) address the impact of the SARS–CoV–2 

20 pandemic on the mental and behavioral health of the 

21 Hispanic and Latino populations. 

22 ‘‘(b) REPORTS.—Beginning not later than 1 year 

23 after the date of the enactment of this section and annu24 ally thereafter, the Secretary, acting through the Assistant 

25 Secretary, shall submit to Congress, and make publicly 


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1 available, a report on the extent to which the strategy de2 veloped and implemented under subsection (a) improved 

3 behavioral and mental health outcomes associated with 

4 mental health conditions and substance abuse among His5 panic and Latino populations. 

6 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

7 is authorized to be appropriated to carry out this section 

8 $1,000,000 for each of fiscal years 2023 through 2025.’’. 

9 SEC. 6073. STRENGTHENING MENTAL HEALTH SUPPORTS 

10 FOR BIPOC COMMUNITIES. 

11 (a) IN GENERAL.—Section 1942(a) of the Public 

12 Health Service Act (42 U.S.C. 300x–52(a)) is amended— 

13 (1) in paragraph (1), by striking ‘‘and’’ at the 

14 end; 

15 (2) by redesignating paragraph (2) as para16 graph (5); and 

17 (3) by inserting after paragraph (1) the fol18 lowing: 

19 ‘‘(2) services provided by the State to adults 

20 with a serious mental illness and children with a se21 rious emotional disturbance who are members of ra22 cial and ethnic minority groups, including— 

23 ‘‘(A) the extent to which such services are 

24 provided to such adults and children; and 


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1 ‘‘(B) the outcomes experienced by such 

2 adults and children as a result of the provision 

3 of such services, including with respect to— 

4 ‘‘(i) diversions from hospitalization 

5 and criminal justice system involvement; 

6 ‘‘(ii) treatment for first episode psy7 chosis or undefined psychosis; 

8 ‘‘(iii) reductions in suicide and in9 creased utilization of appropriate treat10 ments and interventions for suicidal idea11 tion; 

12 ‘‘(iv) response through crisis services, 

13 including mobile crisis services; 

14 ‘‘(v) treatment of individuals who are 

15 experiencing homelessness or housing inse16 curity and individuals residing in rural 

17 communities; and 

18 ‘‘(vi) increased patient family and 

19 caregiver engagement and education on se20 rious mental illness to reduce social stigma 

21 and promote healthy social support for pa22 tients; 

23 ‘‘(3) any outreach by the State to, and the hir24 ing of, providers of mental health services from mul25 tiple disciplines (such as a psychologist, psychiatrist, 


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1 peer support provider, or social worker) who are 

2 members of racial and ethnic minority groups; 

3 ‘‘(4) any outreach by the State to providers 

4 from multiple disciplines of mental health services— 

5 ‘‘(A) to provide training on culturally ef6 fective, culturally affirming, and linguistically 

7 competent services; and 

8 ‘‘(B) to increase awareness of community9 defined practices by practitioners of racial and 

10 ethnic minority groups; and’’. 

11 (b) APPLICABILITY.—The amendments made by sub12 section (a) shall apply with respect to funding agreements 

13 entered into under section 1911 or 1921 of the Public 

14 Health Service Act (42 U.S.C. 300x; 42 U.S.C. 300x–21) 

15 on or after the date of the enactment of this Act. 

16 SEC. 6074. STRONG SUPPORT FOR CHILDREN. 

17 (a) DATA ANALYSIS AND STRATEGY IMPLEMENTA18 TION TO PREVENT AND MITIGATE CHILDHOOD TRAU19 MA.—Title XXXI of the Public Health Service Act (42 

20 U.S.C. 300kk) is amended by adding at the end the fol21 lowing: 


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1 ‘‘SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTA2 TION TO PREVENT AND MITIGATE CHILD3 HOOD TRAUMA. 

4 ‘‘(a) IN GENERAL.—The Secretary shall establish a 

5 program— 

6 ‘‘(1) to support the development and implemen7 tation of programs that use data analysis methods 

8 to identify and facilitate strategies for early inter9 vention and prevention, in order to prevent and miti10 gate childhood trauma and support communities and 

11 families, including— 

12 ‘‘(A) improving connections through care 

13 coordination; 

14 ‘‘(B) aligning community initiatives in tar15 geted areas of need; and 

16 ‘‘(C) expanding community capacity 

17 through cross-sector collaboration; and 

18 ‘‘(2) to evaluate the effectiveness of these pro19 grams in improving outcomes for children. 

20 ‘‘(b) GRANTS.—The Secretary shall award grants to 

21 up to 5 eligible entities to carry out the activities described 

22 in subsection (a). 

23 ‘‘(c) USE OF FUNDS.—A grant for activities under 

24 this section shall be used to support the development and 

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1 tion and prevention, in order to prevent and mitigate 

2 childhood trauma and support communities and families, 

3 including as follows: 

4 ‘‘(1) Utilize data analysis methods to— 

5 ‘‘(A) identify specific geographic areas, 

6 such as census tracts, with a high prevalence of 

7 adverse childhood experiences and significant 

8 risk factors for poor outcomes for children 

9 (such as increased risk of experiencing adverse 

10 childhood experiences), including areas with 

11 high rates of— 

12 ‘‘(i) poor public health outcomes in13 cluding illness, disease, suicide, and mor14 tality; 

15 ‘‘(ii) exclusionary discipline practices, 

16 including suspensions, expulsions, and re17 ferrals to law enforcement, as well as low 

18 graduation rates; 

19 ‘‘(iii) substance use disorders; 

20 ‘‘(iv) poverty; 

21 ‘‘(v) foster system involvement or re22 ferrals; 

23 ‘‘(vi) housing instability and homeless24 ness; 

25 ‘‘(vii) food insecurity; 


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1 ‘‘(viii) inequity, including disparities 

2 in income, wealth, employment, educational 

3 attainment, health care access, and public 

4 health outcomes, along lines of race, sex, 

5 sexuality and gender identity, ethnicity, or 

6 nationality; 

7 ‘‘(ix) incarceration rates; or 

8 ‘‘(x) other indicators of adversity as 

9 defined by the Secretary; and 

10 ‘‘(B) identify strategies to improve out11 comes for children aged 0 through 17 that build 

12 on strengths in communities that could be fur13 ther supported, including— 

14 ‘‘(i) existing support networks for 

15 families; and 

16 ‘‘(ii) enhanced connections to commu17 nity-based organizations. 

18 ‘‘(2) Implement strategies identified pursuant 

19 to paragraph (1)(B) to facilitate outreach and in20 volvement of children and their caregivers in Fed21 eral, State, or local programs that provide repar22 ative, gender-responsive, culturally specific, and 

23 trauma-informed prevention services, and for which 

24 children and their caregivers are eligible, including— 

25 ‘‘(A) home visiting programs; 


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1 ‘‘(B) training and education on parenting 

2 skills; 

3 ‘‘(C) substance use disorder prevention and 

4 treatment that is voluntary and noncoercive; 

5 ‘‘(D) mental health supports and care that 

6 is voluntary and noncoercive; 

7 ‘‘(E) family and intimate partner violence 

8 prevention services; 

9 ‘‘(F) child advocacy center programming; 

10 ‘‘(G) economic and nutrition support serv11 ices; 

12 ‘‘(H) housing support services, including 

13 emergency and temporary shelter for those ex14 periencing homelessness and housing insecurity, 

15 as well as stable, long-term housing; 

16 ‘‘(I) voluntary, noncoercive, gender-respon17 sive, and culturally specific mental health sup18 ports in school and early childhood education 

19 center-based settings; 

20 ‘‘(J) wraparound programs for 

21 transitioning youth and youth currently in the 

22 foster system; 

23 ‘‘(K) programming to support the health 

24 and well-being of lesbian, gay, bisexual, 


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1 transgender, and intersex children and their 

2 families; and 

3 ‘‘(L) family resource center services. 

4 ‘‘(d) SPECIAL RULES.— 

5 ‘‘(1) PRIMARY PAYER RESTRICTION.—The Sec6 retary may not award a grant under this section to 

7 an eligible entity for a service if the service to be 

8 provided is available pursuant to the State plan ap9 proved under title XIX of the Social Security Act for 

10 the State in which the program funded by the grant 

11 is being conducted unless the State and all eligible 

12 subdivisions involved— 

13 ‘‘(A) will enter into agreements with public 

14 or nonprofit private entities under which the 

15 entities will provide the service; and 

16 ‘‘(B) demonstrate that the State and all el17 igible subdivisions will ensure that the entities 

18 providing the service— 

19 ‘‘(i) will seek payment for each such 

20 service rendered in accordance with the 

21 usual payment schedule under the State 

22 plan; and 

23 ‘‘(ii) the entities have entered into a 

24 participation agreement and are qualified 

25 to receive payments under such plan. 


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1 ‘‘(2) IMPLEMENTATION.—An eligible entity that 

2 receives a grant under this section may use— 

3 ‘‘(A) not more than 25 percent of the 

4 amounts made available through the grant for 

5 the first 24 months of the grant period to uti6 lize data analysis methods to— 

7 ‘‘(i) identify specific geographic areas 

8 where care coordination, prevention and 

9 early intervention, and facilitation services 

10 will be provided; and 

11 ‘‘(ii) identify support and intervention 

12 services to improve outcomes for children 

13 located in a geographic area identified 

14 under subsection (c)(1)(A); and 

15 ‘‘(B) not more than 10 percent of the 

16 grant in each subsequent year to continue data 

17 analysis activities. 

18 ‘‘(3) ADMINISTRATION.—An eligible entity that 

19 receives a grant under this section may not use more 

20 than 5 percent of amounts received through the 

21 grant for administration, reporting, and program 

22 oversight functions, including the development of 

23 systems to improve data collection and data sharing 

24 for the purposes of improving services and the provi25 sion of care. 


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1 ‘‘(4) PRIORITY.— 

2 ‘‘(A) IN GENERAL.—In awarding grants 

3 under this section, the Secretary shall give pri4 ority, to the extent practical, to eligible entities 

5 that use community-based system dynamic 

6 modeling as the primary data analysis method. 

7 ‘‘(B) SYSTEM DYNAMIC MODELING DE8 FINED.—The term ‘system dynamic modeling’ 

9 means a method of data analysis and predictive 

10 modeling that includes— 

11 ‘‘(i) utilization of community-based 

12 participatory research methods for involv13 ing community in the process of under14 standing and changing systems and evalu15 ating outcomes of grants; 

16 ‘‘(ii) consideration of a multitude of 

17 environmental risk factors and ascertain18 ment of the significance of contributing 

19 community risk factors for purposes of 

20 identifying strategies to reduce adverse 

21 child outcomes, including— 

22 ‘‘(I) maltreatment cases; 

23 ‘‘(II) involvement with the juve24 nile criminal legal system or foster 

25 system; 


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1 ‘‘(III) exclusionary school dis2 cipline; or 

3 ‘‘(IV) exposure to violence; and 

4 ‘‘(iii) identification of cross-sector re5 sponses involving reparative, trauma-in6 formed, culturally specific, gender-respon7 sive, and community-based organizations 

8 to reduce adverse child outcomes. 

9 ‘‘(5) SUBGRANT.— 

10 ‘‘(A) IN GENERAL.—An eligible entity that 

11 receives a grant under this section shall use at 

12 least 25 percent of the total amount of the 

13 grant to make subgrants to organizations that 

14 aid in implementing the strategy identified 

15 under subsection (c)(1)(B) for preventing and 

16 mitigating childhood trauma and supporting 

17 communities and families. 

18 ‘‘(B) ELIGIBILITY.—To be eligible to re19 ceive a subgrant under this paragraph, an orga20 nization shall prepare and submit to the eligible 

21 entity an application in such form, and con22 taining such information, as the eligible entity 

23 may require, including evidence that the— 

24 ‘‘(i) needs of the population to be 

25 served are urgent and are not met by the 


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1 services currently available in the geo2 graphic area; and 

3 ‘‘(ii) organization has the capacity to 

4 provide the services listed in subsection 

5 (c)(2). 

6 ‘‘(C) SUPPLEMENT, NOT SUPPLANT.— 

7 Subgrant funds received pursuant to this para8 graph by an organization shall be used to sup9 plement and not supplant State or local funds 

10 provided to the partnership organization for 

11 services listed in subsection (c)(2). 

12 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

13 under this section, an eligible entity shall submit to the 

14 Secretary an application in such form, and containing 

15 such information, as the Secretary may require, to include 

16 the following: 

17 ‘‘(1) A demonstration that— 

18 ‘‘(A) the applicant utilizes trauma-in19 formed, culturally specific, and gender-respon20 sive practices, including a demonstration of the 

21 extent to which the applicant has trained staff 

22 in these practices; 

23 ‘‘(B) the applicant has the capacity to ad24 minister the grant, including conducting all re25 quired data analysis activities; and 


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1 ‘‘(C) services will be provided to children 

2 and families in an accessible, culturally rel3 evant, and linguistically specific manner con4 sistent with local needs. 

5 ‘‘(2) A preliminary analysis of how the appli6 cant will use the grant to— 

7 ‘‘(A) identify the geographic area or areas 

8 to be served using data analysis methods; 

9 ‘‘(B) utilize data analysis methods to iden10 tify strategies to improve outcomes for children 

11 in the geographic area; 

12 ‘‘(C) facilitate strategies identified through 

13 care coordination efforts; and 

14 ‘‘(D) track data for evaluation of out15 comes. 

16 ‘‘(3) A detailed project plan for the use of the 

17 grant that includes anticipated technical assistance 

18 needs. 

19 ‘‘(4) Additional funding sources, including State 

20 and local funds, supporting the prevention and miti21 gation of adverse childhood experiences. 

22 ‘‘(f) GRANT AMOUNT.—The amount of a grant under 

23 this section shall not exceed $9,500,000. 

24 ‘‘(g) PERIOD OF A GRANT.—The period of a grant 

25 under this section shall not exceed 7 years. 


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1 ‘‘(h) SERVICE PROVISION WITHOUT REGARD TO

2 ABILITY TO PAY.—As a condition on receipt of a grant 

3 under this section, an eligible entity shall agree that any 

4 assistance provided to an individual through the grant will 

5 be provided without regard to— 

6 ‘‘(1) the ability of the individual to pay for such 

7 services; 

8 ‘‘(2) the current or past health condition of the 

9 individual to be served; 

10 ‘‘(3) the immigration status of the individual to 

11 be served; 

12 ‘‘(4) the sexual orientation and gender identity 

13 of the individual to be served; and 

14 ‘‘(5) any prior involvement of the individual in 

15 the criminal legal system. 

16 ‘‘(i) PROHIBITIONS.—In addition to any other prohi17 bitions determined by the Secretary, an eligible entity may 

18 not use a grant under this section to— 

19 ‘‘(1) use data analysis methods to inform indi20 vidual case decisions, including child removal or 

21 placement decisions, or to target services at certain 

22 individuals or families; 

23 ‘‘(2) require any individual or family to partici24 pate in any service or program as a condition of reVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01126 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ceipt of a benefit to which the individual or family 

2 is otherwise eligible; 

3 ‘‘(3) increase the presence or funding of law en4 forcement surveillance, involvement, or activity in 

5 implementing the strategies identified under sub6 section (c)(1)(B); or 

7 ‘‘(4) enable the practice of conversion therapy. 

8 ‘‘(j) EVALUATION.— 

9 ‘‘(1) DATA MODEL EVALUATION.—Not later 

10 than 36 months after the date of enactment of this 

11 section, the Assistant Secretary for Planning and 

12 Evaluation of the Department of Health and Human 

13 Services, in coordination with the grantees receiving 

14 a grant under this section, shall complete an evalua15 tion of the effectiveness of the data model accuracy 

16 of the grant program under this section to address 

17 each of the following: 

18 ‘‘(A) Determining the effectiveness of the 

19 grantees’ use of data analysis methods to iden20 tify geographic areas pursuant to subsection 

21 (c)(1). 

22 ‘‘(B) Examining the grantees’ development 

23 and utilization of data analysis methods. 


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1 ‘‘(C) Examining the grantees’ ability to ef2 fectively utilize data analysis methods in future 

3 prevention work. 

4 ‘‘(D) Establishing a method for rigorously 

5 evaluating the activities of grantees and com6 paring the reduction of child and family expo7 sure to adverse experiences in other commu8 nities with similar demographics. 

9 ‘‘(E) Examining the grantees’ utilization of 

10 community-based system dynamics modeling 

11 methods and other community engagement 

12 methods. 

13 ‘‘(2) PROGRAM EVALUATION.—Not later than 6 

14 years after the date of enactment of this section, the 

15 Assistant Secretary for Planning and Evaluation of 

16 the Department of Health and Human Services, in 

17 coordination with eligible entities receiving grants 

18 under this section, shall complete an evaluation of 

19 the effectiveness of the grant program under this 

20 section. 

21 ‘‘(3) DATA COLLECTION.— 

22 ‘‘(A) IN GENERAL.—The Assistant Sec23 retary for Planning and Evaluation of the De24 partment of Health and Human Services and 

25 each eligible entity receiving a grant under this 


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1 section shall collect any relevant data necessary 

2 to complete the evaluations required by para3 graphs (1) and (2) to include— 

4 ‘‘(i) the activities funded by the grant 

5 under this section, including development 

6 and implementation data analysis methods; 

7 ‘‘(ii) the number of children and of 

8 families receiving coordination and facilita9 tion of care and services; and 

10 ‘‘(iii) the effect of activities supported 

11 by the grant under this section on the local 

12 area serviced by the program, including 

13 such effects on— 

14 ‘‘(I) children and adolescents’ 

15 health and well-being; 

16 ‘‘(II) the number of children who 

17 enter into or depart from foster serv18 ices; and 

19 ‘‘(III) homelessness and housing 

20 insecurity. 

21 ‘‘(B) STUDY.— 

22 ‘‘(i) IN GENERAL.—Not later than 7 

23 years after the date of enactment of this 

24 section, the Assistant Secretary for PlanVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01129 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ning and Evaluation of the Department of 

2 Health and Human Services shall— 

3 ‘‘(I) complete a study on the re4 sults of the grant program under this 

5 section using the community-based 

6 participatory action research method, 

7 which focuses on social, structural, 

8 and physical environmental inequities 

9 through active involvement of commu10 nity members, clients, organizational 

11 representatives, and researchers in all 

12 aspects of the research process; and 

13 ‘‘(II) submit a report on the re14 sults of the study to the Congress. 

15 ‘‘(ii) PARTNERS.—In conducting the 

16 study under clause (i), the Assistant Sec17 retary for Planning and Evaluation of the 

18 Department of Health and Human Serv19 ices shall ensure that partners and persons 

20 that have participated in the grant pro21 gram under this section on every level, es22 pecially those such partners or persons re23 ceiving services and support through the 

24 program, have an opportunity to contribute 


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1 their expertise to evaluating the strategy 

2 and outcomes. 

3 ‘‘(k) REPORT.—Not later than three months after the 

4 completion of the evaluation required by subsection (j)(2), 

5 the Assistant Secretary for Planning and Evaluation of 

6 the Department of Health and Human Services shall sub7 mit to Congress and make available to the public on the 

8 internet website of the Department of Health and Human 

9 Services a report based upon the evaluation under sub10 section (j)(2), to include— 

11 ‘‘(1) the impact of the program under this sec12 tion on homelessness and housing insecurity, sub13 stance use disorder and drug deaths, incarceration, 

14 foster system involvement, and other child and fam15 ily outcomes as identified by the Assistant Secretary 

16 for Planning and Evaluation of the Department of 

17 Health and Human Services; 

18 ‘‘(2) an analysis of which elements of the pro19 gram should be replicated and scaled by govern20 mental or non-governmental entities; and 

21 ‘‘(3) such recommendations for legislation and 

22 administrative action as the Secretary determines 

23 appropriate. 

24 ‘‘(l) DEFINITIONS.—In this section: 


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1 ‘‘(1) The term ‘adverse childhood experience’ 

2 means a potentially traumatic experience that occurs 

3 in childhood and can have a tremendous impact on 

4 the child’s lifelong health and opportunity outcomes, 

5 such as any of the following: 

6 ‘‘(A) Abuse, such as any of the following: 

7 ‘‘(i) Emotional and psychological 

8 abuse. 

9 ‘‘(ii) Physical abuse. 

10 ‘‘(iii) Sexual abuse. 

11 ‘‘(B) Household challenges such as any of 

12 the following: 

13 ‘‘(i) A household member is treated 

14 violently. 

15 ‘‘(ii) A household member has a sub16 stance use disorder. 

17 ‘‘(iii) A household member has a men18 tal health condition. 

19 ‘‘(iv) Parental separation or divorce. 

20 ‘‘(v) A household member is incarcer21 ated, is placed in immigrant detention, or 

22 has been deported. 

23 ‘‘(vi) A household member has a life24 threatening illness such as COVID–19. 

25 ‘‘(C) Neglect. 


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1 ‘‘(D) Living in— 

2 ‘‘(i) impoverished communities that 

3 lack access to human services; 

4 ‘‘(ii) areas of high unemployment 

5 neighborhoods; or 

6 ‘‘(iii) communities experiencing de 

7 facto segregation. 

8 ‘‘(E) Experiencing food insecurity and 

9 poor nutrition. 

10 ‘‘(F) Witnessing violence. 

11 ‘‘(G) Involvement with the foster system. 

12 ‘‘(H) Experiencing discrimination. 

13 ‘‘(I) Dealing with historical and ongoing 

14 traumas due to systemic and interpersonal rac15 ism. 

16 ‘‘(J) Dealing with historical and ongoing 

17 traumas regarding systemic and interpersonal 

18 sexism, homophobia, biphobia, and transphobia. 

19 ‘‘(K) Dealing with the threat of deporta20 tion or detention as a result of immigration sta21 tus. 

22 ‘‘(L) The impacts of multigenerational pov23 erty resulting from limited educational and eco24 nomic opportunities. 


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1 ‘‘(M) Living through natural disasters 

2 such as earthquakes, forest fires, floods, or hur3 ricanes. 

4 ‘‘(2) The term ‘eligible entity’ means a State or 

5 local health department. 

6 ‘‘(3) The term ‘practice of conversion ther7 apy’— 

8 ‘‘(A) means any practice or treatment by 

9 any person that seeks to change another indi10 vidual’s sexual orientation or gender identity, 

11 including efforts to change behaviors or gender 

12 expressions, or to eliminate or reduce sexual or 

13 romantic attractions or feelings toward individ14 uals of the same gender, if such person receives 

15 monetary compensation in exchange for any 

16 such practice or treatment; and 

17 ‘‘(B) does not include any practice or 

18 treatment that does not seek to change sexual 

19 orientation or gender identity and— 

20 ‘‘(i) provides assistance to an indi21 vidual undergoing a gender transition; or 

22 ‘‘(ii) provides acceptance, support, 

23 and understanding of a client or facilita24 tion of a client’s coping, social support, 

25 and identity exploration and development. 


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1 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section 

3 for the period of fiscal years 2023 through 2030— 

4 ‘‘(1) to carry out subsection (a)(1) through the 

5 award of grants under subsection (b)— 

6 ‘‘(A) $47,500,000 for grants; and 

7 ‘‘(B) such sums as may be necessary for 

8 the administrative costs of carrying out such 

9 subsection; and 

10 ‘‘(2) $7,500,000 to carry out the evaluation 

11 under subsection (a)(2).’’. 

12 (b) CARE COORDINATION GRANTS.—Part E of title 

13 XII of the Public Health Service Act (42 U.S.C. 300d– 

14 51 et seq.) is amended by adding at the end the following 

15 new section: 

16 ‘‘SEC. 1255. CARE COORDINATION GRANTS. 

17 ‘‘(a) IN GENERAL.—The Secretary shall award 

18 grants to eligible entities to establish or expand trauma19 informed care coordination services to support— 

20 ‘‘(1) children aged 0 through 5 at risk of ad21 verse childhood experiences; and 

22 ‘‘(2) their caregivers, including prenatal people 

23 of any age. 

24 ‘‘(b) NUMBER OF GRANTS.—Subject to the avail25 ability of appropriations, the Secretary shall award not 


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1 fewer than 9 and not more than 40 grants under this sec2 tion. 

3 ‘‘(c) AMOUNT OF GRANTS.—Subject to the avail4 ability of appropriations, the amount of a grant under this 

5 section for a fiscal year shall be— 

6 ‘‘(1) not less than $250,000; and 

7 ‘‘(2) not more than $1,000,000. 

8 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 

9 a grant under this section, an entity shall be a local gov10 ernment or Indian Tribe, acting through the public health 

11 department thereof if such government or Tribe has a 

12 public health department. 

13 ‘‘(e) PRIORITY.— 

14 ‘‘(1) IN GENERAL.—In awarding grants under 

15 this section, the Secretary shall give priority to eligi16 ble entities proposing to serve communities with a 

17 high need for trauma-informed care coordination 

18 services, as demonstrated by indicators such as— 

19 ‘‘(A) pregnant people who face barriers to 

20 prenatal care; 

21 ‘‘(B) mortality or morbidity of people giv22 ing birth or infants; 

23 ‘‘(C) caretakers and parents who are living 

24 with a mental health condition or substance use 

25 disorder; 


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1 ‘‘(D) a high prevalence of community vio2 lence, including domestic violence, as dem3 onstrated by instances of homicide and public 

4 health statistics, including treatment of injury 

5 or trauma; 

6 ‘‘(E) high proportions of low-income chil7 dren; 

8 ‘‘(F) a high prevalence of child fatalities or 

9 near fatalities related to child abuse and ne10 glect; 

11 ‘‘(G) significant disparities in health out12 comes for people giving birth and infants; 

13 ‘‘(H) a high rate of exclusionary discipline 

14 and referrals to law enforcement; and 

15 ‘‘(I) a high rate of homelessness and hous16 ing instability. 

17 ‘‘(2) DATA FROM TRIBAL AREAS.—The Sec18 retary, acting through the Director of the Indian 

19 Health Service, shall consult with Indian Tribes to 

20 establish criteria to measure indicators of need, for 

21 purposes of paragraph (1), with respect to Tribal 

22 areas. 

23 ‘‘(f) USE OF FUNDS.— 

24 ‘‘(1) REQUIRED USES.— 


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1 ‘‘(A) IN GENERAL.—A grant received 

2 under this section shall be used to establish or 

3 expand gender-responsive, culturally specific, 

4 trauma-informed care coordination services, in5 cluding by instituting and conducting risk and 

6 needs assessments including— 

7 ‘‘(i) using strengths-based approaches 

8 focused on protective factors for children 

9 and their caregivers, including prenatal 

10 people of any age; and 

11 ‘‘(ii) inputting screening results into a 

12 centralized intake system to promote a sin13 gle point of access system across providers 

14 and services. 

15 ‘‘(B) TRAINING.—A grant received under 

16 this section shall be used to ensure that individ17 uals employed through the grant funds, in 

18 whole or in part, have received sufficient and 

19 up-to-date training on trauma-informed care 

20 and strategies that are reparative, culturally 

21 sensitive, gender responsive, and healing cen22 tered. 

23 ‘‘(2) PERMISSIBLE USES.—A grant received 

24 under this section may be used for any of the fol25 lowing: 


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1 ‘‘(A) Employing care coordinators, case 

2 managers, community health workers, certified 

3 infant mental health specialists, and outreach 

4 and engagement specialists to work with chil5 dren and their caregivers, including prenatal in6 dividuals, to prevent and respond to adverse 

7 childhood experiences by connecting clients with 

8 culturally specific, trauma-informed care treat9 ment services, including economic, social, food, 

10 and housing supports. 

11 ‘‘(B) Providing training described in para12 graph (1)(B) to community health providers 

13 and community partners. 

14 ‘‘(C) Expanding, enhancing, modifying, 

15 and connecting the existing network of commu16 nity programs and services to achieve a more 

17 comprehensive and coordinated system of care 

18 approach, including— 

19 ‘‘(i) developing local infrastructure to 

20 bolster and shape community support sys21 tems and map and build access to services 

22 in a coordinated and comprehensive way; 

23 and 

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1 cluding those experiencing homelessness 

2 and housing instability, so they acquire ac3 cess to the services and supports they need 

4 and the benefits to which they are entitled. 

5 ‘‘(D) Compiling information on resources 

6 (including any referral services) available 

7 through community-based organizations and 

8 local, State, and Federal agencies, such as— 

9 ‘‘(i) programs addressing social deter10 minants of health, including— 

11 ‘‘(I) emergency, temporary, and 

12 long-term housing; 

13 ‘‘(II) programs that offer free or 

14 affordable and nutritious food; 

15 ‘‘(III) vocational and workforce 

16 development; and 

17 ‘‘(IV) transportation supports; 

18 ‘‘(ii) home visiting programs for new 

19 parents and their infants; 

20 ‘‘(iii) workforce development programs 

21 to support caregivers in skill building; 

22 ‘‘(iv) trauma-responsive, parenting 

23 skills-building programs; 

24 ‘‘(v) the continuum of substance use 

25 prevention, intervention, and treatment 


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1 programs and mental health support pro2 grams, including programs with trauma-in3 formed, gender-responsive, and culturally 

4 specific counseling; and 

5 ‘‘(vi) childcare support and early 

6 childhood education, including Head Start 

7 and Early Head Start programs. 

8 ‘‘(E) Subject to subsection (g)(1), estab9 lishing or updating a database that compiles 

10 data used to track the effectiveness of the care 

11 coordination services funded through the grant. 

12 ‘‘(F) Developing and implementing referral 

13 partnership agreements with community-based 

14 organizations, parent organizations, substance 

15 use disorder treatment providers and facilities, 

16 housing and shelter providers, health care pro17 viders, mental health care providers, and Fed18 eral and State offices and programs that imple19 ment practices to support children ages 0 

20 through 5 who are at risk of adverse childhood 

21 experiences and their caregivers, including pre22 natal people. Such practices shall include— 

23 ‘‘(i) a bilateral ‘warm handoff’ system 

24 whereby a grantee understands the needs 

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1 ilies are involved in addressing these needs; 

2 and 

3 ‘‘(ii) an active service connection 

4 whereby the children and families are each 

5 actively connected with a resource in a 

6 well-coordinated way that ensures avail7 ability and direct contact. 

8 ‘‘(G) Supporting cross-system planning 

9 and collaboration among employees who may 

10 work in emergency medical services, health care 

11 services, public health, early childhood edu12 cation, and substance use disorder treatment 

13 and recovery support. 

14 ‘‘(H) Providing or subsidizing services to 

15 address barriers that children, prenatal individ16 uals, and caregivers face to utilizing community 

17 resources and services, such as by providing or 

18 subsidizing transportation or childcare costs as 

19 applicable and within reasonable amounts. 

20 ‘‘(I) Creating or expanding infrastructure 

21 and investing in technology, including the provi22 sion of communications technology and internet 

23 service to children and their caregivers, to en24 able increased telemedicine capabilities to reach 

25 participants. 


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1 ‘‘(3) INDIAN TRIBES.—In the case of an eligible 

2 entity that is an Indian Tribe, the Secretary may 

3 waive such provisions of this subsection as the Sec4 retary determines appropriate. 

5 ‘‘(4) PROHIBITIONS.—In addition to any other 

6 prohibitions determined by the Secretary, an eligible 

7 entity may not use a grant under this section to— 

8 ‘‘(A) use data analysis methods to inform 

9 individual case decisions, including child re10 moval or placement decisions, or to target serv11 ices at certain individuals or families; 

12 ‘‘(B) require any individual or family to 

13 participate in any service or program as a con14 dition of receipt of a benefit to which the indi15 vidual or family is otherwise eligible; or 

16 ‘‘(C) increase the presence or funding of 

17 law enforcement surveillance, involvement, or 

18 activity in connection with trauma-informed 

19 care coordination services supported pursuant 

20 to this section. 

21 ‘‘(g) REQUIREMENTS.—As a condition on receipt of 

22 a grant under this section, an eligible entity shall agree 

23 to each of the following funding conditions: 

24 ‘‘(1) RESTRICTION OF FUNDING ALLOCATION.— 

25 The eligible entity will not use more than 30 percent 


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1 of the funds made available to the entity through the 

2 grant (for the total grant period) to establish or up3 date a database pursuant to subsection (f)(2)(E). 

4 ‘‘(2) ACCESSIBLE SETTING.— 

5 ‘‘(A) IN GENERAL.—The eligible entity will 

6 ensure that all care coordination services pro7 vided through the grant are provided in a set8 ting that is accessible, including through mobile 

9 settings, to— 

10 ‘‘(i) low-income or no-income individ11 uals, including individuals experiencing 

12 homelessness or housing instability; and 

13 ‘‘(ii) individuals in rural areas. 

14 ‘‘(B) COMMUNITY OUTREACH.—In com15 plying with subparagraph (A), the eligible entity 

16 will ensure that at least 50 percent of the care 

17 coordination services provided through the 

18 grant occur in community settings that are con19 venient to the children and caregivers who are 

20 being served, such as homes, schools, and shel21 ters, whether for initial outreach or as part of 

22 long-term care. 

23 ‘‘(3) SUPPLEMENT, NOT SUPPLANT.—The 

24 grant will be used to supplement, not supplant other 


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1 Federal, State, or local funds available for care co2 ordination services. 

3 ‘‘(4) CONFIDENTIALITY.—The eligible entity 

4 will maintain the confidentiality of individuals receiv5 ing services through the grant in a manner con6 sistent with applicable law. 

7 ‘‘(5) PARTNERING; RISK STRATIFICATION.—In 

8 providing care coordination services through the 

9 grant, the eligible entity will— 

10 ‘‘(A) partner with community-based orga11 nizations with experience serving child popu12 lations prenatally through age 5; 

13 ‘‘(B) coordinate with the local agency re14 sponsible for administering the State plan ap15 proved under title XIX of the Social Security 

16 Act; and 

17 ‘‘(C) employ risk stratification to develop 

18 different effective models of care for different 

19 populations based on their needs. 

20 ‘‘(h) APPLICATION.— 

21 ‘‘(1) IN GENERAL.—To seek a grant under this 

22 section, an eligible entity shall submit an application 

23 to the Secretary at such time, in such manner, and 

24 containing such information, as the Secretary may 

25 require. 


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1 ‘‘(2) CONTENTS.—An application under para2 graph (1) shall, at a minimum, contain each of the 

3 following: 

4 ‘‘(A) Goals to be achieved through the 

5 grant, including the activities that will be un6 dertaken to achieve those goals. 

7 ‘‘(B) The number of individuals likely to 

8 be served through the grant, including demo9 graphic data on the populations to be served. 

10 ‘‘(C) Existing programs and services that 

11 can be used to significantly increase the propor12 tion of children and families who receive needed 

13 supports and services. 

14 ‘‘(D) A plan for expanding, coordinating, 

15 or modifying the existing network of programs 

16 and services to meet the needs of children and 

17 families for preventing and mitigating the trau18 matic impact of adverse childhood experiences. 

19 ‘‘(E) A demonstration of the ability of the 

20 eligible entity to reach the individuals to be 

21 served, including by partnering with local stake22 holders. 

23 ‘‘(F) An indication of how the personnel 

24 involved are reflective of the communities to be 

25 served. 


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1 ‘‘(G) A list of stakeholders with whom the 

2 entity plans to partner or consult. 

3 ‘‘(i) REPORTING BY GRANTEES.—Not later than 4 

4 years after the date of enactment of this section, an eligi5 ble entity receiving a grant under this section shall submit 

6 to the Secretary a report on the activities funded through 

7 the grant. Such report shall include, at a minimum, a de8 scription of— 

9 ‘‘(1) the number of individuals served through 

10 activities funded through the grant, including demo11 graphics as applicable; 

12 ‘‘(2) the number of referrals made through the 

13 grant and the rate of such referrals successfully 

14 linked or closed; 

15 ‘‘(3) a qualitative analysis or number of collabo16 rative partnerships with other organizations in car17 rying out the activities funded through the grant; 

18 ‘‘(4) the number of services provided to individ19 uals through the grant; 

20 ‘‘(5) aggregated and de-identified outcomes ex21 perienced by individuals served through the grant 

22 such as— 

23 ‘‘(A) the rate of successful service connec24 tions; 


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1 ‘‘(B) any increases in development of pro2 tective factors for children; 

3 ‘‘(C) any increase in development of pro4 tective factors for the caregivers; 

5 ‘‘(D) any mitigation of the negative out6 comes associated with adverse childhood experi7 ences or decreased likelihood of children experi8 encing an adverse childhood experience as evi9 denced by— 

10 ‘‘(i) decreased presence of law en11 forcement or other punitive State surveil12 lance in the community; 

13 ‘‘(ii) a parent completing substance 

14 use treatment; 

15 ‘‘(iii) a parent receiving voluntary 

16 treatment for mental health-related condi17 tions; 

18 ‘‘(iv) a family entering into or main19 taining a stable housing situation; 

20 ‘‘(v) a family achieving or maintaining 

21 economic security; 

22 ‘‘(vi) a parent achieving or maintain23 ing job stability; or 

24 ‘‘(vii) a child meeting developmental 

25 markers for school readiness; and 


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1 ‘‘(E) reports of satisfaction with the co2 ordination of care by people served; and 

3 ‘‘(6) any other information required by the Sec4 retary. 

5 ‘‘(j) CONVENING PARTICIPANTS FOR SHARING LES6 SONS LEARNED.—After the period of all grants awarded 

7 under this section has concluded, the Assistant Secretary 

8 for Planning and Evaluation of the Department of Health 

9 and Human Services shall provide an in-person or online 

10 opportunity for persons participating in the programs 

11 funded through this section to share with each other— 

12 ‘‘(1) lessons learned; 

13 ‘‘(2) challenges experienced; and 

14 ‘‘(3) ideas for next steps and solutions. 

15 ‘‘(k) COMPILING FINDINGS AND CONCLUSIONS.— 

16 After providing the opportunity required by subsection (j), 

17 the Secretary shall— 

18 ‘‘(1) compile the findings and conclusions of 

19 grantees under this section on the provision of care 

20 coordination services described in subsection (a); 

21 ‘‘(2) submit a report on such findings and con22 clusions to the appropriate congressional commit23 tees; and 

24 ‘‘(3) make such report publicly available. 

25 ‘‘(l) DEFINITIONS.—In this section: 


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1 ‘‘(1) ADVERSE CHILDHOOD EXPERIENCE.—The 

2 term ‘adverse childhood experience’ means a poten3 tially traumatic experience that occurs in childhood 

4 and can have a tremendous impact on the child’s 

5 lifelong health and opportunity outcomes, such as 

6 any of the following: 

7 ‘‘(A) Abuse, such as any of the following: 

8 ‘‘(i) Emotional and psychological 

9 abuse. 

10 ‘‘(ii) Physical abuse. 

11 ‘‘(iii) Sexual abuse. 

12 ‘‘(B) Household challenges such as any of 

13 the following: 

14 ‘‘(i) A household member is treated 

15 violently. 

16 ‘‘(ii) A household member has a sub17 stance use disorder. 

18 ‘‘(iii) A household member has a men19 tal health condition. 

20 ‘‘(iv) Parental separation or divorce. 

21 ‘‘(v) A household member is incarcer22 ated, is placed in immigrant detention, or 

23 has been deported. 

24 ‘‘(vi) A household member has a life25 threatening illness such as COVID–19. 


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1 ‘‘(C) Neglect. 

2 ‘‘(D) Living in— 

3 ‘‘(i) impoverished communities that 

4 lack access to human services; 

5 ‘‘(ii) areas of high unemployment 

6 neighborhoods; or 

7 ‘‘(iii) communities experiencing de 

8 facto segregation. 

9 ‘‘(E) Experiencing food insecurity and 

10 poor nutrition. 

11 ‘‘(F) Witnessing violence. 

12 ‘‘(G) Involvement with the foster system. 

13 ‘‘(H) Experiencing discrimination. 

14 ‘‘(I) Dealing with historical and ongoing 

15 traumas due to systemic and interpersonal rac16 ism. 

17 ‘‘(J) Dealing with historical and ongoing 

18 traumas regarding systemic and interpersonal 

19 sexism, homophobia, biphobia, and transphobia. 

20 ‘‘(K) Dealing with the threat of deporta21 tion or detention as a result of immigration sta22 tus. 

23 ‘‘(L) The impacts of multigenerational pov24 erty resulting from limited educational and eco25 nomic opportunities. 


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1 ‘‘(M) Living through natural disasters 

2 such as earthquakes, forest fires, floods, or hur3 ricanes. 

4 ‘‘(2) CARE COORDINATION.—The term ‘care co5 ordination’ means an active, ongoing process that— 

6 ‘‘(A) assists children ages 0 through 5 at 

7 risk of, or who have experienced, an adverse 

8 childhood experience, and their caregivers, in9 cluding prenatal people of any age, to identify, 

10 access, and use community resources and serv11 ices; 

12 ‘‘(B) is client centered and comprehensive 

13 of the services a child or caregiver may need; 

14 ‘‘(C) ensures a closed loop referral by ob15 taining feedback from the families served; and 

16 ‘‘(D) works across systems and services to 

17 promote collaboration to effectively meet the 

18 needs of community members. 

19 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 

20 has the meaning given such term in section 4 of the 

21 Indian Self-Determination and Education Assistance 

22 Act. 

23 ‘‘(4) PROTECTIVE FACTORS.—The term ‘protec24 tive factors’ refers to any supportive element in a 

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1 taker to withstand trauma such as a stable school 

2 environment or supportive peer relationships. 

3 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.— 

4 ‘‘(1) IN GENERAL.—To carry out this section, 

5 there is authorized to be appropriated $15,000,000 

6 for each of the 5 fiscal years following the fiscal year 

7 in which this section is enacted. 

8 ‘‘(2) GRANTS TO INDIAN TRIBES.—Of the 

9 amount made available to carry out this section for 

10 a fiscal year, the Secretary shall use not less than 

11 10 percent of such amount for grants to eligible en12 tities that are Indian Tribes. 

13 ‘‘(3) ADMINISTRATIVE EXPENSES.—Of the 

14 amount made available to carry out this section for 

15 a fiscal year, the Secretary may use not more than 

16 15 percent of such amount for administrative ex17 penses, including the expenses of the Assistant Sec18 retary for Planning and Evaluation of the Depart19 ment of Health and Human Services for compiling 

20 and reporting information. 

21 ‘‘(4) TECHNICAL ASSISTANCE.—Of the amount 

22 made available to carry out this section for a fiscal 

23 year, the Secretary may reserve up to 5 percent of 

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1 ble entities in preparing and submitting applications 

2 under this section.’’. 

3 SEC. 6075. IMPROVING ACCESS TO MENTAL HEALTH. 

4 (a) ACCESS TO CLINICAL SOCIAL WORKERS.—Sec5 tion 1833(a)(1)(F)(ii) of the Social Security Act (42 

6 U.S.C. 1395l(a)(1)(F)(ii)) is amended by striking ‘‘75 

7 percent of the amount determined for payment of a psy8 chologist under clause (L)’’ and inserting ‘‘85 percent of 

9 the fee schedule amount provided under section 1848’’. 

10 (b) ACCESS TO CLINICAL SOCIAL WORKER SERVICES

11 PROVIDED TO RESIDENTS OF SKILLED NURSING FACILI12 TIES.— 

13 (1) IN GENERAL.—Section 1888(e)(2)(A)(ii) of 

14 the Social Security Act (42 U.S.C. 

15 1395yy(e)(2)(A)(ii)), as amended by section 

16 6011(a)(5), is amended by inserting ‘‘clinical social 

17 worker services,’’ after ‘‘peer support specialist serv18 ices (as defined in section 1861(nnn)(7)),’’. 

19 (2) CONFORMING AMENDMENT.—Section 

20 1861(hh)(2) of the Social Security Act (42 U.S.C. 

21 1395x(hh)(2)) is amended by striking ‘‘and other 

22 than services furnished to an inpatient of a skilled 

23 nursing facility which the facility is required to pro24 vide as a requirement for participation’’. 


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1 (c) ACCESS TO THE COMPLETE SET OF CLINICAL SO2 CIAL WORKER SERVICES.—Section 1861(hh)(2) of the So3 cial Security Act (42 U.S.C. 1395x(hh)(2)) is further 

4 amended by striking ‘‘for the diagnosis and treatment of 

5 mental illnesses (other than services’’ and inserting ‘‘(in6 cluding services for the diagnosis and treatment of mental 

7 illnesses or services for health and behavior assessment 

8 and intervention (identified as of January 1, 2022, by 

9 HCPCS codes 96150 through 96161 (and any succeeding 

10 codes)), but not including services’’. 

11 (d) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to items and services furnished on 

13 or after January 1, 2023. 

14 SEC. 6076. MENTAL HEALTH IN SCHOOLS EXCELLENCE 

15 PROGRAM. 

16 (a) PROGRAM TO ESTABLISH PUBLIC-PRIVATE CON17 TRIBUTIONS TO INCREASE THE AVAILABLE WORKFORCE

18 OF SCHOOL-BASED MENTAL HEALTH SERVICE PRO19 VIDERS.— 

20 (1) PROGRAM AUTHORIZED.—The Secretary 

21 shall carry out a program under which eligible grad22 uate institutions may enter into an agreement with 

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1 tions shall be matched by equivalent contributions 

2 towards such cost of attendance by the Secretary. 

3 (2) DESIGNATION OF PROGRAM.—The program 

4 under this subsection shall be known as the ‘‘Mental 

5 Health in Schools Excellence Program’’. 

6 (3) AGREEMENTS.—The Secretary shall enter 

7 into an agreement with each eligible graduate insti8 tution seeking to participate in the program under 

9 this section. Each agreement shall specify the fol10 lowing: 

11 (A) The manner (whether by direct grant, 

12 scholarship, or otherwise) in which the eligible 

13 graduate institution will contribute to the cost 

14 of attendance of a participating student. 

15 (B) The maximum amount of the contribu16 tion to be made by the eligible graduate institu17 tion with respect to any particular participating 

18 student in any given academic year. 

19 (C) The maximum number of individuals 

20 for whom the eligible graduate institution will 

21 make contributions in any given academic year. 

22 (D) That the eligible graduate institution, 

23 in selecting participating students to receive as24 sistance under the program, shall prioritize the 


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1 participating students described in paragraph 

2 (4)(B). 

3 (E) Such other matters as the Secretary 

4 and the eligible graduate institution determine 

5 appropriate. 

6 (4) OUTREACH.—The Secretary shall— 

7 (A) make publicly available and periodi8 cally update on the internet website of the De9 partment of Education a list of the eligible 

10 graduate institutions participating in the pro11 gram under this subsection that shall specify, 

12 for each such graduate institution, appropriate 

13 information on the agreement between the Sec14 retary and such college or university under 

15 paragraph (3); and 

16 (B) conduct outreach about the program 

17 under this section to participating students 

18 who, as undergraduates— 

19 (i) received a Federal Pell Grant 

20 under section 401 of the Higher Education 

21 Act of 1965 (20 U.S.C. 1070a); or 

22 (ii) attended an institution listed in 

23 section 371(a) of the Higher Education 

24 Act of 1965 (20 U.S.C. 1067q(a)). 


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1 (5) MATCHING CONTRIBUTIONS.—The Sec2 retary may provide a contribution of up to 50 per3 cent of the cost of attendance of a participating stu4 dent if the eligible graduate institution at which 

5 such student is enrolled enters into an agreement 

6 under paragraph (3) with the Secretary to match 

7 such contribution. 

8 (b) DEFINITIONS.—In this section: 

9 (1) COST OF ATTENDANCE.—The term ‘‘cost of 

10 attendance’’ has the meaning given the term in sec11 tion 472 of the Higher Education Act of 1965 (20 

12 U.S.C. 1087ll). 

13 (2) ELIGIBLE GRADUATE INSTITUTION.—The 

14 term ‘‘eligible graduate institution’’ means an insti15 tution of higher education that offers a program of 

16 study that leads to a graduate degree— 

17 (A) in school psychology that is accredited 

18 or approved by the National Association of 

19 School Psychologists’ Program Accreditation 

20 Board or the Commission on Accreditation of 

21 the American Psychological Association and 

22 that prepares students in such program for the 

23 State licensing or certification examination in 

24 school psychology at the specialist level; 


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1 (B) in an accredited school counseling pro2 gram that prepares students in such program 

3 for the State licensing or certification examina4 tion in school counseling; 

5 (C) in school social work that is accredited 

6 by the Council on Social Work Education and 

7 that prepares students in such program for the 

8 State licensing or certification examination in 

9 school social work; 

10 (D) in another school-based mental health 

11 field that prepares students in such program 

12 for the State licensing or certification examina13 tion in such field, if applicable; or 

14 (E) in any combination of study described 

15 in subparagraphs (A) through (D). 

16 (3) INSTITUTION OF HIGHER EDUCATION.—The 

17 term ‘‘institution of higher education’’ has the 

18 meaning given such term in section 101 of the High19 er Education Act of 1965 (20 U.S.C. 1001), but ex20 cludes any institution of higher education described 

21 in section 102(a)(1)(C) of such Act. 

22 (4) PARTICIPATING STUDENT.—The term ‘‘par23 ticipating student’’ means an individual who is en24 rolled in a graduate degree program in a schoolVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01159 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 based mental health field at a participating eligible 

2 graduate institution. 

3 (5) SCHOOL-BASED MENTAL HEALTH FIELD.— 

4 The term ‘‘school-based mental health field’’ means 

5 each of the following fields: 

6 (A) School counseling. 

7 (B) School social work. 

8 (C) School psychology. 

9 (D) Any other field of study that leads to 

10 employment as a school-based mental health 

11 services provider, as determined by the Sec12 retary. 

13 (6) SCHOOL-BASED MENTAL HEALTH SERVICES

14 PROVIDER.—The term ‘‘school-based mental health 

15 services provider’’ has the meaning given the term in 

16 section 4102 of the Elementary and Secondary Edu17 cation Act of 1965 (20 U.S.C. 7112). 

18 (7) SECRETARY.—The term ‘‘Secretary’’ means 

19 the Secretary of Education. 

20 SEC. 6077. SCHOOL SOCIAL WORKERS IMPROVING STU21 DENT SUCCESS. 

22 (a) SCHOOL SOCIAL WORKER GRANTS.— 

23 (1) PURPOSES.—The purpose of this section is 

24 to assist States and local educational agencies in hir25 ing additional school social workers in order to inVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01160 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 crease access to mental health and other student 

2 support services to students in elementary and sec3 ondary schools in the United States to the minimum 

4 ratios recommended by the National Association of 

5 Social Workers, the School Social Work Association 

6 of America, and the American Council for School 

7 Social Work of one school social worker for every 

8 250 students, and one school social worker for every 

9 50 students when a social worker is providing serv10 ices to students with intensive needs. 

11 (2) ESEA AMENDMENT.—Subpart 4 of part F 

12 of title IV of the Elementary and Secondary Edu13 cation Act of 1965 (20 U.S.C. 7271 et seq.) is 

14 amended by adding at the end the following new sec15 tion: 

16 ‘‘SEC. 4645. GRANTS FOR SCHOOL SOCIAL WORKERS. 

17 ‘‘(a) GRANTS AUTHORIZED.— 

18 ‘‘(1) IN GENERAL.—From the amounts appro19 priated under subsection (g), the Secretary shall 

20 award grants to high-need local educational agencies 

21 to enable such agencies to retain school social work22 ers employed by such agencies or to hire additional 

23 school social workers. 


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1 ‘‘(2) DURATION.—A grant awarded under this 

2 section shall be awarded for a period not to exceed 

3 4 years. 

4 ‘‘(3) SUPPLEMENT, NOT SUPPLANT.—Funds 

5 made available under this section shall be used to 

6 supplement, and not to supplant, other Federal, 

7 State, or local funds used for hiring and retaining 

8 school social workers. 

9 ‘‘(b) APPLICATION.— 

10 ‘‘(1) IN GENERAL.—To be eligible to receive a 

11 grant under this section, a high-need local edu12 cational agency shall submit to the Secretary an ap13 plication at such time, in such manner, and con14 taining such information as the Secretary may re15 quire. 

16 ‘‘(2) CONTENTS.—An application submitted 

17 under paragraph (1) shall include an assurance that 

18 each school social worker who receives assistance 

19 under the grant will provide the services described in 

20 subsection (d), and a description of the specific serv21 ices to be provided by such social worker. 

22 ‘‘(c) USE OF FUNDS.—A high-need local educational 

23 agency receiving a grant under this section— 

24 ‘‘(1) shall use the grant— 


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1 ‘‘(A) to achieve a ratio of not less than 1 

2 school social worker for every 250 students 

3 served by the agency, by— 

4 ‘‘(i) retaining school social workers 

5 employed by such agency; or 

6 ‘‘(ii)(I) employing additional school 

7 social workers; or 

8 ‘‘(II) hiring contractors to serve as 

9 school social workers only in a case in 

10 which— 

11 ‘‘(aa) the local educational agen12 cy demonstrates to the Secretary that 

13 the agency— 

14 ‘‘(AA) has not been able to 

15 employ a sufficient number of 

16 school social workers under sub17 clause (I) to achieve such ratio 

18 despite strong and continuing ef19 forts to recruit and employ school 

20 social workers; and 

21 ‘‘(BB) hiring contractors is 

22 the only viable option to ensure 

23 students have adequate access to 

24 school social work services; and 


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1 ‘‘(bb) each such contractor meets 

2 the requirements of subparagraphs 

3 (A) and (B) of subsection (h)(2); and 

4 ‘‘(B) to ensure that each school social 

5 worker who receives assistance under such 

6 grant provides the services described in sub7 section (d); and 

8 ‘‘(2) may use the grant to reimburse school so9 cial workers who receive assistance under such grant 

10 for— 

11 ‘‘(A) in the case of a school served by the 

12 agency in which the majority of students are 

13 higher risk students, to hire or retain additional 

14 school social workers in accordance with clauses 

15 (i) and (ii) of paragraph (1)(A) to achieve a 

16 ratio of not less than 1 school social worker for 

17 every 50 students; 

18 ‘‘(B) travel expenses incurred during home 

19 visits and other school-related trips; 

20 ‘‘(C) any additional expenses incurred by 

21 such social workers in rendering any service de22 scribed in subsection (d); and 

23 ‘‘(D) the cost of clinical social work super24 vision for such social workers. 


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1 ‘‘(d) RESPONSIBILITIES OF A SCHOOL SOCIAL WORK2 ER.—A school social worker who receives assistance under 

3 a grant under this section shall provide the following serv4 ices: 

5 ‘‘(1) Identifying high-need students in each 

6 school that the social worker serves, and targeting 

7 services provided at the school to such students. 

8 ‘‘(2) Providing students in each school that the 

9 school social worker serves, social work services to 

10 promote school engagement and improve academic 

11 outcomes, including— 

12 ‘‘(A) counseling and crisis intervention; 

13 ‘‘(B) trauma-informed services; 

14 ‘‘(C) evidence-based educational, behav15 ioral, and mental health services (such as imple16 menting multi-tiered programs and practices, 

17 monitoring progress, and evaluating service ef18 fectiveness); 

19 ‘‘(D) addressing the social and emotional 

20 learning needs of students; 

21 ‘‘(E) promoting a school climate and cul22 ture conducive to student learning and teaching 

23 excellence (such as promoting effective school 

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1 sonnel, and facilitating engagement between 

2 student, family, school, and community); 

3 ‘‘(F) providing access to school-based and 

4 community-based resources (such as promoting 

5 a continuum of services, mobilizing resources 

6 and promoting assets, providing leadership, 

7 interdisciplinary collaboration, systems coordi8 nation, and professional consultation, and con9 necting students and families to resource sys10 tems); 

11 ‘‘(G) working with students, families, 

12 schools, and communities to address barriers to 

13 educational attainment (such as homelessness 

14 and housing insecurity, lack of transportation, 

15 food insecurity, equity, social justice issues, ac16 cess to quality education, and school, family, 

17 and community risk factors); 

18 ‘‘(H) providing assistance to schools and 

19 teachers to design social-emotional, educational, 

20 behavioral, and mental health interventions; 

21 ‘‘(I) case management activities to coordi22 nate the delivery of and access to the appro23 priate social work services to the highest-need 

24 students; 


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1 ‘‘(J) home visits to meet the family of stu2 dents in need of social work services in the 

3 home environment; 

4 ‘‘(K) supervising or coordinating district 

5 level school social work services; and 

6 ‘‘(L) other services the Secretary deter7 mines, in partnership with students, educators, 

8 and community member voices, are necessary to 

9 be carried out by such a social worker. 

10 ‘‘(e) GRANT RENEWAL.— 

11 ‘‘(1) IN GENERAL.—A grant awarded under 

12 this section may be renewed for additional periods 

13 with the same duration as the original grant period. 

14 ‘‘(2) CONTINUING ELIGIBILITY APPLICATION.— 

15 To be eligible for a renewal under this section a 

16 high-need local educational agency shall submit to 

17 the Secretary, for each renewal, a report on the 

18 progress of such agency in retaining and hiring 

19 school social workers to achieve the ratio of not less 

20 than 1 school social worker for every 250 students 

21 served by the agency, and shall include— 

22 ‘‘(A) a description of the staffing expan23 sion of school social workers funded through the 

24 original grant received under this section; and 


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1 ‘‘(B) a description of the work conducted 

2 by such social workers for higher risk students. 

3 ‘‘(f) TECHNICAL ASSISTANCE.— 

4 ‘‘(1) IN GENERAL.—The Secretary shall provide 

5 technical assistance to high-need local educational 

6 agencies, including such agencies that do not have 

7 adequate staff, in applying for grants under this sec8 tion. 

9 ‘‘(2) EXTENSION OF APPLICATION PERIOD.— 

10 The Secretary shall extend any application period 

11 for a grant under this section for any high-need local 

12 educational agency that— 

13 ‘‘(A) submits to the Secretary a written 

14 notification of the intent to apply for a grant 

15 under this section before requesting technical 

16 assistance under paragraph (1); and 

17 ‘‘(B) after submitting the notification 

18 under subparagraph (A), requests such tech19 nical assistance. 

20 ‘‘(g) AUTHORIZATION FOR APPROPRIATIONS.—There 

21 is authorized to be appropriated to carry out this section, 

22 $100,000,000 for each of fiscal years 2023 through 2027. 

23 ‘‘(h) DEFINITIONS.—In this section: 

24 ‘‘(1) HIGH-NEED LOCAL EDUCATIONAL AGEN25 CY.—The term ‘high-need local educational agency’ 


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1 has the meaning given the term in section 200 of the 

2 Higher Education Act of 1965 (20 U.S.C. 1021). 

3 ‘‘(2) SCHOOL SOCIAL WORKER.—The term 

4 ‘school social worker’ means an individual who— 

5 ‘‘(A) has a graduate degree in social work 

6 from a social work program that is accredited 

7 by the Council on Social Work Education; and 

8 ‘‘(B) meets all other State and local 

9 credentialing requirements for practicing as a 

10 social worker in an elementary school or sec11 ondary school.’’. 

12 (b) NATIONAL TECHNICAL ASSISTANCE CENTER FOR

13 SCHOOL SOCIAL WORK.— 

14 (1) IN GENERAL.—The Secretary of Education 

15 shall establish an evaluation, documentation, dis16 semination, and technical assistance resource center 

17 to provide appropriate information, training, and 

18 technical assistance to States, political subdivisions 

19 of States, federally recognized Indian Tribes, Tribal 

20 organizations, institutions of higher education, State 

21 and local educational agencies, and individual stu22 dents and educators with respect to hiring and re23 taining school social workers at elementary schools 

24 and secondary schools served by local educational 

25 agencies. 


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1 (2) RESPONSIBILITIES OF THE CENTER.—The 

2 center established under paragraph (1) shall conduct 

3 activities for the purpose of— 

4 (A) developing and continuing statewide or 

5 Tribal strategies for improving the effectiveness 

6 of the school social work workforce; 

7 (B) studying the costs and effectiveness of 

8 school social work programs at institutions of 

9 higher education to identify areas of improve10 ment and provide information on relevant issues 

11 of importance to State, Tribal, and national 

12 policymakers; 

13 (C) working with Federal agencies and 

14 other State, Tribal, and national stakeholders 

15 to collect, evaluate, and disseminate data re16 garding school social work ratios, outcomes and 

17 best practices of school-based mental health 

18 services, and impact of expanding the number 

19 of school social workers within elementary 

20 schools and secondary schools; and 

21 (D) establishing partnerships among na22 tional, State, Tribal, and local governments, 

23 and local educational agencies, institutions of 

24 higher education, non-profit organizations, and 


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1 State and national trade associations for the 

2 purposes of— 

3 (i) data collection and dissemination; 

4 (ii) establishing a school social work 

5 workforce development program; 

6 (iii) documenting the success of school 

7 social work methods on a national level; 

8 and 

9 (iv) conducting other activities deter10 mined appropriate by the Secretary. 

11 (3) DEFINITIONS.—In this subsection: 

12 (A) ESEA TERMS.—Except as otherwise 

13 provided, any term used in this subsection that 

14 is defined in section 8101 of the Elementary 

15 and Secondary Education Act of 1965 (20 

16 U.S.C. 7801) shall have the meaning given that 

17 term in such section. 

18 (B) SCHOOL SOCIAL WORKER.—The term 

19 ‘‘school social worker’’ has the meaning given 

20 the term in section 4645(h) of the Elementary 

21 and Secondary Education Act of 1965, as 

22 added by subsection (a). 


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1 SEC. 6078. OPIOID GRANTS TO SUPPORT CAREGIVERS, KIN2 SHIP CARE FAMILIES, AND KINSHIP CARE3 GIVERS. 

4 (a) OPIOID GRANTS.—Section 1003(b)(2) of the 21st 

5 Century Cures Act (42 U.S.C. 290ee–3 note) is amend6 ed— 

7 (1) by redesignating subparagraph (E) as sub8 paragraph (F); and 

9 (2) by inserting after subparagraph (D) the fol10 lowing: 

11 ‘‘(E) Supporting opioid abuse prevention 

12 and treatment services within a State provided 

13 by State and local agencies for children and 

14 caregivers, kinship care families, and kinship 

15 caregivers through— 

16 ‘‘(i) workforce recruitment and train17 ing; 

18 ‘‘(ii) health care services (including 

19 such services described in subparagraph 

20 (D)); and 

21 ‘‘(iii) foster and adoptive parent re22 cruitment and training.’’. 

23 (b) DEFINITIONS.—Section 1003 of the 21st Century 

24 Cures Act (42 U.S.C. 290ee–3 note) is amended— 

25 (1) by redesignating subsections (h), (i), and (j) 

26 as subsections (i), (j), and (k), respectively; and 


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1 (2) by inserting after subsection (g) the fol2 lowing: 

3 ‘‘(h) DEFINITIONS.—In this section: 

4 ‘‘(1) The term ‘kinship care family’ means a 

5 family with a kinship caregiver. 

6 ‘‘(2) The term ‘kinship caregiver’ means a rel7 ative of a child by blood, marriage, or adoption, 

8 who— 

9 ‘‘(A) lives with the child; 

10 ‘‘(B) is the primary caregiver of the child 

11 because the biological or adoptive parent of the 

12 child is unable or unwilling to serve as the pri13 mary caregiver of the child; and 

14 ‘‘(C) has a legal relationship to the child or 

15 is raising the child informally.’’. 

16 (c) AUTHORIZATION OF APPROPRIATIONS.—Section 

17 1003(i) of the 21st Century Cures Act (42 U.S.C. 290ee– 

18 3 note), as redesignated, is amended by inserting ‘‘, and 

19 $255,000,000 for each of fiscal years 2022 through 2026’’ 

20 after ‘‘2021’’. 

21 (d) SET ASIDE.—Section 1003(j) of the 21st Century 

22 Cures Act (42 U.S.C. 290ee–3 note), as redesignated, is 

23 amended— 

24 (1) by striking ‘‘, and up to’’ and inserting ‘‘, 

25 up to’’; and 


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1 (2) by inserting before the period at the end ‘‘, 

2 and 1 percent of such amount for such fiscal year 

3 shall be made available to carry out subsection 

4 (b)(2)(E)’’. 

5 TITLE VII—ADDRESSING HIGH6 IMPACT MINORITY DISEASES 

7 Subtitle A—Cancer 

8 SEC. 7001. LUNG CANCER MORTALITY REDUCTION. 

9 (a) FINDINGS.—Congress makes the following find10 ings: 

11 (1) Lung cancer is the leading cause of cancer 

12 death for both men and women, accounting for 25 

13 percent of all cancer deaths. 

14 (2) Since the National Cancer Act of 1971 

15 (Public Law 92–218; 85 Stat. 778), coordinated and 

16 comprehensive research has raised the 5-year sur17 vival rates for breast cancer to 90 percent, for pros18 tate cancer to 99 percent, and for colon cancer to 

19 64 percent. 

20 (3) The 5-year survival rate for lung cancer is 

21 still only 18 percent, and a similar coordinated and 

22 comprehensive research effort is required to achieve 

23 increases in lung cancer survivability rates. 

24 (4) Sixty percent of lung cancer cases are now 

25 diagnosed in nonsmokers or former smokers. 


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1 (5) Two-thirds of nonsmokers diagnosed with 

2 lung cancer are women. 

3 (6) Certain minority populations, such as Afri4 can-American males, have disproportionately high 

5 rates of lung cancer incidence and mortality, despite 

6 their smoking rate being similar to other racial 

7 groups. 

8 (7) Members of the Baby Boomer Generation 

9 are entering their 60s, the most common age at 

10 which people develop lung cancer. 

11 (8) Tobacco addiction and exposure to other 

12 lung cancer carcinogens such as Agent Orange and 

13 other herbicides and battlefield emissions are serious 

14 problems among military personnel and war vet15 erans. 

16 (9) Significant and rapid improvements in lung 

17 cancer mortality can be expected through greater 

18 use and access to lung cancer screening tests for at19 risk individuals. 

20 (10) Recent research has shown that screening 

21 with low-dose computed tomography scan reduced 

22 lung cancer death mortality by 20 percent for those 

23 with a high risk of lung cancer through early detec24 tion. The Centers for Medicare & Medicaid Services 


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1 supports annual lung cancer screening for high-risk 

2 patients with low-dose computed tomography. 

3 (11) Additional strategies are necessary to fur4 ther enhance the existing tests and therapies avail5 able to diagnose and treat lung cancer in the future. 

6 (12) The August 2001 Report of the Lung 

7 Cancer Progress Review Group of the National Can8 cer Institute stated that funding for lung cancer re9 search was ‘‘far below the levels characterized for 

10 other common malignancies and far out of propor11 tion to its massive health impact’’. 

12 (13) The Report of the Lung Cancer Progress 

13 Review Group identified as its ‘‘highest priority’’ the 

14 creation of integrated, multidisciplinary, multi-insti15 tutional research consortia organized around the 

16 problem of lung cancer rather than around specific 

17 research disciplines. 

18 (14) The United States must enhance its re19 sponse to the issues raised in the Report of the 

20 Lung Cancer Progress Review Group, and this can 

21 be accomplished through the establishment of a co22 ordinated effort designed to reduce the lung cancer 

23 mortality rate by 50 percent by 2023 and targeted 

24 funding to support this coordinated effort. 


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1 (b) SENSE OF CONGRESS CONCERNING INVESTMENT

2 IN LUNG CANCER RESEARCH.—It is the sense of the Con3 gress that— 

4 (1) lung cancer mortality reduction should be 

5 made a national public health priority; and 

6 (2) a comprehensive mortality reduction pro7 gram coordinated by the Secretary of Health and 

8 Human Services is justified and necessary to ade9 quately address and reduce lung cancer mortality. 

10 (c) LUNG CANCER MORTALITY REDUCTION PRO11 GRAM.— 

12 (1) IN GENERAL.—Subpart 1 of part C of title 

13 IV of the Public Health Service Act (42 U.S.C. 285 

14 et seq.) is amended by adding at the end the fol15 lowing: 

16 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO17 GRAM. 

18 ‘‘(a) IN GENERAL.—Not later than 6 months after 

19 the date of the enactment of the Health Equity and Ac20 countability Act of 2022, the Secretary, in consultation 

21 with the Secretary of Defense, the Secretary of Veterans 

22 Affairs, the Director of the National Institutes of Health, 

23 the Director of the Centers for Disease Control and Pre24 vention, the Commissioner of Food and Drugs, the Admin25 istrator of the Centers for Medicare & Medicaid Services, 


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1 the Director of the National Institute on Minority Health 

2 and Health Disparities, the Administrator of the Environ3 mental Protection Agency, and other members of the 

4 Lung Cancer Advisory Board established under section 

5 7001 of the Health Equity and Accountability Act of 

6 2022, shall implement a comprehensive program, to be 

7 known as the Lung Cancer Mortality Reduction Program, 

8 to achieve a reduction of at least 25 percent in the mor9 tality rate of lung cancer by 2027. 

10 ‘‘(b) REQUIREMENTS.—The Program shall include at 

11 least the following: 

12 ‘‘(1) With respect to the National Institutes of 

13 Health— 

14 ‘‘(A) a strategic review and prioritization 

15 by the National Cancer Institute of research 

16 grants to achieve the goal specified in sub17 section (a); 

18 ‘‘(B) the provision of funds to enable the 

19 Airway Biology and Disease Branch of the Na20 tional Heart, Lung, and Blood Institute to ex21 pand its research programs to include pre22 dispositions to lung cancer, the interrelationship 

23 between lung cancer and other pulmonary and 

24 cardiac disease, and the diagnosis and treat25 ment of such diseases; 


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1 ‘‘(C) the provision of funds to enable the 

2 National Institute of Biomedical Imaging and 

3 Bioengineering to expedite the development of 

4 computer-assisted diagnostic, surgical, treat5 ment, and drug-testing innovations to reduce 

6 lung cancer mortality, such as through expan7 sion of the Institute’s Quantum Grant Program 

8 and Image-Guided Interventions program; and 

9 ‘‘(D) the provision of funds to enable the 

10 National Institute of Environmental Health 

11 Sciences to implement research programs rel12 ative to the lung cancer incidence. 

13 ‘‘(2) With respect to the Food and Drug Ad14 ministration— 

15 ‘‘(A) activities under section 529B of the 

16 Federal Food, Drug, and Cosmetic Act; and 

17 ‘‘(B) activities under section 561 of the 

18 Federal Food, Drug, and Cosmetic Act to ex19 pand access to investigational drugs and devices 

20 for the diagnosis, monitoring, or treatment of 

21 lung cancer. 

22 ‘‘(3) With respect to the Centers for Disease 

23 Control and Prevention, the establishment of an 

24 early disease research and management program 

25 under section 1511. 


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1 ‘‘(4) With respect to the Agency for Healthcare 

2 Research and Quality, the conduct of a biannual re3 view of lung cancer screening, diagnostic, and treat4 ment protocols, and the issuance of updated guide5 lines. 

6 ‘‘(5) The promotion (including education) of 

7 lung cancer screening within minority and rural pop8 ulations and the study of the effectiveness of efforts 

9 to increase such screening. 

10 ‘‘(6) The cooperation and coordination of all 

11 minority and health disparity programs within the 

12 Department of Health and Human Services to en13 sure that all aspects of the Lung Cancer Mortality 

14 Reduction Program under this section adequately 

15 address the burden of lung cancer on minority and 

16 rural populations. 

17 ‘‘(7) The cooperation and coordination of all to18 bacco control and cessation programs within agen19 cies of the Department of Health and Human Serv20 ices to achieve the goals of the Lung Cancer Mor21 tality Reduction Program under this section with 

22 particular emphasis on the coordination of drug and 

23 other cessation treatments with early detection pro24 tocols.’’. 


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1 (2) FEDERAL FOOD, DRUG, AND COSMETIC

2 ACT.—Subchapter B of chapter V of the Federal 

3 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 

4 seq.) is amended by adding at the end the following: 

5 ‘‘SEC. 529B. DRUGS RELATING TO LUNG CANCER. 

6 ‘‘(a) IN GENERAL.—The provisions of this sub7 chapter shall apply to a drug described in subsection (b) 

8 to the same extent and in the same manner as such provi9 sions apply to a drug for a rare disease or condition (as 

10 defined in section 526). 

11 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 

12 subsection is— 

13 ‘‘(1) a chemoprevention drug for precancerous 

14 conditions of the lung; 

15 ‘‘(2) a drug for targeted therapeutic treat16 ments, including any vaccine, for lung cancer; or 

17 ‘‘(3) a drug to curtail or prevent nicotine addic18 tion. 

19 ‘‘(c) BOARD.—The Board established under section 

20 7001 of the Health Equity and Accountability Act of 2022 

21 shall monitor the program implemented under this sec22 tion.’’. 

23 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec24 tion 561(e) of the Federal Food, Drug, and Cos25 metic Act (21 U.S.C. 360bbb(e)) is amended by inVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01181 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 serting before the period the following: ‘‘and shall 

2 include expanding access to drugs under section 

3 529B, with substantial consideration being given to 

4 whether the totality of information available to the 

5 Secretary regarding the safety and effectiveness of 

6 an investigational drug, as compared to the risk of 

7 morbidity and death from the disease, indicates that 

8 a patient may obtain more benefit than risk if treat9 ed with the drug’’. 

10 (4) CDC.—Title XV of the Public Health Serv11 ice Act (42 U.S.C. 300k et seq.) is amended by add12 ing at the end the following: 

13 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 

14 PROGRAM. 

15 ‘‘The Secretary shall establish and implement an 

16 early disease research and management program targeted 

17 at the high incidence and mortality rates of lung cancer 

18 among minority and low-income populations.’’. 

19 (d) DEPARTMENT OF DEFENSE AND DEPARTMENT

20 OF VETERANS AFFAIRS.—The Secretary of Defense and 

21 the Secretary of Veterans Affairs, each in coordination 

22 with the Secretary of Health and Human Services, shall 

23 engage— 

24 (1) in the implementation within the Depart25 ment of Defense and the Department of Veterans 


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1 Affairs, as the case may be, of an early detection 

2 and disease management research program for mem3 bers of the Armed Forces and veterans whose smok4 ing history and exposure to carcinogens during serv5 ice on active duty in the Armed Forces has increased 

6 their risk for lung cancer; and 

7 (2) in the implementation of coordinated care 

8 programs for members of the Armed Forces and vet9 erans diagnosed with lung cancer. 

10 (e) LUNG CANCER ADVISORY BOARD.— 

11 (1) IN GENERAL.—The Secretary of Health and 

12 Human Services shall convene a Lung Cancer Advi13 sory Board (referred to in this section as the 

14 ‘‘Board’’)— 

15 (A) to monitor the programs established 

16 under this section (and the amendments made 

17 by this section); and 

18 (B) to provide annual reports to the Con19 gress concerning benchmarks, expenditures, 

20 lung cancer statistics, and the public health im21 pact of such programs. 

22 (2) COMPOSITION.—The Board shall be com23 posed of— 

24 (A) the Secretary of Health and Human 

25 Services; 


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1 (B) the Secretary of Defense; 

2 (C) the Secretary of Veterans Affairs; and 

3 (D) 2 representatives each from the fields 

4 of clinical medicine focused on lung cancer, 

5 lung cancer research, imaging, drug develop6 ment, and lung cancer advocacy, to be ap7 pointed by the Secretary of Health and Human 

8 Services. 

9 (f) AUTHORIZATION OF APPROPRIATIONS.— 

10 (1) IN GENERAL.—To carry out this section 

11 (and the amendments made by this section), there 

12 are authorized to be appropriated $75,000,000 for 

13 fiscal year 2023 and such sums as may be necessary 

14 for each of fiscal years 2024 through 2026. 

15 (2) LUNG CANCER MORTALITY REDUCTION PRO16 GRAM.—The amounts appropriated under paragraph 

17 (1) shall be allocated as follows: 

18 (A) $25,000,000 for fiscal year 2023, and 

19 such sums as may be necessary for each of fis20 cal years 2024 through 2026, for the activities 

21 described in section 417H(b)(1)(B) of the Pub22 lic Health Service Act, as added by subsection 

23 (d); 

24 (B) $25,000,000 for fiscal year 2023, and 

25 such sums as may be necessary for each of fisVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01184 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 cal years 2024 through 2026, for the activities 

2 described in section 417H(b)(1)(C) of the Pub3 lic Health Service Act; 

4 (C) $10,000,000 for fiscal year 2023, and 

5 such sums as may be necessary for each of fis6 cal years 2024 through 2026, for the activities 

7 described in section 417H(b)(1)(D) of the Pub8 lic Health Service Act; and 

9 (D) $15,000,000 for fiscal year 2023, and 

10 such sums as may be necessary for each of fis11 cal years 2024 through 2026, for the activities 

12 described in section 417H(b)(3) of the Public 

13 Health Service Act. 

14 SEC. 7002. EXPANSION OF PROSTATE CANCER RESEARCH, 

15 OUTREACH, SCREENING, TESTING, ACCESS, 

16 AND TREATMENT EFFECTIVENESS. 

17 (a) FINDINGS.—Congress makes the following find18 ings: 

19 (1) Prostate cancer is the second leading cause 

20 of cancer death among men. 

21 (2) In 2020, an estimated 191,930 individuals 

22 in the United States will be diagnosed with prostate 

23 cancer and approximately 33,330 will die from the 

24 disease. 


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1 (3) Roughly 2,000,000 to 3,000,000 people in 

2 the United States are living with a diagnosis of pros3 tate cancer and its consequences. 

4 (4) Although prostate cancer generally affects 

5 older individuals, younger men are also at risk for 

6 the disease, and when prostate cancer appears in 

7 early middle age, it frequently takes on a more ag8 gressive form. 

9 (5) There are significant racial and ethnic dis10 parities that demand attention, for example, African 

11 Americans have prostate cancer mortality rates that 

12 are more than double those in the White population. 

13 (6) Underserved rural populations have higher 

14 rates of mortality compared to their urban counter15 parts, and innovative and cost-efficient methods to 

16 improve rural access to high-quality care should take 

17 advantage of advances in telehealth to diagnose and 

18 treat prostate cancer when appropriate. 

19 (7) Certain populations of veterans may have 

20 nearly twice the incidence of prostate cancer as the 

21 general population of the United States. 

22 (8) Urologists may constitute the specialists 

23 who diagnose and treat the vast majority of prostate 

24 cancer patients. 


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1 (9) Although much basic and translational re2 search has been completed and much is currently 

3 known, there are still many unanswered questions, 

4 such as the extent to which known disparities are at5 tributable to disease etiology, access to care, or edu6 cation and awareness in the community. 

7 (10) Causes of prostate cancer are not known. 

8 There is not good information regarding how to dif9 ferentiate accurately, early on, between aggressive 

10 and indolent forms of the disease. As a result, there 

11 is significant overtreatment in prostate cancer. 

12 There are no treatments that can durably arrest 

13 growth or cure prostate cancer once it has metasta14 sized. 

15 (11) A significant proportion of cases may be 

16 clinically indolent and overdiagnosed, resulting in 

17 significant overtreatment. More accurate tests will 

18 allow men and their families to face less physical, 

19 psychological, financial, and emotional trauma, and 

20 billions of dollars could be saved in private and pub21 lic health care systems. 

22 (12) Prostate cancer research and health care 

23 programs across Federal agencies should be coordi24 nated to improve accountability and actively encour25 age the translation of research into practice and to 


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1 identify and implement best practices in order to 

2 foster an integrated and consistent focus on effective 

3 prevention, diagnosis, and treatment of the disease. 

4 (b) PROSTATE CANCER COORDINATION AND EDU5 CATION.— 

6 (1) INTERAGENCY PROSTATE CANCER COORDI7 NATION AND EDUCATION TASK FORCE.—Not later 

8 than 180 days after the date of the enactment of 

9 this Act, the Secretary of Veterans Affairs, in co10 operation with the Secretary of Defense and the Sec11 retary of Health and Human Services, shall estab12 lish an Interagency Prostate Cancer Coordination 

13 and Education Task Force (in this section referred 

14 to as the ‘‘Prostate Cancer Task Force’’). 

15 (2) DUTIES.—The Prostate Cancer Task Force 

16 shall— 

17 (A) develop a summary of advances in 

18 prostate cancer research supported or con19 ducted by Federal agencies relevant to the diag20 nosis, prevention, and treatment of prostate 

21 cancer, including psychosocial impairments re22 lated to prostate cancer treatment, and compile 

23 a list of best practices that warrant broader 

24 adoption in health care programs; 


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1 (B) consider establishing, and advocating 

2 for, a guidance to enable physicians to allow 

3 screening of men who are age 74 or older, on 

4 a case-by-case basis, taking into account quality 

5 of life and family history of prostate cancer; 

6 (C) share and coordinate information on 

7 research and health care program activities by 

8 the Federal Government, including activities re9 lated to— 

10 (i) determining how to improve re11 search and health care programs, including 

12 psychosocial impairments related to pros13 tate cancer treatment; 

14 (ii) identifying any gaps in the overall 

15 research inventory and in health care pro16 grams; 

17 (iii) identifying opportunities to pro18 mote translation of research into practice; 

19 and 

20 (iv) maximizing the effects of Federal 

21 Government efforts by identifying opportu22 nities for collaboration and leveraging of 

23 resources in research and health care pro24 grams that serve individuals who are susVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01189 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ceptible to or diagnosed with prostate can2 cer; 

3 (D) develop a comprehensive interagency 

4 strategy and advise relevant Federal agencies in 

5 the solicitation of proposals for collaborative, 

6 multidisciplinary research and health care pro7 grams, including proposals to evaluate factors 

8 that may be related to the etiology of prostate 

9 cancer, that would— 

10 (i) result in innovative approaches to 

11 study emerging scientific opportunities or 

12 eliminate knowledge gaps in research to 

13 improve the prostate cancer research port14 folio of the Federal Government; and 

15 (ii) outline key research questions, 

16 methodologies, and knowledge gaps; 

17 (E) develop a coordinated message related 

18 to screening and treatment for prostate cancer 

19 to be reflected in educational and beneficiary 

20 materials for Federal health programs as such 

21 materials are updated; and 

22 (F) not later than two years after the date 

23 of the establishment of the Prostate Cancer 

24 Task Force, submit to the expert advisory pan25 els appointed under paragraph (4) to be reVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01190 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 viewed and returned within 30 days, and then 

2 within 90 days submitted to Congress, rec3 ommendations— 

4 (i) regarding any appropriate changes 

5 to research and health care programs, in6 cluding recommendations to improve the 

7 research portfolio of the Department of 

8 Veterans Affairs, the Department of De9 fense, the National Institutes of Health, 

10 and other Federal agencies to ensure that 

11 scientifically based strategic planning is 

12 implemented in support of research and 

13 health care program priorities; 

14 (ii) designed to ensure that the re15 search and health care programs and ac16 tivities of the Department of Veterans Af17 fairs, the Department of Defense, the De18 partment of Health and Human Services, 

19 and other Federal agencies are free of un20 necessary duplication; 

21 (iii) regarding public participation in 

22 decisions relating to prostate cancer re23 search and health care programs to in24 crease the involvement of patient advo25 cates, community organizations, and medVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01191 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ical associations representing a broad geo2 graphical area; 

3 (iv) on how to best disseminate infor4 mation on prostate cancer research and 

5 progress achieved by health care programs; 

6 (v) on how to expand partnerships be7 tween public entities, including Federal 

8 agencies, and private entities to encourage 

9 collaborative, cross-cutting research and 

10 health care delivery; 

11 (vi) assessing any cost savings and ef12 ficiencies realized through the efforts iden13 tified in, and supported through, this sub14 section and recommending expansion of 

15 those efforts that have proved most prom16 ising while also ensuring against any con17 flicts in directives in law; 

18 (vii) identifying key priority action 

19 items from among the recommendations 

20 specified in clauses (i) through (vi); and 

21 (viii) with respect to the level of fund22 ing needed by each agency to implement 

23 such recommendations. 

24 (3) MEMBERS OF THE PROSTATE CANCER TASK

25 FORCE.—The Prostate Cancer Task Force shall be 


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1 composed of representatives from such Federal agen2 cies as the head of each such applicable agency de3 termines necessary, so as to coordinate a uniform 

4 message relating to prostate cancer screening and 

5 treatment where appropriate, including representa6 tives of each of the following: 

7 (A) The Department of Veterans Affairs, 

8 including representatives of each relevant pro9 gram area of the Department of Veterans Af10 fairs. 

11 (B) The Prostate Cancer Research Pro12 gram of the Congressionally Directed Medical 

13 Research Program of the Department of De14 fense. 

15 (C) The Department of Health and 

16 Human Services, including, at a minimum, rep17 resentatives of each of the following: 

18 (i) The National Institutes of Health. 

19 (ii) National research institutes and 

20 centers, including the National Cancer In21 stitute, the National Institute of Allergy 

22 and Infectious Diseases, and the Office of 

23 Minority Health. 

24 (iii) The Centers for Medicare & Med25 icaid Services. 


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1 (iv) The Food and Drug Administra2 tion. 

3 (v) The Centers for Disease Control 

4 and Prevention. 

5 (vi) The Agency for Healthcare Re6 search and Quality. 

7 (vii) The Health Resources and Serv8 ices Administration. 

9 (4) APPOINTING EXPERT ADVISORY PANELS.— 

10 The Prostate Cancer Task Force shall appoint ex11 pert advisory panels, as the task force determines 

12 appropriate, to provide input and concurrence 

13 from— 

14 (A) individuals and organizations from the 

15 medical, prostate cancer patient and advocate, 

16 research, and delivery communities with exper17 tise in prostate cancer diagnosis, treatment, 

18 and research, including practicing urologists, 

19 primary care providers, and others; and 

20 (B) individuals with expertise in education 

21 and outreach to underserved populations af22 fected by prostate cancer. 

23 (5) MEETINGS.—The Prostate Cancer Task 

24 Force shall convene not less frequently than twice 


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1 each year, or more frequently as the Secretary of 

2 Veterans Affairs determines to be appropriate. 

3 (6) FEDERAL ADVISORY COMMITTEE ACT.—The 

4 Federal Advisory Committee Act (5 U.S.C. App.) 

5 shall apply to the Prostate Cancer Task Force. 

6 (7) SUNSET DATE.—The Prostate Cancer Task 

7 Force shall terminate on September 30, 2025. 

8 (c) PROSTATE CANCER RESEARCH.— 

9 (1) RESEARCH COORDINATION PROGRAM.— 

10 (A) IN GENERAL.—The Secretary of Vet11 erans Affairs, in coordination with the Sec12 retary of Defense and the Secretary of Health 

13 and Human Services, shall establish and carry 

14 out a program to coordinate and intensify pros15 tate cancer research. 

16 (B) ELEMENTS.—The program established 

17 under subparagraph (A) shall— 

18 (i) develop advances in diagnostic and 

19 prognostic methods and tests, including 

20 biomarkers and an improved prostate can21 cer screening blood test, including improve22 ments or alternatives to the prostate spe23 cific antigen test and additional tests to 

24 distinguish indolent from aggressive dis25 ease; 


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1 (ii) develop a better understanding of 

2 the etiology of the disease (including an 

3 analysis of lifestyle factors proven to be in4 volved in higher rates of prostate cancer, 

5 such as obesity and diet, and in different 

6 ethnic, racial, and socioeconomic groups, 

7 such as the African-American, Latino or 

8 Hispanic, and American Indian popu9 lations and men with a family history of 

10 prostate cancer) to improve prevention ef11 forts; 

12 (iii) expand basic research into pros13 tate cancer, including studies of funda14 mental molecular and cellular mechanisms; 

15 (iv) identify and provide clinical test16 ing of novel agents for the prevention and 

17 treatment of prostate cancer; 

18 (v) establish clinical registries for 

19 prostate cancer; 

20 (vi) use the National Institute of Bio21 medical Imaging and Bioengineering and 

22 the National Cancer Institute for assess23 ment of appropriate imaging modalities; 

24 and 


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1 (vii) address such other matters relat2 ing to prostate cancer research as may be 

3 identified by the Federal agencies partici4 pating in such program. 

5 (C) UNDERSERVED MINORITY GRANT PRO6 GRAM.—In carrying out the program estab7 lished under subparagraph (A), the Secretary 

8 shall— 

9 (i) award grants to eligible entities to 

10 carry out components of the research out11 lined in subparagraph (B); 

12 (ii) integrate and build upon existing 

13 knowledge gained from comparative effec14 tiveness research; and 

15 (iii) recognize and address— 

16 (I) the racial and ethnic dispari17 ties in the incidence and mortality 

18 rates of prostate cancer and men with 

19 a family history of prostate cancer; 

20 (II) any barriers in access to care 

21 and participation in clinical trials that 

22 are specific to racial, ethnic, and other 

23 underserved minorities and men with 

24 a family history of prostate cancer; 


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1 (III) outreach and educational ef2 forts to raise awareness among the 

3 populations described in subclause 

4 (II); and 

5 (IV) appropriate access and utili6 zation of imaging modalities. 

7 (2) PROSTATE CANCER ADVISORY BOARD.— 

8 (A) IN GENERAL.—There is established in 

9 the Office of the Chief Scientist of the Food 

10 and Drug Administration a Prostate Cancer 

11 Scientific Advisory Board. 

12 (B) DUTIES.—The board established under 

13 subparagraph (A) shall be responsible for accel14 erating real-time sharing of the latest research 

15 data and accelerating movement of new medi16 cines for the treatment of prostate cancer to 

17 patients. 

18 (d) TELEHEALTH AND RURAL ACCESS PILOT

19 PROJECTS.— 

20 (1) ESTABLISHMENT OF PILOT PROJECTS.— 

21 (A) IN GENERAL.—The Secretary of Vet22 erans Affairs, in cooperation with the Secretary 

23 of Defense and the Secretary of Health and 

24 Human Services (referred to in this subsection 

25 collectively as the ‘‘Secretaries’’) shall establish 


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1 four-year telehealth pilot projects for the pur2 pose of analyzing the clinical outcomes and 

3 cost-effectiveness associated with telehealth 

4 services in a variety of geographic areas that 

5 contain high proportions of medically under6 served populations, including African Ameri7 cans, Latinos or Hispanics, American Indians 

8 or Alaska Natives, and those in rural areas. 

9 (B) EFFICIENT AND EFFECTIVE CARE.— 

10 Pilot projects established under subparagraph 

11 (A) shall promote efficient use of specialist care 

12 through better coordination of primary care and 

13 physician extender teams in underserved areas 

14 and more effectively employ tumor boards to 

15 better counsel patients. 

16 (2) ELIGIBLE ENTITIES.— 

17 (A) IN GENERAL.—The Secretaries shall 

18 select eligible entities to participate in the pilot 

19 projects established under this subsection. 

20 (B) PRIORITY.—In selecting eligible enti21 ties to participate in the pilot projects under 

22 this subsection, the Secretaries shall give pri23 ority to entities located in medically under24 served areas, particularly those that include Af25 rican Americans, Latinos and Hispanics, and 


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1 facilities of the Indian Health Service, including 

2 facilities operated by the Indian Health Service, 

3 tribally operated facilities, and facilities admin4 istered by an Urban Indian organization (as de5 fined in section 4 of the Indian Health Care 

6 Improvement Act (25 U.S.C. 1603)) pursuant 

7 to title V of that Act (25 U.S.C. 1651 et seq.), 

8 and those in rural areas. 

9 (3) EVALUATION.—The Secretaries shall, 

10 through the pilot projects established under this sub11 section, evaluate— 

12 (A) the effective and economic delivery of 

13 care in diagnosing and treating prostate cancer 

14 with the use of telehealth services in medically 

15 underserved and Tribal areas including collabo16 rative uses of health professionals and integra17 tion of the range of telehealth and other tech18 nologies; 

19 (B) the effectiveness of improving the ca20 pacity of nonmedical providers and nonspecial21 ized medical providers to provide health services 

22 for prostate cancer in medically underserved 

23 and Tribal areas, including the exploration of 

24 innovative medical home models with collabora25 tion between urologists, other relevant medical 


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1 specialists, including oncologists, radiologists, 

2 and primary care teams, and coordination of 

3 care through the efficient use of primary care 

4 teams and physician extenders; and 

5 (C) the effectiveness of using telehealth 

6 services to provide prostate cancer treatment in 

7 medically underserved areas, including the use 

8 of tumor boards to facilitate better patient 

9 counseling. 

10 (4) REPORT.—Not later than one year after the 

11 completion of the pilot projects under this sub12 section, the Secretaries shall submit to Congress a 

13 report describing the outcomes of such pilot projects, 

14 including any cost savings and efficiencies realized, 

15 and providing recommendations, if any, for expand16 ing the use of telehealth services. 

17 (e) EDUCATION AND AWARENESS.— 

18 (1) CAMPAIGN.— 

19 (A) IN GENERAL.—The Secretary of Vet20 erans Affairs shall develop a national education 

21 campaign for prostate cancer. 

22 (B) ELEMENTS.—The campaign developed 

23 under subparagraph (A) shall involve the use of 

24 written educational materials and public service 

25 announcements consistent with the findings of 


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1 the Prostate Cancer Task Force under sub2 section (b) that are intended to encourage men 

3 to seek prostate cancer screening when appro4 priate. 

5 (2) RACIAL DISPARITIES AND THE POPULATION

6 OF MEN WITH A FAMILY HISTORY OF PROSTATE

7 CANCER.—In developing the campaign under para8 graph (1), the Secretary shall ensure that edu9 cational materials and public service announcements 

10 used in the campaign are more readily available in 

11 communities experiencing racial disparities in the in12 cidence and mortality rates of prostate cancer and to 

13 men of any race classification with a family history 

14 of prostate cancer. 

15 (3) GRANTS.—In carrying out the campaign 

16 under this subsection, the Secretary shall award 

17 grants to nonprofit private entities to enable such 

18 entities to test alternative outreach and education 

19 strategies. 

20 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

21 authorized to be appropriated to carry out this section for 

22 the period of fiscal years 2023 through 2027 an amount 

23 equal to the amount of savings for the Federal Govern24 ment projected to be achieved over such period by imple25 mentation of this section. 


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1 SEC. 7003. PROSTATE RESEARCH, IMAGING, AND MEN’S 

2 EDUCATION. 

3 (a) FINDINGS.—Congress makes the following find4 ings: 

5 (1) Prostate cancer has reached epidemic pro6 portions, particularly among African-American men, 

7 and strikes and kills men in numbers comparable to 

8 the number of women who lose their lives from 

9 breast cancer. 

10 (2) Life-saving breakthroughs in screening, di11 agnosis, and treatment of breast cancer resulted 

12 from the development of advanced imaging tech13 nologies led by the Federal Government. 

14 (3) Men should have accurate and affordable 

15 prostate cancer screening exams and minimally 

16 invasive treatment tools, similar to what women have 

17 for breast cancer. 

18 (4) While it is important for men to take ad19 vantage of current prostate cancer screening tech20 niques, a recent National Cancer Institute study 

21 demonstrated that the most common available meth22 ods of detecting prostate cancer (PSA blood test and 

23 physical exams) are not foolproof, causing numerous 

24 false alarms and false reassurances. 

25 (5) The absence of advanced imaging tech26 nologies for prostate cancer causes the lack of accuVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01203 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 rate information critical for clinical decisions, result2 ing in missed cancers and lost lives, as well as un3 necessary and costly medical procedures, with re4 lated complications. 

5 (6) With prostate imaging tools, men and their 

6 families would face less physical, psychological, fi7 nancial, and emotional trauma and billions of dollars 

8 could be saved in private and public health care sys9 tems. 

10 (b) RESEARCH AND DEVELOPMENT OF PROSTATE

11 CANCER IMAGING TECHNOLOGIES.— 

12 (1) EXPANSION OF RESEARCH.—The Secretary 

13 of Health and Human Services (referred to in this 

14 section as the ‘‘Secretary’’), acting through the Di15 rector of the National Institutes of Health and the 

16 Administrator of the Health Resources and Services 

17 Administration, and in consultation with the Sec18 retary of Defense, shall carry out a program to ex19 pand and intensify research to develop innovative 

20 advanced imaging technologies for prostate cancer 

21 detection, diagnosis, and treatment comparable to 

22 state-of-the-art mammography technologies. 

23 (2) EARLY STAGE RESEARCH.—In imple24 menting the program under paragraph (1), the Sec25 retary, acting through the Administrator of the 


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1 Health Resources and Services Administration, shall 

2 carry out a grant program to encourage the early 

3 stages of research in prostate imaging to develop 

4 and implement new ideas, proof of concepts, and 

5 pilot studies for high-risk technologic innovation in 

6 prostate cancer imaging that would have a high po7 tential impact for improving patient care, including 

8 individualized care, quality of life, and cost-effective9 ness. 

10 (3) LARGE SCALE LATER STAGE RESEARCH.— 

11 In implementing the program under paragraph (1), 

12 the Secretary, acting through the Director of the 

13 National Institutes of Health, shall utilize the Na14 tional Institute of Biomedical Imaging and Bio15 engineering and the National Cancer Institute for 

16 advanced stages of research in prostate imaging, in17 cluding technology development and clinical trials for 

18 projects determined by the Secretary to have dem19 onstrated promising preliminary results and proof of 

20 concept. 

21 (4) INTERDISCIPLINARY PRIVATE-PUBLIC PART22 NERSHIPS.—In developing the program under para23 graph (1), the Secretary, acting through the Admin24 istrator of the Health Resources and Services Ad25 ministration, shall establish interdisciplinary privateVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01205 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 public partnerships to develop and implement re2 search strategies for expedited innovation in imaging 

3 and image-guided treatment and to conduct such re4 search. 

5 (5) RACIAL DISPARITIES.—In developing the 

6 program under paragraph (1), the Secretary shall 

7 recognize and address— 

8 (A) the racial disparities in the incidences 

9 of prostate cancer and mortality rates with re10 spect to such disease; and 

11 (B) any barriers in access to care and par12 ticipation in clinical trials that are specific to 

13 racial minorities. 

14 (6) AUTHORIZATION OF APPROPRIATIONS.— 

15 (A) IN GENERAL.—Subject to subpara16 graph (B), there is authorized to be appro17 priated to carry out this subsection, 

18 $100,000,000 for each of fiscal years 2023 

19 through 2027. 

20 (B) SPECIFIC ALLOCATIONS.—Of the 

21 amount authorized to be appropriated under 

22 subparagraph (A) for each of the fiscal years 

23 described in such subparagraph— 


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1 (i) no less than 10 percent may be 

2 used to carry out the grant program under 

3 paragraph (2); and 

4 (ii) no more than 1 percent may be 

5 used to carry out paragraph (4). 

6 (c) PUBLIC AWARENESS AND EDUCATION CAM7 PAIGN.— 

8 (1) NATIONAL CAMPAIGN.—The Secretary shall 

9 carry out a national campaign to increase the aware10 ness and knowledge of individuals in the United 

11 States with respect to the need for prostate cancer 

12 screening and for improved detection technologies. 

13 (2) REQUIREMENTS.—The national campaign 

14 conducted under this subsection shall include— 

15 (A) roles for the Health Resources Services 

16 Administration, the Office of Minority Health 

17 of the Department of Health and Human Serv18 ices, the Centers for Disease Control and Pre19 vention, and the Office of Minority Health and 

20 Health Equity of the Centers for Disease Con21 trol and Prevention; and 

22 (B) the development and distribution of 

23 written educational materials, and the develop24 ment and placing of public service announce25 ments, that are intended to encourage men to 


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1 seek prostate cancer screening and to create 

2 awareness of the need for improved imaging 

3 technologies for prostate cancer screening and 

4 diagnosis, including in-vitro blood testing and 

5 imaging technologies. 

6 (3) RACIAL DISPARITIES.—In developing the 

7 national campaign under paragraph (1), the Sec8 retary shall recognize and address— 

9 (A) the racial disparities in the incidences 

10 of prostate cancer and mortality rates with re11 spect to such disease; and 

12 (B) any barriers in access to care and par13 ticipation in clinical trials that are specific to 

14 racial minorities. 

15 (4) GRANTS.—The Secretary shall establish a 

16 program to award grants to nonprofit private enti17 ties to enable such entities to test alternative out18 reach and education strategies to increase the 

19 awareness and knowledge of individuals in the 

20 United States with respect to the need for prostate 

21 cancer screening and improved imaging technologies. 

22 (5) AUTHORIZATION OF APPROPRIATIONS.— 

23 There is authorized to be appropriated to carry out 

24 this subsection $10,000,000 for each of fiscal years 

25 2023 through 2027. 


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1 (d) IMPROVING PROSTATE CANCER SCREENING

2 BLOOD TESTS.— 

3 (1) IN GENERAL.—The Secretary, in coordina4 tion with the Secretary of Defense, shall support re5 search to develop an improved prostate cancer 

6 screening blood test using in-vitro detection. 

7 (2) AUTHORIZATION OF APPROPRIATIONS.— 

8 There is authorized to be appropriated to carry out 

9 this subsection, $20,000,000 for each of fiscal years 

10 2023 through 2027. 

11 (e) REPORTING AND COMPLIANCE.— 

12 (1) REPORT AND STRATEGY.—Not later than 

13 12 months after the date of the enactment of this 

14 Act, the Secretary shall submit to Congress a report 

15 that details the strategy of the Secretary for imple16 menting the requirements of this section and the 

17 status of such efforts. 

18 (2) FULL COMPLIANCE.—Not later than 36 

19 months after the date of the enactment of this Act, 

20 and annually thereafter, the Secretary shall submit 

21 to Congress a report that— 

22 (A) describes the research and development 

23 and public awareness and education campaigns 

24 funded under this section; 


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1 (B) provides evidence that projects involv2 ing high-risk, high-impact technologic innova3 tion, proof of concept, and pilot studies are 

4 prioritized; 

5 (C) provides evidence that the Secretary 

6 recognizes and addresses any barriers in access 

7 to care and participation in clinical trials that 

8 are specific to racial minorities in the imple9 mentation of this section; 

10 (D) contains assurances that all the other 

11 provisions of this section are fully implemented; 

12 and 

13 (E) certifies compliance with the provisions 

14 of this section, or in the case of a Federal agen15 cy that has not complied with any of such pro16 visions, an explanation as to such failure to 

17 comply. 

18 SEC. 7004. PROSTATE CANCER DETECTION RESEARCH AND 

19 EDUCATION. 

20 (a) PLAN TO DEVELOP AND VALIDATE A TEST OR

21 TESTS FOR PROSTATE CANCER.— 

22 (1) IN GENERAL.—The Secretary of Health and 

23 Human Services (referred to in this section as the 

24 ‘‘Secretary’’), acting through the Director of the Na25 tional Institutes of Health, shall establish an adviVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01210 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 sory council on prostate cancer (referred to in this 

2 section as the ‘‘advisory council’’) to draft a plan for 

3 the development and validation of an accurate test 

4 or tests, such as biomarkers or imaging, to detect 

5 and diagnose prostate cancer. 

6 (2) ADVISORY COUNCIL.— 

7 (A) MEMBERSHIP.— 

8 (i) FEDERAL MEMBERS.—The advi9 sory council shall be composed of the fol10 lowing experts: 

11 (I) A designee of the Centers for 

12 Disease Control and Prevention. 

13 (II) A designee of the Centers for 

14 Medicare & Medicaid Services. 

15 (III) A designee of the Office of 

16 the Director of the National Cancer 

17 Institute. 

18 (IV) A designee of the Director 

19 of the Department of Defense Con20 gressionally Directed Medical Re21 search Programs. 

22 (V) A designee of the Director of 

23 the National Institute of Biomedical 

24 Imaging and Bioengineering. 


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1 (VI) A designee of the Director 

2 of the National Institute of General 

3 Medical Sciences. 

4 (VII) A designee of the Director 

5 of the National Institute on Minority 

6 Health and Health Disparities. 

7 (VIII) A designee of the Director 

8 of the National Institutes of Health. 

9 (IX) A designee of the Commis10 sioner of Food and Drugs. 

11 (X) A designee of the Director of 

12 the Agency for Healthcare Research 

13 and Quality. 

14 (XI) A designee of the Director 

15 of the Telemedicine and Advanced 

16 Technology Research Center of the 

17 Department of Defense. 

18 (ii) NON-FEDERAL MEMBERS.—In ad19 dition to the members described in clause 

20 (i), the advisory council shall include 8 ex21 pert members from outside the Federal 

22 Government to be appointed by the Sec23 retary, which shall include— 

24 (I) 2 prostate cancer patient ad25 vocates; 


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1 (II) 2 health care providers with 

2 a range of expertise and experience in 

3 prostate cancer; and 

4 (III) 4 leading researchers with 

5 prostate cancer-related expertise in a 

6 range of clinical disciplines. 

7 (B) MEETINGS.—The advisory council 

8 shall meet quarterly and such meetings shall be 

9 open to the public. 

10 (C) ADVICE.—The advisory council shall 

11 advise the Secretary, or the Secretary’s des12 ignee. 

13 (D) ANNUAL REPORT.—Not later than 1 

14 year after the date of enactment of this Act, the 

15 advisory council shall provide to the Secretary, 

16 or the Secretary’s designee, and Congress— 

17 (i) an initial evaluation of all federally 

18 funded efforts in prostate cancer research 

19 relating to the development and validation 

20 of an accurate test or tests to detect and 

21 diagnose prostate cancer; 

22 (ii) a plan for the development and 

23 validation of a reliable test or tests for the 

24 detection and accurate diagnosis of pros25 tate cancer; and 


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1 (iii) a set of standards for prostate 

2 cancer screening, developed in coordination 

3 with the United States Preventive Services 

4 Task Force, to ensure that any tools for 

5 screening, detection, and diagnosis devel6 oped in accordance with the plan under 

7 clause (ii) will meet the requirements of 

8 the Task Force for recommendation as a 

9 proven preventive or diagnostic service. 

10 (E) TERMINATION.—The advisory council 

11 shall terminate on December 31, 2026. 

12 (3) FUNDING.—Notwithstanding any other pro13 vision of law, the Secretary may make available 

14 $1,000,000, from any unobligated amounts appro15 priated to the National Institutes of Health, for each 

16 of fiscal years 2023 through 2027 to carry out this 

17 subsection. 

18 (b) COORDINATION AND INTENSIFICATION OF PROS19 TATE CANCER RESEARCH.— 

20 (1) IN GENERAL.—The Director of the National 

21 Institutes of Health, in consultation with the Sec22 retary of Defense, shall coordinate and intensify re23 search in accordance with the plan provided under 

24 subsection (a)(2)(D)(ii), with particular attention 

25 provided to leveraging existing research to develop 


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1 and validate a test or tests, such as biomarkers or 

2 imaging, to detect and accurately diagnose prostate 

3 cancer in order to improve quality of life for millions 

4 of individuals in the United States, and decrease 

5 health care system costs. 

6 (2) FUNDING.—Notwithstanding any other pro7 vision of law, the Secretary may make available 

8 $30,000,000, from any unobligated amounts appro9 priated to the National Institutes of Health, for each 

10 of fiscal years 2024 through 2028 to carry out this 

11 subsection. 

12 SEC. 7005. NATIONAL PROSTATE CANCER COUNCIL. 

13 (a) NATIONAL PROSTATE CANCER COUNCIL.— 

14 (1) ESTABLISHMENT.—There is established in 

15 the Office of the Secretary of Health and Human 

16 Services (referred to in this section as the ‘‘Sec17 retary’’) the National Prostate Cancer Council on 

18 Screening, Early Detection, Assessment, and Moni19 toring of Prostate Cancer (referred to in this section 

20 as the ‘‘Council’’). 

21 (2) PURPOSE OF THE COUNCIL.—The Council 

22 shall— 

23 (A) develop and implement a national stra24 tegic plan for the accelerated creation, advance25 ment, and testing of diagnostic tools to improve 


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1 screening, early detection, assessment, and 

2 monitoring of prostate cancer, including— 

3 (i) early detection of aggressive pros4 tate cancer to save lives; 

5 (ii) monitoring of tumor response to 

6 treatment, including recurrence and pro7 gression; and 

8 (iii) accurate assessment and surveil9 lance of indolent disease to reduce unnec10 essary biopsies and treatment; 

11 (B) provide information and coordination 

12 of prostate cancer research and services across 

13 all Federal agencies; 

14 (C) review diagnostic tools and their over15 all effectiveness at screening, detecting, assess16 ing, and monitoring of prostate cancer; 

17 (D) evaluate all programs in prostate can18 cer that are in existence on the date of enact19 ment of this Act, including Federal budget re20 quests and approvals and public-private part21 nerships; 

22 (E) submit an annual report to the Sec23 retary and Congress on the creation and imple24 mentation of the national strategic plan under 

25 subparagraph (A); and 


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1 (F) ensure the inclusion of men at high 

2 risk for prostate cancer, including men from 

3 minority ethnic and racial populations and men 

4 who are least likely to receive care, in clinical, 

5 research, and service efforts, with the purpose 

6 of decreasing health disparities. 

7 (3) MEMBERSHIP.— 

8 (A) FEDERAL MEMBERS.—The Council 

9 shall be led by the Secretary or the Secretary’s 

10 designee and composed of the following experts: 

11 (i) Two representatives of the Na12 tional Institutes of Health, including 1 rep13 resentative of the National Institute of 

14 Biomedical Imaging and Bioengineering 

15 and 1 representative of the National Can16 cer Institute. 

17 (ii) A representative of the Centers 

18 for Disease Control and Prevention. 

19 (iii) A representative of the Centers 

20 for Medicare & Medicaid Services. 

21 (iv) A designee of the Director of the 

22 Department of Defense Congressionally 

23 Directed Medical Research Programs. 

24 (v) A designee of the Director of the 

25 Office of Minority Health. 


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1 (vi) A representative of the Food and 

2 Drug Administration. 

3 (vii) A representative of the Agency 

4 for Healthcare Research and Quality. 

5 (B) NON-FEDERAL MEMBERS.—In addi6 tion to the members described in subparagraph 

7 (A), the Council shall include 14 expert mem8 bers from outside the Federal Government, 

9 which shall include— 

10 (i) 6 prostate cancer patient advo11 cates, including— 

12 (I) 2 patient-survivors; 

13 (II) 2 caregivers of prostate can14 cer patients; and 

15 (III) 2 representatives from na16 tional prostate cancer disease organi17 zations that fund research or have 

18 demonstrated experience in providing 

19 assistance to patients, families, and 

20 medical professionals, including infor21 mation on health care options, edu22 cation, and referral; and 

23 (ii) 8 health care stakeholders with 

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1 pertise, including medical oncology, radi2 ology, radiation oncology, urology, and pa3 thology. 

4 (4) MEETINGS.—The Council shall meet quar5 terly and meetings shall be open to the public. 

6 (5) ADVICE.—The Council shall advise the Sec7 retary, or the Secretary’s designee. 

8 (6) ANNUAL REPORT.—The Council shall sub9 mit annual reports, beginning not later than 1 year 

10 after the date of enactment of this Act, to the Sec11 retary or the Secretary’s designee and to Congress. 

12 The annual report shall include— 

13 (A) in the first year— 

14 (i) an evaluation of all federally fund15 ed efforts in prostate cancer research and 

16 gaps relating to the development and vali17 dation of diagnostic tools for prostate can18 cer; and 

19 (ii) recommendations for priority ac20 tions to expand, eliminate, coordinate, or 

21 condense programs based on the perform22 ance, mission, and purpose of the pro23 grams; and 

24 (B) annually thereafter for 5 years— 


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1 (i) an outline for the development and 

2 implementation of a national research plan 

3 for creation and validation of accurate di4 agnostic tools to improve prostate cancer 

5 care in accordance with paragraph (1); 

6 (ii) roles for the National Cancer In7 stitute, National Institute on Minority 

8 Health and Health Disparities, and the Of9 fice of Minority Health of the Department 

10 of Health and Human Services; 

11 (iii) an analysis of the disparities in 

12 the incidence and mortality rates of pros13 tate cancer in men at high risk of the dis14 ease, including individuals with family his15 tory, increasing age, or African-American 

16 heritage; and 

17 (iv) a review of the progress towards 

18 the realization of the proposed strategic 

19 plan. 

20 (7) TERMINATION.—The Council shall termi21 nate on December 31, 2027. 


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1 SEC. 7006. IMPROVED MEDICAID COVERAGE FOR CERTAIN 

2 BREAST AND CERVICAL CANCER PATIENTS 

3 IN THE TERRITORIES. 

4 (a) ELIMINATION OF FUNDING LIMITATIONS.—Sec5 tion 1108(g)(4) of the Social Security Act (42 U.S.C. 

6 1308(g)(4)) is amended— 

7 (1) by striking ‘‘paragraphs (1), (2), (3), and 

8 (4) of’’; and 

9 (2) by adding at the end the following: ‘‘With 

10 respect to fiscal years beginning with fiscal year 

11 2023, payment for medical assistance for individuals 

12 who are eligible for such assistance only on the basis 

13 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 

14 taken into account in applying subsection (f) (as in15 creased in accordance with this subsection) to Puer16 to Rico, the Virgin Islands, Guam, the Northern 

17 Mariana Islands, or American Samoa for such fiscal 

18 year.’’. 

19 (b) APPLICATION OF ENHANCED FMAP FOR HIGH20 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 

21 1396d(b)) is amended by adding at the end the following: 

22 ‘‘Notwithstanding the first sentence of this subsection, 

23 with respect to medical assistance described in clause (4) 

24 of such sentence that is furnished in Puerto Rico, the Vir25 gin Islands, Guam, the Northern Mariana Islands, or 

26 American Samoa in a fiscal year, the Federal medical asVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01221 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 sistance percentage is equal to the highest such percentage 

2 applied under such clause for such fiscal year for any of 

3 the 50 States or the District of Columbia that provides 

4 such medical assistance for any portion of such fiscal 

5 year.’’. 

6 (c) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to payment for medical assistance 

8 for items and services furnished on or after October 1, 

9 2023. 

10 SEC. 7007. CANCER PREVENTION AND TREATMENT DEM11 ONSTRATION FOR ETHNIC AND RACIAL MI12 NORITIES. 

13 (a) DEMONSTRATION.— 

14 (1) IN GENERAL.—The Secretary of Health and 

15 Human Services (in this section referred to as the 

16 ‘‘Secretary’’) shall conduct demonstration projects 

17 for the purpose of developing models and evaluating 

18 methods that— 

19 (A) improve the quality of items and serv20 ices provided to target individuals in order to 

21 facilitate reduced disparities in early detection 

22 and treatment of cancer; 

23 (B) improve clinical outcomes, satisfaction, 

24 quality of life, appropriate use of items and 

25 services covered under the Medicare program 


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1 under title XVIII of the Social Security Act (42 

2 U.S.C. 1395 et seq.), and referral patterns with 

3 respect to target individuals with cancer; 

4 (C) eliminate disparities in the rate of pre5 ventive cancer screening measures, such as Pap 

6 smears, prostate cancer screenings, colon and 

7 colorectal cancer screenings, breast cancer 

8 screenings, and computed tomography scans, 

9 for lung cancer among target individuals; 

10 (D) promote collaboration with community11 based organizations to ensure cultural com12 petency of health care professionals and lin13 guistic access for target individuals who are 

14 persons with limited English proficiency; and 

15 (E) encourage the incorporation of commu16 nity health workers to increase the efficiency 

17 and appropriateness of cancer screening pro18 grams. 

19 (2) COMMUNITY HEALTH WORKER DEFINED.— 

20 In this section, the term ‘‘community health worker’’ 

21 includes a community health advocate, a lay health 

22 worker, a community health representative, a peer 

23 health promoter, a community health outreach work24 er, and a promotore de salud, who promotes health 


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1 or nutrition within the community in which the indi2 vidual resides. 

3 (3) TARGET INDIVIDUAL DEFINED.—In this 

4 section, the term ‘‘target individual’’ means an indi5 vidual of a racial and ethnic minority group, as de6 fined in section 1707(g)(1) of the Public Health 

7 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti8 tled to benefits under part A, and enrolled under 

9 part B, of title XVIII of the Social Security Act. 

10 (b) PROGRAM DESIGN.— 

11 (1) INITIAL DESIGN.—Not later than 1 year 

12 after the date of the enactment of this Act, the Sec13 retary shall evaluate best practices in the private 

14 sector, community programs, and academic research 

15 of methods that reduce disparities among individuals 

16 of racial and ethnic minority groups in the preven17 tion and treatment of cancer and shall design the 

18 demonstration projects based on such evaluation. 

19 (2) NUMBER AND PROJECT AREAS.—Not later 

20 than 2 years after the date of the enactment of this 

21 Act, the Secretary shall implement at least 9 dem22 onstration projects, including the following: 

23 (A) Two projects, each of which shall tar24 get different ethnic subpopulations, for each of 


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1 the 5 following major racial and ethnic minority 

2 groups: 

3 (i) American Indians and Alaska Na4 tives, Eskimos, and Aleuts. 

5 (ii) Asian Americans. 

6 (iii) Blacks and African Americans. 

7 (iv) Latinos and Hispanics. 

8 (v) Native Hawaiians and other Pa9 cific Islanders. 

10 (B) One project within the Pacific Islands 

11 or United States insular areas. 

12 (C) At least one project in a rural area. 

13 (D) At least one project in an inner-city 

14 area. 

15 (3) EXPANSION OF PROJECTS; IMPLEMENTA16 TION OF DEMONSTRATION PROJECT RESULTS.—The 

17 Secretary shall continue the existing demonstration 

18 projects and may expand the number of demonstra19 tion projects if the initial report under subsection (c) 

20 contains an evaluation that demonstration 

21 projects— 

22 (A) reduce expenditures under the Medi23 care program under title XVIII of the Social 

24 Security Act (42 U.S.C. 1395 et seq.); or 


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1 (B) do not increase expenditures under 

2 such Medicare program and reduce racial and 

3 ethnic health disparities in the quality of health 

4 care services provided to target individuals and 

5 increase satisfaction of Medicare beneficiaries 

6 and health care providers. 

7 (c) REPORT TO CONGRESS.— 

8 (1) IN GENERAL.—Not later than 2 years after 

9 the date the Secretary implements the initial dem10 onstration projects, and biannually thereafter, the 

11 Secretary shall submit to Congress a report regard12 ing the demonstration projects. 

13 (2) CONTENT OF REPORT.—Each report under 

14 paragraph (1) shall include the following: 

15 (A) A description of the demonstration 

16 projects. 

17 (B) An evaluation of— 

18 (i) the cost-effectiveness of the dem19 onstration projects; 

20 (ii) the quality of the health care serv21 ices provided to target individuals under 

22 the demonstration projects; and 

23 (iii) beneficiary and health care pro24 vider satisfaction under the demonstration 

25 projects. 


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1 (C) Any other information regarding the 

2 demonstration projects that the Secretary de3 termines to be appropriate. 

4 (d) WAIVER AUTHORITY.—The Secretary shall waive 

5 compliance with the requirements of title XVIII of the So6 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

7 and for such period as the Secretary determines is nec8 essary to conduct demonstration projects. 

9 SEC. 7008. REDUCING CANCER DISPARITIES WITHIN MEDI10 CARE. 

11 (a) DEVELOPMENT OF MEASURES OF DISPARITIES

12 IN QUALITY OF CANCER CARE.— 

13 (1) DEVELOPMENT OF MEASURES.—The Sec14 retary of Health and Human Services (in this sec15 tion referred to as the ‘‘Secretary’’) shall enter into 

16 an agreement with an entity that specializes in de17 veloping quality measures for cancer care under 

18 which the entity shall develop a uniform set of meas19 ures to evaluate disparities in the quality of cancer 

20 care and annually update such set of measures. 

21 (2) MEASURES TO BE INCLUDED.—Such set of 

22 measures shall include, with respect to the treatment 

23 of cancer, measures of patient outcomes, the process 

24 for delivering medical care related to such treat25 ment, patient counseling and engagement in decision 


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1 making, patient experience of care, resource use, and 

2 practice capabilities, such as care coordination. 

3 (b) ESTABLISHMENT OF REPORTING PROCESS.— 

4 (1) IN GENERAL.—The Secretary shall establish 

5 a reporting process that requires and provides for a 

6 method for health care providers specified under 

7 paragraph (2) to submit to the Secretary and make 

8 public data on the performance of such providers 

9 during each reporting period through use of the 

10 measures developed pursuant to subsection (a). Such 

11 data shall be submitted in a form and manner and 

12 at a time specified by the Secretary. 

13 (2) SPECIFICATION OF PROVIDERS TO REPORT

14 ON MEASURES.—The Secretary shall specify the 

15 classes of Medicare providers of services and sup16 pliers, including hospitals, cancer centers, physi17 cians, primary care providers, and specialty pro18 viders, that will be required under such process to 

19 publicly report on the measures specified under sub20 section (a). 

21 (3) ASSESSMENT OF CHANGES.—Under such 

22 reporting process, the Secretary shall establish a for23 mat that assesses changes in both the absolute and 

24 relative disparities in cancer care over time. These 

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1 sible format, such as those presented in the final 

2 publications relating to Healthy People 2010 or the 

3 National Healthcare Disparities Report. 

4 (4) INITIAL IMPLEMENTATION.—The Secretary 

5 shall implement the reporting process under this 

6 subsection for reporting periods beginning not later 

7 than 6 months after the date that measures are first 

8 established under subsection (a). 

9 Subtitle B—Viral Hepatitis and 

10 Liver Cancer Control and Pre11 vention 

12 SEC. 7051. VIRAL HEPATITIS AND LIVER CANCER CONTROL 

13 AND PREVENTION. 

14 (a) SHORT TITLE.—This section may be cited as the 

15 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 

16 Act of 2022’’. 

17 (b) FINDINGS.—Congress finds the following: 

18 (1) In the United States, nearly 5,000,000 per19 sons are living with the hepatitis B virus (referred 

20 to in this section as ‘‘HBV’’) or the hepatitis C virus 

21 (referred to in this section as ‘‘HCV’’). 

22 (2) The Centers for Disease Control and Pre23 vention (referred to in this section as the ‘‘CDC’’), 

24 has recognized HCV as the Nation’s most common 


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1 chronic bloodborne virus infection and HBV as the 

2 deadliest vaccine-preventable disease. 

3 (3) HBV is transmitted through contact with 

4 infectious blood, semen, or other bodily fluids and is 

5 100 times more infectious than HIV. HCV is trans6 mitted by contact with infectious blood, particularly 

7 through percutaneous exposures (such as puncture 

8 through the skin). 

9 (4) In the United States, chronic HBV and 

10 HCV are the most common causes of liver cancer, 

11 the second deadliest and fastest growing cancer in 

12 this country. These viruses are the most common 

13 cause of chronic liver disease, liver cirrhosis, and the 

14 most common indications for liver transplantation. 

15 In 2019, nearly 16,000 deaths per year in the 

16 United States were attributed to chronic HBV and 

17 HCV. Chronic HCV is also a leading cause of death 

18 in Americans living with HIV/AIDS, many of those 

19 living with HIV/AIDS are coinfected with chronic 

20 HBV, chronic HCV, or both. 

21 (5) The CDC estimates that in 2019, 57,500 

22 people in the United States were newly infected with 

23 HCV and 20,700 people in the United States were 

24 newly infected with HBV. These estimates could be 

25 much higher due to many reasons, including lack of 


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1 screening education and awareness, and perceived 

2 marginalization of the populations at risk. 

3 (6) The CDC reported a 374 percent increase 

4 in hepatitis C cases from 2010 to 2017, stemming 

5 from the opioid, heroin, and overdose epidemics af6 fecting communities nationwide. From 2014 to 

7 2015, the number of reported cases of acute hepa8 titis B infection in the United States rose for the 

9 first time since 2006, increasing by 20.7 percent, 

10 which is also largely attributable to the opioid epi11 demic. 

12 (7) HBV and HCV disproportionately affect 

13 certain populations in the United States. Although 

14 representing only about 6 percent of the population, 

15 Asian Americans and Pacific Islanders account for 

16 half of all chronic HBV cases in the United States. 

17 Baby boomers (those born between 1945 and 1965) 

18 account for approximately 75 percent of domestic 

19 chronic HCV cases. In addition, African Americans, 

20 Latinos, and American Indian and Native Alaskans 

21 are among the groups which have disproportionately 

22 high rates of HBV or HCV infections in the United 

23 States. 

24 (8) Liver cancer is a leading cause of cancer 

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1 lander community. Asian and Pacific Islander men 

2 and women are more than twice as likely to develop 

3 liver cancer compared to the non-Hispanic White 

4 population. The higher incidence rate of liver cancer 

5 is partially explained by higher incidence rates of 

6 hepatitis B and diabetes, which are comorbidities 

7 shown to increase an individual’s risk of developing 

8 liver cancer. 

9 (9) Chronic HBV and chronic HCV usually do 

10 not cause symptoms early in the course of the dis11 ease, but after many years of a clinically ‘‘silent’’ 

12 phase, CDC estimates show more than 33 percent of 

13 infected individuals will develop cirrhosis, end-stage 

14 liver disease, or liver cancer. Since most individuals 

15 with chronic HBV, HCV, or both are unaware of 

16 their infection, they do not know to take precautions 

17 to prevent the spread of their infection and can un18 knowingly exacerbate their own disease progression. 

19 For those chronically infected with HBV or HCV, 

20 regular monitoring can lead to the early detection of 

21 liver cancer at a stage where a treatment is still pos22 sible. 

23 (10) For both chronic HBV and chronic HCV, 

24 behavioral changes and appropriate medical care can 

25 slow disease progression if diagnosis is made early. 


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1 Early diagnosis, which is determined through simple 

2 blood tests, can reduce the risk of transmission and 

3 disease progression through education and vaccina4 tion of household members and other susceptible 

5 persons at risk. 

6 (11) Treatment for chronic HCV can eradicate 

7 the disease in approximately 90 percent of those cur8 rently treated. While there is no cure for chronic 

9 HBV, available treatments can effectively suppress 

10 viral replication in the overwhelming majority of 

11 those treated, thereby reducing the risk of trans12 mission and progression to liver scarring or liver 

13 cancer. 

14 (12) The annual health care costs attributable 

15 to HBV and HCV in the United States are signifi16 cant. For HBV, it is estimated to be approximately 

17 $2,500,000,000 ($2,000 per infected person). In 

18 2000, the lifetime cost of HBV, before the avail19 ability of most current therapies, was approximately 

20 $80,000 per chronically infected person, totaling 

21 more than $100,000,000,000. For HCV, medical 

22 costs for patients are expected to increase from 

23 $30,000,000,000 in 2009 to over $85,000,000,000 

24 in 2024. Avoiding these costs by screening and diag25 nosing individuals earlier, and connecting them to 


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1 appropriate treatment and care, will save lives and 

2 critical health care dollars. Currently, without a 

3 comprehensive screening, testing, and diagnosis pro4 gram, most patients are diagnosed too late when 

5 they need a liver transplant costing at least 

6 $314,000 for uncomplicated cases or when they have 

7 liver cancer or end-stage liver disease which costs 

8 $30,980 to $110,576 per hospital admission. As 

9 health care costs continue to grow, it is critical that 

10 the Federal Government invests in effective mecha11 nisms to avoid documented cost drivers. 

12 (13) In 2021, the Department of Health and 

13 Human Services released its ‘‘Viral Hepatitis Na14 tional Strategic Plan: A Roadmap for Elimination 

15 for the United States, 2021–2025’’ (referred to in 

16 this section as the ‘‘HHS Strategic Plan’’). In 

17 March 2017, the National Academies of Sciences, 

18 Engineering, and Medicine released a report enti19 tled, ‘‘A National Strategy for the Elimination of 

20 Hepatitis B and C: Phase Two Report’’ (referred to 

21 in this section as the ‘‘NAS report’’), recommending 

22 specific actions to eliminate viral hepatitis as public 

23 health problems in the United States by 2030. 

24 (14) According to the NAS report, chronic 

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1 bidity and mortality despite being preventable and 

2 treatable. Deficiencies in the implementation of es3 tablished guidelines for the prevention, diagnosis, 

4 and medical management of chronic HBV and HCV 

5 infections perpetuate personal and economic bur6 dens. Existing grants are not sufficient for the scale 

7 of the health burden presented by HBV and HCV. 

8 (15) Screening and testing for HBV and HCV 

9 is aligned with the goals of Healthy People 2030 to 

10 increase immunization rates, reduce rates of infec11 tious diseases, and improve health for people with 

12 chronic infections. Awareness of disease and access 

13 to prevention and treatment remain essential compo14 nents for reducing infectious disease transmission. 

15 (16) Federal support is necessary to increase 

16 knowledge and awareness of HBV and HCV and to 

17 assist State and local prevention and control efforts 

18 in reducing the morbidity and mortality of these 

19 epidemics. 

20 (17) The Secretary of Health and Human Serv21 ices has the discretion to carry out this section (in22 cluding the amendments made by this section) di23 rectly and through whichever of the agencies of the 

24 Public Health Service the Secretary determines to be 

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1 tion) include the Centers for Disease Control and 

2 Prevention, the Health Resources and Services Ad3 ministration, the Substance Abuse and Mental 

4 Health Services Administration, the National Insti5 tutes of Health (including the National Institute on 

6 Minority Health and Health Disparities), and other 

7 agencies of such Service. 

8 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 

9 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 

10 AND MEDICAL MANAGEMENT PLAN.—Title III of the 

11 Public Health Service Act (42 U.S.C. 241 et seq.) is fur12 ther amended— 

13 (1) by striking section 317N (42 U.S.C. 247b– 

14 15); and 

15 (2) by adding after part V the following: 

16 ‘‘PART W—BIENNIAL ASSESSMENT OF HHS HEPA17 TITIS B AND HEPATITIS C PREVENTION, EDU18 CATION, RESEARCH, AND MEDICAL MANAGE19 MENT PLAN 

20 ‘‘SEC. 399OO. BIENNIAL UPDATE OF THE PLAN. 

21 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi22 ennial assessment of the Secretary’s plan for the preven23 tion, control, and medical management of, and education 

24 and research relating to, hepatitis B and hepatitis C, for 

25 the purposes of— 


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1 ‘‘(1) incorporating into such plan new knowl2 edge or observations relating to hepatitis B and hep3 atitis C (such as knowledge and observations that 

4 may be derived from clinical, laboratory, and epide5 miological research and disease detection, preven6 tion, and surveillance outcomes); 

7 ‘‘(2) addressing gaps in the coverage or effec8 tiveness of the plan; and 

9 ‘‘(3) evaluating and, if appropriate, updating 

10 recommendations, guidelines, or educational mate11 rials of the Centers for Disease Control and Preven12 tion or the National Institutes of Health for health 

13 care providers or the public on viral hepatitis in 

14 order to be consistent with the plan. 

15 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 

16 Not later than October 1 of the first even-numbered year 

17 beginning after the date of the enactment of this part, 

18 and October 1 of each even-numbered year thereafter, the 

19 Secretary shall publish in the Federal Register a notice 

20 of the results of the assessments conducted under sub21 section (a). Such notice shall include— 

22 ‘‘(1) a description of any revisions to the plan 

23 referred to in subsection (a) as a result of the as24 sessment; 


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1 ‘‘(2) an explanation of the basis for any such 

2 revisions, including the ways in which such revisions 

3 can reasonably be expected to further promote the 

4 original goals and objectives of the plan; and 

5 ‘‘(3) in the case of a determination by the Sec6 retary that the plan does not need revision, an expla7 nation of the basis for such determination. 

8 ‘‘SEC. 399OO–1. ELEMENTS OF PROGRAM. 

9 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 

10 Secretary, acting through the Director of the Centers for 

11 Disease Control and Prevention, the Administrator of the 

12 Health Resources and Services Administration, and the 

13 Assistant Secretary for Mental Health and Substance Use, 

14 and in accordance with the plan referred to in section 

15 399OO(a), shall implement programs to increase aware16 ness and enhance knowledge and understanding of hepa17 titis B and hepatitis C. Such programs shall include— 

18 ‘‘(1) the conduct of culturally and linguistically 

19 appropriate health education in primary and sec20 ondary schools, college campuses, public awareness 

21 campaigns, and community outreach activities (espe22 cially to the ethnic communities with high rates of 

23 chronic hepatitis B and chronic hepatitis C and 

24 other high-risk groups) to promote public awareness 

25 and knowledge about— 


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1 ‘‘(A) the value of hepatitis A and hepatitis 

2 B immunization; 

3 ‘‘(B) risk factors, transmission, and pre4 vention of hepatitis B and hepatitis C; 

5 ‘‘(C) the value of screening for the early 

6 detection of hepatitis B and hepatitis C; and 

7 ‘‘(D) options available for the treatment of 

8 chronic hepatitis B and chronic hepatitis C; 

9 ‘‘(2) the promotion of immunization programs 

10 that increase awareness and access to hepatitis A 

11 and hepatitis B vaccines for susceptible adults and 

12 children; 

13 ‘‘(3) the training of health care professionals 

14 regarding the importance of vaccinating individuals 

15 infected with hepatitis C and individuals who are at 

16 risk for hepatitis C infection against hepatitis A and 

17 hepatitis B; 

18 ‘‘(4) the training of health care professionals 

19 regarding the importance of vaccinating individuals 

20 chronically infected with hepatitis B and individuals 

21 who are at risk for chronic hepatitis B infection 

22 against the hepatitis A virus; 

23 ‘‘(5) the training of health care professionals 

24 and health educators to make them aware of the 

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1 titis C in certain adult ethnic populations, and the 

2 importance of prevention, detection, and medical 

3 management of hepatitis B and hepatitis C and of 

4 liver cancer screening; 

5 ‘‘(6) the development and distribution of health 

6 education curricula (including information relating 

7 to the special needs of individuals infected with or 

8 at risk of hepatitis B and hepatitis C, such as the 

9 importance of prevention and early intervention, reg10 ular monitoring, the recognition of psychosocial 

11 needs, appropriate treatment, and liver cancer 

12 screening) for individuals providing hepatitis B and 

13 hepatitis C counseling; and 

14 ‘‘(7) support for the implementation of the cur15 ricula described in paragraph (6) by State and local 

16 public health agencies. 

17 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL

18 PROGRAMS.— 

19 ‘‘(1) IN GENERAL.—The Secretary, acting 

20 through the Director of the Centers for Disease 

21 Control and Prevention, shall support the integra22 tion of activities described in paragraph (3) into ex23 isting clinical and public health programs at State, 

24 local, territorial, and Tribal levels (including commu25 nity health clinics, programs for the prevention and 


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1 treatment of HIV/AIDS, sexually transmitted infec2 tions, and substance abuse, and programs for indi3 viduals in correctional settings). 

4 ‘‘(2) COORDINATION OF DEVELOPMENT OF

5 FEDERAL SCREENING GUIDELINES.— 

6 ‘‘(A) REFERENCES.—For purposes of this 

7 subsection, the term ‘CDC Director’ means the 

8 Director of the Centers for Disease Control and 

9 Prevention, and the term ‘AHRQ Director’ 

10 means the Director of the Agency for 

11 Healthcare Research and Quality. 

12 ‘‘(B) AGENCY FOR HEALTHCARE RE13 SEARCH AND QUALITY.—Due to the rapidly 

14 evolving standard of care associated with diag15 nosing and treating viral hepatitis infection, the 

16 AHRQ Director shall convene the Preventive 

17 Services Task Force under section 915(a) to re18 view its recommendation for screening for HBV 

19 and HCV infection every 3 years. 

20 ‘‘(3) ACTIVITIES.— 

21 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 

22 ‘‘(i) IN GENERAL.—The Secretary 

23 shall establish a mechanism by which to 

24 support and promote the development of 

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1 untary hepatitis B and hepatitis C testing 

2 programs to screen the high-prevalence 

3 populations to aid in the early identifica4 tion of chronically infected individuals. 

5 ‘‘(ii) CONFIDENTIALITY OF THE TEST

6 RESULTS.—The Secretary shall prohibit 

7 the use of the results of a hepatitis B or 

8 hepatitis C test conducted by a testing pro9 gram developed or supported under this 

10 subparagraph for any of the following: 

11 ‘‘(I) Issues relating to health in12 surance. 

13 ‘‘(II) To screen or determine 

14 suitability for employment. 

15 ‘‘(III) To discharge a person 

16 from employment. 

17 ‘‘(B) COUNSELING REGARDING VIRAL HEP18 ATITIS.—The Secretary shall support State, 

19 local, territorial, and Tribal programs in a wide 

20 variety of settings, including those providing 

21 primary and specialty health care services in 

22 nonprofit private and public sectors, to— 

23 ‘‘(i) provide individuals with ongoing 

24 risk factors for hepatitis B and hepatitis C 


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1 infection with client-centered education 

2 and counseling which concentrates on— 

3 ‘‘(I) promoting testing of individ4 uals that have been exposed to their 

5 blood, family members, and their sex6 ual partners; and 

7 ‘‘(II) changing behaviors that 

8 place individuals at risk for infection; 

9 ‘‘(ii) provide individuals chronically in10 fected with hepatitis B or hepatitis C with 

11 education, health information, and coun12 seling to reduce their risk of— 

13 ‘‘(I) dying from end-stage liver 

14 disease and liver cancer; and 

15 ‘‘(II) transmitting viral hepatitis 

16 to others; and 

17 ‘‘(iii) provide people chronically in18 fected with hepatitis B or hepatitis C who 

19 are pregnant or of childbearing age with 

20 culturally and linguistically appropriate 

21 health information, such as how to prevent 

22 hepatitis B perinatal infection, and to al23 leviate fears associated with pregnancy or 

24 raising a family. 


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1 ‘‘(C) IMMUNIZATION.—The Secretary shall 

2 support State, local, territorial, and Tribal ef3 forts to expand the current vaccination pro4 grams to protect every child in the Nation and 

5 all susceptible adults, particularly those infected 

6 with hepatitis C and high-prevalence ethnic 

7 populations and other high-risk groups, from 

8 the risks of acute and chronic hepatitis B infec9 tion by— 

10 ‘‘(i) ensuring continued funding for 

11 hepatitis B vaccination for all children 18 

12 years of age or younger through the Vac13 cines for Children program; 

14 ‘‘(ii) ensuring that the recommenda15 tions of the Advisory Committee on Immu16 nization Practices of the Centers for Dis17 ease Control and Prevention are followed 

18 regarding hepatitis B vaccination for in19 fants, children, and adults; 

20 ‘‘(iii) requiring proof of hepatitis B 

21 vaccination for entry into public or private 

22 daycare, preschool, elementary school, sec23 ondary school, and institutions of higher 

24 education; 


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1 ‘‘(iv) expanding the availability of 

2 hepatitis B vaccination for all adults to 

3 protect them from becoming acutely or 

4 chronically infected, including ethnic and 

5 other populations with high prevalence 

6 rates of chronic hepatitis B infection; 

7 ‘‘(v) expanding the availability of hep8 atitis B vaccination for all adults, particu9 larly those of reproductive age (women and 

10 men less than 45 years of age), to protect 

11 them from the risk of hepatitis B infection; 

12 ‘‘(vi) ensuring the vaccination of indi13 viduals infected, or at risk for infection, 

14 with hepatitis C against hepatitis A, hepa15 titis B, and other infectious diseases, as 

16 appropriate, for which such individuals 

17 may be at increased risk; and 

18 ‘‘(vii) ensuring the vaccination of indi19 viduals infected, or at risk for infection, 

20 with hepatitis B against hepatitis A virus 

21 and other infectious diseases, as appro22 priate, for which such individuals may be 

23 at increased risk. 


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1 ‘‘(D) MEDICAL REFERRAL.—The Secretary 

2 shall support State, local, territorial, and Tribal 

3 programs that support— 

4 ‘‘(i) referral of persons chronically in5 fected with hepatitis B or hepatitis C— 

6 ‘‘(I) for medical evaluation to de7 termine the appropriateness for 

8 antiviral treatment to reduce the risk 

9 of progression to cirrhosis and liver 

10 cancer; and 

11 ‘‘(II) for ongoing medical man12 agement including regular monitoring 

13 of liver function and screening for 

14 liver cancer; and 

15 ‘‘(ii) referral of persons infected with 

16 acute or chronic hepatitis B infection or 

17 acute or chronic hepatitis C infection for 

18 drug and alcohol abuse treatment where 

19 appropriate. 

20 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL

21 HEPATITIS PREVENTION COORDINATORS.—The Sec22 retary, acting through the CDC Director, shall pro23 vide increased support to adult viral hepatitis pre24 vention coordinators in State, local, territorial, and 

25 Tribal health departments in order to enhance the 


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1 additional management, networking, and technical 

2 expertise needed to ensure successful integration of 

3 hepatitis B and hepatitis C prevention and control 

4 activities into existing public health programs. 

5 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 

6 ‘‘(1) IN GENERAL.—The Secretary, acting 

7 through the Director of the Centers for Disease 

8 Control and Prevention, shall support the establish9 ment and maintenance of a national chronic and 

10 acute hepatitis B and hepatitis C surveillance pro11 gram, in order to identify— 

12 ‘‘(A) trends in the incidence of acute and 

13 chronic hepatitis B and acute and chronic hepa14 titis C; 

15 ‘‘(B) trends in the prevalence of acute and 

16 chronic hepatitis B and acute and chronic hepa17 titis C infection among groups that may be dis18 proportionately affected; and 

19 ‘‘(C) trends in liver cancer and end-stage 

20 liver disease incidence and deaths, caused by 

21 chronic hepatitis B and chronic hepatitis C in 

22 the high-risk ethnic populations. 

23 ‘‘(2) SEROPREVALENCE AND LIVER CANCER

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1 tion, shall prepare a report outlining the population2 based seroprevalence studies currently underway, fu3 ture planned studies, the criteria involved in deter4 mining which seroprevalence studies to conduct, 

5 defer, or suspend, and the scope of those studies, the 

6 economic and clinical impact of hepatitis B and hep7 atitis C, and the impact of chronic hepatitis B and 

8 chronic hepatitis C infections on the quality of life. 

9 Not later than one year after the date of the enact10 ment of this part, the Secretary shall submit the re11 port to the Committee on Health, Education, Labor, 

12 and Pensions of the Senate and the Committee on 

13 Energy and Commerce of the House of Representa14 tives. 

15 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 

16 not disclose any individually identifiable information 

17 identified under paragraph (1) or derived through 

18 studies under paragraph (2). 

19 ‘‘(d) RESEARCH.—The Secretary, acting through the 

20 Director of the Centers for Disease Control and Preven21 tion, the Director of the National Cancer Institute, and 

22 the Director of the National Institutes of Health, shall— 

23 ‘‘(1) conduct epidemiologic and community24 based research to develop, implement, and evaluate 

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1 vention especially in the ethnic populations with high 

2 rates of chronic hepatitis B and chronic hepatitis C 

3 and other high-risk groups; 

4 ‘‘(2) conduct research on hepatitis B and hepa5 titis C natural history, pathophysiology, improved 

6 treatments and prevention (such as the hepatitis C 

7 vaccine), and noninvasive tests that help to predict 

8 the risk of progression to liver cirrhosis and liver 

9 cancer; 

10 ‘‘(3) conduct research that will lead to better 

11 noninvasive or blood tests to screen for liver cancer, 

12 and more effective treatments of liver cancer caused 

13 by chronic hepatitis B and chronic hepatitis C; and 

14 ‘‘(4) conduct research comparing the effective15 ness of screening, diagnostic, management, and 

16 treatment approaches for chronic hepatitis B, chron17 ic hepatitis C, and liver cancer in the affected com18 munities. 

19 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF20 FECTED POPULATIONS.—In carrying out this section, the 

21 Secretary shall provide expanded support for individuals 

22 with limited access to health education, testing, and health 

23 care services and groups that may be disproportionately 

24 affected by hepatitis B and hepatitis C. 


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1 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 

2 shall develop benchmarks for evaluating the effectiveness 

3 of the programs and activities conducted under this sec4 tion and make determinations as to whether such bench5 marks have been achieved. 

6 ‘‘SEC. 399OO–2. GRANTS. 

7 ‘‘(a) IN GENERAL.—The Secretary may award grants 

8 to, or enter into contracts or cooperative agreements with, 

9 States, political subdivisions of States, territories, Indian 

10 Tribes, or nonprofit entities that have special expertise re11 lating to hepatitis B, hepatitis C, or both, to carry out 

12 activities under this part. 

13 ‘‘(b) APPLICATION.—To be eligible for a grant, con14 tract, or cooperative agreement under subsection (a), an 

15 entity shall prepare and submit to the Secretary an appli16 cation at such time, in such manner, and containing such 

17 information as the Secretary may require. 

18 ‘‘SEC. 399OO–3. AUTHORIZATION OF APPROPRIATIONS. 

19 ‘‘There are authorized to be appropriated to carry out 

20 this part $90,000,000 for fiscal year 2023, $110,000,000 

21 for fiscal year 2024, $130,000,000 for fiscal year 2025, 

22 and $150,000,000 for fiscal year 2026.’’. 


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1 SEC. 7052. LIVER CANCER AND DISEASE PREVENTION, 

2 AWARENESS, AND PATIENT TRACKING 

3 GRANTS. 

4 Subpart I of part D of title III of the Public Health 

5 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

6 at the end the following new section: 

7 ‘‘SEC. 330Q. LIVER CANCER AND DISEASE PREVENTION, 

8 AWARENESS, AND PATIENT TRACKING 

9 GRANTS. 

10 ‘‘(a) PREVENTION INITIATIVE GRANT PROGRAM.— 

11 ‘‘(1) IN GENERAL.—The Secretary, acting 

12 through the Director of the Centers for Disease 

13 Control and Prevention, may award grants and 

14 enter into cooperative agreements with entities for 

15 the purpose of expanding and supporting— 

16 ‘‘(A) prevention activities (including pro17 viding screenings, vaccinations, or other pre18 ventative interventions) for conditions known to 

19 increase an individual’s risk of developing a 

20 major liver disease, such as liver cancer, hepa21 titis B, hepatitis C, nonalcoholic fatty liver dis22 ease, nonalcoholic steatohepatitis, and cirrhosis 

23 of the liver; 

24 ‘‘(B) activities relating to detection and 

25 provision of guidance for individuals at high 


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1 risk for contracting liver cancer and other liver 

2 diseases; and 

3 ‘‘(C) viral hepatitis surveillance to provide 

4 for timely and accurate information regarding 

5 progress to eliminate viral hepatitis. 

6 ‘‘(2) REPORT.—An entity that receives a grant 

7 or cooperative agreement under paragraph (1) shall 

8 submit to the Secretary, at a time specified by the 

9 Secretary, a report describing each activity carried 

10 out pursuant to such paragraph and evaluating the 

11 effectiveness of such activity in promoting prevention 

12 and treatment of liver cancer and other liver dis13 eases. 

14 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

15 For purposes of carrying out this subsection, there 

16 is authorized to be appropriated $90,000,000 for 

17 each of fiscal years 2023 through 2027. 

18 ‘‘(b) AWARENESS INITIATIVE GRANT PROGRAM.— 

19 ‘‘(1) IN GENERAL.—The Secretary, acting 

20 through the Director of the Centers for Disease 

21 Control and Prevention, may award grants to eligi22 ble entities for the purpose of raising awareness for 

23 liver cancer and other liver diseases, which may in24 clude the production, dissemination, and distribution 

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1 nities and populations with a higher risk for devel2 oping liver cancer and other liver diseases. 

3 ‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re4 ceive a grant under paragraph (1), an entity shall 

5 submit to the Secretary an application, at such time, 

6 in such manner, and containing such information as 

7 the Secretary may require, including a description of 

8 how the entity, in disseminating information on liver 

9 cancer and other liver diseases pursuant to para10 graph (1), will— 

11 ‘‘(A) with respect to any community or 

12 population, consult with members of such com13 munity or population and provide such informa14 tion in a manner that is culturally and linguis15 tically appropriate for such community or popu16 lation; 

17 ‘‘(B) highlight the range of preventative 

18 measures and treatments available for liver can19 cer and other liver diseases; 

20 ‘‘(C) integrate information on available 

21 hepatitis B and hepatitis C testing programs 

22 into any liver cancer presentations carried out 

23 by the entity; and 


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1 ‘‘(D) address communities and populations 

2 with a higher risk for contracting liver cancer 

3 and other liver diseases. 

4 ‘‘(3) PREFERENCE.—In awarding grants under 

5 paragraph (1), the Secretary shall give preference to 

6 entities that— 

7 ‘‘(A) work with a Federally qualified 

8 health center; 

9 ‘‘(B) are community-based organizations; 

10 or 

11 ‘‘(C) serve communities and populations 

12 with a higher risk for contracting liver cancer 

13 and other liver diseases. 

14 ‘‘(4) REPORT.—An entity that receives a grant 

15 under paragraph (1) shall submit to the Secretary, 

16 at a time specified by the Secretary, a report de17 scribing each activity carried out pursuant to such 

18 paragraph and evaluating the effectiveness of such 

19 activity in raising awareness for liver cancer and 

20 other liver diseases. 

21 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

22 For purposes of carrying out this subsection, there 

23 is authorized to be appropriated $10,000,000 for 

24 each of fiscal years 2023 through 2027.’’. 


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1 Subtitle C—Acquired Bone Marrow 

2 Failure Diseases 

3 SEC. 7101. ACQUIRED BONE MARROW FAILURE DISEASES. 

4 (a) SHORT TITLE.—This section may be cited as the 

5 ‘‘Bone Marrow Failure Disease Research and Treatment 

6 Act’’. 

7 (b) FINDINGS.—The Congress finds the following: 

8 (1) Between 20,000 and 30,000 people in the 

9 United States are diagnosed each year with 

10 myelodysplastic syndromes, aplastic anemia, parox11 ysmal nocturnal hemoglobinuria, and other acquired 

12 bone marrow failure diseases. 

13 (2) Acquired bone marrow failure diseases have 

14 a debilitating and often fatal impact on those diag15 nosed with these diseases. 

16 (3) While some treatments for acquired bone 

17 marrow failure diseases can prolong and improve the 

18 quality of patients’ lives, there is no single cure for 

19 these diseases. 

20 (4) The prevalence of acquired bone marrow 

21 failure diseases in the United States will continue to 

22 grow as the general public ages. 

23 (5) Evidence exists suggesting that acquired 

24 bone marrow failure diseases occur more often in 


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1 minority populations, particularly in Asian-American 

2 and Latino or Hispanic populations. 

3 (6) The National Heart, Lung, and Blood Insti4 tute and the National Cancer Institute have con5 ducted important research into the causes of and 

6 treatments for acquired bone marrow failure dis7 eases. 

8 (7) The National Marrow Donor Program Reg9 istry has made significant contributions to the fight 

10 against bone marrow failure diseases by connecting 

11 millions of potential marrow donors with individuals 

12 and families suffering from these conditions. 

13 (8) Despite these advances, a more comprehen14 sive Federal strategic effort among numerous Fed15 eral agencies is needed to discover a cure for ac16 quired bone marrow failure disorders. 

17 (9) Greater Federal surveillance of acquired 

18 bone marrow failure diseases is needed to gain a bet19 ter understanding of the causes of acquired bone 

20 marrow failure diseases. 

21 (10) The Federal Government should increase 

22 its research support for and engage with public and 

23 private organizations in developing a comprehensive 

24 approach to combat and cure acquired bone marrow 

25 failure diseases. 


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1 (c) NATIONAL ACQUIRED BONE MARROW FAILURE

2 DISEASE REGISTRY.—Title III of the Public Health Serv3 ice Act (42 U.S.C. 241 et seq.) is amended by inserting 

4 after section 317V, as added by section 1009, the fol5 lowing: 

6 ‘‘SEC. 317W. NATIONAL ACQUIRED BONE MARROW FAILURE 

7 DISEASE REGISTRY. 

8 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 

9 ‘‘(1) IN GENERAL.—Not later than 6 months 

10 after the date of the enactment of this section, the 

11 Secretary, acting through the Director of the Cen12 ters for Disease Control and Prevention, shall— 

13 ‘‘(A) develop a system to collect data on 

14 acquired bone marrow failure diseases; and 

15 ‘‘(B) establish and maintain a national and 

16 publicly available registry, to be known as the 

17 National Acquired Bone Marrow Failure Dis18 ease Registry, in accordance with paragraph 

19 (3). 

20 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM21 MITTEE.—In carrying out this subsection, the Sec22 retary shall take into consideration the recommenda23 tions of the Advisory Committee on Acquired Bone 

24 Marrow Failure Diseases established under sub25 section (b). 


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1 ‘‘(3) PURPOSES OF REGISTRY.—The National 

2 Acquired Bone Marrow Failure Disease Registry 

3 shall— 

4 ‘‘(A) identify the incidence and prevalence 

5 of acquired bone marrow failure diseases in the 

6 United States; 

7 ‘‘(B) be used to collect and store data on 

8 acquired bone marrow failure diseases, includ9 ing data concerning— 

10 ‘‘(i) the age, race or ethnicity, general 

11 geographic location, sex, and family history 

12 of individuals who are diagnosed with ac13 quired bone marrow failure diseases, and 

14 any other characteristics of such individ15 uals determined appropriate by the Sec16 retary; 

17 ‘‘(ii) the genetic and environmental 

18 factors that may be associated with devel19 oping acquired bone marrow failure dis20 eases; 

21 ‘‘(iii) treatment approaches for deal22 ing with acquired bone marrow failure dis23 eases; 

24 ‘‘(iv) outcomes for individuals treated 

25 for acquired bone marrow failure diseases, 


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1 including outcomes for recipients of stem 

2 cell therapeutic products as contained in 

3 the database established pursuant to sec4 tion 379A; and 

5 ‘‘(v) any other factors pertaining to 

6 acquired bone marrow failure diseases de7 termined appropriate by the Secretary; and 

8 ‘‘(C) be made available— 

9 ‘‘(i) to the general public; and 

10 ‘‘(ii) to researchers to facilitate fur11 ther research into the causes of, and treat12 ments for, acquired bone marrow failure 

13 diseases in accordance with standard prac14 tices of the Centers for Disease Control 

15 and Prevention. 

16 ‘‘(b) ADVISORY COMMITTEE.— 

17 ‘‘(1) ESTABLISHMENT.—Not later than 6 

18 months after the date of the enactment of this sec19 tion, the Secretary, acting through the Director of 

20 the Centers for Disease Control and Prevention, 

21 shall establish an advisory committee, to be known 

22 as the Advisory Committee on Acquired Bone Mar23 row Failure Diseases. 

24 ‘‘(2) MEMBERS.—The members of the Advisory 

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1 eases shall be appointed by the Secretary, acting 

2 through the Director of the Centers for Disease 

3 Control and Prevention, and shall include at least 

4 one representative from each of the following: 

5 ‘‘(A) A national patient advocacy organiza6 tion with experience advocating on behalf of pa7 tients suffering from acquired bone marrow 

8 failure diseases. 

9 ‘‘(B) The National Institutes of Health, in10 cluding at least one representative from each 

11 of— 

12 ‘‘(i) the National Cancer Institute; 

13 ‘‘(ii) the National Heart, Lung, and 

14 Blood Institute; and 

15 ‘‘(iii) the Office of Rare Diseases. 

16 ‘‘(C) The Centers for Disease Control and 

17 Prevention. 

18 ‘‘(D) Clinicians with experience in— 

19 ‘‘(i) diagnosing or treating acquired 

20 bone marrow failure diseases; or 

21 ‘‘(ii) medical data registries. 

22 ‘‘(E) Epidemiologists who have experience 

23 with data registries. 


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1 ‘‘(F) Publicly or privately funded research2 ers who have experience researching acquired 

3 bone marrow failure diseases. 

4 ‘‘(G) The entity operating the C.W. Bill 

5 Young Cell Transplantation Program estab6 lished pursuant to section 379 and the entity 

7 operating the C.W. Bill Young Cell Transplan8 tation Program Outcomes Database. 

9 ‘‘(3) RESPONSIBILITIES.—The Advisory Com10 mittee on Acquired Bone Marrow Failure Diseases 

11 shall provide recommendations to the Secretary on 

12 the establishment and maintenance of the National 

13 Acquired Bone Marrow Failure Disease Registry, in14 cluding recommendations on the collection, mainte15 nance, and dissemination of data. 

16 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 

17 shall make the recommendations of the Advisory 

18 Committee on Acquired Bone Marrow Failure Dis19 ease publicly available. 

20 ‘‘(c) GRANTS.—The Secretary, acting through the 

21 Director of the Centers for Disease Control and Preven22 tion, may award grants to, and enter into contracts and 

23 cooperative agreements with, public or private nonprofit 

24 entities for the management of, as well as the collection, 


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1 analysis, and reporting of data to be included in, the Na2 tional Acquired Bone Marrow Failure Disease Registry. 

3 ‘‘(d) DEFINITION.—In this section, the term ‘ac4 quired bone marrow failure disease’ means— 

5 ‘‘(1) myelodysplastic syndromes; 

6 ‘‘(2) aplastic anemia; 

7 ‘‘(3) paroxysmal nocturnal hemoglobinuria; 

8 ‘‘(4) pure red cell aplasia; 

9 ‘‘(5) acute myeloid leukemia that has pro10 gressed from myelodysplastic syndromes; or 

11 ‘‘(6) large granular lymphocytic leukemia. 

12 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated to carry out this section 

14 $3,000,000 for each of fiscal years 2023 through 2027.’’. 

15 (d) PILOT STUDIES THROUGH THE AGENCY FOR

16 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 

17 (1) PILOT STUDIES.—The Secretary of Health 

18 and Human Services, acting through the Director of 

19 the Agency for Toxic Substances and Disease Reg20 istry, shall conduct pilot studies to determine which 

21 environmental factors, including exposure to toxins, 

22 may cause acquired bone marrow failure diseases. 

23 (2) COLLABORATION WITH THE RADIATION IN24 JURY TREATMENT NETWORK.—In carrying out the 

25 directives of this section, the Secretary of Health 


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1 and Human Services may collaborate with the Radi2 ation Injury Treatment Network of the C.W. Bill 

3 Young Cell Transplantation Program established 

4 pursuant to section 379 of the Public Health Service 

5 Act (42 U.S.C. 274k) to— 

6 (A) augment data for the pilot studies au7 thorized by this section; 

8 (B) access technical assistance that may be 

9 provided by the Radiation Injury Treatment 

10 Network; or 

11 (C) perform joint research projects. 

12 (3) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to carry out 

14 this subsection $1,000,000 for each of fiscal years 

15 2023 through 2027. 

16 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED

17 BONE MARROW FAILURE DISEASES.—Title XVII of the 

18 Public Health Service Act (42 U.S.C. 300u et seq.) is 

19 amended by inserting after section 1707A the following: 

20 ‘‘SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON AC21 QUIRED BONE MARROW FAILURE DISEASE. 

22 ‘‘(a) INFORMATION AND REFERRAL SERVICES.— 

23 ‘‘(1) IN GENERAL.—Not later than 6 months 

24 after the date of the enactment of this section, the 

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1 retary for Minority Health, shall establish and co2 ordinate outreach and informational programs tar3 geted to minority populations affected by acquired 

4 bone marrow failure diseases. 

5 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo6 cused outreach and informational programs author7 ized by this section at the National Minority Health 

8 Resource Center supported under section 1707(b)(8) 

9 (including by means of the Center’s website, through 

10 appropriate locations such as the Center’s knowledge 

11 center, and through appropriate programs such as 

12 the Center’s resource persons network) and through 

13 minority health consultants located at each Depart14 ment of Health and Human Services regional of15 fice— 

16 ‘‘(A) shall make information about treat17 ment options and clinical trials for acquired 

18 bone marrow failure diseases publicly available; 

19 and 

20 ‘‘(B) shall provide referral services for 

21 treatment options and clinical trials. 

22 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC

23 ISLANDER OUTREACH.— 

24 ‘‘(1) IN GENERAL.—The Secretary, acting 

25 through the Deputy Assistant Secretary for Minority 


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1 Health, shall undertake a coordinated outreach ef2 fort to connect Hispanic, Asian-American, and Pa3 cific Islander communities with comprehensive serv4 ices focused on treatment of, and information about, 

5 acquired bone marrow failure diseases. 

6 ‘‘(2) COLLABORATION.—In carrying out this 

7 subsection, the Secretary may collaborate with public 

8 health agencies, nonprofit organizations, community 

9 groups, and online entities to disseminate informa10 tion about treatment options and clinical trials for 

11 acquired bone marrow failure diseases. 

12 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 

13 ‘‘(1) IN GENERAL.—Not later than 6 months 

14 after the date of the enactment of this section, the 

15 Secretary, acting through the Deputy Assistant Sec16 retary for Minority Health, shall award grants to, or 

17 enter into cooperative agreements with, entities to 

18 perform research on acquired bone marrow failure 

19 diseases. 

20 ‘‘(2) REQUIREMENT.—Grants and cooperative 

21 agreements authorized by this subsection shall be 

22 awarded or entered into on a competitive, peer-re23 viewed basis. 

24 ‘‘(3) SCOPE OF RESEARCH.—Research funded 

25 under this subsection shall examine factors affecting 


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1 the incidence of acquired bone marrow failure dis2 eases in minority populations. 

3 ‘‘(d) DEFINITION.—In this section, the term ‘ac4 quired bone marrow failure disease’ has the meaning given 

5 to such term in section 317W(d). 

6 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

7 is authorized to be appropriated to carry out this section 

8 $2,000,000 for each of fiscal years 2023 through 2027’’. 

9 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC10 QUIRED BONE MARROW FAILURE DISEASES.— 

11 (1) GRANTS.—The Secretary of Health and 

12 Human Services, acting through the Director of the 

13 Agency for Healthcare Research and Quality, shall 

14 award grants to entities to improve diagnostic prac15 tices and quality of care with respect to patients 

16 with acquired bone marrow failure diseases. 

17 (2) AUTHORIZATION OF APPROPRIATIONS.— 

18 There is authorized to be appropriated to carry out 

19 this subsection $2,000,000 for each of fiscal years 

20 2023 through 2027. 

21 (g) DEFINITION.—In this section, the term ‘‘acquired 

22 bone marrow failure disease’’ has the meaning given such 

23 term in section 317W(d) of the Public Health Service Act, 

24 as added by subsection (c). 


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1 Subtitle D—Cardiovascular Dis2 ease, Chronic Disease, Obesity, 

3 and Other Disease Issues 

4 SEC. 7151. GUIDELINES FOR DISEASE SCREENING FOR MI5 NORITY PATIENTS. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services (in this section referred to as the ‘‘Sec8 retary’’), acting through the Director of the Agency for 

9 Healthcare Research and Quality, shall convene a series 

10 of meetings to develop guidelines for disease screening for 

11 minority patient populations that have a higher than aver12 age risk for many chronic diseases and cancers. 

13 (b) PARTICIPANTS.—In convening meetings under 

14 subsection (a), the Secretary shall ensure that meeting 

15 participants include representatives of— 

16 (1) professional societies and associations; 

17 (2) minority health organizations; 

18 (3) health care researchers and providers, in19 cluding those with expertise in minority health; 

20 (4) Federal health agencies, including the Of21 fice of Minority Health, the National Institute on 

22 Minority Health and Health Disparities, and the 

23 National Institutes of Health; and 

24 (5) other experts as the Secretary determines 

25 appropriate. 


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1 (c) DISEASES.—Screening guidelines for minority 

2 populations shall be developed as appropriate under sub3 section (a) for— 

4 (1) hypertension; 

5 (2) hypercholesterolemia; 

6 (3) diabetes; 

7 (4) cardiovascular disease; 

8 (5) cancers, including breast, prostate, colon, 

9 cervical, and lung cancer; 

10 (6) other pulmonary problems including sleep 

11 apnea; 

12 (7) asthma; 

13 (8) kidney diseases; 

14 (9) eye diseases and disorders, including glau15 coma; 

16 (10) HIV/AIDS and sexually transmitted infec17 tions; 

18 (11) uterine fibroids; 

19 (12) autoimmune diseases, including lupus; 

20 (13) mental health conditions; 

21 (14) dental health conditions and oral diseases, 

22 including oral cancer; 

23 (15) environmental and related health illnesses 

24 and conditions; 

25 (16) sickle cell disease and sickle cell trait; 


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1 (17) violence and injury prevention and control; 

2 (18) genetic and related conditions; 

3 (19) heart disease and stroke; 

4 (20) tuberculosis; 

5 (21) chronic obstructive pulmonary disease; 

6 (22) musculoskeletal diseases, arthritis, and 

7 obesity; and 

8 (23) other diseases determined appropriate by 

9 the Secretary. 

10 (d) DISSEMINATION.—Not later than 2 years after 

11 the date of enactment of this Act, the Secretary shall pub12 lish and disseminate to health care provider organizations 

13 the guidelines developed under subsection (a). 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section 

16 such sums as may be necessary for each of fiscal years 

17 2023 through 2027. 

18 SEC. 7152. CDC WISEWOMAN SCREENING PROGRAM. 

19 Section 1509 of the Public Health Service Act (42 

20 U.S.C. 300n–4a) is amended— 

21 (1) in subsection (a)— 

22 (A) by striking the heading and inserting 

23 ‘‘IN GENERAL.—’’; and 

24 (B) in the matter preceding paragraph (1), 

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1 lows through ‘‘purpose’’ and inserting the fol2 lowing: ‘‘may make grants to such States for 

3 the purpose’’; and 

4 (2) in subsection (d)(1), by striking ‘‘there are 

5 authorized’’ and all that follows through the period 

6 and inserting ‘‘there are authorized to be appro7 priated $23,000,000 for fiscal year 2023, 

8 $25,300,000 for fiscal year 2024, $27,800,000 for 

9 fiscal year 2025, $30,800,000 for fiscal year 2026, 

10 and $34,000,000 for fiscal year 2027.’’. 

11 SEC. 7153. REPORT ON CARDIOVASCULAR CARE FOR 

12 WOMEN AND MINORITIES. 

13 Part P of title III of the Public Health Service Act 

14 (42 U.S.C. 280g et seq.), as amended by section 

15 5201(a)(6), is amended by adding at the end the following: 

16 ‘‘SEC. 399V–9. REPORT ON CARDIOVASCULAR CARE FOR 

17 WOMEN AND MINORITIES. 

18 ‘‘Not later than September 30, 2023, and annually 

19 thereafter, the Secretary shall prepare and submit to Con20 gress a report on the quality of and access to care for 

21 women and minorities with heart disease, stroke, and 

22 other cardiovascular diseases. The report shall contain rec23 ommendations for eliminating disparities in, and improv24 ing the treatment of, heart disease, stroke, and other car25 diovascular diseases in women, racial and ethnic minoriVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01270 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ties, those for whom English is not their primary lan2 guage, and individuals with disabilities.’’. 

3 SEC. 7154. COVERAGE OF COMPREHENSIVE TOBACCO CES4 SATION SERVICES IN MEDICAID, CHIP, AND 

5 PRIVATE HEALTH INSURANCE. 

6 (a) REQUIRING MEDICAID COVERAGE OF COUN7 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO8 BACCO USE AND TEMPORARY ENHANCED FMAP FOR

9 COVERAGE OF TOBACCO CESSATION SERVICES.—Section 

10 1905 of the Social Security Act (42 U.S.C. 1396d) is 

11 amended— 

12 (1) by amending subsection (a)(4)(D) to read 

13 as follows: 

14 ‘‘(D) counseling and pharmacotherapy for 

15 cessation of tobacco use by individuals who are 

16 eligible under the State plan (as defined in sub17 section (bb)); and’’; 

18 (2) in subsection (b), by inserting ‘‘(bb)(2),’’ 

19 after ‘‘(aa),’’; and 

20 (3) by striking subsection (bb) and inserting 

21 the following: 

22 ‘‘(bb) COUNSELING AND PHARMACOTHERAPY FOR

23 CESSATION OF TOBACCO USE.— 

24 ‘‘(1) IN GENERAL.—For purposes of this title, 

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1 sation of tobacco use by individuals who are eligible 

2 under the State plan’ means diagnostic, therapy, 

3 and counseling services and pharmacotherapy (in4 cluding the coverage of prescription and nonprescrip5 tion tobacco cessation agents approved by the Food 

6 and Drug Administration) for the cessation of to7 bacco use by individuals who use tobacco products or 

8 who are being treated for tobacco use that is fur9 nished— 

10 ‘‘(A) by or under the supervision of a phy11 sician; or 

12 ‘‘(B) by any other health care professional 

13 who— 

14 ‘‘(i) is legally authorized to furnish 

15 such services under State law (or the State 

16 regulatory mechanism provided by State 

17 law) of the State in which the services are 

18 furnished; and 

19 ‘‘(ii) is authorized to receive payment 

20 for other services under this title or is des21 ignated by the Secretary for this purpose; 

22 which is recommended in the guideline entitled, 

23 ‘Treating Tobacco Use and Dependence: 2008 

24 Update: A Clinical Practice Guideline’ pub25 lished by the Public Health Service in May 


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1 2008 (or any subsequent modification of such 

2 guideline) or is recommended for the cessation 

3 of tobacco use by the United States Preventive 

4 Services Task Force or any additional interven5 tion approved by the Food and Drug Adminis6 tration as safe and effective in helping smokers 

7 quit. 

8 ‘‘(2) TEMPORARY ENHANCED FMAP FOR COV9 ERAGE OF TOBACCO CESSATION SERVICES.—Not10 withstanding subsection (b), for calendar quarters 

11 occurring during the period beginning on the date of 

12 the enactment of this paragraph and ending 2 years 

13 after the last day of the emergency period described 

14 in section 1135(g)(1)(B), the Federal medical assist15 ance percentage with respect to amounts expended 

16 by a State for medical assistance for counseling and 

17 pharmacotherapy for cessation of tobacco use by in18 dividuals who are eligible under the State plan (as 

19 defined in paragraph (1)) shall be equal to 100 per20 cent.’’. 

21 (b) NO COST SHARING.— 

22 (1) IN GENERAL.—Subsections (a)(2) and 

23 (b)(2) of section 1916 of the Social Security Act (42 

24 U.S.C. 1396o), as amended by section 2007(d)(4), 

25 are each amended— 


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1 (A) in subparagraph (B), by striking ‘‘, 

2 and counseling’’ and all that follows through 

3 ‘‘section 1905(bb)(2)(A)’’; 

4 (B) in subparagraph (I), by striking ‘‘or’’ 

5 after the comma; 

6 (C) in subparagraph (J), by striking ‘‘; 

7 and’’ and inserting ‘‘, or’’; and 

8 (D) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(K) counseling and pharmacotherapy for 

11 cessation of tobacco use by individuals who are 

12 eligible under the State plan (as defined in sec13 tion 1905(bb)) and covered outpatient drugs (as 

14 defined in subsection (k)(2) of section 1927 and 

15 including nonprescription drugs described in 

16 subsection (d)(2) of such section) that are pre17 scribed for purposes of promoting tobacco ces18 sation in accordance with the guideline specified 

19 in section 1905(bb); and’’. 

20 (2) APPLICATION TO ALTERNATIVE COST SHAR21 ING.—Section 1916A(b)(3)(B) of the Social Security 

22 Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended— 

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1 bacco use by pregnant women (as defined in 

2 section 1905(bb))’’; and 

3 (B) by adding at the end the following new 

4 clause: 

5 ‘‘(xiv) Counseling and 

6 pharmacotherapy for cessation of tobacco 

7 use by individuals who are eligible under 

8 the State plan (as defined in section 

9 1905(bb)) and covered outpatient drugs 

10 (as defined in subsection (k)(2) of section 

11 1927 and including nonprescription drugs 

12 described in subsection (d)(2) of such sec13 tion) that are prescribed for purposes of 

14 promoting tobacco cessation in accordance 

15 with the guideline specified in section 

16 1905(bb).’’. 

17 (c) EXCEPTION FROM OPTIONAL RESTRICTION

18 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 

19 Section 1927(d)(2)(F) of the Social Security Act (42 

20 U.S.C. 1396r–8(d)(2)(F)) is amended to read as follows: 

21 ‘‘(F) Nonprescription drugs, except, when 

22 recommended in accordance with the guideline 

23 referred to in section 1905(bb), agents ap24 proved by the Food and Drug Administration 


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1 under the over-the-counter monograph process 

2 for purposes of promoting tobacco cessation.’’. 

3 (d) STATE MONITORING AND PROMOTING OF COM4 PREHENSIVE TOBACCO CESSATION SERVICES UNDER

5 MEDICAID.—Section 1902(a) of the Social Security Act 

6 (42 U.S.C. 1396a(a)), as amended by section 

7 4251(d)(3)(A), is amended— 

8 (1) in paragraph (87), by striking ‘‘and’’ at the 

9 end; 

10 (2) in paragraph (88), by striking the period at 

11 the end and inserting ‘‘; and’’; and 

12 (3) by inserting after paragraph (8) the fol13 lowing new paragraph: 

14 ‘‘(89) provide for the State to monitor and pro15 mote the use of comprehensive tobacco cessation 

16 services under the State plan (including conducting 

17 an outreach campaign to increase awareness of the 

18 benefits of using such services) among— 

19 ‘‘(A) individuals entitled to medical assist20 ance under the State plan who use tobacco 

21 products; and 

22 ‘‘(B) clinicians and others who provide 

23 services to individuals entitled to medical assist24 ance under the State plan.’’. 


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1 (e) FEDERAL REIMBURSEMENT FOR OUTREACH

2 CAMPAIGN.—Section 1903(a) of the Social Security Act 

3 (42 U.S.C. 1396b(a)) is amended— 

4 (1) in paragraph (6)(B), by striking ‘‘plus’’ at 

5 the end; 

6 (2) in paragraph (7), by striking the period at 

7 the end and inserting ‘‘; plus’’; and 

8 (3) by inserting after paragraph (7) the fol9 lowing new paragraph: 

10 ‘‘(8) with respect to the development, imple11 mentation, and evaluation of an outreach campaign 

12 to— 

13 ‘‘(A) increase awareness of comprehensive 

14 tobacco cessation services covered in the State 

15 plan among— 

16 ‘‘(i) individuals who are likely to be el17 igible for medical assistance under the 

18 State plan; and 

19 ‘‘(ii) clinicians and others who provide 

20 services to individuals who are likely to be 

21 eligible for medical assistance under the 

22 State plan; and 

23 ‘‘(B) increase awareness of the benefits of 

24 using comprehensive tobacco cessation services 

25 covered in the State plan among— 


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1 ‘‘(i) individuals who are likely to be el2 igible for medical assistance under the 

3 State plan; and 

4 ‘‘(ii) clinicians and others who provide 

5 services to individuals who are likely to be 

6 eligible for medical assistance under the 

7 State plan about the benefits of using com8 prehensive tobacco cessation services; 

9 for calendar quarters occurring during the pe10 riod beginning on the date of the enactment of 

11 this paragraph and ending on 2 years after the 

12 last day of the emergency period described in 

13 section 1135(g)(1)(B), an amount equal to 100 

14 percent of the sums expended during each quar15 ter which are attributable to such development, 

16 implementation, and evaluation, and for cal17 endar quarters succeeding such period, an 

18 amount equal to Federal medical assistance 

19 percentage determined under section 1905(b) of 

20 the sums expended during each quarter which 

21 are so attributable.’’. 

22 (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES23 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 

24 the Social Security Act (42 U.S.C. 1396r–8(d)) is amend25 ed— 


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1 (1) in paragraph (1)(A), by striking ‘‘A State’’ 

2 and inserting ‘‘Subject to paragraph (8), a State’’; 

3 and 

4 (2) by adding at the end the following new 

5 paragraph: 

6 ‘‘(8) NO PRIOR AUTHORIZATION PROGRAMS FOR

7 TOBACCO CESSATION DRUGS.—A State plan may not 

8 require, as a condition of coverage or payment for 

9 a covered outpatient drug, the approval of an agent 

10 to promote smoking cessation (including agents ap11 proved by the Food and Drug Administration) or to12 bacco cessation.’’. 

13 (g) EXCLUSION OF ENHANCED PAYMENTS FROM

14 TERRITORIAL CAPS.—Notwithstanding any other provi15 sion of law, for purposes of section 1108 of the Social Se16 curity Act (42 U.S.C. 1308), with respect to any addi17 tional amount paid to a territory as a result of the applica18 tion of section 1905(bb)(2) of the Social Security Act (42 

19 U.S.C. 1396d(bb)(2))— 

20 (1) the limitation on payments to territories 

21 under subsections (f) and (g) of such section 1108 

22 shall not apply to such additional amounts; and 

23 (2) such additional amounts shall be dis24 regarded in applying such subsections. 


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1 (h) REQUIRING CHIP COVERAGE OF COUNSELING

2 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO

3 USE.— 

4 (1) IN GENERAL.—Section 2103(c)(2) of the 

5 Social Security Act (42 U.S.C. 1397cc(c)(2)) is 

6 amended by adding at the end the following new 

7 subparagraph: 

8 ‘‘(D) Counseling and pharmacotherapy for 

9 cessation of tobacco use by individuals who are 

10 eligible under the State child health plan.’’. 

11 (2) COUNSELING AND PHARMACOTHERAPY FOR

12 CESSATION OF TOBACCO USE DEFINED.—Section 

13 2110(c) of the Social Security Act (42 U.S.C. 

14 1397jj(c)) is amended by adding at the end the fol15 lowing new paragraph: 

16 ‘‘(10) COUNSELING AND PHARMACOTHERAPY

17 FOR CESSATION OF TOBACCO USE.—The term ‘coun18 seling and pharmacotherapy for cessation of tobacco 

19 use’ means diagnostic, therapy, and counseling serv20 ices and pharmacotherapy (including the coverage of 

21 prescription and nonprescription tobacco cessation 

22 agents approved by the Food and Drug Administra23 tion) for the cessation of tobacco use by individuals 

24 who use tobacco products or who are being treated 

25 for tobacco use that are furnished— 


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1 ‘‘(A) by or under the supervision of a phy2 sician; or 

3 ‘‘(B) by any other health care professional 

4 who— 

5 ‘‘(i) is legally authorized to furnish 

6 such services under State law (or the State 

7 regulatory mechanism provided by State 

8 law) of the State in which the services are 

9 furnished; and 

10 ‘‘(ii) is authorized to receive payment 

11 for other services under this title or is des12 ignated by the Secretary for this purpose; 

13 which is recommended in the guideline entitled, 

14 ‘Treating Tobacco Use and Dependence: 2008 

15 Update: A Clinical Practice Guideline’ pub16 lished by the Public Health Service in May 

17 2008 (or any subsequent modification of such 

18 guideline) or is recommended for the cessation 

19 of tobacco use by the United States Preventive 

20 Services Task Force or any additional interven21 tion approved by the Food and Drug Adminis22 tration as safe and effective in helping smokers 

23 quit.’’. 


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1 (i) NO COST SHARING.—Section 2103(e) of the So2 cial Security Act (42 U.S.C. 1397cc(e)) is amended by 

3 adding at the end the following new paragraph: 

4 ‘‘(5) NO COST SHARING ON BENEFITS FOR

5 COUNSELING AND PHARMACOTHERAPY FOR CES6 SATION OF TOBACCO USE.—The State child health 

7 plan may not impose deductibles, coinsurance, or 

8 other cost sharing with respect to benefits for coun9 seling and pharmacotherapy for cessation of tobacco 

10 use (as defined in section 2110(c)(10)) and prescrip11 tion drugs that are covered under a State child 

12 health plan that are prescribed for purposes of pro13 moting tobacco cessation in accordance with the 

14 guideline specified in section 2110(c)(10)(B).’’. 

15 (j) EXCEPTION FROM OPTIONAL RESTRICTION

16 UNDER CHIP PRESCRIPTION DRUG COVERAGE.—Section 

17 2103 of the Social Security Act (42 U.S.C. 1397cc) is 

18 amended by adding at the end the following new sub19 section: 

20 ‘‘(g) EXCEPTION FROM OPTIONAL RESTRICTION

21 UNDER CHIP PRESCRIPTION DRUG COVERAGE.—The 

22 State child health plan may exclude or otherwise restrict 

23 nonprescription drugs, except, in the case of— 

24 ‘‘(1) pregnant women when recommended in ac25 cordance with the guideline specified in section 


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1 2110(c)(10)(B), agents approved by the Food and 

2 Drug Administration under the over-the-counter 

3 monograph process for purposes of promoting to4 bacco cessation; and 

5 ‘‘(2) individuals who are eligible under the 

6 State child health plan when recommended in ac7 cordance with the Guideline referred to in section 

8 2110(c)(10)(B), agents approved by the Food and 

9 Drug Administration under the over-the-counter 

10 monograph process for purposes of promoting to11 bacco cessation.’’. 

12 (k) STATE MONITORING AND PROMOTING OF COM13 PREHENSIVE TOBACCO CESSATION SERVICES UNDER

14 CHIP.—Section 2102 of the Social Security Act (42 

15 U.S.C. 1397bb) is amended by adding at the end the fol16 lowing new subsection: 

17 ‘‘(d) STATE MONITORING AND PROMOTING OF COM18 PREHENSIVE TOBACCO CESSATION SERVICES UNDER

19 CHIP.—A State child health plan shall include a descrip20 tion of the procedures to be used by the State to monitor 

21 and promote the use of comprehensive tobacco cessation 

22 services under the State plan (including conducting an 

23 outreach campaign to increase awareness of the benefits 

24 of using such services) among— 


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1 ‘‘(1) individuals entitled to medical assistance 

2 under the State child health plan who use tobacco 

3 products; and 

4 ‘‘(2) clinicians and others who provide services 

5 to individuals entitled to medical assistance under 

6 the State child health plan.’’. 

7 (l) FEDERAL REIMBURSEMENT FOR CHIP COV8 ERAGE AND OUTREACH CAMPAIGN.— 

9 (1) IN GENERAL.—Section 2105(a) of the So10 cial Security Act (42 U.S.C. 1397ee(a)) is amended 

11 by adding at the end the following new paragraph: 

12 ‘‘(5) FEDERAL REIMBURSEMENT FOR CHIP

13 COVERAGE OF COMPREHENSIVE TOBACCO CES14 SATION SERVICES AND OUTREACH CAMPAIGN.—In 

15 addition to the payments made under paragraph (1) 

16 for calendar quarters occurring during the period be17 ginning on the date of the enactment of this para18 graph and ending on 2 years after the last day of 

19 the emergency period described in section 

20 1135(g)(1)(B), the Secretary shall pay— 

21 ‘‘(A) an amount equal to 100 percent of 

22 the sums expended during each quarter which 

23 are attributable to the cost of furnishing coun24 seling and pharmacotherapy for cessation of to25 bacco use by individuals who are eligible under 


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1 the State child health plan (net of any pay2 ments made to the State under paragraph (1) 

3 with respect to such counseling and 

4 pharmacotherapy); plus 

5 ‘‘(B) an amount equal to 100 percent of 

6 the sums expended during each quarter which 

7 are attributable to the development, implemen8 tation, and evaluation of an outreach campaign 

9 to— 

10 ‘‘(i) increase awareness of comprehen11 sive tobacco cessation services covered in 

12 the State child health plan among— 

13 ‘‘(I) individuals who are likely to 

14 be eligible for medical assistance 

15 under the State child health plan; and 

16 ‘‘(II) clinicians and others who 

17 provide services to individuals who are 

18 likely to be eligible for medical assist19 ance under the State child health 

20 plan; and 

21 ‘‘(ii) increase awareness of the bene22 fits of using comprehensive tobacco ces23 sation services covered in the State child 

24 health plan among— 


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1 ‘‘(I) individuals who are likely to 

2 be eligible for medical assistance 

3 under the State child health plan; and 

4 ‘‘(II) clinicians and others who 

5 provide services to individuals who are 

6 likely to be eligible for medical assist7 ance under the State child health plan 

8 about the benefits of using com9 prehensive tobacco cessation serv10 ices.’’. 

11 (2) ADJUSTMENT OF CHIP ALLOTMENTS.—Sec12 tion 2104(m) of the Social Security Act (42 U.S.C. 

13 1397dd(m)) is amended— 

14 (A) in paragraph (2)(B), by striking ‘‘and 

15 (12)’’ and inserting ‘‘(12), and (13)’’; and 

16 (B) by adding at the end the following new 

17 paragraph: 

18 ‘‘(13) ADJUSTING ALLOTMENTS TO ACCOUNT

19 FOR FEDERAL PAYMENTS FOR CHIP COVERAGE OF

20 COMPREHENSIVE TOBACCO CESSATION SERVICES

21 AND OUTREACH CAMPAIGN.—If a State (including 

22 the District of Columbia and each commonwealth 

23 and territory) receives a payment for a fiscal year 

24 under section 2105(a)(5), the allotment determined 


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1 for the State for such fiscal year shall be increased 

2 by the amount of such payment.’’. 

3 (m) NO PRIOR AUTHORIZATION FOR TOBACCO CES4 SATION DRUGS UNDER CHIP.—Section 2103 of the So5 cial Security Act (42 U.S.C. 1397cc), as amended by sub6 section (h), is further amended— 

7 (1) in subsection (c)(2)(A), by inserting ‘‘(in ac8 cordance with subsection (h))’’ after ‘‘Coverage of 

9 prescription drugs’’; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘(h) NO PRIOR AUTHORIZATION PROGRAMS FOR TO13 BACCO CESSATION DRUGS.—A State child health plan 

14 may not require, as a condition of coverage or payment 

15 for prescription drugs, the approval of an agent to pro16 mote smoking cessation (including agents approved by the 

17 Food and Drug Administration) or tobacco cessation.’’. 

18 (n) COMPREHENSIVE COVERAGE OF TOBACCO CES19 SATION COVERAGE IN PRIVATE HEALTH INSURANCE.— 

20 Section 2713 of the Public Health Service Act (42 U.S.C. 

21 300gg–13) is amended by adding at the end the following: 

22 ‘‘(d) NO PRIOR AUTHORIZATION.—A group health 

23 plan and a health insurance issuer offering group or indi24 vidual health insurance coverage shall not impose any 

25 prior authorization requirement for tobacco cessation 


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1 counseling and pharmacotherapy that has in effect a rat2 ing of ‘A’ or ‘B’ in the current recommendations of the 

3 United States Preventive Services Task Force.’’. 

4 (o) RULE OF CONSTRUCTION.—None of the amend5 ments made by this section shall be construed to limit cov6 erage of any counseling or pharmacotherapy for individ7 uals under 18 years of age. 

8 (p) EFFECTIVE DATE.—The amendments made by 

9 this section shall take effect on the first day of the first 

10 fiscal year that begins on or after the date of enactment 

11 of this Act. 

12 SEC. 7155. CLINICAL RESEARCH FUNDING FOR ORAL 

13 HEALTH. 

14 (a) IN GENERAL.—The Secretary of Health and 

15 Human Services shall expand and intensify the conduct 

16 and support of the research activities of the National In17 stitutes of Health and the National Institute of Dental 

18 and Craniofacial Research to improve the oral health of 

19 the population through the prevention and management 

20 of oral diseases and conditions. 

21 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

22 activities under subsection (a) shall include— 

23 (1) comparative effectiveness research and clin24 ical disease management research addressing early 

25 childhood cancer and oral cancer; and 


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1 (2) awarding of grants and contracts to support 

2 the training and development of health services re3 searchers, comparative effectiveness researchers, and 

4 clinical researchers whose research improves the oral 

5 health of the population. 

6 SEC. 7156. GUIDE ON EVIDENCE-BASED STRATEGIES FOR 

7 PUBLIC HEALTH DEPARTMENT OBESITY PRE8 VENTION PROGRAMS. 

9 (a) DEVELOPMENT AND DISSEMINATION OF AN EVI10 DENCE-BASED STRATEGIES GUIDE.—The Secretary of 

11 Health and Human Services (referred to in this section 

12 as the ‘‘Secretary’’), acting through the Director of the 

13 Centers for Disease Control and Prevention, not later than 

14 2 years after the date of enactment of this Act, shall— 

15 (1) develop a guide on evidence-based strategies 

16 for State, territorial, and local health departments to 

17 use to build and maintain effective obesity preven18 tion and reduction programs, and, in consultation 

19 with stakeholders that have expertise in Tribal 

20 health, a guide on such evidence-based strategies 

21 with respect to Indian Tribes and Tribal organiza22 tions for such Indian Tribes and Tribal organiza23 tions to use for such purpose, both of which guides 

24 shall— 


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1 (A) describe an integrated program struc2 ture for implementing interventions proven to 

3 be effective in preventing and reducing the inci4 dence of obesity; and 

5 (B) recommend— 

6 (i) optimal resources, including staff7 ing and infrastructure, for promoting nu8 trition and obesity prevention and reduc9 tion; and 

10 (ii) strategies for effective obesity pre11 vention programs for State and local 

12 health departments, Indian Tribes, and 

13 Tribal organizations, including strategies 

14 related to— 

15 (I) the application of evidence16 based and evidence-informed practices 

17 to prevent and reduce obesity rates; 

18 (II) the development, implemen19 tation, and evaluation of obesity pre20 vention and reduction strategies for 

21 specific communities and populations; 

22 (III) demonstrated knowledge of 

23 obesity prevention practices that re24 duce associated preventable diseases, 


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1 health conditions, death, and health 

2 care costs; 

3 (IV) best practices for the coordi4 nation of efforts to prevent and re5 duce obesity and related chronic dis6 eases; 

7 (V) addressing the underlying 

8 risk factors and social determinants of 

9 health that impact obesity rates; and 

10 (VI) interdisciplinary coordina11 tion between relevant public health of12 ficials specializing in fields such as 

13 nutrition, physical activity, epidemi14 ology, communications, and policy im15 plementation, and collaboration be16 tween public health officials and com17 munity-based organizations; and 

18 (2) disseminate the guides and current re19 search, evidence-based practices, tools, and edu20 cational materials related to obesity prevention, con21 sistent with the guides, to State and local health de22 partments, Indian Tribes, and Tribal organizations. 

23 (b) TECHNICAL ASSISTANCE.—The Secretary, acting 

24 through the Director of the Centers for Disease Control 

25 and Prevention, shall provide technical assistance to State 


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1 and local health departments, Indian Tribes, and Tribal 

2 organizations to support such health departments in im3 plementing the guides developed under subsection (a)(1). 

4 (c) INDIAN TRIBES; TRIBAL ORGANIZATIONS.—In 

5 this section, the terms ‘‘Indian Tribe’’ and ‘‘Tribal organi6 zation’’ have the meanings given the terms in section 4 

7 of the Indian Self-Determination and Education Assist8 ance Act (25 U.S.C. 5304). 

9 SEC. 7157. STEPHANIE TUBBS JONES UTERINE FIBROID RE10 SEARCH AND EDUCATION ACT. 

11 (a) RESEARCH WITH RESPECT TO UTERINE

12 FIBROIDS.— 

13 (1) RESEARCH.—The Secretary of Health and 

14 Human Services (referred to in this section as the 

15 ‘‘Secretary’’) shall expand, intensify, and coordinate 

16 programs for the conduct and support of research 

17 with respect to uterine fibroids. 

18 (2) ADMINISTRATION AND COORDINATION.— 

19 The Secretary shall carry out the conduct and sup20 port of research pursuant to paragraph (1), in co21 ordination with the appropriate institutes, offices, 

22 and centers of the National Institutes of Health and 

23 any other relevant Federal agency, as determined by 

24 the Director of the National Institutes of Health. 


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1 (3) AUTHORIZATION OF APPROPRIATIONS.—For 

2 the purpose of carrying out this subsection, there 

3 are authorized to be appropriated $30,000,000 for 

4 each of fiscal years 2023 through 2027. 

5 (b) RESEARCH WITH RESPECT TO MEDICAID COV6 ERAGE OF UTERINE FIBROIDS TREATMENT.— 

7 (1) RESEARCH.—The Secretary (or the Sec8 retary’s designee) shall establish a research data9 base, or expand an existing research database, to 

10 collect data on services furnished to individuals diag11 nosed with uterine fibroids under a State plan (or a 

12 waiver of such a plan) under the Medicaid program 

13 under title XIX of the Social Security Act (42 

14 U.S.C. 1396 et seq.) or under a State child health 

15 plan (or a waiver of such a plan) under the Chil16 dren’s Health Insurance Program under title XXI of 

17 such Act (42 U.S.C. 1397aa et seq.) for the treat18 ment of such fibroids for purposes of assessing the 

19 frequency at which such individuals are furnished 

20 such services. 

21 (2) REPORT.— 

22 (A) IN GENERAL.—Not later than the date 

23 that is two years after the date of the enact24 ment of this Act, the Secretary shall submit to 

25 Congress a report on the amount of Federal 


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1 and State expenditures with respect to services 

2 furnished for the treatment of uterine fibroids 

3 under State plans (or waivers of such plans) 

4 under the Medicaid program under such title 

5 XIX and State child health plans (or waivers of 

6 such plans) under the Children’s Health Insur7 ance Program under such title XXI. 

8 (B) COORDINATION.—The Secretary shall 

9 coordinate the development and submission of 

10 the report required under subparagraph (A) 

11 with any other relevant Federal agency, as de12 termined by the Secretary. 

13 (c) EDUCATION AND DISSEMINATION OF INFORMA14 TION WITH RESPECT TO UTERINE FIBROIDS.— 

15 (1) UTERINE FIBROIDS PUBLIC EDUCATION

16 PROGRAM.—The Secretary shall develop and dis17 seminate to the public information regarding uterine 

18 fibroids, including information on— 

19 (A) the awareness, incidence, and preva20 lence of uterine fibroids among individuals, in21 cluding all minority individuals; 

22 (B) the elevated risk for minority individ23 uals to develop uterine fibroids; and 

24 (C) the availability, as medically appro25 priate, of the range of treatment options for 


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1 symptomatic uterine fibroids, including non2 hysterectomy treatments and procedures. 

3 (2) DISSEMINATION OF INFORMATION.—The 

4 Secretary may disseminate information under para5 graph (1) directly or through arrangements with 

6 intra-agency initiatives, nonprofit organizations, con7 sumer groups, institutions of higher education (as 

8 defined in section 101 of the Higher Education Act 

9 of 1965 (20 U.S.C. 1001)), or Federal, State, or 

10 local public private partnerships. 

11 (3) AUTHORIZATION OF APPROPRIATIONS.—For 

12 the purpose of carrying out this subsection, there 

13 are authorized to be appropriated such sums as may 

14 be necessary for each of fiscal years 2023 through 

15 2027. 

16 Subtitle E—HIV/AIDS 

17 SEC. 7201. STATEMENT OF POLICY. 

18 It is the policy of the United States to achieve an 

19 AIDS-free generation, and to— 

20 (1) expand access to lifesaving antiretroviral 

21 therapy for people living with HIV and immediately 

22 link people to continuous and coordinated high-qual23 ity care when they learn they are living with HIV; 

24 (2) expand targeted efforts to prevent HIV in25 fection using a combination of effective, evidenceVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01295 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 based approaches, including routine HIV screening, 

2 and universal access to HIV prevention tools, includ3 ing preexposure prophylaxis, in communities dis4 proportionately impacted by HIV, particularly com5 munities of color; 

6 (3) ensure laws, policies, and regulations do not 

7 impede access to prevention, treatment, and care for 

8 people living with HIV or disproportionately im9 pacted by HIV; 

10 (4) accelerate research for more efficacious HIV 

11 prevention and treatments, tools, a cure, and a vac12 cine; and 

13 (5) respect the human rights and dignity of 

14 persons living with HIV. 

15 SEC. 7202. FINDINGS. 

16 The Congress finds the following: 

17 (1) Over 1,100,000 people are estimated to be 

18 living with HIV in the United States according to 

19 the Centers for Disease Control and Prevention, 14 

20 percent of whom are unaware they are living with 

21 HIV. 

22 (2) The Centers for Disease Control and Pre23 vention estimates that, in 2019, there were approxi24 mately 34,800 people newly diagnosed with HIV. 

25 New HIV infections declined 8 percent from 37,800 


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1 in 2015, after a period of general stability. From 

2 2015 to 2019, new infections among young gay and 

3 bisexual men (ages 13 to 24) dropped 33 percent 

4 overall, with declines in young men of all races, but 

5 African Americans, Hispanics, and Latinos continue 

6 to be severely and disproportionately affected. 

7 (3) HIV disproportionately affects certain popu8 lations in the United States. Though Blacks/African 

9 Americans represent approximately 13 percent of 

10 the population, they account for almost half (44 per11 cent) of all people living with HIV in the United 

12 States. Black/African-American men who have sex 

13 with men account for 26 percent of all new HIV in14 fections and have remained stable from 2010 to 

15 2019. 

16 (4) Disparities continue to exist among Latinos 

17 and Hispanics; in 2019, Latinos and Hispanics 

18 made up 18 percent of the United States population 

19 and 30 percent of new infections. 

20 (5) Though the rate of new infections among 

21 American Indians and Alaska Natives (referred to in 

22 this section as ‘‘AI/AN’’) is proportional to their 

23 population size, from 2015 to 2019, the annual 

24 number of HIV diagnoses increased among Amer25 ican Indians and Alaska Natives. 


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1 (6) Asian Americans account for about 2 per2 cent of new HIV infections, but in 2013, 22 percent 

3 were undiagnosed, the highest rate of undiagnosed 

4 HIV among any race or ethnicity. Between 2010 

5 and 2016, the number of Asian Americans receiving 

6 an HIV diagnosis increased by 42 percent. 

7 (7) The latest data from the Centers for Dis8 ease Control and Prevention indicates that new in9 fections among women remained stable in 2019. 

10 (8) The history of HIV shows that culturally 

11 relevant and gender-responsive supportive services, 

12 including psychosocial support, treatment literacy, 

13 case management, and transportation are necessary 

14 strategies to reach and engage women and girls in 

15 medical care. 

16 (9) From 2015 through 2019 in the United 

17 States and 6 dependent areas, the number of diag18 noses of HIV infection for transgender adults and 

19 adolescents increased. In 2019, among transgender 

20 adults and adolescents, the largest percentage (93 

21 percent) of diagnoses of HIV infections was for 

22 transgender male-to-female (MTF) people. By age, 

23 in 2019, the largest percentage (24 percent) of diag24 noses of HIV infection among transgender persons 

25 was for transgender MTF adults and adolescents 


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1 aged 20 to 24 years, followed by transgender MTF 

2 adults and adolescents aged 25 to 29 years (23 per3 cent). 

4 (10) Stigma and discrimination contribute to 

5 such disparities. 

6 (11) The Centers for Disease Control and Pre7 vention has determined that increasing the propor8 tion of people who know their HIV status is an es9 sential component of comprehensive HIV treatment 

10 and prevention efforts and that early diagnosis is 

11 critical in order for people with HIV to receive life12 extending therapy. Additionally, the Centers for Dis13 ease Control and Prevention recommends routine 

14 HIV screening in health care settings for all patients 

15 aged 13 to 64, regardless of risk. 

16 (12) In 1998, Congress created the National 

17 Minority AIDS Initiative to provide technical assist18 ance, build capacity, and strengthen outreach efforts 

19 among local institutions and community-based orga20 nizations that serve racial and ethnic minorities liv21 ing with or vulnerable to HIV. 

22 (13) To combat the HIV epidemic in the United 

23 States, the National HIV/AIDS Strategy (referred 

24 to in this section as ‘‘NHAS’’) provides a framework 

25 of increasing access to care, reducing new infections, 


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1 and eliminating HIV-related health disparities. The 

2 vision of NHAS is ‘‘The United States will be a 

3 place where new HIV infections are prevented, every 

4 person knows their status, and every person with 

5 HIV has high-quality care and treatment, lives free 

6 from stigma and discrimination, and can achieve 

7 their full potential for health and well-being across 

8 their lifespan. This vision includes all people, regard9 less of age, sex, gender identity, sexual orientation, 

10 race, ethnicity, religion, disability, geographic loca11 tion, or socioeconomic circumstance.’’. 

12 (14) In January 2019, the Department of 

13 Health and Human Services began implementing the 

14 initiative ‘‘Ending the HIV Epidemic: A Plan for 

15 America’’. The initiative seeks to reduce the number 

16 of new HIV infections in the United States by 75 

17 percent by 2025, and then by at least 90 percent by 

18 2030, for an estimated 250,000 total HIV infection 

19 averted. 

20 (15) At present, many States and United 

21 States territories have criminal statutes based on 

22 ‘‘exposure’’ to HIV. Most of these laws were adopted 

23 before the availability of effective antiretroviral 

24 treatment for HIV/AIDS. 


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1 (16) Research shows that stable housing leads 

2 to better health outcomes for those living with HIV. 

3 Inadequate or unstable housing is not only a barrier 

4 to effective treatment, but also increases the likeli5 hood of engaging in risky behaviors leading to HIV 

6 infection. Insecure housing puts people with HIV/ 

7 AIDS at risk of premature death from exposure to 

8 other diseases, poor nutrition, and lack of medical 

9 care. 

10 (17) Due to advances in treatment, many peo11 ple living with HIV today are living healthy lives and 

12 have the ability and desire to fully participate in all 

13 aspects of community life, including employment. 

14 Research associates being employed with tremendous 

15 economic, social, and health benefits for many people 

16 living with HIV. 

17 (18) Despite the tremendous progress made in 

18 the treatment and prevention of HIV/AIDS, dis19 criminatory policies stemming from continued stig20 matization of HIV/AIDS and the LGBTQ+ commu21 nity continue to plague the scientific community. 

22 This includes blood donation guidance updated by 

23 Food and Drug Administration in 2020 that rec24 ommends a 3-month deferral policy for gay and bi25 sexual men before they are eligible to donate blood. 


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1 Health agencies in the United States must imple2 ment blood donation policies that are grounded in 

3 science and that do not unfairly single out any 

4 group of individuals. 

5 (19) The common benefits associated with em6 ployment include income, autonomy, productivity, 

7 status within society, daily structure, making a con8 tribution to one’s community, and increased skills 

9 and self-esteem. Research also indicates that many 

10 people with disabilities, including people living with 

11 HIV, report perceiving themselves as being less dis12 abled or not disabled at all, when working. Further13 more, some studies link working with better physical 

14 and mental health outcomes for people living with 

15 HIV when compared to those who are not working. 

16 Preliminary data also suggest that transitioning to 

17 employment is associated with reduced HIV-related 

18 health risk behavior for many people. 

19 (20) In July 2012, the Food and Drug Admin20 istration approved the first drug to be used as pre21 exposure prophylaxis (PrEP). PrEP reduces the risk 

22 of HIV infection in HIV-negative individuals. Stud23 ies have shown that PrEP reduces HIV transmission 

24 from sex by about 99 percent when taken consist25 ently. Despite increases in PrEP uptake, PrEP use 


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1 remains low among gay and bisexual men of color. 

2 The Centers for Disease Control and Prevention 

3 found that uptake was lower among African-Amer4 ican (26 percent) and Latino (30 percent) men com5 pared with White men (42 percent). Similarly, PrEP 

6 awareness was lower among African-American (86 

7 percent) and Latino (87 percent) men compared 

8 with White men (95 percent). While clinical research 

9 on transgender populations and PrEP is currently 

10 limited, the Centers for Disease Control and Preven11 tion recommends PrEP use in transgender popu12 lations. In September 2019, the Food and Drug Ad13 ministration approved the second drug to be used as 

14 PrEP. 

15 (21) Syringe service programs have been associ16 ated with lowered HIV infections, lower hepatitis C 

17 infections, and increased linkage to substance use 

18 treatment. 

19 (22) There is now conclusive scientific evidence 

20 that a person living with HIV who is on 

21 antiretroviral therapy and is durably virally sup22 pressed (defined as having a consistent viral load of 

23 less than 200 copies/ml) does not sexually transmit 

24 HIV. The conclusive evidence about the highly effec25 tive preventative benefits of antiretroviral therapy 


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1 provides an unprecedented opportunity to improve 

2 the lives of people living with HIV, improve treat3 ment uptake and adherence, and advocate for ex4 panded access to treatment and care. 

5 SEC. 7203. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST6 ANCE PROGRAM TREATMENTS. 

7 Section 2623 of the Public Health Service Act (42 

8 U.S.C. 300ff–31b) is amended by adding at the end the 

9 following: 

10 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS11 SISTANCE PROGRAM TREATMENTS.—In addition to 

12 amounts otherwise authorized to be appropriated for car13 rying out this subpart, there are authorized to be appro14 priated such sums as may be necessary to carry out sec15 tions 2612(b)(3)(B) and 2616 for each of fiscal years 

16 2023 through 2026.’’. 

17 SEC. 7204. ENHANCING THE NATIONAL HIV SURVEILLANCE 

18 SYSTEM. 

19 (a) GRANTS.—The Secretary of Health and Human 

20 Services, acting through the Director of the Centers for 

21 Disease Control and Prevention, shall make grants to 

22 States to support integration of public health surveillance 

23 systems into all electronic health records in order to allow 

24 rapid communications between the clinical setting and 

25 health departments, by means that include— 


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1 (1) providing technical assistance and policy 

2 guidance to State and local health departments, clin3 ical providers, and other agencies serving individuals 

4 with HIV to improve the interoperability of data sys5 tems relevant to monitoring HIV care and sup6 portive services; 

7 (2) capturing longitudinal data pertaining to 

8 the initiation and ongoing prescription or dispensing 

9 of antiretroviral therapy for individuals diagnosed 

10 with HIV (such as through pharmacy-based report11 ing); 

12 (3) obtaining information— 

13 (A) on a voluntary basis, on sexual orienta14 tion and gender identity; and 

15 (B) on sources of coverage (or the lack of 

16 coverage) for medical treatment (including cov17 erage through the Medicaid program under title 

18 XIX of the Social Security Act (42 U.S.C. 1396 

19 et seq.), the Medicare program under title 

20 XVIII of such Act (42 U.S.C. 1395 et seq.), the 

21 program under title XXVI of the Public Health 

22 Service Act (42 U.S.C. 300ff–11 et seq.; com23 monly referred to as the ‘‘Ryan White HIV/ 

24 AIDS Program’’), other public funding, private 


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1 insurance, and health maintenance organiza2 tions); and 

3 (4) obtaining and using current geographic 

4 markers of residence (such as current address, ZIP 

5 Code, partial ZIP Code, and census block). 

6 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car7 rying out this section, the Secretary of Health and Human 

8 Services shall ensure that appropriate privacy and security 

9 safeguards are met to prevent unauthorized disclosure of 

10 protected health information and compliance with the 

11 HIPAA privacy and security law (as defined in section 

12 3009 of the Public Health Service Act (42 U.S.C. 300jj– 

13 19)) and other relevant laws and regulations. 

14 (c) PROHIBITION AGAINST IMPROPER USE OF

15 DATA.—No grant under this section may be used to allow 

16 or facilitate the collection or use of surveillance or clinical 

17 data or records— 

18 (1) for punitive measures of any kind, civil or 

19 criminal, against the subject of such data or records; 

20 or 

21 (2) for imposing any requirement or restriction 

22 with respect to an individual without the individual’s 

23 written consent. 

24 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

25 out this section, there are authorized to be appropriated 


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1 such sums as may be necessary for each of fiscal years 

2 2023 through 2026. 

3 SEC. 7205. EVIDENCE-BASED STRATEGIES FOR IMPROVING 

4 LINKAGE TO, AND RETENTION IN, APPRO5 PRIATE CARE. 

6 (a) STRATEGIES.—The Secretary of Health and 

7 Human Services, in collaboration with the Director of the 

8 Centers for Disease Control and Prevention, the Assistant 

9 Secretary for Mental Health and Substance Use, the Di10 rector of the Office of AIDS Research, the Administrator 

11 of the Health Resources and Services Administration, and 

12 the Administrator of the Centers for Medicare & Medicaid 

13 Services, shall— 

14 (1) identify evidence-based strategies most ef15 fective at addressing the multifaceted issues that im16 pede disease status awareness with respect to HIV/ 

17 AIDS and linkage to, and retention in, appropriate 

18 care, taking into consideration health care systems 

19 issues, clinic and provider issues, and individual psy20 chosocial, environmental, and other contextual fac21 tors; 

22 (2) support the wide-scale implementation of 

23 the evidence-based strategies identified pursuant to 

24 paragraph (1), including through incorporating such 

25 strategies into health care coverage supported by the 


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1 Medicaid program under title XIX of the Social Se2 curity Act (42 U.S.C. 1396 et seq.), the program 

3 under title XXVI of the Public Health Service Act 

4 (42 U.S.C. 300ff–11 et seq.; commonly referred to 

5 as the ‘‘Ryan White HIV/AIDS Program’’), and 

6 health plans purchased through an Exchange estab7 lished under title I of the Patient Protection and Af8 fordable Care Act (Public Law 111–148); and 

9 (3) not later than 1 year after the date of the 

10 enactment of this Act, submit a report to the Con11 gress on the status of activities under paragraphs 

12 (1) and (2). 

13 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

14 out this section, there are authorized to be appropriated 

15 such sums as may be necessary for fiscal years 2023 

16 through 2026. 

17 SEC. 7206. IMPROVING ENTRY INTO, AND RETENTION IN, 

18 CARE AND ANTIRETROVIRAL ADHERENCE 

19 FOR PERSONS WITH HIV. 

20 (a) SENSE OF CONGRESS.—It is the sense of Con21 gress that AIDS research has led to scientific advance22 ments that have— 

23 (1) saved the lives of millions of people living 

24 with HIV; 


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1 (2) prevented millions of individuals from re2 ceiving new diagnoses of HIV; and 

3 (3) had broad benefits that extend far beyond 

4 helping people at risk for, or living with, HIV. 

5 (b) IN GENERAL.—The Secretary of Health and 

6 Human Services, acting through the Director of the Na7 tional Institutes of Health, shall expand, intensify, and co8 ordinate operational and translational research and other 

9 activities of the National Institutes of Health regarding 

10 methods— 

11 (1) to increase adoption of evidence-based ad12 herence strategies within HIV care and treatment 

13 programs; 

14 (2) to increase HIV testing and case detection 

15 rates; 

16 (3) to reduce HIV-related health disparities; 

17 (4) to ensure that research to improve adher18 ence to HIV care and treatment programs address 

19 the unique concerns of women; 

20 (5) to integrate HIV prevention and care serv21 ices with mental health and substance use preven22 tion and treatment delivery systems; 

23 (6) to increase knowledge on the implementa24 tion of preexposure prophylaxis (referred to in this 

25 section as ‘‘PrEP’’), including with respect to— 


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1 (A) who can benefit most from PrEP; 

2 (B) how to provide PrEP safely and effi3 ciently; 

4 (C) how to integrate PrEP with other es5 sential prevention methods such as condoms; 

6 and 

7 (D) how to ensure high levels of adherence; 

8 and 

9 (7) to increase knowledge of ‘‘undetectable and 

10 untransmittable’’, when a person living with HIV 

11 who is on antiretroviral therapy and is durably 

12 virally suppressed (defined as having a consistent 

13 viral load of less than 200 copies/ml) cannot sexually 

14 transmit HIV. 

15 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

16 out this section, there are authorized to be appropriated 

17 such sums as may be necessary for fiscal years 2023 

18 through 2026. 

19 SEC. 7207. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 

20 ETHNIC MINORITY COMMUNITIES. 

21 (a) IN GENERAL.—For the purpose of reducing new 

22 HIV diagnoses in racial and ethnic minority communities, 

23 the Secretary of Health and Human Services, acting 

24 through the Deputy Assistant Secretary for Minority 


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1 Health, may make grants to public health agencies and 

2 faith-based organizations to conduct— 

3 (1) outreach activities related to HIV preven4 tion and testing activities; 

5 (2) HIV prevention activities; 

6 (3) HIV testing activities; and 

7 (4) public health education campaigns on ac8 cessing HIV prevention medication. 

9 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

10 out this section, there are authorized to be appropriated 

11 such sums as may be necessary for fiscal years 2023 

12 through 2026. 

13 SEC. 7208. MINORITY AIDS INITIATIVE. 

14 (a) EXPANDED FUNDING.—The Secretary of Health 

15 and Human Services, in collaboration with the Deputy As16 sistant Secretary for Minority Health, the Director of the 

17 Centers for Disease Control and Prevention, the Adminis18 trator of the Health Resources and Services Administra19 tion, and the Assistant Secretary for Mental Health and 

20 Substance Use, shall provide funds and carry out activities 

21 to expand the Minority AIDS Initiative. 

22 (b) USE OF FUNDS.—The additional funds made 

23 available under this section may be used, through the Mi24 nority AIDS Initiative, to support the following activities: 


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1 (1) Providing technical assistance and infra2 structure support to reduce HIV/AIDS in minority 

3 populations. 

4 (2) Increasing minority populations’ access to 

5 HIV prevention and care services. 

6 (3) Building strong community programs and 

7 partnerships to address HIV prevention and the 

8 health care needs of specific racial and ethnic minor9 ity populations. 

10 (c) PRIORITY INTERVENTIONS.—Within the racial 

11 and ethnic minority populations referred to in subsection 

12 (b), priority in conducting intervention services shall be 

13 given to— 

14 (1) men who have sex with men; 

15 (2) youth; 

16 (3) persons who engage in intravenous drug 

17 abuse; 

18 (4) women; 

19 (5) homeless individuals; 

20 (6) individuals incarcerated or in the penal sys21 tem; 

22 (7) transgender individuals; and 

23 (8) nonbinary individuals. 

24 (d) AUTHORIZATION OF APPROPRIATIONS.—For car25 rying out this section, there are authorized to be approVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01312 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 priated $610,000,000 for fiscal year 2023 and such sums 

2 as may be necessary for each of fiscal years 2024 through 

3 2027. 

4 SEC. 7209. HEALTH CARE PROFESSIONALS TREATING INDI5 VIDUALS WITH HIV. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services, acting through the Administrator of the 

8 Health Resources and Services Administration, shall ex9 pand, intensify, and coordinate workforce initiatives of the 

10 Health Resources and Services Administration to increase 

11 the capacity of the health workforce focusing primarily on 

12 HIV to meet the demand for culturally competent care, 

13 and may award grants for any of the following: 

14 (1) Development of curricula for training pri15 mary care providers in HIV/AIDS prevention and 

16 care, including routine HIV testing. 

17 (2) Support to expand access to culturally and 

18 linguistically accessible benefits counselors, trained 

19 peer navigators, and mental and behavioral health 

20 professionals with expertise in HIV. 

21 (3) Training health care professionals to pro22 vide care to individuals living with HIV. 

23 (4) Development by grant recipients under title 

24 XXVI of the Public Health Service Act (42 U.S.C. 

25 300ff–11 et seq.; commonly referred to as the ‘‘Ryan 


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1 White HIV/AIDS Program’’) and other persons, of 

2 policies for providing culturally relevant and sen3 sitive treatment to individuals living with HIV, with 

4 particular emphasis on treatment to racial and eth5 nic minorities, men who have sex with men, and 

6 women, young people, and children living with HIV. 

7 (5) Development and implementation of pro8 grams to increase the use of telehealth to respond to 

9 HIV-specific health care needs in rural and minority 

10 communities, with particular emphasis given to 

11 medically underserved communities and insular 

12 areas. 

13 (6) Evaluating interdisciplinary medical pro14 vider care team models that promote high-quality 

15 care, with particular emphasis on care to racial and 

16 ethnic minorities. 

17 (7) Training health care professionals to make 

18 them aware of the high rates of chronic hepatitis B 

19 and chronic hepatitis C in adult racial and ethnic 

20 minority populations, and the importance of preven21 tion, detection, and medical management of hepatitis 

22 B and hepatitis C and of liver cancer screening. 

23 (8) Development of curricula for training pri24 mary care providers that HIV and tuberculosis are 

25 significant mutual comorbidities, and that a patient 


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1 who tests positive for one disease should be offered 

2 and encouraged to receive testing for the other. 

3 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

4 out this section, there are authorized to be appropriated 

5 such sums as may be necessary for fiscal years 2023 

6 through 2026. 

7 SEC. 7210. HIV/AIDS PROVIDER LOAN REPAYMENT PRO8 GRAM. 

9 (a) IN GENERAL.—The Secretary may enter into an 

10 agreement with any physician, nurse practitioner, or phy11 sician assistant under which— 

12 (1) the physician, nurse practitioner, or physi13 cian assistant agrees to serve as a medical provider 

14 for a period of not less than 2 years— 

15 (A) at a Ryan White-funded or title X16 funded facility with a critical shortage of doc17 tors (as determined by the Secretary); or 

18 (B) in an area with a high incidence of 

19 HIV/AIDS; and 

20 (2) the Secretary agrees to make payments in 

21 accordance with subsection (b) on the professional 

22 education loans of the physician, nurse practitioner, 

23 or physician assistant. 


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1 (b) MANNER OF PAYMENTS.—The payments de2 scribed in subsection (a) shall be made by the Secretary 

3 as follows: 

4 (1) Upon completion by the physician, nurse 

5 practitioner, or physician assistant for whom the 

6 payments are to be made of the first year of the 

7 service specified in the agreement entered into with 

8 the Secretary under subsection (a), the Secretary 

9 shall pay 30 percent of the principal of and the in10 terest on the individual’s professional education 

11 loans. 

12 (2) Upon completion by the physician, nurse 

13 practitioner, or physician assistant of the second 

14 year of such service, the Secretary shall pay another 

15 30 percent of the principal of and the interest on 

16 such loans. 

17 (3) Upon completion by that individual of a 

18 third year of such service, the Secretary shall pay 

19 another 25 percent of the principal of and the inter20 est on such loans. 

21 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub22 part III of part D of title III of the Public Health Service 

23 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 

24 with this section, apply to the program carried out under 

25 this section in the same manner and to the same extent 


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1 as such provisions apply to the National Health Service 

2 Corps loan repayment program. 

3 (d) REPORTS.—Not later than 18 months after the 

4 date of the enactment of this Act, and annually thereafter, 

5 the Secretary shall prepare and submit to Congress a re6 port describing the program carried out under this section, 

7 including statements regarding the following: 

8 (1) The number of physicians, nurse practi9 tioners, and physician assistants enrolled in the pro10 gram. 

11 (2) The number and amount of loan repay12 ments provided through the program. 

13 (3) The placement location of loan repayment 

14 recipients at facilities described in subsection (a)(1). 

15 (4) The default rate on such loans and actions 

16 required. 

17 (5) The amount of outstanding default funds 

18 with respect to such loans. 

19 (6) To the extent that it can be determined, the 

20 reason for the default on such a loan. 

21 (7) The demographics of individuals partici22 pating in the program. 

23 (8) An evaluation of the overall costs and bene24 fits of the program. 

25 (e) DEFINITIONS.—In this section: 


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1 (1) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 

2 human immunodeficiency virus and acquired im3 mune deficiency syndrome. 

4 (2) NURSE PRACTITIONER.—The term ‘‘nurse 

5 practitioner’’ means a registered nurse who has com6 pleted an accredited graduate degree program in ad7 vanced nurse practice and has successfully passed a 

8 national certification exam. 

9 (3) PHYSICIAN.—The term ‘‘physician’’ means 

10 a graduate of a school of medicine who has com11 pleted postgraduate training in general or pediatric 

12 medicine. 

13 (4) PHYSICIAN ASSISTANT.—The term ‘‘physi14 cian assistant’’ means a medical provider who com15 pleted an accredited physician assistant training pro16 gram and successfully passed the Physician Assist17 ant National Certifying Examination. 

18 (5) PROFESSIONAL EDUCATION LOAN.—The 

19 term ‘‘professional education loan’’— 

20 (A) means a loan that is incurred for the 

21 cost of attendance (including tuition, other rea22 sonable educational expenses, and reasonable 

23 living costs) at a school of medicine, school of 

24 nursing, or physician assistant training pro25 gram; and 


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1 (B) includes only the portion of the loan 

2 that is outstanding on the date the physician, 

3 nurse practitioner, or physician assistant in4 volved begins the service specified in the agree5 ment under subsection (a). 

6 (6) RYAN WHITE-FUNDED.—The term ‘‘Ryan 

7 White-funded’’ means, with respect to a facility, re8 ceiving funds under title XXVI of the Public Health 

9 Service Act (42 U.S.C. 300ff–11 et seq.). 

10 (7) SECRETARY.—The term ‘‘Secretary’’ means 

11 the Secretary of Health and Human Services. 

12 (8) SCHOOL OF MEDICINE.—The term ‘‘school 

13 of medicine’’ has the meaning given to that term in 

14 section 799B of the Public Health Service Act (42 

15 U.S.C. 295p). 

16 (9) TITLE X-FUNDED.—The term ‘‘title X-fund17 ed’’ means, with respect to a facility, receiving funds 

18 under title X of the Public Health Service Act (42 

19 U.S.C. 300 et seq.). 

20 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there are authorized to be appropriated 

22 such sums as may be necessary for fiscal years 2023 

23 through 2026. 


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1 SEC. 7211. DENTAL EDUCATION LOAN REPAYMENT PRO2 GRAM. 

3 (a) IN GENERAL.—The Secretary may enter into an 

4 agreement with any dentist under which— 

5 (1) the dentist agrees to serve as a dentist for 

6 a period of not less than 2 years at a facility with 

7 a critical shortage of dentists (as determined by the 

8 Secretary) in an area with a high incidence of HIV/ 

9 AIDS; and 

10 (2) the Secretary agrees to make payments in 

11 accordance with subsection (b) on the dental edu12 cation loans of the dentist. 

13 (b) MANNER OF PAYMENTS.—The payments de14 scribed in subsection (a) shall be made by the Secretary 

15 as follows: 

16 (1) Upon completion by the dentist for whom 

17 the payments are to be made of the first year of the 

18 service specified in the agreement entered into with 

19 the Secretary under subsection (a), the Secretary 

20 shall pay 30 percent of the principal of and the in21 terest on the dental education loans of the dentist. 

22 (2) Upon completion by the dentist of the sec23 ond year of such service, the Secretary shall pay an24 other 30 percent of the principal of and the interest 

25 on such loans. 


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1 (3) Upon completion by that individual of a 

2 third year of such service, the Secretary shall pay 

3 another 25 percent of the principal of and the inter4 est on such loans. 

5 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub6 part III of part D of title III of the Public Health Service 

7 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 

8 with this section, apply to the program carried out under 

9 this section in the same manner and to the same extent 

10 as such provisions apply to the National Health Service 

11 Corps Loan Repayment Program. 

12 (d) REPORTS.—Not later than 18 months after the 

13 date of the enactment of this Act, and annually thereafter, 

14 the Secretary shall prepare and submit to the Congress 

15 a report describing the program carried out under this sec16 tion, including statements regarding the following: 

17 (1) The number of dentists enrolled in the pro18 gram. 

19 (2) The number and amount of loan repay20 ments provided through the program. 

21 (3) The placement location of loan repayment 

22 recipients at facilities described in subsection (a)(1). 

23 (4) The default rate on such loans and actions 

24 required. 


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1 (5) The amount of outstanding default funds 

2 with respect to such loans. 

3 (6) To the extent that it can be determined, the 

4 reason for the default on such a loan. 

5 (7) The demographics of individuals partici6 pating in the program. 

7 (8) An evaluation of the overall costs and bene8 fits of the program. 

9 (e) DEFINITIONS.—In this section: 

10 (1) DENTAL EDUCATION LOAN.—The term 

11 ‘‘dental education loan’’— 

12 (A) means a loan that is incurred for the 

13 cost of attendance (including tuition, other rea14 sonable educational expenses, and reasonable 

15 living costs) at a school of dentistry; and 

16 (B) includes only the portion of the loan 

17 that is outstanding on the date the dentist in18 volved begins the service specified in the agree19 ment under subsection (a). 

20 (2) DENTIST.—The term ‘‘dentist’’ means a 

21 graduate of a school of dentistry who has completed 

22 postgraduate training in general or pediatric den23 tistry. 


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1 (3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 

2 human immunodeficiency virus and acquired im3 mune deficiency syndrome. 

4 (4) SCHOOL OF DENTISTRY.—The term ‘‘school 

5 of dentistry’’ has the meaning given to that term in 

6 section 799B of the Public Health Service Act (42 

7 U.S.C. 295p). 

8 (5) SECRETARY.—The term ‘‘Secretary’’ means 

9 the Secretary of Health and Human Services. 

10 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 such sums as may be necessary for each of fiscal years 

13 2023 through 2026. 

14 SEC. 7212. REDUCING NEW HIV INFECTIONS AMONG IN15 JECTING DRUG USERS. 

16 (a) SENSE OF CONGRESS.—It is the sense of Con17 gress that providing sterile syringes and sterilized equip18 ment to injecting drug users substantially reduces risk of 

19 HIV infection, increases the probability that they will ini20 tiate drug treatment, and does not increase drug use. 

21 (b) IN GENERAL.—The Secretary of Health and 

22 Human Services may provide grants and technical assist23 ance for the purpose of reducing the rate of HIV infections 

24 among injecting drug users through a comprehensive 

25 package of services for such users, including the provision 


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1 of sterile syringes, education and outreach, access to infec2 tious disease testing, overdose prevention, and treatment 

3 for drug dependence. 

4 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

5 out this section, there are authorized to be appropriated 

6 such sums as may be necessary for fiscal years 2023 

7 through 2026. 

8 SEC. 7213. REPORT ON IMPACT OF HIV/AIDS IN VULNER9 ABLE POPULATIONS. 

10 (a) IN GENERAL.—The Secretary of Health and 

11 Human Services shall submit to Congress and the Presi12 dent an annual report on the impact of HIV/AIDS for 

13 racial and ethnic minority communities, women, and youth 

14 aged 24 and younger. 

15 (b) CONTENTS.—The report under subsection (a) 

16 shall include information on the— 

17 (1) progress that has been made in reducing 

18 the impact of HIV/AIDS in such communities; 

19 (2) opportunities that exist to make additional 

20 progress in reducing the impact of HIV/AIDS in 

21 such communities; 

22 (3) challenges that may impede such additional 

23 progress; and 


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1 (4) Federal funding necessary to achieve sub2 stantial reductions in HIV/AIDS in racial and ethnic 

3 minority communities. 

4 SEC. 7214. NATIONAL HIV/AIDS OBSERVANCE DAYS. 

5 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 

6 of Congress that national observance days highlighting the 

7 impact of HIV on communities of color include the fol8 lowing: 

9 (1) National Black HIV/AIDS Awareness Day. 

10 (2) National Latino AIDS Awareness Day. 

11 (3) National Asian and Pacific Islander HIV/ 

12 AIDS Awareness Day. 

13 (4) National Native American HIV/AIDS 

14 Awareness Day. 

15 (5) National Youth HIV/AIDS Awareness Day. 

16 (b) CALL TO ACTION.—It is the sense of Congress 

17 that the President should call on members of communities 

18 of color— 

19 (1) to become involved at the local community 

20 level in HIV testing, policy, and advocacy; 

21 (2) to become aware, engaged, and empowered 

22 on the HIV epidemic within their communities; and 

23 (3) to urge members of their communities to re24 duce risk factors, practice safe sex and other prevenVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01325 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tive measures, be tested for HIV, and seek care 

2 when appropriate. 

3 SEC. 7215. REVIEW OF ALL FEDERAL AND STATE LAWS, 

4 POLICIES, AND REGULATIONS REGARDING 

5 THE CRIMINAL PROSECUTION OF INDIVID6 UALS FOR HIV-RELATED OFFENSES. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

9 (1) At present, 32 States and 2 United States 

10 territories have criminal statutes based on perceived 

11 exposure to HIV, rather than behaviors motivated by 

12 an intent to harm, presenting a significant risk of 

13 transmission and resulting in actual transmission of 

14 HIV to another. 11 States have HIV-specific laws 

15 that make spitting or biting a felony, even though it 

16 is not possible to transmit HIV via saliva. 24 States 

17 require persons who are aware that they have HIV 

18 to disclose their status to sexual partners, regardless 

19 of whether they are noninfectious. 14 of these 24 

20 States also require disclosure to needle-sharing part21 ners. 25 States criminalize 1 or more behaviors that 

22 pose a low or negligible risk for HIV transmission. 

23 (2) HIV-specific criminal laws are classified as 

24 felonies in 28 States. In 3 States, a person’s expo25 sure to another to HIV does not subject the person 


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1 to criminal prosecution for that act alone but may 

2 result in a sentence enhancement. 18 States impose 

3 sentences of up to 10 years per violation, 7 States 

4 impose sentences between 11 and 20 years, and 5 

5 States impose sentences of greater than 20 years. 

6 (3) When members of the Armed Forces ac7 quire HIV, they are issued orders that require them 

8 to disclose and use a condom under all cir9 cumstances, including when the known risk of trans10 mission is 0. Failure to disclose can result in pros11 ecution under the Uniform Code of Military Justice 

12 (UCMJ). 

13 (4) The number of prosecutions, arrests, and 

14 instances where HIV-based charges are used to in15 duce plea agreements is unknown. Because State16 level prosecution and arrest data are not readily 

17 available in any national legal database, the societal 

18 impact of these laws may be underestimated, and 

19 most cases that go to trial are not reduced to writ20 ten, published opinions. 

21 (5) State and Federal criminal law does not 

22 currently reflect the 4 decades of medical advances 

23 and discoveries made with regard to transmission 

24 and treatment of HIV/AIDS. 


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1 (6) According to the CDC, correct and con2 sistent male or female condom use, or adherence to 

3 a preexposure prophylaxis (PrEP) regimen that re4 sults in viral suppression, are very effective in pre5 venting HIV transmission. However, most State 

6 HIV-specific laws and prosecutions do not treat the 

7 use of a condom during sexual intercourse or adher8 ence to PrEP as a mitigating factor or evidence that 

9 the defendant did not intend to transmit HIV. 

10 (7) Criminal laws and prosecutions do not take 

11 into account the benefits of effective antiretroviral 

12 medications, which suppress the virus to extremely 

13 low levels and further reduce the already low risk of 

14 transmitting HIV to near 0. 

15 (8) In addition to HIV-specific criminal laws, 

16 general criminal laws are often misused to prosecute 

17 people based on their HIV status. Although HIV, 

18 and even AIDS, currently is viewed as a treatable, 

19 chronic, medical condition, people living with HIV 

20 have been charged under aggravated assault, at21 tempted murder, and even bioterrorism statutes be22 cause prosecutors, courts, and legislators continue to 

23 view and characterize the blood, semen, and saliva of 

24 people living with HIV as a ‘‘deadly weapon’’. 


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1 (9) Multiple peer-reviewed studies demonstrate 

2 that HIV-specific laws do not reduce risk-taking be3 havior or increase disclosure by people living with or 

4 at risk of HIV, and there is increasing evidence that 

5 these laws reduce the willingness to get tested. Fur6 thermore, placing legal responsibility for preventing 

7 the transmission of HIV and other pathogens that 

8 can be sexually transmitted exclusively on people di9 agnosed with a sexually transmitted infection under10 mines the public health message that all people are 

11 responsible for practicing behaviors that protect 

12 themselves from HIV and other sexually transmitted 

13 infections. Unfortunately, some State laws that cre14 ate an expectation of disclosure work against public 

15 health communication and discourage risk-reduction 

16 measures that could prevent transmission as a result 

17 of those who are acutely infected and unaware of 

18 their status. 

19 (10) The identity of an individual subject to an 

20 HIV-based prosecution is broadcast through media 

21 reports, potentially destroying employment opportu22 nities and relationships and violating the person’s 

23 right to privacy. 

24 (11) Individuals who are convicted after an 

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1 fenders, even in cases involving consensual sexual 

2 activity. Their employability is destroyed, and their 

3 family relationships are fractured. 

4 (12) The United Nations, including the Joint 

5 United Nations Programme on HIV/AIDS 

6 (UNAIDS), urges governments to ‘‘limit criminaliza7 tion to cases of intentional transmission’’. This re8 quirement would limit prosecutions to situations 

9 ‘‘where a person knows his or her HIV-positive sta10 tus, acts with the intention to transmit HIV, and 

11 does in fact transmit it’’. UNAIDS also recommends 

12 that criminal law should not be applied to cases 

13 where there is no significant risk of transmission. 

14 (13) In 2010, the Federal Government released 

15 the first ever National HIV/AIDS Strategy (NHAS), 

16 which addressed HIV-specific criminal laws, stating: 

17 ‘‘While we understand the intent behind these laws, 

18 they may not have the desired effect and they may 

19 make people less willing to disclose their status by 

20 making people feel at even greater risk of discrimi21 nation. In some cases, it may be appropriate for leg22 islators to reconsider whether existing laws continue 

23 to further the public interest and public health. In 

24 many instances, the continued existence and enforce25 ment of these types of laws run counter to scientific 


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1 evidence about routes of HIV transmission and may 

2 undermine the public health goals of promoting HIV 

3 screening and treatment.’’. The NHAS also states 

4 that State legislatures should consider reviewing 

5 HIV-specific criminal statutes to ensure that they 

6 are consistent with current knowledge of HIV trans7 mission and support public health approaches to pre8 venting and treating HIV. 

9 (14) The Global Commission on HIV and the 

10 Law was launched in June 2010 to examine laws 

11 and practices that criminalize people living with and 

12 vulnerable to HIV and to develop evidence-based rec13 ommendations for effective HIV responses. The 

14 Commission calls for ‘‘governments, civil society and 

15 international bodies to repeal punitive laws and 

16 enact laws that facilitate and enable effective re17 sponses to HIV prevention, care and treatment serv18 ices for all who need them’’. The Commission rec19 ommends against the enactment of ‘‘laws that ex20 plicitly criminalize HIV transmission, exposure or 

21 non-disclosure of HIV status, which are counter22 productive’’. 

23 (15) In February 2019, the Department of 

24 Health and Human Services (HHS) launched ‘‘End25 ing the HIV Epidemic: A Plan for America’’, a new 


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1 initiative with an ambitious goal to end the domestic 

2 HIV epidemic in 10 years by reducing new cases of 

3 HIV by 75 percent by 2025 and by 90 percent by 

4 2030. In this plan, HHS notes that stigma ‘‘can be 

5 a debilitating barrier preventing people living with, 

6 or at risk for, HIV from receiving the health care, 

7 services, and respect they need and deserve’’. Many 

8 of the States and jurisdictions identified as a pri9 ority for the first 5 years of the plan have stigma10 based criminal statutes for perceived exposure to 

11 HIV. These statutes run counter to the goals of this 

12 new initiative and stand in the way of ending the do13 mestic HIV epidemic. 

14 (b) SENSE OF CONGRESS REGARDING LAWS OR REG15 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV.— 

16 It is the sense of Congress that Federal and State laws, 

17 policies, and regulations regarding people living with 

18 HIV— 

19 (1) should not place unique or additional bur20 dens on such individuals solely as a result of their 

21 HIV status; and 

22 (2) should instead demonstrate a public health23 oriented, evidence-based, medically accurate, and 

24 contemporary understanding of— 


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1 (A) the multiple factors that lead to HIV 

2 transmission; 

3 (B) the relative risk of demonstrated HIV 

4 transmission routes; 

5 (C) the current health implications of liv6 ing with HIV; 

7 (D) the associated benefits of treatment 

8 and support services for people living with HIV; 

9 and 

10 (E) the impact of punitive HIV-specific 

11 laws, policies, regulations, and judicial prece12 dents and decisions on public health, on people 

13 living with or affected by HIV, and on their 

14 families and communities. 

15 (c) REVIEW OF FEDERAL AND STATE LAWS.— 

16 (1) REVIEW OF FEDERAL AND STATE LAWS.— 

17 (A) IN GENERAL.—Not later than 90 days 

18 after the date of the enactment of this Act, the 

19 Attorney General, the Secretary of Health and 

20 Human Services, and the Secretary of Defense 

21 acting jointly (in this section referred to as the 

22 ‘‘designated officials’’) shall initiate a national 

23 review of Federal and State laws, including the 

24 Uniform Code of Military Justice (referred to in 

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1 tions, and judicial precedents and decisions re2 garding criminal and related civil commitment 

3 cases involving people living with HIV/AIDS. 

4 (B) CONSULTATION.—In carrying out the 

5 review under subparagraph (A), the designated 

6 officials shall seek to include diverse participa7 tion from, and consultation with, each of the 

8 following: 

9 (i) Each State. 

10 (ii) State attorneys general (or their 

11 representatives). 

12 (iii) State public health officials (or 

13 their representatives). 

14 (iv) State judicial and court system 

15 officers, including judges, district attor16 neys, prosecutors, defense attorneys, law 

17 enforcement, and correctional officers. 

18 (v) Members of the United States 

19 Armed Forces, including members of other 

20 Federal services subject to the UCMJ. 

21 (vi) People living with HIV/AIDS, 

22 particularly those who have been subject to 

23 HIV-related prosecution or who are from 

24 minority communities whose members have 


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1 been disproportionately subject to HIV2 specific arrests and prosecution. 

3 (vii) Legal advocacy and HIV/AIDS 

4 service organizations that work with people 

5 living with HIV/AIDS. 

6 (viii) Nongovernmental health organi7 zations that work on behalf of people living 

8 with HIV/AIDS, including syringe services 

9 programs, LGBTQ-focused health organi10 zations, and organizations who serve peo11 ple who engage in sex work. 

12 (ix) Trade organizations or associa13 tions representing persons or entities de14 scribed in clauses (i) through (vii). 

15 (C) RELATION TO OTHER REVIEWS.—In 

16 carrying out the review under subparagraph 

17 (A), the designated officials may utilize other 

18 existing reviews of criminal and related civil 

19 commitment cases involving people living with 

20 HIV, including any such review conducted by 

21 any Federal or State agency or any public 

22 health, legal advocacy, or trade organization or 

23 association if the designated officials determines 

24 that such reviews were conducted in accordance 

25 with the principles set forth in subsection (b). 


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1 (2) REPORT.—Not later than 180 days after 

2 initiating the review required under paragraph (1), 

3 the Attorney General shall transmit to the Congress 

4 and make publicly available a report containing the 

5 results of the review, which includes the following: 

6 (A) For each State and for the UCMJ, a 

7 summary of the relevant laws, policies, regula8 tions, and judicial precedents and decisions re9 garding criminal cases involving people living 

10 with HIV, including the following: 

11 (i) A determination of whether such 

12 laws, policies, regulations, and judicial 

13 precedents and decisions place any unique 

14 or additional burdens upon people living 

15 with HIV. 

16 (ii) A determination of whether such 

17 laws, policies, regulations, and judicial 

18 precedents and decisions demonstrate a 

19 public health-oriented, evidence-based, 

20 medically accurate, and contemporary un21 derstanding of— 

22 (I) the multiple factors that lead 

23 to HIV transmission; 

24 (II) the relative risk of HIV 

25 transmission routes, including that a 


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1 person that has an undetectable viral 

2 load cannot transmit HIV; 

3 (III) the current health implica4 tions of living with HIV, including 

5 data disaggregated by race and eth6 nicity; 

7 (IV) the current status of pro8 viding protection to people who en9 gage in survival sex work against 

10 whom condom possession has been 

11 used as evidence of intent to commit 

12 a crime; 

13 (V) States that have the classi14 fication of mandatory sex offenders; 

15 (VI) the associated benefits of 

16 treatment and support services for 

17 people living with HIV; and 

18 (VII) the impact of punitive 

19 HIV-specific laws and policies on pub20 lic health, on people living with or af21 fected by HIV, and on their families 

22 and communities, including people 

23 who are in abusive, dependent, violent, 

24 or nonconsensual relationships and 


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1 are unable to both negotiate the use 

2 of condoms and status disclosure. 

3 (iii) An analysis of the public health 

4 and legal implications of such laws, poli5 cies, regulations, and judicial precedents 

6 and decisions, including an analysis of the 

7 consequences of having a similar penal 

8 scheme applied to comparable situations 

9 involving other communicable diseases. 

10 (iv) An analysis of the proportionality 

11 of punishments imposed under HIV-spe12 cific laws, policies, regulations, and judicial 

13 precedents, taking into consideration pen14 alties attached to violation of State laws 

15 against similar degrees of endangerment or 

16 harm, such as driving while intoxicated or 

17 transmission of other communicable dis18 eases, or more serious harms, such as ve19 hicular manslaughter offenses. 

20 (B) An analysis of common elements 

21 shared between State laws, policies, regulations, 

22 and judicial precedents. 

23 (C) A set of best practice recommendations 

24 directed to State governments, including State 

25 attorneys general, public health officials, and 


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1 judicial officers, in order to ensure that laws, 

2 policies, regulations, and judicial precedents re3 garding people living with HIV are in accord4 ance with the principles set forth in subsection 

5 (b). 

6 (D) Recommendations for adjustments to 

7 the UCMJ, including discontinuing the use of a 

8 service member’s HIV diagnosis as the basis for 

9 prosecution, enhanced penalties, or discharge 

10 from military service, in order to ensure that 

11 laws, policies, regulations, and judicial prece12 dents regarding people living with HIV are in 

13 accordance with the principles set forth in sub14 section (b). Such recommendations should in15 clude any necessary and appropriate changes to 

16 ‘‘Orders to Follow Preventative Medicine Re17 quirements’’. 

18 (3) GUIDANCE.—Not later than 90 days after 

19 the date of the release of the report required by 

20 paragraph (2), the Attorney General and the Sec21 retary of Health and Human Services shall jointly 

22 develop and publicly release updated guidance for 

23 States based on the set of best practice rec24 ommendations required under paragraph (2)(C) in 

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1 lated civil commitment cases regarding people living 

2 with HIV. 

3 (4) MONITORING AND EVALUATION SYSTEM.— 

4 Not later than 60 days after the date of the release 

5 of the guidance required under paragraph (3), the 

6 Attorney General and the Secretary of Health and 

7 Human Services shall jointly establish an integrated 

8 monitoring and evaluation system that includes, 

9 where appropriate, objective and quantifiable per10 formance goals and indicators to measure progress 

11 toward statewide implementation in each State of 

12 the best practice recommendations required under 

13 paragraph (2)(C). 

14 (5) MODERNIZATION OF FEDERAL LAWS, POLI15 CIES, AND REGULATIONS.—Not later than 90 days 

16 after the date of the release of the report required 

17 under paragraph (2), the designated officials shall 

18 develop and transmit to the President and the Con19 gress, and make publicly available, such proposals as 

20 may be necessary to implement adjustments to Fed21 eral laws, policies, or regulations, including the 

22 UCMJ, based on the recommendations required 

23 under paragraph (2)(D), either through Executive 

24 order or through changes to statutory law. 


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1 (d) RULE OF CONSTRUCTION.—Nothing in this sec2 tion shall be construed to discourage the prosecution of 

3 individuals who intentionally transmit or attempt to trans4 mit HIV to another individual. 

5 (e) NO ADDITIONAL APPROPRIATIONS AUTHOR6 IZED.—This section shall not be construed to increase the 

7 amount of appropriations that are authorized to be appro8 priated for any fiscal year. 

9 SEC. 7216. EXPANDING SUPPORT FOR CONDOMS IN PRIS10 ONS. 

11 (a) SENSE OF CONGRESS REGARDING DISTRIBUTION

12 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE

13 PRISON SYSTEMS.—It is the sense of the Congress that 

14 States shall allow for the legal distribution of sexual bar15 rier protection devices in State correctional facilities to re16 duce the prevalence and spread of STIs in those facilities. 

17 (b) AUTHORITY TO ALLOW COMMUNITY ORGANIZA18 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION

19 EDUCATION, AND SEXUAL BARRIER PROTECTION DE20 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 

21 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 

22 later than 30 days after the date of enactment of 

23 this Act, the Attorney General shall direct the Direc24 tor of the Bureau of Prisons to allow community or25 ganizations to, in accordance with all relevant FedVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01341 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 eral laws and regulations that govern visitation in 

2 Federal correctional facilities— 

3 (A) distribute sexual barrier protection de4 vices in Federal correctional facilities; and 

5 (B) engage in STI counseling and STI pre6 vention education in Federal correctional facili7 ties. 

8 (2) INFORMATION REQUIREMENT.—Any com9 munity organization permitted to distribute sexual 

10 barrier protection devices under paragraph (1) shall 

11 ensure that the individuals to whom the devices are 

12 distributed are informed about the proper use and 

13 disposal of sexual barrier protection devices in ac14 cordance with established public health practices. 

15 Any community organization conducting STI coun16 seling or STI prevention education under paragraph 

17 (1) shall offer comprehensive sexuality education. 

18 (3) POSSESSION OF DEVICE PROTECTED.—A 

19 Federal correctional facility may not, because of the 

20 possession or use of a sexual barrier protection de21 vice— 

22 (A) take adverse action against an incar23 cerated individual; or 

24 (B) consider possession or use as evidence 

25 of prohibited activity for the purpose of any 


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1 Federal correctional facility administrative pro2 ceeding. 

3 (4) IMPLEMENTATION.—The Attorney General 

4 and the Director of the Bureau of Prisons shall im5 plement this section according to established public 

6 health practices in a manner that protects the 

7 health, safety, and privacy of incarcerated individ8 uals and of correctional facility staff. 

9 (c) SURVEY OF AND REPORT ON CORRECTIONAL FA10 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF

11 STIS.— 

12 (1) SURVEY.—Not later than 180 days after 

13 the date of enactment of this Act, and annually 

14 thereafter for 5 years, the Attorney General, after 

15 consulting with the Secretary of Health and Human 

16 Services, State officials, and community organiza17 tions, shall, to the maximum extent practicable, con18 duct a survey of all Federal and State correctional 

19 facilities, to determine the following: 

20 (A) COUNSELING, TREATMENT, AND SUP21 PORTIVE SERVICES.—Whether the correctional 

22 facility— 

23 (i) requires incarcerated individuals to 

24 participate in counseling, treatment, and 

25 supportive services related to STIs; or 


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1 (ii) offers such programs to incarcer2 ated individuals. 

3 (B) ACCESS TO SEXUAL BARRIER PROTEC4 TION DEVICES.—Whether incarcerated individ5 uals can— 

6 (i) possess sexual barrier protection 

7 devices; 

8 (ii) purchase sexual barrier protection 

9 devices; 

10 (iii) purchase sexual barrier protection 

11 devices at a reduced cost; or 

12 (iv) obtain sexual barrier protection 

13 devices without cost. 

14 (C) INCIDENCE OF SEXUAL VIOLENCE.— 

15 The incidence of sexual violence and assault 

16 committed by incarcerated individuals and by 

17 correctional facility staff. 

18 (D) PREVENTION EDUCATION OFFERED.— 

19 The type of prevention education, information, 

20 or training offered to incarcerated individuals 

21 and correctional facility staff regarding sexual 

22 violence and the spread of STIs, including 

23 whether such education, information, or train24 ing— 


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1 (i) constitutes comprehensive sexuality 

2 education; 

3 (ii) is compulsory for new incarcerated 

4 individuals and for new correctional facility 

5 staff; and 

6 (iii) is offered on an ongoing basis. 

7 (E) STI TESTING.—Whether the correc8 tional facility tests incarcerated individuals for 

9 STIs or gives them the option to undergo such 

10 testing— 

11 (i) at intake; 

12 (ii) on a regular basis; and 

13 (iii) prior to release. 

14 (F) STI TEST RESULTS.—The number of 

15 incarcerated individuals who are tested for STIs 

16 and the outcome of such tests at each correc17 tional facility, disaggregated to include results 

18 for— 

19 (i) the type of STI tested for; 

20 (ii) the race and ethnicity of an indi21 vidual tested; 

22 (iii) the age of an individual tested; 

23 and 

24 (iv) the gender of the individual test25 ed. 


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1 (G) PRERELEASE REFERRAL POLICY.— 

2 Whether incarcerated individuals are informed 

3 prior to release about STI-related services or 

4 other health services in their communities, in5 cluding free and low-cost counseling and treat6 ment options. 

7 (H) PRERELEASE REFERRALS MADE.— 

8 The number of referrals to community-based 

9 organizations or public health facilities offering 

10 STI-related or other health services provided to 

11 incarcerated individuals prior to release, and 

12 the type of counseling or treatment for which 

13 the referral was made. 

14 (I) REINSTATEMENT OF MEDICAID BENE15 FITS.—Whether— 

16 (i) the correctional facility assists in17 carcerated individuals that were enrolled in 

18 the State Medicaid program prior to their 

19 incarceration in reinstating their enroll20 ment upon release; and 

21 (ii) such individuals receive referrals 

22 as described in subparagraph (G) to enti23 ties that accept the State Medicaid pro24 gram, including, if applicable— 


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1 (I) the number of such individ2 uals, including those diagnosed with 

3 HIV, that have been reinstated; 

4 (II) a list of obstacles to rein5 stating enrollment or to making deter6 minations of eligibility for reinstate7 ment, if any; and 

8 (III) the number of individuals 

9 denied enrollment. 

10 (J) OTHER ACTIONS TAKEN.—Whether the 

11 correctional facility has taken any other action, 

12 in conjunction with community organizations or 

13 otherwise, to reduce the prevalence and spread 

14 of STIs in that facility. 

15 (2) PRIVACY.—In conducting the survey under 

16 paragraph (1), the Attorney General shall not re17 quest or retain the identity of any individual who 

18 has sought or been offered counseling, treatment, 

19 testing, or prevention education information regard20 ing an STI (including information about sexual bar21 rier protection devices), or who has tested positive 

22 for an STI. 

23 (3) REPORT.— 

24 (A) IN GENERAL.—The Attorney General 

25 shall transmit to Congress and make publicly 


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1 available the results of the survey required 

2 under paragraph (1), both for the United 

3 States as a whole and disaggregated as to each 

4 State and each correctional facility. 

5 (B) DEADLINES.—To the maximum extent 

6 possible, the Attorney General shall— 

7 (i) issue the first report under sub8 paragraph (A) not later than 1 year after 

9 the date of enactment of this Act; and 

10 (ii) issue reports under subparagraph 

11 (A) annually thereafter for 5 years. 

12 (d) STRATEGY.— 

13 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 

14 Attorney General, in consultation with the Secretary 

15 of Health and Human Services, State officials, and 

16 community organizations, shall develop and imple17 ment a 5-year strategy to reduce the prevalence and 

18 spread of STIs in Federal and State correctional fa19 cilities. To the maximum extent possible, the strat20 egy shall be developed, transmitted to Congress, and 

21 made publicly available not later than 180 days after 

22 the transmission of the first report required under 

23 subsection (c)(3). 


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1 (2) CONTENTS OF STRATEGY.—The strategy 

2 developed under paragraph (1) shall include the fol3 lowing: 

4 (A) PREVENTION EDUCATION.—A plan for 

5 improving prevention education, information, 

6 and training offered to incarcerated individuals 

7 and correctional facility staff, including infor8 mation and training on sexual violence and the 

9 spread of STIs, and comprehensive sexuality 

10 education. 

11 (B) SEXUAL BARRIER PROTECTION DEVICE

12 ACCESS.—A plan for expanding access to sexual 

13 barrier protection devices in correctional facili14 ties. 

15 (C) SEXUAL VIOLENCE REDUCTION.—A 

16 plan for reducing the incidence of sexual vio17 lence among incarcerated individuals and cor18 rectional facility staff. 

19 (D) COUNSELING AND SUPPORTIVE SERV20 ICES.—A plan for expanding access to coun21 seling and supportive services related to STIs in 

22 correctional facilities. 

23 (E) TESTING.—A plan for testing incarcer24 ated individuals for STIs during intake, during 


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1 regular health exams, and prior to release 

2 that— 

3 (i) is conducted in accordance with 

4 guidelines established by the Centers for 

5 Disease Control and Prevention; 

6 (ii) includes pretest counseling; 

7 (iii) requires that incarcerated individ8 uals are notified of their option to decline 

9 testing at any time; 

10 (iv) requires that incarcerated individ11 uals are confidentially notified of their test 

12 results in a timely manner; and 

13 (v) ensures that incarcerated individ14 uals testing positive for STIs receive post15 test counseling, care, treatment, and sup16 portive services. 

17 (F) TREATMENT.—A plan for ensuring 

18 that correctional facilities have the necessary 

19 medicine and equipment to treat and monitor 

20 STIs and for ensuring that incarcerated indi21 viduals living with or testing positive for STIs 

22 receive and have access to care and treatment 

23 services. 

24 (G) STRATEGIES FOR DEMOGRAPHIC

25 GROUPS.—A plan for developing and impleVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01350 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 menting culturally appropriate, sensitive, and 

2 specific strategies to reduce the spread of STIs 

3 among demographic groups heavily impacted by 

4 STIs. 

5 (H) LINKAGES WITH COMMUNITIES AND

6 FACILITIES.—A plan for establishing and 

7 strengthening linkages to local community and 

8 health facilities that— 

9 (i) provide counseling, testing, care, 

10 and treatment services; 

11 (ii) may receive individuals recently 

12 released from incarceration who are living 

13 with STIs; and 

14 (iii) accept payment through the State 

15 Medicaid program. 

16 (I) ENROLLMENT IN STATE MEDICAID

17 PROGRAMS.—Plans to ensure that— 

18 (i) incarcerated individuals who were 

19 enrolled in their State Medicaid program 

20 prior to incarceration in a correctional fa21 cility are automatically reenrolled in such 

22 program upon their release; and 

23 (ii) incarcerated individuals who were 

24 not enrolled in their State Medicaid pro25 gram prior to incarceration, and who are 


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1 diagnosed with HIV while incarcerated in 

2 a correctional facility, are automatically 

3 enrolled in such program upon their re4 lease. 

5 (J) OTHER PLANS.—Any other plans de6 veloped by the Attorney General for reducing 

7 the spread of STIs or improving the quality of 

8 health care in correctional facilities. 

9 (K) MONITORING SYSTEM.—A monitoring 

10 system that establishes performance goals re11 lated to reducing the prevalence and spread of 

12 STIs in correctional facilities and which, where 

13 feasible, expresses such goals in quantifiable 

14 form. 

15 (L) MONITORING SYSTEM PERFORMANCE

16 INDICATORS.—Performance indicators that 

17 measure or assess the achievement of the per18 formance goals described in subparagraph (K). 

19 (M) COST ESTIMATE.—A detailed estimate 

20 of the funding necessary to implement the 

21 strategy at the Federal and State levels for all 

22 5 years, including the amount of funds required 

23 by community organizations to implement the 

24 parts of the strategy in which they take part. 


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1 (3) REPORT.—Not later than 1 year after the 

2 date of the enactment of this Act, and annually 

3 thereafter, the Attorney General shall transmit to 

4 Congress and make publicly available an annual 

5 progress report regarding the implementation and 

6 effectiveness of the strategy described in paragraph 

7 (1). The progress report shall include an evaluation 

8 of the implementation of the strategy using the mon9 itoring system and performance indicators provided 

10 for in subparagraphs (K) and (L) of paragraph (2). 

11 (e) AUTHORIZATION OF APPROPRIATIONS.— 

12 (1) IN GENERAL.—There are authorized to be 

13 appropriated such sums as may be necessary to 

14 carry out this section for each of fiscal years 2023 

15 through 2027. 

16 (2) AVAILABILITY OF FUNDS.—Amounts made 

17 available under paragraph (1) are authorized to re18 main available until expended. 

19 (f) DEFINITIONS.—In this section: 

20 (1) COMMUNITY ORGANIZATION.—The term 

21 ‘‘community organization’’ means a public health 

22 care facility or a nonprofit organization that pro23 vides health- or STI-related services according to es24 tablished public health standards. 


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1 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

2 The term ‘‘comprehensive sexuality education’’ 

3 means sexuality education— 

4 (A) that includes information about absti5 nence and about the proper use and disposal of 

6 sexual barrier protection devices; and 

7 (B) that is— 

8 (i) evidence based; 

9 (ii) medically accurate; 

10 (iii) age and developmentally appro11 priate; 

12 (iv) gender and identity sensitive; 

13 (v) culturally and linguistically appro14 priate; and 

15 (vi) structured to promote critical 

16 thinking, self-esteem, respect for others, 

17 and the development of healthy attitudes 

18 and relationships. 

19 (3) CORRECTIONAL FACILITY.—The term ‘‘cor20 rectional facility’’ means any prison, penitentiary, 

21 adult detention facility, juvenile detention facility, 

22 jail, or other facility to which individuals may be 

23 sent after conviction of a crime or act of juvenile de24 linquency within the United States. 


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1 (4) INCARCERATED INDIVIDUAL.—The term 

2 ‘‘incarcerated individual’’ means any individual who 

3 is serving a sentence in a correctional facility after 

4 conviction of a crime. 

5 (5) SEXUAL BARRIER PROTECTION DEVICE.— 

6 The term ‘‘sexual barrier protection device’’ means 

7 any physical device approved, cleared, or otherwise 

8 authorized by the Food and Drug Administration 

9 that has not been tampered with and which reduces 

10 the probability of STI transmission or infection be11 tween sexual partners, including female condoms, 

12 male condoms, and dental dams. 

13 (6) SEXUALLY TRANSMITTED INFECTION.—The 

14 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 

15 means any disease or infection that is commonly 

16 transmitted through sexual activity, including HIV, 

17 gonorrhea, chlamydia, syphilis, genital herpes, viral 

18 hepatitis, and human papillomavirus. 

19 (7) STATE.—The term ‘‘State’’ includes the 

20 District of Columbia, American Samoa, the Com21 monwealth of the Northern Mariana Islands, Guam, 

22 Puerto Rico, and the United States Virgin Islands. 

23 (8) STATE MEDICAID PROGRAM.—The term 

24 ‘‘State Medicaid program’’ means the State plan (or 


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1 a waiver of such plan) under title XIX of the Social 

2 Security Act (42 U.S.C. 1396 et seq.). 

3 SEC. 7217. AUTOMATIC REINSTATEMENT OR ENROLLMENT 

4 IN MEDICAID FOR PEOPLE WHO TEST POSI5 TIVE FOR HIV BEFORE REENTERING COMMU6 NITIES. 

7 (a) IN GENERAL.—Section 1902(e) of the Social Se8 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 

9 the end the following: 

10 ‘‘(17) ENROLLMENT OF EX-OFFENDERS.— 

11 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN12 STATEMENT.— 

13 ‘‘(i) IN GENERAL.—The State plan 

14 shall provide for the automatic enrollment 

15 or reinstatement of enrollment of an eligi16 ble individual— 

17 ‘‘(I) if such individual is sched18 uled to be released from a public insti19 tution due to the completion of sen20 tence, not less than 30 days prior to 

21 the scheduled date of the release; and 

22 ‘‘(II) if such individual is to be 

23 released from a public institution on 

24 parole or on probation, as soon as 

25 possible after the date on which the 


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1 determination to release such indi2 vidual was made, and before the date 

3 such individual is released. 

4 ‘‘(ii) EXCEPTION.—If a State makes a 

5 determination that an individual is not eli6 gible to be enrolled under the State plan— 

7 ‘‘(I) on or before the date by 

8 which the individual would be enrolled 

9 under clause (i), such clause shall not 

10 apply to such individual; or 

11 ‘‘(II) after such date, the State 

12 may terminate the enrollment of such 

13 individual. 

14 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO

15 PAYMENT FOR SERVICES.— 

16 ‘‘(i) IN GENERAL.—Subject to sub17 paragraph (A)(ii), an eligible individual 

18 who is enrolled, or whose enrollment is re19 instated, under subparagraph (A) shall be 

20 eligible for all services for which medical 

21 assistance is provided under the State plan 

22 after the date that the eligible individual is 

23 released from the public institution. 

24 ‘‘(ii) RELATIONSHIP TO PAYMENT

25 PROHIBITION FOR INMATES.—No provision 


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1 of this paragraph may be construed to per2 mit payment for care or services for which 

3 payment is excluded under subdivision (A) 

4 following the last numbered paragraph of 

5 section 1905(a). 

6 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI7 BILITY.— 

8 ‘‘(i) SUSPENSION FOR INMATES.—Any 

9 period of continuous eligibility under this 

10 title shall be suspended on the date an in11 dividual enrolled under this title becomes 

12 an inmate of a public institution (except as 

13 a patient of a medical institution). 

14 ‘‘(ii) DETERMINATION OF REMAINING

15 PERIOD.—Notwithstanding any changes to 

16 State law related to continuous eligibility 

17 during the time that an individual is an in18 mate of a public institution (except as a 

19 patient of a medical institution), subject to 

20 clause (iii), with respect to an eligible indi21 vidual who was subject to a suspension 

22 under clause (i), on the date that such in23 dividual is released from a public institu24 tion the suspension of continuous eligibility 

25 under such clause shall be lifted for a peVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01358 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 riod that is equal to the time remaining in 

2 the period of continuous eligibility for such 

3 individual on the date that such period was 

4 suspended under such clause. 

5 ‘‘(iii) EXCEPTION.—If a State makes 

6 a determination that an individual is not 

7 eligible to be enrolled under the State 

8 plan— 

9 ‘‘(I) on or before the date that 

10 the suspension of continuous eligibility 

11 is lifted under clause (ii), such clause 

12 shall not apply to such individual; or 

13 ‘‘(II) after such date, the State 

14 may terminate the enrollment of such 

15 individual. 

16 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN17 STATEMENT OF ENROLLMENT DEFINED.—For 

18 purposes of this paragraph, the term ‘automatic 

19 enrollment or reinstatement of enrollment’ 

20 means that the State determines eligibility for 

21 medical assistance under the State plan without 

22 a program application from, or on behalf of, the 

23 eligible individual, but an individual can only be 

24 automatically enrolled in the State Medicaid 

25 plan if the individual affirmatively consents to 


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1 being enrolled through affirmation in writing, 

2 by telephone, orally, through electronic signa3 ture, or through any other means specified by 

4 the Secretary. 

5 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 

6 For purposes of this paragraph, the term ‘eligi7 ble individual’ means an individual who is an 

8 inmate of a public institution (except as a pa9 tient in a medical institution)— 

10 ‘‘(i) who was enrolled under the State 

11 plan for medical assistance immediately be12 fore becoming an inmate of such an insti13 tution; or 

14 ‘‘(ii) who is diagnosed with human im15 munodeficiency virus.’’. 

16 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE17 MENTATION OF AUTOMATIC REINSTATEMENT OF MED18 ICAID BENEFITS.— 

19 (1) IN GENERAL.—Subject to paragraph (3), 

20 with respect to a State, for each of the first 4 cal21 endar quarters in which the State plan meets the re22 quirements of paragraph (17) of section 1902(e) of 

23 the Social Security Act (42 U.S.C. 1396a(e)) (as 

24 added by subsection (a)), the Federal matching pay25 ments (including payments based on the Federal 


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1 medical assistance percentage) made to such State 

2 under section 1903 of the Social Security Act (42 

3 U.S.C. 1396b) for the State expenditures described 

4 in paragraph (2) shall be increased by 5 percentage 

5 points. 

6 (2) EXPENDITURES.—The expenditures de7 scribed in this paragraph are the following: 

8 (A) Expenditures for which payment is 

9 available under section 1903 of the Social Secu10 rity Act (42 U.S.C. 1396b) and which are at11 tributable to strengthening the State’s enroll12 ment and administrative resources for the pur13 pose of improving processes for enrolling (or re14 instating the enrollment of) eligible individuals 

15 (as such term is defined in subparagraph (E) of 

16 paragraph (16) of section 1902(e) of the Social 

17 Security Act (42 U.S.C. 1396a(e)) (as amended 

18 by subsection (a))). 

19 (B) Expenditures for medical assistance 

20 (as such term is defined in section 1905(a) of 

21 the Social Security Act (42 U.S.C. 1396d(a))) 

22 provided to such eligible individuals. 

23 (3) REQUIREMENTS; LIMITATION.— 

24 (A) REPORT.—A State is not eligible for 

25 an increase in its Federal matching payments 


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1 under paragraph (1) unless the State agrees to 

2 submit to the Secretary of Health and Human 

3 Services, and make publicly available, a report 

4 that contains the information required under 

5 paragraph (4) by the end of the 1-year period 

6 during which the State receives increased Fed7 eral matching payments in accordance with that 

8 paragraph. 

9 (B) MAINTENANCE OF ELIGIBILITY.— 

10 (i) IN GENERAL.—Subject to clause 

11 (ii), a State is not eligible for an increase 

12 in its Federal matching payments under 

13 paragraph (1) if eligibility standards, 

14 methodologies, or procedures under its 

15 State plan under title XIX of the Social 

16 Security Act (42 U.S.C. 1396 et seq.), or 

17 waiver of such a plan, are more restrictive 

18 than the eligibility standards, methodolo19 gies, or procedures, respectively, under 

20 such plan or waiver as in effect on the date 

21 of enactment of this Act. 

22 (ii) STATE REINSTATEMENT OF ELIGI23 BILITY PERMITTED.—A State that has re24 stricted eligibility standards, methodolo25 gies, or procedures under its State plan 


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1 under title XIX of the Social Security Act 

2 (42 U.S.C. 1396 et seq.), or a waiver of 

3 such plan, after the date of enactment of 

4 this Act, is no longer ineligible under 

5 clause (i) beginning with the first calendar 

6 quarter in which the State has reinstated 

7 eligibility standards, methodologies, or pro8 cedures that are no more restrictive than 

9 the eligibility standards, methodologies, or 

10 procedures, respectively, under such plan 

11 (or waiver) as in effect on such date. 

12 (C) LIMITATION OF MATCHING PAYMENTS

13 TO 100 PERCENT.—In no case shall an increase 

14 in Federal matching payments under paragraph 

15 (1) result in Federal matching payments that 

16 exceed 100 percent of State expenditures. 

17 (4) REQUIRED REPORT INFORMATION.—The in18 formation that is required in the report under para19 graph (3)(A) shall include— 

20 (A) the results of an evaluation of the im21 pact of the implementation of the requirements 

22 of paragraph (17) of section 1902(e) of the So23 cial Security Act (42 U.S.C. 1396a(e)) on im24 proving the State’s processes for enrolling indiVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01363 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 viduals who are released from public institu2 tions under the State Medicaid plan; 

3 (B) the number of individuals who were 

4 automatically enrolled (or whose enrollment was 

5 reinstated) under such paragraph during the 1- 

6 year period during which the State received in7 creased payments under this subsection; and 

8 (C) any other information that is required 

9 by the Secretary of Health and Human Serv10 ices. 

11 (c) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—Except as provided in para13 graph (2), the amendments made by subsection (a) 

14 shall take effect 180 days after the date of the en15 actment of this Act. 

16 (2) RULE FOR CHANGES REQUIRING STATE

17 LEGISLATION.—In the case of a State plan for med18 ical assistance under title XIX of the Social Security 

19 Act (42 U.S.C. 1396 et seq.) which the Secretary of 

20 Health and Human Services determines requires 

21 State legislation (other than legislation appro22 priating funds) in order for the plan to meet the ad23 ditional requirement imposed by the amendments 

24 made by subsection (a), the State plan shall not be 

25 regarded as failing to comply with the requirements 


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1 of such title solely on the basis of its failure to meet 

2 this additional requirement before the first day of 

3 the first calendar quarter beginning after the close 

4 of the first regular session of the State legislature 

5 that begins after the date of the enactment of this 

6 Act. For purposes of the previous sentence, in the 

7 case of a State that has a 2-year legislative session, 

8 each year of such session shall be deemed to be a 

9 separate regular session of the State legislature. 

10 SEC. 7218. STOP HIV IN PRISON. 

11 (a) SHORT TITLE.—This section may be cited as the 

12 ‘‘Stop HIV in Prison Act’’. 

13 (b) HIV POLICY.—The Director of the Bureau of 

14 Prisons (referred to in this section as the ‘‘Director’’) shall 

15 develop a comprehensive policy to provide HIV testing, 

16 treatment, and prevention for inmates within the correc17 tional setting and upon reentry. 

18 (c) PURPOSE.—The purposes of the policy required 

19 to be developed under subsection (b) shall be as follows: 

20 (1) To stop the spread of HIV among inmates. 

21 (2) To protect guards and other personnel at 

22 correctional facilities from HIV infection. 

23 (3) To provide comprehensive medical treat24 ment to inmates who are living with HIV. 


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1 (4) To promote HIV awareness and prevention 

2 among inmates. 

3 (5) To encourage inmates to take personal re4 sponsibility for their health. 

5 (6) To reduce the risk that inmates will trans6 mit HIV to other persons in the community fol7 lowing their release from a correctional facility. 

8 (d) CONSULTATION.—The Director shall consult with 

9 appropriate officials of the Department of Health and 

10 Human Services, the Office of National Drug Control Pol11 icy, the Office of National AIDS Policy, and the Centers 

12 for Disease Control and Prevention regarding the develop13 ment of the policy required under subsection (b). 

14 (e) TIME LIMIT.—Not later than 1 year after the 

15 date of enactment of this Act, the Director shall draft ap16 propriate regulations to implement the policy required to 

17 be developed under subsection (b). 

18 (f) REQUIREMENTS FOR POLICY.—The policy re19 quired to be developed under subsection (b) shall provide 

20 for the following: 

21 (1) TESTING AND COUNSELING UPON IN22 TAKE.— 

23 (A) Health care personnel shall provide 

24 routine HIV testing to all inmates as a part of 

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1 diately following admission to a facility. Health 

2 care personnel need not provide routine HIV 

3 testing to an inmate who is transferred to a fa4 cility from another facility if the inmate’s med5 ical records are transferred with the inmate and 

6 indicate that the inmate has been tested pre7 viously. 

8 (B) With respect to all inmates admitted 

9 to a facility prior to the effective date of the 

10 policy— 

11 (i) health care personnel shall provide 

12 routine HIV testing by not later than 180 

13 days after such effective date; and 

14 (ii) HIV testing described in clause (i) 

15 may be performed in conjunction with 

16 other health services provided to these in17 mates by health care personnel. 

18 (C) All HIV tests under this paragraph 

19 shall comply with the opt-out provision under 

20 paragraph (9). 

21 (2) PRE-TEST AND POST-TEST COUNSELING.— 

22 Health care personnel shall provide confidential pre23 test and post-test counseling to all inmates who are 

24 tested for HIV. Counseling may be included with 


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1 other general health counseling provided to inmates 

2 by health care personnel. 

3 (3) HIV PREVENTION EDUCATION.— 

4 (A) Health care personnel shall improve 

5 HIV awareness through frequent educational 

6 programs for all inmates. HIV educational pro7 grams may be provided by community-based or8 ganizations, local health departments, and in9 mate peer educators. 

10 (B) HIV educational materials shall be 

11 made available to all inmates at orientation, at 

12 health care clinics, at regular educational pro13 grams, and prior to release. Both written and 

14 audiovisual materials shall be made available to 

15 all inmates. 

16 (C)(i) The HIV educational programs and 

17 materials under this paragraph shall include in18 formation on— 

19 (I) modes of transmission, including 

20 transmission through tattooing, sexual con21 tact, and intravenous drug use; 

22 (II) prevention methods; 

23 (III) treatment; and 

24 (IV) disease progression. 


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1 (ii) The programs and materials shall be 

2 culturally sensitive, written or designed for low3 literacy levels, available in a variety of lan4 guages, and present scientifically accurate in5 formation in a clear and understandable man6 ner. 

7 (4) HIV TESTING UPON REQUEST.— 

8 (A) Health care personnel shall allow in9 mates to obtain HIV tests upon request once 

10 per year or whenever an inmate has a reason to 

11 believe the inmate may have been exposed to 

12 HIV. Health care personnel shall, both orally 

13 and in writing, inform inmates, during orienta14 tion and periodically throughout incarceration, 

15 of their right to obtain HIV tests. 

16 (B) Health care personnel shall encourage 

17 inmates to request HIV tests if the inmate is 

18 sexually active, has been raped, uses intra19 venous drugs, receives a tattoo, or if the inmate 

20 is concerned that the inmate may have been ex21 posed to HIV. 

22 (C) An inmate’s request for an HIV test 

23 shall not be considered an indication that the 

24 inmate has put themselves at risk of infection 


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1 or committed a violation of the rules of the cor2 rectional facility. 

3 (5) HIV TESTING OF PREGNANT WOMAN.— 

4 (A) Health care personnel shall provide 

5 routine HIV testing to all inmates who become 

6 pregnant. 

7 (B) All HIV tests under this paragraph 

8 shall comply with the opt-out provision under 

9 paragraph (9). 

10 (6) COMPREHENSIVE TREATMENT.— 

11 (A) Health care personnel shall provide all 

12 inmates who test positive for HIV— 

13 (i) timely, comprehensive medical 

14 treatment; 

15 (ii) confidential counseling on man16 aging their medical condition and pre17 venting its transmission to other persons; 

18 and 

19 (iii) voluntary partner notification 

20 services. 

21 (B) Health care provided under this para22 graph shall be consistent with Department of 

23 Health and Human Services guidelines and 

24 standard medical practice. Health care per25 sonnel shall discuss treatment options, the imVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01370 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 portance of adherence to antiretroviral therapy, 

2 and the side effects of medications with inmates 

3 receiving treatment. 

4 (C) Health care personnel and pharmacy 

5 personnel shall ensure that the facility for6 mulary contains all Food and Drug Administra7 tion-approved medications necessary to provide 

8 comprehensive treatment for inmates living with 

9 HIV, and that the facility maintains adequate 

10 supplies of such medications to meet inmates’ 

11 medical needs. Health care personnel and phar12 macy personnel shall also develop and imple13 ment automatic renewal systems for these medi14 cations to prevent interruptions in care. 

15 (D) Correctional staff, health care per16 sonnel, and pharmacy personnel shall develop 

17 and implement distribution procedures to en18 sure timely and confidential access to medica19 tions. 

20 (7) PROTECTION OF CONFIDENTIALITY.— 

21 (A) Health care personnel shall develop 

22 and implement procedures to ensure the con23 fidentiality of inmate tests, diagnoses, and 

24 treatment. Health care personnel and correc25 tional staff shall receive regular training on the 


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1 implementation of these procedures. Penalties 

2 for violations of inmate confidentiality by health 

3 care personnel or correctional staff shall be 

4 specified and strictly enforced. 

5 (B) HIV testing, counseling, and treat6 ment shall be provided in a confidential setting 

7 where other routine health services are provided 

8 and in a manner that allows the inmate to re9 quest and obtain these services as routine med10 ical services. 

11 (8) TESTING, COUNSELING, AND REFERRAL

12 PRIOR TO REENTRY.— 

13 (A) Health care personnel shall provide 

14 routine HIV testing to all inmates not earlier 

15 than 90 days prior to their release and reentry 

16 into the community. Inmates who are already 

17 known to be infected need not be tested again. 

18 This requirement may be waived if an inmate’s 

19 release occurs without sufficient notice to the 

20 Director to allow health care personnel to per21 form a routine HIV test and notify the inmate 

22 of the results. 

23 (B) All HIV tests under this paragraph 

24 shall comply with the opt-out provision under 

25 paragraph (9). 


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1 (C) With respect to all inmates who test 

2 positive for HIV and all inmates who already 

3 are known to have HIV, health care personnel 

4 shall provide— 

5 (i) confidential prerelease counseling 

6 on managing their medical condition in the 

7 community, accessing appropriate treat8 ment and services in the community, and 

9 preventing the transmission of their condi10 tion to family members and other persons 

11 in the community; 

12 (ii) referrals to appropriate health 

13 care providers and social service agencies 

14 in the community that meet the inmate’s 

15 individual needs, including voluntary part16 ner notification services and prevention 

17 counseling services for people living with 

18 HIV; and 

19 (iii) a 30-day supply of any medically 

20 necessary medications the inmate is cur21 rently receiving. 

22 (9) OPT-OUT PROVISION.—Inmates shall have 

23 the right to refuse routine HIV testing. Inmates 

24 shall be informed both orally and in writing of this 

25 right. Oral and written disclosure of this right may 


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1 be included with other general health information 

2 and counseling provided to inmates by health care 

3 personnel. If an inmate refuses a routine test for 

4 HIV, health care personnel shall make a note of the 

5 inmate’s refusal in the inmate’s confidential medical 

6 records. However, the inmate’s refusal shall not be 

7 considered a violation of the rules of the correctional 

8 facility or result in disciplinary action. 

9 (10) EXCLUSION OF TESTS PERFORMED UNDER

10 SECTION 4014(b) FROM THE DEFINITION OF ROU11 TINE HIV TESTING.—HIV testing of an inmate 

12 under section 4014(b) of title 18, United States 

13 Code, is not routine HIV testing for the purposes of 

14 the opt-out provision under paragraph (9). Health 

15 care personnel shall document the reason for testing 

16 under section 4014(b) of title 18, United States 

17 Code, in the inmate’s confidential medical records. 

18 (11) TIMELY NOTIFICATION OF TEST RE19 SULTS.—Health care personnel shall provide timely 

20 notification to inmates of the results of HIV tests. 

21 (g) CHANGES IN EXISTING LAW.— 

22 (1) SCREENING IN GENERAL.—Section 4014(a) 

23 of title 18, United States Code, is amended— 

24 (A) by striking ‘‘for a period of 6 months 

25 or more’’; 


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1 (B) by striking ‘‘, as appropriate,’’; and 

2 (C) by striking ‘‘if such individual is deter3 mined to be at risk for infection with such virus 

4 in accordance with the guidelines issued by the 

5 Bureau of Prisons relating to infectious disease 

6 management’’ and inserting ‘‘unless the indi7 vidual declines. The Attorney General shall also 

8 cause such individual to be so tested before re9 lease from that incarceration unless the indi10 vidual declines.’’. 

11 (2) INADMISSIBILITY OF HIV TEST RESULTS IN

12 CIVIL AND CRIMINAL PROCEEDINGS.—Section 

13 4014(d) of title 18, United States Code, is amended 

14 by inserting ‘‘or under the Stop HIV in Prison Act’’ 

15 after ‘‘under this section’’. 

16 (3) SCREENING AS PART OF ROUTINE SCREEN17 ING.—Section 4014(e) of title 18, United States 

18 Code, is amended by adding at the end the fol19 lowing: ‘‘Such rules shall also provide that the initial 

20 test under this section be performed as part of the 

21 routine health screening conducted at intake.’’. 

22 (h) REPORTING REQUIREMENTS.— 

23 (1) REPORT ON HEPATITIS, LIVER, AND OTHER

24 DISEASES.—Not later than 1 year after the date of 

25 enactment of this Act, the Director shall submit to 


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1 Congress a report on the policies and procedures of 

2 the Bureau of Prisons to provide testing, treatment, 

3 and prevention education programs for hepatitis, 

4 liver failure, and other liver-related diseases trans5 mitted through sexual activity, intravenous drug use, 

6 or other means. The Director shall consult with ap7 propriate officials of the Department of Health and 

8 Human Services, the Office of National Drug Con9 trol Policy, the Office of National AIDS Policy, and 

10 the Centers for Disease Control and Prevention re11 garding the development of this report. 

12 (2) ANNUAL REPORTS.— 

13 (A) GENERALLY.—Not later than 2 years 

14 after the date of enactment of this Act, and an15 nually thereafter, the Director submit to Con16 gress a report on the incidence among inmates 

17 of diseases transmitted through sexual activity 

18 and intravenous drug use. 

19 (B) MATTERS PERTAINING TO VARIOUS

20 DISEASES.—Each report under subparagraph 

21 (A) shall discuss— 

22 (i) the incidence among inmates of 

23 HIV, hepatitis, and other diseases trans24 mitted through sexual activity and intra25 venous drug use; and 


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1 (ii) updates on the testing, treatment, 

2 and prevention education programs for 

3 these diseases conducted by the Bureau of 

4 Prisons. 

5 (C) MATTERS PERTAINING TO HIV

6 ONLY.—Each report under subparagraph (A) 

7 shall also include— 

8 (i) the number of inmates who tested 

9 positive for HIV upon intake; 

10 (ii) the number of inmates who tested 

11 positive for HIV prior to reentry; 

12 (iii) the number of inmates who were 

13 not tested for HIV prior to reentry because 

14 they were released without sufficient no15 tice; 

16 (iv) the number of inmates who opted 

17 out of taking an HIV test; 

18 (v) the number of inmates who were 

19 tested under section 4014(b) of title 18, 

20 United States Code; and 

21 (vi) the number of inmates under 

22 treatment for HIV. 

23 (D) CONSULTATION.—The Director shall 

24 consult with appropriate officials of the Depart25 ment of Health and Human Services, the Office 


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1 of National Drug Control Policy, the Office of 

2 National AIDS Policy, and the Centers for Dis3 ease Control and Prevention regarding the de4 velopment of each report under subparagraph 

5 (A). 

6 SEC. 7219. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 

7 ENDING THE HIV EPIDEMIC: A PLAN FOR 

8 AMERICA. 

9 Title II of the Public Health Service Act (42 U.S.C. 

10 202 et seq.) is amended by inserting after section 241 (42 

11 U.S.C. 238j) the following: 

12 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 

13 OF NATIONAL HIV/AIDS STRATEGY. 

14 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre15 tionary appropriations made available to the Department 

16 of Health and Human Services for any fiscal year for pro17 grams and activities that, as determined by the Secretary, 

18 pertain to HIV, the Secretary may transfer up to 1 per19 cent of such appropriations to the Office of the Assistant 

20 Secretary for Health for implementation of the Ending the 

21 HIV Epidemic: A Plan for America. 

22 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 

23 30 days before making any transfer under this section, 

24 the Secretary shall give notice of the transfer to the Con25 gress. 


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1 ‘‘(c) DEFINITIONS.—In this section, the term ‘End2 ing the HIV Epidemic: A Plan for America’ means the 

3 initiative of the Department of Health and Human Serv4 ices that seeks to reduce the number of new HIV infec5 tions in the United States by 75 percent by 2025, and 

6 then by at least 90 percent by 2030, for an estimated 

7 250,000 total HIV infections averted.’’. 

8 SEC. 7220. PrEP ACCESS AND COVERAGE. 

9 (a) COVERAGE OF HIV TESTING AND PREVENTION

10 SERVICES.— 

11 (1) PRIVATE INSURANCE.— 

12 (A) IN GENERAL.—Section 2713(a) of the 

13 Public Health Service Act (42 U.S.C. 300gg– 

14 13(a)) is amended— 

15 (i) in paragraph (2), by striking ‘‘; 

16 and’’ and inserting a semicolon; 

17 (ii) in paragraph (3), by striking the 

18 period and inserting a semicolon; 

19 (iii) in paragraph (4), by striking the 

20 period and inserting a semicolon; 

21 (iv) in paragraph (5), by striking the 

22 period and inserting ‘‘; and’’; and 

23 (v) by adding at the end the following: 

24 ‘‘(6) any prescription drug approved by the 

25 Food and Drug Administration for the prevention of 


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1 HIV (other than a drug subject to preauthorization 

2 requirements consistent with section 2729A), admin3 istrative fees for such drugs, laboratory and other 

4 diagnostic procedures associated with the use of 

5 such drugs, and clinical follow-up and monitoring, 

6 including any related services recommended in cur7 rent United States Public Health Service clinical 

8 practice guidelines, without limitation.’’. 

9 (B) PROHIBITION ON PREAUTHORIZATION

10 REQUIREMENTS.—Subpart II of part A of title 

11 XXVII of the Public Health Service Act (42 

12 U.S.C. 300gg–11 et seq.), as amended by sec13 tion 7602(d), is amended by adding at the end 

14 the following: 

15 ‘‘SEC. 2729A. PROHIBITION ON PREAUTHORIZATION RE16 QUIREMENTS WITH RESPECT TO CERTAIN 

17 SERVICES. 

18 ‘‘A group health plan or a health insurance issuer of19 fering group or individual health insurance coverage shall 

20 not impose any preauthorization requirements with re21 spect to coverage of the services described in section 

22 2713(a)(1)(E), except that a plan or issuer may impose 

23 preauthorization requirements with respect to coverage of 

24 a particular drug approved under section 505(c) of the 

25 Federal Food, Drug, and Cosmetic Act or section 351(a) 


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1 of this Act if such plan or issuer provides coverage without 

2 any preauthorization requirements for a drug that is ther3 apeutically equivalent.’’. 

4 (2) COVERAGE UNDER FEDERAL EMPLOYEES

5 HEALTH BENEFITS PROGRAM.—Section 8904 of title 

6 5, United States Code, is amended by adding at the 

7 end the following: 

8 ‘‘(c) Any health benefits plan offered under this chap9 ter shall include benefits for, and may not impose any cost 

10 sharing requirements for, any prescription drug approved 

11 by the Food and Drug Administration for the prevention 

12 of HIV, administrative fees for such drugs, laboratory and 

13 other diagnostic procedures associated with the use of 

14 such drugs, and clinical follow-up and monitoring, includ15 ing any related services recommended in current United 

16 States Public Health Service clinical practice guidelines, 

17 without limitation.’’. 

18 (3) MEDICAID.— 

19 (A) IN GENERAL.—Section 1905 of the So20 cial Security Act (42 U.S.C. 1396d), as pre21 viously amended by this Act, is amended— 

22 (i) in subsection (a)(4)— 

23 (I) by striking ‘‘; and (D)’’ and 

24 inserting ‘‘; (D)’’; 


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1 (II) by striking ‘‘; and (E)’’ and 

2 inserting ‘‘; (E)’’; 

3 (III) by striking ‘‘; and (F)’’ and 

4 inserting ‘‘; (F)’’; and 

5 (IV) by striking the semicolon at 

6 the end and inserting ‘‘; and (G) HIV 

7 prevention services;’’; and 

8 (ii) by adding at the end the following 

9 new subsection: 

10 ‘‘(pp) HIV PREVENTION SERVICES.—For purposes 

11 of subsection (a)(4)(G), the term ‘HIV prevention serv12 ices’ means prescription drugs for the prevention of HIV 

13 acquisition, administrative fees for such drugs, laboratory 

14 and other diagnostic procedures associated with the use 

15 of such drugs, and clinical follow-up and monitoring, in16 cluding any related services recommended in current 

17 United States Public Health Service clinical practice 

18 guidelines, without limitation.’’. 

19 (B) NO COST-SHARING.—Title XIX of the 

20 Social Security Act (42 U.S.C. 1396 et seq.) is 

21 amended— 

22 (i) in section 1916, by inserting ‘‘HIV 

23 prevention services described in section 

24 1905(a)(4)(G),’’ after ‘‘section 

25 1905(a)(4)(C),’’ each place it appears; and 


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1 (ii) in section 1916A(b)(3)(B), by 

2 adding at the end the following new clause: 

3 ‘‘(xii) HIV prevention services de4 scribed in section 1905(a)(4)(G).’’. 

5 (C) INCLUSION IN BENCHMARK COV6 ERAGE.—Section 1937(b)(7) of the Social Secu7 rity Act (42 U.S.C. 1396u–7(b)(7)) is amend8 ed— 

9 (i) in the paragraph header, by insert10 ing ‘‘AND HIV PREVENTION SERVICES’’ 

11 after ‘‘SUPPLIES’’; and 

12 (ii) by striking ‘‘includes for any indi13 vidual described in section 1905(a)(4)(C), 

14 medical assistance for family planning 

15 services and supplies in accordance with 

16 such section’’ and inserting ‘‘includes med17 ical assistance for HIV prevention services 

18 described in section 1905(a)(4)(G), and in19 cludes, for any individual described in sec20 tion 1905(a)(4)(C), medical assistance for 

21 family planning services and supplies in ac22 cordance with such section’’. 

23 (4) CHIP.— 


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1 (A) IN GENERAL.—Section 2103 of the So2 cial Security Act (42 U.S.C. 1397cc), as 

3 amended by section 2007(d)(5), is amended— 

4 (i) in subsection (a), by striking ‘‘and 

5 (12)’’ and inserting ‘‘(12), and (13)’’; and 

6 (ii) in subsection (c), by adding at the 

7 end the following new paragraph: 

8 ‘‘(13) HIV PREVENTION SERVICES.—Regard9 less of the type of coverage elected by a State under 

10 subsection (a), the child health assistance provided 

11 for a targeted low-income child, and, in the case of 

12 a State that elects to provide pregnancy-related as13 sistance pursuant to section 2112, the pregnancy-re14 lated assistance provided for a targeted low-income 

15 pregnant woman (as such terms are defined for pur16 poses of such section), shall include coverage of HIV 

17 prevention services (as defined in section 1905(jj)).’’. 

18 (B) NO COST-SHARING.—Section 

19 2103(e)(2) of the Social Security Act (42 

20 U.S.C. 1397cc(e)(2)) is amended by inserting 

21 ‘‘HIV prevention services described in sub22 section (c)(13),’’ before ‘‘or for pregnancy-re23 lated assistance’’. 

24 (C) EFFECTIVE DATE.— 


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1 (i) IN GENERAL.—Subject to clause 

2 (ii), the amendments made by paragraph 

3 (3) and this paragraph shall take effect on 

4 January 1, 2023. 

5 (ii) DELAY PERMITTED IF STATE LEG6 ISLATION REQUIRED.—In the case of a 

7 State plan approved under title XIX or 

8 XXI of the Social Security Act which the 

9 Secretary of Health and Human Services 

10 determines requires State legislation (other 

11 than legislation appropriating funds) in 

12 order for the plan to meet the additional 

13 requirements imposed by this subsection, 

14 the State plan shall not be regarded as 

15 failing to comply with the requirements of 

16 such title solely on the basis of the failure 

17 of the plan to meet such additional re18 quirements before the 1st day of the 1st 

19 calendar quarter beginning after the close 

20 of the 1st regular session of the State leg21 islature that ends after the 1-year period 

22 beginning with the date of the enactment 

23 of this Act. For purposes of the preceding 

24 sentence, in the case of a State that has a 

25 2-year legislative session, each year of the 


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1 session is deemed to be a separate regular 

2 session of the State legislature. 

3 (5) COVERAGE AND ELIMINATION OF COST4 SHARING UNDER MEDICARE.— 

5 (A) COVERAGE OF HIV PREVENTION SERV6 ICES UNDER PART B.— 

7 (i) COVERAGE.— 

8 (I) IN GENERAL.—Section 

9 1861(s)(2) of the Social Security Act 

10 (42 U.S.C. 1395x(s)(2)), as amended 

11 by section 4251(c)(1) and 6011(a)(1), 

12 is amended— 

13 (aa) in subparagraph (II), 

14 by striking ‘‘and’’ at the end; 

15 (bb) in subparagraph (JJ), 

16 by striking the period at the end 

17 and inserting ‘‘; and’’; and 

18 (cc) by adding at the end 

19 the following new subparagraph: 

20 ‘‘(KK) HIV prevention services (as defined in 

21 subsection (ppp));’’. 

22 (II) DEFINITION.—Section 1861 

23 of the Social Security Act (42 U.S.C. 

24 1395x), as amended by sections 

25 2007(b), 4221(a), 4251(c)(2), and 


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1 6011(a)(2), is amended by adding at 

2 the end the following new subsection: 

3 ‘‘(ppp) HIV PREVENTION SERVICES.—The term 

4 ‘HIV prevention services’ means— 

5 ‘‘(1) drugs or biologicals approved by the Food 

6 and Drug Administration for the prevention of HIV; 

7 ‘‘(2) administrative fees for such drugs; 

8 ‘‘(3) laboratory and other diagnostic procedures 

9 associated with the use of such drugs; and 

10 ‘‘(4) clinical follow-up and monitoring, including 

11 any related services recommended in current United 

12 States Public Health Service clinical practice guide13 lines, without limitation.’’. 

14 (ii) ELIMINATION OF COINSURANCE.— 

15 Section 1833(a)(1) of the Social Security 

16 Act (42 U.S.C. 1395l(a)(1)), as amended 

17 by sections 4251(c)(3) and 6011(a)(4), is 

18 amended— 

19 (I) by striking ‘‘and’’ and before 

20 ‘‘(FF)’’; and 

21 (II) by inserting before the semi22 colon at the end the following: ‘‘and 

23 (GG) with respect to HIV prevention 

24 services (as defined in section 

25 1861(ppp)), the amount paid shall be 


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1 100 percent of (i) except as provided 

2 in clause (ii), the lesser of the actual 

3 charge for the service or the amount 

4 determined under the fee schedule 

5 that applies to such services under 

6 this part, and (ii) in the case of such 

7 services that are covered OPD serv8 ices (as defined in subsection 

9 (t)(1)(B)), the amount determined 

10 under subsection (t)’’. 

11 (iii) EXEMPTION FROM PART B DE12 DUCTIBLE.—Section 1833(b) of the Social 

13 Security Act (42 U.S.C. 1395l(b)) is 

14 amended— 

15 (I) in paragraph (11), by striking 

16 ‘‘and’’ at the end; and 

17 (II) in paragraph (12), by strik18 ing the period at the end and insert19 ing ‘‘, and (13) such deductible shall 

20 not apply with respect to HIV preven21 tion services (as defined in section 

22 1861(lll).’’. 

23 (iv) EFFECTIVE DATE.—The amend24 ments made by this subparagraph shall 


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1 apply to items and services furnished on or 

2 after January 1, 2023. 

3 (B) ELIMINATION OF COST-SHARING FOR

4 DRUGS FOR THE PREVENTION OF HIV UNDER

5 PART D.— 

6 (i) IN GENERAL.—Section 1860D– 

7 2(b) of the Social Security Act (42 U.S.C. 

8 1395w–102(b)) is amended— 

9 (I) in paragraph (1)(A), in the 

10 matter preceding clause (i), by strik11 ing ‘‘The coverage’’ and inserting 

12 ‘‘Subject to paragraph (8), the cov13 erage’’; 

14 (II) in paragraph (2)— 

15 (aa) in subparagraph (A), in 

16 the matter preceding clause (i), 

17 by striking ‘‘and (D)’’ and insert18 ing ‘‘and (D) and paragraph 

19 (8)’’; 

20 (bb) in subparagraph (C)(i), 

21 in the matter preceding subclause 

22 (I), by striking ‘‘paragraph (4)’’ 

23 and inserting ‘‘paragraphs (4) 

24 and (8)’’; and 


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1 (cc) in subparagraph (D)(i), 

2 in the matter preceding subclause 

3 (I), by striking ‘‘paragraph (4)’’ 

4 and inserting ‘‘paragraphs (4) 

5 and (8)’’; 

6 (III) in paragraph (3)(A), in the 

7 matter preceding clause (i), by strik8 ing ‘‘and (4)’’ and inserting ‘‘(4), and 

9 (8)’’; 

10 (IV) in paragraph (4)(A)(i), in 

11 the matter preceding subclause (I), by 

12 striking ‘‘The coverage’’ and inserting 

13 ‘‘Subject to paragraph (8), the cov14 erage’’; and 

15 (V) by adding at the end the fol16 lowing new paragraph: 

17 ‘‘(8) ELIMINATION OF COST-SHARING FOR

18 DRUGS FOR THE PREVENTION OF HIV.— 

19 ‘‘(A) IN GENERAL.—For plan year 2023 

20 and each subsequent plan year, there shall be 

21 no cost-sharing under this part (including 

22 under section 1814D–14) for covered part D 

23 drugs that are for the prevention of HIV. 


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1 ‘‘(B) COST-SHARING.—For purposes of 

2 subparagraph (A), the elimination of cost-shar3 ing shall include the following: 

4 ‘‘(i) NO APPLICATION OF DEDUCT5 IBLE.—The waiver of the deductible under 

6 paragraph (1). 

7 ‘‘(ii) NO APPLICATION OF COINSUR8 ANCE.—The waiver of coinsurance under 

9 paragraph (2). 

10 ‘‘(iii) NO APPLICATION OF INITIAL

11 COVERAGE LIMIT.—The initial coverage 

12 limit under paragraph (3) shall not apply. 

13 ‘‘(iv) NO COST-SHARING ABOVE AN14 NUAL OUT-OF-POCKET THRESHOLD.—The 

15 waiver of cost-sharing under paragraph 

16 (4).’’. 

17 (ii) CONFORMING AMENDMENTS TO

18 COST-SHARING FOR LOW-INCOME INDIVID19 UALS.—Section 1860D–14(a) of the Social 

20 Security Act (42 U.S.C. 1395w–114(a)) is 

21 amended— 

22 (I) in paragraph (1), in the mat23 ter preceding subparagraph (A), by 

24 striking ‘‘In the case’’ and inserting 


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1 ‘‘Subject to section 1860D–2(b)(8), in 

2 the case’’; and 

3 (II) in paragraph (2), in the mat4 ter preceding subparagraph (A), by 

5 striking ‘‘In the case’’ and inserting 

6 ‘‘Subject to section 1860D–2(b)(8), in 

7 the case’’. 

8 (6) COVERAGE OF HIV PREVENTION TREAT9 MENT BY DEPARTMENT OF VETERANS AFFAIRS.— 

10 (A) ELIMINATION OF MEDICATION COPAY11 MENTS.—Section 1722A(a) of title 38, United 

12 States Code, is amended by adding at the end 

13 the following new paragraph: 

14 ‘‘(5) Paragraph (1) does not apply to a medication 

15 for the prevention of HIV.’’. 

16 (B) ELIMINATION OF HOSPITAL CARE AND

17 MEDICAL SERVICES COPAYMENTS.—Section 

18 1710 of such title is amended— 

19 (i) in subsection (f)— 

20 (I) by redesignating paragraph 

21 (5) as paragraph (6); and 

22 (II) by inserting after paragraph 

23 (4) the following new paragraph (5): 

24 ‘‘(5) A veteran shall not be liable to the United States 

25 under this subsection for any amounts for laboratory and 


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1 other diagnostic procedures associated with the use of any 

2 prescription drug approved by the Food and Drug Admin3 istration for the prevention of HIV, administrative fees for 

4 such drugs, or for laboratory or other diagnostic proce5 dures associated with the use of such drugs, or clinical 

6 follow-up and monitoring, including any related services 

7 recommended in current United States Public Health 

8 Service clinical practice guidelines, without limitation.’’; 

9 and 

10 (ii) in subsection (g)(3), by adding at 

11 the end the following new subparagraph: 

12 ‘‘(C) Any prescription drug approved by the 

13 Food and Drug Administration for the prevention of 

14 HIV, administrative fees for such drugs, laboratory 

15 and other diagnostic procedures associated with the 

16 use of such drugs, and clinical follow-up and moni17 toring, including any related services recommended 

18 in current United States Public Health Service clin19 ical practice guidelines, without limitation.’’. 

20 (C) INCLUSION AS PREVENTIVE HEALTH

21 SERVICE.—Section 1701(9) of such title is 

22 amended— 

23 (i) in subparagraph (K), by striking ‘‘; 

24 and’’ and inserting a semicolon; 


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1 (ii) by redesignating subparagraph 

2 (L) as subparagraph (M); and 

3 (iii) by inserting after subparagraph 

4 (K) the following new subparagraph (L): 

5 ‘‘(L) any prescription drug approved by 

6 the Food and Drug Administration for the pre7 vention of HIV, administrative fees for such 

8 drugs, laboratory and other diagnostic proce9 dures associated with the use of such drugs, 

10 and clinical follow-up and monitoring, including 

11 any related services recommended in current 

12 United States Public Health Service clinical 

13 practice guidelines, without limitation; and’’. 

14 (7) COVERAGE OF HIV PREVENTION TREAT15 MENT BY DEPARTMENT OF DEFENSE.— 

16 (A) IN GENERAL.—Chapter 55 of title 10, 

17 United States Code, is amended by inserting 

18 after section 1079c the following new section: 

19 ‘‘§ 1079d. Coverage of HIV prevention treatment 

20 ‘‘(a) IN GENERAL.—The Secretary of Defense shall 

21 ensure coverage under the TRICARE program of HIV 

22 prevention treatment described in subsection (b) for any 

23 beneficiary under section 1074(a) of this title. 

24 ‘‘(b) HIV PREVENTION TREATMENT DESCRIBED.— 

25 HIV prevention treatment described in this subsection inVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01394 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 cludes any prescription drug approved by the Food and 

2 Drug Administration for the prevention of HIV, adminis3 trative fees for such drugs, laboratory and other diagnostic 

4 procedures associated with the use of such drugs, and clin5 ical follow-up and monitoring, including any related serv6 ices recommended in current United States Public Health 

7 Service clinical practice guidelines, without limitation. 

8 ‘‘(c) NO COST-SHARING.—Notwithstanding section 

9 1075, 1075a, or 1074g(a)(6) of this title or any other pro10 vision of law, there is no cost-sharing requirement for HIV 

11 prevention treatment covered under this section.’’. 

12 (B) CLERICAL AMENDMENT.—The table of 

13 sections at the beginning of such chapter is 

14 amended by inserting after the item relating to 

15 section 1079c the following new item: 

‘‘1079d. Coverage of HIV prevention treatment.’’. 

16 (8) INDIAN HEALTH SERVICE TESTING, MONI17 TORING, AND PRESCRIPTION DRUGS FOR THE PRE18 VENTION OF HIV.—Title II of the Indian Health 

19 Care Improvement Act is amended by inserting after 

20 section 223 (25 U.S.C. 1621v) the following: 

21 ‘‘SEC. 224. TESTING, MONITORING, AND PRESCRIPTION 

22 DRUGS FOR THE PREVENTION OF HIV. 

23 ‘‘(a) IN GENERAL.—The Secretary, acting through 

24 the Service, Indian tribes, and tribal organizations, shall 

25 provide, without limitation, funding for any prescription 


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1 drug approved by the Food and Drug Administration for 

2 the prevention of human immunodeficiency virus (com3 monly known as ‘HIV’), administrative fees for that drug, 

4 laboratory and other diagnostic procedures associated with 

5 the use of that drug, and clinical follow-up and moni6 toring, including any related services recommended in cur7 rent United States Public Health Service clinical practice 

8 guidelines. 

9 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated such sums as may be 

11 necessary to carry out this section.’’. 

12 (9) EFFECTIVE DATE.—The amendments made 

13 by paragraphs (1), (2), (5), (6), (7), and (8) shall 

14 take effect with respect to plan years beginning on 

15 or after January 1, 2023. 

16 (b) PROHIBITION ON DENIAL OF COVERAGE OR IN17 CREASE IN PREMIUMS OF LIFE, DISABILITY, OR LONG18 TERM CARE INSURANCE FOR INDIVIDUALS TAKING

19 MEDICATION FOR THE PREVENTION OF HIV ACQUISI20 TION.— 

21 (1) PROHIBITION.—Notwithstanding any other 

22 provision of law, it shall be unlawful to— 

23 (A) decline or limit coverage of a person 

24 under any life insurance policy, disability insur25 ance policy, or long-term care insurance policy, 


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1 on account of the individual taking medication 

2 for the purpose of preventing the acquisition of 

3 HIV; 

4 (B) preclude an individual from taking 

5 medication for the purpose of preventing the ac6 quisition of HIV as a condition of receiving a 

7 life insurance policy, disability insurance policy, 

8 or long-term care insurance policy; 

9 (C) consider whether an individual is tak10 ing medication for the purpose of preventing 

11 the acquisition of HIV in determining the pre12 mium rate for coverage of such individual under 

13 a life insurance policy, disability insurance pol14 icy, or long-term care insurance policy; or 

15 (D) otherwise discriminate in the offering, 

16 issuance, cancellation, amount of such coverage, 

17 price, or any other condition of a life insurance 

18 policy, disability insurance policy, or long-term 

19 care insurance policy for an individual, based 

20 solely and without any additional actuarial risks 

21 upon whether the individual is taking medica22 tion for the purpose of preventing the acquisi23 tion of HIV. 

24 (2) ENFORCEMENT.—A State insurance regu25 lator may take such actions to enforce paragraph (1) 


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1 as are specifically authorized under the laws of such 

2 State. 

3 (3) DEFINITIONS.—In this subsection: 

4 (A) DISABILITY INSURANCE POLICY.—The 

5 term ‘‘disability insurance policy’’ means a con6 tract under which an entity promises to pay a 

7 person a sum of money in the event that an ill8 ness or injury resulting in a disability prevents 

9 such person from working. 

10 (B) LIFE INSURANCE POLICY.—The term 

11 ‘‘life insurance policy’’ means a contract under 

12 which an entity promises to pay a designated 

13 beneficiary a sum of money upon the death of 

14 the insured. 

15 (C) LONG-TERM CARE INSURANCE POL16 ICY.—The term ‘‘long-term care insurance pol17 icy’’ means a contract for which the only insur18 ance protection provided under the contract is 

19 coverage of qualified long-term care services (as 

20 defined in section 7702B(c) of the Internal 

21 Revenue Code of 1986). 

22 (c) PATIENT CONFIDENTIALITY.—The Secretary of 

23 Health and Human Services shall amend the regulations 

24 promulgated under section 264(c) of the Health Insurance 

25 Portability and Accountability Act of 1996 (42 U.S.C. 


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1 1320d–2 note), as necessary, to ensure that individuals 

2 are able to access the benefits described in section 

3 2713(a)(1)(E) of the Public Health Service Act (as 

4 amended by section 7602(d)) under a family plan without 

5 any other individual enrolled in such family plan, including 

6 a primary subscriber or policyholder of such plan, being 

7 informed of such use of such benefits. 

8 (d) PRE-EXPOSURE PROPHYLAXIS AND POST-EXPO9 SURE PROPHYLAXIS FUNDING.—Part P of title III of the 

10 Public Health Service Act (42 U.S.C. 280g et seq.), as 

11 amended by section 7153, is further amended by adding 

12 at the end the following: 

13 ‘‘SEC. 399V–10. PRE-EXPOSURE PROPHYLAXIS AND POST-EX14 POSURE PROPHYLAXIS FUNDING. 

15 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

16 date of enactment of this section, the Secretary shall es17 tablish a program that awards grants to States, terri18 tories, Indian Tribes, and directly eligible entities for the 

19 establishment and support of pre-exposure prophylaxis 

20 (referred to in this section as ‘PrEP’) and post-exposure 

21 prophylaxis (referred to in this section as ‘PEP’) HIV pro22 grams. 

23 ‘‘(b) APPLICATIONS.—To be eligible to receive a 

24 grant under subsection (a), a State, territory, Indian 

25 Tribe, or directly eligible entity shall— 


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1 ‘‘(1) submit an application to the Secretary at 

2 such time, in such manner, and containing such in3 formation as the Secretary may require, including a 

4 plan describing how any funds awarded will be used 

5 to increase access to PrEP for uninsured and under6 insured individuals and reduce disparities in access 

7 to PrEP and PEP for uninsured and underinsured 

8 individuals and reduce disparities in access to PrEP 

9 and PEP; and 

10 ‘‘(2) appoint a PrEP and PEP grant adminis11 trator to manage the program. 

12 ‘‘(c) DIRECTLY ELIGIBLE ENTITY.—For purposes of 

13 this section, the term ‘directly eligible entity’— 

14 ‘‘(1) means a Federally qualified health center 

15 or other nonprofit entity engaged in providing PrEP 

16 and PEP information and services; and 

17 ‘‘(2) may include— 

18 ‘‘(A) a Federally qualified health center 

19 (as defined in section 1861(aa)(4) of the Social 

20 Security Act (42 U.S.C. 1395x(aa)(4))); 

21 ‘‘(B) a family planning grantee (other than 

22 States) funded under section 1001 of the Public 

23 Health Service Act (42 U.S.C. 300); 


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1 ‘‘(C) a rural health clinic (as defined in 

2 section 1861(aa)(2) of the Social Security Act 

3 (42 U.S.C. 1395x(aa)(2))); 

4 ‘‘(D) a health facility operated by or pur5 suant to a contract with the Indian Health 

6 Service; 

7 ‘‘(E) a community-based organization, clin8 ic, hospital, or other health facility that pro9 vides services to individuals at risk for or living 

10 with HIV; and 

11 ‘‘(F) a nonprofit private entity providing 

12 comprehensive primary care to populations at 

13 risk of HIV, including faith-based and commu14 nity-based organizations. 

15 ‘‘(d) AWARDS.—In determining whether to award a 

16 grant, and the grant amount for each grant awarded, the 

17 Secretary shall consider the grant application and the 

18 need for PrEP and PEP services in the area, the number 

19 of uninsured and underinsured individuals in the area, and 

20 how the State, territory, or Indian Tribe coordinates 

21 PrEP and PEP activities with the directly funded entity, 

22 if the State, territory, or Indian Tribe applies for the 

23 funds. 

24 ‘‘(e) USE OF FUNDS.— 


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1 ‘‘(1) IN GENERAL.—Any State, territory, Indian 

2 Tribe, or directly eligible entity that is awarded 

3 funds under subsection (a) shall use such funds for 

4 eligible PrEP and PEP expenses. 

5 ‘‘(2) ELIGIBLE PREP EXPENSES.—The Sec6 retary shall publish a list of expenses that qualify as 

7 eligible PrEP and PEP expenses for purposes of this 

8 section, which shall include— 

9 ‘‘(A) any prescription drug approved by 

10 the Food and Drug Administration for the pre11 vention of HIV, administrative fees for such 

12 drugs, laboratory and other diagnostic proce13 dures associated with the use of such drugs, 

14 and clinical follow-up and monitoring, including 

15 any related services recommended in current 

16 United States Public Health Service clinical 

17 practice guidelines, without limitation; 

18 ‘‘(B) outreach and public education activi19 ties directed toward populations overrepresented 

20 in the domestic HIV epidemic that increase 

21 awareness about the existence of PrEP and 

22 PEP, provide education about access to and 

23 health care coverage of PrEP and PEP, PrEP 

24 and PEP adherence programs, and counter 


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1 stigma associated with the use of PrEP and 

2 PEP; and 

3 ‘‘(C) outreach activities directed toward 

4 physicians and other providers that provide 

5 education about PrEP and PEP. 

6 ‘‘(f) REPORT TO CONGRESS.—The Secretary shall, in 

7 each of the first 5 years beginning one year after the date 

8 of the enactment of this section, submit to Congress, and 

9 make public on the internet website of the Department 

10 of Health and Human Services, a report on the impact 

11 of any grants provided to States, territories, and Indian 

12 Tribes and directly eligible entities for the establishment 

13 and support of pre-exposure prophylaxis programs under 

14 this section. 

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

16 carry out this section, there are authorized to be appro17 priated such sums as may be necessary for each of fiscal 

18 years 2023 through 2028.’’. 

19 (e) CLARIFICATION.—This section, including the 

20 amendments made by this section, shall apply notwith21 standing any other provision of law, including Public Law 

22 103–141. 

23 (f) PRIVATE RIGHT OF ACTION.—Any person ag24 grieved by a violation of this section, including the amend25 ments made by this section, may commence a civil action 


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1 in an appropriate United States District Court or other 

2 court of competent jurisdiction to obtain relief as allowed 

3 by law as either an individual or member of a class. If 

4 the plaintiff is the prevailing party in such an action, the 

5 court shall order the defendant to pay the costs and rea6 sonable attorney fees of the plaintiff. 

7 Subtitle F—Diabetes 

8 SEC. 7251. RESEARCH, TREATMENT, AND EDUCATION. 

9 Subpart 3 of part C of title IV of the Public Health 

10 Service Act (42 U.S.C. 285c et seq.) is amended by adding 

11 at the end the following new section: 

12 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 

13 ‘‘(a) IN GENERAL.—The Director of NIH shall ex14 pand, intensify, and support ongoing research and other 

15 activities with respect to prediabetes and diabetes, particu16 larly type 2, in minority populations. 

17 ‘‘(b) RESEARCH.— 

18 ‘‘(1) DESCRIPTION.—Research under subsection 

19 (a) shall include investigation into— 

20 ‘‘(A) the causes of diabetes, including so21 cioeconomic, geographic, clinical, environmental, 

22 genetic, and other factors that may contribute 

23 to increased rates of diabetes in minority popu24 lations; and 


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1 ‘‘(B) the causes of increased incidence of 

2 diabetes complications in minority populations, 

3 and possible interventions to decrease such inci4 dence. 

5 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 

6 In conducting and supporting research described in 

7 subsection (a), the Director of NIH shall seek to in8 clude minority participants as study subjects in clin9 ical trials. 

10 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 

11 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 

12 Interagency Coordinating Committee shall— 

13 ‘‘(A) prepare and submit to the Congress, 

14 not later than 6 months after the date of enact15 ment of this section, a report on Federal re16 search and public health activities with respect 

17 to prediabetes and diabetes in minority popu18 lations; and 

19 ‘‘(B) develop and submit to Congress, not 

20 later than 1 year after the date of enactment of 

21 this section, an effective and comprehensive 

22 Federal plan (including all appropriate Federal 

23 health programs) to address prediabetes and di24 abetes in minority populations. 


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1 ‘‘(2) CONTENTS.—The report under paragraph 

2 (1)(A) shall at minimum address each of the fol3 lowing: 

4 ‘‘(A) Research on diabetes and prediabetes 

5 in minority populations, including such research 

6 on— 

7 ‘‘(i) genetic, behavioral, socio8 economic, and environmental factors; 

9 ‘‘(ii) prevention of diabetes within 

10 these populations and who have individuals 

11 at increased risk of developing diabetes; 

12 ‘‘(iii) prevention of complications 

13 among individuals in these populations who 

14 have already developed diabetes; and 

15 ‘‘(iv) barriers to health care access 

16 and diabetes treatment within populations 

17 at increased risk of developing diabetes. 

18 ‘‘(B) Surveillance and data collection on 

19 diabetes and prediabetes in minority popu20 lations, including with respect to— 

21 ‘‘(i) efforts to better determine the 

22 prevalence of diabetes among Asian-Amer23 ican and Pacific Islander subgroups; and 

24 ‘‘(ii) efforts to coordinate data collec25 tion on the American Indian population. 


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1 ‘‘(C) Community-based interventions to ad2 dress diabetes and prediabetes targeting minor3 ity populations, including— 

4 ‘‘(i) the evidence base for such inter5 ventions; 

6 ‘‘(ii) the cultural appropriateness of 

7 such interventions; and 

8 ‘‘(iii) efforts to educate the public on 

9 the causes and consequences of diabetes. 

10 ‘‘(D) Education and training programs for 

11 health professionals (including community 

12 health workers) on the prevention and manage13 ment of diabetes and its related complications 

14 that is supported by the Health Resources and 

15 Services Administration, including such pro16 grams supported by— 

17 ‘‘(i) the National Health Service 

18 Corps; or 

19 ‘‘(ii) the community health centers 

20 program under section 330. 

21 ‘‘(d) EDUCATION.—The Director of NIH shall— 

22 ‘‘(1) through the National Institute on Minority 

23 Health and Health Disparities and the National Di24 abetes Education Program— 


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1 ‘‘(A) make grants to programs funded 

2 under section 464z–4 for the purpose of estab3 lishing a medical education program for health 

4 care professionals to be more involved in weight 

5 counseling, obesity research, nutrition, and 

6 shared decision making; and 

7 ‘‘(B) provide for the participation of mi8 nority health professionals in diabetes-focused 

9 research programs; and 

10 ‘‘(2) make grants to programs that establish a 

11 professional pipeline that will increase the participa12 tion of minority individuals in diabetes-focused 

13 health fields by expanding Minority Access to Re14 search Careers program internships and mentoring 

15 opportunities for the purposes of recruitment. 

16 ‘‘(e) DEFINITIONS.—For purposes of this section: 

17 ‘‘(1) DIABETES MELLITUS INTERAGENCY CO18 ORDINATING COMMITTEE.—The ‘Diabetes Mellitus 

19 Interagency Coordinating Committee’ means the Di20 abetes Mellitus Interagency Coordinating Committee 

21 established under section 429. 

22 ‘‘(2) MINORITY POPULATION.—The term ‘mi23 nority population’ means a racial and ethnic minor24 ity group, as defined in section 1707.’’. 


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1 SEC. 7252. RESEARCH, EDUCATION, AND OTHER ACTIVI2 TIES. 

3 Part B of title III of the Public Health Service Act 

4 (42 U.S.C. 243 et seq.), as amended by section 7101, is 

5 further amended by inserting after section 317W the fol6 lowing section: 

7 ‘‘SEC. 317X. DIABETES IN MINORITY POPULATIONS. 

8 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

9 ‘‘(1) IN GENERAL.—The Secretary, acting 

10 through the Director of the Centers for Disease 

11 Control and Prevention, shall conduct and support 

12 research and public health activities with respect to 

13 diabetes in minority populations. 

14 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

15 paragraph (1) regarding diabetes in minority popu16 lations shall include the following: 

17 ‘‘(A) Further enhancing the National 

18 Health and Nutrition Examination Survey by 

19 oversampling Asian Americans, Native Hawai20 ians, and Pacific Islanders in appropriate geo21 graphic areas to better determine the preva22 lence of diabetes in such populations as well as 

23 to improve the data collection of diabetes pene24 tration disaggregated into major ethnic groups 

25 within such populations. The Secretary shall en26 sure that any such oversampling does not reVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01409 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 duce the oversampling of other minority popu2 lations including African-American and Latino 

3 populations. 

4 ‘‘(B) Through the Division of Diabetes 

5 Translation— 

6 ‘‘(i) providing for prevention research 

7 to better understand how to influence 

8 health care systems changes to improve 

9 quality of care being delivered to such pop10 ulations; 

11 ‘‘(ii) carrying out model demonstra12 tion projects to design, implement, and 

13 evaluate effective diabetes prevention and 

14 control interventions for minority popu15 lations, including culturally appropriate 

16 community-based interventions; 

17 ‘‘(iii) developing and implementing a 

18 strategic plan to reduce diabetes in minor19 ity populations through applied research to 

20 reduce disparities and culturally and lin21 guistically appropriate community-based 

22 interventions; 

23 ‘‘(iv) supporting, through the national 

24 diabetes prevention program under section 

25 399V–3, diabetes prevention program sites 


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1 in underserved regions highly impacted by 

2 diabetes; and 

3 ‘‘(v) implementing, through the na4 tional diabetes prevention program under 

5 section 399V–3, a demonstration program 

6 developing new metrics measuring health 

7 outcomes related to diabetes that can be 

8 stratified by specific minority populations. 

9 ‘‘(b) EDUCATION.—The Secretary, acting through 

10 the Director of the Centers for Disease Control and Pre11 vention, shall direct the Division of Diabetes Translation 

12 to conduct and support both programs to educate the pub13 lic on diabetes in minority populations and programs to 

14 educate minority populations about the causes and effects 

15 of diabetes. 

16 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION

17 INITIATIVES, AND ACCESS.—The Secretary, acting 

18 through the Director of the Centers for Disease Control 

19 and Prevention and the National Diabetes Education Pro20 gram, shall conduct and support programs to educate spe21 cific minority populations through culturally appropriate 

22 and linguistically appropriate information campaigns and 

23 initiatives about prevention of, and managing, diabetes. 


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1 ‘‘(d) DEFINITION.—For purposes of this section, the 

2 term ‘minority population’ means a racial and ethnic mi3 nority group, as defined in section 1707.’’. 

4 SEC. 7253. PROGRAMS TO EDUCATE HEALTH PROVIDERS 

5 ON THE CAUSES AND EFFECTS OF DIABETES 

6 IN MINORITY POPULATIONS. 

7 Part P of title III of the Public Health Service Act 

8 (42 U.S.C. 280g et seq.), as amended by section 7220, 

9 is further amended by adding at the end the following new 

10 section: 

11 ‘‘SEC. 399V–11. PROGRAMS TO EDUCATE HEALTH PRO12 VIDERS ON THE CAUSES AND EFFECTS OF DI13 ABETES IN MINORITY POPULATIONS. 

14 ‘‘(a) IN GENERAL.—The Secretary, acting through 

15 the Administrator of the Health Resources and Services 

16 Administration, shall conduct and support programs de17 scribed in subsection (b) to educate health professionals 

18 on the causes and effects of diabetes in minority popu19 lations. 

20 ‘‘(b) PROGRAMS.—Programs described in this sub21 section, with respect to education on diabetes in minority 

22 populations, shall include the following: 

23 ‘‘(1) Giving priority, under the primary care 

24 training and enhancement program under section 

25 747— 


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1 ‘‘(A) to awarding grants to focus on or ad2 dress diabetes; and 

3 ‘‘(B) to adding minority populations to the 

4 list of vulnerable populations that should be 

5 served by such grants. 

6 ‘‘(2) Providing additional funds for the Health 

7 Careers Opportunity Program, the Centers of Excel8 lence, and the Minority Faculty Fellowship Program 

9 to partner with the Office of Minority Health under 

10 section 1707 and the National Institutes of Health 

11 to strengthen programs for career opportunities fo12 cused on diabetes treatment and care within under13 served regions highly impacted by diabetes. 

14 ‘‘(3) Developing a diabetes focus within, and 

15 providing additional funds for, the National Health 

16 Service Corps scholarship program— 

17 ‘‘(A) to place individuals in areas that are 

18 disproportionately affected by diabetes and to 

19 provide diabetes treatment and care in such 

20 areas; and 

21 ‘‘(B) to provide such individuals continuing 

22 medical education specific to diabetes care.’’. 


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1 SEC. 7254. RESEARCH, EDUCATION, AND OTHER ACTIVITIES 

2 REGARDING DIABETES IN AMERICAN INDIAN 

3 POPULATIONS. 

4 Part P of title III of the Public Health Service Act 

5 (42 U.S.C. 280g et seq.), as amended by section 7253, 

6 is further amended by adding at the end the following sec7 tion: 

8 ‘‘SEC. 399V–12. RESEARCH, EDUCATION, AND OTHER ACTIVI9 TIES REGARDING DIABETES IN AMERICAN IN10 DIAN POPULATIONS. 

11 ‘‘In addition to activities under sections 317X, 399V– 

12 11, and 434B, the Secretary, acting through the Indian 

13 Health Service and in collaboration with other appropriate 

14 Federal agencies, shall— 

15 ‘‘(1) conduct and support research and other 

16 activities with respect to diabetes; and 

17 ‘‘(2) coordinate the collection of data on clini18 cally and culturally appropriate diabetes treatment, 

19 care, prevention, and services by health care profes20 sionals to the American Indian population.’’. 

21 SEC. 7255. UPDATED REPORT ON HEALTH DISPARITIES. 

22 The Secretary of Health and Human Services shall 

23 seek to enter into an arrangement with the National Acad24 emy of Medicine under which the National Academy will— 

25 (1) not later than 1 year after the date of en26 actment of this Act, submit to Congress an updated 


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1 version of the 2003 report entitled ‘‘Unequal Treat2 ment: Confronting Racial and Ethnic Disparities in 

3 Health Care’’; and 

4 (2) in such updated version, address how racial 

5 and ethnic health disparities have changed since the 

6 publication of the original report. 

7 Subtitle G—Lung Disease 

8 SEC. 7301. NATIONAL ASTHMA BURDEN. 

9 Congress finds as follows: 

10 (1) The prevalence of asthma has increased 

11 since 1980 and affects more than 26,000,000 people 

12 in the United States. 

13 (2) Significant disparities in asthma morbidity 

14 and mortality exist for both adults and children par15 ticularly for low-income and minority populations, 

16 particularly African Americans and Puerto Ricans. 

17 (3) African-American children are twice as like18 ly to have asthma as White children. 

19 (4) In 2016, almost 4,500,000 non-Hispanic 

20 African Americans reported having asthma. African 

21 Americans with asthma are 3 times as likely to visit 

22 the emergency department and twice as likely to get 

23 hospitalized as White patients with asthma. 

24 (5) Puerto Ricans are 3.4 times as likely to die 

25 from asthma compared with all other Hispanic or 


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1 Latino groups. Overall Hispanic Americans are 30 

2 percent more likely to be hospitalized for asthma 

3 than non-Hispanic Whites. 

4 (6) The majority of adults with asthma are 

5 women. 

6 SEC. 7302. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

7 FOR DISEASE CONTROL AND PREVENTION. 

8 Section 317I of the Public Health Service Act (42 

9 U.S.C. 247b–10) is amended to read as follows: 

10 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

11 FOR DISEASE CONTROL AND PREVENTION. 

12 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

13 EDUCATION TO THE PUBLIC.—The Secretary, acting 

14 through the Director of the Centers for Disease Control 

15 and Prevention, shall collaborate with State and local 

16 health departments to conduct activities, including the 

17 provision of information and education to the public re18 garding asthma including— 

19 ‘‘(1) deterring the harmful consequences of un20 controlled asthma; and 

21 ‘‘(2) disseminating health education and infor22 mation regarding prevention of asthma episodes and 

23 strategies for managing asthma. 

24 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 

25 The Secretary, acting through the Director of the Centers 


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1 for Disease Control and Prevention, shall collaborate with 

2 State and local health departments to develop State plans 

3 incorporating public health responses to reduce the burden 

4 of asthma, particularly regarding disproportionately af5 fected populations. 

6 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 

7 through the Director of the Centers for Disease Control 

8 and Prevention, shall, in cooperation with State and local 

9 public health officials— 

10 ‘‘(1) conduct asthma surveillance activities to 

11 collect data on the prevalence and severity of asth12 ma, the effectiveness of public health asthma inter13 ventions, and the quality of asthma management, in14 cluding— 

15 ‘‘(A) collection of data among people with 

16 asthma to monitor the impact on health and 

17 quality of life; 

18 ‘‘(B) surveillance of health care facilities; 

19 and 

20 ‘‘(C) collection of data not containing indi21 vidually identifiable information from electronic 

22 health records or other electronic communica23 tions; 

24 ‘‘(2) compile and annually publish data regard25 ing the prevalence and incidence of childhood asthVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01417 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ma, the child mortality rate, and the number of hos2 pital admissions and emergency department visits by 

3 children associated with asthma nationally and in 

4 each State and at the county level by age, sex, race, 

5 and ethnicity, as well as lifetime and current preva6 lence; and 

7 ‘‘(3) compile and annually publish data regard8 ing the prevalence and incidence of adult asthma, 

9 the adult mortality rate, and the number of hospital 

10 admissions and emergency department visits by 

11 adults associated with asthma nationally and in each 

12 State and at the county level by age, sex, race, eth13 nicity, industry, and occupation, as well as lifetime 

14 and current prevalence. 

15 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 

16 Director of the Centers for Disease Control and Preven17 tion, in conjunction with State and local health depart18 ments, shall coordinate data collection activities under 

19 paragraphs (2) and (3) of subsection (c) so as to maximize 

20 comparability of results. 

21 ‘‘(e) COLLABORATION.— 

22 ‘‘(1) IN GENERAL.—The Centers for Disease 

23 Control and Prevention may collaborate with na24 tional, State, and local nonprofit organizations to 


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1 provide information and education about asthma, 

2 and to strengthen such collaborations when possible. 

3 ‘‘(2) SPECIFIC ACTIVITIES.—The Director of 

4 the Centers for Disease Control and Prevention, act5 ing through the Division of Population Health of the 

6 Centers, may expand activities relating to asthma 

7 with non-Federal partners, especially State-level en8 tities. 

9 ‘‘(f) REPORTS TO CONGRESS.— 

10 ‘‘(1) IN GENERAL.—Not later than 3 years 

11 after the date of the enactment of the Health Equity 

12 and Accountability Act of 2022, and once 2 years 

13 thereafter, the Secretary shall, in consultation with 

14 patient groups, nonprofit organizations, medical so15 cieties, and other relevant governmental and non16 governmental entities, submit to Congress a report 

17 that— 

18 ‘‘(A) catalogs, with respect to asthma pre19 vention, management, and surveillance— 

20 ‘‘(i) the activities of the Federal Gov21 ernment, including an assessment of the 

22 progress of the Federal Government and 

23 States, with respect to achieving the goals 

24 of the Healthy People 2030 initiative; and 


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1 ‘‘(ii) the activities of other entities 

2 that participate in the program under this 

3 section, including nonprofit organizations, 

4 patient advocacy groups, and medical soci5 eties; and 

6 ‘‘(B) makes recommendations for the fu7 ture direction of asthma activities, in consulta8 tion with researchers from the National Insti9 tutes of Health and other member bodies of the 

10 Asthma Disparities Subcommittee, including— 

11 ‘‘(i) a description of how the Federal 

12 Government may improve its response to 

13 asthma, including identifying any barriers 

14 that may exist; 

15 ‘‘(ii) a description of how the Federal 

16 Government may continue, expand, and 

17 improve its private-public partnerships 

18 with respect to asthma including identi19 fying any barriers that may exist; 

20 ‘‘(iii) identification of steps that may 

21 be taken to reduce the— 

22 ‘‘(I) morbidity, mortality, and 

23 overall prevalence of asthma; 

24 ‘‘(II) financial burden of asthma 

25 on society; 


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1 ‘‘(III) burden of asthma on dis2 proportionately affected areas, par3 ticularly those in medically under4 served populations (as defined in sec5 tion 330(b)(3)); and 

6 ‘‘(IV) burden of asthma as a 

7 chronic disease that can be worsened 

8 by environmental exposures; 

9 ‘‘(iv) the identification of programs 

10 and policies that have achieved the steps 

11 described under clause (iii), and steps that 

12 may be taken to expand such programs 

13 and policies to benefit larger populations; 

14 and 

15 ‘‘(v) recommendations for future re16 search and interventions. 

17 ‘‘(2) SUBSEQUENT REPORTS.— 

18 ‘‘(A) CONGRESSIONAL REQUEST.—During 

19 the 5-year period following the submission of 

20 the second report under paragraph (1), the Sec21 retary shall submit updates and revisions of the 

22 report upon the request of the Congress. 

23 ‘‘(B) FIVE-YEAR REEVALUATION.—At the 

24 end of the 5-year period referred to in subpara25 graph (A), the Secretary shall— 


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1 ‘‘(i) evaluate the analyses and rec2 ommendations made in previous reports; 

3 and 

4 ‘‘(ii) determine whether an additional 

5 report is needed and if so submit such an 

6 updated report to the Congress, including 

7 appropriate recommendations. 

8 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS FUND9 ING.—In addition to any other authorization of appropria10 tions that is available to the Centers for Disease Control 

11 and Prevention for the purpose of carrying out this sec12 tion, there is authorized to be appropriated to such Cen13 ters $65,000,000 for the period of fiscal years 2023 

14 through 2027 for the purpose of carrying out this sec15 tion.’’. 

16 SEC. 7303. INFLUENZA AND PNEUMONIA VACCINATION 

17 CAMPAIGN. 

18 (a) IN GENERAL.—The Secretary of Health and 

19 Human Services shall— 

20 (1) enhance the annual campaign by the De21 partment of Health and Human Services to increase 

22 the number of people vaccinated each year for influ23 enza and pneumonia; and 

24 (2) include in such campaign the use of written 

25 educational materials, public service announcements, 


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1 physician education, and any other means which the 

2 Secretary deems effective. 

3 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 

4 out the annual campaign described in subsection (a), the 

5 Secretary of Health and Human Services shall ensure 

6 that— 

7 (1) educational materials and public service an8 nouncements are readily and widely available in 

9 communities experiencing disparities in the incidence 

10 and mortality rates of influenza and pneumonia; and 

11 (2) the campaign uses targeted, culturally ap12 propriate messages and messengers to reach under13 served communities. 

14 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section 

16 such sums as may be necessary for each of fiscal years 

17 2023 through 2027. 

18 SEC. 7304. CHRONIC OBSTRUCTIVE PULMONARY DISEASE. 

19 (a) FINDINGS.—Congress finds as follows: 

20 (1) Chronic obstructive pulmonary disease (re21 ferred to in this subsection as ‘‘COPD’’) refers to 

22 chronic bronchitis and emphysema, incurable dis23 eases that make it difficult to exhale all the air from 

24 one’s lungs, and that can cause persistent coughing, 

25 shortness of breath, and sputum. 


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1 (2) COPD exacerbations—episodes of acute dif2 ficulty breathing and moderate to severe fatigue— 

3 are dangerous, and their treatment often requires 

4 hospitalization. 

5 (3) While smoking is the primary risk factor for 

6 COPD, other risk factors include air pollution, occu7 pational exposures, heredity, a history of childhood 

8 respiratory infections, and socioeconomic status. 

9 (4) It is estimated that over 16,000,000 adults 

10 in the United States have COPD. 

11 (5) COPD is a leading cause of death in the 

12 United States, claiming over 156,000 lives in 2019. 

13 (6) Since 2000, deaths for women with COPD 

14 have exceeded deaths in men. 

15 (7) Although African Americans have a lower 

16 prevalence of COPD in the United States, research17 ers have shown that African Americans may be 

18 underdiagnosed. Furthermore, research has shown 

19 that African Americans develop COPD with less cu20 mulative smoke exposure and at a younger age. 

21 (b) IN GENERAL.—The Director of the Centers for 

22 Disease Control and Prevention shall conduct, support, 

23 and expand public health strategies, prevention, diagnosis, 

24 surveillance, and public and professional awareness activi25 ties regarding chronic obstructive pulmonary disease. 


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1 (c) CHRONIC DISEASE PREVENTION PROGRAMS.— 

2 The Director of the National Heart, Lung, and Blood In3 stitute shall carry out the following: 

4 (1) Conduct public education and awareness ac5 tivities with patient and professional organizations 

6 to stimulate earlier diagnosis and improve patient 

7 outcomes from treatment of chronic obstructive pul8 monary disease. To the extent known and relevant, 

9 such public education and awareness activities shall 

10 reflect differences in chronic obstructive pulmonary 

11 disease by cause (tobacco, environmental, occupa12 tional, biological, and genetic) and include a focus 

13 on outreach to undiagnosed and, as appropriate, mi14 nority populations. 

15 (2) Supplement and expand upon the activities 

16 of the National Heart, Lung, and Blood Institute by 

17 making grants to nonprofit organizations, State and 

18 local jurisdictions, and Indian Tribes for the purpose 

19 of reducing the burden of chronic obstructive pul20 monary disease, especially in disproportionately im21 pacted communities, through public health interven22 tions and related activities. 

23 (3) Coordinate with the Centers for Disease 

24 Control and Prevention, the Indian Health Service, 

25 the Health Resources and Services Administration, 


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1 and the Department of Veterans Affairs to develop 

2 pilot programs to demonstrate best practices for the 

3 diagnosis and management of chronic obstructive 

4 pulmonary disease. 

5 (4) Develop improved techniques and identify 

6 best practices, in coordination with the Secretary of 

7 Veterans Affairs, for assisting chronic obstructive 

8 pulmonary disease patients to successfully stop 

9 smoking, including identification of subpopulations 

10 with different needs. Initiatives under this para11 graph may include research to determine whether 

12 successful smoking cessation strategies are different 

13 for chronic obstructive pulmonary disease patients 

14 compared to such strategies for patients with other 

15 chronic diseases. 

16 (d) ENVIRONMENTAL AND OCCUPATIONAL HEALTH

17 PROGRAMS.—The Director of the Centers for Disease 

18 Control and Prevention shall— 

19 (1) support research into the environmental and 

20 occupational causes and biological mechanisms that 

21 contribute to chronic obstructive pulmonary disease; 

22 and 

23 (2) develop and disseminate public health inter24 ventions that will lessen the impact of environmental 


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1 and occupational causes of chronic obstructive pul2 monary disease. 

3 (e) DATA COLLECTION.—Not later than 180 days 

4 after the date of enactment of this Act, the Director of 

5 the National Heart, Lung, and Blood Institute and the 

6 Director of the Centers for Disease Control and Preven7 tion, acting jointly, shall assess the depth and quality of 

8 information on chronic obstructive pulmonary disease that 

9 is collected in surveys and population studies conducted 

10 by the Centers for Disease Control and Prevention, includ11 ing whether there are additional opportunities for informa12 tion to be collected in the National Health and Nutrition 

13 Examination Survey, the National Health Interview Sur14 vey, and the Behavioral Risk Factors Surveillance System 

15 surveys. 

16 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 such sums as may be necessary for each of fiscal years 

19 2023 through 2027. 

20 Subtitle H—Tuberculosis 

21 SEC. 7351. ELIMINATION OF ALL FORMS OF TUBERCULOSIS. 

22 (a) SHORT TITLE.—This subtitle may be cited as the 

23 ‘‘End Tuberculosis Act’’. 

24 (b) FINDINGS.—Congress makes the following find25 ings: 


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1 (1) In the United States, 7,174 people were di2 agnosed with tuberculosis (referred to in this section 

3 as ‘‘TB’’) in 2020. 

4 (2) Disparities in TB exist and significantly im5 pact minority communities in the United States. The 

6 Centers for Disease Control and Prevention (re7 ferred to in this section as ‘‘CDC’’) finds that 89 

8 percent of people diagnosed with TB disease in 2020 

9 self-identified as racial and ethnic minorities. 

10 (3) African Americans comprised 19.6 percent 

11 of people diagnosed with TB disease during 2020. 

12 The population-adjusted rate of TB among African 

13 Americans is 1.5 times higher than the national 

14 total, and 8.0 times higher than among Whites. 

15 (4) Asian Americans, Native Hawaiians, and 

16 other Pacific Islanders comprised 37.4 percent of 

17 people diagnosed with TB disease during 2020. The 

18 population-adjusted rate of TB among Asian Ameri19 cans is 6 times higher than the national total, and 

20 33.25 times higher than among Whites. The popu21 lation-adjusted rate of TB among Native Hawaiians 

22 and other Pacific Islanders is 8.5 times higher than 

23 the national total, and 46.75 times higher than 

24 among Whites. 


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1 (5) Hispanics and Latinos comprised 29.7 per2 cent of people diagnosed with TB disease during 

3 2020. The population-adjusted rate of TB among 

4 Hispanics and Latinos is 1.6 times higher than the 

5 national total, and 8.75 times higher than among 

6 Whites. 

7 (6) TB is both preventable and curable, but the 

8 current rate of decline of TB in the United States 

9 remains too slow to achieve TB elimination in this 

10 century. 

11 (7) TB is transmitted through the air when a 

12 person who has TB disease in their lungs coughs or 

13 sneezes. People who are in close proximity to the 

14 person with TB can breathe in the TB bacteria, and 

15 the bacteria will initially settle in their lungs. Living 

16 conditions related to poverty, such as crowded hous17 ing and poor ventilation, can greatly increase the 

18 risk of transmission. Without proper and timely di19 agnosis and access to treatment, the TB bacteria 

20 may grow and spread to other parts of their body. 

21 (8) As many as 13,000,000 people in the 

22 United States may have latent TB infection (re23 ferred to in this section as ‘‘LTBI’’). People with 

24 LTBI have TB bacteria in their bodies, but their 

25 immune system is containing the bacteria, and they 


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1 are not sick, nor do they have any current risk of 

2 spreading TB to others. LTBI can activate into in3 fectious, life-threatening TB if not treated. Modeling 

4 has shown that eliminating TB is not possible with5 out addressing LTBI. 

6 (9) Comorbidities associated with TB include 

7 cancer, diabetes mellitus, and HIV. People with 

8 these medical conditions and compromised immune 

9 systems are more likely to develop active TB disease 

10 and to have worse outcomes from TB. Many of the 

11 communities placed at highest risk of other adverse 

12 health outcomes and injustices are also dispropor13 tionately impacted by TB, and these include people 

14 experiencing homelessness and housing instability, 

15 people in congregate living and carceral settings, and 

16 people born outside of the United States. 

17 (10) Forms of active TB that do not show drug 

18 resistance are classified as drug-susceptible TB (re19 ferred to in this section as ‘‘DS–TB’’). Drug-resist20 ant TB (referred to in this section as ‘‘DR–TB’’) is 

21 a rising threat to the public health of the United 

22 States. DR–TB that exhibits resistance to two or 

23 more first-line drugs is referred to as multi-drug re24 sistant TB (referred to in this section as ‘‘MDR– 

25 TB’’). MDR–TB that also is resistant to at least 


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1 one fluoroquinolone, and at least one additional 

2 group A second-line medicine is classified as exten3 sively drug-resistant TB (referred to in this section 

4 as ‘‘XDR–TB’’). 

5 (11) Approximately 56 people in the United 

6 States were diagnosed with MDR–TB in 2020. One 

7 person was diagnosed with XDR–TB in the same 

8 year. 

9 (12) In the United States, $503,000,000 was 

10 spent in 2020 to treat TB; direct treatment costs 

11 average $20,211 to treat a patient with DS–TB, 

12 $182,186 to treat a patient with MDR–TB, and 

13 $567,708 to treat a patient with XDR–TB. When 

14 factoring in productivity losses during treatment, 

15 DS–TB averages $24,661, MDR–TB averages 

16 $347,324, and XDR–TB averages $729,039. Treat17 ment is often difficult, with daily complex multi-pill 

18 regimens, with side effects ranging from hearing and 

19 vision loss to mental health issues. 

20 (13) Recognizing the public health, economic, 

21 and societal costs to the threat of MDR–TB, the 

22 National Action Plan to Combat MDR–TB was de23 veloped by the White House to provide the United 

24 States with a comprehensive three-pronged strategy 

25 to address MDR–TB by strengthening domestic caVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01431 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 pacity to combat MDR–TB; improve international 

2 capacity and cooperation to combat MDR–TB; and 

3 accelerate basic and applied research and develop4 ment for new therapies, diagnostics, and prevention 

5 strategies to combat MDR–TB. 

6 (14) Additional Federal support is necessary to 

7 expand TB control efforts in case finding and treat8 ment to address LTBI in a national prevention ini9 tiative. Key policy and research breakthroughs in10 crease the success of a TB prevention initiative: the 

11 U.S. Preventative Services Task Force recommenda12 tion’s ‘‘B’’ rating, screening for LTBI among high13 risk adults as a covered service increases the likeli14 hood that impacted racial and ethnic minority 

15 groups can get tested for TB; a new, shorter course 

16 treatment regimen reduces the length of treatment 

17 for LTBI from every day for 6 to 9 months to one 

18 dose per week for 12 weeks, increasing the likelihood 

19 of treatment completion; and the use of blood-based 

20 diagnostic tests, Interferon-gamma release assays or 

21 IGRAs, increases the ability to detect LTBI among 

22 patients in affected communities. 

23 (15) The right to health, and the right to 

24 science as a necessary human right to help achieve 

25 the right to health, is enshrined in Articles 25 and 


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1 27 of the Universal Declaration of Human Rights. 

2 These fundamental human rights cannot be achieved 

3 when anyone lacks access to TB prevention or treat4 ment, and when the benefits of scientific innovation 

5 are not extended to people with all forms of TB. 

6 SEC. 7352. ADDITIONAL FUNDING FOR STATES IN COM7 BATING AND ELIMINATING TUBERCULOSIS. 

8 Section 317E(h) of the Public Health Act (42 U.S.C. 

9 247b–6(h)) is amended by adding at the end the following: 

10 ‘‘(3) ADDITIONAL FUNDING FOR STATES IN

11 COMBATING AND ELIMINATING TUBERCULOSIS.—In 

12 addition to amounts otherwise authorized to be ap13 propriated to carry out this section, there are au14 thorized to be appropriated such sums as may be 

15 necessary to carry out this section for each of fiscal 

16 years 2023 through 2024.’’. 

17 SEC. 7353. STRENGTHENING CLINICAL RESEARCH FUND18 ING FOR TUBERCULOSIS. 

19 (a) IN GENERAL.—The Secretary of Health and 

20 Human Services shall expand and intensify support for 

21 current and prospective research activities of the National 

22 Institutes of Health, the Biomedical Advanced Research 

23 and Development Authority, and the Centers for Disease 

24 Control and Prevention Division of Tuberculosis Elimi25 nation to develop new therapeutics, diagnostics, vaccines, 


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1 and other prevention modalities in addressing all forms 

2 of tuberculosis (referred to in this section as ‘‘TB’’). 

3 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

4 activities under subsection (a) shall include— 

5 (1) research and development, and pathways to 

6 approval, for novel, safe drugs and drug regimens 

7 for the treatment of TB, including in adolescent and 

8 pediatric populations and in pregnant and lactating 

9 people; 

10 (2) research to develop rapid diagnostic tests 

11 for all forms of TB, including diagnostics that can 

12 be used for pediatric populations and people living 

13 with HIV, diagnostics that can detect extra pul14 monary TB and drug resistance, and diagnostics 

15 that can be used at the point of care; 

16 (3) research to advance basic knowledge of the 

17 pathogenesis of TB and its major comorbidities, in18 cluding HIV and diabetes mellitus; 

19 (4) research to improve knowledge and under20 standings of the role of latency in TB and the fac21 tors that increase the risk of latent TB infection 

22 progressing to active, symptomatic TB disease; 

23 (5) awarding grants and contracts to specifi24 cally develop new and needed vaccines to address 

25 TB; 


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1 (6) awarding grants and contracts to support 

2 the training and development of clinical researchers 

3 whose research improves the landscape of tools to 

4 combat TB; and 

5 (7) awarding grants and contracts to support 

6 capacity building and develop clinical trial site infra7 structure in the United States and in TB endemic 

8 countries to support the aforementioned research ac9 tivities. 

10 Subtitle I—Osteoarthritis and 

11 Musculoskeletal Diseases 

12 SEC. 7401. FINDINGS. 

13 Congress finds as follows: 

14 (1) Eighty percent of African-American women 

15 and nearly 74 percent of Hispanic men are either 

16 overweight or obese, speeding the onset and progres17 sion of knee arthritis. 

18 (2) Arthritis affects 58,500,000 people in the 

19 United States, and that number will rise to 

20 78,000,000 by the year 2040. 

21 (3) 32,500,000 people in the United States suf22 fer from osteoarthritis, the most common form of ar23 thritis, making it the leading cause of disability in 

24 the United States. Osteoarthritis is sometimes re25 ferred to as degenerative joint disease. 


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1 (4) Obesity accelerates the onset of arthritis: 70 

2 percent of obese adults with mild osteoarthritis of 

3 the knee at age 60 will develop advanced end-stage 

4 disease by age 80. In contrast, just 43 percent of 

5 non-obese adults will have end-stage disease over the 

6 same time period. 

7 (5) Arthritis affects 1 in 4 people in the United 

8 States and is the single greatest cause of chronic 

9 pain and disability in the United States. 

10 (6) Women, Black Americans, and Hispanics 

11 have more severe arthritis and functional limitations. 

12 These same individuals are more likely to be obese 

13 and diabetic, and have a higher incidence of heart 

14 diseases. 

15 (7) Arthritis costs $304,000,000,000 a year, in16 cluding $140,000,000,000 in direct costs (medical) 

17 and $164,000,000,000 in indirect costs (lost earn18 ings). 

19 (8) Obesity and other chronic health conditions 

20 exacerbate the debilitating impact of arthritis, lead21 ing to inactivity, loss of independence, and a per22 petual cycle of comorbid chronic conditions. 

23 (9) Sixty-one percent of arthritis sufferers are 

24 women, and women represent 64 percent of an esti25 mated 43,000,000 annual visits to physicians’ offices 


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1 and outpatient clinics where arthritis was the pri2 mary diagnosis. Women also represented 60 percent 

3 of approximately 1,000,000 hospitalizations that oc4 curred in 2003 for which arthritis was the primary 

5 diagnosis. 

(10) Women ages 65 and older have up to 21 6 ⁄2

7 times more disabilities than men of the same age. 

8 Higher rates of obesity and arthritis among this 

9 group explained up to 48 percent of the gender gap 

10 in disability, above all other common chronic health 

11 conditions. 

12 (11) The primary indication for total knee 

13 arthroplasty (referred to in this section as ‘‘TKA’’), 

14 also known as knee replacement, is relief of signifi15 cant, disabling pain caused by severe arthritis. 

16 (12) Knee replacement is surgery for people 

17 with severe knee damage. Knee replacement can re18 lieve pain and allow an individual to be more active. 

19 The process for a total knee replacement involves 

20 the surgeon removing damaged cartilage and bone 

21 from the surface of the knee joint and replacing the 

22 cartilage and bone with a man-made surface of 

23 metal and plastic. In a partial knee replacement, the 

24 surgeon only replaces part of the knee joint. 


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1 (13) Total hip replacement, also called total hip 

2 arthroplasty (referred to in this section as ‘‘THA’’), 

3 is used if hip pain interferes with daily activities and 

4 more conservative treatments have not helped. Ar5 thritis damage is the most common reason to need 

6 hip replacement. 

7 (14) The odds of a family practice physician 

8 recommending TKA to a male patient with moderate 

9 arthritis are twice that of a female patient, while the 

10 odds of an orthopedic surgeon recommending TKA 

11 to a male patient with moderate arthritis are 22 

12 times that of a female patient. 

13 (15) Black Americans with doctor-diagnosed ar14 thritis have a higher prevalence of severe pain attrib15 utable to arthritis, compared with White Americans 

16 (34.0 percent versus 22.6 percent). Black Ameri17 cans, compared to White Americans, report a higher 

18 proportion of work limitations (39.5 percent versus 

19 28.0 percent) and a higher prevalence of arthritis-at20 tributable work limitation (6.6 percent versus 4.6 

21 percent). 

22 (16) Hispanics are 50 percent more likely than 

23 non-Hispanic Whites to report needing assistance 

24 with at least one instrumental activity of daily living 

25 and to have difficulty walking. 


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1 (17) Black Americans and Hispanics were 1.3 

2 times more likely to have activity limitation, 1.6 

3 times more likely to have work limitations, and 1.9 

4 times more likely to have severe joint pain than 

5 Whites. 

6 (18) In 2003, the National Academy of Medi7 cine reported that the rates of TKA and THA 

8 among Black American and Hispanic patients are 

9 significantly lower than for Whites—even for those 

10 with equitable health care coverage such as through 

11 Medicare or the Department of Veterans Affairs. 

12 (19) According to the Centers for Disease Con13 trol and Prevention, in 2000, Black American Medi14 care enrollees were 37 percent less likely than White 

15 Medicare enrollees to undergo total knee replace16 ments. In 2006, the disparity increased to 39 per17 cent. 

18 (20) Even after adjusting for insurance and 

19 health access, Hispanics and Black Americans are 

20 almost 50 percent less likely to undergo total knee 

21 replacement than Whites. 


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1 SEC. 7402. OSTEOARTHRITIS AND OTHER MUSCULO2 SKELETAL HEALTH-RELATED ACTIVITIES OF 

3 THE CENTERS FOR DISEASE CONTROL AND 

4 PREVENTION. 

5 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 

6 Secretary of Health and Human Services, acting through 

7 the Director of the Centers for Disease Control and Pre8 vention, shall direct the National Center for Chronic Dis9 ease Prevention and Health Promotion to conduct and ex10 pand the Health Community Program and Arthritis Pro11 gram to educate the public on— 

12 (1) the causes of, preventive health actions for, 

13 and effects of arthritis, lupus, and other musculo14 skeletal conditions in minority patient populations; 

15 and 

16 (2) the effects of such conditions on other 

17 comorbidities including obesity, hypertension, and 

18 cardiovascular disease. 

19 (b) PROGRAMS ON ARTHRITIS AND MUSCULO20 SKELETAL CONDITIONS.—Education and awareness pro21 grams of the Centers for Disease Control and Prevention 

22 on arthritis and other musculoskeletal conditions in minor23 ity communities shall— 

24 (1) be culturally and linguistically appropriate 

25 to minority patients, targeting musculoskeletal 


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1 health promotion and prevention programs of each 

2 major ethnic group, including— 

3 (A) Native Americans and Alaska Natives; 

4 (B) Asian Americans; 

5 (C) African Americans and Blacks; 

6 (D) Hispanic and Latino Americans; and 

7 (E) Native Hawaiians and Pacific Island8 ers; and 

9 (2) include public awareness campaigns directed 

10 toward these patient populations that emphasize the 

11 importance of musculoskeletal health, physical activ12 ity, diet and healthy lifestyle, and weight reduction 

13 for overweight and obese patients. 

14 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

15 out this section, there are authorized to be appropriated 

16 such sums as are necessary for fiscal year 2023 and each 

17 subsequent fiscal year. 

18 SEC. 7403. GRANTS FOR COMPREHENSIVE OSTEO19 ARTHRITIS AND MUSCULOSKELETAL DIS20 EASE HEALTH EDUCATION WITHIN HEALTH 

21 PROFESSIONS SCHOOLS. 

22 (a) PROGRAM AUTHORIZED.—The Secretary of 

23 Health and Human Services (in this section referred to 

24 as the ‘‘Secretary’’), in coordination with the Secretary of 

25 Education, shall award grants, on a competitive basis, to 


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1 academic health science centers, health professions 

2 schools, and institutions of higher education to enable 

3 such centers, schools, and institutions to provide people 

4 with comprehensive education on arthritis and musculo5 skeletal health, particularly— 

6 (1) obesity-related musculoskeletal diseases; 

7 (2) arthritis and osteoarthritis; 

8 (3) arthritis and musculoskeletal health dispari9 ties; and 

10 (4) the relationship between arthritis and mus11 culoskeletal diseases and metabolic activity, psycho12 logical health, and comorbidities such as diabetes, 

13 cardiovascular disease, lupus, and hypertension. 

14 (b) DURATION.—Grants awarded under this section 

15 shall be for a period of 5 years. 

16 (c) APPLICATIONS.—An academic health science cen17 ter, health professions school, or institution of higher edu18 cation seeking a grant under this section shall submit an 

19 application to the Secretary at such time, in such manner, 

20 and containing such information as the Secretary may re21 quire. 

22 (d) PRIORITY.—In awarding grants under this sec23 tion, the Secretary shall give priority to an institution of 

24 higher education that— 


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1 (1) has an enrollment of needy students, as de2 fined in section 318(b) of the Higher Education Act 

3 of 1965 (20 U.S.C. 1059e(b)); 

4 (2) is a Hispanic-serving institution, as defined 

5 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 

6 (3) is a Tribal College or University, as defined 

7 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

8 (4) is an Alaska Native-serving institution, as 

9 defined in section 317(b) of such Act (20 U.S.C. 

10 1059d(b)); 

11 (5) is a Native Hawaiian-serving institution, as 

12 defined in section 317(b) of such Act (20 U.S.C. 

13 1059d(b)); 

14 (6) is a Predominately Black Institution, as de15 fined in section 318(b) of such Act (20 U.S.C. 

16 1059e(b)); 

17 (7) is a Native American-serving, non-Tribal in18 stitution, as defined in section 319(b) of such Act 

19 (20 U.S.C. 1059f(b)); 

20 (8) is an Asian American and Native American 

21 Pacific Islander-serving institution, as defined in 

22 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 

23 (9) is a minority institution, as defined in sec24 tion 365 of such Act (20 U.S.C. 1067k), with an enVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01443 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 rollment of needy students, as defined in section 312 

2 of such Act (20 U.S.C. 1058). 

3 (e) USES OF FUNDS.—An academic health science 

4 center, health professions school, or institution of higher 

5 education receiving a grant under this section may use the 

6 grant funds to integrate issues relating to comprehensive 

7 arthritis and musculoskeletal health into the academic or 

8 support sectors of the center, school, or institution in 

9 order to reach a large number of students, by carrying 

10 out 1 or more of the following activities: 

11 (1) Developing educational content for issues 

12 relating to comprehensive arthritis and musculo13 skeletal health education that will be incorporated 

14 into first-year orientation or core courses. 

15 (2) Creating innovative technology-based ap16 proaches to deliver arthritis and musculoskeletal 

17 health education to students, faculty, and staff. 

18 (3) Developing and employing peer-outreach 

19 and education programs to generate discussion, edu20 cate, and raise awareness among students about 

21 issues relating to arthritis and musculoskeletal 

22 health disorders, and their relationship to diabetes, 

23 hypertension, cardiovascular disease, psychological 

24 health, and other comorbid conditions. 

25 (f) REPORT TO CONGRESS.— 


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1 (1) IN GENERAL.—Not later than 1 year after 

2 the date of the enactment of this Act, and annually 

3 thereafter for a period of 5 years, the Secretary shall 

4 prepare and submit to the appropriate committees of 

5 Congress a report on the activities to provide health 

6 professions students with comprehensive arthritis 

7 and musculoskeletal health education funded under 

8 this section. 

9 (2) REPORT ELEMENTS.—The report described 

10 in paragraph (1) shall include information about— 

11 (A) the number of entities that are receiv12 ing a grant under this section; 

13 (B) the specific activities supported by 

14 grants under this section; 

15 (C) the number of students served by pro16 grams supported by grants under this section; 

17 and 

18 (D) the status of evaluations of such pro19 grams. 

20 (g) DEFINITION OF INSTITUTION OF HIGHER EDU21 CATION.—In this section, the term ‘‘institution of higher 

22 education’’ has the meaning given such term in section 

23 101(b) of the Higher Education Act of 1965 (20 U.S.C. 

24 1001(b)). 


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1 Subtitle J—Sleep and Circadian 

2 Rhythm Disorders 

3 SEC. 7451. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This subtitle may be cited as the 

5 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari6 ties Act’’. 

7 (b) FINDINGS.—Congress finds the following: 

8 (1) Decrements in sleep health such as sleep 

9 apnea, insufficient sleep time, and insomnia, affect 

10 50,000,000 to 70,000,000 adults in the United 

11 States. An estimated 25,000,000 adults in the 

12 United States have sleep apnea, a chronic disorder 

13 characterized by one or more pauses in breathing 

14 which can last from a few seconds to minutes. They 

15 may occur 30 times or more an hour, disrupting 

16 sleep and resulting in excessive daytime sleepiness 

17 and loss in productivity. 

18 (2) Seventy percent of high school students are 

19 not getting enough sleep on school nights, while 35 

20 percent of people in the United States get fewer 

21 than 7 hours of sleep per night, and roughly 1,550 

22 fatal motor vehicle crashes per year are caused by 

23 drowsy drivers. 

24 (3) Insufficient sleep and insomnia are more 

25 prevalent in women. Women who are pregnant and 


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1 have sleep apnea are at an increased risk of cardio2 vascular complications during pregnancy. The im3 pact of disparities in sleep health is associated with 

4 a growing number of health problems, including the 

5 following: 

6 (A) Hypertension. 

7 (B) Cancer. 

8 (C) Stroke. 

9 (D) Cardiac arrhythmia. 

10 (E) Chronic heart failure and heart dis11 ease. 

12 (F) Diabetes. 

13 (G) Cognitive functioning and behavior. 

14 (H) Depression and bipolar disorder. 

15 (I) Substance abuse. 

16 (4) A sleep disparity exists in that poor sleep 

17 quality is strongly associated with poverty, race, and 

18 social determinants of health. Factors such as em19 ployment, education, and health status, amongst 

20 others, significantly mediated this effect only in poor 

21 subjects, suggesting a differential vulnerability to 

22 these factors in poor relative to nonpoor individuals 

23 in the context of sleep quality. 

24 (5) Black Americans sleep worse than White 

25 Americans. Black Americans take longer to fall 


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1 asleep, report poorer sleep quality, have more light 

2 and less deep sleep, and nap more often and longer. 

3 (6) Black Americans and individuals in lower 

4 socioeconomic status groups may be at an increased 

5 risk for sleep disturbances and associated health 

6 consequences. 

7 (7) Among young Black Americans, the likeli8 hood of having sleep disordered breathing and exhib9 iting risk factors for poor sleep is twice that in 

10 young White Americans. Frequent snoring is more 

11 common among Black American and Hispanic 

12 women and Hispanic men compared to non-Hispanic 

13 White Americans, independent of other factors in14 cluding obesity. 

15 (8) Black Americans with sleep-disordered 

16 breathing develop symptoms at a younger age than 

17 Caucasians but appear less likely to be diagnosed 

18 and treated in a timely manner. This delay may at 

19 least in part be due to reduced access to care. 

20 (9) Sleep loss contributes to increased risk for 

21 chronic conditions such as obesity, diabetes, and hy22 pertension, all of which have increased prevalence in 

23 underserved, underrepresented minorities. Racial 

24 and ethnic disparities related to obesity may also 


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1 contribute to disparities in health outcomes related 

2 to sleep-disordered breathing. 

3 (10) Underrepresented minorities in the United 

4 States report an insomnia rate of 12.9 percent com5 pared to only 6.6 percent for White Americans. 

6 (11) Black women have a higher incidence of 

7 insomnia than Black men, perhaps related in part to 

8 higher risk for chronic persisting symptoms. 

9 SEC. 7452. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE10 SEARCH ACTIVITIES OF THE NATIONAL IN11 STITUTES OF HEALTH. 

12 (a) IN GENERAL.—The Director of the National In13 stitutes of Health, acting through the Director of the Na14 tional Heart, Lung, and Blood Institute, shall— 

15 (1) continue to expand research activities ad16 dressing sleep health disparities; and 

17 (2) continue implementation of the NIH Sleep 

18 Disorders Research Plan across all institutes and 

19 centers of the National Institutes of Health to im20 prove treatment and prevention of sleep health dis21 parities. 

22 (b) REQUIRED RESEARCH ACTIVITIES.—In con23 ducting or supporting research relating to sleep and circa24 dian rhythm, the Director of the National Heart, Lung, 

25 and Blood Institute shall— 


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1 (1) advance epidemiology and clinical research 

2 to achieve a more complete understanding of dispari3 ties in domains of sleep health and across population 

4 subgroups for which cardiovascular and metabolic 

5 health disparities exist, including— 

6 (A) prevalence and severity of sleep apnea; 

7 (B) habitual sleep duration; 

8 (C) sleep timing and regularity; and 

9 (D) insomnia; 

10 (2) develop study designs and analytical ap11 proaches to explain and predict multilevel and life12 course determinants of sleep health and to elucidate 

13 the sleep-related causes of cardiovascular and meta14 bolic health disparities across the age spectrum, in15 cluding such determinants and causes that are— 

16 (A) environmental; 

17 (B) biological or genetic; 

18 (C) psychosocial; 

19 (D) societal; 

20 (E) political; or 

21 (F) economic; 

22 (3) determine the contribution of sleep impair23 ments such as sleep apnea, insufficient sleep dura24 tion, irregular sleep schedules, and insomnia to unVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01450 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 explained disparities in cardiovascular and metabolic 

2 risk and disease outcomes; 

3 (4) develop study designs, data sampling and 

4 collection tools, and analytical approaches to opti5 mize understanding of mediating and moderating 

6 factors, and feedback mechanisms coupling sleep to 

7 cardiovascular and metabolic health disparities; 

8 (5) advance research to understand cultural 

9 and linguistic barriers (on the person, provider, or 

10 system level) to access to care, medical diagnosis, 

11 and treatment of sleep disorders in diverse popu12 lation groups; 

13 (6) develop and test multilevel interventions (in14 cluding sleep health education in diverse commu15 nities) to reduce disparities in sleep health that will 

16 impact the ability to improve disparities in cardio17 vascular and metabolic risk or disease; 

18 (7) create opportunities to integrate sleep and 

19 health disparity science by strategically utilizing re20 sources (involving existing or anticipated cohorts) 

21 and exchanging scientific data and ideas (including 

22 through cross-over into scientific meetings); and 

23 (8) enhance the diversity and foster career de24 velopment of young investigators involved in sleep 

25 and health disparities science. 


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1 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there are authorized to be appropriated 

3 such sums as may be necessary for fiscal year 2023 and 

4 each subsequent fiscal year. 

5 SEC. 7453. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS6 PARITIES-RELATED ACTIVITIES OF THE CEN7 TERS FOR DISEASE CONTROL AND PREVEN8 TION. 

9 (a) IN GENERAL.—The Director of the Centers for 

10 Disease Control and Prevention shall conduct, support, 

11 and expand public health strategies and prevention, diag12 nosis, surveillance, and public and professional awareness 

13 activities regarding sleep and circadian rhythm disorders. 

14 (b) FINDINGS.—Congress finds as follows: 

15 (1) Sleep disorders and sleep deficiency unre16 lated to a primary sleep disorder are underdiagnosed 

17 and are increasingly detrimental to health status. 

18 (2) The consequences to society include addi19 tional diseases, motor vehicle accidents, decreased 

20 longevity, elevated direct medical costs, and indirect 

21 costs related to work absenteeism and property dam22 age. 

23 (c) REQUIRED SURVEILLANCE AND EDUCATION

24 AWARENESS ACTIVITIES.—In conducting or supporting 

25 research relating to sleep and circadian rhythm disorders 


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1 surveillance and education awareness activities, the Direc2 tor of the Centers for Disease Control and Prevention 

3 shall— 

4 (1) ensure that such activities are culturally 

5 and linguistically appropriate to minority patients, 

6 targeting sleep and circadian rhythm health pro7 motion and prevention programs of each major eth8 nic group, including— 

9 (A) Native Americans and Alaska Natives; 

10 (B) Asian Americans; 

11 (C) African Americans and Blacks; 

12 (D) Hispanic and Latino-Americans; and 

13 (E) Native Hawaiians and Pacific Island14 ers; 

15 (2) collect and compile national and State sur16 veillance data on sleep disorders health disparities; 

17 (3) continue to develop and implement new 

18 sleep questions in public health surveillance systems 

19 to increase public awareness of sleep health and 

20 sleep disorders and their impact on health; 

21 (4) publish monthly reports highlighting geo22 graphic, racial, and ethnic disparities in sleep health, 

23 as well as relationships between insufficient sleep 

24 and chronic disease, health risk behaviors, and other 


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1 outcomes as determined necessary by the Director; 

2 and 

3 (5) include public awareness campaigns that in4 form patient populations from major ethnic groups 

5 about the prevalence of sleep and circadian rhythm 

6 disorders and emphasize the importance of sleep 

7 health. 

8 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

9 out this section, there are authorized to be appropriated 

10 such sums as may be necessary for fiscal year 2023 and 

11 each subsequent fiscal year. 

12 SEC. 7454. GRANTS FOR COMPREHENSIVE SLEEP AND CIR13 CADIAN HEALTH EDUCATION WITHIN 

14 HEALTH PROFESSIONS SCHOOLS. 

15 (a) PROGRAM AUTHORIZED.—The Secretary of 

16 Health and Human Services (referred to in this section 

17 as the ‘‘Secretary’’), in coordination with the Secretary of 

18 Education, shall award grants, on a competitive basis, to 

19 academic health science centers, health professions 

20 schools, and institutions of higher education to enable 

21 such centers, schools, and institutions to provide people 

22 with comprehensive education on sleep and circadian 

23 health, particularly— 

24 (1) poor sleep health; 

25 (2) sleep disorders; 


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1 (3) sleep health disparities; and 

2 (4) the relationship between sleep and circadian 

3 health on metabolic activity, neurological activity, 

4 comorbidities, and other diseases. 

5 (b) DURATION.—Grants awarded under this section 

6 shall be for a period of 5 years. 

7 (c) APPLICATIONS.—An academic health science cen8 ter, health professions school, or institution of higher edu9 cation seeking a grant under this section shall submit an 

10 application to the Secretary at such time, in such manner, 

11 and containing such information as the Secretary may re12 quire. 

13 (d) PRIORITY.—In awarding grants under this sec14 tion, the Secretary shall give priority to an institution of 

15 higher education that— 

16 (1) has an enrollment of needy students, as de17 fined in section 318(b) of the Higher Education Act 

18 of 1965 (20 U.S.C. 1059e(b)); 

19 (2) is a Hispanic-serving institution, as defined 

20 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 

21 (3) is a Tribal College or University, as defined 

22 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

23 (4) is an Alaska Native-serving institution, as 

24 defined in section 317(b) of such Act (20 U.S.C. 

25 1059d(b)); 


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1 (5) is a Native Hawaiian-serving institution, as 

2 defined in section 317(b) of such Act (20 U.S.C. 

3 1059d(b)); 

4 (6) is a Predominately Black Institution, as de5 fined in section 318(b) of such Act (20 U.S.C. 

6 1059e(b)); 

7 (7) is a Native American-serving, nontribal in8 stitution, as defined in section 319(b) of such Act 

9 (20 U.S.C. 1059f(b)); 

10 (8) is an Asian American and Native American 

11 Pacific Islander-serving institution, as defined in 

12 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 

13 (9) is a minority institution, as defined in sec14 tion 365 of such Act (20 U.S.C. 1067k), with an en15 rollment of needy students, as defined in section 312 

16 of such Act (20 U.S.C. 1058). 

17 (e) USES OF FUNDS.—An academic health science 

18 center, health professions school, or institution of higher 

19 education receiving a grant under this section may use the 

20 grant funds to integrate issues relating to comprehensive 

21 sleep and circadian health into the academic or support 

22 sectors of the center, school, or institution, in order to 

23 reach a large number of students, by carrying out 1 or 

24 more of the following activities: 


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1 (1) Developing educational content for issues 

2 relating to comprehensive sleep and circadian health 

3 education that will be incorporated into first-year 

4 orientation or core courses. 

5 (2) Creating innovative technology-based ap6 proaches to deliver sleep health education to stu7 dents, faculty, and staff. 

8 (3) Developing and employing peer-outreach 

9 and education programs to generate discussion, edu10 cate, and raise awareness among students about 

11 issues relating to poor quality sleep, sleep and circa12 dian disorders, and the role sleep health plays in 

13 other diseases and comorbidities. 

14 (f) REPORT TO CONGRESS.— 

15 (1) IN GENERAL.—Not later than 1 year after 

16 the date of the enactment of this Act, and annually 

17 thereafter for a period of 5 years, the Secretary shall 

18 prepare and submit to the appropriate committees of 

19 Congress a report on the activities to provide health 

20 professions students with comprehensive sleep and 

21 circadian health education funded under this section. 

22 (2) REPORT ELEMENTS.—The report described 

23 in paragraph (1) shall include information about— 

24 (A) the number of entities that are receiv25 ing a grant under this section; 


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1 (B) the specific activities supported by 

2 grants under this section; 

3 (C) the number of students served by pro4 grams supported by grants under this section; 

5 and 

6 (D) the status of evaluations of programs 

7 supported by such grants. 

8 (g) DEFINITION OF INSTITUTION OF HIGHER EDU9 CATION.—In this section, the term ‘‘institution of higher 

10 education’’ has the meaning given such term in section 

11 101(b) of the Higher Education Act of 1965 (20 U.S.C. 

12 1001(b)). 

13 SEC. 7455. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 

14 HEALTH DISORDERS IN VULNERABLE AND 

15 RACIAL/ETHNIC POPULATIONS. 

16 (a) IN GENERAL.—Not later than 1 year after the 

17 date of enactment of this Act, the Secretary of Health and 

18 Human Services shall submit to Congress and the Presi19 dent a report on the impact of sleep and circadian health 

20 disorders for racial and ethnic minority communities and 

21 other vulnerable populations. 

22 (b) CONTENTS.—The report under subsection (a) 

23 shall include information on the— 


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1 (1) progress that has been made in reducing 

2 the impact of sleep and circadian health disorders in 

3 such communities and populations; 

4 (2) opportunities that exist to make additional 

5 progress in reducing the impact of sleep and circa6 dian health disorders in such communities and popu7 lations; 

8 (3) challenges that may impede such additional 

9 progress; and 

10 (4) Federal funding necessary to achieve sub11 stantial reductions in sleep and circadian health dis12 orders in racial and ethnic minority communities. 

13 Subtitle K—Kidney Disease Re14 search, Surveillance, Preven15 tion, and Treatment 

16 SEC. 7501. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, 

17 PREVENTION, AND TREATMENT. 

18 (a) SHORT TITLE.—This subtitle may be cited as the 

19 ‘‘Kidney Disease Research, Surveillance, Prevention and 

20 Treatment Improvement Act of 2022’’. 

21 (b) FINDINGS.—Congress makes the following find22 ings: 

23 (1) Kidney diseases impact 37,000,000 individ24 uals in the United States. 


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1 (2) Black Americans comprise just 13 percent 

2 of the United States population, but 33 percent of 

3 the United States dialysis patient population. Com4 pared to White Americans, kidney failure prevalence 

5 is about 3.7 times greater in Black Americans, 1.4 

6 times greater in Native Americans, and 1.5 times 

7 greater in Asian Americans. 

8 (3) Peritoneal dialysis and home hemodialysis 

9 use is 40–50 percent lower among Black Americans 

10 and Hispanics. 

11 (4) Every racial and ethnic minority group in 

12 the United States is significantly less likely to be 

13 treated with home dialysis than Whites, and demo14 graphic and clinical characteristics are insufficient to 

15 explain this differential use. 

16 (5) Black Americans on dialysis, irrespective of 

17 dialysis modality, and Hispanics undergoing PD or 

18 in-center HD, are significantly less likely than their 

19 White counterparts to receive a kidney transplant. 

20 (6) Black Americans, Hispanics, and Asian 

21 Americans are less likely to receive living donor kid22 ney transplants than Whites. Efforts to reduce dis23 parities in live donor kidney transplantation for 

24 Black American, Hispanic, and Asian patients with 

25 kidney failure have been largely unsuccessful. 


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1 (7) Medicare and Medicaid patients are less 

2 likely to receive a preemptive transplant from a de3 ceased donor compared to private insurance patients 

4 (5 percent and 11 percent versus 24 percent), and 

5 Black and Hispanic patients are less likely to receive 

6 a preemptive transplant from a deceased donor com7 pared with White patients even after changes to the 

8 kidney allocation system (5 percent of Black patients 

9 and 5 percent of Hispanic patients compared with 

10 18 percent of White patients). 

11 (8) Low-income populations are significantly 

12 more likely to progress to kidney failure. 

13 (9) Low socioeconomic status is associated with 

14 increased incidence of chronic kidney disease, pro15 gression to kidney failure, inadequate dialysis treat16 ment, and reduced access to kidney transplantation. 

17 (10) The 3 goals of Executive Order 13879 of 

18 July 10, 2019 (84 Fed. Reg. 33817; relating to Ad19 vancing American Kidney Health), recognize the 

20 need for more transplants, better prevention and 

21 education, and improved access to treatment modali22 ties. 

23 SEC. 7502. KIDNEY DISEASE RESEARCH IN MINORITY POPU24 LATIONS. 

25 (a) IN GENERAL.— 


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1 (1) RESEARCH AND TRAINING CENTERS.—Sec2 tion 431(c)(3) of the Public Health Service Act (42 

3 U.S.C. 285c–5(c)(3)) is amended— 

4 (A) in subparagraph (B), by striking 

5 ‘‘and’’ at the end; 

6 (B) in subparagraph (C), by striking 

7 ‘‘and’’ at the end; and 

8 (C) by adding at the end the following: 

9 ‘‘(D) improving data science through im10 provement in bioinformatics, data integration, 

11 and data sharing; 

12 ‘‘(E) defining the chronic kidney disease 

13 mechanism and identifying new therapeutic tar14 gets for chronic kidney disease using specific 

15 tools, including mapping the genetic architec16 ture of kidney function and disease and trans17 lating genetic maps to disease-causing genes 

18 and mechanisms, especially among minority 

19 populations; 

20 ‘‘(F) improving models of human disease 

21 including better humanized animal models, im22 proved reproducibility, and functional character23 ization of kidney organoids, and accelerating 

24 the development of in vivo imaging technologies; 

25 and 


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1 ‘‘(G) developing cell-specific drug delivery 

2 systems and gene editing, including targeted 

3 systems for the delivery of therapeutic com4 pounds to specific kidney compartments or cell 

5 types and accelerating the implementation of 

6 gene editing and gene therapy for the treatment 

7 of kidney diseases in vivo; and’’. 

8 (2) INCLUSION OF MINORITY PARTICIPANTS.— 

9 In conducting and supporting research described in 

10 the amendment made by paragraph (1), the Director 

11 of the National Institutes of Health shall work with 

12 the Director of the National Institute on Minority 

13 Health and Health Disparities to improve the num14 ber of minority participants as study subjects in 

15 clinical trials. Such work may include— 

16 (A) developing and sustaining clinical trial 

17 consortia that can recruit patients with chronic 

18 kidney disease to ensure adequate capacity for 

19 assessment of kidney outcomes and increase the 

20 enrollment of underrepresented populations; 

21 (B) encouraging the use of novel designs in 

22 clinical trials to enhance the recruitment and 

23 retention of underrepresented populations which 

24 will enhance the generalizability of study find25 ings; 


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1 (C) supporting outreach initiatives that in2 corporate acknowledgment of both historical 

3 and current grounds for participation reluc4 tance, and that prioritize demonstrating trust5 worthiness, in order to enhance the ability to 

6 promote and effectively convey the benefits of 

7 clinical research participation; 

8 (D) completing clinical trials that test 

9 interventions to improve patient quality of life 

10 and address patient-reported outcomes; and 

11 (E) encouraging inclusion of persons with 

12 chronic kidney disease in clinical trials of treat13 ments for nonkidney diseases. 

14 (b) REPORT; COMPREHENSIVE PLAN.—Section 429 

15 of the Public Health Services Act (42 U.S.C. 285c–3) is 

16 amended by adding at the end the following: 

17 ‘‘(c) REPORT BY KIDNEY, UROLOGIC, AND HEMATO18 LOGIC DISEASES COORDINATING COMMITTEE.— 

19 ‘‘(1) IN GENERAL.—The Kidney, Urologic, and 

20 Hematologic Diseases Coordinating Committee, in 

21 coordination with the Chronic Kidney Disease Initia22 tive at the Centers for Disease Control and Preven23 tion, shall— 

24 ‘‘(A) prepare and submit to the Congress, 

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1 ment of this subsection, a report on Federal re2 search and public health activities with respect 

3 to kidney disease in minority populations; and 

4 ‘‘(B) develop and submit to the Congress, 

5 the Secretary, the Director of the National In6 stitutes of Health, and the Advisory Board es7 tablished under section 430 for the diseases for 

8 which the Committee was established, not later 

9 than 1 year after the date of enactment of this 

10 subsection, an effective and comprehensive Fed11 eral plan (including all appropriate Federal 

12 health programs) to address kidney disease in 

13 minority populations. 

14 ‘‘(2) CONTENTS.—The report under paragraph 

15 (1)(A) shall at minimum address each of the fol16 lowing: 

17 ‘‘(A) Research on kidney disease in minor18 ity populations, including such research on— 

19 ‘‘(i) genetic, behavioral, and environ20 mental factors; 

21 ‘‘(ii) prevention and complications 

22 among individuals within these populations 

23 who have already developed kidney disease; 

24 ‘‘(iii) the delivery of evidenced-based 

25 care for all chronic kidney disease stages, 


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1 especially in underrepresented and under2 served populations; 

3 ‘‘(iv) expanding support for a root4 cause analysis approach to disparities, in5 cluding causes, detection, and management 

6 of chronic kidney disease for underserved 

7 populations; 

8 ‘‘(v) developing research teams that 

9 engage with community organizations to 

10 develop and implement interventions which 

11 halt or delay development and progression 

12 of chronic kidney disease; and 

13 ‘‘(vi) continued support of observa14 tional studies of kidney disease measures 

15 and outcomes. 

16 ‘‘(B) Surveillance and data collection on 

17 kidney disease in minority populations, includ18 ing with respect to— 

19 ‘‘(i) efforts to better determine the 

20 prevalence of kidney disease among Asian21 American and Pacific Islander subgroups; 

22 and 

23 ‘‘(ii) efforts to coordinate data collec24 tion on the American Indian population. 


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1 ‘‘(C) Community-based interventions to ad2 dress kidney disease targeting minority popu3 lations, including— 

4 ‘‘(i) the evidence bases for such inter5 ventions; 

6 ‘‘(ii) the cultural appropriateness of 

7 such interventions; and 

8 ‘‘(iii) efforts to educate the public on 

9 the causes and consequences of kidney dis10 ease. 

11 ‘‘(D) Education and training programs for 

12 health professionals (including community 

13 health workers) on the prevention and manage14 ment of kidney disease and its related complica15 tions that are supported by the Health Re16 sources and Services Administration, including 

17 such programs supported by the Bureau of 

18 Health Workforce, the Bureau of Primary 

19 Health Care, and the Health Systems Bureau. 

20 This shall include— 

21 ‘‘(i) identification of effective strate22 gies to increase implementation of proven 

23 therapies to slow chronic kidney disease in24 cidence and progression, especially in high25 risk underrepresented populations; and 


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1 ‘‘(ii) identification of effective practice 

2 improvement strategies in large and small 

3 health systems to reduce chronic kidney 

4 disease incidence and progression.’’. 

5 SEC. 7503. KIDNEY DISEASE ACTION PLAN. 

6 (a) IN GENERAL.—The Director of the Centers for 

7 Disease Control and Prevention shall conduct, support, 

8 and expand public health strategies, prevention, diagnosis, 

9 surveillance, and public and professional awareness activi10 ties regarding kidney disease. 

11 (b) NATIONAL ACTION PLAN.— 

12 (1) DEVELOPMENT.—Pursuant to section 426 

13 of the Public Health Service Act (42 U.S.C. 285c), 

14 not later than 2 years after the date of the enact15 ment of this Act, the Director of the National Insti16 tute of Diabetes and Digestive and Kidney Diseases, 

17 in consultation with the Director of the National In18 stitute on Minority Health and Health Disparities 

19 and the Director of the Centers for Disease Control 

20 and Prevention, shall develop a national action plan 

21 to address kidney disease in the United States with 

22 participation from patients, caregivers, health pro23 fessionals, patient advocacy organizations, research24 ers, providers, public health professionals, and other 

25 stakeholders. 


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1 (2) CONTENTS.—At a minimum, such plan 

2 shall include recommendations for— 

3 (A) public health interventions for the pur4 pose of implementation of the national plan; 

5 (B) biomedical, health services, and public 

6 health research on kidney disease; and 

7 (C) inclusion of kidney disease in the 

8 health data collections of all Federal agencies. 

9 (c) KIDNEY DISEASE PREVENTION PROGRAMS.—The 

10 Director of the Centers for Disease Control and Preven11 tion, through the Chronic Kidney Disease Initiative, shall 

12 carry out the following: 

13 (1) Conduct public education and awareness ac14 tivities with patient and professional organizations 

15 to stimulate earlier diagnosis and improve patient 

16 outcomes from treatment of kidney disease. To the 

17 extent known and relevant, such public education 

18 and awareness activities shall reflect differences in 

19 kidney disease by cause (such as hypertension, dia20 betes, lupus nephritis, COVID–19, and polycystic 

21 kidney disease) and include a focus on outreach to 

22 undiagnosed and, as appropriate, minority popu23 lations. 

24 (2) Supplement and expand upon the activities 

25 of the Centers for Disease Control and Prevention 


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1 by making grants to nonprofit organizations, State 

2 and local jurisdictions, and Indian Tribes for the 

3 purpose of reducing the burden of kidney disease, 

4 especially in disproportionately impacted commu5 nities, through public health interventions and re6 lated activities. 

7 (3) Coordinate with the National Institute of 

8 Diabetes and Digestive and Kidney Diseases, the In9 dian Health Service, the Health Resources and Serv10 ices Administration, and the Department of Vet11 erans Affairs to develop pilot programs to dem12 onstrate best practices for the diagnosis and man13 agement of kidney disease. 

14 (4) Develop improved techniques and identify 

15 best practices, in coordination with the Secretary of 

16 Veterans Affairs, for assisting kidney disease pa17 tients. 

18 (d) DATA COLLECTION.—Not later than 180 days 

19 after the date of enactment of this Act, the Director of 

20 the National Institute of Diabetes and Digestive and Kid21 ney Diseases and the Director of the Centers for Disease 

22 Control and Prevention, acting jointly, shall assess the 

23 depth and quality of information on kidney disease that 

24 is collected in surveys and population studies conducted 

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1 ing whether there are additional opportunities for informa2 tion to be collected in the National Health and Nutrition 

3 Examination Survey, the National Health Interview Sur4 vey, and the Behavioral Risk Factor Surveillance System 

5 surveys. The Director of the National Institute of Diabetes 

6 and Digestive and Kidney Diseases shall include the re7 sults of such assessment in the national action plan under 

8 subsection (b). 

9 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

11 $1,000,000 for fiscal year 2023, $1,000,000 for fiscal year 

12 2024, $1,000,000 for fiscal year 2025, $1,000,000 for fis13 cal year 2026, and $1,000,000 for fiscal year 2027. 

14 SEC. 7504. HOME DIALYSIS AND INCREASING END-STAGE 

15 RENAL DISEASE TREATMENT MODALITIES IN 

16 MINORITY COMMUNITIES ACTION PLAN. 

17 (a) IN GENERAL.—Section 1881(b)(14) of the Social 

18 Security Act (42 U.S.C. 1395rr(b)(14)) is amended by 

19 adding at the end the following new subparagraph: 

20 ‘‘(J)(i) For services furnished on or after the 

21 date which is 1 year after the date of the enactment 

22 of this subparagraph which are staff-assisted home 

23 dialysis (as defined in clause (iv)(III)), the Secretary 

24 shall increase the single payment that would other25 wise apply under this paragraph for renal dialysis 


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1 services furnished to new and respite individuals in 

2 accordance with the payment system established 

3 under clause (iii) by qualified providers. 

4 ‘‘(ii)(I) Subject to subclause (II), staff-assisted 

5 home dialysis may only be furnished during— 

6 ‘‘(aa) with respect to an individual de7 scribed in subclause (iv)(I)(aa), one 90-day pe8 riod which may be renewed up to two 30-day 

9 periods; and 

10 ‘‘(bb) with respect to an individual de11 scribed in subclause (iv)(I)(bb) and notwith12 standing whether such an individual receives 

13 any respite care under part A, any 30-day pe14 riod. 

15 ‘‘(II) Notwithstanding the limits described in 

16 subclause (I), staff-assisted home dialysis may be 

17 furnished for as long as the Secretary determines 

18 appropriate to an individual who— 

19 ‘‘(aa) is blind; 

20 ‘‘(bb) has a cognitive or neurological im21 pairment (including a stroke, Alzheimer’s, de22 mentia, amyotrophic lateral sclerosis, or any 

23 other impairment determined by the Secretary); 

24 or 


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1 ‘‘(cc) has any other illness or injury that 

2 reduces mobility (including cerebral palsy, spi3 nal cord injuries, or any other illness or injury 

4 determined by the Secretary). 

5 ‘‘(iii) The Secretary shall establish an add-on to 

6 the single payment under this paragraph through 

7 regulations to determine the amounts payable to 

8 qualified providers for staff-assisted home dialysis. 

9 In establishing such system add-on payment, the 

10 Secretary may consider— 

11 ‘‘(I) the costs of furnishing staff-assisted 

12 home dialysis; 

13 ‘‘(II) consultations with dialysis providers, 

14 dialysis patients, private payers, and Medicare 

15 Advantage plans; 

16 ‘‘(III) payment amounts for similar items 

17 and services under parts A and B; and 

18 ‘‘(IV) payment amounts established by 

19 Medicare Advantage plans under part C, group 

20 health plans, and health insurance coverage of21 fered by health insurance issuers. 

22 ‘‘(iv) In this subparagraph: 

23 ‘‘(I) The term ‘new and respite individual’ 

24 means an individual described in subsection (a) 

25 who is— 


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1 ‘‘(aa) initiating either peritoneal or 

2 home hemodialysis; 

3 ‘‘(bb) receiving home dialysis and is 

4 unable to self-dialyze due to illness, injury, 

5 caregiver issues, or other temporary cir6 cumstances; or 

7 ‘‘(cc) returning to home dialysis after 

8 a period of hospitalization. 

9 ‘‘(II) The term ‘qualified provider’ means 

10 a trained professional (as determined by the 

11 Secretary, including nurses and certified patient 

12 technicians) who furnishes renal dialysis serv13 ices and— 

14 ‘‘(aa) meets requirements (as deter15 mined by the Secretary) that ensures com16 petency in patient care and modality 

17 usage; and 

18 ‘‘(bb) provides in-person assistance to 

19 a patient for an appropriate number of di20 alysis sessions (as determined by the Sec21 retary) at least 75 percent of staff-assisted 

22 home dialysis sessions during a period de23 scribed in clause (ii)(I). 

24 ‘‘(III)(aa) The term ‘staff-assisted home 

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1 fessionals to assist individuals who have been 

2 determined to have end stage renal disease, and 

3 the frequency of such home dialysis is deter4 mined by such professionals in coordination 

5 with the patient and his or her care partner, 

6 and outlined in a patient plan of care. 

7 ‘‘(bb) The term ‘care partner’ means any8 one who is designated by the patient who as9 sists the individual with the furnishing of home 

10 dialysis. 

11 ‘‘(cc) The term ‘patient plan of care’ has 

12 the meaning given such term in section 494.90 

13 of title 42, Code of Federal Regulations.’’. 

14 (b) PATIENT EDUCATION AND TRAINING RELATING

15 TO STAFF-ASSISTED HOME DIALYSIS.—Section 

16 1881(b)(5) of the Social Security Act (42 U.S.C. 

17 1395rr(b)(5)) is amended— 

18 (1) in subparagraph (C), by striking at the end 

19 ‘‘and’’; 

20 (2) in subparagraph (D), by striking the period 

21 at the end and inserting a semicolon; and 

22 (3) by adding at the end the following: 

23 ‘‘(E) educate patients of the opportunity to 

24 receive staff-assisted home dialysis (as defined 

25 in paragraph (14)(J)(iv)(III)) during the period 


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1 beginning 30 days after the first day such facil2 ity furnishes renal dialysis services to an indi3 vidual and ending 60 days after such day; and 

4 ‘‘(F) provide for nurses, certified patient 

5 technicians, social workers and or other profes6 sionals to train patients and their care partners 

7 in skills and procedures needed to perform 

8 home dialysis (as defined in paragraph 

9 (14)(J)(iv)(III)) treatment— 

10 ‘‘(i) regularly and independently; 

11 ‘‘(ii) through telehealth services or 

12 through group training (as described in the 

13 interpretive guidance relating to tag num14 ber V590 of ‘Advance Copy–End Stage 

15 Renal Disease (ESRD) Program Interpre16 tive Guidance Version 1.1’ (published on 

17 October 3, 2008)) in accordance with the 

18 Federal regulations (concerning the privacy 

19 of individually identifiable health informa20 tion) promulgated under section 264(c) of 

21 the Health Insurance Portability and Ac22 countability Act of 1996; and 

23 ‘‘(iii) in the home or residence of a 

24 patient, in a dialysis facility, or in the 


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1 place in which the patient intends to re2 ceive staff-assisted home dialysis.’’. 

3 (c) NATIONAL ACTION PLAN.— 

4 (1) DEVELOPMENT.—Not later than 2 years 

5 after the date of the enactment of this Act, the Di6 rector of the National Institute of Diabetes and Di7 gestive and Kidney Diseases, in consultation with 

8 the Director of the Centers for Disease Control and 

9 Prevention, shall develop a national action plan to 

10 increase the number of home dialyzers and choice in 

11 dialysis treatment modality in the United States 

12 with participation from patients, caregivers, health 

13 professionals, patient advocacy organizations, re14 searchers, providers, public health professionals, and 

15 other stakeholders in minority communities. 

16 (2) CONTENTS.—At a minimum, such plan 

17 shall include recommendations for— 

18 (A) public health officials for the purpose 

19 of implementation of the national plan; 

20 (B) biomedical, health services, and public 

21 health research on home dialysis and modalities 

22 in minority communities; and 

23 (C) inclusion of dialysis location and mo24 dality in the health data collections of all Fed25 eral agencies. 


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1 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $1,000,000 for fiscal year 2023, $1,000,000 for fiscal year 

4 2024, $1,000,000 for fiscal year 2025, $1,000,000 for fis5 cal year 2026, and $1,000,000 for fiscal year 2027. 

6 SEC. 7505. INCREASING KIDNEY TRANSPLANTS IN MINOR7 ITY POPULATIONS. 

8 (a) IN GENERAL.—The Director of the National In9 stitutes of Health shall expand, intensify, and support on10 going research and other activities with respect to kidney 

11 transplants in minority populations. 

12 (b) CMS DATA COLLECTION AND REPORTING.—The 

13 Centers for Medicare & Medicaid Services shall collect and 

14 report annual data on dialysis facility and nephrologist 

15 performance on transplant referral, with an emphasis on 

16 data relating to patients of color. 

17 (c) OPTN DATA COLLECTION AND REPORTING.— 

18 The Organ Procurement and Transplantation Network 

19 shall collect and the Scientific Registry of Transplant Re20 cipients shall report annual data, broken down by demo21 graphic and socioeconomic characteristics, on individual 

22 transplant center performance as it relates to patients re23 ferred, evaluated, waitlisted, and successfully trans24 planted. 


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1 (d) TRANSPLANT CENTER DATA.—Each organ trans2 plant center shall report on the percent of appropriate 

3 waitlisted patients (including socioeconomic and demo4 graphic data) giving and receiving annual informed con5 sent for offers for suboptimal kidneys (such as kidneys 

6 with a kidney donor profile index of greater than 85 per7 cent or kidney age 50 with diabetes, or age greater than 

8 60). 

9 (e) ORGAN PROCUREMENT ORGANIZATION DATA.— 

10 Each organ procurement organization shall report annual 

11 data on referrals, refusals (patient or doctor), and accept12 ance of organs by hospital, ZIP Code, race, ethnicity, and 

13 age strata except as prohibited by need for confidentiality. 

14 (f) DATA TRANSPARENCY FOR PATIENTS.—Each 

15 organ transplant center shall provide to each patient of 

16 such center, on an annual basis— 

17 (1) the number of times an organ was offered 

18 to the patient, declined, and transplanted into an19 other patient from organs within a 500-mile radius; 

20 and 

21 (2) the number of times an organ was offered 

22 to and declined for the patient from a low-risk donor 

23 which was subsequently transplanted into another 

24 patient. 


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1 (g) IMPROVED TRANSPLANTATION EDUCATION.— 

2 The Centers for Medicare & Medicaid Services shall certify 

3 a nonbiased, third-party organization to accredit organ 

4 transplant education. 

5 (h) RESEARCH.—Research under subsection (a) shall 

6 include investigation into— 

7 (1) the causes of lower rates of kidney trans8 plants in minority populations, including socio9 economic, geographic, clinical, environmental, ge10 netic, and other factors that may contribute to lower 

11 rates of kidney transplants in minority populations; 

12 and 

13 (2) possible interventions to increase kidney 

14 transplants. 

15 (i) REPORT; COMPREHENSIVE PLAN.— 

16 (1) IN GENERAL.—The Secretary of Health and 

17 Human Services shall— 

18 (A) prepare and submit to the Congress, 

19 not later than 6 months after the date of enact20 ment of this section, a report on Federal re21 search and public health activities with respect 

22 to kidney transplants as a treatment for end23 stage renal disease in minority populations; and 

24 (B) develop and submit to the Congress, 

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1 ment of this section, an effective and com2 prehensive Federal plan (including all appro3 priate Federal health programs) to increase the 

4 number of kidney transplants in minority popu5 lations. 

6 (2) CONTENTS.—The report under paragraph 

7 (1)(A) shall at a minimum address each of the fol8 lowing: 

9 (A) Research on kidney transplants in mi10 nority populations, including such research on 

11 financial, insurance coverage, genetic, behav12 ioral, and environmental factors. 

13 (B) Surveillance and data collection on 

14 kidney transplants in minority populations, in15 cluding with respect to— 

16 (i) efforts to increase kidney trans17 plants among Asian-American and Pacific 

18 Islander subgroups with end-stage renal 

19 disease; and 

20 (ii) efforts to increase kidney trans21 plants in the American Indian population. 

22 (C) Community-based efforts to increase 

23 kidney transplants targeting minority popu24 lations, including— 


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1 (i) the evidence base for such in2 creases; 

3 (ii) the cultural appropriateness of 

4 such increases; and 

5 (iii) efforts to educate the public on 

6 kidney transplants. 

7 (D) Education and training programs for 

8 health professionals (including community 

9 health workers) on the kidney transplants that 

10 are supported by the Health Resources and 

11 Services Administration, including such pro12 grams supported by the Bureau of Health 

13 Workforce, the Bureau of Primary Health Care, 

14 and the Health Systems Bureau. 

15 SEC. 7506. ENVIRONMENTAL AND OCCUPATIONAL HEALTH 

16 PROGRAMS. 

17 The Director of the Centers for Disease Control and 

18 Prevention shall— 

19 (1) support research into the environmental and 

20 occupational causes and biological mechanisms that 

21 contribute to kidney disease; and 

22 (2) develop and disseminate public health inter23 ventions that will lessen the impact of environmental 

24 and occupational causes of kidney disease. 


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1 SEC. 7507. UNDERSTANDING THE TREATMENT PATTERNS 

2 ASSOCIATED WITH PROVIDING CARE AND 

3 TREATMENT OF KIDNEY FAILURE IN MINOR4 ITY POPULATIONS. 

5 (a) STUDY.—The Secretary of Health and Human 

6 Services (in this section referred to as the ‘‘Secretary’’) 

7 shall conduct a study on treatment patterns associated 

8 with providing care, under the Medicare program under 

9 title XVIII of the Social Security Act (42 U.S.C. 1395 

10 et seq.), under the Medicaid program under title XIX of 

11 such Act (42 U.S.C. 1396 et seq.), and through private 

12 health insurance, to minority populations that are dis13 proportionately affected by kidney failure. 

14 (b) REPORT.—Not later than 1 year after the date 

15 of the enactment of this Act, the Secretary shall submit 

16 to Congress a report on the study conducted under sub17 section (a), together with such recommendations as the 

18 Secretary determines to be appropriate. 

19 SEC. 7508. IMPROVING ACCESS IN UNDERSERVED AREAS. 

20 (a) DEFINITION OF PRIMARY CARE SERVICES.—Sec21 tion 331(a)(3)(D) of the Public Health Service Act (42 

22 U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘nephrol23 ogy,’’ after ‘‘dentistry,’’. 

24 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR25 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 

26 Service Act (42 U.S.C. 254l(a)(2)) is amended by insertVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01483 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ing ‘‘, which may include kidney health professionals’’ be2 fore the period at the end. 

3 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE4 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 

5 Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 

6 by inserting ‘‘, which may include kidney health profes7 sionals’’ before the period at the end. 

8 SEC. 7509. THE JACK REYNOLDS MEMORIAL MEDIGAP EX9 PANSION ACT; MEDIGAP COVERAGE FOR 

10 BENEFICIARIES WITH END-STAGE RENAL DIS11 EASE. 

12 (a) GUARANTEED AVAILABILITY OF MEDIGAP POLI13 CIES TO ALL ESRD MEDICARE BENEFICIARIES.— 

14 (1) IN GENERAL.—Section 1882(s) of the So15 cial Security Act (42 U.S.C. 1395ss(s)) is amend16 ed— 

17 (A) in paragraph (2)— 

18 (i) in subparagraph (A), by striking 

19 ‘‘is 65’’ and all that follows through the 

20 period at the end and inserting the fol21 lowing: ‘‘is— 

22 ‘‘(i) 65 years of age or older and is en23 rolled for benefits under part B; or 

24 ‘‘(ii) is entitled to benefits under 226A(b) 

25 and is enrolled for benefits under part B.’’; and 


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1 (ii) in subparagraph (D), in the mat2 ter preceding clause (i), by inserting ‘‘(or 

3 is entitled to benefits under 226A(b))’’ 

4 after ‘‘is 65 years of age or older’’; and 

5 (B) in paragraph (3)(B)— 

6 (i) in clause (ii), by inserting ‘‘(or is 

7 entitled to benefits under 226A(b))’’ after 

8 ‘‘is 65 years of age or older’’; and 

9 (ii) in clause (vi), by inserting ‘‘(or 

10 under 226A(b))’’ after ‘‘at age 65’’. 

11 (2) EFFECTIVE DATE.—The amendments made 

12 by paragraph (1) shall apply to Medicare supple13 mental policies effective on or after January 1, 

14 2023. 

15 (b) ADDITIONAL ENROLLMENT PERIOD FOR CER16 TAIN INDIVIDUALS.— 

17 (1) ONE-TIME ENROLLMENT PERIOD.— 

18 (A) IN GENERAL.—In the case of an indi19 vidual described in paragraph (2), the Secretary 

20 of Health and Human Services shall establish a 

21 one-time enrollment period during which such 

22 an individual may enroll in any Medicare sup23 plemental policy under section 1882 of the So24 cial Security Act (42 U.S.C. 1395ss) of the in25 dividual’s choosing. 


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1 (B) ENROLLMENT PERIOD.—The enroll2 ment period established under subparagraph 

3 (A) shall begin on January 1, 2023, and shall 

4 end June 30, 2023. 

5 (2) INDIVIDUAL DESCRIBED.—An individual de6 scribed in this paragraph is an individual who— 

7 (A) is entitled to hospital insurance bene8 fits under part A of title XVIII of the Social 

9 Security Act under section 226A(b) of such Act 

10 (42 U.S.C. 426–1(b)); 

11 (B) is enrolled for benefits under part B of 

12 such title XVIII; and 

13 (C) would not, but for the provisions of, 

14 and amendments made by, subsection (a) be eli15 gible for the guaranteed issue of a Medicare 

16 supplemental policy under paragraph (2) or (3) 

17 of section 1882(s) of such Act (42 U.S.C. 

18 1395ss(s)). 

19 Subtitle L—Diversity in Clinical 

20 Trials 

21 SEC. 7551. FDA REVIEW OF CLINICAL TRIAL BEST PRAC22 TICES. 

23 The Commissioner of Food and Drugs shall— 

24 (1) aggregate information on the accumulated 

25 experience of sponsors of drugs that develop and 


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1 execute clinical trial diversity plans during drug de2 velopment; 

3 (2) include in such aggregated information an 

4 analysis from the perspectives of the Food and Drug 

5 Administration and such sponsors of which actions 

6 worked or which did not work to enhance clinical 

7 trial diversity; 

8 (3) not later than September 30, 2024, convene 

9 a public meeting, including representatives from the 

10 regulated industry and patient organizations, to dis11 cuss findings and recommendations for specific ac12 tions that have led to measurable improvements in 

13 the representation of racial and ethnic populations 

14 in clinical research; and 

15 (4) not later than September 30, 2025, update 

16 the guidance of the Food and Drug Administration 

17 titled ‘‘Enhancing the Diversity of Clinical Trial 

18 Populations—Eligibility Criteria, Enrollment Prac19 tices, and Trial Designs’’ to align such guidance 

20 with findings and recommendations that were dis21 cussed at the meeting under paragraph (3). 


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1 SEC. 7552. DIVERSIFYING INVESTIGATIONS VIA EQUITABLE 

2 RESEARCH STUDIES FOR EVERYONE TRIALS 

3 ACT. 

4 (a) GUIDANCE ON DECENTRALIZED CLINICAL

5 TRIALS.— 

6 (1) DEFINITION.—In this subsection, the term 

7 ‘‘decentralized clinical trials’’ includes clinical trials 

8 that are executed through a broad spectrum of op9 tions, such as telemedicine or other mobile or digital 

10 technologies, to allow for the remote collection and 

11 assessment of clinical trial data from participants, 

12 including in the home or office setting. 

13 (2) GUIDANCE.—Not later than 6 months after 

14 the date of enactment of this Act, the Secretary of 

15 Health and Human Services (referred to in this sec16 tion as the ‘‘Secretary’’), acting through the Com17 missioner of Food and Drugs (referred to in this 

18 section as the ‘‘Commissioner’’), shall issue a draft 

19 guidance that addresses how to conduct decentral20 ized clinical trials with meaningful demographic di21 versity, including racial, ethnic, age, gender, and ge22 ographic diversity in patient engagement, enroll23 ment, and participation, including how to appro24 priately use digital health technologies or other re25 mote assessment options, such as telemedicine, to 

26 support such trials. Not later than 6 months after 


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1 the date the public comment period for the draft 

2 guidance ends, the Secretary shall issue a final guid3 ance. 

4 (3) CONTENT OF GUIDANCE.—The guidance 

5 under paragraph (2) shall address the following: 

6 (A) Strategies to engage with prospective 

7 clinical trial participants and community part8 ners, such as patient advocacy groups with di9 verse representation, to incorporate input of 

10 such patients and partners into the design of 

11 decentralized clinical trials. 

12 (B) Recommendations for— 

13 (i) protocol design approaches; 

14 (ii) appropriate clinical endpoints; 

15 (iii) institutional review board com16 position and ensuring that such boards in17 clude members with expertise in decentral18 ized clinical trials; 

19 (iv) delegation of clinical research or20 ganization responsibilities and suitable 

21 proxies for clinical research organizations; 

22 and 

23 (v) simplifying informed consent. 

24 (C) Recommendations for how digital 

25 health technology or other remote assessment 


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1 options, such as telemedicine, could support de2 centralized clinical trials, including guidance on 

3 appropriate technological platforms and medi4 ums, data collection and use, data integrity, 

5 and communication to study participants 

6 through digital technology. 

7 (D) Recommendations for appropriate 

8 methods of patient recruitment and retention, 

9 including institutional review board oversight, 

10 patient communication, and the role of study 

11 participants and community partners as advo12 cates to facilitate clinical trial recruitment, par13 ticularly with respect to underrepresented popu14 lations. 

15 (E) Information regarding when and how a 

16 study sponsor may solicit a meeting with the 

17 Secretary regarding the issues described in sub18 paragraphs (A) through (D). 

19 (4) INTERNATIONAL HARMONIZATION.—After 

20 issuing the final guidance under paragraph (2), the 

21 Secretary, acting through the Commissioner, may 

22 work with foreign regulators pursuant to existing 

23 memoranda of understanding governing exchange of 

24 information to facilitate international harmonization 

25 of the regulation of decentralized clinical trials and 


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1 use of digital health technology or other remote as2 sessment options. 

3 (b) ENCOURAGEMENT OF CLINICAL TRIAL ENROLL4 MENT BY RACIALLY AND ETHNICALLY DIVERSE POPU5 LATIONS.— 

6 (1) NO COST PROVISION OF DIGITAL HEALTH

7 TECHNOLOGIES.—The free provision of digital 

8 health technologies by drug or device manufacturers 

9 to their clinical trial participants shall not be consid10 ered a violation of section 1128A of the Social Secu11 rity Act (commonly known as the ‘‘Civil Monetary 

12 Penalties Law’’) (42 U.S.C. 1320a–7a), section 

13 1128B of the Social Security Act (42 U.S.C. 1320a– 

14 7b), or sections 3729 through 3733 of title 31, 

15 United States Code (commonly known as the ‘‘False 

16 Claims Act’’), provided that— 

17 (A) the use of digital health technologies 

18 will facilitate in any phase of clinical develop19 ment the inclusion of diversity of patient popu20 lations, such as underrepresented racial and 

21 ethnic minorities, low-income populations, and 

22 the elderly; 

23 (B) the digital health technologies will fa24 cilitate individuals’ participation, or are nec25 essary to such participation; 


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1 (C) all features of the digital health tech2 nologies that are unrelated to use in the clinical 

3 trial are disabled or only allowed to remain acti4 vated to model real-world usage of the digital 

5 technology; and 

6 (D) the clinical trial sponsor requires par7 ticipants to return, purchase, or disable the dig8 ital health technologies by the conclusion of the 

9 trial. 

10 (2) GRANTS AND CONTRACTS.— 

11 (A) IN GENERAL.—The Secretary may 

12 issue grants to, and enter into contracts with, 

13 entities to support community education, out14 reach, and recruitment activities for clinical 

15 trials with respect to drugs, including vaccines 

16 for diseases or conditions which have a dis17 proportionate impact on underrepresented pop18 ulations (including on racial and ethnic minor19 ity populations), including for the diagnosis, 

20 prevention, or treatment of COVID–19. Such 

21 activities may include— 

22 (i) working with community clinical 

23 trial sites, including community health cen24 ters, academic health centers, and other fa25 cilities; 


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1 (ii) training health care personnel in2 cluding potential clinical trial investigators, 

3 with a focus on significantly increasing the 

4 number of underrepresented racial and 

5 ethnic minority health care personnel who 

6 are clinical trial investigators at the com7 munity sites for ongoing clinical trials; 

8 (iii) engaging community stakeholders 

9 to encourage participation in clinical trials, 

10 especially in underrepresented racial and 

11 ethnic minority communities; and 

12 (iv) fostering partnerships with com13 munity-based organizations serving under14 represented racial and ethnical minority 

15 populations, including labor organizations 

16 and frontline health care workers. 

17 (B) PRIORITY FOR GRANT AND CONTRACT

18 AWARDS.—In awarding grants and contracts 

19 under this paragraph, the Secretary shall 

20 prioritize entities that— 

21 (i) develop educational, recruitment, 

22 and training materials in multiple lan23 guages; or 

24 (ii) undertake clinical trial outreach 

25 efforts in more diverse racial and ethnic 


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1 communities that are traditionally under2 represented in clinical trials, such as Trib3 al areas. 

4 (C) AUTHORIZATION OF APPROPRIA5 TIONS.—There is authorized to be appropriated 

6 for fiscal years 2023 and 2024 such sums as 

7 may be necessary to carry out this paragraph. 

8 (c) CLARIFICATION THAT CERTAIN REMUNERATION

9 RELATED TO PARTICIPATION IN CLINICAL TRIALS DOES

10 NOT CONSTITUTE REMUNERATION UNDER THE FED11 ERAL CIVIL MONEY PENALTIES LAW.— 

12 (1) IN GENERAL.—Section 1128A(i)(6)(F) of 

13 the Social Security Act (42 U.S.C. 1320a– 

14 7a(i)(6)(F)) is amended by inserting ‘‘(including re15 muneration offered or transferred to an individual to 

16 promote the participation in an approved clinical 

17 trial, as defined in subsection (d) of the first section 

18 2709 of the Public Health Service Act (relating to 

19 coverage for individuals participating in approved 

20 clinical trials), as so designated by section 

21 1563(c)(10)(C) of the Patient Protection and Af22 fordable Care Act, that is registered with the data23 base of clinical trials maintained by the National Li24 brary of Medicine (or any successor database), so 

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1 sion of patients from all relevant demographic and 

2 socioeconomic populations and is related to patient 

3 participation in the approved clinical trial)’’ after 

4 ‘‘promotes access to care’’. 

5 (2) EFFECTIVE DATE.—The amendment made 

6 by paragraph (1) shall apply to remuneration pro7 vided on or after the date of the enactment of this 

8 Act. 

9 (d) NATIONAL ACADEMY OF MEDICINE STUDY.— 

10 (1) IN GENERAL.—The Secretary shall seek to 

11 enter into an arrangement with the National Acad12 emy of Medicine under which the National Academy 

13 agrees to study and propose a design for a national 

14 interoperable data platform to improve access to 

15 health data, and other relevant data needs, during 

16 public health emergencies. 

17 (2) REPORT.—The arrangement under para18 graph (1) shall provide for submission by the Na19 tional Academy of Medicine to the Secretary and 

20 Congress, not later than 120 days after the date of 

21 enactment of this Act, of a report on the results of 

22 the study under paragraph (1) and the design pro23 posed based on such study. 


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1 SEC. 7553. CLINICAL TRIAL DIVERSITY. 

2 (a) DIVERSITY REQUIREMENTS FOR APPLICATIONS

3 FOR FEDERAL FUNDING FOR CLINICAL TRIALS.— 

4 (1) APPLICATIONS.—Beginning on the date of 

5 the enactment of this Act, the Secretary of Health 

6 and Human Services, acting through the Director of 

7 the National Institutes of Health (in this subsection 

8 referred to as the ‘‘Secretary’’), shall require that an 

9 entity seeking to conduct a clinical trial investigating 

10 a drug or device (as those terms are defined in sec11 tion 201 of the Federal Food, Drug, and Cosmetic 

12 Act (21 U.S.C. 321)) or biological product (as de13 fined in section 351(i) of the Public Health Service 

14 Act (42 U.S.C. 262(i))) that is funded by the Na15 tional Institutes of Health and conducted at any na16 tional research institute or national center, submit 

17 an application (or renewal thereof) for such funding 

18 that includes— 

19 (A) clear and measurable goals for the re20 cruitment and retention of participants that re21 flect— 

22 (i) the race, ethnicity, age, and gender 

23 or sex of patients with the disease or con24 dition being investigated; or 

25 (ii) the race, ethnicity, age, and gen26 der or sex of the general population of the 


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1 United States if the prevalence of the dis2 ease or condition is not known; 

3 (B) a rationale for the goals specified 

4 under subparagraph (A) that specifies— 

5 (i) how investigators will calculate the 

6 number of participants for each population 

7 category that reflect the population groups 

8 specified in subparagraph (A); and 

9 (ii) strategies that will be used to en10 roll and retain participants across the dif11 ferent racial, ethnic, age, and gender or 

12 sex categories; 

13 (C) a detailed plan for how the clinical 

14 trial will achieve the goals specified under sub15 paragraph (A) that specifies— 

16 (i) the requirements for researchers, 

17 in conducting the trial to analyze the popu18 lation groups specified in subparagraph 

19 (A) separately; 

20 (ii) the role of community partners or 

21 community institutional review boards in 

22 reviewing the plans; and 

23 (iii) how the trial will recruit a study 

24 population that is— 


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1 (I) in proportion to the preva2 lence of the disease or condition in 

3 such groups relative to the prevalence 

4 of the disease or condition in the over5 all population of the United States; 

6 (II) in sufficient numbers to ob7 tain clinically and statistically mean8 ingful determinations of the safety 

9 and effectiveness of the drug being 

10 studied in the respective race, eth11 nicity, age, and gender or sex groups; 

12 and 

13 (III) consistent with the guidance 

14 under section 505(b)(1) of the Fed15 eral Food, Drug, and Cosmetic Act 

16 (21 U.S.C. 355(b)(1)) and guidance 

17 issued by the National Institutes of 

18 Health on the inclusion of women and 

19 minorities in clinical trials; 

20 (D) the entity’s plan for implementing, or 

21 an explanation of why the entity cannot imple22 ment, alternative clinical trial follow-up require23 ments that are less burdensome for trial partici24 pants, such as— 

25 (i) requiring fewer follow-up visits; 


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1 (ii) allowing phone follow-up or home 

2 visits by nurse trial coordinators (in lieu of 

3 in-person visits by patients); 

4 (iii) allowing for online follow-up op5 tions; 

6 (iv) permitting the patient’s primary 

7 care provider to perform some of the fol8 low-up visit requirements and to reimburse 

9 the patient for any out-of-pocket costs in10 curred by the patient for such follow-up 

11 visits; 

12 (v) allowing for weekend hours for re13 quired follow-up visits; 

14 (vi) allowing virtual or telemedicine 

15 visits; 

16 (vii) use of wearable technology to 

17 record key health parameters; and 

18 (viii) use of alternate labs or imaging 

19 centers, which may be closer to the resi20 dence of the patients participating in the 

21 trial; and 

22 (E) the entity’s education and training re23 quirements for researchers and other individ24 uals conducting or supporting the clinical trial 

25 with respect to diversity and health inequities in 


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1 underrepresented populations, including a re2 quirement to consult with, and review materials 

3 made available by, such committees, task forces, 

4 and working groups other entities the Secretary 

5 determines are appropriate, including the fol6 lowing: 

7 (i) The Equity Committee of the Na8 tional Institutes of Health. 

9 (ii) The National Advisory Council on 

10 Minority Health and Health Disparities. 

11 (iii) The Advisory Committee on Re12 search on Women’s Health. 

13 (iv) The Sexual & Gender Minority 

14 Research Coordinating Committee of the 

15 National Institutes of Health. 

16 (v) The Tribal Health Research Co17 ordinating Committee of the National In18 stitutes of Health. 

19 (2) TERMS.— 

20 (A) IN GENERAL.—As a condition on the 

21 receipt of funding through the National Insti22 tutes of Health, as described in paragraph (1), 

23 with respect to a clinical trial, the sponsor of 

24 the clinical trial shall agree to terms requiring 

25 that— 


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1 (i) the aggregate demographic infor2 mation of trial participants be shared on 

3 an annual basis with the Secretary while 

4 participant recruitment and data collection 

5 in such trial is ongoing, and that such in6 formation is provided with respect to— 

7 (I) underrepresented populations, 

8 including populations grouped by race, 

9 ethnicity, age, sex, gender identity 

10 and expression, geographic region, 

11 primary written and spoken language, 

12 disability status, sexual orientation, 

13 socioeconomic status, occupation, and 

14 other relevant factors; and 

15 (II) such populations that reflect 

16 the prevalence of the disease or condi17 tion that is the subject of the clinical 

18 trial involved (as available and as ap19 propriate to the scientific objective for 

20 the study, as determined by the Direc21 tor of the National Institutes of 

22 Health); 

23 (ii) the sponsor submits to the pro24 gram officer and grants management spe25 cialist of the specific National Institutes of 


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1 Health national research institute or na2 tional center, as frequently as such officer 

3 or specialist determines necessary, the re4 tention rate of participants in the clinical 

5 trial, disaggregated by race, ethnicity, gen6 der or sex, and age; 

7 (iii) both the clinical trial researchers 

8 and the applicant reviewers complete edu9 cation and training programs on diversity 

10 in clinical trials; and 

11 (iv) at the conclusion of the trial, the 

12 sponsor submits to the Secretary the num13 ber of participants in the trial, 

14 disaggregated by race, ethnicity, age, and 

15 gender or sex. 

16 (B) PRIVACY PROTECTIONS.—Any data 

17 shared under subparagraph (A) may not in18 clude any individually identifiable information 

19 or protected health information with respect to 

20 clinical trial participants and shall only be dis21 closed to the extent allowed under Federal pri22 vacy laws. 

23 (3) EXCEPTION.—In lieu of submitting an ap24 plication under paragraph (1) and documentation of 

25 goals as required by subparagraph (A) of such paraVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01502 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 graph, an applicant may provide reasoning (other 

2 than cost) for why the recruitment of each of the 

3 population groups specified in subparagraph (A) of 

4 paragraph (1) is not necessary and why such re5 cruitment is not scientifically justified or possible. 

6 (4) PUBLICATION.—The Secretary shall— 

7 (A) publish on a public website of the Na8 tional Institutes of Health, upon receipt of an 

9 application to which paragraph (1) applies or 

10 reasoning under paragraph (3)— 

11 (i) a summary of the disease being 

12 targeted in the clinical trial that is the 

13 subject of the application and the preva14 lence of such disease across race, ethnicity, 

15 gender or sex, age, and clinical trial rep16 resentation in each such category; 

17 (ii) the goals specified in such applica18 tion, as required by paragraph (1)(A); or 

19 (iii) the reasoning described in para20 graph (3); and 

21 (B) ensure that, in publishing information 

22 relating to an application or reasoning under 

23 subparagraph (A), the design of the study in24 volved is not disclosed. 

25 (5) REMEDIATION.— 


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1 (A) IN GENERAL.—In the case of a clinical 

2 trial subject to paragraph (1) that fails to meet 

3 the condition specified pursuant to paragraph 

4 (1) by such date as may be agreed upon by the 

5 sponsor of the trial and the program officer and 

6 grants management specialist of the specific 

7 National Institutes of Health national research 

8 institute or national center, the Secretary shall 

9 require the sponsor of that clinical trial, not 

10 later than 60 days after such date occurs— 

11 (i) to develop, in consultation with the 

12 Secretary and advocacy and community13 based organizations representing individ14 uals who are members of relevant demo15 graphic groups specified in paragraph 

16 (1)(A), a strategic plan to increase partici17 pation in such clinical trial of such individ18 uals; and 

19 (ii) to submit to the Secretary, such 

20 strategic plan. 

21 (B) PUBLICATION.—The Secretary shall 

22 make publicly available on the website of the 

23 National Institutes of Health, the strategic plan 

24 received under subparagraph (A) as soon as 

25 possible after receipt. The Secretary shall enVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01504 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 sure that, in publishing such plan under the 

2 preceding sentence, the design of the study in3 volved is not disclosed. 

4 (C) IMPLEMENTATION.—The sponsor of 

5 the clinical trial that is the subject of the stra6 tegic plan published under subparagraph (B), 

7 shall, not later than 60 days after such date as 

8 may be agreed upon by the sponsor of the trial 

9 and the appropriate program officer and grants 

10 management specialist of the National Insti11 tutes of Health, implement the strategic plan. 

12 (D) TECHNICAL ASSISTANCE.—The Sec13 retary may provide technical assistance to a 

14 sponsor of a clinical trial, as necessary for the 

15 sponsor to meet the requirements of subpara16 graph (C). 

17 (6) PENALTIES IN CASE OF FAILURE OF REME18 DIATION.— 

19 (A) IN GENERAL.—In the case of a clinical 

20 trial subject to paragraph (1) that, after the 

21 close of the 60-day period specified in para22 graph (5)(C), continues to fail to meet the con23 dition specified pursuant to paragraph (1)(A), 

24 the Secretary shall— 


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1 (i) hold the noncompeting continu2 ation of funding received through the grant 

3 involved; 

4 (ii) apply specific conditions on the 

5 award of funds to such sponsor to conduct 

6 such clinical trial; or 

7 (iii) terminate such funding. 

8 (B) WAIVER.— 

9 (i) IN GENERAL.—In the case of a 

10 clinical trial subject to the penalty under 

11 subparagraph (A) that fails to meet the 

12 condition referred to in such subpara13 graph, the sponsor of such clinical trial 

14 may, prior to the conclusion of the 60-day 

15 period referred to in subparagraph (A), 

16 submit an application to the relevant pro17 gram officer and grants specialist request18 ing a waiver of such condition. Such an ap19 plication shall specify reasoning for why 

20 the recruitment of each of the population 

21 groups specified in subparagraph (A) of 

22 paragraph (1) is not necessary or why such 

23 recruitment is not scientifically justified or 

24 possible. 


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1 (ii) REVIEW.—Not later than 30 days 

2 after a date agreed upon by the sponsor of 

3 the trial and the appropriate program offi4 cer and grants management specialist of 

5 the National Institutes of Health, the Sec6 retary shall— 

7 (I) complete the review of such 

8 application; and 

9 (II) make a determination to ap10 prove or deny the application. 

11 (iii) NO ADDITIONAL PENALTIES.—No 

12 additional penalties may be applied with 

13 respect to a sponsor of a clinical trial 

14 under subparagraph (A) during the 30-day 

15 period specified in clause (ii). 

16 (C) TERMINATION OF FUNDING.—In the 

17 case of a clinical trial described in subpara18 graph (B)(i), the Secretary may elect to termi19 nate funding described in paragraph (1) for the 

20 clinical trial if no request for a waiver under 

21 subparagraph (B) is received by the conclusion 

22 60-day period referred to in subparagraph (A). 

23 (7) WAIVER FOR CERTAIN CLINICAL TRIALS.— 

24 (A) IN GENERAL.—In the case of a clinical 

25 trial that received funding through the National 


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1 Institutes of Health and is ongoing as of the 

2 date of the enactment of this Act, the sponsor 

3 of such clinical trial is exempt from the require4 ments of (and associated penalties imposed by) 

5 this section. 

6 (B) REPORT.—The Secretary shall include 

7 in the triennial report required to be submitted 

8 under section 403 of the Public Health Service 

9 Act (42 U.S.C. 283), a list of all clinical trials 

10 receiving funding through the National Insti11 tutes of Health— 

12 (i) that requested and received waiv13 ers under this subsection; or 

14 (ii) with respect to which funding has 

15 been terminated pursuant to this sub16 section. 

17 (8) STUDY.— 

18 (A) IN GENERAL.—The Comptroller Gen19 eral of the United States shall conduct a study 

20 that— 

21 (i) examines which actions Federal 

22 agencies have taken to address barriers to 

23 participation in federally funded clinical 

24 trials by the demographic groups specified 

25 in paragraph (1)(A); and 


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1 (ii) identifies challenges, if any, in im2 plementing such actions. 

3 (B) REPORT.—Not later than 1 year after 

4 the date of the enactment of this Act, the 

5 Comptroller General of the United States shall 

6 submit to Congress a report on the findings of 

7 the study conducted under subparagraph (A). 

8 (9) NONDISCRIMINATION.—Section 1557 of the 

9 Patient Protection and Affordable Care Act (42 

10 U.S.C. 18116) shall apply with respect to a clinical 

11 trial subject to paragraph (1). 

12 (b) ELIMINATING COST BARRIERS.— 

13 (1) STUDY ON MODERNIZATION OF HUMAN

14 SUBJECT REGULATIONS.—Not later than 2 years 

15 after the date of the enactment of this Act, the Sec16 retary of Health and Human Services, acting 

17 through the Director of the National Institutes of 

18 Health (referred to in this subsection as the ‘‘Sec19 retary’’), shall conduct and complete a study on— 

20 (A) the need for review of human subject 

21 regulations specified in part 46 of title 45, Code 

22 of Federal Regulations (or successor regula23 tions), and related guidance; 

24 (B) the modernization of such regulations 

25 and guidance to establish updated guidelines for 


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1 reimbursement of out-of-pocket expenses of 

2 human subjects, compensation of human sub3 jects for time spent participating in the clinical 

4 trial, and incentives for recruitment of human 

5 subjects; and 

6 (C) the need for updated safe harbor rules 

7 under section 1001.952 of title 42, Code of 

8 Federal Regulations (or successor regulations) 

9 and section 1128B of the Social Security Act 

10 (commonly referred to as the Federal Anti11 Kickback Statute (42 U.S.C. 1320a–7b)) with 

12 respect to the assistance provided under this 

13 subsection. 

14 (2) REIMBURSEMENT FOR COSTS ASSOCIATED

15 WITH CLINICAL TRIAL PARTICIPATION.—As a condi16 tion on receipt of any funding provided through the 

17 National Institutes of Health to conduct a clinical 

18 trial investigating a drug or device (as those terms 

19 are defined in section 201 of the Federal Food, 

20 Drug, and Cosmetic Act (21 U.S.C. 321)) or biologi21 cal product (as defined in section 351(i) of the Pub22 lic Health Service Act (42 U.S.C. 262(i))), the Sec23 retary shall require that the sponsor of such clinical 

24 trial— 


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1 (A) works with institutional review boards 

2 and program officers of the National Institutes 

3 of Health to determine when reimbursement for 

4 the costs associated with clinical trial participa5 tion is warranted; and 

6 (B) subject to paragraph (3), provides to 

7 clinical trial participants reimbursement for ex8 penses (using funds other than funds supplied 

9 through the National Institutes of Health) in10 curred as a result of that participation, which 

11 may include— 

12 (i) missed or forgone salary; 

13 (ii) language assistance, including in14 terpreter services; 

15 (iii) food expenses; 

16 (iv) childcare expenses; 

17 (v) lodging expenses; 

18 (vi) transportation expenses; or 

19 (vii) other expenses as identified by 

20 the participant, subject to review by the 

21 clinical trial sponsor, at its discretion, on a 

22 case-by-case basis. 

23 (3) PROVISION OF COSTS ASSOCIATED WITH

24 CLINICAL TRIAL PARTICIPATION.— 


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1 (A) APPLICATION AND DOCUMENTA2 TION.— 

3 (i) IN GENERAL.—A sponsor of a clin4 ical trial to which subsection (a)(1) applies, 

5 may require that, in order to receive reim6 bursement as described in paragraph (2), a 

7 participant complete an application and 

8 share with the sponsor such documentation 

9 of expenses described in such paragraph, 

10 as the sponsor may require. 

11 (ii) TIMING.—Not later than 30 days 

12 after the date on which a sponsor of a clin13 ical trial receives an application under 

14 clause (i), the sponsor shall— 

15 (I) review the application; and 

16 (II) provide for reimbursement of 

17 eligible expenses documented in such 

18 application, as determined at the dis19 cretion of the clinical trial sponsor on 

20 a case-by-case basis. 

21 (B) ENFORCEMENT.—A sponsor of a clin22 ical trial to which subsection (a)(1) applies, 

23 shall submit on an annual basis, as part of the 

24 progress reports submitted to the Secretary 

25 pursuant to section 402(j) of the Public Health 


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1 Service Act (42 U.S.C. 282(j)), during the data 

2 collection period of the clinical trial, to the Sec3 retary an accounting of the reimbursements 

4 made to clinical trial participants under sub5 paragraph (A). Such data shall— 

6 (i) include relevant aggregate data 

7 with respect to each population group spec8 ified in subsection (a)(2)(A)(i) when such 

9 data will not compromise the identities of 

10 study participants and in a manner con11 sistent with applicable privacy protections; 

12 and 

13 (ii) not later than 6 months after re14 ceipt by the Secretary, be published on a 

15 public website of the National Institutes of 

16 Health. 

17 (c) PUBLIC AWARENESS AND EDUCATION CAM18 PAIGN.— 

19 (1) NATIONAL CAMPAIGN.—The Secretary of 

20 Health and Human Services, acting through the Di21 rector of the National Institutes of Health and the 

22 Commissioner of Food and Drugs (referred to in 

23 this subsection as the ‘‘Secretary’’), in consultation 

24 with the stakeholders specified in paragraph (5), 

25 shall carry out a national campaign to increase the 


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1 awareness and knowledge of individuals in the 

2 United States with respect to the need for diverse 

3 clinical trials among the demographic groups identi4 fied pursuant to subsection (a)(1)(A). 

5 (2) REQUIREMENTS.—The national campaign 

6 conducted shall include— 

7 (A) the development and distribution of 

8 written educational materials, and the develop9 ment and placing of public service announce10 ments, that are intended to encourage individ11 uals who are members of the demographic 

12 groups identified pursuant to subsection 

13 (a)(2)(A)(i)(I) to seek to participate in clinical 

14 trials; 

15 (B) such efforts as are reasonable and nec16 essary to ensure meaningful access by con17 sumers with limited English proficiency; 

18 (C) the development and distribution of 

19 best practices and training for recruiting under20 represented study populations, including a 

21 method for sharing such best practices among 

22 clinical trial sponsors, providers, community23 based organizations who assist with recruit24 ment, and with the public; and 


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1 (D) the conduct of focus groups to better 

2 understand the concerns and fears of certain 

3 underrepresented groups who may be reluctant 

4 to participate in clinical trials. 

5 (3) HEALTH INEQUITIES.—In developing the 

6 national campaign under paragraph (1), the Sec7 retary shall recognize and address— 

8 (A) health inequities among individuals 

9 who are members of the population groups 

10 specified in subsection (a)(2)(A)(i) with respect 

11 to access to care and participation in clinical 

12 trials; and 

13 (B) any barriers in access to care and par14 ticipation in clinical trials that are specific to 

15 individuals who are members of such groups. 

16 (4) GRANTS.—The Secretary shall establish a 

17 program to award grants to nonprofit private enti18 ties, including community-based organizations and 

19 faith communities, institutions of higher education 

20 eligible to receive funds under section 371 of the 

21 Higher Education Act of 1965 (20 U.S.C. 1067q) 

22 and national organizations that serve underrep23 resented populations and community pharmacies to 

24 enable such entities— 


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1 (A) to test alternative outreach and edu2 cation strategies to increase the awareness and 

3 knowledge of individuals in the United States, 

4 with respect to the need for diverse clinical 

5 trials that reflect the race, ethnicity, age, and 

6 gender or sex of patients with the disease or 

7 condition being investigated; and 

8 (B) to cover administrative costs of such 

9 entities in assisting in diversifying clinical trials 

10 subject to subsection (a). 

11 (5) STAKEHOLDERS SPECIFIED.—The stake12 holders specified in this paragraph are the following: 

13 (A) Representatives of the Health Re14 sources Services Administration, the Office of 

15 Minority Health of the Department of Health 

16 and Human Services, the Centers for Disease 

17 Control and Prevention, and the National Insti18 tutes of Health. 

19 (B) Community-based resources and advo20 cates. 

21 (6) AUTHORIZATION OF APPROPRIATIONS.— 

22 There is authorized to be appropriated to carry out 

23 this subsection $10,000,000 for each of fiscal years 

24 2023 through 2026. 

25 (d) DEFINITIONS.—In this section: 


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1 (1) CLINICAL TRIAL.—The term ‘‘clinical trial’’ 

2 means a research study in which one or more human 

3 subjects are prospectively assigned to one or more 

4 interventions (which may include placebo or other 

5 control) to evaluate the effects of those interventions 

6 on health-related biomedical or behavioral outcomes. 

7 (2) SPONSOR.—The term ‘‘sponsor’’ has the 

8 meaning given such term in section 50.3 of title 21, 

9 Code of Federal Regulations (or successor regula10 tions). 

11 SEC. 7554. PATIENT EXPERIENCE DATA. 

12 (a) POLICY.—Section 569C of the Federal Food, 

13 Drug, and Cosmetic Act (21 U.S.C. 360bbb–8c) is amend14 ed— 

15 (1) by redesignating subsections (b) and (c) as 

16 subsections (c) and (d), respectively; and 

17 (2) by inserting after subsection (a) the fol18 lowing new subsection: 

19 ‘‘(b) COLLECTION, SUBMISSION, AND USE OF

20 DATA.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall— 

22 ‘‘(A) for any drug for which an exemption 

23 is granted for investigational use under section 

24 505(i) of this Act or section 351(a) of the Pub25 lic Health Service Act, require the sponsor of 


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1 the drug to collect standardized patient experi2 ence data as part of the clinical trials conducted 

3 pursuant to such exemption; 

4 ‘‘(B) require any application for the ap5 proval or licensing of such drug under section 

6 505(b) of this Act or section 351(a) of the Pub7 lic Health Service Act to include— 

8 ‘‘(i) the standardized patient experi9 ence data so collected; and 

10 ‘‘(ii) such related information as the 

11 Secretary may require; and 

12 ‘‘(C) consider patient experience data and 

13 related information that is submitted pursuant 

14 to subparagraph (B) in deciding whether to ap15 prove or license, as applicable, the drug in16 volved. 

17 ‘‘(2) APPLICABILITY.—Paragraph (1) applies 

18 only with respect to drugs for which a request for 

19 an exemption described in paragraph (1)(A) is sub20 mitted on or after the date of the enactment of the 

21 Health Equity and Accountability Act of 2022, or an 

22 application under section 505(b) of this Act or sec23 tion 351(a) of the Public Health Service Act is filed, 

24 as applicable, on or after the day that is 2 years 


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1 after the date of the enactment of the Health Equity 

2 and Accountability Act of 2022.’’. 

3 (b) REGULATIONS.—Not later than 1 year after the 

4 date of the enactment of this Act, the Secretary of Health 

5 and Human Services, acting through the Commissioner of 

6 Food and Drugs, shall promulgate final regulations to im7 plement section 569C(b) of the Federal Food, Drug, and 

8 Cosmetic Act, as added by this section. 

9 Subtitle M—Additional Provisions 

10 Addressing High-Impact Minor11 ity Diseases 

12 SEC. 7601. MEDICARE COVERAGE OF MULTI-CANCER EARLY 

13 DETECTION SCREENING TESTS. 

14 (a) COVERAGE.—Section 1861 of the Social Security 

15 Act (42 U.S.C. 1395x), as amended be sections 2007, 

16 4221, 4251, 6011, and 7220, is amended— 

17 (1) in subsection (s)(2)— 

18 (A) in subparagraph (JJ), by striking 

19 ‘‘and’’ at the end; 

20 (B) in subparagraph (KK), by striking the 

21 period at the end and inserting ‘‘; and’’; and 

22 (C) by adding at the end the following new 

23 subparagraph: 

24 ‘‘(LL) multi-cancer early detection screen25 ing tests (as defined in subsection (qqq));’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(qqq) MULTI-CANCER EARLY DETECTION SCREEN4 ING TESTS.—The term ‘multi-cancer early detection 

5 screening test’ means any of the following tests, approved 

6 or cleared by the Food and Drug Administration, fur7 nished to an individual for the purpose of early detection 

8 of cancer across many cancer types (as categorized in the 

9 Annual Report to the Nation on the Status of Cancer 

10 issued by the National Cancer Institute): 

11 ‘‘(1) A genomic sequencing blood or blood prod12 uct test that includes the analysis of cell-free nucleic 

13 acids. 

14 ‘‘(2) Such other equivalent tests (which are 

15 based on urine or another sample of biological mate16 rial) as the Secretary determines appropriate.’’. 

17 (b) PAYMENT AND FREQUENCY LIMIT.— 

18 (1) PAYMENT UNDER FEE SCHEDULE.—Section 

19 1833(h) of the Social Security Act (42 U.S.C. 

20 1395l(h)) is amended— 

21 (A) in paragraph (1)(A), by inserting after 

22 ‘‘(including’’ the following: ‘‘multi-cancer early 

23 detection screening tests under section 

24 1861(qqq) and including’’; and 


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1 (B) by adding at the end the following new 

2 paragraph: 

3 ‘‘(10) No payment may be made under this 

4 part for a multi-cancer early detection screening test 

5 (as defined in section 1861(qqq)) for an individual 

6 if such a test was furnished to the individual during 

7 the previous 11 months.’’. 

8 (2) CONFORMING AMENDMENT.—Section 

9 1862(a) of the Social Security Act (42 U.S.C. 

10 1395y(a)) is amended— 

11 (A) in paragraph (1)— 

12 (i) in subparagraph (O), by striking 

13 ‘‘and’’ at the end; 

14 (ii) in subparagraph (P), by striking 

15 the semicolon at the end and inserting ‘‘, 

16 and’’; and 

17 (iii) by adding at the end the fol18 lowing new subparagraph: 

19 ‘‘(Q) in the case of multi-cancer early detection 

20 screening tests (as defined in section 1861(qqq)), 

21 which are performed more frequently than is covered 

22 under section 1833(h)(10);’’; and 

23 (B) in paragraph (7), by striking ‘‘or (P)’’ 

24 and inserting ‘‘(P), or (Q)’’. 


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1 (c) RULE OF CONSTRUCTION RELATING TO OTHER

2 CANCER SCREENING TESTS.—Nothing in this section, in3 cluding the amendments made by this section, shall be 

4 construed— 

5 (1) in the case of an individual who undergoes 

6 a multi-cancer early detection screening test, to af7 fect coverage under part B for other cancer screen8 ing tests covered under this section, such as screen9 ing tests for breast, cervical, colorectal, lung, or 

10 prostate cancer; or 

11 (2) in the case of an individual who undergoes 

12 another cancer screening test, to affect coverage for 

13 a multi-cancer early detection screening test or the 

14 use of such a test as a diagnostic or confirmatory 

15 test for a result of the other cancer screening test. 

16 SEC. 7602. AMPUTATION REDUCTION AND COMPASSION 

17 ACT. 

18 (a) PERIPHERAL ARTERY DISEASE EDUCATION PRO19 GRAM.—Part P of title III of the Public Health Service 

20 Act (42 U.S.C. 280g et seq.), as amended by section 7254, 

21 is further amended by adding at the end the following new 

22 section: 


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1 ‘‘SEC. 399V–13. PERIPHERAL ARTERY DISEASE EDUCATION 

2 PROGRAM. 

3 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

4 through the Director of the Centers for Disease Control 

5 and Prevention, in collaboration with the Administrator 

6 of the Centers for Medicare & Medicaid Services and the 

7 Administrator of the Health Resources and Services Ad8 ministration, shall establish and coordinate a peripheral 

9 artery disease education program to support, develop, and 

10 implement educational initiatives and outreach strategies 

11 that inform health care professionals and the public about 

12 the existence of peripheral artery disease and methods to 

13 reduce amputations related to such disease, particularly 

14 with respect to at-risk populations. 

15 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

16 is authorized to be appropriated to carry out this section 

17 such sums as may be necessary for each of fiscal years 

18 2023 through 2027.’’. 

19 (b) MEDICARE COVERAGE OF PERIPHERAL ARTERY

20 DISEASE SCREENING TESTS FURNISHED TO AT-RISK

21 BENEFICIARIES WITHOUT IMPOSITION OF COST SHARING

22 REQUIREMENTS.— 

23 (1) IN GENERAL.—Section 1861 of the Social 

24 Security Act (42 U.S.C. 1395x), as amended by sec25 tions 2007, 4221, 4251, 6011, 7220, and 7601, is 

26 amended— 


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1 (A) in subsection (s)(2)— 

2 (i) in subparagraph (KK), by striking 

3 ‘‘and’’ at the end; 

4 (ii) in subparagraph (LL), by striking 

5 the period at the end and inserting ‘‘; 

6 and’’; and 

7 (iii) by adding at the end the fol8 lowing new subparagraph: 

9 ‘‘(MM) peripheral artery disease screening 

10 tests furnished to at-risk beneficiaries (as such 

11 terms are defined in subsection (rrr)).’’; and 

12 (B) by adding at the end the following new 

13 subsection: 

14 ‘‘(rrr) PERIPHERAL ARTERY DISEASE SCREENING

15 TEST; AT-RISK BENEFICIARY.—(1) The term ‘peripheral 

16 artery disease screening test’ means— 

17 ‘‘(A) noninvasive physiologic studies of extrem18 ity arteries (commonly referred to as ankle-brachial 

19 index testing); 

20 ‘‘(B) arterial duplex scans of lower extremity 

21 arteries vascular; and 

22 ‘‘(C) such other items and services as the Sec23 retary determines, in consultation with relevant 

24 stakeholders, to be appropriate for screening for pe25 ripheral artery disease for at-risk beneficiaries. 


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1 ‘‘(2) The term ‘at-risk beneficiary’ means an indi2 vidual entitled to, or enrolled for, benefits under part A 

3 and enrolled for benefits under part B— 

4 ‘‘(A) who is 65 years of age or older; 

5 ‘‘(B) who is at least 50 years of age but not 

6 older than 64 years of age with risk factors for ath7 erosclerosis (such as diabetes mellitus, a history of 

8 smoking, hyperlipidemia, and hypertension) or a 

9 family history of peripheral artery disease; 

10 ‘‘(C) who is younger than 50 years of age with 

11 diabetes mellitus and one additional risk factor for 

12 atherosclerosis; or 

13 ‘‘(D) with a known atherosclerotic disease in 

14 another vascular bed such as coronary, carotid, sub15 clavian, renal, or mesenteric artery stenosis, or ab16 dominal aortic aneurysm. 

17 ‘‘(3) The Secretary shall, in consultation with appro18 priate organizations, establish standards regarding the 

19 frequency for peripheral artery disease screening tests de20 scribed in subsection (s)(2)(II) for purposes of coverage 

21 under this title.’’. 

22 (2) INCLUSION OF PERIPHERAL ARTERY DIS23 EASE SCREENING TESTS IN INITIAL PREVENTIVE

24 PHYSICAL EXAMINATION.—Section 1861(ww)(2) of 


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1 the Social Security Act (42 U.S.C. 1395x(ww)(2)) is 

2 amended— 

3 (A) in subparagraph (N), by moving the 

4 margins of such subparagraph 2 ems to the 

5 left; 

6 (B) by redesignating subparagraph (O) as 

7 subparagraph (P); and 

8 (C) by inserting after subparagraph (N) 

9 the following new subparagraph: 

10 ‘‘(O) Peripheral artery disease screening 

11 tests furnished to at-risk beneficiaries (as such 

12 terms are defined in subsection (rrr)).’’. 

13 (3) PAYMENT.— 

14 (A) IN GENERAL.—Section 1833(a) of the 

15 Social Security Act (42 U.S.C. 1395l(a)), as 

16 amended by sections 4251(c)(3), 6011(a)(4), 

17 and 7220, is amended— 

18 (i) in paragraph (1)— 

19 (I) in subparagraph (N), by in20 serting ‘‘and other than peripheral ar21 tery disease screening tests furnished 

22 to at-risk beneficiaries (as such terms 

23 are defined in section 1861(lll))’’ after 

24 ‘‘other than personalized prevention 


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1 plan services (as defined in section 

2 1861(hhh)(1))’’; 

3 (II) by striking ‘‘and’’ before 

4 ‘‘(GG)’’; and 

5 (III) by inserting before the 

6 semicolon at the end the following: ‘‘, 

7 and (HH) with respect to peripheral 

8 artery disease screening tests fur9 nished to at-risk beneficiaries (as such 

10 terms are defined in section 

11 1861(rrr)), the amount paid shall be 

12 100 percent of the lesser of the actual 

13 charge for the services or the amount 

14 determined under the payment basis 

15 determined under section 1848’’; and 

16 (ii) in paragraph (2)— 

17 (I) in subparagraph (G), by 

18 striking ‘‘and’’ at the end; 

19 (II) in subparagraph (H), by 

20 striking the comma at the end and in21 serting ‘‘; and’’; and 

22 (III) by inserting after subpara23 graph (H) the following new subpara24 graph: 


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1 ‘‘(I) with respect to peripheral artery disease 

2 screening tests (as defined in paragraph (1) of sec3 tion 1861(rrr)) furnished by an outpatient depart4 ment of a hospital to at-risk beneficiaries (as defined 

5 in paragraph (2) of such section), the amount deter6 mined under paragraph (1)(EE),’’. 

7 (B) NO DEDUCTIBLE.—Section 1833(b) of 

8 the Social Security Act (42 U.S.C. 1395l(b)), as 

9 amended by section 6075, is amended, in the 

10 first sentence— 

11 (i) by striking ‘‘and’’ before ‘‘(13)’’; 

12 and 

13 (ii) by inserting ‘‘, and (14) such de14 ductible shall not apply with respect to pe15 ripheral artery disease screening tests fur16 nished to at-risk beneficiaries (as such 

17 terms are defined in section 1861(rrr))’’ 

18 before the period at the end. 

19 (C) EXCLUSION FROM PROSPECTIVE PAY20 MENT SYSTEM FOR HOSPITAL OUTPATIENT DE21 PARTMENT SERVICES.—Section 

22 1833(t)(1)(B)(iv) of the Social Security Act (42 

23 U.S.C. 1395l(t)(1)(B)(iv)) is amended— 

24 (i) by striking ‘‘, or personalized’’ and 

25 inserting ‘‘, personalized’’; and 


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1 (ii) by inserting ‘‘, or peripheral ar2 tery disease screening tests furnished to 

3 at-risk beneficiaries (as such terms are de4 fined in section 1861(rrr))’’ after ‘‘person5 alized prevention plan services (as defined 

6 in section 1861(hhh)(1))’’. 

7 (D) PAYMENT UNDER PHYSICIAN FEE

8 SCHEDULE.—Section 1848(j)(3) of the Social 

9 Security Act (42 U.S.C. 1395w–4(j)(3)), as 

10 amended by section 4251(c)(4), is amended by 

11 inserting ‘‘, (2)(MM),’’ after ‘‘(2)(II)’’. 

12 (4) EXCLUSION FROM COVERAGE AND MEDI13 CARE AS SECONDARY PAYER FOR TESTS PERFORMED

14 MORE FREQUENTLY THAN ALLOWED.—Section 

15 1862(a)(1) of the Social Security Act (42 U.S.C. 

16 1395y(a)(1)), as amended by section 7601, is 

17 amended— 

18 (A) in subparagraph (P), by striking 

19 ‘‘and’’ at the end; 

20 (B) in subparagraph (Q), by striking the 

21 semicolon at the end and inserting ‘‘, and’’; and 

22 (C) by adding at the end the following new 

23 subparagraph: 

24 ‘‘(R) in the case of peripheral artery dis25 ease screening tests furnished to at-risk beneVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01529 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ficiaries (as such terms are defined in section 

2 1861(rrr)), which are performed more fre3 quently than is covered under such section;’’. 

4 (5) AUTHORITY TO MODIFY OR ELIMINATE COV5 ERAGE OF CERTAIN PREVENTIVE SERVICES.—Sec6 tion 1834(n) of the Social Security Act (42 U.S.C. 

7 1395m(n)) is amended— 

8 (A) by redesignating subparagraphs (A) 

9 and (B) of paragraph (1) as clauses (i) and (ii), 

10 respectively, and moving the margins of such 

11 clauses, as so redesignated, 2 ems to the right; 

12 (B) by redesignating paragraphs (1) and 

13 (2) as subparagraphs (A) and (B), respectively, 

14 and moving the margins of such subparagraphs, 

15 as so redesignated, 2 ems to the right; 

16 (C) by striking ‘‘CERTAIN PREVENTIVE

17 SERVICES’’ and all that follows through ‘‘any 

18 other provision of this title’’ and inserting: 

19 ‘‘CERTAIN PREVENTIVE SERVICES.— 

20 ‘‘(1) IN GENERAL.—Notwithstanding any other 

21 provision of this title’’; and 

22 (D) by adding at the end the following new 

23 paragraph: 

24 ‘‘(2) INAPPLICABILITY.—The Secretarial au25 thority described in paragraph (1) shall not apply 


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1 with respect to preventive services described in sec2 tion 1861(ww)(2)(O).’’. 

3 (6) EFFECTIVE DATE.—The amendments made 

4 by this subsection shall apply with respect to items 

5 and services furnished on or after January 1, 2023. 

6 (c) MEDICAID COVERAGE OF PERIPHERAL ARTERY

7 DISEASE SCREENING TESTS FURNISHED TO AT-RISK

8 BENEFICIARIES WITHOUT IMPOSITION OF COST SHARING

9 REQUIREMENTS.— 

10 (1) IN GENERAL.—Section 1905 of the Social 

11 Security Act (42 U.S.C. 1396d) as amended by sec12 tions 2007(d)(3) and 5201(a)(5)(G)(i), is amend13 ed— 

14 (A) in subsection (a)— 

15 (i) by redesignating paragraph (33) as 

16 paragraph (34); 

17 (ii) in paragraph (32), by striking 

18 ‘‘and’’ after the semicolon; and 

19 (iii) by inserting after paragraph (32) 

20 the following new paragraph: 

21 ‘‘(33) peripheral artery disease screening tests 

22 furnished to at-risk beneficiaries (as such terms are 

23 defined in subsection (qq)); and’’; and 

24 (B) by adding at the end the following new 

25 subsection: 


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1 ‘‘(qq) PERIPHERAL ARTERY DISEASE SCREENING

2 TEST; AT-RISK BENEFICIARY.— 

3 ‘‘(1) PERIPHERAL ARTERY DISEASE SCREENING

4 TEST.—The term ‘peripheral artery disease screen5 ing test’ means— 

6 ‘‘(A) noninvasive physiologic studies of ex7 tremity arteries (commonly referred to as ankle8 brachial index testing); 

9 ‘‘(B) arterial duplex scans of lower extrem10 ity arteries vascular; and 

11 ‘‘(C) such other items and services as the 

12 Secretary determines, in consultation with rel13 evant stakeholders, to be appropriate for 

14 screening for peripheral artery disease for at15 risk beneficiaries. 

16 ‘‘(2) AT-RISK BENEFICIARY.—The term ‘at-risk 

17 beneficiary’ means an individual enrolled under a 

18 State plan (or a waiver of such plan)— 

19 ‘‘(A) who is 65 years of age or older; 

20 ‘‘(B) who is at least 50 years of age but 

21 not older than 64 years of age with risk factors 

22 for atherosclerosis (such as diabetes mellitus, a 

23 history of smoking, hyperlipidemia, and hyper24 tension) or a family history of peripheral artery 

25 disease; 


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1 ‘‘(C) who is younger than 50 years of age 

2 with diabetes mellitus and one additional risk 

3 factor for atherosclerosis; or 

4 ‘‘(D) with a known atherosclerotic disease 

5 in another vascular bed such as coronary, ca6 rotid, subclavian, renal, or mesenteric artery 

7 stenosis, or abdominal aortic aneurysm. 

8 ‘‘(3) FREQUENCY.—The Secretary shall, in con9 sultation with appropriate organizations, establish 

10 standards regarding the frequency for peripheral ar11 tery disease screening tests described in subsection 

12 (a)(33) for purposes of coverage under a State plan 

13 under this title.’’. 

14 (2) NO COST SHARING.— 

15 (A) IN GENERAL.—Subsections (a)(2) and 

16 (b)(2) of section 1916 of the Social Security 

17 Act (42 U.S.C. 1396o), as amended by section 

18 7154(b)(1), are each amended— 

19 (i) in subparagraph (J), by striking 

20 ‘‘or’’ after the comma at the end; 

21 (ii) in subparagraph (K), by striking 

22 ‘‘; and’’ and inserting ‘‘, or’’; and 

23 (iii) by adding at the end the fol24 lowing new subparagraph: 


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1 ‘‘(L) peripheral artery disease screening 

2 tests furnished to at-risk beneficiaries (as such 

3 terms are defined in section 1905(hh)); and’’. 

4 (B) APPLICATION TO ALTERNATIVE COST

5 SHARING.—Section 1916A(b)(3)(B) of the So6 cial Security Act (42 U.S.C. 1396o– 

7 1(b)(3)(B)), as amended by section 7154(b)(2), 

8 is amended by adding at the end the following 

9 new clause: 

10 ‘‘(xv) Peripheral artery disease screen11 ing tests furnished to at-risk beneficiaries 

12 (as such terms are defined in section 

13 1905(qq)).’’. 

14 (3) MANDATORY COVERAGE.—Section 

15 1902(a)(10)(A) of the Social Security Act (42 

16 U.S.C. 1396a(a)(10)(A)), as amended by section 

17 2007(d)(2), is amended by striking ‘‘and (31)’’ and 

18 inserting ‘‘(31), and (33)’’. 

19 (d) REQUIREMENT FOR GROUP HEALTH PLANS AND

20 HEALTH INSURANCE ISSUERS OFFERING GROUP OR IN21 DIVIDUAL HEALTH INSURANCE COVERAGE TO PROVIDE

22 COVERAGE FOR PERIPHERAL ARTERY DISEASE SCREEN23 ING TESTS FURNISHED TO AT-RISK ENROLLEES WITH24 OUT IMPOSITION OF COST SHARING REQUIREMENTS.— 


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1 (1) IN GENERAL.—Section 2713 of the Public 

2 Health Service Act (42 U.S.C. 300gg–13) is amend3 ed— 

4 (A) by amending subsection (a), as amend5 ed by section 7220(a)(1)(A), to read as follows: 

6 ‘‘(a) COVERAGE OF PREVENTIVE HEALTH SERV7 ICES.— 

8 ‘‘(1) IN GENERAL.—A group health plan and a 

9 health insurance issuer offering group or individual 

10 health insurance coverage shall, at a minimum, pro11 vide coverage for and shall not impose any cost shar12 ing requirements for— 

13 ‘‘(A) evidence-based items or services that 

14 have in effect a rating of ‘A’ or ‘B’ in the cur15 rent recommendations of the United States Pre16 ventive Services Task Force; 

17 ‘‘(B) immunizations that have in effect a 

18 recommendation from the Advisory Committee 

19 on Immunization Practices of the Centers for 

20 Disease Control and Prevention with respect to 

21 the individual involved; 

22 ‘‘(C) with respect to infants, children, and 

23 adolescents, evidence-informed preventive care 

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1 sive guidelines supported by the Health Re2 sources and Services Administration; 

3 ‘‘(D) with respect to women, such addi4 tional preventive care and screenings not de5 scribed in subparagraph (A) as provided for in 

6 comprehensive guidelines supported by the 

7 Health Resources and Services Administration 

8 for purposes of this subparagraph; 

9 ‘‘(E) any prescription drug approved by 

10 the Food and Drug Administration for the pre11 vention of HIV (other than a drug subject to 

12 preauthorization requirements consistent with 

13 section 2729A), administrative fees for such 

14 drugs, laboratory and other diagnostic proce15 dures associated with the use of such drugs, 

16 and clinical follow-up and monitoring, including 

17 any related services recommended in current 

18 United States Public Health Service clinical 

19 practice guidelines, without limitation; and 

20 ‘‘(F) with respect to at-risk enrollees, pe21 ripheral artery disease screening tests. 

22 ‘‘(2) PERIPHERAL ARTERY DISEASE SCREENING

23 TEST; AT-RISK ENROLLEE.—For purposes of para24 graph (1)(E): 


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1 ‘‘(A) PERIPHERAL ARTERY DISEASE

2 SCREENING TEST.—The term ‘peripheral artery 

3 disease screening test’ means— 

4 ‘‘(i) noninvasive physiologic studies of 

5 extremity arteries (commonly referred to 

6 as ankle-brachial index testing); 

7 ‘‘(ii) arterial duplex scans of lower ex8 tremity arteries vascular; and 

9 ‘‘(iii) such other items and services as 

10 the Secretary determines, in consultation 

11 with relevant stakeholders, to be appro12 priate for screening for peripheral artery 

13 disease for at-risk enrollees. 

14 ‘‘(B) AT-RISK ENROLLEE.—The term ‘at15 risk enrollee’ means an individual enrolled in a 

16 group health plan or group or individual health 

17 insurance coverage— 

18 ‘‘(i) who is 65 years of age or older; 

19 ‘‘(ii) who is at least 50 years of age 

20 but not older than 64 years of age with 

21 risk factors for atherosclerosis (such as di22 abetes mellitus, a history of smoking, 

23 hyperlipidemia, and hypertension) or a 

24 family history of peripheral artery disease; 


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1 ‘‘(iii) who is younger than 50 years of 

2 age with diabetes mellitus and one addi3 tional risk factor for atherosclerosis; or 

4 ‘‘(iv) with a known atherosclerotic dis5 ease in another vascular bed such as coro6 nary, carotid, subclavian, renal, or mesen7 teric artery stenosis, or abdominal aortic 

8 aneurysm. 

9 ‘‘(C) FREQUENCY.—The Secretary shall, 

10 in consultation with appropriate organizations, 

11 establish standards regarding the frequency for 

12 peripheral artery disease screening tests de13 scribed in paragraph (1)(E) for purposes of 

14 coverage under this section. 

15 ‘‘(3) CLARIFICATION REGARDING BREAST CAN16 CER SCREENING, MAMMOGRAPHY, AND PREVENTION

17 RECOMMENDATIONS.—For the purposes of this Act, 

18 and for the purposes of any other provision of law, 

19 the current recommendations of the United States 

20 Preventive Service Task Force regarding breast can21 cer screening, mammography, and prevention shall 

22 be considered the most current other than those 

23 issued in or around November 2009. 

24 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 

25 this subsection shall be construed to prohibit a plan 


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1 or issuer from providing coverage for services in ad2 dition to those recommended by the United States 

3 Preventive Services Task Force or to deny coverage 

4 for services that are not recommended by such Task 

5 Force.’’; and 

6 (B) in subsection (b)(1)— 

7 (i) by striking ‘‘subsection (a)(1) or 

8 (a)(2) or a guideline under subsection 

9 (a)(3)’’ and inserting ‘‘subparagraph (A) 

10 or (B) of subsection (a)(1) or a guideline 

11 under subparagraph (C) of such sub12 section’’; and 

13 (ii) by striking ‘‘described in sub14 section (a)’’ and inserting ‘‘described in 

15 subsection (a)(1)’’. 

16 (2) EFFECTIVE DATE.—The amendments made 

17 by paragraph (1) shall apply with respect to plan 

18 years beginning on or after January 1, 2023. 

19 (e) DISALLOWANCE OF PAYMENT FOR NONTRAU20 MATIC AMPUTATION SERVICES FURNISHED WITHOUT

21 ANATOMICAL TESTING SERVICES.—Section 1834 of the 

22 Social Security Act (42 U.S.C. 1395m), as amended by 

23 section 4221(b)(2), is amended by adding at the end the 

24 following new subsection: 


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1 ‘‘(aa) DISALLOWANCE OF PAYMENT FOR NONTRAU2 MATIC AMPUTATION SERVICES FURNISHED WITHOUT

3 ANATOMICAL TESTING SERVICES.— 

4 ‘‘(1) IN GENERAL.—In the case of nontrau5 matic amputation services furnished by a supplier on 

6 or after January 1, 2023, to an individual entitled 

7 to, or enrolled for, benefits under part A and en8 rolled for benefits under this part, for which pay9 ment is made under this part, payment may only be 

10 made under this part if— 

11 ‘‘(A) such supplier furnishes anatomical 

12 testing services to such individual during the 3- 

13 month period preceding the date on which such 

14 nontraumatic amputation services is furnished; 

15 or 

16 ‘‘(B) such individual has a pre-existing 

17 dysfunctional or unsalvageable limb, life-threat18 ening sepsis, intractable infection, extensive 

19 gangrene or necrotic tissue loss beyond salvage, 

20 a poor functional status, severe dementia, or a 

21 short life expectancy after shared decision mak22 ing with a health care team and patient, family, 

23 or caregiver. 

24 ‘‘(2) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) ANATOMICAL TESTING SERVICES.— 

2 The term ‘anatomical testing services’ means 

3 arterial duplex scanning, computed tomography 

4 angiography, and magnetic resonance 

5 angiography. 

6 ‘‘(B) NONTRAUMATIC AMPUTATION SERV7 ICES.—The term ‘nontraumatic amputation 

8 services’ means amputations as a result of ath9 erosclerotic vascular disease or a related comor10 bidity of such disease (including diabetes).’’. 

11 (f) DEVELOPMENT AND IMPLEMENTATION OF QUAL12 ITY MEASURES.— 

13 (1) DEVELOPMENT.—The Secretary of Health 

14 and Human Services (referred to in this subsection 

15 as the ‘‘Secretary’’) shall, in consultation with rel16 evant stakeholders, develop quality measures for 

17 nontraumatic, lower-limb, major amputation that 

18 utilize appropriate diagnostic screening (including 

19 peripheral artery disease screening) in order to en20 courage alternative treatments (including 

21 revascularization) in lieu of such an amputation. 

22 (2) IMPLEMENTATION.—After appropriate test23 ing and validation of the measures developed under 

24 paragraph (1), the Secretary shall incorporate such 

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1 priate providers of services and suppliers under the 

2 Medicare program under title XVIII of the Social 

3 Security Act (42 U.S.C. 1395 et seq.), including for 

4 purposes of— 

5 (A) the merit-based incentive payment sys6 tem under section 1848(q) of such Act (42 

7 U.S.C. 1395w–4(q)); 

8 (B) incentive payments for participation in 

9 eligible alternative payment models under sec10 tion 1833(z) of such Act (42 U.S.C. 1395l(z)); 

11 (C) the shared savings program under sec12 tion 1899 of such Act (42 U.S.C. 1395jjj); 

13 (D) models under section 1115A of such 

14 Act (42 U.S.C. 1315a); and 

15 (E) such other payment systems or models 

16 as the Secretary may specify. 

17 SEC. 7603. ELIMINATING THE COINSURANCE REQUIRE18 MENT FOR CERTAIN COLORECTAL CANCER 

19 SCREENING TESTS FURNISHED UNDER THE 

20 MEDICARE PROGRAM. 

21 Section 1833(dd) of the Social Security Act (42 

22 U.S.C. 1395l(dd)) is amended— 

23 (1) in paragraph (1), by striking ‘‘and before 

24 January 1, 2030,’’; and 

25 (2) in paragraph (2)— 


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1 (A) in subparagraph (A), by adding ‘‘and’’ 

2 at the end; 

3 (B) in subparagraph (B), by striking 

4 ‘‘through 2026, 85 percent; and’’ and inserting 

5 ‘‘and each subsequent year, 100 percent.’’; and 

6 (C) by striking subparagraph (C). 

7 SEC. 7604. EXPANDING THE AVAILABILITY OF MEDICAL NU8 TRITION THERAPY SERVICES UNDER THE 

9 MEDICARE PROGRAM. 

10 (a) IN GENERAL.—Section 1861 of the Social Secu11 rity Act (42 U.S.C. 1395x) is amended— 

12 (1) in subsection (s)(2)(V), by striking ‘‘in the 

13 case of’’ and all that follows through ‘‘organiza14 tions’’; and 

15 (2) in subsection (vv)— 

16 (A) in paragraph (1)— 

17 (i) by striking ‘‘disease management’’ 

18 and inserting ‘‘the prevention, manage19 ment, or treatment of a disease or condi20 tion specified in paragraph (4)’’; and 

21 (ii) by striking ‘‘by a physician’’ and 

22 all that follows through the period at the 

23 end and inserting the following: ‘‘by a— 

24 ‘‘(A) physician (as defined in subsection 

25 (r)(1)); 


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1 ‘‘(B) physician assistant; 

2 ‘‘(C) nurse practitioner; 

3 ‘‘(D) clinical nurse specialist (as defined in 

4 subsection (aa)(5)(B)); or 

5 ‘‘(E) in the case of such services furnished 

6 to manage such a disease or condition that is 

7 an eating disorder, a clinical psychologist (as 

8 defined by the Secretary). 

9 Such term shall not include any services furnished 

10 to an individual for the prevention, management, or 

11 treatment of a renal disease if such individual is re12 ceiving maintenance dialysis for which payment is 

13 made under section 1881.’’; and 

14 (B) by adding at the end the following new 

15 paragraph: 

16 ‘‘(4) For purposes of paragraph (1), the diseases and 

17 conditions specified in this paragraph are the following: 

18 ‘‘(A) Diabetes and prediabetes. 

19 ‘‘(B) A renal disease. 

20 ‘‘(C) Obesity (as defined for purposes of sub21 section (yy)(2)(C) or as otherwise defined by the 

22 Secretary). 

23 ‘‘(D) Hypertension. 

24 ‘‘(E) Dyslipidemia. 

25 ‘‘(F) Malnutrition. 


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1 ‘‘(G) Eating disorders. 

2 ‘‘(H) Cancer. 

3 ‘‘(I) Gastrointestinal diseases, including celiac 

4 disease. 

5 ‘‘(J) HIV. 

6 ‘‘(K) AIDS. 

7 ‘‘(L) Cardiovascular disease. 

8 ‘‘(M) Any other disease or condition— 

9 ‘‘(i) specified by the Secretary relating to 

10 unintentional weight loss; 

11 ‘‘(ii) for which the Secretary determines 

12 the services described in paragraph (1) to be 

13 medically necessary and appropriate for the 

14 prevention, management, or treatment of such 

15 disease or condition, consistent with any appli16 cable recommendations of the United States 

17 Preventive Services Task Force; or 

18 ‘‘(iii) for which the Secretary determines 

19 the services described in paragraph (1) are 

20 medically necessary, consistent with either pro21 tocols established by registered dietitians or nu22 trition professional organizations or with ac23 cepted clinical guidelines identified by the Sec24 retary.’’. 


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1 (b) EXCLUSION MODIFICATION.—Section 1862(a)(1) 

2 of the Social Security Act (42 U.S.C. 1395y(a)(1)), as 

3 amended by sections 7601 and 7602, is amended— 

4 (1) in subparagraph (Q), by striking ‘‘and’’ at 

5 the end; 

6 (2) in subparagraph (R), by striking the semi7 colon at the end and inserting ‘‘, and’’; and 

8 (3) by adding at the end the following new sub9 paragraph: 

10 ‘‘(S) in the case of medical nutrition therapy 

11 services (as defined in section 1861(vv)), which are 

12 not furnished for the prevention, management, or 

13 treatment of a disease or condition specified in para14 graph (4) of such section;’’. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply with respect to items and services 

17 furnished on or after January 1, 2023. 

18 SEC. 7605. ENCOURAGING THE DEVELOPMENT AND USE OF 

19 DISARM ANTIMICROBIAL DRUGS. 

20 (a) ADDITIONAL PAYMENT FOR DISARM ANTI21 MICROBIAL DRUGS UNDER MEDICARE.— 

22 (1) IN GENERAL.—Section 1886(d)(5) of the 

23 Social Security Act (42 U.S.C. 1395ww(d)(5)) is 

24 amended by adding at the end the following new 

25 subparagraph: 


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1 ‘‘(N)(i)(I) Effective for discharges beginning on or 

2 after October 1, 2023, or such sooner date as specified 

3 by the Secretary, subject to subclause (II), the Secretary 

4 shall, after notice and opportunity for public comment (in 

5 the publications required by subsection (e)(5) for a fiscal 

6 year or otherwise), provide for an additional payment 

7 under a mechanism (separate from the mechanism estab8 lished under subparagraph (K)), with respect to such dis9 charges involving any DISARM antimicrobial drug, in an 

10 amount equal to— 

11 ‘‘(aa) the amount payable under section 1847A 

12 for such drug during the calendar quarter in which 

13 the discharge occurred; or 

14 ‘‘(bb) if no amount for such drug is determined 

15 under section 1847A, an amount to be determined 

16 by the Secretary in a manner similar to the manner 

17 in which payment amounts are determined under 

18 section 1847A based on information submitted by 

19 the manufacturer or sponsor of such drug (as re20 quired under clause (v)). 

21 ‘‘(II) In determining the amount payable under sec22 tion 1847A for purposes of items (aa) and (bb) of sub23 clause (I), subparagraphs (A) and (B) of subsection (b)(1) 

24 of such section shall be applied by substituting ‘102 per25 cent’ for ‘106 percent’ each place it appears and paraVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01547 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 graph (8)(B) of such section shall be applied by sub2 stituting ‘2 percent’ for ‘6 percent’. 

3 ‘‘(ii) For purposes of this subparagraph, a DISARM 

4 antimicrobial drug is— 

5 ‘‘(I) a drug— 

6 ‘‘(aa) that— 

7 ‘‘(AA) is approved by the Food and 

8 Drug Administration; 

9 ‘‘(BB) is designated by the Food and 

10 Drug Administration as a qualified infec11 tious disease product under subsection (d) 

12 of section 505E of the Federal Food, 

13 Drug, and Cosmetic Act; and 

14 ‘‘(CC) has received an extension of its 

15 exclusivity period pursuant to subsection 

16 (a) of such section; and 

17 ‘‘(bb) that has been designated by the Sec18 retary pursuant to the process established 

19 under clause (iv)(I)(bb); or 

20 ‘‘(II) an antibacterial or antifungal biological 

21 product— 

22 ‘‘(aa) that is licensed for use, or an anti23 bacterial or antifungal biological product for 

24 which an indication is first licensed for use, by 

25 the Food and Drug Administration on or after 


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1 June 5, 2014, under section 351(a) of the Pub2 lic Health Service Act for human use to treat 

3 serious or life-threatening infections, as deter4 mined by the Food and Drug Administration, 

5 including those caused by, or likely to be caused 

6 by— 

7 ‘‘(AA) an antibacterial or antifungal 

8 resistant pathogen, including novel or 

9 emerging infectious pathogens; or 

10 ‘‘(BB) a qualifying pathogen (as de11 fined under section 505E(f) of the Federal 

12 Food, Drug, and Cosmetic Act); and 

13 ‘‘(bb) has been designated by the Secretary 

14 pursuant to the process established under 

15 clause (iv)(I)(bb). 

16 ‘‘(iii) The mechanism established pursuant to clause 

17 (i) shall provide that the additional payment under clause 

18 (i) shall— 

19 ‘‘(I) with respect to a discharge, only be made 

20 to a subsection (d) hospital that, as determined by 

21 the Secretary— 

22 ‘‘(aa) is participating in the National 

23 Healthcare Safety Network Antimicrobial Use 

24 and Resistance Module of the Centers for Dis25 ease Control and Prevention; and 


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1 ‘‘(bb) has an antimicrobial stewardship 

2 program that aligns with the Core Elements of 

3 Hospital Antibiotic Stewardship Programs of 

4 the Centers for Disease Control and Prevention 

5 or the Antimicrobial Stewardship Standard set 

6 by the Joint Commission; and 

7 ‘‘(II) apply to discharges occurring on or after 

8 October 1 of the year in which the drug or biological 

9 product is designated by the Secretary as a DIS10 ARM antimicrobial drug. 

11 For purposes of this clause, in the case of a similar report12 ing program described in item (aa), a subsection (d) hos13 pital shall be treated as participating in such a program 

14 if the entity maintaining such program identifies to the 

15 Secretary such hospital as so participating. 

16 ‘‘(iv)(I) The mechanism established pursuant to 

17 clause (i) shall provide for a process for— 

18 ‘‘(aa) a manufacturer or sponsor of a drug or 

19 biological product to request the Secretary to des20 ignate the drug or biological product as a DISARM 

21 antimicrobial drug; and 

22 ‘‘(bb) the designation (and removal of such des23 ignation) by the Secretary of drugs and biological 

24 products as DISARM antimicrobial drugs. 


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1 ‘‘(II) A designation of a drug or biological product 

2 as a DISARM antimicrobial drug may be revoked by the 

3 Secretary if the Secretary determines that— 

4 ‘‘(aa) the drug or biological product no longer 

5 meets the requirements for a DISARM antimicrobial 

6 drug under clause (ii); 

7 ‘‘(bb) the request for such designation con8 tained an untrue statement of material fact; or 

9 ‘‘(cc) clinical or other information that was not 

10 available to the Secretary at the time such designa11 tion was made shows that— 

12 ‘‘(AA) such drug or biological product is 

13 unsafe for use or not shown to be safe for use 

14 for individuals who are entitled to benefits 

15 under part A; or 

16 ‘‘(BB) an alternative to such drug or bio17 logical product is an advance that substantially 

18 improves the diagnosis or treatment of such in19 dividuals. 

20 ‘‘(III) Not later than October 1, 2023, the Secretary 

21 shall publish in the Federal Register a list of the DISARM 

22 antimicrobial drugs designated under this subparagraph 

23 pursuant to the process established under subclause 

24 (I)(bb). The Secretary shall annually update such list. 


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1 ‘‘(v)(I) For purposes of determining additional pay2 ment amounts under clause (i), a manufacturer or sponsor 

3 of a drug or biological product that submits a request de4 scribed in clause (iv)(I)(aa) shall submit to the Secretary 

5 information described in section 1927(b)(3)(A)(iii). 

6 ‘‘(II) The penalties for failure to provide timely infor7 mation under clause (i) of subparagraph (C) section 

8 1927(b)(3) and for providing false information under 

9 clause (ii) of such subparagraph shall apply to manufac10 turers and sponsors of a drug or biological product under 

11 this section with respect to information under subclause 

12 (I) in the same manner as such penalties apply to manu13 facturers under such clauses with respect to information 

14 under subparagraph (A) of such section. 

15 ‘‘(vi)(I) The mechanism established pursuant to 

16 clause (i) shall provide that— 

17 ‘‘(aa) except as provided in item (bb), no addi18 tional payment shall be made under this subpara19 graph for discharges involving a DISARM anti20 microbial drug if any additional payments have been 

21 made for discharges involving such drug as a new 

22 medical service or technology under subparagraph 

23 (K); 

24 ‘‘(bb) additional payments may be made under 

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1 ARM antimicrobial drug if any additional payments 

2 have been made for discharges occurring prior to the 

3 date of enactment of this subparagraph involving 

4 such drug as a new medical service or technology 

5 under subparagraph (K); and 

6 ‘‘(cc) no additional payment shall be made 

7 under subparagraph (K) for discharges involving a 

8 DISARM antimicrobial drug as a new medical serv9 ice or technology if any additional payments for dis10 charges involving such drug have been made under 

11 this subparagraph.’’. 

12 (2) CONFORMING AMENDMENT.—Section 

13 1886(d)(5)(K)(ii)(III) of the Social Security Act (42 

14 U.S.C. 1395ww(d)(5)(K)(ii)(III)) is amended by 

15 striking ‘‘provide’’ and inserting ‘‘subject to sub16 paragraph (N)(vii), provide’’. 

17 (b) AUTHORIZATION OF APPROPRIATIONS FOR THE

18 CENTERS FOR DISEASE CONTROL AND PREVENTION.— 

19 There is authorized to be appropriated to the Centers for 

20 Disease Control and Prevention $500,000,000, to remain 

21 available until expended, to support establishment and im22 plementation of antimicrobial stewardship programs and 

23 data reporting capabilities to the Antimicrobial Use and 

24 Resistance option of the CDC National Healthcare Safety 

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1 pitals, and community hospitals, to support detection, sur2 veillance, containment, and prevention of resistant patho3 gens in the United States and overseas. 

4 (c) STUDY AND REPORTS ON REMOVING BARRIERS

5 TO THE DEVELOPMENT OF DISARM ANTIMICROBIAL

6 DRUGS.— 

7 (1) STUDY.—The Comptroller General of the 

8 United States (in this subsection referred to as the 

9 ‘‘Comptroller General’’) shall, in consultation with 

10 the Director of the National Institutes of Health, 

11 the Commissioner of Food and Drugs, the Adminis12 trator of the Centers for Medicare & Medicaid Serv13 ices, and the Director of the Centers for Disease 

14 Control and Prevention, conduct a study over a 5- 

15 year period of the barriers that prevent the develop16 ment of DISARM antimicrobial drugs (as defined in 

17 section 1886(d)(5)(N)(ii) of the Social Security Act, 

18 as added by subsection (a)), including— 

19 (A) patient outcomes in conjunction with 

20 the use of DISARM drugs, including— 

21 (i) duration of stay in the intensive 

22 care unit; 

23 (ii) recidivism within 30 days; and 

24 (iii) measures of additional follow-up 

25 care; 


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1 (B) the effectiveness of antimicrobial stew2 ardship and surveillance programs, including— 

3 (i) changes in the percentage of hos4 pitals in the United States with an anti5 microbial stewardship program in place 

6 that aligns with the Core Elements of Hos7 pital Antibiotic Stewardship Programs, as 

8 outlined by the Centers for Disease Control 

9 and Prevention; 

10 (ii) changes in inpatient care of 

11 clostridioides difficile infection; and 

12 (iii) changes in inpatient rates of re13 sistance to key pathogens; and 

14 (C) considerations relating to Medicare 

15 payment reform, including— 

16 (i) changes in the number of qualified 

17 antimicrobial products approved; 

18 (ii) changes in wholesale acquisition 

19 cost of individual qualified antimicrobial 

20 products over time; 

21 (iii) changes in year-over-year volume 

22 of individual qualified antimicrobial prod23 ucts sold; and 

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1 gram as a proportion of total Medicare 

2 part A spending. 

3 (2) REPORT.—Not later than 5 years after the 

4 date of the enactment of this section, the Comp5 troller General shall submit to Congress a report 

6 containing the results of the study conducted under 

7 paragraph (1), together with recommendations for 

8 such legislation and administrative action as the 

9 Comptroller General determines appropriate. 

10 SEC. 7606. TREAT AND REDUCE OBESITY ACT. 

11 (a) AUTHORITY TO EXPAND HEALTH CARE PRO12 VIDERS QUALIFIED TO FURNISH INTENSIVE BEHAVIORAL

13 THERAPY.—Section 1861(ddd) of the Social Security Act 

14 (42 U.S.C. 1395x(ddd)) is amended by adding at the end 

15 the following new paragraph: 

16 ‘‘(4)(A) Subject to subparagraph (B), the Sec17 retary may, in addition to qualified primary care 

18 physicians and other primary care practitioners, 

19 cover intensive behavioral therapy for obesity fur20 nished by any of the following: 

21 ‘‘(i) A physician (as defined in subsection 

22 (r)(1)) who is not a qualified primary care phy23 sician. 

24 ‘‘(ii) Any other appropriate health care 

25 provider (including a physician assistant, nurse 


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1 practitioner, or clinical nurse specialist (as 

2 those terms are defined in subsection (aa)(5)), 

3 a clinical psychologist, a registered dietitian or 

4 nutrition professional (as defined in subsection 

5 (vv))). 

6 ‘‘(iii) An evidence-based, community-based 

7 lifestyle counseling program approved by the 

8 Secretary. 

9 ‘‘(B) In the case of intensive behavioral therapy 

10 for obesity furnished by a provider described in 

11 clause (ii) or (iii) of subparagraph (A), the Secretary 

12 may only cover such therapy if such therapy is fur13 nished— 

14 ‘‘(i) upon referral from, and in coordina15 tion with, a physician or primary care practi16 tioner operating in a primary care setting or 

17 any other setting specified by the Secretary; 

18 and 

19 ‘‘(ii) in an office setting, a hospital out20 patient department, a community-based site 

21 that complies with the Federal regulations con22 cerning the privacy of individually identifiable 

23 health information promulgated under section 

24 264(c) of the Health Insurance Portability and 


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1 Accountability Act of 1996, or another setting 

2 specified by the Secretary. 

3 ‘‘(C) In order to ensure a collaborative effort, 

4 the coordination described in subparagraph (B)(i) 

5 shall include the health care provider or lifestyle 

6 counseling program communicating to the referring 

7 physician or primary care practitioner any rec8 ommendations or treatment plans made regarding 

9 the therapy.’’. 

10 (b) MEDICARE PART D COVERAGE OF OBESITY

11 MEDICATION.— 

12 (1) IN GENERAL.—Section 1860D–2(e)(2)(A) 

13 of the Social Security Act (42 U.S.C. 1395w– 

14 102(e)(2)(A)) is amended, in the first sentence— 

15 (A) by striking ‘‘and other than’’ and in16 serting ‘‘other than’’; and 

17 (B) by inserting after ‘‘benzodiazepines),’’ 

18 the following: ‘‘and other than subparagraph 

19 (A) of such section if the drug is used for the 

20 treatment of obesity (as defined in section 

21 1861(yy)(2)(C)) or for weight loss management 

22 for an individual who is overweight (as defined 

23 in section 1861(yy)(2)(F)(i)) and has one or 

24 more related comorbidities,’’. 


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1 (2) EFFECTIVE DATE.—The amendments made 

2 by paragraph (1) shall apply to plan years beginning 

3 on or after the date that is 2 years after the date 

4 of the enactment of this section. 

5 (c) REPORT TO CONGRESS.—Not later than the date 

6 that is 1 year after the date of the enactment of this sec7 tion, and every 2 years thereafter, the Secretary of Health 

8 and Human Services shall submit a report to Congress 

9 describing the steps the Secretary has taken to implement 

10 the provisions of, and amendments made by, this section. 

11 Such report shall also include recommendations for better 

12 coordination and leveraging of programs within the De13 partment of Health and Human Services and other Fed14 eral agencies that relate in any way to supporting appro15 priate research and clinical care (such as any interactions 

16 between physicians and other health care providers and 

17 their patients) to treat, reduce, and prevent obesity in the 

18 adult population. 

19 SEC. 7607. INCENTIVES, IMPROVEMENTS, AND OUTREACH 

20 TO INCREASE DIVERSITY IN ALZHEIMER’S 

21 DISEASE RESEARCH. 

22 (a) IMPROVING ACCESS FOR AND OUTREACH TO

23 UNDERREPRESENTED POPULATIONS.— 

24 (1) EXPANDING ACCESS TO ALZHEIMER’S RE25 SEARCH CENTERS.— 


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1 (A) IN GENERAL.—Section 445(a)(1) of 

2 the Public Health Service Act (42 U.S.C. 285e– 

3 2(a)(1)) is amended— 

4 (i) by striking ‘‘(a)(1) The Director of 

5 the Institute may’’ and inserting the fol6 lowing: 

7 ‘‘(a)(1) The Director of the Institute— 

8 ‘‘(A) may’’; 

9 (ii) by striking ‘‘disease.’’ and insert10 ing ‘‘disease; and’’; and 

11 (iii) by adding at the end the fol12 lowing: 

13 ‘‘(B) beginning January 1, 2023, shall enter 

14 into cooperative agreements and make grants to 

15 public or private nonprofit entities under this sub16 section for the planning, establishment, and oper17 ation of new such centers that are located in areas 

18 with a higher concentration of minority groups (as 

19 determined under section 444(d)(3)(D)), such as en20 tities that are historically Black colleges and univer21 sities, Hispanic-serving institutions, Tribal colleges 

22 and universities, or centers of excellence for other 

23 minority populations.’’. 

24 (B) USE OF FUNDING FOR CLINICS TO OP25 ERATE CLINICAL TRIALS.—Section 445(b) of 


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1 the Public Health Service Act (42 U.S.C. 285e– 

2 2(b)) is amended by adding at the end the fol3 lowing: 

4 ‘‘(3) Federal payments made under a cooperative 

5 agreement or grant under subsection (a) from funds made 

6 available under section 7607(g) of the Health Equity and 

7 Accountability Act of 2022 shall, with respect to Alz8 heimer’s disease, be used in part to establish and operate 

9 diagnostic and treatment clinics designed— 

10 ‘‘(A) to meet the special needs of minority and 

11 rural populations and other underserved populations; 

12 and 

13 ‘‘(B) to operate clinical trials.’’. 

14 (2) OUTREACH.— 

15 (A) ALZHEIMER’S DISEASE CENTERS.— 

16 Section 445(b) of the Public Health Service Act 

17 (42 U.S.C. 285e–2(b)), as amended by para18 graph (1)(B), is further amended by adding at 

19 the end the following new paragraph: 

20 ‘‘(4) Federal payments made under a cooperative 

21 agreement or grant under subsection (a) shall be used to 

22 establish engagement centers to carry out public outreach, 

23 education efforts, and dissemination of information for 

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1 tion. Activities funded pursuant to the preceding sentence 

2 shall include— 

3 ‘‘(A) using established mechanisms to encour4 age members of minority groups to participate in 

5 clinical trials on Alzheimer’s disease; 

6 ‘‘(B) expanding education efforts to make mem7 bers of minority groups aware of ongoing clinical 

8 trials; 

9 ‘‘(C) working with trial sponsors to increase the 

10 number of recruitment events for members of minor11 ity groups; 

12 ‘‘(D) conducting outreach to national, State, 

13 and local physician professional organizations, espe14 cially for members of such organizations who are 

15 primary care physicians or physicians who specialize 

16 in dementia, to increase awareness of clinical re17 search opportunities for members of minority 

18 groups; and 

19 ‘‘(E) using community-based participatory re20 search methodologies to engage with minority popu21 lations.’’. 

22 (B) RESOURCE CENTERS FOR MINORITY

23 AGING RESEARCH.—Section 444(c) of the Pub24 lic Health Service Act (42 U.S.C. 285e–1(c)) is 

25 amended— 


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1 (i) by striking ‘‘(c)’’ and inserting 

2 ‘‘(c)(1)’’; and 

3 (ii) by adding at the end the following 

4 new paragraph: 

5 ‘‘(2) The Director of the Institute, acting through the 

6 Resource Centers for Minority Aging Research of the In7 stitute, shall carry out public outreach, education efforts, 

8 and dissemination of information for members of minority 

9 groups about participation in clinical research on Alz10 heimer’s disease carried out or supported under this sub11 part.’’. 

12 (b) INCENTIVES TO INCREASE DIVERSITY IN ALZ13 HEIMER’S DISEASE RESEARCH THROUGH PRINCIPAL IN14 VESTIGATORS AND RESEARCHERS FROM UNDERREP15 RESENTED POPULATIONS.— 

16 (1) ALZHEIMER’S CLINICAL RESEARCH AND

17 TRAINING AWARDS.—Section 445I of the Public 

18 Health Service Act (42 U.S.C. 285e–10a) is amend19 ed by adding at the end the following new sub20 section: 

21 ‘‘(d) ENHANCING THE PARTICIPATION OF PRINCIPAL

22 INVESTIGATORS AND RESEARCHERS WHO ARE MEMBERS

23 OF UNDERREPRESENTED POPULATIONS.— 

24 ‘‘(1) IN GENERAL.—The Director of the Insti25 tute shall enhance diversity in the conduct or supVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01563 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 port of clinical research on Alzheimer’s disease 

2 under this subpart by encouraging the participation 

3 of individuals from groups that are underrepresented 

4 in the biomedical, clinical, behavioral, and social 

5 sciences as principal investigators of such clinical re6 search, as researchers for such clinical research, or 

7 both. 

8 ‘‘(2) TRAINING FOR PRINCIPAL INVESTIGA9 TORS.—The Director of the Institute shall provide 

10 training for principal investigators who are members 

11 of a minority group with respect to skills for— 

12 ‘‘(A) the design and conduct of clinical re13 search and clinical protocols; 

14 ‘‘(B) applying for grants for clinical re15 search; and 

16 ‘‘(C) such other areas as the Director of 

17 the Institute determines to be appropriate.’’. 

18 (2) SENIOR RESEARCHER AWARDS.—Section 

19 445B(a) of the Public Health Service Act (42 

20 U.S.C. 285e–4(a)) is amended by inserting ‘‘, in21 cluding senior researchers who are members of a mi22 nority group’’ before the period at the end of the 

23 first sentence. 

24 (c) INCENTIVES TO INCREASE DIVERSITY IN ALZ25 HEIMER’S DISEASE RESEARCH THROUGH TRIAL SITES.— 


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1 Section 444(d) of the Public Health Service Act (42 

2 U.S.C. 285e–1(d)) is amended— 

3 (1) by striking ‘‘(d)’’ and inserting ‘‘(d)(1)’’; 

4 and 

5 (2) by adding at the end the following new 

6 paragraphs: 

7 ‘‘(2) In conducting or supporting clinical research on 

8 Alzheimer’s disease for purposes of this subpart, in addi9 tion to requirements otherwise imposed under this title, 

10 including under section 492B, the Director of the Institute 

11 shall increase the participation of members of minority 

12 groups in such clinical research through one or more of 

13 the activities described in paragraph (3). 

14 ‘‘(3)(A) The Director of the Institute shall provide 

15 incentives for the support of clinical research on Alz16 heimer’s disease with clinical trial sites established in 

17 areas with a higher concentration of minority groups, in18 cluding rural areas if practicable. 

19 ‘‘(B) In determining whether to conduct or support 

20 clinical research on Alzheimer’s disease, the Director of 

21 the Institute shall encourage the conduct of clinical re22 search with clinical trial sites in areas described in sub23 paragraph (A) as a higher-level priority criterion among 

24 the criteria established to evaluate whether to conduct or 

25 support clinical research. 


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1 ‘‘(C) In determining the amount of funding to be pro2 vided for the conduct or support of such clinical research, 

3 the Director of the Institute shall provide additional fund4 ing for the conduct of such clinical research with clinical 

5 trial sites in areas described in subparagraph (A). 

6 ‘‘(D) In determining whether an area is an area with 

7 a higher concentration of minority groups, the Director 

8 of the Institute— 

9 ‘‘(i) shall consider the most recent data col10 lected by the Bureau of the Census; and 

11 ‘‘(ii) may also consider— 

12 ‘‘(I) data from the Centers for Medicare & 

13 Medicaid Services on the incidence of Alz14 heimer’s disease in the United States by region; 

15 and 

16 ‘‘(II) such other data as the Director de17 termines appropriate. 

18 ‘‘(4) In order to facilitate the participation of mem19 bers of minority groups in clinical research supported 

20 under this subpart, in addition to activities described in 

21 paragraph (3), the Director of the Institute shall— 

22 ‘‘(A) ensure that such clinical research uses 

23 community-based participatory research methodolo24 gies; and 


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1 ‘‘(B) encourage the use of remote health tech2 nologies, including telehealth, remote patient moni3 toring, and mobile technologies, that reduce or elimi4 nate barriers to participation of members of minor5 ity groups in such clinical research. 

6 ‘‘(5)(A) Clinical research on Alzheimer’s disease con7 ducted or supported under this subpart shall ensure that 

8 such research includes outreach activities designed to in9 crease the participation of members of minority groups in 

10 such research. 

11 ‘‘(B)(i) Each applicant for a grant under this subpart 

12 for clinical research on Alzheimer’s disease shall submit 

13 to the Director of the Institute in the application for such 

14 grant— 

15 ‘‘(I) a budget for outreach activities to members 

16 of minority populations with respect to participation 

17 in such clinical research; and 

18 ‘‘(II) a description of the plan to conduct such 

19 outreach. 

20 ‘‘(ii) The Director of the Institute shall encourage ap21 plicants for, and recipients of, grants under this subpart 

22 to conduct clinical research on Alzheimer’s disease to en23 gage with community-based organizations to increase par24 ticipation of minority populations in such research. 

25 ‘‘(6) For purposes of this subpart: 


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1 ‘‘(A) The term ‘clinical research’ includes a 

2 clinical trial. 

3 ‘‘(B) The term ‘minority group’ has the mean4 ing given such term under section 492B(g).’’. 

5 (d) PARTICIPANT ELIGIBILITY CRITERIA.—Section 

6 445I of the Public Health Service Act (42 U.S.C. 285e– 

7 10a), as amended by subsection (b)(1), is further amended 

8 by adding at the end the following new subsection: 

9 ‘‘(e) PARTICIPANT ELIGIBILITY CRITERIA.—The Di10 rector of the Institute shall take such actions as are nec11 essary to ensure that clinical research on Alzheimer’s dis12 ease conducted or supported under this subpart is de13 signed with eligibility criteria that ensure the clinical trial 

14 population reflects the diversity of the prospective patient 

15 population. Such actions may include the following: 

16 ‘‘(1) EXAMINATION OF CRITERIA.— 

17 ‘‘(A) IN GENERAL.—An examination of 

18 each exclusion criterion to determine if the cri19 terion is necessary to ensure the safety of trial 

20 participants or to achieve the study objectives. 

21 ‘‘(B) MODIFICATION OF CRITERIA.—In the 

22 case of an exclusion criterion that is not nec23 essary to ensure the safety of trial participants 

24 or to achieve the study objectives— 


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1 ‘‘(i) encouraging the modification or 

2 elimination of the criterion; or 

3 ‘‘(ii) encouraging tailoring the cri4 terion as narrowly as possible to avoid un5 necessary limits to the population of the 

6 clinical study. 

7 ‘‘(2) REQUIREMENT FOR STRONG JUSTIFICA8 TION FOR EXCLUSION.—A review of each exclusion 

9 criterion to ensure that populations are included in 

10 clinical trials, such as older adults, individuals with 

11 a mild form of disease, individuals at the extremes 

12 of the weight range, or children, unless there is a 

13 strong clinical or scientific justification to exclude 

14 them. 

15 ‘‘(3) USE OF ADAPTIVE DESIGN.—Encouraging 

16 the use of an adaptive clinical trial design that— 

17 ‘‘(A) starts with a defined population 

18 where there are concerns about safety; and 

19 ‘‘(B) may expand to a broader population 

20 based on initial data from the trial and external 

21 data.’’. 

22 (e) RESOURCE CENTER FOR SUCCESSFUL STRATE23 GIES TO INCREASE PARTICIPATION OF UNDERREP24 RESENTED POPULATIONS IN ALZHEIMER’S DISEASE

25 CLINICAL RESEARCH.—Section 444 of the Public Health 


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1 Service Act (42 U.S.C. 285e–1) is amended by adding at 

2 the end the following new subsection: 

3 ‘‘(e)(1) Acting through the Office of Special Popu4 lations and in consultation with the Division of Extra5 mural Activities, the Director of the Institute shall support 

6 resource information and technical assistance to grantees 

7 under section 445 (relating to Alzheimer’s disease cen8 ters), other grantees, and prospective grantees, designed 

9 to increase the participation of minority populations in 

10 clinical research on Alzheimer’s disease conducted or sup11 ported under this subpart. 

12 ‘‘(2) The resource information and technical assist13 ance provided under paragraph (1) shall include the main14 tenance of a central resource library in order to collect, 

15 prepare, analyze, and disseminate information relating to 

16 strategies and best practices used by recipients of grants 

17 under this subpart and other researchers in the develop18 ment of the clinical research designed to increase the par19 ticipation of minority populations in such clinical re20 search.’’. 

21 (f) ANNUAL REPORTS.—Section 444 of the Public 

22 Health Service Act (42 U.S.C. 285e–1), as amended by 

23 subsection (e), is further amended by adding at the end 

24 the following new subsection: 


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1 ‘‘(f)(1)(A) The Director of the Institute shall submit 

2 annual reports to the Congress on the impact of the 

3 amendments made to this subpart by the Health Equity 

4 and Accountability Act of 2022. 

5 ‘‘(B) The Secretary shall transmit a copy of each 

6 such report to the Advisory Council on Alzheimer’s Re7 search, Care, and Services established under section 2(e) 

8 of the National Alzheimer’s Project Act (Public Law 111– 

9 375). 

10 ‘‘(2) In each report under paragraph (1), the Director 

11 of the Institute shall include information and data on the 

12 following matters with respect to clinical trials on Alz13 heimer’s disease conducted during the preceding year: 

14 ‘‘(A) The number of participants who are mem15 bers of a minority group in such clinical trials. 

16 ‘‘(B) The number of such clinical trials for 

17 which incentives under subsection (d)(3) were made 

18 available, the nature of such incentives, the amount 

19 of increased funding (if any) made available for re20 search on Alzheimer’s disease, and the training pro21 vided to principal investigators who are members of 

22 a minority group and the amount of funding (if any) 

23 for such training. 


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1 ‘‘(C) The number of such clinical trials for 

2 which the principal investigator is a member of a mi3 nority group. 

4 ‘‘(D) The number of such clinical trials for 

5 which a significant percentage of researchers are 

6 members of a minority group. 

7 ‘‘(E) Modifications to patient eligibility criteria 

8 in clinical trial designs under section 445I(e). 

9 ‘‘(F) Outreach and education efforts conducted 

10 under section 445(b)(4). 

11 ‘‘(3) The Director of the Institute shall make each 

12 report under paragraph (1) available to the public, includ13 ing through posting on the appropriate website of the De14 partment of Health and Human Services.’’. 

15 (g) AUTHORIZATION OF APPROPRIATIONS.—For each 

16 of fiscal years 2023 through 2027, there is authorized to 

17 be appropriated to the Secretary of Health and Human 

18 Services $60,000,000 to carry out the amendments made 

19 by this section, to remain available until expended. 

20 TITLE VIII—HEALTH 

21 INFORMATION TECHNOLOGY 

22 SEC. 8001. DEFINITIONS. 

23 In this title: 

24 (1) ACCESS.—The term ‘‘access’’, with respect 

25 to health information, means access described in secVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01572 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tion 164.524 of title 45, Code of Federal Regula2 tions (or any successor regulations). 

3 (2) CERTIFIED ELECTRONIC HEALTH RECORD

4 TECHNOLOGY.—The term ‘‘certified EHR tech5 nology’’— 

6 (A) has the meaning given such term in 

7 section 3000 of the Public Health Service Act 

8 (42 U.S.C. 300jj); 

9 (B) includes the health information infra10 structure for interoperability, access, exchange, 

11 and use of electronic health information re12 quired under title XXX of the Public Health 

13 Service Act (42 U.S.C. 300jj et seq.); and 

14 (C) is not limited to electronic health 

15 records maintained by doctors. 

16 (3) EHR.—The term ‘‘EHR’’— 

17 (A) means an electronic health record; 

18 (B) includes the health information infra19 structure for interoperability, access, exchange, 

20 and use of electronic health information re21 quired under title XXX of the Public Health 

22 Service Act (42 U.S.C. 300jj et seq.); and 

23 (C) is not limited to electronic health 

24 records maintained by doctors. 


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1 (4) INTEROPERABILITY.—The term ‘‘interoper2 ability’’ has the meaning given such term in section 

3 3000 of the Public Health Service Act (42 U.S.C. 

4 300jj). 

5 Subtitle A—Reducing Health 

6 Disparities Through Health IT 

7 SEC. 8101. HRSA ASSISTANCE TO HEALTH CENTERS FOR 

8 PROMOTION OF HEALTH IT. 

9 (a) IN GENERAL.—The Secretary of Health and 

10 Human Services, acting through the Administrator of the 

11 Health Resources and Services Administration, shall ex12 pand and intensify the programs and activities of the Ad13 ministration (directly or through grants or contracts) to 

14 provide technical assistance and resources to health cen15 ters (as defined in section 330(a) of the Public Health 

16 Service Act (42 U.S.C. 254b(a))) to adopt and meaning17 fully use certified EHR technology for the management 

18 of chronic diseases and health conditions and reduction 

19 of health disparities. 

20 (b) FUNDING INITIATIVES.—The activities under 

21 subsection (a) may include funding initiatives, including 

22 establishing basic connectivity such as 5G internet for 

23 telemedicine capabilities, grant funding to implement the 

24 next generation of EHR, and funding for technology hard25 ware. 


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1 SEC. 8102. ASSESSMENT OF IMPACT OF HEALTH IT ON RA2 CIAL AND ETHNIC MINORITY COMMUNITIES; 

3 OUTREACH AND ADOPTION OF HEALTH IT IN 

4 SUCH COMMUNITIES. 

5 (a) NATIONAL COORDINATOR FOR HEALTH INFOR6 MATION TECHNOLOGY.— 

7 (1) IN GENERAL.—Not later than 18 months 

8 after the date of enactment of this Act, the National 

9 Coordinator for Health Information Technology (re10 ferred to in this title as the ‘‘National Coordinator’’) 

11 shall— 

12 (A) conduct an evaluation of the level of 

13 interoperability, access, use, and accessibility of 

14 electronic health records in racial and ethnic 

15 minority communities, focusing on whether pa16 tients in such communities have providers who 

17 use electronic health records, and the degree to 

18 which patients in such communities can access, 

19 exchange, and use without special effort their 

20 health information in those electronic health 

21 records; 

22 (B) include in such evaluation an indica23 tion of whether such providers— 

24 (i) are participating in the Medicare 

25 program under title XVIII of the Social 

26 Security Act (42 U.S.C. 1395 et seq.) or 


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1 a State plan under title XIX of such Act 

2 (42 U.S.C. 1396 et seq.) (or a waiver of 

3 such plan); 

4 (ii) have received incentive payments 

5 or incentive payment adjustments under 

6 Medicare and Medicaid Electronic Health 

7 Records Incentive Programs (as defined in 

8 subsection (c)(2)); 

9 (iii) are MIPS eligible professionals, 

10 as defined in paragraph (1)(C) of section 

11 1848(q) of the Social Security Act (42 

12 U.S.C. 1395w–4(q)), for purposes of the 

13 Merit-Based Incentive Payment System 

14 under such section; or 

15 (iv) have been recruited by any of the 

16 Health Information Technology Regional 

17 Extension Centers established under sec18 tion 3012 of the Public Health Service Act 

19 (42 U.S.C. 300jj–32); and 

20 (C) publish the results of such evaluation 

21 including the indications under subparagraph 

22 (B), the race and ethnicity of such providers, 

23 and the populations served by such providers. 

24 (2) EVALUATION OF INTEROPERABILITY.—The 

25 evaluation of the level of interoperability described in 


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1 paragraph (1)(A) shall consider exchange of elec2 tronic health information, usability of exchanged 

3 electronic health information, effective application 

4 and use of the exchanged electronic health informa5 tion, and impact on outcomes of interoperability. 

6 (3) CERTIFICATION CRITERION.—Not later 

7 than 1 year after the date of enactment of this Act, 

8 the National Coordinator shall— 

9 (A) promulgate a certification criterion and 

10 module of certified EHR technology that strati11 fies quality measures for purposes of the Merit12 Based Incentive Payment System by disparity 

13 characteristics, including race, ethnicity, lan14 guage, gender, gender identity, sexual orienta15 tion, socio-economic status, and disability sta16 tus, as such characteristics are defined for pur17 poses of certified EHR technology; and 

18 (B) report to the Centers for Medicare & 

19 Medicaid Services the quality measures strati20 fied by race and at least 2 other disparity char21 acteristics. 

22 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 

23 As soon as practicable after the date of enactment of this 

24 Act, the Director of the National Center for Health Statis25 tics shall provide to Congress a more detailed analysis of 


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1 the data presented in National Center for Health Statis2 tics data brief entitled ‘‘Adoption of Certified Electronic 

3 Health Record Systems and Electronic Information Shar4 ing in Physician Offices: United States, 2013 and 2014’’ 

5 (NCHS Data Brief No. 236). 

6 (c) CENTERS FOR MEDICARE & MEDICAID SERV7 ICES.— 

8 (1) IN GENERAL.—As part of the process of 

9 collecting information, with respect to a provider, at 

10 registration and attestation for purposes of Medicare 

11 and Medicaid Electronic Health Records Incentive 

12 Programs (as defined in paragraph (2)) or the 

13 Merit-Based Incentive Payment System under sec14 tion 1848(q) of the Social Security Act (42 U.S.C. 

15 1395w–4(q)), the Secretary of Health and Human 

16 Services shall collect the race and ethnicity of such 

17 provider. 

18 (2) MEDICARE AND MEDICAID ELECTRONIC

19 HEALTH RECORDS INCENTIVE PROGRAMS DE20 FINED.—For purposes of paragraph (1), the term 

21 ‘‘Medicare and Medicaid Electronic Health Records 

22 Incentive Programs’’ means the incentive programs 

23 under the following: 

24 (A) Subsection (l)(3) of section 1814(l)(3) 

25 of the Social Security Act (42 U.S.C. 1395f). 


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1 (B) Subsections (a)(7) and (o) of section 

2 1848 of such Act (42 U.S.C. 1395w–4). 

3 (C) Subsections (l) and (m) of section 

4 1853 of such Act (42 U.S.C. 1395w–23). 

5 (D) Subsections (b)(3)(B)(ix)(I) and (n) of 

6 section 1886 of such Act (42 U.S.C. 1395ww). 

7 (E) Subsections (a)(3)(F) and (t) of sec8 tion 1903 such Act (42 U.S.C. 1396b). 

9 (d) NATIONAL COORDINATOR’S ASSESSMENT OF IM10 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 

11 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 

12 amended— 

13 (1) in the heading by inserting ‘‘, RACIAL AND

14 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH

15 DISPARITIES’’; 

16 (2) by inserting ‘‘, in communities with a high 

17 proportion of individuals from racial and ethnic mi18 nority groups (as defined in section 1707(g)), in19 cluding people with disabilities in such groups,’’ 

20 after ‘‘communities with health disparities’’; 

21 (3) by striking ‘‘The National Coordinator’’ and 

22 inserting the following: 

23 ‘‘(i) IN GENERAL.—The National Co24 ordinator’’; and 

25 (4) by adding at the end the following: 


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1 ‘‘(ii) CRITERIA.—In any publication 

2 under clause (i), the National Coordinator 

3 shall include best practices for encouraging 

4 partnerships between the Federal Govern5 ment, States, private entities, national 

6 nonprofit intermediaries, and community7 based organizations to expand outreach 

8 and education for and the adoption of cer9 tified EHR technology in communities with 

10 a high proportion of individuals from racial 

11 and ethnic minority groups (as defined in 

12 section 1707(g)), while also maintaining 

13 the accessibility requirements of section 

14 508 of the Rehabilitation Act of 1973 to 

15 encourage patient involvement in patient 

16 health care. The National Coordinator 

17 shall— 

18 ‘‘(I) not later than 6 months 

19 after the submission of the report re20 quired under section 8302 of the 

21 Health Equity and Accountability Act 

22 of 2022, establish criteria for evalu23 ating the impact of health information 

24 technology on communities with a 

25 high proportion of individuals from 


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1 racial and ethnic minority groups (as 

2 so defined) taking into account the 

3 findings in such report; and 

4 ‘‘(II) not later than 1 year after 

5 the submission of such report, publish 

6 the results of an evaluation of such 

7 impact.’’. 

8 SEC. 8103. NONDISCRIMINATION AND HEALTH EQUITY IN 

9 HEALTH INFORMATION TECHNOLOGY. 

10 (a) IN GENERAL.—Covered entities shall ensure that 

11 electronic and information technology in their health pro12 grams or activities does not exclude individuals from par13 ticipation in, deny individuals the benefits of, or subject 

14 individuals to discrimination under any health program or 

15 activity on the basis of race, color, national origin, sex, 

16 age, or disability. 

17 (b) COVERED ENTITIES.—In this section, the term 

18 ‘‘covered entity’’ means— 

19 (1) an entity that operates a health program or 

20 activity, any part of which receives Federal financial 

21 assistance; 

22 (2) an entity established under title I of the Pa23 tient Protection and Affordable Care Act (Public 

24 Law 114–148) that administers a health program or 

25 activity; or 


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1 (3) the Department of Health and Human 

2 Services. 

3 SEC. 8104. LANGUAGE ACCESS IN HEALTH INFORMATION 

4 TECHNOLOGY. 

5 The National Coordinator shall— 

6 (1) not later than 18 months after the date of 

7 enactment of this Act, propose a rule for providing 

8 access to patients, through certified EHR tech9 nology, to their personal health information in a 

10 computable format, including using patient portals 

11 or third-party applications (as described in section 

12 3009(e) of the Public Health Service Act (42 U.S.C. 

13 300jj–19(e))), in the 10 most common non-English 

14 languages; 

15 (2) hold a public hearing to identify best prac16 tices for carrying out paragraph (1); and 

17 (3) not later than 6 months after the public 

18 hearing under paragraph (2), promulgate a final 

19 regulation with respect to paragraph (1). 


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1 Subtitle B—Modifications To 

2 Achieve Parity in Existing Pro3 grams 

4 SEC. 8201. EXTENDING FUNDING TO STRENGTHEN THE 

5 HEALTH IT INFRASTRUCTURE IN RACIAL 

6 AND ETHNIC MINORITY COMMUNITIES. 

7 Section 3011 of the Public Health Service Act (42 

8 U.S.C. 300jj–31) is amended— 

9 (1) in subsection (a), in the matter preceding 

10 paragraph (1), by inserting ‘‘, including with respect 

11 to communities with a high proportion of individuals 

12 from racial and ethnic minority groups (as defined 

13 in section 1707(g))’’ before the colon at the end; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 

17 National Coordinator shall report annually to Congress on 

18 activities and expenditures under this section.’’. 

19 SEC. 8202. EXTENDING COMPETITIVE GRANTS FOR THE DE20 VELOPMENT OF LOAN PROGRAMS TO FACILI21 TATE ADOPTION OF CERTIFIED EHR TECH22 NOLOGY BY PROVIDERS SERVING RACIAL 

23 AND ETHNIC MINORITY GROUPS. 

24 Section 3014(e) of the Public Health Service Act (42 

25 U.S.C. 300jj–34(e)) is amended, in the matter preceding 


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1 paragraph (1), by inserting ‘‘, including with respect to 

2 communities with a high proportion of individuals from 

3 racial and ethnic minority groups (as defined in section 

4 1707(g))’’ after ‘‘health care provider to’’. 

5 SEC. 8203. AUTHORIZATION OF APPROPRIATIONS. 

6 Section 3018 of the Public Health Service Act (42 

7 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 

8 2009 through 2013’’ and inserting ‘‘fiscal years 2023 

9 through 2028’’. 

10 Subtitle C—Additional Research 

11 and Studies 

12 SEC. 8301. DATA COLLECTION AND ASSESSMENTS CON13 DUCTED IN COORDINATION WITH MINORITY14 SERVING INSTITUTIONS. 

15 Section 3001(c)(6) of the Public Health Service Act 

16 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 

17 end the following new subparagraph: 

18 ‘‘(F) DATA COLLECTION AND ASSESS19 MENTS CONDUCTED IN COORDINATION WITH

20 MINORITY-SERVING INSTITUTIONS.— 

21 ‘‘(i) IN GENERAL.—In carrying out 

22 subparagraph (C) with respect to commu23 nities with a high proportion of individuals 

24 from racial and ethnic minority groups (as 

25 defined in section 1707(g)), the National 


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1 Coordinator shall, to the greatest extent 

2 possible, coordinate with an entity de3 scribed in clause (ii). 

4 ‘‘(ii) MINORITY-SERVING INSTITU5 TIONS.—For purposes of clause (i), an en6 tity described in this clause is a historically 

7 Black college or university, a Hispanic8 serving institution, a Tribal College or 

9 University, or an Asian-American-, Native 

10 American-, or Pacific Islander-serving in11 stitution with an accredited public health, 

12 health policy, or health services research 

13 program.’’. 

14 SEC. 8302. STUDY OF HEALTH INFORMATION TECHNOLOGY 

15 IN MEDICALLY UNDERSERVED COMMU16 NITIES. 

17 (a) IN GENERAL.—Not later than 2 years after the 

18 date of enactment of this Act, the Secretary of Health and 

19 Human Services shall— 

20 (1) enter into an agreement with the National 

21 Academies of Sciences, Engineering, and Medicine to 

22 conduct a study on the development, implementa23 tion, and effectiveness of health information tech24 nology within medically underserved areas; and 


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1 (2) submit a report to Congress describing the 

2 results of such study, including any recommenda3 tions for legislative or administrative action. 

4 (b) STUDY.—The study described in subsection 

5 (a)(1) shall— 

6 (1) identify barriers to successful implementa7 tion of health information technology in medically 

8 underserved areas; 

9 (2) survey a cross-section of individuals in 

10 medically underserved areas and report their opin11 ions about the various topics of study; 

12 (3) examine the degree of interoperability 

13 among health information technology and users of 

14 health information technology in medically under15 served areas, including patients, providers, and com16 munity services, which such examination shall con17 sider the exchange of electronic health information, 

18 usability of exchanged electronic health information, 

19 effective application and use of the exchanged elec20 tronic health information, and impact on outcomes 

21 of interoperability; 

22 (4) examine the impact of health information 

23 technology on providing quality care and reducing 

24 the cost of care to individuals in such areas, includ25 ing the impact of such technology on improved 


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1 health outcomes for individuals, including which 

2 technology worked for which population and how it 

3 improved health outcomes for that population; 

4 (5) examine the impact of health information 

5 technology on improving health care-related deci6 sions by both patients and providers in such areas; 

7 (6) identify specific best practices for using 

8 health information technology to foster the con9 sistent provision of physical accessibility and reason10 able policy accommodations in health care to individ11 uals with disabilities in such areas; 

12 (7) assess the feasibility and costs associated 

13 with the use of health information technology in 

14 such areas; 

15 (8) evaluate whether the adoption and use of 

16 qualified electronic health records (as defined in sec17 tion 3000 of the Public Health Service Act (42 

18 U.S.C. 300jj)) is effective in reducing health dispari19 ties, including analysis of clinical quality measures 

20 reported by providers who are participating in the 

21 Medicare program under title XVIII of the Social 

22 Security Act (42 U.S.C. 1395 et seq.) or a State 

23 plan under title XIX of such Act (42 U.S.C. 1396 

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1 grams to encourage the adoption and use of certified 

2 EHR technology; 

3 (9) identify providers in medically underserved 

4 areas that are not electing to adopt and use elec5 tronic health records and determine what barriers 

6 are preventing those providers from adopting and 

7 using such records; and 

8 (10) examine urban and rural community 

9 health systems and determine the impact that health 

10 information technology may have on the capacity of 

11 primary health providers in those systems. 

12 (c) MEDICALLY UNDERSERVED AREA.—In this sec13 tion, the term ‘‘medically underserved area’’ means— 

14 (1) a population that has been designated as a 

15 medically underserved population under section 

16 330(b)(3) of the Public Health Service Act (42 

17 U.S.C. 254b(b)(3)); 

18 (2) an area that has been designated as a 

19 health professional shortage area under section 332 

20 of the Public Health Service Act (42 U.S.C. 254e); 

21 (3) an area or population that has been des22 ignated as a medically underserved community under 

23 section 799B of the Public Health Service Act (42 

24 U.S.C. 295p); or 

25 (4) another area or population that— 


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1 (A) experiences significant barriers to ac2 cessing quality health services; and 

3 (B) has a high prevalence of diseases or 

4 conditions described in title VII, with such dis5 eases or conditions having a disproportionate 

6 impact on racial and ethnic minority groups (as 

7 defined in section 1707(g) of the Public Health 

8 Service Act (42 U.S.C. 300u–6(g))) or a sub9 group of people with disabilities who have spe10 cific functional impairments. 

11 SEC. 8303. ASSESSMENT OF USE AND MISUSE OF DE-IDEN12 TIFIED HEALTH DATA. 

13 (a) IN GENERAL.—Not later than 18 months after 

14 the date of enactment of this Act, the Secretary of Health 

15 and Human Services shall— 

16 (1) enter into an agreement with the Office of 

17 the National Coordinator of Health Information 

18 Technology to conduct a study, in consultation with 

19 relevant stakeholders, on the impact of digital health 

20 technology on medically underserved areas (as de21 fined in section 8302(c)); and 

22 (2) submit a report to Congress describing the 

23 results of such study, including any recommenda24 tions for legislative or administrative action. 


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1 (b) STUDY.—The study described in subsection 

2 (a)(1) shall— 

3 (1) examine the overall prevalence, and histor4 ical and existing practices and their respective preva5 lence, of use and misuse of de-identified protected 

6 health information to discriminate against or benefit 

7 medically underserved areas; 

8 (2) identify best practices and tools to leverage 

9 the benefits and prevent misuse of de-identified pro10 tected health information to discriminate against 

11 medically underserved areas; 

12 (3) examine the overall prevalence, and histor13 ical and existing practices and their respective preva14 lence, of use and misuse of de-identified personal 

15 health information other than protected health infor16 mation to discriminate against or benefit medically 

17 underserved areas; and 

18 (4) identify best practices and tools to leverage 

19 the benefits and prevent misuse of de-identified per20 sonal health information other than protected health 

21 information to discriminate against medically under22 served areas. 

23 (c) DEFINITION OF PROTECTED HEALTH INFORMA24 TION.—In this section, the term ‘‘protected health infor25 mation’’ has the meaning given such term in section 


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1 160.103, title 45, Code of Federal Regulations (or any 

2 successor regulations). 

3 Subtitle D—Closing Gaps in 

4 Funding To Adopt Certified EHRs 

5 SEC. 8401. EXTENDING MEDICAID EHR INCENTIVE PAY6 MENTS TO REHABILITATION FACILITIES, 

7 LONG-TERM CARE FACILITIES, AND HOME 

8 HEALTH AGENCIES. 

9 (a) IN GENERAL.—Section 1903(t)(2)(B) of the So10 cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend11 ed— 

12 (1) in clause (i), by striking ‘‘, or’’ and insert13 ing a semicolon; 

14 (2) in clause (ii), by striking the period at the 

15 end and inserting a semicolon; and 

16 (3) by inserting after clause (ii) the following 

17 new clauses: 

18 ‘‘(iii) a rehabilitation facility (as defined in sec19 tion 1886(j)(1)) that furnishes acute or subacute re20 habilitation services; 

21 ‘‘(iv) a long-term care hospital described in sec22 tion 1886(d)(1)(B)(iv); or 

23 ‘‘(v) a home health agency (as defined in sec24 tion 1861(o)).’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply with respect to amounts ex3 pended under section 1903(a)(3)(F) of the Social Security 

4 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be5 ginning on or after the date of the enactment of this Act. 

6 SEC. 8402. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 

7 FOR MEDICAID ELECTRONIC HEALTH 

8 RECORD INCENTIVE PAYMENTS. 

9 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 

10 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 

11 amended to read as follows: 

12 ‘‘(v) physician assistant.’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 subsection (a) shall apply with respect to amounts ex15 pended under section 1903(a)(3)(F) of the Social Security 

16 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be17 ginning on or after the date of the enactment of this Act. 

18 Subtitle E—Expanding Access to 

19 Telehealth Services 

20 SEC. 8501. REMOVING GEOGRAPHIC REQUIREMENTS FOR 

21 TELEHEALTH SERVICES. 

22 Section 1834(m)(4)(C) of the Social Security Act (42 

23 U.S.C. 1395m(m)(4)(C)) is amended— 


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1 (1) in clause (i), in the matter preceding sub2 clause (I), by striking ‘‘clause (iii)’’ and inserting 

3 ‘‘clauses (iii) and (iv)’’; and 

4 (2) by adding at the end the following new 

5 clause: 

6 ‘‘(iv) REMOVAL OF GEOGRAPHIC RE7 QUIREMENTS.—The geographic require8 ments described in clause (i) shall not 

9 apply with respect to telehealth services 

10 furnished on or after the first day after the 

11 end of the period for which clause (iii) ap12 plies.’’. 

13 SEC. 8502. EXPANDING ORIGINATING SITES. 

14 (a) EXPANDING THE HOME AS AN ORIGINATING

15 SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu16 rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 

17 to read as follows: 

18 ‘‘(X)(aa) Prior to the date de19 scribed in item (bb), the home of an 

20 individual but only for purposes of 

21 section 1881(b)(3)(B) or telehealth 

22 services described in paragraph (7) or 

23 clause (iii). 

24 ‘‘(bb) On or after the first day 

25 after the end of the period for which 


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1 clause (iii) applies, the home of an in2 dividual.’’. 

3 (b) ALLOWING ADDITIONAL ORIGINATING SITES.— 

4 Section 1834(m)(4)(C)(ii) of the Social Security Act (42 

5 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 

6 end the following new subclause: 

7 ‘‘(XII) Any other site determined 

8 appropriate by the Secretary at which 

9 an eligible telehealth individual is lo10 cated at the time a telehealth service 

11 is furnished via a telecommunications 

12 system.’’. 

13 (c) PARAMETERS FOR NEW ORIGINATING SITES.— 

14 Section 1834(m)(4)(C) of the Social Security Act (42 

15 U.S.C. 1395m(m)(4)(C)), as amended by section 8501, is 

16 amended by adding at the end the following new clause: 

17 ‘‘(v) REQUIREMENTS FOR NEW

18 SITES.— 

19 ‘‘(I) IN GENERAL.—The Sec20 retary may establish requirements for 

21 the furnishing of telehealth services at 

22 sites described in clause (ii)(XII) to 

23 provide for beneficiary and program 

24 integrity protections. 


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1 ‘‘(II) CLARIFICATION.—Nothing 

2 in this clause shall be construed to 

3 preclude the Secretary from estab4 lishing requirements for other origi5 nating sites described in clause (ii)’’. 

6 (d) NO ORIGINATING SITE FACILITY FEE FOR NEW

7 SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 

8 Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 

9 (1) in the heading, by striking ‘‘IF ORIGINATING

10 SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN

11 SITES’’; and 

12 (2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 

13 inserting ‘‘subclause (X) or (XII) of paragraph 

14 (4)(C)’’. 


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1 TITLE IX—ACCOUNTABILITY 

2 AND EVALUATION 

3 SEC. 9001. PROHIBITION ON DISCRIMINATION IN FEDERAL 

4 ASSISTED HEALTH CARE SERVICES AND RE5 SEARCH ON THE BASIS OF SEX (INCLUDING 

6 SEXUAL ORIENTATION, GENDER IDENTITY, 

7 AND PREGNANCY, INCLUDING TERMINATION 

8 OF PREGNANCY), RACE, COLOR, NATIONAL 

9 ORIGIN, MARITAL STATUS, FAMILIAL STATUS, 

10 OR DISABILITY STATUS. 

11 (a) IN GENERAL.—No person in the United States 

12 shall, on the basis of sex (including sexual orientation, 

13 gender identity, and pregnancy, including termination of 

14 pregnancy), race, color, national origin, marital status, fa15 milial status, sexual orientation, gender identity, or dis16 ability status, be excluded from participation in, be denied 

17 the benefits of, or be subjected to discrimination under— 

18 (1) any health program or activity, including 

19 any health research program or activity, receiving 

20 Federal financial assistance, including credits, sub21 sidies, or contracts of insurance; or 

22 (2) any health program or activity that is ad23 ministered by an executive agency. 

24 (b) DEFINITION.—In this section, the term ‘‘familial 

25 status’’ means, with respect to one or more individuals— 


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1 (1) being domiciled with any individual related 

2 by blood or affinity whose close association with the 

3 individual is the equivalent of a family relationship; 

4 (2) being in the process of securing legal cus5 tody of any individual; or 

6 (3) being pregnant. 

7 SEC. 9002. TREATMENT OF MEDICARE PAYMENTS UNDER 

8 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 

9 For the purposes of title VI of the Civil Rights Act 

10 of 1964 (42 U.S.C. 2000d et seq.), a payment made under 

11 part A, B, C, or D of title XVIII of the Social Security 

12 Act (42 U.S.C. 1395 et seq.) to a provider of services, 

13 physician, or other supplier (including a payment made 

14 to a subcontractor of the provider of services, physician, 

15 or other supplier) shall be deemed a grant, not a contract 

16 of insurance or guaranty. 

17 SEC. 9003. ACCOUNTABILITY AND TRANSPARENCY WITHIN 

18 THE DEPARTMENT OF HEALTH AND HUMAN 

19 SERVICES. 

20 Title XXXIV of the Public Health Service Act, as 

21 amended by titles I, II, III, and IV of this Act, is further 

22 amended by inserting after subtitle D the following: 


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1 ‘‘Subtitle E—Strengthening 

2 Accountability 

3 ‘‘SEC. 3451. ELEVATION OF THE OFFICE FOR CIVIL RIGHTS 

4 AND HEALTH EQUITY. 

5 ‘‘(a) IN GENERAL.— 

6 ‘‘(1) NAME OF OFFICE.—Beginning on the date 

7 of enactment of this subtitle, the Office for Civil 

8 Rights of the Department of Health and Human 

9 Services shall be known as the ‘Office for Civil 

10 Rights and Health Equity’ of the Department of 

11 Health and Human Services. Any reference to the 

12 Office for Civil Rights of the Department of Health 

13 and Human Services in any law, regulation, map, 

14 document, record, or other paper of the United 

15 States shall be deemed to be a reference to the Of16 fice for Civil Rights and Health Equity. 

17 ‘‘(2) HEAD OF OFFICE.—The head of the Office 

18 for Civil Rights and Health Equity shall be the Di19 rector for Civil Rights and Health Equity, to be ap20 pointed by the President. Any reference to the Di21 rector of the Office for Civil Rights of the Depart22 ment of Health and Human Services in any law, 

23 regulation, map, document, record, or other paper of 

24 the United States shall be deemed to be a reference 

25 to the Director for Civil Rights and Health Equity. 


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1 ‘‘(b) PURPOSE.—The Director for Civil Rights and 

2 Health Equity shall ensure that the health programs, ac3 tivities, policies, projects, procedures, and operations of 

4 health entities that receive Federal financial assistance are 

5 in compliance with title VI of the Civil Rights Act of 1964 

6 (42 U.S.C. 2000d et seq.), including through the following 

7 activities: 

8 ‘‘(1) The development and implementation of 

9 an action plan to address racial and ethnic health 

10 care disparities. Such plan shall— 

11 ‘‘(A) address concerns relating to the Of12 fice for Civil Rights and Health Equity as re13 leased by the United States Commission on 

14 Civil Rights in the report entitled ‘Health Care 

15 Challenge: Acknowledging Disparity, Con16 fronting Discrimination, and Ensuring Equity’ 

17 (September 1999), in conjunction with existing 

18 and future reports of the National Academy of 

19 Medicine (formerly known as the Institute of 

20 Medicine) including the reports titled ‘Unequal 

21 Treatment: Confronting Racial and Ethnic Dis22 parities in Health Care’, ‘Crossing the Quality 

23 Chasm: A New Health System for the 21st 

24 Century’, ‘In the Nation’s Compelling Interest: 

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1 force’, ‘The National Partnership for Action to 

2 End Health Disparities’, and ‘The Health of 

3 Lesbian, Gay, Bisexual, and Transgender Peo4 ple’, and other related reports of the National 

5 Academies of Sciences, Engineering, and Medi6 cine; 

7 ‘‘(B) be issued in proposed form for public 

8 review and comment; and 

9 ‘‘(C) be finalized taking into consideration 

10 any comments or concerns that are received by 

11 the Office. 

12 ‘‘(2) Investigative and enforcement actions 

13 against intentional or in effect discrimination and 

14 policies and practices that have a disparate impact 

15 on racial or ethnic minorities and communities of 

16 color pursuant to section 9007 of the Health Equity 

17 and Accountability Act of 2022. 

18 ‘‘(3) The review of racial, ethnic, gender iden19 tity, sexual orientation, sex, disability status, socio20 economic status, and primary language health data 

21 collected by Federal health agencies to assess health 

22 care disparities related to intentional discrimination 

23 and policies and practices that have a disparate im24 pact on minorities. Such review shall include an asVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01600 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 sessment of health disparities in communities with a 

2 combination of these classes. 

3 ‘‘(4) Outreach and education activities relating 

4 to compliance with title VI of the Civil Rights Act 

5 of 1964, including the process of filing a complaint 

6 in accordance with section 9007 of the Health Eq7 uity and Accountability Act of 2022. 

8 ‘‘(5) The provision of technical assistance for 

9 health entities to facilitate compliance with title VI 

10 of the Civil Rights Act of 1964. 

11 ‘‘(6) Coordination and oversight of activities of 

12 the civil rights compliance offices established under 

13 section 3452. 

14 ‘‘(7) Ensuring— 

15 ‘‘(A) at a minimum, compliance with the 

16 most recent version of the Office of Manage17 ment and Budget statistical policy directive en18 titled ‘Standards for Maintaining, Collecting, 

19 and Presenting Federal Data on Race and Eth20 nicity’; and 

21 ‘‘(B) consideration of available data and 

22 language standards such as— 

23 ‘‘(i) the standards for collecting, mon24 itoring, and reporting data under section 

25 3101; and 


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1 ‘‘(ii) the National Standards on Cul2 turally and Linguistically Appropriate 

3 Services of the Office of Minority Health. 

4 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en5 sure the effectiveness of the Office for Civil Rights and 

6 Health Equity by ensuring that the Office is provided 

7 with— 

8 ‘‘(1) adequate funding to enable the Office to 

9 carry out its duties under this section; and 

10 ‘‘(2) staff with expertise in— 

11 ‘‘(A) epidemiology; 

12 ‘‘(B) statistics; 

13 ‘‘(C) health quality assurance; 

14 ‘‘(D) minority health and health dispari15 ties; 

16 ‘‘(E) health equity; 

17 ‘‘(F) cultural and linguistic competency; 

18 ‘‘(G) civil rights; and 

19 ‘‘(H) social, political, mental, behavioral, 

20 economic, and related determinants of health, 

21 including education access and quality, health 

22 care access and quality, neighborhood and built 

23 environment, and social and community context. 

24 ‘‘(d) ADVISORY BOARD.— 


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1 ‘‘(1) ESTABLISHMENT.—The Secretary, in col2 laboration with the Director Civil Rights and Health 

3 Equity and the Deputy Assistant Secretary for Mi4 nority Health, shall establish an advisory board (in 

5 this subsection referred to as the ‘advisory board’) 

6 to report in accordance with paragraph (2). 

7 ‘‘(2) REPORTS TO CONGRESS.—Not later than 

8 December 31, 2023, and annually thereafter, the ad9 visory board shall publish and submit to the Office, 

10 other Federal agencies, and the Congress a report 

11 that includes— 

12 ‘‘(A) the number of complaints filed in ac13 cordance with section 9007 of the Health Eq14 uity and Accountability Act of 2022 during the 

15 reporting period under title VI of the Civil 

16 Rights Act of 1964, broken down by category; 

17 ‘‘(B) the number of such complaints inves18 tigated and closed by the Office; 

19 ‘‘(C) the outcomes of such complaints in20 vestigated; 

21 ‘‘(D) the staffing levels of the Office, in22 cluding staff credentials; 

23 ‘‘(E) the number of such complaints that 

24 are pending (including backlogged complaints) 

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1 onstrated and an explanation of why such com2 plaints remain pending; and 

3 ‘‘(F) trends among filed complaints and 

4 other systemic patterns or themes, including an 

5 analysis from the Department of Justice about 

6 litigation concerning such complaints. 

7 ‘‘(3) COMPOSITION.—The members of the advi8 sory board shall include— 

9 ‘‘(A) representatives of stakeholders; and 

10 ‘‘(B) subject matter- and disciplinary-ap11 propriate experts. 

12 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 such sums as may be necessary for each of fiscal years 

15 2023 through 2027. 

16 ‘‘SEC. 3452. ESTABLISHMENT OF HEALTH PROGRAM OF17 FICES FOR CIVIL RIGHTS WITHIN AGENCIES 

18 OF DEPARTMENT OF HEALTH AND HUMAN 

19 SERVICES. 

20 ‘‘(a) IN GENERAL.—The Secretary shall establish 

21 civil rights compliance offices in each agency within the 

22 Department of Health and Human Services that admin23 isters health programs. 

24 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

25 under subsection (a) shall ensure that recipients of FedVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01604 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 eral financial assistance under Federal health programs 

2 administer programs, and determine and implement poli3 cies, services, and activities, in a manner that— 

4 ‘‘(1) does not discriminate, either intentionally 

5 or in effect, on the basis of race, color, national ori6 gin, language, ethnicity, sex, age, disability status, 

7 sexual orientation, or gender identity; and 

8 ‘‘(2) promotes the reduction and elimination of 

9 disparities in health and health care based on race, 

10 color, national origin, language, ethnicity, sex, age, 

11 disability status, sexual orientation, or gender iden12 tity. 

13 ‘‘(c) POWERS AND DUTIES.—The offices established 

14 in subsection (a) shall, with respect to the applicable agen15 cy, have the following powers and duties: 

16 ‘‘(1) The establishment of compliance and pro17 gram participation standards for recipients of Fed18 eral financial assistance under each program admin19 istered by the agency, including the establishment of 

20 disparity reduction standards to encompass dispari21 ties in health and health care related to race, color, 

22 national origin, language, ethnicity, sex, age, dis23 ability, sexual orientation, or gender identity. 

24 ‘‘(2) The development and implementation of 

25 policies, procedures, and program-specific guidelines 


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1 that interpret and apply Department of Health and 

2 Human Services guidance under title VI of the Civil 

3 Rights Act of 1964 and section 1557 of the Patient 

4 Protection and Affordable Care Act to each Federal 

5 health program administered by the agency. 

6 ‘‘(3) The development of a disparity-reduction 

7 impact analysis methodology that shall— 

8 ‘‘(A) be applied to every rule issued by the 

9 agency and published as part of the formal 

10 rulemaking process under sections 555, 556, 

11 and 557 of title 5, United States Code; and 

12 ‘‘(B) include an analysis of the intersecting 

13 forms of discrimination. 

14 ‘‘(4) Oversight of data collection, reporting, 

15 analysis, and publication requirements for all recipi16 ents of Federal financial assistance under each Fed17 eral health program administered by the agency, 

18 compliance with, at a minimum, the most recent 

19 version of the Office of Management and Budget 

20 statistical policy directive entitled ‘Standards for 

21 Maintaining, Collecting, and Presenting Federal 

22 Data on Race and Ethnicity’, and consideration of 

23 available data and language standards such as— 

24 ‘‘(A) the standards for collecting and re25 porting data under section 3101; 


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1 ‘‘(B) the National Standards on Culturally 

2 and Linguistically Appropriate Services of the 

3 Office of Minority Health; and 

4 ‘‘(C) the disaggregation of all health and 

5 health care data by racial and ethnic minority 

6 population group. 

7 ‘‘(5) The conduct of publicly available studies 

8 regarding discrimination within Federal health pro9 grams administered by the agency as well as dis10 parity reduction initiatives by recipients of Federal 

11 financial assistance under Federal health programs. 

12 ‘‘(6) Annual reports to the Committee on 

13 Health, Education, Labor, and Pensions and the 

14 Committee on Finance of the Senate and the Com15 mittee on Energy and Commerce and the Committee 

16 on Ways and Means of the House of Representatives 

17 on the progress in reducing disparities in health and 

18 health care through the Federal programs adminis19 tered by the agency. 

20 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

21 IN THE DEPARTMENT OF JUSTICE.— 

22 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

23 SERVICES.—The Office for Civil Rights of the De24 partment of Health and Human Services shall pro25 vide standard-setting and compliance review invesVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01607 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tigation support services to each civil rights compli2 ance office established under subsection (a), subject 

3 to paragraph (2). 

4 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

5 for Civil Rights of the Department of Justice may, 

6 as appropriate, institute formal proceedings when a 

7 civil rights compliance office established under sub8 section (a) determines that a recipient of Federal fi9 nancial assistance is not in compliance with the dis10 parity reduction standards of the applicable agency. 

11 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

12 health programs’ mean programs— 

13 ‘‘(1) under the Social Security Act (42 U.S.C. 

14 301 et seq.) that pay for health care and services; 

15 and 

16 ‘‘(2) under this Act that— 

17 ‘‘(A) provide Federal financial assistance 

18 for health care, biomedical research, or health 

19 services research; or 

20 ‘‘(B) are designed to improve the public’s 

21 health, including health service programs.’’. 

22 SEC. 9004. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

23 (a) COORDINATION WITHIN DEPARTMENT OF JUS24 TICE OF ACTIVITIES REGARDING HEALTH DISPARIVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01608 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 TIES.—Section 3(a) of the Civil Rights Commission Act 

2 of 1983 (42 U.S.C. 1975a(a)) is amended— 

3 (1) in paragraph (1), by striking ‘‘and’’ at the 

4 end; 

5 (2) in paragraph (2), by striking the period at 

6 the end and inserting ‘‘; and’’; and 

7 (3) by adding at the end the following: 

8 ‘‘(3) shall, with respect to activities carried out 

9 in health care and correctional facilities, toward the 

10 goal of eliminating health disparities between the 

11 general population and members of minority groups 

12 based on race or color, promote coordination of such 

13 activities of— 

14 ‘‘(A) the Office of Justice Programs of the 

15 Department of Justice, including the Office for 

16 Civil Rights within that Office; 

17 ‘‘(B) the Office for Civil Rights within the 

18 Department of Health and Human Services; 

19 and 

20 ‘‘(C) the Office of Minority Health within 

21 the Department of Health and Human Serv22 ices.’’. 

23 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

24 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

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1 serting the following: ‘‘For the purpose of carrying out 

2 this Act, there are authorized to be appropriated 

3 $30,000,000 for fiscal year 2023, and such sums as may 

4 be necessary for each of the fiscal years 2024 through 

5 2028.’’. 

6 SEC. 9005. SENSE OF CONGRESS CONCERNING FULL FUND7 ING OF ACTIVITIES TO ELIMINATE RACIAL 

8 AND ETHNIC HEALTH DISPARITIES. 

9 (a) FINDINGS.—Congress finds the following: 

10 (1) The health status of the population of the 

11 United States is declining, and the United States 

12 currently ranks below most industrialized nations in 

13 health status measured by longevity, sickness, and 

14 mortality. 

15 (2) Racial and ethnic minority populations tend 

16 to have the poorest health status and face substan17 tial cultural, social, political, and economic barriers 

18 to obtaining high-quality health care. 

19 (3) Racial and ethnic minority populations ex20 perience and suffer from the extreme and egregious 

21 health disparities and inequities that are caused by 

22 racism, discrimination, and implicit racial and ethnic 

23 bias in and throughout the health care system. 

24 (4) Communities of color with intersecting iden25 tities and backgrounds, including children, older 


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1 adults, women, people with disabilities, people with 

2 limited English proficiency, immigrants, lesbian, 

3 gay, bisexual, transgender, queer, and questioning 

4 populations, and people with lower incomes experi5 ence significant personal and structural barriers to 

6 obtaining affordable, high-quality health care. 

7 (5) Efforts to reduce and eliminate racial and 

8 ethnic health disparities and inequities, and improve 

9 minority health, have been limited by inadequate re10 sources (such as funding, staffing, and stewardship), 

11 a lack of prioritization, and a lack of accountability 

12 from the Federal Government, particularly due to 

13 stagnant or declining appropriations that are not in 

14 line with the dire need faced by communities that 

15 are impacted. 

16 (b) SENSE OF CONGRESS.—It is the sense of the 

17 Congress that— 

18 (1) health disparities negatively impact out19 comes for health and human security of the Nation; 

20 (2) reducing racial, ethnic, age, sexual, and 

21 gender disparities in prevention and treatment are 

22 unique civil and human rights challenges and, as 

23 such, Federal agencies and health care entities and 

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1 able for their role in causing disparities and in2 equity; 

3 (3) funding for the National Institute on Mi4 nority Health and Health Disparities, the Office of 

5 Civil Rights in the Department of Health and 

6 Human Services, the National Institute of Nursing 

7 Research, and the Office of Minority Health should 

8 be doubled by fiscal year 2023, to effectively address 

9 racial and ethnic disparities elimination in health 

10 and health care as a matter of health and national 

11 security; 

12 (4) adequate funding by fiscal year 2023, and 

13 subsequent funding increases, should be provided for 

14 health and human service professions training pro15 grams, the Racial and Ethnic Approaches to Com16 munity Health Initiative at the Centers for Disease 

17 Control and Prevention, the Minority HIV/AIDS 

18 Initiative, the Excellence Centers to Eliminate Eth19 nic/Racial Disparities Program at the Agency for 

20 Healthcare Research and Quality, and the National 

21 Health Service Corps Scholarship Program initia22 tives, programs, policies, projects, and activities that 

23 are the backbone of the Nation’s agenda to eliminate 

24 racial and ethnic health disparities and inequities; 


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1 (5) adequate funding for fiscal year 2023 and 

2 increased funding for future years should be pro3 vided for the Racial and Ethnic Approaches to Com4 munity Health Initiative’s United States Risk Fac5 tor Survey to ensure adequate data collection to 

6 track health disparities, and there should be appro7 priate avenues provided to disseminate findings to 

8 the general public; 

9 (6) current and newly created health disparity 

10 elimination incentives, programs, agencies, and de11 partments under this Act (and the amendments 

12 made by this Act) should receive adequate staffing 

13 and funding by fiscal year 2023; and 

14 (7) stewardship and accountability should be 

15 provided to the Congress and the President for 

16 measurable and sustainable progress toward health 

17 disparity elimination under programs under this Act, 

18 including increased data collection and reporting, ca19 pacity building for impacted communities, technical 

20 assistance, training programs, and avenues to dis21 seminate program details and successes to the public 

22 and to policymakers. 

23 SEC. 9006. GAO AND NIH REPORTS. 

24 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH25 NIC DIVERSITY.— 


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1 (1) IN GENERAL.—The Comptroller General of 

2 the United States shall conduct a study on the racial 

3 and ethnic diversity among the following groups: 

4 (A) All applicants for grants, contracts, 

5 and cooperative agreements awarded by the Na6 tional Institutes of Health during the period be7 ginning on January 1, 2023, and ending De8 cember 31, 2032. 

9 (B) All recipients of such grants, con10 tracts, and cooperative agreements during such 

11 period. 

12 (C) All members of the peer review panels 

13 of such applicants and recipients, respectively. 

14 (2) REPORT.—Not later than 6 months after 

15 the date of enactment of this Act, the Comptroller 

16 General shall complete the study under paragraph 

17 (1) and submit to the Congress a report containing 

18 the results of such study. 

19 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA20 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH

21 DISPARITIES.—Not later than 6 months after the date of 

22 enactment of this Act, and biennially thereafter, the Direc23 tor of the National Institutes of Health, in collaboration 

24 with the Director of the National Institute on Minority 


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1 Health and Health Disparities, shall submit to the Con2 gress a report that details and evaluates— 

3 (1) the steps taken during the applicable report 

4 period by the Director of the National Institutes of 

5 Health to plan, coordinate, review, and evaluate all 

6 minority health and health disparity research that is 

7 conducted or supported by the institutes and centers 

8 at the National Institutes of Health; and 

9 (2) the outcomes of such steps. 

10 (c) GAO REPORT RELATED TO RECIPIENTS OF

11 PPACA FUNDING.—Not later than one year after the 

12 date of enactment of this Act and biennially thereafter, 

13 the Comptroller General of the United States shall submit 

14 to the Congress a report that identifies— 

15 (1) the racial and ethnic diversity of commu16 nity-based organizations that applied for Federal en17 rollment funding provided pursuant to the Patient 

18 Protection and Affordable Care Act (Public Law 

19 111–148) (including the amendments made by such 

20 Act); 

21 (2) the percentage of such organizations that 

22 were awarded such funding; and 

23 (3) the impact of such community-based organi24 zations’ enrollment efforts on the insurance status of 

25 their communities. 


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1 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL

2 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS3 PARITIES.—The Director of the National Institute on Mi4 nority Health and Health Disparities shall prepare an an5 nual report on the activities carried out or to be carried 

6 out by such institute, and shall submit each such report 

7 to the Committee on Health, Education, Labor, and Pen8 sions of the Senate, the Committee on Energy and Com9 merce of the House of Representatives, the Secretary of 

10 Health and Human Services, and the Director of the Na11 tional Institutes of Health. With respect to the fiscal year 

12 involved, the report shall— 

13 (1) describe and evaluate the progress made in 

14 health disparities research conducted or supported 

15 by institutes and centers of the National Institutes 

16 of Health; 

17 (2) summarize and analyze expenditures made 

18 for activities with respect to health disparities re19 search conducted or supported by the National Insti20 tutes of Health; 

21 (3) include a separate statement applying the 

22 requirements of paragraphs (1) and (2) specifically 

23 to minority health disparities research; and 

24 (4) contain such recommendations as the Direc25 tor of the Institute considers appropriate. 


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1 SEC. 9007. INVESTIGATIVE AND ENFORCEMENT ACTIONS. 

2 (a) IN GENERAL.—In carrying out the investigative 

3 and enforcement actions of section 3451(b)(2) of the Pub4 lic Health Service Act, as added by section 9003 of this 

5 Act, the Director for Civil Rights and Health Equity (re6 ferred to in this section as the ‘‘Director’’) shall pursue 

7 such investigative and enforcement actions pursuant to 

8 this section. 

9 (b) ADMINISTRATIVE COMPLAINT AND CONCILIATION

10 PROCESS.— 

11 (1) COMPLAINTS AND ANSWERS.— 

12 (A) IN GENERAL.—An aggrieved person 

13 may, not later than 1 year after an alleged vio14 lation of subsection (a) has occurred or con15 cluded, file a complaint with the Director alleg16 ing inequitable provision of health care by a 

17 provider described in subsection (a). 

18 (B) COMPLAINT.—A complaint submitted 

19 pursuant to subparagraph (A) shall be in writ20 ing and shall contain such information and be 

21 in such form as the Director requires. 

22 (C) OATH OR AFFIRMATION.—The com23 plaint and any answer made under this sub24 section shall be made under oath or affirmation, 

25 and may be reasonably and fairly modified at 

26 any time. 


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1 (2) RESPONSE TO COMPLAINTS.— 

2 (A) IN GENERAL.—Upon the filing of a 

3 complaint under this subsection, the following 

4 procedures shall apply: 

5 (i) COMPLAINANT NOTICE.—The Di6 rector shall serve notice upon the com7 plainant acknowledging receipt of such fil8 ing and advising the complainant of the 

9 time limits and procedures provided under 

10 this section. 

11 (ii) RESPONDENT NOTICE.—The Di12 rector shall, not later than 30 days after 

13 receipt of such filing— 

14 (I) serve on the respondent a no15 tice of the complaint, together with a 

16 copy of the original complaint; and 

17 (II) advise the respondent of the 

18 procedural rights and obligations of 

19 respondents under this section. 

20 (iii) ANSWER.—The respondent may 

21 file, not later than 60 days after receipt of 

22 the notice from the Director, an answer to 

23 such complaint. 

24 (iv) INVESTIGATIVE DUTIES.—The Di25 rector shall— 


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1 (I) make an investigation of the 

2 alleged inequitable provision of health 

3 care; and 

4 (II) complete such investigation 

5 within 180 days (unless it is impracti6 cable to complete such investigation 

7 within 180 days) after the filing of 

8 the complaint. 

9 (B) INVESTIGATIONS.— 

10 (i) PATTERN OR PRACTICE.—In the 

11 course of investigating the complaint, the 

12 Director may seek records of care provided 

13 to patients other than the complainant if 

14 necessary to demonstrate or disprove an 

15 allegation of inequitable provision of health 

16 care or to determine whether there is a 

17 pattern or practice of such care. 

18 (ii) ACCOUNTING FOR SOCIAL DETER19 MINANTS OF HEALTH.—In investigating 

20 the complaint and reaching a determina21 tion on the validity of the complaint, the 

22 Director shall account for social deter23 minants of health and the effect of such 

24 social determinants on health care out25 comes. 


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1 (iii) INABILITY TO COMPLETE INVES2 TIGATION.—If the Director is unable to 

3 complete (or finds it is impracticable to 

4 complete) the investigation within 180 

5 days after the filing of the complaint (or, 

6 if the Secretary takes further action under 

7 paragraph (6)(B) with respect to a com8 plaint, within 180 days after the com9 mencement of such further action), the Di10 rector shall notify the complainant and re11 spondent in writing of the reasons in12 volved. 

13 (C) REPORT.— 

14 (i) FINAL REPORT.—On completing 

15 each investigation under this paragraph, 

16 the Director shall prepare a final investiga17 tive report. 

18 (ii) MODIFICATION OF REPORT.—A 

19 final report under this subparagraph may 

20 be modified if additional evidence is later 

21 discovered. 

22 (3) CONCILIATION.— 

23 (A) IN GENERAL.—During the period be24 ginning on the date on which a complaint is 

25 filed under this subsection and ending on the 


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1 date of final disposition of such complaint (in2 cluding during an investigation under para3 graph (2)(B)), the Director shall, to the extent 

4 feasible, engage in conciliation with respect to 

5 such complaint. 

6 (B) CONCILIATION AGREEMENT.—A con7 ciliation agreement arising out of such concilia8 tion shall be an agreement between the re9 spondent and the complainant, and shall be 

10 subject to approval by the Director. 

11 (C) RIGHTS PROTECTED.—The Director 

12 shall approve a conciliation agreement only if 

13 the agreement protects the rights of the com14 plainant and other persons similarly situated. 

15 (D) PUBLICLY AVAILABLE AGREEMENT.— 

16 (i) IN GENERAL.—Subject to clause 

17 (ii), the Secretary shall make available to 

18 the public a copy of a conciliation agree19 ment entered into pursuant to this sub20 section unless the complainant and re21 spondent otherwise agree, and the Sec22 retary determines, that disclosure is not re23 quired to further the purposes of this sub24 section. 


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1 (ii) LIMITATION.—A conciliation 

2 agreement that is made available to the 

3 public pursuant to clause (i) may not dis4 close individually identifiable health infor5 mation. 

6 (4) FAILURE TO COMPLY WITH CONCILIATION

7 AGREEMENT.—Whenever the Director has reason8 able cause to believe that a respondent has breached 

9 a conciliation agreement, the Director shall refer the 

10 matter to the Attorney General to consider filing a 

11 civil action to enforce such agreement. 

12 (5) WRITTEN CONSENT FOR DISCLOSURE OF

13 INFORMATION.—Nothing said or done in the course 

14 of conciliation under this subsection may be made 

15 public, or used as evidence in a subsequent pro16 ceeding under this subsection, without the written 

17 consent of the parties to the conciliation. 

18 (6) PROMPT JUDICIAL ACTION.— 

19 (A) IN GENERAL.—If the Director deter20 mines at any time following the filing of a com21 plaint under this subsection that prompt judi22 cial action is necessary to carry out the pur23 poses of this subsection, the Director may rec24 ommend that the Attorney General promptly 

25 commence a civil action under subsection (d). 


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1 (B) IMMEDIATE SUIT.—If the Director de2 termines at any time following the filing of a 

3 complaint under this subsection that the public 

4 interest would be served by allowing the com5 plainant to bring a civil action under subsection 

6 (c) in a State or Federal court immediately, the 

7 Director shall certify that the administrative 

8 process has concluded and that the complainant 

9 may file such a suit immediately. 

10 (7) ANNUAL REPORT.—Not later than 1 year 

11 after the date of enactment of this Act, and annually 

12 thereafter, the Director shall make publicly available 

13 a report detailing the activities of the Office for Civil 

14 Rights and Health Equity under this subsection, in15 cluding— 

16 (A) the number of complaints filed and the 

17 basis on which the complaints were filed; 

18 (B) the number of investigations under19 taken as a result of such complaints; and 

20 (C) the disposition of all such investiga21 tions. 

22 (c) ENFORCEMENT BY PRIVATE PERSONS.— 

23 (1) IN GENERAL.— 

24 (A) CIVIL ACTION.— 


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1 (i) IN SUIT.—A complainant under 

2 subsection (b) may commence a civil action 

3 to obtain appropriate relief with respect to 

4 an alleged violation of subsection (a), or 

5 for breach of a conciliation agreement 

6 under subsection (b), in an appropriate 

7 district court of the United States or State 

8 court— 

9 (I) not sooner than the earliest 

10 of— 

11 (aa) the date a conciliation 

12 agreement is reached under sub13 section (b); 

14 (bb) the date of a final dis15 position of a complaint under 

16 subsection (b); or 

17 (cc) 180 days after the first 

18 day of the alleged violation; and 

19 (II) not later than 2 years after 

20 the final day of the alleged violation. 

21 (ii) STATUTE OF LIMITATIONS.—The 

22 computation of such 2-year period shall 

23 not include any time during which an ad24 ministrative proceeding (including inves25 tigation or conciliation) under subsection 


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1 (b) was pending with respect to a com2 plaint under such subsection. 

3 (B) BARRING SUIT.—If the Director has 

4 obtained a conciliation agreement under sub5 section (b) regarding an alleged violation of 

6 subsection (a), no action may be filed under 

7 this paragraph by the complainant involved 

8 with respect to the alleged violation except for 

9 the purpose of enforcing the terms of such an 

10 agreement. 

11 (2) RELIEF WHICH MAY BE GRANTED.— 

12 (A) IN GENERAL.—In a civil action under 

13 paragraph (1), if the court finds that a viola14 tion of subsection (a) or breach of a conciliation 

15 agreement has occurred, the court may award 

16 to the plaintiff actual and punitive damages, 

17 and may grant as relief, as the court deter18 mines to be appropriate, any permanent or tem19 porary injunction, temporary restraining order, 

20 or other order (including an order enjoining the 

21 defendant from engaging in a practice violating 

22 subsection (a) or ordering such affirmative ac23 tion as may be appropriate). 

24 (B) FEES AND COSTS.—In a civil action 

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1 tion, may allow the prevailing party, other than 

2 the United States, a reasonable attorney’s fee 

3 and costs. The United States shall be liable for 

4 such fees and costs to the same extent as a pri5 vate person. 

6 (3) INTERVENTION BY ATTORNEY GENERAL.— 

7 Upon timely application, the Attorney General may 

8 intervene in a civil action under paragraph (1), if 

9 the Attorney General certifies that the case is of 

10 general public importance. 

11 (d) ENFORCEMENT BY THE ATTORNEY GENERAL.— 

12 (1) COMMENCEMENT OF ACTIONS.— 

13 (A) PATTERN OR PRACTICE CASES.—The 

14 Attorney General may commence a civil action 

15 in any appropriate district court of the United 

16 States if the Attorney General has reasonable 

17 cause to believe that any health care provider 

18 covered by subsection (a)— 

19 (i) is engaged in a pattern or practice 

20 that violates such subsection; or 

21 (ii) is engaged in a violation of such 

22 subsection that raises an issue of signifi23 cant public importance. 

24 (B) CASES BY REFERRAL.—The Director 

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1 plaints, a pattern of violations, a review of data 

2 reported by a health care provider covered by 

3 subsection (a), or any other means, that there 

4 is reasonable cause to believe a health care pro5 vider is engaged in a pattern or practice that 

6 violates subsection (a). If the Director makes 

7 such a determination, the Director shall refer 

8 the related findings to the Attorney General. If 

9 the Attorney General finds that such reasonable 

10 cause exists, the Attorney General may com11 mence a civil action in any appropriate district 

12 court of the United States. 

13 (2) ENFORCEMENT OF SUBPOENAS.—The At14 torney General, on behalf of the Director, or another 

15 party at whose request a subpoena is issued under 

16 this subsection, may enforce such subpoena in ap17 propriate proceedings in the district court of the 

18 United States for the district in which the person to 

19 whom the subpoena was addressed resides, was 

20 served, or transacts business. 

21 (3) RELIEF WHICH MAY BE GRANTED IN CIVIL

22 ACTIONS.— 

23 (A) IN GENERAL.—In a civil action under 

24 paragraph (1), the court— 


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1 (i) may award such preventive relief, 

2 including a permanent or temporary in3 junction, temporary restraining order, or 

4 other order against the person responsible 

5 for a violation of subsection (a) as is nec6 essary to assure the full enjoyment of the 

7 rights granted by this subsection; 

8 (ii) may award such other relief as the 

9 court determines to be appropriate, includ10 ing monetary damages, to aggrieved per11 sons; and 

12 (iii) may, to vindicate the public inter13 est, assess punitive damages against the 

14 respondent— 

15 (I) in an amount not exceeding 

16 $500,000, for a first violation; and 

17 (II) in an amount not exceeding 

18 $1,000,000, for any subsequent viola19 tion. 

20 (B) FEES AND COSTS.—In a civil action 

21 under this subsection, the court, in its discre22 tion, may allow the prevailing party, other than 

23 the United States, a reasonable attorney’s fee 

24 and costs. The United States shall be liable for 


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1 such fees and costs to the extent provided by 

2 section 2412 of title 28, United States Code. 

3 (4) INTERVENTION IN CIVIL ACTIONS.—Upon 

4 timely application, any person may intervene in a 

5 civil action commenced by the Attorney General 

6 under paragraphs (1) and (2) if the action involves 

7 an alleged violation of subsection (a) with respect to 

8 which such person is an aggrieved person (including 

9 a person who is a complainant under subsection (b)) 

10 or a conciliation agreement to which such person is 

11 a party. 

12 SEC. 9008. FEDERAL HEALTH EQUITY COMMISSION. 

13 (a) ESTABLISHMENT OF COMMISSION.— 

14 (1) IN GENERAL.—There is established the 

15 Federal Health Equity Commission (hereinafter in 

16 this section referred to as the ‘‘Commission’’). 

17 (2) MEMBERSHIP.— 

18 (A) IN GENERAL.—The Commission shall 

19 be composed of— 

20 (i) 8 voting members appointed under 

21 subparagraph (B); and 

22 (ii) the nonvoting, ex officio members 

23 listed in subparagraph (C). 

24 (B) VOTING MEMBERS.—Not more than 4 

25 of the members described in subparagraph 


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1 (A)(i) shall at any one time be of the same po2 litical party. Such members shall have recog3 nized expertise in and personal experience with 

4 racial and ethnic health inequities, health care 

5 needs of vulnerable and marginalized popu6 lations, and health equity as a vehicle for im7 proving health status and health outcomes. 

8 Such members shall be appointed to the Com9 mission as follows: 

10 (i) Four members of the Commission 

11 shall be appointed by the President. 

12 (ii) Two members of the Commission 

13 shall be appointed by the President pro 

14 tempore of the Senate, upon the rec15 ommendations of the majority leader and 

16 the minority leader of the Senate. Each 

17 member appointed to the Commission 

18 under this clause shall be appointed from 

19 a different political party. 

20 (iii) Two members of the Commission 

21 shall be appointed by the Speaker of the 

22 House of Representatives upon the rec23 ommendations of the majority leader and 

24 the minority leader of the House of Rep25 resentatives. Each member appointed to 


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1 the Commission under this clause shall be 

2 appointed from a different political party. 

3 (C) EX OFFICIO MEMBER.—The Commis4 sion shall have the following nonvoting, ex offi5 cio members: 

6 (i) The Director for Civil Rights and 

7 Health Equity of the Department of 

8 Health and Human Services. 

9 (ii) The Deputy Assistant Secretary 

10 for Minority Health of the Department of 

11 Health and Human Services. 

12 (iii) The Director of the National In13 stitute on Minority Health and Health Dis14 parities. 

15 (iv) The Chairperson of the Advisory 

16 Committee on Minority Health established 

17 under section 1707(c) of the Public Health 

18 Service Act (42 U.S.C. 300u–6(c)). 

19 (3) TERMS.—The term of office of each mem20 ber appointed under paragraph (2)(B) of the Com21 mission shall be 6 years. 

22 (4) CHAIRPERSON; VICE CHAIRPERSON.— 

23 (A) CHAIRPERSON.—The President shall, 

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1 graph (2)(B), designate a Chairperson from 

2 among the members of the Commission ap3 pointed under such paragraph. 

4 (B) VICE CHAIRPERSON.— 

5 (i) DESIGNATION.—The Speaker of 

6 the House of Representatives shall, in con7 sultation with the majority leaders and the 

8 minority leaders of the Senate and the 

9 House of Representatives and with the 

10 concurrence of a majority of the members 

11 of the Commission appointed under para12 graph (2)(B), designate a Vice Chairperson 

13 from among the members of the Commis14 sion appointed under such paragraph. The 

15 Vice Chairperson may not be a member of 

16 the same political party as the Chair17 person. 

18 (ii) DUTY.—The Vice Chairperson 

19 shall act in place of the Chairperson in the 

20 absence of the Chairperson. 

21 (5) REMOVAL OF MEMBERS.—The President 

22 may remove a member of the Commission only for 

23 neglect of duty or malfeasance in office. 

24 (6) QUORUM.—A majority of members of the 

25 Commission appointed under paragraph (2)(B) shall 


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1 constitute a quorum of the Commission, but a lesser 

2 number of members may hold hearings. 

3 (b) DUTIES OF THE COMMISSION.— 

4 (1) IN GENERAL.—The Commission shall— 

5 (A) monitor and report on the implementa6 tion of this Act; and 

7 (B) investigate, monitor, and report on 

8 progress towards health equity and the elimi9 nation of health disparities. 

10 (2) ANNUAL REPORT.—The Commission 

11 shall— 

12 (A) submit to the President and Congress 

13 at least one report annually on health equity 

14 and health disparities; and 

15 (B) include in such report— 

16 (i) a description of actions taken by 

17 the Department of Health and Human 

18 Services and any other Federal agency re19 lated to health equity or health disparities; 

20 and 

21 (ii) recommendations on ensuring eq22 uitable health care and eliminating health 

23 disparities. 

24 (c) POWERS.— 

25 (1) HEARINGS.— 


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1 (A) IN GENERAL.—The Commission or, at 

2 the direction of the Commission, any sub3 committee or member of the Commission, may, 

4 for the purpose of carrying out this section, as 

5 the Commission or the subcommittee or mem6 ber considers advisable— 

7 (i) hold such hearings, meet and act 

8 at such times and places, take such testi9 mony, receive such evidence, and admin10 ister such oaths; and 

11 (ii) require, by subpoena or otherwise, 

12 the attendance and testimony of such wit13 nesses and the production of such books, 

14 records, correspondence, memoranda, pa15 pers, documents, tapes, and materials. 

16 (B) LIMITATION ON HEARINGS.—The 

17 Commission may hold a hearing under subpara18 graph (A)(i) only if the hearing is approved— 

19 (i) by a majority of the members of 

20 the Commission appointed under sub21 section (a)(2)(B); or 

22 (ii) by a majority of such members 

23 present at a meeting when a quorum is 

24 present. 


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1 (2) ISSUANCE AND ENFORCEMENT OF SUB2 POENAS.— 

3 (A) ISSUANCE.—A subpoena issued under 

4 paragraph (1) shall— 

5 (i) bear the signature of the Chair6 person of the Commission; and 

7 (ii) be served by any person or class 

8 of persons designated by the Chairperson 

9 for that purpose. 

10 (B) ENFORCEMENT.—In the case of contu11 macy or failure to obey a subpoena issued 

12 under paragraph (1), the United States district 

13 court for the district in which the subpoenaed 

14 person resides, is served, or may be found may 

15 issue an order requiring the person to appear at 

16 any designated place to testify or to produce 

17 documentary or other evidence. 

18 (C) NONCOMPLIANCE.—Any failure to 

19 obey the order of the court may be punished by 

20 the court as a contempt of court. 

21 (3) WITNESS ALLOWANCES AND FEES.— 

22 (A) IN GENERAL.—Section 1821 of title 

23 28, United States Code, shall apply to a witness 

24 requested or subpoenaed to appear at a hearing 

25 of the Commission. 


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1 (B) EXPENSES.—The per diem and mile2 age allowances for a witness shall be paid from 

3 funds available to pay the expenses of the Com4 mission. 

5 (4) POSTAL SERVICES.—The Commission may 

6 use the United States mails in the same manner and 

7 under the same conditions as other agencies of the 

8 Federal Government. 

9 (5) GIFTS.—The Commission may accept, use, 

10 and dispose of gifts or donations of services or prop11 erty. 

12 (d) ADMINISTRATIVE PROVISIONS.— 

13 (1) STAFF.— 

14 (A) DIRECTOR.—There shall be a full-time 

15 staff director for the Commission who shall— 

16 (i) serve as the administrative head of 

17 the Commission; and 

18 (ii) be appointed by the Chairperson 

19 with the concurrence of the Vice Chair20 person. 

21 (B) OTHER PERSONNEL.—The Commis22 sion may— 

23 (i) appoint such other personnel as it 

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1 erning appointments in the competitive 

2 service, and the provisions of chapter 51 

3 and subchapter III of chapter 53 of that 

4 title relating to classification and General 

5 Schedule pay rates; and 

6 (ii) may procure temporary and inter7 mittent services under section 3109(b) of 

8 title 5, United States Code, at rates for in9 dividuals not in excess of the daily equiva10 lent paid for positions at the maximum 

11 rate for GS–15 of the General Schedule 

12 under section 5332 of title 5, United 

13 States Code. 

14 (2) COMPENSATION OF MEMBERS.— 

15 (A) NON-FEDERAL EMPLOYEES.—Each 

16 member of the Commission who is not an offi17 cer or employee of the Federal Government 

18 shall be compensated at a rate equal to the 

19 daily equivalent of the annual rate of basic pay 

20 prescribed for level IV of the Executive Sched21 ule under section 5315 of title 5, United States 

22 Code, for each day (including travel time) dur23 ing which the member is engaged in the per24 formance of the duties of the Commission. 


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1 (B) FEDERAL EMPLOYEES.—Each member 

2 of the Commission who is an officer or em3 ployee of the Federal Government shall serve 

4 without compensation in addition to the com5 pensation received for the services of the mem6 ber as an office or employee of the Federal 

7 Government. 

8 (C) TRAVEL EXPENSES.—A member of the 

9 Commission shall be allowed travel expenses, in10 cluding per diem in lieu of subsistence, at rates 

11 authorized for an employee of an agency under 

12 subchapter I of chapter 57 of title 5, United 

13 States Code, while away from the home or reg14 ular place of business of the member in the per15 formance of the duties of the Commission. 

16 (3) COOPERATION.—The Commission may se17 cure directly from any Federal department or agency 

18 such information as the Commission considers nec19 essary to carry out this Act. Upon request of the 

20 Chairman of the Commission, the head of such de21 partment or agency shall furnish such information to 

22 the Commission. 

23 (e) PERMANENT COMMISSION.—Section 14 of the 

24 Federal Advisory Committee Act (5 U.S.C. App.) shall not 

25 apply to the Commission. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated for fiscal year 2023 and 

3 each fiscal year thereafter such sums as may be necessary 

4 to carry out the duties of the Commission. 

5 TITLE X—ADDRESSING SOCIAL 

6 DETERMINANTS AND IM7 PROVING ENVIRONMENTAL 

8 JUSTICE 

9 Subtitle A—In General 

10 SEC. 10001. DEFINITIONS. 

11 In this title: 

12 (1) ADMINISTRATOR.—The term ‘‘Adminis13 trator’’ means the Administrator of the Environ14 mental Protection Agency. 

15 (2) AGENCY.—The term ‘‘Agency’’ means the 

16 Environmental Protection Agency. 

17 (3) BUILT ENVIRONMENT.—The term ‘‘built 

18 environment’’ means the components of the environ19 ment, and the location of those components in a geo20 graphically defined space, that are created or modi21 fied by individuals to form the physical and social 

22 characteristics of a community or enhance quality of 

23 human life, including— 

24 (A) homes, schools, and places of work and 

25 worship; 


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1 (B) parks, recreation areas, and green2 ways; 

3 (C) transportation systems; 

4 (D) business, industry, and agriculture; 

5 and 

6 (E) land-use plans, projects, and policies 

7 that impact the physical or social characteris8 tics of a community, including access to services 

9 and amenities. 

10 (4) DETERMINANTS OF HEALTH.—The term 

11 ‘‘determinants of health’’— 

12 (A) means the range of nonclinical factors 

13 inclusive of personal, social, economic, and envi14 ronmental factors that directly influence health 

15 status; and 

16 (B) includes social determinants of health. 

17 (5) ECONOMIC DETERMINANTS OF HEALTH.— 

18 The term ‘‘economic determinants of health’’ means 

19 income and social status. 

20 (6) ENVIRONMENTAL DETERMINANTS OF

21 HEALTH.—The term ‘‘environmental determinants 

22 of health’’ means the broad physical (including man23 made and natural), psychological, social, spiritual, 

24 cultural, and aesthetic environment. 


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1 (7) PERSONAL DETERMINANTS OF HEALTH.— 

2 The term ‘‘personal determinants of health’’ means 

3 an individual’s behavior, biology, and genetics. 

4 (8) SECRETARY.—The term ‘‘Secretary’’ means 

5 the Secretary of Health and Human Services. 

6 (9) SOCIAL DETERMINANTS OF HEALTH.—The 

7 term ‘‘social determinants of health’’— 

8 (A) means a subset of determinants of the 

9 health of individuals and environments (such as 

10 communities, neighborhoods, and societies) that 

11 describe an individual’s or group of people’s so12 cial identity, describe the social and economic 

13 resources to which such individual or group has 

14 access, and describe the conditions in which an 

15 individual or group of people works, lives, and 

16 plays; and 

17 (B) are sometimes referred to as ‘‘social 

18 and economic determinants of health’’, ‘‘socio19 economic determinants of health’’, ‘‘environ20 mental determinants of health’’, ‘‘social drivers 

21 of inequality’’, or ‘‘personal determinants of 

22 health’’. 

23 SEC. 10002. FINDINGS. 

24 Congress finds as follows: 


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1 (1) Social determinants of health are the great2 est predictors of health outcomes. 

3 (2) Social determinants of health, including 

4 health-related behaviors, social and economic factors, 

5 and physical environment factors account for 80 per6 cent of health outcomes, whereas clinical care ac7 counts for 20 percent of improved health outcomes. 

8 Yet, in 2017, public health spending represented 

9 only 2.5 percent of all health spending in the United 

10 States. 

11 (3) There are more opportunities to improve 

12 health for everyone when we understand that health 

13 starts, not in a medical setting, but in our families, 

14 in our schools and workplaces, in our neighborhoods, 

15 in the air we breathe, and in the water we drink. 

16 (4)(A) Healthy People 2030 identifies health 

17 and health care quality as a function of not only ac18 cess to health care, but also the social determinants 

19 of health, categorized into the following: neighbor20 hoods and the built environment; social and commu21 nity context; education; and economic stability. 

22 (B) The following examples illustrate the nexus 

23 between the unequal distribution of the social deter24 minants of health and health inequities: 


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1 (i) The built environment influences resi2 dents’ level of physical activity. Neighborhoods 

3 with high levels of poverty are significantly less 

4 likely to have places where children can be 

5 physically active, such as parks, green spaces, 

6 and bike paths and lanes. Neighborhoods and 

7 communities can provide opportunities for phys8 ical activity and support active lifestyles 

9 through accessible and safe parks and open 

10 spaces and through land use policy, zoning, and 

11 healthy community design. 

12 (ii) Emotional and physical health and 

13 well-being are directly impacted by perceived 

14 levels of safety, such as unlit streets at night. 

15 Community members have expressed that safety 

16 is not only a barrier to accessing programs and 

17 services that increase quality of life, but also a 

18 barrier to accessing physical activity in their 

19 community through the built environment. 

20 (iii) Historical and institutional racism in 

21 the United States has shaped the way in which 

22 social and economic resources and exposure to 

23 health promoting environments are distributed. 

24 Income, education, occupation, neighborhood 

25 conditions, schools, workplaces, the use of 


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1 health and social services, and experiences with 

2 the criminal justice system are all highly pat3 terned by race, with people of color experiencing 

4 more that is health harming. Finding ways to 

5 uncouple the link between race and access to re6 sources and healthy environments is a principal 

7 means of reducing health inequities. Addition8 ally, the anticipation of racism itself causes 

9 higher psychological and cardiovascular stress 

10 levels that are linked to poor health outcomes. 

11 Remedying discriminatory practices at the indi12 vidual and systemic levels will likely reduce 

13 health inequities caused by this unequal dis14 tribution of stress. 

15 (iv) Poor health among Native Americans 

16 has largely been driven by post-colonial oppres17 sion and historical trauma. The expropriation of 

18 native lands and territories to the American 

19 state had severe consequences on Native Amer20 ican health. This resulted in the deprivation of 

21 traditional food sources—and nutrients—for 

22 Native Americans and also the destruction of 

23 traditional economies and community organiza24 tion. Today, Native Americans have twice the 

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1 ognition of the origins of diabetes as having a 

2 social and community context, rather than just 

3 individual responsibility and genetic predisposi4 tion, will shape better policy to provide food se5 curity. 

6 (v) In the context of prisons, overcrowding 

7 has led to the deterioration of the physical and 

8 mental health of individuals after they leave 

9 prison. In particular, the mass incarceration of 

10 African-American males as a result of inequities 

11 within and treatment in the criminal justice 

12 system has contributed to an overburdening of 

13 certain infectious diseases within the African14 American community. As a social institution, 

15 incarceration amplifies existing adverse health 

16 conditions by concentrating diseases and harm17 ful health behaviors such as tobacco use, drug 

18 use, and violence. 

19 (vi) Educational attainment is the strong20 est predictor of adult mortality. It is a basic 

21 component of socioeconomic status that shapes 

22 earning potential, and consequently, access to 

23 resources that promote health. People with 

24 more education are less likely to report that 


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1 they are in poor health, and are also less likely 

2 to have diabetes and other chronic diseases. 

3 (vii) Individuals with lower levels of edu4 cational attainment are much more likely to re5 port to be current smokers. In 2017, smoking 

6 prevalence was 36.8 percent among adults with 

7 a GED diploma, 23.1 percent with less than a 

8 high school diploma, and 18.7 percent with a 

9 high school diploma, while dropping signifi10 cantly to 7.1 percent among adults with an un11 dergraduate college degree and 4.1 percent with 

12 a postgraduate college degree. 

13 (viii) Income inequality differences account 

14 for a large part of health inequities. For exam15 ple, children living in poverty experience poorer 

16 housing conditions, increased exposure to in17 door allergens and toxins (such as pesticides, 

18 lead, mercury, radon, air pollution, and carcino19 gens), increased food insecurity, and more psy20 chological stress. These experiences culminate 

21 in worse adult health as compared with children 

22 with higher socioeconomic status. Specifically, 

23 children living in lower socioeconomic neighbor24 hoods have higher rates of asthma due to high25 er rates of psychological stress resulting from 


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1 higher rates of violence. Food insecurity is asso2 ciated with obesity, and racial and ethnic mi3 norities have higher rates of food insecurity. 

4 (ix) Lesbian, gay, bisexual, transgender, 

5 queer or questioning, intersex, and asexual or 

6 allied (referred to in this section as 

7 ‘‘LGBTQIA+’’) individuals face health inequi8 ties linked to societal stigma, discrimination, 

9 and denial of their civil and human rights. Dis10 crimination against LGBTQIA+ individuals 

11 has been associated with high rates of psy12 chiatric disorders, substance abuse, and suicide. 

13 Experiences of violence and victimization are 

14 frequent for LGBTQIA+ individuals, and have 

15 long-lasting effects on the individual and the 

16 community. Personal, family, and social accept17 ance of sexual orientation and gender identity 

18 affects the mental health and personal safety of 

19 LGBTQIA+ individuals. 

20 (x) Individuals in older and cheaper hous21 ing are at higher risk to be exposed to lead, 

22 particularly in housing built prior to 1960. The 

23 threat of lead poisoning disproportionally af24 fects vulnerable populations, with children living 

25 in poverty (5.6 percent) and Black children 


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1 (5.6) experiencing the highest rates. According 

2 to the Department of Housing and Urban De3 velopment, about 3,600,000 homes nationwide 

4 that house young children have lead hazards 

5 such as contaminated drinking water, peeling 

6 paint, contaminated dust, or toxic soil. The 

7 combined cost of medical treatment and special 

8 education for lead poisoned children averages 

9 about $5,600 per child per year, and lead poi10 soning costs the United States an estimated 

11 $50,000,000,000 annually. 

12 (xi) According to the report Healthy Peo13 ple 2030, people with disabilities, as a group, 

14 experience health inequities in routine public 

15 health arenas such as health behaviors, clinical 

16 preventive services, and chronic conditions. 

17 Compared with people without disabilities, peo18 ple with disabilities are— 

19 (I) less likely to receive recommended 

20 preventive health care services, such as 

21 routine teeth cleanings and cancer 

22 screenings; 

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1 related injuries, and mood disorders such 

2 as depression; and 

3 (III) more likely to engage in 

4 unhealthy behaviors that put their health 

5 at risk, such as cigarette smoking and in6 adequate physical activity. 

7 (5) Laws and regulations that improve opportu8 nities to live in safe neighborhoods with more social 

9 cohesion, attain higher education, sustain stable em10 ployment, and bridge class differences help foster 

11 the health and safety of individuals. 

12 (6) The global public health community has 

13 reached consensus through the Rio Political Declara14 tion of Social Determinants of Health adopted by 

15 the World Health Organization in October 2011 that 

16 ‘‘[c]ollaboration in coordinated and intersectoral pol17 icy actions has proven to be effective. Health in All 

18 Policies, an initiative of the American Public Health 

19 Association, together with intersectoral cooperation 

20 and action, is one promising approach to enhance 

21 accountability in other sectors of health, as well as 

22 the promotion of health equity and more inclusive 

23 and productive societies.’’. 


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1 SEC. 10003. HEALTH IMPACT ASSESSMENTS. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) Health impact assessment is a tool to help 

5 planners, health officials, decision makers, and the 

6 public make more informed decisions about the po7 tential health effects of proposed plans, policies, pro8 grams, and projects in order to maximize health 

9 benefits and minimize harms. 

10 (2) Health impact assessments foster commu11 nity leadership, ownership, and participation in deci12 sion-making processes. 

13 (3) Health impact assessments can build com14 munity support and reduce opposition to a project or 

15 policy, thereby facilitating economic growth by aid16 ing the development of consensus regarding new de17 velopment proposals. 

18 (4) Health impact assessments facilitate col19 laboration across sectors. 

20 (b) PURPOSES.—It is the purpose of this section to— 

21 (1) provide more information about the poten22 tial human health effects of policy decisions and the 

23 distribution of those effects; 

24 (2) improve how health is considered in plan25 ning and decision-making processes; and 


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1 (3) build stronger, healthier communities 

2 through the use of health impact assessments. 

3 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 

4 III of the Public Health Service Act (42 U.S.C. 280g et 

5 seq.), as amended by section 7602(a), is further amended 

6 by adding at the end the following: 

7 ‘‘SEC. 399V–14. HEALTH IMPACT ASSESSMENTS. 

8 ‘‘(a) DEFINITIONS.—In this section: 

9 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis10 trator’ means the Administrator of the Environ11 mental Protection Agency. 

12 ‘‘(2) DIRECTOR.—The term ‘Director’ means 

13 the Director of the Centers for Disease Control and 

14 Prevention. 

15 ‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 

16 ‘health impact assessment’ means a systematic proc17 ess that uses an array of data sources and analytic 

18 methods and considers input from stakeholders to 

19 determine the potential effects of a proposed policy, 

20 plan, program, or project on the health of a popu21 lation and the distribution of those effects within the 

22 population. Such term includes identifying and rec23 ommending appropriate actions on monitoring and 

24 maximizing potential benefits and minimizing poten25 tial harms. 


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1 ‘‘(4) HEALTH INEQUITY.—The term ‘health in2 equity’ means a particular type of health difference 

3 that is closely linked with social, economic, or envi4 ronmental disadvantage and that adversely affects 

5 groups of people who have systematically experi6 enced greater obstacles to health based on their ra7 cial or ethnic group; religion; socioeconomic status; 

8 gender; age; mental health; cognitive, sensory, or 

9 physical disability; sexual orientation or gender iden10 tity; geographic location; citizenship status; or other 

11 characteristics historically linked to discrimination 

12 or exclusion. 

13 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

14 through the Director and in collaboration with the Admin15 istrator, shall— 

16 ‘‘(1) in consultation with the Director of the 

17 National Center for Chronic Disease Prevention and 

18 Health Promotion and relevant offices within the 

19 Department of Housing and Urban Development, 

20 the Department of Transportation, and the Depart21 ment of Agriculture, establish a program at the Na22 tional Center for Environmental Health at the Cen23 ters for Disease Control and Prevention focused on 

24 advancing the field of health impact assessment that 

25 includes— 


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1 ‘‘(A) collecting and disseminating best 

2 practices; 

3 ‘‘(B) administering capacity building 

4 grants to States, Indian Tribes, and Tribal or5 ganizations to support subgrantees in initiating 

6 health impact assessments, in accordance with 

7 subsection (d); 

8 ‘‘(C) providing technical assistance; 

9 ‘‘(D) developing training tools and pro10 viding training on conducting health impact as11 sessment and the implementation of built envi12 ronment and health indicators; 

13 ‘‘(E) making information available, as ap14 propriate, regarding the existence of other com15 munity healthy living tools, checklists, and indi16 ces that help connect public health to other sec17 tors, and tools to help examine the effect of the 

18 indoor built environment and building codes on 

19 population health; 

20 ‘‘(F) conducting research and evaluations 

21 of health impact assessments; and 

22 ‘‘(G) awarding competitive extramural re23 search grants; 


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1 ‘‘(2) develop guidance and guidelines to conduct 

2 health impact assessments in accordance with sub3 section (c); and 

4 ‘‘(3) establish a grant program to allow States, 

5 Indian Tribes, and Tribal organizations to award 

6 subgrants to eligible entities to conduct health im7 pact assessments. 

8 ‘‘(c) GUIDANCE.— 

9 ‘‘(1) IN GENERAL.—Not later than 1 year after 

10 the date of enactment of the Correcting Hurtful and 

11 Alienating Names in Government Expression Act, 

12 the Secretary, acting through the Director, shall 

13 issue final guidance for conducting health impact as14 sessments. In developing such guidance the Sec15 retary shall— 

16 ‘‘(A) consult with the Director of the Na17 tional Center for Environmental Health, the Di18 rector of the National Center for Chronic Dis19 ease Prevention and Health Promotion, and rel20 evant offices within the Department of Housing 

21 and Urban Development, the Department of 

22 Transportation, and the Department of Agri23 culture; and 

24 ‘‘(B) consider available international health 

25 impact assessment guidance, North American 


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1 health impact assessment practice standards, 

2 and recommendations from the National Acad3 emy of Science. 

4 ‘‘(2) CONTENT.—The guidance under this sub5 section shall include— 

6 ‘‘(A) background on national and inter7 national efforts to bridge urban planning, cli8 mate forecasting, and public health institutions 

9 and disciplines, including a review of health im10 pact assessment best practices internationally; 

11 ‘‘(B) evidence-based direct and indirect 

12 pathways that link land-use planning, transpor13 tation, and housing policy and objectives to 

14 human health outcomes; 

15 ‘‘(C) data resources and quantitative and 

16 qualitative forecasting methods to evaluate both 

17 the status of health determinants and health ef18 fects, including identification of existing pro19 grams that can disseminate these resources; 

20 ‘‘(D) best practices for inclusive public in21 volvement in conducting health impact assess22 ments; and 

23 ‘‘(E) technical assistance for other agen24 cies seeking to develop their own guidelines and 

25 procedures for health impact assessment. 


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1 ‘‘(d) GRANT PROGRAM.— 

2 ‘‘(1) IN GENERAL.—The Secretary, acting 

3 through the Director and in collaboration with the 

4 Administrator, shall— 

5 ‘‘(A) award grants to States, Indian 

6 Tribes, and Tribal organizations to award sub7 grants to eligible entities for capacity building 

8 or to prepare health impact assessments; and 

9 ‘‘(B) ensure that States, Indian Tribes, 

10 and Tribal organizations receiving a grant 

11 under this subsection further support training 

12 and technical assistance for subgrantees under 

13 subparagraph (A) by funding and overseeing 

14 appropriate experts on health impact assess15 ments from local, State, and Tribal govern16 ments, the Federal Government, institutions of 

17 higher education, and nonprofit organizations 

18 to provide such training and technical assist19 ance. 

20 ‘‘(2) APPLICATIONS FOR SUBGRANTS.— 

21 ‘‘(A) IN GENERAL.—To be eligible to re22 ceive a subgrant under this section, an eligible 

23 entity shall— 

24 ‘‘(i) be a community-based organiza25 tion serving individuals or populations the 


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1 health of which are, or will be, affected by 

2 an activity or a proposed activity; and 

3 ‘‘(ii) submit to the grantee an applica4 tion in accordance with this subsection, at 

5 such time, in such manner, and containing 

6 such additional information as the Sec7 retary (acting through the Director and in 

8 collaboration with the Administrator) and 

9 the grantee may require. 

10 ‘‘(B) INCLUSION.—An application for a 

11 subgrant under this subsection shall include— 

12 ‘‘(i) a list of proposed activities that 

13 require or would benefit from conducting a 

14 health impact assessment within six 

15 months of receiving the subgrant; 

16 ‘‘(ii) supporting documentation, in17 cluding letters of support, from potential 

18 conductors of health impact assessments 

19 for the listed proposed activities; 

20 ‘‘(iii) an assessment by the applicant 

21 of the health of the population to be served 

22 through the subgrant; and 

23 ‘‘(iv) a description of potential adverse 

24 or positive effects on health that the pro25 posed activities may create. 


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1 ‘‘(C) PREFERENCE.—In awarding sub2 grants under this subsection, States may give 

3 preference to eligible entities that demonstrate 

4 the potential to significantly improve population 

5 health or lower health care costs as a result of 

6 potential health impact assessment work. 

7 ‘‘(3) USE OF FUNDS.— 

8 ‘‘(A) IN GENERAL.—A State, Indian Tribe, 

9 or Tribal organization receiving a grant under 

10 this subsection shall use such grant to conduct 

11 health impact assessment capacity building in 

12 support of a subgrantee conducting a health im13 pact assessment for a proposed activity in ac14 cordance with this subsection. 

15 ‘‘(B) PURPOSES.—The purposes of a 

16 health impact assessment under this subsection 

17 are— 

18 ‘‘(i) to facilitate the involvement of 

19 Tribal, State, and local public health offi20 cials in community planning, transpor21 tation, housing, and land use decisions and 

22 other decisions affecting the built environ23 ment to identify any potential health con24 cern or health benefit relating to an activ25 ity or proposed activity; 


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1 ‘‘(ii) to provide for an investigation of 

2 any health-related issue of concern raised 

3 in a planning process, an environmental 

4 impact assessment process, or policy ap5 praisal relating to a proposed activity; 

6 ‘‘(iii) to describe and compare alter7 natives (including no-action alternatives) to 

8 a proposed activity to provide clarification 

9 with respect to the potential health out10 comes associated with the proposed activity 

11 and, where appropriate, to the related ben12 efit-cost or cost-effectiveness of the pro13 posed activity and alternatives; 

14 ‘‘(iv) to contribute, when applicable, 

15 to the findings of a planning process, pol16 icy appraisal, or an environmental impact 

17 statement with respect to the terms and 

18 conditions of implementing a proposed ac19 tivity or related mitigation recommenda20 tions, as necessary; 

21 ‘‘(v) to ensure that the dispropor22 tionate distribution of negative impacts 

23 among vulnerable populations is minimized 

24 as much as possible; 


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1 ‘‘(vi) to engage affected community 

2 members and ensure adequate opportunity 

3 for public comment on all stages of the 

4 health impact assessment; 

5 ‘‘(vii) where appropriate, to consult 

6 with local and county health departments 

7 and appropriate organizations, including 

8 planning, transportation, and housing or9 ganizations, and provide them information 

10 and tools regarding how to conduct and in11 tegrate health impact assessment into their 

12 work; and 

13 ‘‘(viii) to inspect homes, water sys14 tems, and other elements that pose risks to 

15 lead exposure, with an emphasis on areas 

16 that pose a higher risk to children. 

17 ‘‘(4) ASSESSMENTS.—Health impact assess18 ments carried out using funds under this section 

19 shall— 

20 ‘‘(A) take appropriate health factors into 

21 consideration as early as practicable during the 

22 planning, review, or decision-making processes; 

23 ‘‘(B) assess the effect on the health of in24 dividuals and populations of proposed policies, 


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1 projects, or plans that result in modifications to 

2 the built environment; and 

3 ‘‘(C) assess the distribution of health ef4 fects across various factors, such as race, in5 come, ethnicity, age, disability status, gender, 

6 and geography. 

7 ‘‘(5) ELIGIBLE ACTIVITIES.— 

8 ‘‘(A) IN GENERAL.—A State, Indian Tribe, 

9 or Tribal organization receiving a grant under 

10 this section shall conduct an evaluation of any 

11 activity proposed to be funded through the 

12 grant, including through a subgrant, to deter13 mine whether such activity will have a signifi14 cant adverse or positive effect on the health of 

15 the affected population to be served, based on 

16 the criteria described in subparagraph (B). 

17 ‘‘(B) CRITERIA.—The criteria described in 

18 this subparagraph include, as applicable to the 

19 proposed activity, the following: 

20 ‘‘(i) Any substantial adverse effect or 

21 significant health benefit on health out22 comes or factors known to influence health, 

23 including the following: 

24 ‘‘(I) Physical activity. 

25 ‘‘(II) Injury. 


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1 ‘‘(III) Mental health. 

2 ‘‘(IV) Accessibility to health-pro3 moting goods and services. 

4 ‘‘(V) Respiratory health. 

5 ‘‘(VI) Chronic disease. 

6 ‘‘(VII) Nutrition. 

7 ‘‘(VIII) Land use changes that 

8 promote local, sustainable food 

9 sources. 

10 ‘‘(IX) Infectious disease. 

11 ‘‘(X) Health inequities. 

12 ‘‘(XI) Existing air quality, 

13 ground or surface water quality or 

14 quantity, or noise levels. 

15 ‘‘(XII) Lead exposure. 

16 ‘‘(XIII) Drinking water quality 

17 and accessibility. 

18 ‘‘(ii) Other factors that may be con19 sidered, including— 

20 ‘‘(I) the potential for a proposed 

21 activity to result in systems failure 

22 that leads to a public health emer23 gency; 

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1 cant increase in tourism, economic de2 velopment, or employment in the pop3 ulation to be served; 

4 ‘‘(III) any other significant po5 tential hazard or enhancement to 

6 human health, as determined by the 

7 grantee; or 

8 ‘‘(IV) whether the evaluation of a 

9 proposed activity would duplicate an10 other analysis or study being under11 taken in conjunction with the pro12 posed activity. 

13 ‘‘(C) FACTORS FOR CONSIDERATION.—In 

14 evaluating a proposed activity under subpara15 graph (A), a grantee may take into consider16 ation any reasonable, direct, indirect, or cumu17 lative effect that can be clearly related to poten18 tial health effects and that is related to the pro19 posed activity, including the effect of any action 

20 that is— 

21 ‘‘(i) included in the long-range plan 

22 relating to the proposed activity; 

23 ‘‘(ii) likely to be carried out in coordi24 nation with the proposed activity; 


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1 ‘‘(iii) dependent on the occurrence of 

2 the proposed activity; or 

3 ‘‘(iv) likely to have a disproportionate 

4 impact on high-risk or vulnerable popu5 lations. 

6 ‘‘(6) REQUIREMENTS.—A health impact assess7 ment prepared with funds awarded under this sub8 section shall incorporate the following, after con9 ducting the screening phase (identifying projects or 

10 policies for which a health impact assessment would 

11 be valuable and feasible) through the application 

12 process: 

13 ‘‘(A) SCOPING.—Identifying which health 

14 effects to consider and the research methods to 

15 be utilized. 

16 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 

17 Assessing the baseline health status and factors 

18 known to influence the health status in the af19 fected community, which may include aggre20 gating and synthesizing existing health assess21 ment evidence and data from the community. 

22 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 

23 Suggesting changes to proposals to promote 

24 positive or mitigate adverse health effects. 


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1 ‘‘(D) REPORTING.—Synthesizing the as2 sessment and recommendations and commu3 nicating the results to decision makers. 

4 ‘‘(E) MONITORING AND EVALUATING.— 

5 Tracking the decision and implementation effect 

6 on health determinants and health status. 

7 ‘‘(7) PLAN.—A subgrantee under this section 

8 shall develop and implement a plan, to be approved 

9 by the Secretary (acting through the Director and in 

10 collaboration with the Administrator) and the grant11 ee, for meaningful and inclusive stakeholder involve12 ment in all phases of the health impact assessment. 

13 Stakeholders may include community leaders, com14 munity-based organizations, youth-serving organiza15 tions, planners, public health experts, State and 

16 local public health departments and officials, health 

17 care experts or officials, housing experts or officials, 

18 and transportation experts or officials. 

19 ‘‘(8) SUBMISSION OF FINDINGS.—A grantee 

20 under this section shall submit the findings of any 

21 funded health impact assessment activities to the 

22 Secretary and make these findings publicly available. 

23 ‘‘(9) ASSESSMENT OF IMPACTS.—A subgrantee 

24 under this section shall ensure the assessment of the 

25 distribution of health impacts (related to the proVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01665 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 posed activity) across race, ethnicity, income, age, 

2 gender, disability status, and geography. 

3 ‘‘(10) CONDUCT OF ASSESSMENT.—To the 

4 greatest extent feasible, a health impact assessment 

5 shall be conducted under this section in a manner 

6 that respects the needs and timing of the decision7 making process such assessment evaluates. 

8 ‘‘(11) METHODOLOGY.—In preparing a health 

9 impact assessment funded under this subsection, a 

10 subgrantee under this section shall follow the guid11 ance published under subsection (c). 

12 ‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 

13 The Secretary, acting through the Director and in collabo14 ration with the Administrator, shall establish, maintain, 

15 and make publicly available a health impact assessment 

16 database, including— 

17 ‘‘(1) a catalog of health impact assessments re18 ceived under this section; 

19 ‘‘(2) an inventory of tools used by subgrantees 

20 to conduct health impact assessments; and 

21 ‘‘(3) guidance for subgrantees with respect to 

22 the selection of appropriate tools described in para23 graph (2). 

24 ‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 

25 Secretary shall award competitive grants to Prevention 


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1 Research Centers, or nonprofit organizations or academic 

2 institutions with expertise in health impact assessments 

3 to— 

4 ‘‘(1) assist grantees and subgrantees with the 

5 provision of training and technical assistance in the 

6 conducting of health impact assessments; 

7 ‘‘(2) evaluate the activities carried out with 

8 grants and subgrants under subsection (d); and 

9 ‘‘(3) assist the Secretary in disseminating evi10 dence, best practices, and lessons learned from 

11 grantees and subgrantees. 

12 ‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 

13 after the date of enactment of the Correcting Hurtful and 

14 Alienating Names in Government Expression Act, the Sec15 retary shall submit to Congress a report concerning the 

16 evaluation of the programs under this section, including 

17 recommendations as to how lessons learned from such pro18 grams can be incorporated into future guidance docu19 ments developed and provided by the Secretary and other 

20 Federal agencies, as appropriate. 

21 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated to carry out this section 

23 such sums as may be necessary. 


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1 ‘‘SEC. 399V–15. IMPLEMENTATION OF RESEARCH FINDINGS 

2 TO IMPROVE HEALTH OUTCOMES THROUGH 

3 THE BUILT ENVIRONMENT. 

4 ‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 

5 in collaboration with the Administrator of the Environ6 mental Protection Agency (referred to in this section as 

7 the ‘Administrator’), shall award grants to public agencies 

8 or private nonprofit institutions to implement evidence9 based programming to improve human health through im10 provements to the built environment and subsequently 

11 human health, by addressing— 

12 ‘‘(1) levels of physical activity; 

13 ‘‘(2) consumption of nutritional foods; 

14 ‘‘(3) rates of crime; 

15 ‘‘(4) air, water, and soil quality; 

16 ‘‘(5) risk or rate of injury; 

17 ‘‘(6) accessibility to health-promoting goods and 

18 services; 

19 ‘‘(7) chronic disease rates; 

20 ‘‘(8) community design; 

21 ‘‘(9) housing; 

22 ‘‘(10) transportation options; and 

23 ‘‘(11) other factors, as the Secretary determines 

24 appropriate. 

25 ‘‘(b) APPLICATIONS.—A public agency or private 

26 nonprofit institution desiring a grant under this section 


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1 shall submit to the Secretary an application at such time, 

2 in such manner, and containing such agreements, assur3 ances, and information as the Secretary, in consultation 

4 with the Administrator, may require. 

5 ‘‘(c) RESEARCH.—The Secretary, in consultation 

6 with the Administrator, shall support, through grants 

7 awarded under this section, research that— 

8 ‘‘(1) uses evidence-based research to improve 

9 the built environment and human health; 

10 ‘‘(2) examines— 

11 ‘‘(A) the scope and intensity of the impacts 

12 that the built environment (including the var13 ious characteristics of the built environment) 

14 has on human health; or 

15 ‘‘(B) the distribution of such impacts by— 

16 ‘‘(i) location; and 

17 ‘‘(ii) population subgroup; 

18 ‘‘(3) is used to develop— 

19 ‘‘(A) measures and indicators to address 

20 health impacts and the connection of health to 

21 the built environment; 

22 ‘‘(B) efforts to link the measures to trans23 portation, land use, and health databases; and 

24 ‘‘(C) efforts to enhance the collection of 

25 built environment surveillance data; 


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1 ‘‘(4) distinguishes carefully between personal 

2 attitudes and choices and external influences on be3 havior to determine how much the association be4 tween the built environment and the health of resi5 dents, versus the lifestyle preferences of the people 

6 that choose to live in the neighborhood, reflects the 

7 physical characteristics of the neighborhood; and 

8 ‘‘(5)(A) identifies or develops effective interven9 tion strategies focusing on enhancements to the built 

10 environment that promote increased use physical ac11 tivity, access to nutritious foods, or other health-pro12 moting activities by residents; and 

13 ‘‘(B) in developing the intervention strategies 

14 under subparagraph (A), ensures that the interven15 tion strategies will reach out to high-risk or vulner16 able populations, including low-income urban and 

17 rural communities and aging populations, in addi18 tion to the general population. 

19 ‘‘(d) SURVEYS.—The Secretary may allow recipients 

20 of grants under this section to use such grant funds to 

21 support the expansion of national surveys and data track22 ing systems to provide more detailed information about 

23 the connection between the built environment and health. 


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1 ‘‘(e) PRIORITY.—In awarding grants under this sec2 tion, the Secretary and the Administrator shall give pri3 ority to entities with programming that incorporates— 

4 ‘‘(1) interdisciplinary approaches; or 

5 ‘‘(2) the expertise of the public health, physical 

6 activity, urban planning, land use, and transpor7 tation research communities in the United States 

8 and abroad. 

9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated such sums as may be 

11 necessary to carry out this section. The Secretary may al12 locate not more than 20 percent of the amount so appro13 priated for a fiscal year for purposes of conducting re14 search under subsection (c).’’. 

15 SEC. 10004. GRANT PROGRAM TO CONDUCT ENVIRON16 MENTAL HEALTH IMPROVEMENT ACTIVITIES 

17 AND TO IMPROVE SOCIAL DETERMINANTS OF 

18 HEALTH. 

19 (a) DEFINITIONS.—In this section: 

20 (1) DIRECTOR.—The term ‘‘Director’’ means 

21 the Director of the Centers for Disease Control and 

22 Prevention, acting in collaboration with the Adminis23 trator and the Director of the National Institute of 

24 Environmental Health Sciences. 


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1 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti2 ty’’ means a State, Indian Tribe, Tribal organiza3 tion, or local community that— 

4 (A) bears a disproportionate burden of ex5 posure to environmental health hazards; 

6 (B) bears a disproportionate burden of ex7 posure to unhealthy living conditions, low 

8 standard housing conditions, low socioeconomic 

9 status, poor nutrition, less opportunity for edu10 cational attainment, disproportionately high un11 employment rates, or lower literacy levels and 

12 access to information; 

13 (C) has established a coalition— 

14 (i) with not less than 1 community15 based organization or demonstration pro16 gram; and 

17 (ii) with not less than 1— 

18 (I) public health entity; 

19 (II) health care provider organi20 zation; 

21 (III) academic institution, includ22 ing any minority-serving institution 

23 (including a Hispanic-serving institu24 tion, a historically Black college or 


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1 university, or a Tribal College or Uni2 versity); 

3 (IV) child-serving institution; or 

4 (V) landlord or housing provider 

5 working on lead remediation; 

6 (D) ensures planned activities and funding 

7 streams are coordinated to improve community 

8 health; and 

9 (E) submits an application in accordance 

10 with subsection (c). 

11 (b) ESTABLISHMENT.—The Director shall establish a 

12 grant program under which eligible entities shall receive 

13 grants to conduct environmental health improvement ac14 tivities and to improve social determinants of health. 

15 (c) APPLICATION.—To receive a grant under this sec16 tion, an eligible entity shall submit an application to the 

17 Director at such time, in such manner, and accompanied 

18 by such information as the Director may require. 

19 (d) USE OF GRANT FUNDS.—An eligible entity may 

20 use a grant under this section— 

21 (1) to promote environmental health; 

22 (2) to address environmental health inequities 

23 among all populations, including children; and 

24 (3) to address racial and ethnic inequities in so25 cial determinants of health. 


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1 (e) AMOUNT OF COOPERATIVE AGREEMENT.—The 

2 Director shall award grants to eligible entities at the fol3 lowing 3 funding levels: 

4 (1) LEVEL 1 COOPERATIVE AGREEMENTS.— 

5 (A) IN GENERAL.—An eligible entity 

6 awarded a grant under this paragraph shall use 

7 the funds to identify environmental health prob8 lems and solutions by— 

9 (i) establishing a planning and 

10 prioritizing council in accordance with sub11 paragraph (B); and 

12 (ii) conducting an environmental 

13 health assessment in accordance with sub14 paragraph (C). 

15 (B) PLANNING AND PRIORITIZING COUN16 CIL.— 

17 (i) IN GENERAL.—A planning and 

18 prioritizing council established under sub19 paragraph (A)(i) (referred to in this para20 graph as a ‘‘PPC’’) shall assist the envi21 ronmental health assessment process and 

22 environmental health promotion activities 

23 of the eligible entity. 

24 (ii) MEMBERSHIP.—Membership of a 

25 PPC shall consist of representatives from 


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1 various organizations within public health, 

2 planning, development, and environmental 

3 services and shall include stakeholders 

4 from vulnerable groups such as children, 

5 the elderly, disabled, and minority ethnic 

6 groups that are often not actively involved 

7 in democratic or decision-making proc8 esses. 

9 (iii) DUTIES.—A PPC shall— 

10 (I) identify key stakeholders and 

11 engage and coordinate potential part12 ners in the planning process; 

13 (II) establish a formal advisory 

14 group to plan for the establishment of 

15 services; 

16 (III) conduct an in-depth review 

17 of the nature and extent of the need 

18 for an environmental health assess19 ment, including a local epidemiological 

20 profile, an evaluation of the service 

21 provider capacity of the community, 

22 and a profile of any target popu23 lations; and 

24 (IV) define the components of 

25 care and form essential programmatic 


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1 linkages with related providers in the 

2 community. 

3 (C) ENVIRONMENTAL HEALTH ASSESS4 MENT.— 

5 (i) IN GENERAL.—A PPC shall carry 

6 out an environmental health assessment to 

7 identify environmental health concerns. 

8 (ii) ASSESSMENT PROCESS.—The 

9 PPC shall— 

10 (I) define the goals of the assess11 ment; 

12 (II) generate the environmental 

13 health issue list; 

14 (III) analyze issues with a sys15 tems framework; 

16 (IV) develop appropriate commu17 nity environmental health indicators; 

18 (V) rank the environmental 

19 health issues; 

20 (VI) set priorities for action; 

21 (VII) develop an action plan; 

22 (VIII) implement the plan; and 

23 (IX) evaluate progress and plan24 ning for the future. 


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1 (D) EVALUATION.—Each eligible entity 

2 that receives a grant under this paragraph shall 

3 evaluate, report, and disseminate program find4 ings and outcomes. 

5 (E) TECHNICAL ASSISTANCE.—The Direc6 tor may provide such technical and other non7 financial assistance to eligible entities as the 

8 Director determines to be necessary. 

9 (2) LEVEL 2 COOPERATIVE AGREEMENTS.— 

10 (A) ELIGIBILITY.— 

11 (i) IN GENERAL.—The Director shall 

12 award grants under this paragraph to eli13 gible entities that have already— 

14 (I) established broad-based col15 laborative partnerships; and 

16 (II) completed environmental as17 sessments. 

18 (ii) NO LEVEL 1 REQUIREMENT.—To 

19 be eligible to receive a grant under this 

20 paragraph, an eligible entity is not re21 quired to have successfully completed a 

22 Level 1 Cooperative Agreement (as de23 scribed in paragraph (1)). 

24 (B) USE OF GRANT FUNDS.—An eligible 

25 entity awarded a grant under this paragraph 


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1 shall use the funds to further activities to carry 

2 out environmental health improvement activi3 ties, including— 

4 (i) addressing community environ5 mental health priorities in accordance with 

6 paragraph (1)(C)(ii), including— 

7 (I) geography; 

8 (II) the built environment; 

9 (III) air quality; 

10 (IV) water quality; 

11 (V) land use; 

12 (VI) solid waste; 

13 (VII) housing; 

14 (VIII) violence; 

15 (IX) socioeconomic status; 

16 (X) ethnicity, social construct, 

17 and language preference; 

18 (XI) educational attainment; 

19 (XII) employment; 

20 (XIII) food safety, accessibility, 

21 and affordability; 

22 (XIV) nutrition; 

23 (XV) health care services; and 

24 (XVI) injuries; 


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1 (ii) building partnerships between 

2 planning, public health, and other sectors, 

3 including child-serving institutions, to ad4 dress how the built environment impacts 

5 food availability and access and physical 

6 activity to promote healthy behaviors and 

7 lifestyles and reduce overweight and obe8 sity, musculoskeletal diseases, respiratory 

9 conditions, infectious diseases, dental, oral, 

10 and mental health conditions, poverty, and 

11 related co-morbidities; 

12 (iii) establishing programs to ad13 dress— 

14 (I) how environmental and social 

15 conditions of work and living choices 

16 influence physical activity and dietary 

17 intake; or 

18 (II) how the conditions described 

19 in subclause (I) influence the concerns 

20 and needs of people who have im21 paired mobility and use assistance de22 vices, including wheelchairs, lower 

23 limb prostheses, and hip, knee, and 

24 other joint replacements; and 


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1 (iv) convening intervention and dem2 onstration programs that examine the role 

3 of the social environment in connection 

4 with the physical and chemical environ5 ment in— 

6 (I) determining access to nutri7 tional food; 

8 (II) improving physical activity to 

9 reduce overweight, obesity, and co10 morbidities and increase quality of 

11 life; and 

12 (III) location and access to med13 ical facilities. 

14 (3) LEVEL 3 COOPERATIVE AGREEMENTS.— 

15 (A) IN GENERAL.—An eligible entity 

16 awarded a grant under this paragraph shall use 

17 the funds to identify and address racial and 

18 ethnic inequities in social determinants of 

19 health by creating demonstration programs that 

20 assess the feasibility of establishing a federally 

21 funded comprehensive program and describe 

22 key outcomes that address racial and ethnic in23 equities in social determinants of health. 

24 (B) PROGRAM DESIGN.— 


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1 (i) EVALUATION.—No later than 1 

2 year after enactment of this Act, the Di3 rector shall evaluate the best practices of 

4 existing programs from the private, public, 

5 community-based, and academically sup6 ported initiatives focused on reducing in7 equities in the social determinants of 

8 health for racial and ethnic populations. 

9 (ii) DEMONSTRATION PROJECTS.— 

10 Not later than 2 years after the date of en11 actment of this Act, the Director shall im12 plement at least 12 demonstration 

13 projects, including at least one project for 

14 each major racial and ethnic minority 

15 group, each of which is unique to the cul16 tural and linguistic needs of each of the 

17 following groups: 

18 (I) Native Americans and Alaska 

19 Natives. 

20 (II) Asian Americans. 

21 (III) African Americans/Blacks. 

22 (IV) Hispanic/Latino-Americans. 

23 (V) Native Hawaiians and Pacific 

24 Islanders. 


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1 (VI) Middle Eastern and North2 ern African communities. 

3 (iii) REPORT TO CONGRESS.—No later 

4 than 2 years after the implementation of 

5 the initial demonstration projects under 

6 this paragraph, the Director shall submit 

7 to Congress a report that includes— 

8 (I) a description of each dem9 onstration project and design; 

10 (II) an evaluation of the cost-ef11 fectiveness of each project’s preven12 tion and treatment efforts; 

13 (III) an evaluation of the cultural 

14 and linguistic appropriateness of each 

15 project by racial and ethnic group; 

16 and 

17 (IV) an evaluation of the bene18 ficiary’s health status improvement 

19 under the demonstration project. 

20 (iv) ANY OTHER INFORMATION

21 DEEMED APPROPRIATE BY THE DIREC22 TOR.—The Director shall require eligible 

23 entities awarded a grant under this para24 graph to report any other information the 

25 Director determines appropriate to be 


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1 shared by or developed by such entity, in2 cluding the following: 

3 (I) Developing models and evalu4 ating methods that improve the cul5 tural and linguistically appropriate 

6 services provided through the Centers 

7 for Disease Control and Prevention to 

8 target individuals impacted by health 

9 inequities based on their race, eth10 nicity, gender, or sexual orientation. 

11 (II) Promoting the collaboration 

12 between primary and specialty care 

13 health care providers and patients, to 

14 ensure patients impacted by health in15 equities based on race, ethnicity, gen16 der, or sexual orientation are receiving 

17 comprehensive and organized treat18 ment and care. 

19 (III) Educating health care pro20 fessionals on the causes and effects of 

21 inequities in the social determinants 

22 of health in relation to minority and 

23 racial and ethnic communities and the 

24 need for culturally and linguistically 


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1 appropriate care in the prevention and 

2 treatment of high-impact diseases. 

3 (IV) Encouraging collaboration 

4 among community- and patient-based 

5 organizations which work to address 

6 inequities in the social determinants 

7 of health in relation to high-impact 

8 diseases in minority and racial and 

9 ethnic populations. 

10 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated to carry out this sec12 tion— 

13 (1) $25,000,000 for fiscal year 2023; and 

14 (2) such sums as may be necessary for fiscal 

15 years 2024 through 2026. 

16 SEC. 10005. ADDITIONAL RESEARCH ON THE RELATION17 SHIP BETWEEN THE BUILT ENVIRONMENT 

18 AND THE HEALTH OF COMMUNITY RESI19 DENTS. 

20 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 

21 section, the term ‘‘eligible institution’’ means a public or 

22 private nonprofit institution that submits to the Secretary 

23 and the Administrator an application for a grant under 

24 the grant program authorized under subsection (b)(2) at 

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1 ments, assurances, and information as the Secretary and 

2 Administrator may require. 

3 (b) RESEARCH GRANT PROGRAM.— 

4 (1) DEFINITION OF HEALTH.—In this section, 

5 the term ‘‘health’’ includes— 

6 (A) levels of physical activity; 

7 (B) degree of mobility due to factors such 

8 as musculoskeletal diseases, arthritis, and obe9 sity; 

10 (C) consumption of nutritional foods; 

11 (D) rates of crime; 

12 (E) air, water, and soil quality; 

13 (F) risk of injury; 

14 (G) accessibility to health care services; 

15 (H) levels of educational attainment; and 

16 (I) other indicators as determined appro17 priate by the Secretary. 

18 (2) GRANTS.—The Secretary, in collaboration 

19 with the Administrator, shall provide grants to eligi20 ble institutions to conduct and coordinate research 

21 on the built environment and its influence on indi22 vidual and population-based health. 

23 (3) RESEARCH.—The Secretary shall support 

24 research that— 


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1 (A) investigates and defines the causal 

2 links between all aspects of the built environ3 ment and the health of residents; 

4 (B) examines— 

5 (i) the extent of the impact of the 

6 built environment (including the various 

7 characteristics of the built environment) on 

8 the health of residents; 

9 (ii) the variation in the health of resi10 dents by— 

11 (I) location (such as inner cities, 

12 inner suburbs, outer suburbs, reserva13 tions, and rural areas); and 

14 (II) population subgroup (includ15 ing children, young adults, the elderly, 

16 the disadvantaged); or 

17 (iii) the importance of the built envi18 ronment to the total health of residents, 

19 which is the primary variable of interest 

20 from a public health perspective; 

21 (C) is used to develop— 

22 (i) measures to address health and the 

23 connection of health to the built environ24 ment; and 


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1 (ii) efforts to link the measures to 

2 travel and health databases; 

3 (D) distinguishes carefully between per4 sonal attitudes and choices and external influ5 ences on observed behavior to determine how 

6 much an observed association between the built 

7 environment and the health of residents, versus 

8 the lifestyle preferences of the people that 

9 choose to live in the neighborhood, reflects the 

10 physical characteristics of the neighborhood; 

11 and 

12 (E)(i) identifies or develops effective inter13 vention strategies to promote better health 

14 among residents with a focus on behavioral 

15 interventions and enhancements of the built en16 vironment that promote increased use by resi17 dents; and 

18 (ii) in developing the intervention strate19 gies under clause (i), ensures that the interven20 tion strategies will reach out to high-risk popu21 lations, including racial and ethnic minorities, 

22 low-income urban and rural communities, and 

23 children. 

24 (4) PRIORITY.—In providing assistance under 

25 the grant program authorized under paragraph (2), 


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1 the Secretary and the Administrator shall give pri2 ority to research that incorporates— 

3 (A) minority-serving institutions as grant4 ees; 

5 (B) interdisciplinary approaches; or 

6 (C) the expertise of the public health, 

7 physical activity, nutrition and health care (in8 cluding child health), urban planning, and 

9 transportation research communities in the 

10 United States and abroad. 

11 SEC. 10006. ENVIRONMENT AND PUBLIC HEALTH RESTORA12 TION. 

13 (a) FINDINGS.—Congress finds that— 

14 (1) humans share an environment with a wide 

15 variety of habitats and ecosystems that nurture and 

16 sustain a diversity of species; 

17 (2) the abundance of natural resources in the 

18 environment forms the basis for the economy and 

19 has greatly contributed to human development 

20 throughout history; 

21 (3) the accelerated pace of human development 

22 over the last several hundred years has significantly 

23 impacted— 

24 (A) the natural environment and its re25 sources; 


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1 (B) the health and diversity of plant and 

2 animal life; 

3 (C) the availability of critical habitats; 

4 (D) the quality of the air and water; and 

5 (E) the global climate; 

6 (4) the intervention of the Federal Government 

7 is necessary to minimize and mitigate human impact 

8 on the environment— 

9 (A) for the benefit of public health; 

10 (B) to maintain air quality and water qual11 ity; 

12 (C) to sustain the diversity of plants and 

13 animals; 

14 (D) to combat global climate change; and 

15 (E) to protect the environment; 

16 (5) laws and regulations in the United States 

17 have been enacted and promulgated to minimize and 

18 mitigate human impact on the environment for the 

19 benefit of public health, to maintain air quality and 

20 water quality, to sustain wildlife, and to protect the 

21 environment; and 

22 (6) attempts to repeal or weaken key environ23 mental safeguards pose dangers to the public health, 

24 air quality, water quality, wildlife, and the environ25 ment. 


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1 (b) STATEMENT OF POLICY.—It is the policy of the 

2 Federal Government to work in conjunction with States, 

3 territories, Tribal governments, international organiza4 tions, and foreign governments as a steward of the envi5 ronment for the benefit of public health, to maintain air 

6 quality and water quality, to sustain the diversity of plant 

7 and animal species, to combat global climate change, and 

8 to protect the environment for future generations. 

9 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN10 VIRONMENTAL IMPACT OF REVISED RULES, REGULA11 TIONS, LAWS, OR OTHER AGENCY DECISIONS.— 

12 (1) STUDY.—Not later than 30 days after the 

13 date of enactment of this Act, the President shall 

14 seek to enter into an arrangement under which the 

15 National Academy of Sciences shall conduct a study 

16 to determine the effects on public health, air quality, 

17 water quality, wildlife, and the environment of the 

18 following regulations, laws, and other agency deci19 sions: 

20 (A) CLEAN WATER.— 

21 (i) The final rule of the Environ22 mental Protection Agency and the Corps of 

23 Engineers entitled ‘‘Final Revisions to the 

24 Clean Water Act Regulatory Definitions of 

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1 rial’ ’’ and published in the Federal Reg2 ister on May 9, 2002 (67 Fed. Reg. 

3 31129). 

4 (ii) The final rule of the Environ5 mental Protection Agency entitled ‘‘Na6 tional Pollutant Discharge Elimination 

7 System Permit Regulation for Con8 centrated Animal Feeding Operations: Re9 moval of Vacated Elements in Response to 

10 2011 Court Decision’’ and published in the 

11 Federal Register on July 30, 2012 (77 

12 Fed. Reg. 44494). 

13 (iii) The final rule entitled ‘‘With14 drawal of Revisions to the Water Quality 

15 Planning and Management Regulation and 

16 Revisions to the National Pollutant Dis17 charge Elimination System Program in 

18 Support of Revisions to the Water Quality 

19 Planning and Management Regulation’’ 

20 and published in the Federal Register on 

21 March 19, 2003 (68 Fed. Reg. 13608). 

22 (iv) The final rule of the Environ23 mental Protection Agency entitled ‘‘Con24 solidated Permit Regulations: RCRA Haz25 ardous Waste; SDWA Underground InjecVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01691 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 tion Control; CWA National Pollutant Dis2 charge Elimination System; CWA Section 

3 404 Dredge or Fill Programs; and CAA 

4 Prevention of Significant Deterioration’’ 

5 and published in the Federal Register on 

6 May 19, 1980 (45 Fed. Reg. 33290), with 

7 respect to the definition of the ‘‘waters of 

8 the United States’’. 

9 (v) The final rule of the Corps of En10 gineers and the Environmental Protection 

11 Agency entitled ‘‘Definition of ‘Waters of 

12 the United States’—Recodification of Pre13 Existing Rules’’ and published in the Fed14 eral Register on October 22, 2019 (84 

15 Fed. Reg. 56626). 

16 (vi) The final rule of the Corps of En17 gineers and the Environmental Protection 

18 Agency entitled ‘‘The Navigable Waters 

19 Protection Rule: Definition of ‘Waters of 

20 the United States’ ’’ and published in the 

21 Federal Register on April 21, 2020 (85 

22 Fed. Reg. 22250). 

23 (B) FORESTS AND LAND MANAGEMENT.— 

24 (i) The Healthy Forests Restoration 

25 Act of 2003 (16 U.S.C. 6501 et seq.). 


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1 (ii) The application of section 553(e) 

2 of title 5, United States Code, such that a 

3 State may petition for a special rule for 

4 the National Forest System inventoried 

5 roadless areas within the State. 

6 (iii) The final rules entitled ‘‘National 

7 Forest System Land Management Plan8 ning’’ (77 Fed. Reg. 21162) and ‘‘National 

9 Forest System Land Management Plan10 ning’’ (81 Fed. Reg. 90723), published on 

11 April 19, 2013, and December 15, 2016, 

12 respectively. 

13 (iv) The final rule entitled ‘‘Oil Shale 

14 Management—General’’ and published on 

15 January 15, 2009 (73 Fed. Reg. 69414). 

16 (v) The record of decision described in 

17 the notice of availability entitled ‘‘Notice of 

18 Availability of Approved Land Use Plan 

19 Amendments/Record of Decision for Allo20 cation of Oil Shale and Tar Sands Re21 sources on Lands Administered by the Bu22 reau of Land Management in Colorado, 

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1 ment’’ and published on April 1, 2013 (78 

2 Fed. Reg. 19518). 

3 (C) SCIENTIFIC REVIEW.—The final rule 

4 entitled ‘‘Interagency Cooperation Under the 

5 Endangered Species Act’’ (December 16, 2008) 

6 (73 Fed. Reg. 76272), as amended by the final 

7 rule entitled ‘‘Endangered and Threatened 

8 Wildlife and Plants; Regulations for Inter9 agency Cooperation’’ (August 27, 2019) (84 

10 Fed. Reg. 44976). 

11 (2) METHOD.—In conducting the study under 

12 paragraph (1), the National Academy of Sciences 

13 may use and compare existing scientific studies re14 garding the regulations, laws, and other agency deci15 sions described in paragraph (1). 

16 (3) REPORT.—Not later than 270 days after 

17 the date on which the President enters into the ar18 rangement under paragraph (1), the National Acad19 emy of Sciences shall make publicly available and 

20 shall submit to Congress and to the head of each de21 partment and agency of the Federal Government 

22 that issued, implements, or would implement a regu23 lation, law, or other agency decision described in 

24 paragraph (1), a report that includes— 


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1 (A) a description of the effects of each reg2 ulation, law, or other agency decision described 

3 in paragraph (1) on public health, air quality, 

4 water quality, wildlife, and the environment, 

5 compared to the impact of preexisting regula6 tions, laws, or other agency decisions in effect, 

7 as applicable, including— 

8 (i) any negative impacts to air quality 

9 or water quality; 

10 (ii) any negative impacts to wildlife; 

11 (iii) any delays in hazardous waste 

12 cleanup that are projected to be hazardous 

13 to public health; and 

14 (iv) any other negative impact on pub15 lic health or the environment; and 

16 (B) any recommendations that the Na17 tional Academy of Sciences considers appro18 priate to maintain, restore, or improve in whole 

19 or in part protections for public health, air 

20 quality, water quality, wildlife, and the environ21 ment for each of the regulations, laws, and 

22 other agency decisions described in paragraph 

23 (1), which may include recommendations for 

24 the adoption of any regulation or law in place 

25 or proposed prior to January 1, 2001. 


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1 (d) DEPARTMENT AND AGENCY REVISION OF EXIST2 ING RULES, REGULATIONS, OR LAWS.—Not later than 

3 180 days after the date on which the report is submitted 

4 pursuant to subsection (c)(3), the head of each depart5 ment or agency that has issued or implemented a regula6 tion, law, or other agency decision described in subsection 

7 (c)(1) shall submit to Congress a plan describing the steps 

8 the department or agency will take, or has taken, to re9 store or improve protections for public health and the envi10 ronment in whole or in part that were in existence prior 

11 to the issuance of the applicable regulation, law, or other 

12 agency decision. 

13 SEC. 10007. GAO REPORT ON HEALTH EFFECTS OF DEEP14 WATER HORIZON OIL RIG EXPLOSION IN THE 

15 GULF COAST. 

16 (a) STUDY.—The Comptroller General of the United 

17 States shall conduct a study on the type and scope of 

18 health care services administered through the Department 

19 of Health and Human Services addressing the provision 

20 of health care to racial and ethnic minorities, including 

21 residents, cleanup workers, and volunteers, affected by the 

22 blowout and explosion of the mobile offshore drilling unit 

23 Deepwater Horizon that occurred on April 20, 2010, and 

24 resulting hydrocarbon releases into the environment. 


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1 (b) SPECIFIC COMPONENTS.—In carrying out sub2 section (a), the Comptroller General of the United States 

3 shall— 

4 (1) assess the type, size, and scope of programs 

5 administered by the Secretary that focus on the pro6 vision of health care to communities on the Gulf 

7 Coast; 

8 (2) identify the merits and disadvantages asso9 ciated with each of the programs; 

10 (3) perform an analysis of the costs and bene11 fits of the programs; and 

12 (4) determine whether there is any duplication 

13 of programs. 

14 (c) REPORT.—Not later than 180 days after the date 

15 of enactment of this Act, the Comptroller General of the 

16 United States shall submit to Congress a report that in17 cludes— 

18 (1) the findings of the study conducted under 

19 subsection (a); and 

20 (2) recommendations for improving access to 

21 health care for racial and ethnic minorities. 

22 SEC. 10008. ESTABLISH AN INTERAGENCY COUNSEL AND 

23 GRANT PROGRAMS ON SOCIAL DETER24 MINANTS OF HEALTH. 

25 (a) FINDINGS; PURPOSES.— 


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1 (1) FINDINGS.—Congress finds as follows: 

2 (A) There is a significant body of evidence 

3 showing that economic and social conditions 

4 have a powerful impact on individual and popu5 lation health outcomes and well-being, as well 

6 as medical costs. 

7 (B) State, local, and Tribal governments 

8 and the service delivery partners of such gov9 ernments face significant challenges in coordi10 nating benefits and services delivered through 

11 the Medicaid program under title XIX of the 

12 Social Security Act (42 U.S.C. 1396 et seq.) 

13 and other social services programs because of 

14 the fragmented and complex nature of Federal 

15 and State funding and administrative require16 ments. 

17 (C) The Federal Government should 

18 prioritize and proactively assist State and local 

19 governments to strengthen the capacity of State 

20 and local governments to improve health and 

21 social outcomes for individuals, thereby improv22 ing cost-effectiveness and return on investment. 

23 (2) PURPOSES.—The purposes of this section 

24 are as follows: 


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1 (A) To establish effective, coordinated Fed2 eral technical assistance to help State and local 

3 governments to improve outcomes and cost-ef4 fectiveness of, and return on investment from, 

5 health and social services programs. 

6 (B) To build a pipeline of State and locally 

7 designed, cross-sector interventions and strate8 gies that generate rigorous evidence about how 

9 to improve health and social outcomes, and in10 crease the cost-effectiveness of, and return on 

11 investment from, Federal, State, local, and 

12 Tribal health and social services programs. 

13 (C) To enlist State and local governments 

14 and the service providers of such governments 

15 as partners in identifying Federal statutory, 

16 regulatory, and administrative challenges in im17 proving the health and social outcomes of, cost18 effectiveness of, and return on investment from, 

19 Federal spending on individuals enrolled in 

20 Medicaid. 

21 (D) To develop strategies to improve 

22 health and social outcomes without denying 

23 services to, or restricting the eligibility of, vul24 nerable populations. 


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1 (b) SOCIAL DETERMINANTS ACCELERATOR COUN2 CIL.— 

3 (1) ESTABLISHMENT.—The Secretary of Health 

4 and Human Services (referred to in this section as 

5 the ‘‘Secretary’’), in coordination with the Adminis6 trator of the Centers for Medicare & Medicaid Serv7 ices (referred to in this section as the ‘‘Adminis8 trator’’), shall establish an interagency council, to be 

9 known as the Social Determinants Accelerator Inter10 agency Council (referred to in this section as the 

11 ‘‘Council’’) to achieve the purposes listed in sub12 section (b)(2). 

13 (2) MEMBERSHIP.— 

14 (A) FEDERAL COMPOSITION.—The Council 

15 shall be composed of at least one designee from 

16 each of the following Federal agencies: 

17 (i) The Office of Management and 

18 Budget. 

19 (ii) The Department of Agriculture. 

20 (iii) The Department of Education. 

21 (iv) The Indian Health Service. 

22 (v) The Department of Housing and 

23 Urban Development. 

24 (vi) The Department of Labor. 


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1 (vii) The Department of Transpor2 tation. 

3 (viii) Any other Federal agency the 

4 Chair of the Council determines necessary. 

5 (B) DESIGNATION.— 

6 (i) IN GENERAL.—The head of each 

7 agency specified in subparagraph (A) shall 

8 designate at least one employee described 

9 in clause (ii) to serve as a member of the 

10 Council. 

11 (ii) RESPONSIBILITIES.—An employee 

12 described in this clause shall be a senior 

13 employee of the agency— 

14 (I) whose responsibilities relate 

15 to authorities, policies, and procedures 

16 with respect to the health and well17 being of individuals receiving medical 

18 assistance under a State plan (or a 

19 waiver of such plan) under title XIX 

20 of the Social Security Act (42 U.S.C. 

21 1396 et seq.); or 

22 (II) who has authority to imple23 ment and evaluate transformative ini24 tiatives that harness data or conduct 

25 rigorous evaluation to improve the imVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01701 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 pact and cost-effectiveness of federally 

2 funded services and benefits. 

3 (C) HHS REPRESENTATION.—In addition 

4 to the designees under subparagraph (A), the 

5 Council shall include designees from at least 3 

6 agencies within the Department of Health and 

7 Human Services, including the Centers for 

8 Medicare & Medicaid Services, at least one of 

9 whom shall meet the criteria under subpara10 graph (B)(ii). 

11 (D) OMB ROLE.—The Director of the Of12 fice of Management and Budget shall facilitate 

13 the timely resolution of Federal Government14 wide and multiagency issues to help the Council 

15 achieve consensus recommendations described 

16 under this section. 

17 (E) NON-FEDERAL COMPOSITION.—The 

18 Comptroller General of the United States may 

19 designate up to 6 Council designees— 

20 (i) who have relevant subject matter 

21 expertise, including expertise implementing 

22 and evaluating transformative initiatives 

23 that harness data and conduct evaluations 

24 to improve the impact and cost-effective25 ness of Federal Government services; and 


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1 (ii) that each represent— 

2 (I) State, local, and Tribal health 

3 and human services agencies; 

4 (II) public housing authorities or 

5 State housing finance agencies; 

6 (III) State and local government 

7 budget offices; 

8 (IV) State Medicaid agencies; or 

9 (V) national consumer advocacy 

10 organizations. 

11 (F) CHAIR.— 

12 (i) IN GENERAL.—The Secretary shall 

13 select the Chair of the Council from among 

14 the members of the Council. 

15 (ii) INITIATING GUIDANCE.—The 

16 Chair, on behalf of the Council, shall iden17 tify and invite individuals from diverse en18 tities to provide the Council with advice 

19 and information pertaining to addressing 

20 social determinants of health, including— 

21 (I) individuals from State and 

22 local government health and human 

23 services agencies; 

24 (II) individuals from State Med25 icaid agencies; 


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1 (III) individuals from State and 

2 local government budget offices; 

3 (IV) individuals from public 

4 housing authorities or State housing 

5 finance agencies; 

6 (V) individuals from nonprofit or7 ganizations, small businesses, and 

8 philanthropic organizations; 

9 (VI) advocates; 

10 (VII) researchers; and 

11 (VIII) any other individuals the 

12 Chair determines to be appropriate. 

13 (3) DUTIES.—The duties of the Council are— 

14 (A) to make recommendations to the Sec15 retary and the Administrator regarding the cri16 teria for making awards under this section; 

17 (B) to identify Federal authorities and op18 portunities for use by States or local govern19 ments to improve coordination of funding and 

20 administration of Federal programs, the bene21 ficiaries of whom include individuals, and which 

22 may be unknown or underutilized, and to make 

23 information on such authorities and opportuni24 ties publicly available; 


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1 (C) to provide targeted technical assistance 

2 to States developing a social determinants ac3 celerator plan under this section, including 

4 identifying potential statutory or regulatory 

5 pathways for implementation of the plan and 

6 assisting in identifying potential sources of 

7 funding to implement the plan; 

8 (D) to report to Congress annually on the 

9 subjects set forth in this section; 

10 (E) to develop and disseminate evaluation 

11 guidelines and standards that can be used to 

12 reliably assess the impact of an intervention or 

13 approach that may be implemented pursuant to 

14 this section on outcomes, cost-effectiveness of, 

15 and return on investment from Federal, State, 

16 local, and Tribal governments, and to facilitate 

17 technical assistance, where needed, to help to 

18 improve State and local evaluation designs and 

19 implementation; 

20 (F) to seek feedback from State, local, and 

21 Tribal governments, including through an an22 nual survey by an independent third party, on 

23 how to improve the technical assistance the 

24 Council provides to better equip State, local, 


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1 and Tribal governments to coordinate health 

2 and social service programs; 

3 (G) to solicit applications for grants under 

4 subsection (c); and 

5 (H) to coordinate with other cross-agency 

6 initiatives focused on improving the health and 

7 well-being of low-income and at-risk populations 

8 in order to prevent unnecessary duplication be9 tween agency initiatives. 

10 (4) SCHEDULE.—Not later than 60 days after 

11 the date of enactment of this Act, the Council shall 

12 convene to develop a schedule and plan for carrying 

13 out the duties described in this section, including so14 licitation of applications for the grants under this 

15 section. 

16 (5) REPORT TO CONGRESS.—The Council shall 

17 submit an annual report to Congress, which shall in18 clude— 

19 (A) a list of the Council members; 

20 (B) activities and expenditures of the 

21 Council; 

22 (C) summaries of the interventions and ap23 proaches that will be supported by State, local, 

24 and Tribal governments that received a grant 

25 under this section, including— 


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1 (i) the best practices and evidence2 based approaches such governments plan 

3 to employ to achieve the purposes listed in 

4 this section; and 

5 (ii) a description of how the practices 

6 and approaches will impact the outcomes, 

7 cost-effectiveness of, and return on invest8 ment from, Federal, State, local, and Trib9 al governments with respect to such pur10 poses; 

11 (D) the feedback received from State and 

12 local governments on ways to improve the tech13 nical assistance of the Council, including find14 ings from a third-party survey and actions the 

15 Council plans to take in response to such feed16 back; and 

17 (E) the major statutory, regulatory, and 

18 administrative challenges identified by State, 

19 local, and Tribal governments that received a 

20 grant under subsection (c), and the actions that 

21 Federal agencies are taking to address such 

22 challenges. 

23 (6) FACA APPLICABILITY.—The Federal Advi24 sory Committee Act (5 U.S.C. App.) shall not apply 

25 to the Council. 


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1 (7) COUNCIL PROCEDURES.—The Secretary, in 

2 consultation with the Comptroller General of the 

3 United States and the Director of the Office of Man4 agement and Budget, shall establish procedures for 

5 the Council to— 

6 (A) ensure that adequate resources are 

7 available to effectively execute the responsibil8 ities of the Council; 

9 (B) effectively coordinate with other rel10 evant advisory bodies and working groups to 

11 avoid unnecessary duplication; 

12 (C) create transparency to the public and 

13 Congress with regard to Council membership, 

14 costs, and activities, including through use of 

15 modern technology and social media to dissemi16 nate information; and 

17 (D) avoid conflicts of interest that would 

18 jeopardize the ability of the Council to make de19 cisions and provide recommendations. 

20 (c) SOCIAL DETERMINANTS ACCELERATOR GRANTS

21 TO STATES OR LOCAL GOVERNMENTS.— 

22 (1) GRANTS TO STATES, LOCAL GOVERNMENTS, 

23 AND TRIBES.—Not later than 180 days after the 

24 date of enactment of this Act, the Administrator, in 

25 consultation with the Secretary and the Council, 


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1 shall award on a competitive basis not more than 25 

2 grants to eligible applicants described in this sub3 section, for the development of social determinants 

4 accelerator plans, as described in this subsection. 

5 (2) ELIGIBLE APPLICANT.—An eligible appli6 cant described in this subsection is a State, local, or 

7 Tribal health or human services agency that— 

8 (A) demonstrates the support of relevant 

9 parties across relevant State, local, or Tribal ju10 risdictions; and 

11 (B) in the case of an applicant that is a 

12 local government agency, provides to the Sec13 retary a letter of support from the lead State 

14 health or human services agency for the State 

15 in which the local government is located. 

16 (3) AMOUNT OF GRANT.—The Administrator, 

17 in coordination with the Council, shall determine the 

18 total amount that the Administrator will make avail19 able to each grantee under this subsection. 

20 (4) APPLICATION.—An eligible applicant seek21 ing a grant under this subsection shall include in the 

22 application the following information: 

23 (A) The target population (or populations) 

24 that would benefit from implementation of the 


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1 social determinants accelerator plan proposed to 

2 be developed by the applicant. 

3 (B) A description of the objective or objec4 tives and outcome goals of such proposed plan, 

5 which shall include at least one health outcome 

6 and at least one other important social out7 come. 

8 (C) The sources and scope of inefficiencies 

9 that, if addressed by the plan, could result in 

10 improved cost-effectiveness of or return on in11 vestment from Federal, State, local, and Tribal 

12 governments. 

13 (D) A description of potential interventions 

14 that could be designed or enabled using such 

15 proposed plan. 

16 (E) The State, local, and Tribal govern17 ments, academic institutions, nonprofit organi18 zations, community-based organizations, and 

19 other public and private sector partners that 

20 would participate in the development of the pro21 posed plan and subsequent implementation of 

22 programs or initiatives included in such pro23 posed plan. 

24 (F) Such other information as the Admin25 istrator, in consultation with the Secretary and 


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1 the Council, determines necessary to achieve the 

2 purposes of this section. 

3 (5) USE OF FUNDS.—A recipient of a grant 

4 under this subsection may use funds received 

5 through the grant for the following purposes: 

6 (A) To convene and coordinate with rel7 evant government entities and other stake8 holders across sectors to assist in the develop9 ment of a social determinant accelerator plan. 

10 (B) To identify populations of individuals 

11 receiving medical assistance under a State plan 

12 (or a waiver of such plan) under title XIX of 

13 the Social Security Act (42 U.S.C. 1396 et 

14 seq.) who may benefit from the proposed ap15 proaches to improving the health and well-being 

16 of such individuals through the implementation 

17 of the proposed social determinants accelerator 

18 plan. 

19 (C) To engage qualified research experts to 

20 advise on relevant research and to design a pro21 posed evaluation plan, in accordance with the 

22 standards and guidelines issued by the Admin23 istrator. 


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1 (D) To collaborate with the Council to sup2 port the development of social determinants ac3 celerator plans. 

4 (E) To prepare and submit a final social 

5 determinants accelerator plan to the Council. 

6 (6) CONTENTS OF PLANS.—A social deter7 minant accelerator plan developed under this sub8 section shall include the following: 

9 (A) A description of the target population 

10 (or populations) that would benefit from imple11 mentation of the social determinants accelerator 

12 plan, including an analysis describing the pro13 jected impact on the well-being of individuals 

14 described in paragraph (5)(B). 

15 (B) A description of the interventions or 

16 approaches designed under the social deter17 minants accelerator plan and the evidence for 

18 selecting such interventions or approaches. 

19 (C) The objectives and outcome goals of 

20 such interventions or approaches, including at 

21 least one health outcome and at least one other 

22 important social outcome. 

23 (D) A plan for accessing and linking rel24 evant data to enable coordinated benefits and 

25 services for the jurisdictions described in this 


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1 section and an evaluation of the proposed inter2 ventions and approaches. 

3 (E) A description of the State, local, and 

4 Tribal governments, academic institutions, non5 profit organizations, or any other public or pri6 vate sector organizations that would participate 

7 in implementing the proposed interventions or 

8 approaches, and the role each would play to 

9 contribute to the success of the proposed inter10 ventions or approaches. 

11 (F) The identification of the funding 

12 sources that would be used to finance the pro13 posed interventions or approaches. 

14 (G) A description of any financial incen15 tives that may be provided, including outcome16 focused contracting approaches to encourage 

17 service providers and other partners to improve 

18 outcomes of, cost-effectiveness of, and return on 

19 investment from, Federal, State, local, or Tribal 

20 government spending. 

21 (H) The identification of the applicable 

22 Federal, State, local, or Tribal statutory and 

23 regulatory authorities, including waiver authori24 ties, to be leveraged to implement the proposed 

25 interventions or approaches. 


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1 (I) A description of potential consider2 ations that would enhance the impact, 

3 scalability, or sustainability of the proposed 

4 interventions or approaches and the actions the 

5 grant awardee would take to address such con6 siderations. 

7 (J) A proposed evaluation plan, to be car8 ried out by an independent evaluator, to meas9 ure the impact of the proposed interventions or 

10 approaches on the outcomes of, cost-effective11 ness of, and return on investment from, Fed12 eral, State, local, and Tribal governments. 

13 (K) Precautions for ensuring that vulner14 able populations will not be denied access to 

15 Medicaid or other essential services as a result 

16 of implementing the proposed plan. 

17 (d) FUNDING.— 

18 (1) IN GENERAL.—Out of any money in the 

19 Treasury not otherwise appropriated, there is appro20 priated to carry out this section $25,000,000 to re21 main available for obligation until the date that is 

22 5 years after the date of enactment of this section. 

23 (2) RESERVATION OF FUNDS.— 

24 (A) IN GENERAL.—Of the funds made 

25 available under paragraph (1), the Secretary 


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1 shall reserve not less than 20 percent to award 

2 grants to eligible applicants for the development 

3 of social determinants accelerator plans under 

4 this section intended to serve rural populations. 

5 (B) EXCEPTION.—In the case of a fiscal 

6 year for which the Secretary determines that 

7 there are not sufficient eligible applicants to 

8 award up to 25 grants under subsection (d) 

9 that are intended to serve rural populations and 

10 the Secretary cannot satisfy the 20-percent re11 quirement, the Secretary may reserve an 

12 amount that is less than 20 percent of amounts 

13 made available under paragraph (1) to award 

14 grants for such purpose. 

15 (3) RULE OF CONSTRUCTION.—Nothing in this 

16 section shall prevent Federal agencies represented 

17 on the Council from contributing additional funding 

18 from other sources to support activities to improve 

19 the effectiveness of the Council. 

20 SEC. 10009. CORRECTING HURTFUL AND ALIENATING 

21 NAMES IN GOVERNMENT EXPRESSION 

22 (CHANGE). 

23 (a) SHORT TITLE.—This section may be cited as the 

24 ‘‘Correcting Hurtful and Alienating Names in Government 

25 Expression Act’’ or the ‘‘CHANGE Act’’. 


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1 (b) DEFINITIONS.—In this section: 

2 (1) EMPLOYEE.—The term ‘‘employee’’ has the 

3 meaning given the term in section 2105 of title 5, 

4 United States Code. 

5 (2) EXECUTIVE AGENCY.—The term ‘‘Executive 

6 agency’’ has the meaning given the term in section 

7 105 of title 5, United States Code. 

8 (3) OFFICER.—The term ‘‘officer’’ has the 

9 meaning given the term in section 2104 of title 5, 

10 United States Code. 

11 (4) PROHIBITED TERM.—The term ‘‘prohibited 

12 term’’ means— 

13 (A) the term ‘‘alien’’, when used to refer to 

14 an individual who is not a citizen or national of 

15 the United States; and 

16 (B) the term ‘‘illegal alien’’, when used to 

17 refer to an individual who— 

18 (i) is unlawfully present in the United 

19 States; or 

20 (ii) lacks a lawful immigration status 

21 in the United States. 

22 (c) MODERNIZATION OF LANGUAGE REFERRING TO

23 INDIVIDUALS WHO ARE NOT CITIZENS OR NATIONALS OF

24 THE UNITED STATES.— 


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1 (1) IN GENERAL.—Except as provided in para2 graph (2), on and after the date of enactment of this 

3 Act, an Executive agency may not use a prohibited 

4 term in any proposed or final rule, regulation, inter5 pretation, publication, other document, display, or 

6 sign issued by the Executive agency. 

7 (2) EXCEPTION.—An Executive agency may use 

8 a prohibited term under paragraph (1) if the Execu9 tive agency uses the prohibited term while quoting 

10 or reproducing text written by a source that is not 

11 an officer or employee of the Executive agency. 

12 (d) UNIFORM DEFINITION.— 

13 (1) IN GENERAL.—Chapter 1 of title 1, United 

14 States Code, is amended by adding at the end the 

15 following: 

16 ‘‘§ 9. Definition of ‘foreign national’ 

17 ‘‘In determining the meaning of any Act of Congress 

18 or any ruling, regulation, or interpretation of an adminis19 trative bureau or agency of the United States, the term 

20 ‘foreign national’ means any individual that is not an indi21 vidual who— 

22 ‘‘(1) is a citizen of the United States; or 

23 ‘‘(2) though not a citizen of the United States, 

24 owes permanent allegiance to the United States.’’. 


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1 (2) TECHNICAL AMENDMENT.—The table of 

2 sections for chapter 1 of title 1, United States Code, 

3 is amended by adding at the end the following: 

‘‘9. Definition of ‘foreign national’.’’. 

4 (e) REFERENCES.—Any reference in any Federal 

5 statute, rule, regulation, Executive order, publication, or 

6 other document of the United States— 

7 (1) to the term ‘‘alien’’, when used to refer to 

8 an individual who is not a citizen or national of the 

9 United States, is deemed to refer to the term ‘‘for10 eign national’’; and 

11 (2) to the term ‘‘illegal alien’’ is deemed to 

12 refer to the term ‘‘undocumented foreign national’’, 

13 when used to refer to an individual who— 

14 (A) is unlawfully present in the United 

15 States; or 

16 (B) lacks a lawful immigration status in 

17 the United States. 

18 SEC. 10010. ANDREW KEARSE ACCOUNTABILITY FOR DE19 NIAL OF MEDICAL CARE. 

20 (a) IN GENERAL.—Chapter 13 of title 18, United 

21 States Code, is amended by adding at the end the fol22 lowing: 

23 ‘‘§ 250. Medical attention for individuals in Federal 

24 custody displaying medical distress 

25 ‘‘(a) DEFINITIONS.—In this section— 


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1 ‘‘(1) the term ‘appropriate Inspector General’, 

2 with respect to a covered official, means— 

3 ‘‘(A) the Inspector General of the Federal 

4 agency that employs the covered official; or 

5 ‘‘(B) in the case of a covered official em6 ployed by a Federal agency that does not have 

7 an Inspector General, the Inspector General of 

8 the Department of Justice; 

9 ‘‘(2) the term ‘covered official’ means— 

10 ‘‘(A) a Federal law enforcement officer (as 

11 defined in section 115); 

12 ‘‘(B) an officer or employee of the Bureau 

13 of Prisons; or 

14 ‘‘(C) an officer or employee of the United 

15 States Marshals Service; and 

16 ‘‘(3) the term ‘medical distress’ includes breath17 ing difficulties. 

18 ‘‘(b) REQUIREMENT.— 

19 ‘‘(1) OFFENSE.—It shall be unlawful for a cov20 ered official to negligently fail to obtain or provide 

21 immediate medical attention to an individual in Fed22 eral custody who displays medical distress in the 

23 presence of the covered official if the individual suf24 fers unnecessary pain, injury, or death as a result of 

25 that failure. 


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1 ‘‘(2) PENALTY.—A covered official who violates 

2 paragraph (1) shall be fined under this title, impris3 oned for not more than 1 year, or both. 

4 ‘‘(3) STATE CIVIL ENFORCEMENT.—Whenever 

5 an attorney general of a State has reasonable cause 

6 to believe that a resident of the State has been ag7 grieved by a violation of paragraph (1) by a covered 

8 official, the attorney general, or another official, 

9 agency, or entity designated by the State, may bring 

10 a civil action in any appropriate district court of the 

11 United States to obtain appropriate equitable and 

12 declaratory relief. 

13 ‘‘(c) INSPECTOR GENERAL INVESTIGATION.— 

14 ‘‘(1) IN GENERAL.—The appropriate Inspector 

15 General shall investigate any instance in which— 

16 ‘‘(A) a covered official fails to obtain or 

17 provide immediate medical attention to an indi18 vidual in Federal custody who displays medical 

19 distress in the presence of the covered official; 

20 and 

21 ‘‘(B) the individual suffers unnecessary 

22 pain, injury, or death as a result of the failure 

23 to obtain or provide immediate medical atten24 tion. 


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1 ‘‘(2) REFERRAL FOR PROSECUTION.—If an ap2 propriate Inspector General, in conducting an inves3 tigation under paragraph (1), concludes that the 

4 covered official acted negligently in failing to obtain 

5 or provide immediate medical attention to the indi6 vidual in Federal custody, the appropriate Inspector 

7 General shall refer the case to the Attorney General 

8 for prosecution under this section. 

9 ‘‘(3) CONFIDENTIAL COMPLAINT PROCESS.— 

10 The Inspector General of a Federal agency that em11 ploys covered officials shall establish a process under 

12 which an individual may confidentially submit a 

13 complaint to the Inspector General regarding an in14 cident described in paragraph (1) involving a covered 

15 official employed by the Federal agency (or, in the 

16 case of the Inspector General of the Department of 

17 Justice, involving a covered official employed by a 

18 Federal agency that does not have an Inspector Gen19 eral). 

20 ‘‘(d) TRAINING.—The head of an agency that em21 ploys covered officials shall provide training to each such 

22 covered official on obtaining or providing medical assist23 ance to individuals in medical distress.’’. 

24 (b) TECHNICAL AND CONFORMING AMENDMENT.— 

25 The table of sections for chapter 13 of title 18, United 


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1 States Code, is amended by adding at the end the fol2 lowing: 

‘‘250. Medical attention for individuals in Federal custody displaying medical 

distress.’’. 

3 SEC. 10011. INVESTING IN COMMUNITY HEALING. 

4 (a) FINDINGS.—Congress finds as follows: 

5 (1) According to the Bureau of Justice Statis6 tics, African Americans are more likely to have face7 to-face contact with law enforcement and are 2.5 

8 times more likely to experience a threat or use of 

9 nonfatal force by police. 

10 (2) Research shows that young men who have 

11 experienced these law enforcement practices display 

12 higher levels of stress, anxiety, and trauma associ13 ated with the interaction. 

14 (3) Witnessing or experiencing invasive encoun15 ters with law enforcement can also be an everyday 

16 stressor for racial and ethnic minorities, leading to 

17 physiological and psychological strain. 

18 (4) Racial and ethnic minorities face inequities 

19 in accessing mental health services. 

20 (5) Addressing the stigma in some communities 

21 of color associated with receiving mental health serv22 ices and informing individuals about available treat23 ment can encourage better utilization of these serv24 ices. 


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1 (b) SENSE OF CONGRESS.—It is the sense of Con2 gress that it is imperative that a comprehensive public 

3 health approach to addressing trauma and mental health 

4 care be focused on care delivery that is culturally sensitive 

5 and competent. 

6 (c) RESEARCH ON ADVERSE HEALTH EFFECTS AS7 SOCIATED WITH INTERACTIONS WITH LAW ENFORCE8 MENT.— 

9 (1) IN GENERAL.—The Secretary, acting 

10 through the Director of the Office of Minority 

11 Health of the Centers for Disease Control and Pre12 vention (established pursuant to section 1707A of 

13 the Public Health Service Act (42 U.S.C. 300u– 

14 6a)), shall conduct research on the adverse health 

15 effects associated with interactions with law enforce16 ment. 

17 (2) EFFECTS AMONG RACIAL AND ETHNIC MI18 NORITIES.—The research under paragraph (1) shall 

19 include research on— 

20 (A) the health consequences, both indi21 vidual and community-wide, of trauma related 

22 to violence committed by law enforcement 

23 among racial and ethnic minorities; and 


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1 (B) the disproportionate burden of mor2 bidity and mortality associated with such trau3 ma. 

4 (3) REPORT.—Not later than 1 year after the 

5 date of enactment of this Act, the Secretary shall— 

6 (A) complete the research under this sub7 section; and 

8 (B) submit to Congress a report on the 

9 findings, conclusions, and recommendations re10 sulting from such research. 

11 (d) GRANTS FOR INCREASING RACIAL AND ETHNIC

12 MINORITY ACCESS TO HIGH-QUALITY TRAUMA SUPPORT

13 SERVICES AND MENTAL HEALTH CARE.— 

14 (1) IN GENERAL.—The Secretary, acting 

15 through the Assistant Secretary for Mental Health 

16 and Substance Use, shall award grants to eligible 

17 entities to establish or expand programs for the pur18 pose of increasing racial and ethnic minority access 

19 to high-quality trauma support services and mental 

20 health care. 

21 (2) ELIGIBLE ENTITIES.—To seek a grant 

22 under this subsection, an entity shall be a commu23 nity-based program or organization that— 

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1 dence-based practices for trauma-informed care; 

2 and 

3 (B) has demonstrated expertise in serving 

4 communities of color or can partner with a pro5 gram that has such demonstrated expertise. 

6 (3) USE OF FUNDS.—As a condition on receipt 

7 of a grant under this subsection, a grantee shall 

8 agree to use the grant to increase racial and ethnic 

9 minority access to high-quality trauma support serv10 ices and mental health care, such as by— 

11 (A) establishing and maintaining commu12 nity-based programs providing evidence-based 

13 services in trauma-informed care and culturally 

14 specific services and other resources; 

15 (B) developing innovative culturally spe16 cific strategies and projects to enhance access 

17 to trauma-informed care and resources for ra18 cial and ethnic minorities who face obstacles to 

19 using more traditional services and resources 

20 (such as obstacles in geographic access to pro21 viders, insurance coverage, and access to audio 

22 and video technologies); 

23 (C) working with State and local govern24 ments and social service agencies to develop and 


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1 enhance effective strategies to provide culturally 

2 specific services to racial and ethnic minorities; 

3 (D) increasing communities’ capacity to 

4 provide culturally specific resources and support 

5 for communities of color; 

6 (E) working in cooperation with the com7 munity to develop education and prevention 

8 strategies highlighting culturally specific issues 

9 and resources regarding racial and ethnic mi10 norities; 

11 (F) providing culturally specific programs 

12 for racial and ethnic minorities exposed to law 

13 enforcement violence; and 

14 (G) examining the dynamics of culture and 

15 its impact on victimization and healing. 

16 (4) PRIORITY.—In awarding grants under this 

17 subsection, the Secretary shall give priority to eligi18 ble entities proposing to serve communities that have 

19 faced high rates of community trauma, including 

20 from exposure to law enforcement violence, intergen21 erational poverty, civil unrest, discrimination, or op22 pression. 

23 (5) GRANT PERIOD.—The period of a grant 

24 under this subsection shall be 4 years. 


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1 (6) EVALUATION.—Not later than 6 months 

2 after the end of the period of all grants under this 

3 subsection, the Secretary shall— 

4 (A) conduct an evaluation of the programs 

5 funded by a grant under this subsection; 

6 (B) include in such evaluation an assess7 ment of the outcomes of each such program; 

8 and 

9 (C) submit a report on the results of such 

10 evaluation to Congress. 

11 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

12 carry out this subsection, there is authorized to be 

13 appropriated $20,000,000 for each of fiscal years 

14 2023 through 2027. 

15 (e) BEHAVIORAL AND MENTAL HEALTH OUTREACH

16 EDUCATION STRATEGY.— 

17 (1) IN GENERAL.—The Secretary, in coordina18 tion with advocacy and behavioral and mental health 

19 organizations serving racial and ethnic minority 

20 groups, shall develop and implement an outreach 

21 and education strategy to promote behavioral and 

22 mental health, and reduce stigma associated with 

23 mental health conditions, among racial and ethnic 

24 minorities. 


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1 (2) DESIGN.—The strategy under this sub2 section shall be designed to— 

3 (A) meet the diverse cultural and language 

4 needs of racial and ethnic minority groups; 

5 (B) provide information on evidence-based, 

6 culturally and linguistically appropriate and 

7 adapted interventions and treatments; 

8 (C) increase awareness of symptoms of 

9 mental illness among racial and ethnic minority 

10 groups; and 

11 (D) ensure full participation of, and en12 gage, both consumers and community members 

13 in the development and implementation of ma14 terials. 

15 (3) REPORT.—Not later than 1 year after the 

16 date of enactment of this Act, the Secretary shall 

17 submit to Congress, and make publicly available, a 

18 report detailing the outreach and education strategy 

19 that is developed and implemented under this sub20 section and the results of such implementation. 

21 SEC. 10012. ENVIRONMENTAL JUSTICE MAPPING AND DATA 

22 COLLECTION. 

23 (a) FINDINGS.—Congress finds that— 

24 (1) environmental hazards causing adverse 

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1 vironmental justice communities as a result of sys2 temic injustices relating to factors that include race 

3 and income; 

4 (2) environmental justice communities have in5 creased vulnerability to the adverse effects of climate 

6 change and need significant investment to face cur7 rent and future environmental hazards; 

8 (3) the Federal Government has lacked a cohe9 sive and consistent strategy to carry out the respon10 sibilities of Federal agencies described in Executive 

11 Order 12898 (42 U.S.C. 4321 note; relating to Fed12 eral actions to address environmental justice in mi13 nority populations and low-income populations); 

14 (4) it is necessary that the Federal Government 

15 meaningfully engage environmental justice commu16 nities in the process of developing a robust strategy 

17 to address environmental justice, including high lev18 els of review, input, and consent; 

19 (5) there is a lack of nationwide high-quality 

20 data relating to environmental justice concerns, such 

21 as socioeconomic factors, air pollution, water pollu22 tion, soil pollution, and public health, and a failure 

23 to update the existing data with adequate frequency; 

24 (6) there is no nationally consistent method to 

25 identify environmental justice communities based on 


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1 the cumulative effects of socioeconomic factors, pol2 lution burden, and public health; 

3 (7) a method described in paragraph (6) is 

4 needed to correct for racist and unjust practices 

5 leading to historical and current environmental in6 justices through the targeted investment in environ7 mental justice communities of at least 40 percent of 

8 the funds provided for a clean energy transition and 

9 other related investments, including transportation 

10 infrastructure, housing infrastructure, and water 

11 quality infrastructure; 

12 (8) funds targeted for environmental justice 

13 communities should include set-asides for technical 

14 assistance and capacity building for environmental 

15 justice communities to access the funds; 

16 (9) particular oversight and care are necessary 

17 when investing in environmental justice communities 

18 to ensure that existing issues are not exacerbated 

19 and new issues are not created, particularly issues 

20 relating to pollution burden and the displacement of 

21 residents; 

22 (10) several States, academic institutions, and 

23 nonprofit organizations have engaged in cumulative 

24 impact environmental justice mapping efforts that 

25 can serve as references for a Federal mapping effort; 


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1 (11) many environmental justice communities, 

2 such as communities in ‘‘Cancer Alley’’ in the State 

3 of Louisiana, have been clearly affected by extreme 

4 environmental hazards such that the communities— 

5 (A) are identifiable before the establish6 ment of the tool under paragraph (2) of sub7 section (d) and the completion of the data gap 

8 audit under paragraph (4) of that subsection; 

9 and 

10 (B) should be eligible for programs tar11 geted toward environmental justice communities 

12 that have faced extreme environmental hazards 

13 before the establishment of that tool and the 

14 completion of that audit; 

15 (12) in addition to investment in environmental 

16 justice communities, pollution reduction is essential 

17 to achieving equitable access to a healthy and clean 

18 environment and an equitable energy system; and 

19 (13) specific policy and permitting decisions 

20 and investments may rely on different combinations 

21 of data sets and indicators relating to environmental 

22 justice, and race alone may be considered a criterion 

23 when assessing the susceptibility of a community to 

24 environmental injustice. 

25 (b) DEFINITIONS.—In this section: 


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1 (1) ADVISORY COUNCIL.—The term ‘‘advisory 

2 council’’ means the advisory council established 

3 under subsection (c)(4)(B)(i). 

4 (2) COMMITTEE.—The term ‘‘Committee’’ 

5 means the Environmental Justice Mapping Com6 mittee established by subsection (c)(1). 

7 (3) ENVIRONMENTAL JUSTICE.—The term ‘‘en8 vironmental justice’’ means the fair treatment and 

9 meaningful involvement of all people regardless of 

10 race, color, culture, national origin, or income, with 

11 respect to the development, implementation, and en12 forcement of environmental laws, regulations, and 

13 policies to ensure that each person enjoys— 

14 (A) the same degree of protection from en15 vironmental and health hazards; and 

16 (B) equal access to any Federal agency ac17 tion relating to the development, implementa18 tion, and enforcement of environmental laws, 

19 regulations, and policies for the purpose of hav20 ing a healthy environment in which to live, 

21 learn, work, and recreate. 

22 (4) ENVIRONMENTAL JUSTICE COMMUNITY.— 

23 The term ‘‘environmental justice community’’ means 

24 a community with significant representation of com25 munities of color, low-income communities, or Tribal 


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1 and indigenous communities, that experiences, or is 

2 at risk of experiencing, higher or more adverse 

3 human health or environmental effects, as compared 

4 to other communities. 

5 (5) GROUND-TRUTHING.—The term ‘‘ground6 truthing’’ means a community fact-finding process 

7 by which residents of a community supplement tech8 nical information with local knowledge for the pur9 pose of better informing policy and project decisions. 

10 (6) RELEVANT STAKEHOLDER.—The term ‘‘rel11 evant stakeholder’’ means— 

12 (A) a representative of a regional, State, 

13 Tribal, or local government agency; 

14 (B) a representative of a nongovernmental 

15 organization with experience in areas that may 

16 include Tribal relations, environmental con17 servation, city and regional planning, and public 

18 health; 

19 (C) a representative of a labor union; 

20 (D) a representative or member of— 

21 (i) an environmental justice commu22 nity; or 

23 (ii) a community-based organization 

24 for an environmental justice community; 


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1 (E) an individual with expertise in cumu2 lative impacts, geospatial data, and environ3 mental justice, particularly such an individual 

4 from an academic or research institution; and 

5 (F) an advocate with experience in envi6 ronmental justice who represents an environ7 mental justice community. 

8 (c) ESTABLISHMENT OF COMMITTEE.— 

9 (1) IN GENERAL.—There is established a com10 mittee, to be known as the ‘‘Environmental Justice 

11 Mapping Committee’’. 

12 (2) MEMBERSHIP.— 

13 (A) IN GENERAL.—The Committee shall be 

14 composed of not fewer than 1 representative of 

15 each of the following: 

16 (i) Of the Environmental Protection 

17 Agency— 

18 (I) the Office of Air and Radi19 ation; 

20 (II) the Office of Chemical Safety 

21 and Pollution Prevention; 

22 (III) the Office of International 

23 and Tribal Affairs; 

24 (IV) the Office of Land and 

25 Emergency Management; 


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1 (V) the Office of Water; 

2 (VI) the Office of Environmental 

3 Justice; 

4 (VII) the Office of Research and 

5 Development; and 

6 (VIII) the Office of Public En7 gagement and Environmental Edu8 cation. 

9 (ii) The Council on Environmental 

10 Quality. 

11 (iii) Of the Department of Com12 merce— 

13 (I) the Office of Oceanic and At14 mospheric Research, including not 

15 fewer than 1 representative of the Cli16 mate Program Office; 

17 (II) the Economics and Statistics 

18 Administration, including not fewer 

19 than 1 representative of the Bureau 

20 of Economic Analysis; and 

21 (III) the National Institute of 

22 Standards and Technology. 

23 (iv) Of the Department of Health and 

24 Human Services— 


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1 (I) the Centers for Disease Con2 trol and Prevention, not including the 

3 Agency for Toxic Substances and Dis4 ease Registry; 

5 (II) the Agency for Toxic Sub6 stances and Disease Registry; 

7 (III) the Administration for Chil8 dren and Families; 

9 (IV) of the National Institutes of 

10 Health— 

11 (aa) the National Institute 

12 of Environmental Health 

13 Sciences; 

14 (bb) the National Institute 

15 of Mental Health; and 

16 (cc) the National Institute 

17 on Minority Health and Health 

18 Disparities; and 

19 (V) the Office for Civil Rights. 

20 (v) Of the Department of the Inte21 rior— 

22 (I) the Bureau of Indian Affairs; 

23 (II) the Office of Civil Rights; 

24 and 


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1 (III) the United States Geologi2 cal Survey. 

3 (vi) The Forest Service. 

4 (vii) The Department of Housing and 

5 Urban Development. 

6 (viii) The Department of Energy. 

7 (ix) The Department of Transpor8 tation. 

9 (x) The Department of Justice. 

10 (xi) The Federal Energy Regulatory 

11 Commission. 

12 (xii) The Department of the Treasury. 

13 (xiii) Such other Federal departments, 

14 agencies, and offices as the Administrator 

15 determines to be appropriate, particularly 

16 offices relating to public engagement. 

17 (B) SELECTION OF REPRESENTATIVES.— 

18 The head of a department or agency described 

19 in subparagraph (A) shall, in appointing to the 

20 Committee a representative of the department 

21 or agency, select a representative— 

22 (i) of a component of the department 

23 or agency that is among the components 

24 that are the most relevant to the respon25 sibilities of the Committee; or 


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1 (ii) who has expertise in areas rel2 evant to those responsibilities, such as de3 mographic indicators relating to socio4 economic hardship, environmental justice, 

5 public engagement, public health, exposure 

6 to pollution, future climate and extreme 

7 weather mapping, affordable energy, sus8 tainable transportation, and access to 

9 water, food, and green space. 

10 (C) CO-CHAIRS.— 

11 (i) IN GENERAL.—The members of 

12 the Committee shall select 3 members to 

13 serve as co-chairs of the Committee— 

14 (I) 1 of whom shall be a rep15 resentative of the Environmental Pro16 tection Agency; 

17 (II) 1 of whom shall be a rep18 resentative of the Council on Environ19 mental Quality; and 

20 (III) 1 of whom shall have sub21 stantial experience in public engage22 ment. 

23 (ii) TERMS.—Each co-chair shall 

24 serve for a term of not more than 3 years. 


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1 (iii) RESPONSIBILITIES OF CO2 CHAIRS.—The co-chairs of the Committee 

3 shall— 

4 (I) determine the agenda of the 

5 Committee, in consultation with other 

6 members of the Committee; 

7 (II) direct the work of the Com8 mittee, including the oversight of a 

9 meaningful public engagement proc10 ess; and 

11 (III) convene meetings of the 

12 Committee not less frequently than 

13 once each fiscal quarter. 

14 (3) ADMINISTRATIVE SUPPORT.— 

15 (A) IN GENERAL.—The Administrator 

16 shall provide technical and administrative sup17 port to the Committee. 

18 (B) FUNDING.—The Administrator may 

19 carry out subparagraph (A) using, in addition 

20 to any amounts made available under sub21 section (f), amounts authorized to be appro22 priated to the Administrator before the date of 

23 enactment of this Act and available for obliga24 tion as of that date of enactment. 

25 (4) CONSULTATION.— 


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1 (A) IN GENERAL.—In carrying out the du2 ties of the Committee, the Committee shall con3 sult with relevant stakeholders. 

4 (B) ADVISORY COUNCIL.— 

5 (i) IN GENERAL.—The Committee 

6 shall establish an advisory council com7 posed of a balanced proportion of relevant 

stakeholders, at least 1 8 ⁄2 of whom shall 

9 represent environmental justice commu10 nities. 

11 (ii) CHAIR.—The advisory council 

12 shall be chaired by an environmental jus13 tice advocate or other relevant stakeholder 

14 with substantial experience in environ15 mental justice. 

16 (iii) REQUIREMENTS.—Consultation 

17 described in subparagraph (A) shall in18 clude— 

19 (I) early and regular engagement 

20 with the advisory council, including in 

21 carrying out public engagement under 

22 subparagraph (C); and 

23 (II) consideration of the rec24 ommendations of the advisory council. 


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1 (iv) RECOMMENDATIONS NOT USED.— 

2 If the Committee does not use a rec3 ommendation of the advisory council, not 

4 later than 60 days after the date on which 

5 the Committee receives notice of the rec6 ommendation, the Committee shall— 

7 (I) make available to the public 

8 on an internet website of the Environ9 mental Protection Agency a written 

10 report describing the rationale of the 

11 Committee for not using the rec12 ommendation; and 

13 (II) submit the report described 

14 in subclause (I) to the Committee on 

15 Environment and Public Works of the 

16 Senate and the Committee on Energy 

17 and Commerce of the House of Rep18 resentatives. 

19 (v) OUTREACH.—The advisory council 

20 may carry out public outreach activities 

21 using amounts made available under sub22 section (f) to supplement public engage23 ment carried out by the Committee under 

24 subparagraph (C). 

25 (C) PUBLIC ENGAGEMENT.— 


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1 (i) IN GENERAL.—The Committee 

2 shall, throughout the process of carrying 

3 out the duties of the Committee described 

4 in subsection (d)— 

5 (I) meaningfully engage with rel6 evant stakeholders, particularly— 

7 (aa) members and represent8 atives of environmental justice 

9 communities; 

10 (bb) environmental justice 

11 advocates; and 

12 (cc) individuals with exper13 tise in cumulative impacts and 

14 geospatial data; and 

15 (II) ensure that the input of the 

16 stakeholders described in subclause (I) 

17 is central to the activities of the Com18 mittee. 

19 (ii) PLAN.— 

20 (I) IN GENERAL.—In carrying 

21 out clause (i), the Committee shall de22 velop a plan, in consultation with the 

23 advisory council, for comprehensive 

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1 mental justice advocates and members 

2 of environmental justice communities. 

3 (II) STRATEGIES TO OVERCOME

4 BARRIERS TO PUBLIC ENGAGE5 MENT.—The plan developed under 

6 subclause (I) shall include strategies 

7 to overcome barriers to public engage8 ment, including— 

9 (aa) language barriers; 

10 (bb) transportation barriers; 

11 (cc) economic barriers; and 

12 (dd) lack of internet access. 

13 (III) CONSIDERATION.—In devel14 oping the plan under subclause (I), 

15 the Committee shall consider the di16 verse and varied experiences of envi17 ronmental justice communities relat18 ing to the scope and types of environ19 mental hazards and socioeconomic in20 justices. 

21 (iii) CONSULTATION AND SOLICITA22 TION OF PUBLIC COMMENT.— 

23 (I) IN GENERAL.—In carrying 

24 out clause (i), not less frequently than 

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1 mittee shall consult with the advisory 

2 council and solicit meaningful public 

3 comment, particularly from relevant 

4 stakeholders, on the activities of the 

5 Committee. 

6 (II) REQUIREMENTS.—The Com7 mittee shall carry out subclause (I) 

8 through means including— 

9 (aa) public notice of a meet10 ing of the Committee occurring 

11 during the applicable fiscal quar12 ter, which shall include— 

13 (AA) notice in publica14 tions relevant to environ15 mental justice communities; 

16 (BB) notification to en17 vironmental justice commu18 nities through direct means, 

19 such as community centers 

20 and schools; and 

21 (CC) direct outreach to 

22 known environmental justice 

23 groups; 

24 (bb) public broadcast of that 

25 meeting, including soliciting and 


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1 receiving comments by virtual 

2 means; and 

3 (cc) public availability of a 

4 transcript of that meeting 

5 through publication on an acces6 sible website. 

7 (III) LANGUAGES.—The Com8 mittee shall provide each notice, noti9 fication, direct outreach, broadcast, 

10 and transcript described in subclause 

11 (II) in each language commonly used 

12 in the applicable environmental justice 

13 community, including through oral in14 terpretation, if applicable. 

15 (iv) FUNDING.—Of amounts made 

16 available under subsection (f), the Admin17 istrator shall make available to the Com18 mittee such sums as are necessary for par19 ticipation by relevant stakeholders in pub20 lic engagement under this paragraph, as 

21 determined by the Administrator, in con22 sultation with the advisory council. 

23 (d) DUTIES OF COMMITTEE.— 

24 (1) IN GENERAL.—The Committee shall— 


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1 (A) establish a tool described in paragraph 

2 (2) to identify environmental justice commu3 nities, including the identification of— 

4 (i) criteria to be used in the tool; and 

5 (ii) a methodology to determine the 

6 cumulative impacts of those criteria; 

7 (B) assess and address data gaps in ac8 cordance with paragraph (4); and 

9 (C) collect data for the environmental jus10 tice data repository established under sub11 section (e). 

12 (2) ESTABLISHMENT OF TOOL.— 

13 (A) IN GENERAL.—The Committee, in con14 sultation with relevant stakeholders and the ad15 visory council, shall establish an interactive, 

16 transparent, integrated, and Federal Govern17 ment-wide tool for assessing and mapping envi18 ronmental justice communities based on the cu19 mulative impacts of all indicators selected by 

20 the Committee to be integrated into the tool. 

21 (B) REQUIREMENTS.—In establishing the 

22 tool under subparagraph (A), the Committee 

23 shall— 


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1 (i) integrate into the tool multiple 

2 data layers of indicators that fall into cat3 egories including— 

4 (I) demographics, particularly re5 lating to socioeconomic hardship and 

6 social stressors, such as— 

7 (aa) race and ethnicity; 

8 (bb) low income; 

9 (cc) high unemployment; 

10 (dd) low levels of home own11 ership; 

12 (ee) high rent burden; 

13 (ff) high transportation bur14 den; 

15 (gg) low levels of educational 

16 attainment; 

17 (hh) linguistic isolation; 

18 (ii) energy insecurity or high 

19 utility rate burden; 

20 (jj) food insecurity; 

21 (kk) health insurance status 

22 and access to health care; and 

23 (ll) membership in an Indian 

24 Tribe; 


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1 (II) public health, particularly 

2 data that are indicative of sensitive 

3 populations, such as— 

4 (aa) rates of asthma; 

5 (bb) rates of cardiovascular 

6 disease; 

7 (cc) childhood leukemia or 

8 other cancers that correlate with 

9 environmental hazards; 

10 (dd) low birth weight; 

11 (ee) maternal mortality; 

12 (ff) rates of lead poisoning; 

13 and 

14 (gg) rates of diabetes; 

15 (III) pollution burdens, such as 

16 pollution burdens created by— 

17 (aa) toxic chemicals; 

18 (bb) air pollutants; 

19 (cc) water pollutants; 

20 (dd) soil contaminants; and 

21 (ee) perfluoroalkyl and 

22 polyfluoroalkyl substances; and 

23 (IV) environmental effects, such 

24 as effects created by proximity to— 


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1 (aa) risk management plan 

2 sites; 

3 (bb) hazardous waste facili4 ties; 

5 (cc) sites on the National 

6 Priorities List developed by the 

7 President in accordance with sec8 tion 105(a)(8)(B) of the Com9 prehensive Environmental Re10 sponse, Compensation, and Li11 ability Act of 1980 (42 U.S.C. 

12 9605(a)(8)(B)); and 

13 (dd) fossil fuel infrastruc14 ture; 

15 (ii) investigate how further indicators 

16 of vulnerability to the impacts of climate 

17 change (including proximity and exposure 

18 to sea level rise, wildfire smoke, flooding, 

19 drought, rising average temperatures, ex20 treme storms, and extreme heat, and fi21 nancial burdens from flood and fire insur22 ance) should be incorporated into the tool 

23 as an additional set of layers; 

24 (iii) identify and consider the effects 

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1 mental justice for integration into the tool 

2 as layers, including— 

3 (I) safe, sufficient, and affordable 

4 drinking water, sanitation, and 

5 stormwater services; 

6 (II) access to and the quality 

7 of— 

8 (aa) green space and tree 

9 canopy cover; 

10 (bb) healthy food; 

11 (cc) affordable energy and 

12 water; 

13 (dd) transportation; 

14 (ee) reliable communication 

15 systems, such as broadband 

16 internet; 

17 (ff) child care; 

18 (gg) high-quality public 

19 schools, early childhood edu20 cation, and child care; and 

21 (hh) health care facilities; 

22 (III) length of commute; 

23 (IV) indoor air quality in multi24 unit dwellings; 

25 (V) mental health; 


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1 (VI) labor market categories, 

2 particularly relating to essential work3 ers; and 

4 (VII) each type of utility expense; 

5 (iv) consider the implementation of 

6 specific regional indicators, with the poten7 tial— 

8 (I) to create regionally and lo9 cally downscaled maps in addition to a 

10 national map; 

11 (II) to provide incentives for 

12 States to collect data and conduct ad13 ditional analyses to capture conditions 

14 specific to their localities; 

15 (III) to provide resources for and 

16 engage in ground-truthing to identify 

17 and verify important data with com18 munity members; and 

19 (IV) to develop companion re20 sources for, and provide technical sup21 port to, regional, State, local, or Trib22 al governments to create their own 

23 maps and environmental justice scores 

24 with relevant regional, State, local, 

25 and Tribal data; 


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1 (v) identify a methodology to account 

2 for the cumulative impacts of all indicators 

3 selected by the Committee under clause (i), 

4 in addition to other indicators as the Com5 mittee determines to be necessary, to pro6 vide relative environmental justice scores 

7 for regions that are— 

8 (I) as small as practicable to 

9 identify communities; and 

10 (II) not larger than a census 

11 tract; 

12 (vi) ensure that the tool is capable of 

13 providing maps of environmental justice 

14 communities based on environmental jus15 tice scores described in clause (v); 

16 (vii) ensure that users of the tool are 

17 able to map available layers together or 

18 independently as desired; 

19 (viii) implement a method for users of 

20 the tool to generate a map and environ21 mental justice score based on a subset of 

22 indicators, particularly for the purpose of 

23 using the tool in addressing various policy 

24 needs, permitting processes, and invest25 ment goals; 


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1 (ix) make the tool customizable to ad2 dress specific policy needs, permitting 

3 processes, and investment goals; 

4 (x) account for conditions that are not 

5 captured by the quantitative data used to 

6 develop the 1 or more maps and environ7 mental justice scores comprising the tool, 

8 by— 

9 (I) developing and executing a 

10 plan to perform outreach to relevant 

11 communities; and 

12 (II) establishing a mechanism by 

13 which communities can self-identify as 

14 environmental justice communities to 

15 be included in the tool, which may in16 clude citing qualitative data on condi17 tions for which quantitative data are 

18 lacking, such as cultural loss in Tribal 

19 communities; 

20 (xi) consider that the tool— 

21 (I) will be used across the Fed22 eral Government in screening Federal 

23 policies, permitting processes, and in24 vestments for environmental and cli25 mate justice impacts; and 


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1 (II) may be used to assess com2 munities for pollution reduction pro3 grams; and 

4 (xii) carry out such other activities as 

5 the Committee determines to be appro6 priate. 

7 (3) TRANSPARENCY AND UPDATES.— 

8 (A) IN GENERAL.— 

9 (i) NOTICE AND COMMENT.—The 

10 Committee shall establish the tool de11 scribed in paragraph (2) after providing 

12 notice and an opportunity for public com13 ment. 

14 (ii) HEARINGS.—In carrying out 

15 clause (i), the Committee shall hold hear16 ings, which shall be time and language ap17 propriate, in communities affected by envi18 ronmental justice issues in geographically 

19 disparate States and Tribal areas. 

20 (B) UPDATES.— 

21 (i) ANNUAL UPDATES.—The Com22 mittee shall update the tool described in 

23 paragraph (2) not less frequently than an24 nually to account for data sets that are up25 dated annually. 


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1 (ii) OTHER UPDATES.—Not less fre2 quently than once every 3 years, the Com3 mittee shall— 

4 (I) update the indicators, meth5 odology, or both for the tool described 

6 in paragraph (2); and 

7 (II) reevaluate data submitted by 

8 Federal departments and agencies 

9 that is used for the tool. 

10 (iii) REPORTS.—After the initial es11 tablishment of the tool described in para12 graph (2) and each update under clause (i) 

13 or (ii), the Committee shall publish a re14 port describing— 

15 (I) the process for identifying in16 dicators relating to environmental jus17 tice in the development of the tool; 

18 (II) the methodology described in 

19 paragraph (2)(B)(v); and 

20 (III) the use of public input and 

21 community engagement in that proc22 ess. 

23 (C) TRAINING TUTORIALS AND SES24 SIONS.— 


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1 (i) IN GENERAL.—The Committee 

2 shall— 

3 (I) develop virtual training tuto4 rials and sessions for environmental 

5 justice communities for the use of the 

6 tool described in paragraph (2); and 

7 (II) where practicable, provide in8 person training sessions for environ9 mental justice communities for the 

10 use of that tool. 

11 (ii) LANGUAGES.—The tutorials and 

12 sessions under clause (i) shall be made 

13 available in each language commonly used 

14 in the applicable environmental justice 

15 community. 

16 (D) PUBLIC AVAILABILITY.— 

17 (i) IN GENERAL.—The Committee 

18 shall make available to the public on an 

19 internet website of the Environmental Pro20 tection Agency— 

21 (I) the tool described in para22 graph (2); 

23 (II) each update under clauses (i) 

24 and (ii) of subparagraph (B); 


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1 (III) each report under subpara2 graph (B)(iii); and 

3 (IV) the training tutorials and 

4 sessions developed under subpara5 graph (C)(i)(I). 

6 (ii) ACCESSIBILITY.—The Committee 

7 shall make the tool, updates, and reports 

8 described in clause (i) accessible to the 

9 public by publication in relevant languages 

10 and with accessibility functions, as appro11 priate. 

12 (iii) REQUIREMENT.—In carrying out 

13 clause (i)(I), the Committee shall take 

14 measures to prevent the tool from being 

15 misused to discriminate against environ16 mental justice communities, such as by 

17 providing safeguards against the use of 

18 downscaled data that may enable the iden19 tification of individuals. 

20 (4) DATA GAP AUDIT.— 

21 (A) IN GENERAL.—In establishing the tool 

22 described in paragraph (2), the Committee shall 

23 direct relevant Federal departments and agen24 cies to conduct an audit of data collected by the 

25 department or agency to identify any data that 


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1 are relevant to environmental justice concerns, 

2 including data relating to— 

3 (i) public health metrics; 

4 (ii) toxic chemicals; 

5 (iii) socioeconomic demographics; 

6 (iv) air quality; 

7 (v) water quality; and 

8 (vi) killings of individuals by law en9 forcement officers. 

10 (B) REQUIREMENTS.—An audit described 

11 in subparagraph (A) shall— 

12 (i) examine the granularity and acces13 sibility of the data; 

14 (ii) address the need for improved air 

15 quality monitoring; and 

16 (iii) include recommendations to other 

17 Federal departments and agencies on 

18 means to improve the quality, granularity, 

19 and transparency of, and public involve20 ment in, data collection and dissemination. 

21 (C) IMPROVEMENTS.—The Committee 

22 shall direct a Federal department or agency, in 

23 conducting an audit under subparagraph (A), to 

24 address gaps in existing data collection that will 

25 assist the Committee in establishing and operVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01758 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 ating the tool described in paragraph (2), in2 cluding by providing to the department or agen3 cy— 

4 (i) benchmarks to meet in addressing 

5 the gaps; 

6 (ii) instructions for consistency in 

7 data formatting that will allow for inclu8 sion of data in the environmental justice 

9 data repository described in subsection (e); 

10 and 

11 (iii) best practices for collecting data 

12 in collaboration with local organizations 

13 and partners, such as engaging in ground14 truthing. 

15 (D) REPORTS.—Not later than 180 days 

16 after a Federal department or agency has con17 ducted an audit under subparagraph (A), the 

18 Committee shall— 

19 (i) make available to the public on an 

20 internet website of the Environmental Pro21 tection Agency a report describing the 

22 findings and conclusions of the audit, in23 cluding the progress made by the Federal 

24 department or agency in addressing envi25 ronmental justice data gaps; and 


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1 (ii) submit the report described in 

2 clause (i) to— 

3 (I) the Committee on Environ4 ment and Public Works of the Senate; 

5 (II) the Committee on Health, 

6 Education, Labor, and Pensions of 

7 the Senate; 

8 (III) the Committee on Energy 

9 and Commerce of the House of Rep10 resentatives; and 

11 (IV) the Committee on Education 

12 and Labor of the House of Represent13 atives. 

14 (e) ENVIRONMENTAL JUSTICE DATA REPOSITORY.— 

15 (1) IN GENERAL.—The Administrator shall es16 tablish an environmental justice data repository to 

17 maintain— 

18 (A) the data collected by the Committee 

19 through the establishment of the tool described 

20 in subsection (d)(2) and the audits conducted 

21 under subsection (d)(4)(A); and 

22 (B) any subnational data collected under 

23 paragraph (3)(B). 

24 (2) UPDATES.—The Administrator shall update 

25 the data in the data repository described in paraVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01760 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 graph (1) as frequently as practicable, including 

2 every year if practicable, but not less frequently than 

3 once every 3 years. 

4 (3) AVAILABILITY; INCLUSION OF SUBNATIONAL

5 DATA.—The Administrator— 

6 (A) shall make the data repository de7 scribed in paragraph (1) available to regional, 

8 State, local, and Tribal governments; and 

9 (B) may collaborate with the governments 

10 described in subparagraph (A) to include within 

11 that data repository subnational data in exist12 ence before the establishment of the tool de13 scribed in subsection (d)(2) and the completion 

14 of the audits under subsection (d)(4)(A). 

15 (4) REQUIREMENT.—The Administrator shall 

16 take measures to prevent the data in the data repos17 itory described in paragraph (1) from being misused 

18 to discriminate against environmental justice com19 munities, such as by providing safeguards against 

20 the use of downscaled data that may enable the 

21 identification of individuals. 

22 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to the Administrator to 

24 carry out this section, including any necessary administra25 tive costs of the Committee— 


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1 (1) $20,000,000 for each of fiscal years 2023 

2 and 2024; and 

3 (2) $18,000,000 for each of fiscal years 2025 

4 through 2027. 

5 (g) EFFECT.—Nothing in any provision of this sec6 tion relating to the tool described in subsection (d)(2) pro7 hibits a State from developing a map relating to environ8 mental justice or pollution burden that relies on different 

9 data, or analyzes data differently, than that tool. 

10 SEC. 10013. ANTIRACISM IN PUBLIC HEALTH. 

11 (a) FINDINGS.—Congress finds as follows: 

12 (1) For centuries, structural racism, defined by 

13 the National Museum of African American History 

14 and Culture as an ‘‘overarching system of racial bias 

15 across institutions and society’’, in the United States 

16 has negatively affected communities of color, espe17 cially Black, Latinx, Asian American, Pacific Is18 lander, and American Indian and Alaska Native peo19 ple, to expand and reinforce White supremacy. 

20 (2) Structural racism determines the conditions 

21 in which people are born, grow, work, live, and age 

22 and determine people’s access to quality housing, 

23 education, food, transportation, and political power, 

24 and other social determinants of health. 


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1 (3) Structural racism serves as a major barrier 

2 to achieving health equity and eliminating racial and 

3 ethnic inequities in health outcomes that exist at 

4 alarming rates and are determined by a wider set of 

5 forces and systems. 

6 (4) Due to structural racism in the United 

7 States, people of color are more likely to suffer from 

8 chronic health conditions (such as heart disease, dia9 betes, asthma, hepatitis, and hypertension) and in10 fectious diseases (such as HIV/AIDS, and COVID– 

11 19) compared to their White counterparts. 

12 (5) Due to structural racism in maternal health 

13 care in the United States, Black and American In14 dian and Alaska Native infants are more than twice 

15 as likely to die than White infants, Black women are 

16 3 to 4 times more likely to die from pregnancy-re17 lated causes than White women, and American In18 dian and Alaska Native women are 5 times more 

19 likely to die from pregnancy-related causes than 

20 White women. This trend persists even when adjust21 ing for income and education. 

22 (6) Due to structural racism in the United 

23 States, Non-Hispanic Black women have the highest 

24 rates for 22 of 25 severe morbidity indicators used 

25 by the Center for Disease Control and Prevention. 


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1 (7) Due to structural racism in the United 

2 States, people of color comprise a disproportionate 

3 percentage of persons with disabilities in the United 

4 States. 

5 (8) Due to structural racism in the United 

States, Black men are up to 31 6 ⁄2 times as likely to 

7 be killed by police as White men, and 1 in every 

8 1,000 Black men will die as a result of police vio9 lence. Policing has adverse effects on mental health 

10 in Black communities. 

11 (9) Due to the confluence of structural racism 

12 and factors such as gender, class, and sexual ori13 entation or gender identity, commonly referred to as 

14 intersectionality, Black and Latinx transgender 

15 women are more likely to die due to violence and 

16 homicide than their White counterparts. 

17 (10) Due to structural racism, inequitable ac18 cess to quality health care and long-term services 

19 and supports also disproportionately burdens com20 munities of color; people of color and immigrants are 

21 less likely to be insured and are more likely to live 

22 in medically underserved areas. 

23 (11) Due to structural racism, older adults of 

24 color are also more likely to be admitted to nursing 

25 homes and assisted living facilities and to reside in 


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1 those of poor quality, and when older adults of color 

2 do receive home and community-based services, Med3 icaid spends less money on their services and they 

4 are more likely to be hospitalized than older White 

5 adults. 

6 (12) In addition, the Federal Government’s fail7 ure to honor the unique political status of American 

8 Indian and Alaska Native people, to respect the in9 herent sovereignty of Tribal Nations, and to uphold 

10 its trust and treaty obligations to Tribal Nations 

11 and American Indian and Alaska Native people, is 

12 an ongoing and unjust manifestation of centuries of 

13 oppression, with the consequence of adverse health 

14 outcomes for Native peoples. 

15 (13) The COVID–19 pandemic has exposed the 

16 devastating impact of structural racism on the 

17 United States ability to ensure equitable health out18 comes for people of color, and made these commu19 nities more likely to suffer from severe outcomes due 

20 to the coronavirus infection. 

21 (14) Racial and ethnic inequity in public health 

22 is a result of systematic, personally mediated, and 

23 internalized racism and racist public and private 

24 policies and practices, and dismantling structural 

25 racism is integral to addressing public health. 


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1 (b) PUBLIC HEALTH RESEARCH AND INVESTMENT

2 IN DISMANTLING STRUCTURAL RACISM.—Part B of title 

3 III of the Public Health Service Act (42 U.S.C. 243 et 

4 seq.) is amended by adding at the end the following: 

5 ‘‘SEC. 320C. NATIONAL CENTER ON ANTIRACISM AND 

6 HEALTH. 

7 ‘‘(a) IN GENERAL.— 

8 ‘‘(1) NATIONAL CENTER.—There is established 

9 within the Centers for Disease Control and Preven10 tion a center to be known as the ‘National Center 

11 on Antiracism and Health’ (referred to in this sec12 tion as the ‘Center’). The Director of the Centers for 

13 Disease Control and Prevention shall appoint a di14 rector to head the Center who has experience living 

15 in and working with racial and ethnic minority com16 munities. The Center shall promote public health 

17 by— 

18 ‘‘(A) declaring racism a public health crisis 

19 and naming racism as an historical and present 

20 threat to the physical and mental health and 

21 well-being of the United States and world; 

22 ‘‘(B) aiming to develop new knowledge in 

23 the science and practice of antiracism, including 

24 by identifying the mechanisms by which racism 


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1 operates in the provision of health care and in 

2 systems that impact health and well-being; 

3 ‘‘(C) transferring that knowledge into 

4 practice, including by developing interventions 

5 that dismantle the mechanisms of racism and 

6 replace such mechanisms with equitable struc7 tures, policies, practices, norms, and values so 

8 that a healthy society can be realized; and 

9 ‘‘(D) contributing to a national and global 

10 conversation regarding the impacts of racism on 

11 the health and well-being of the United States 

12 and world. 

13 ‘‘(2) GENERAL DUTIES.—The Secretary, acting 

14 through the Center, shall undertake activities to 

15 carry out the mission of the Center as described in 

16 paragraph (1), such as the following: 

17 ‘‘(A) Conduct research into, collect, ana18 lyze and make publicly available data on, and 

19 provide leadership and coordination for the 

20 science and practice of antiracism, the public 

21 health impacts of structural racism, and the ef22 fectiveness of intervention strategies to address 

23 these impacts. Topics of research and data col24 lection under this subparagraph may include 

25 identifying and understanding— 


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1 ‘‘(i) policies and practices that have a 

2 disparate impact on the health and well3 being of communities of color; 

4 ‘‘(ii) the public health impacts of im5 plicit racial bias, White supremacy, weath6 ering, xenophobia, discrimination, and 

7 prejudice; 

8 ‘‘(iii) the social determinants of health 

9 resulting from structural racism, including 

10 poverty, housing, employment, political 

11 participation, and environmental factors; 

12 and 

13 ‘‘(iv) the intersection of racism and 

14 other systems of oppression, including as 

15 related to age, sexual orientation, gender 

16 identity, and disability status. 

17 ‘‘(B) Award noncompetitive grants and co18 operative agreements to eligible public and non19 profit private entities, including State, local, 

20 territorial, and Tribal health agencies and orga21 nizations, for the research and collection, anal22 ysis, and reporting of data on the topics de23 scribed in subparagraph (A). 

24 ‘‘(C) Establish, through grants or coopera25 tive agreements, at least 3 regional centers of 


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1 excellence, located in racial and ethnic minority 

2 communities, in antiracism for the purpose of 

3 developing new knowledge in the science and 

4 practice of antiracism in health by researching, 

5 understanding, and identifying the mechanisms 

6 by which racism operates in the health space, 

7 racial and ethnic inequities in health care ac8 cess and outcomes, the history of successful 

9 antiracist movements in health, and other 

10 antiracist public health work. 

11 ‘‘(D) Establish a clearinghouse within the 

12 Centers for Disease Control and Prevention for 

13 the collection and storage of data generated 

14 under the programs implemented under this 

15 section for which there is not an otherwise ex16 isting surveillance system at the Centers for 

17 Disease Control and Prevention. Such data 

18 shall— 

19 ‘‘(i) be comprehensive and 

20 disaggregated, to the extent practicable, by 

21 including racial, ethnic, primary language, 

22 sex, gender identity, sexual orientation, 

23 age, socioeconomic status, and disability 

24 disparities; 

25 ‘‘(ii) be made publicly available; 


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1 ‘‘(iii) protect the privacy of individuals 

2 whose information is included in such data; 

3 and 

4 ‘‘(iv) comply with privacy protections 

5 under the regulations promulgated under 

6 section 264(c) of the Health Insurance 

7 Portability and Accountability Act of 1996. 

8 ‘‘(E) Provide information and education to 

9 the public on the public health impacts of struc10 tural racism and on antiracist public health 

11 interventions. 

12 ‘‘(F) Consult with other Centers and Na13 tional Institutes within the Centers for Disease 

14 Control and Prevention, including the Office of 

15 Minority Health and Health Equity and the 

16 Center for State, Tribal, Local, and Territorial 

17 Support, to ensure that scientific and pro18 grammatic activities initiated by the agency 

19 consider structural racism in their designs, 

20 conceptualizations, and executions, which shall 

21 include— 

22 ‘‘(i) putting measures of racism in 

23 population-based surveys; 

24 ‘‘(ii) establishing a Federal Advisory 

25 Committee on racism and health for the 


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1 Centers for Disease Control and Preven2 tion; 

3 ‘‘(iii) developing training programs, 

4 curricula, and seminars for the purposes of 

5 training public health professionals and re6 searchers around issues of race, racism, 

7 and antiracism; 

8 ‘‘(iv) providing standards and best 

9 practices for programming and grant re10 cipient compliance with Federal data col11 lection standards, including section 3101 

12 of the Public Health Service Act; and 

13 ‘‘(v) establishing leadership and stake14 holder councils with experts and leaders in 

15 racism and public health disparities. 

16 ‘‘(G) Coordinate with the Indian Health 

17 Service and with the Centers for Disease Con18 trol and Prevention’s Tribal Advisory Com19 mittee to ensure meaningful Tribal consulta20 tion, the gathering of information from Tribal 

21 authorities, and respect for Tribal data sov22 ereignty. 

23 ‘‘(H) Engage in government to government 

24 consultation with Indian Tribes and Tribal or25 ganizations. 


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1 ‘‘(I) At least every 2 years, produce and 

2 publicly post on the Centers for Disease Control 

3 and Prevention’s website a report on antiracist 

4 activities completed by the Center, which may 

5 include newly identified antiracist public health 

6 practices. 

7 ‘‘(b) DEFINITIONS.—In this section: 

8 ‘‘(1) ANTIRACISM.—The term ‘antiracism’ is a 

9 collection of antiracist policies that lead to racial eq10 uity, and are substantiated by antiracist ideas. 

11 ‘‘(2) ANTIRACIST.—The term ‘antiracist’ is any 

12 measure that produces or sustains racial equity be13 tween racial groups. 

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated such sums as may be nec16 essary to carry out this section.’’. 

17 (c) PUBLIC HEALTH RESEARCH AND INVESTMENT

18 IN POLICE VIOLENCE.— 

19 (1) IN GENERAL.—The Secretary shall establish 

20 within the National Center for Injury Prevention 

21 and Control of the Centers for Disease Control and 

22 Prevention (referred to in this subsection as the 

23 ‘‘Center’’) a law enforcement violence prevention 

24 program. 


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1 (2) GENERAL DUTIES.—In implementing the 

2 program under paragraph (1), the Center shall con3 duct research into, and provide leadership and co4 ordination for— 

5 (A) the understanding and promotion of 

6 knowledge about the public health impacts of 

7 uses of force by law enforcement, including po8 lice brutality and violence; 

9 (B) developing public health interventions 

10 and perspectives for eliminating deaths, injury, 

11 trauma, and negative mental health effects 

12 from police presence and interactions, including 

13 police brutality and violence; and 

14 (C) ensuring comprehensive data collection, 

15 analysis, and reporting regarding police violence 

16 and misconduct, in consultation with the De17 partment of Justice and independent research18 ers. 

19 (3) FUNCTIONS.—Under the program under 

20 paragraph (1), the Center shall— 

21 (A) summarize and enhance the knowledge 

22 of the distribution, status, and characteristics 

23 of law enforcement-related death, trauma, and 

24 injury; 


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1 (B) conduct research and prepare, with the 

2 assistance of State public health departments— 

3 (i) statistics on law enforcement-re4 lated death, injury, and brutality; 

5 (ii) studies of the factors, including 

6 legal, socioeconomic, discrimination, and 

7 other factors that correlate with or influ8 ence police brutality; 

9 (iii) public information about uses of 

10 force by law enforcement, including police 

11 brutality and violence, for the practical use 

12 of the public health community, including 

13 publications that synthesize information 

14 relevant to the national goal of under15 standing police violence and methods for 

16 its control; 

17 (iv) information to identify socio18 economic groups, communities, and geo19 graphic areas in need of study, and a stra20 tegic plan for research necessary to com21 prehend the extent and nature of police 

22 uses of force by law enforcement, including 

23 police brutality and violence, and deter24 mine what options exist to reduce or eradi25 cate death and injury that result; and 


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1 (v) best practices in police violence 

2 prevention in other countries; 

3 (C) award grants, contracts, and coopera4 tive agreements to provide for the conduct of 

5 epidemiologic research on uses of force by law 

6 enforcement, including police brutality and vio7 lence, by Federal, State, local, and private 

8 agencies, institutions, organizations, and indi9 viduals; 

10 (D) award grants, contracts, and coopera11 tive agreements to community groups, inde12 pendent research organizations, academic insti13 tutions, and other entities to support, execute, 

14 or conduct research on interventions to reduce 

15 or eliminate uses of force by law enforcement, 

16 including police brutality and violence; 

17 (E) coordinate with the Department of 

18 Justice, and other Federal, State, and local 

19 agencies on the standardization of data collec20 tion, storage, and retrieval necessary to collect, 

21 evaluate, analyze, and disseminate information 

22 about the extent and nature of uses of force by 

23 law enforcement, including police brutality and 

24 violence, as well as options for the eradication 

25 of such practices; 


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1 (F) submit an annual report to Congress 

2 on research findings with recommendations to 

3 improve data collection and standardization and 

4 to disrupt processes in policing that preserve 

5 and reinforce racism and racial disparities in 

6 public health; 

7 (G) conduct primary research and explore 

8 uses of force by law enforcement, including po9 lice brutality and violence, and options for its 

10 control; and 

11 (H) study alternatives to law enforcement 

12 response as a method of reducing police vio13 lence. 

14 (4) AUTHORIZATION OF APPROPRIATIONS.— 

15 There is authorized to be appropriated, such sums 

16 as may be necessary to carry out this subsection. 

17 SEC. 10014. LGBTQ ESSENTIAL DATA. 

18 (a) IMPROVING DATA COLLECTION ON THE SEXUAL

19 ORIENTATION AND GENDER IDENTITY OF DECEASED IN20 DIVIDUALS THROUGH THE NATIONAL VIOLENT DEATH

21 REPORTING SYSTEM.— 

22 (1) COLLECTION OF SEXUAL ORIENTATION AND

23 GENDER IDENTITY DATA.— 

24 (A) IN GENERAL.—Not later than 120 

25 days after the date of enactment of this Act, 


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1 the Director of the Centers for Disease Control 

2 and Prevention shall take measures to improve 

3 the incidence of the collection of information on 

4 the sexual orientation and gender identity of de5 ceased individuals through the National Violent 

6 Death Reporting System or any successor pro7 grams. 

8 (B) CONFIDENTIALITY.—Any information 

9 collected relating to the sexual orientation or 

10 gender identity of a decedent shall be main11 tained in accordance with the confidentiality 

12 and privacy standards and policies for the pro13 tection of individuals applicable to all other 

14 data collected for purposes of the National Vio15 lent Death Reporting System. 

16 (2) DEFINITIONS.—In this subsection: 

17 (A) GENDER IDENTITY.—The term ‘‘gen18 der identity’’ means an individual’s sense of 

19 being male, female, transgender, or another 

20 gender, as distinct from the individual’s sex as21 signed at birth. 

22 (B) SEXUAL ORIENTATION.—The term 

23 ‘‘sexual orientation’’ means how a person iden24 tifies in terms of their emotional, romantic, or 

25 sexual attractions, and includes identification as 


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1 straight, heterosexual, gay, lesbian, or bisexual, 

2 among other terms. 

3 (3) AUTHORIZATION.—There is authorized to 

4 be appropriated $25,000,000 for fiscal year 2023 to 

5 carry out this subsection. 

6 (b) SENSE OF CONGRESS.—It is the sense of Con7 gress that— 

8 (1) the Centers for Disease Control and Preven9 tion has made significant efforts to encourage States 

10 and other jurisdictions to collect data on sexual ori11 entation and gender identity through the National 

12 Violent Death Reporting System; and 

13 (2) jurisdictions that participate in the collec14 tion of such data through the National Violent 

15 Death Reporting System should be commended for 

16 their participation. 

17 SEC. 10015. SOCIAL DETERMINANTS ACCELERATOR. 

18 (a) FINDINGS; PURPOSES.— 

19 (1) FINDINGS.—Congress finds as follows: 

20 (A) There is a significant body of evidence 

21 showing that economic and social conditions 

22 have a powerful impact on individual and popu23 lation health outcomes and well-being, as well 

24 as medical costs. 


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1 (B) State, local, and Tribal governments 

2 and the service delivery partners of such gov3 ernments face significant challenges in coordi4 nating benefits and services delivered through 

5 the Medicaid program and other social services 

6 programs because of the fragmented and com7 plex nature of Federal and State funding and 

8 administrative requirements. 

9 (C) The Federal Government should 

10 prioritize and proactively assist State and local 

11 governments to strengthen the capacity of State 

12 and local governments to improve health and 

13 social outcomes for individuals, thereby improv14 ing cost-effectiveness and return on investment. 

15 (2) PURPOSES.—The purposes of this section 

16 are as follows: 

17 (A) To establish effective, coordinated Fed18 eral technical assistance to help State and local 

19 governments to improve outcomes and cost-ef20 fectiveness of, and return on investment from, 

21 health and social services programs. 

22 (B) To build a pipeline of State and locally 

23 designed, cross-sector interventions and strate24 gies that generate rigorous evidence about how 

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1 crease the cost-effectiveness of, and return on 

2 investment from, Federal, State, local, and 

3 Tribal health and social services programs. 

4 (C) To enlist State and local governments 

5 and the service providers of such governments 

6 as partners in identifying Federal statutory, 

7 regulatory, and administrative challenges in im8 proving the health and social outcomes of, cost9 effectiveness of, and return on investment from, 

10 Federal spending on individuals enrolled in 

11 Medicaid. 

12 (D) To develop strategies to improve 

13 health and social outcomes without denying 

14 services to, or restricting the eligibility of, vul15 nerable populations. 

16 (b) SOCIAL DETERMINANTS ACCELERATOR COUN17 CIL.— 

18 (1) ESTABLISHMENT.—The Secretary of Health 

19 and Human Services (referred to in this section as 

20 the ‘‘Secretary’’), in coordination with the Adminis21 trator of the Centers for Medicare & Medicaid Serv22 ices (referred to in this section as the ‘‘Adminis23 trator’’), shall establish an interagency council, to be 

24 known as the Social Determinants Accelerator Inter25 agency Council (referred to in this section as the 


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1 ‘‘Council’’) to achieve the purposes listed in sub2 section (a)(2). 

3 (2) MEMBERSHIP.— 

4 (A) FEDERAL COMPOSITION.—The Council 

5 shall be composed of at least one designee from 

6 each of the following Federal agencies: 

7 (i) The Office of Management and 

8 Budget. 

9 (ii) The Department of Agriculture. 

10 (iii) The Department of Education. 

11 (iv) The Indian Health Service. 

12 (v) The Department of Housing and 

13 Urban Development. 

14 (vi) The Department of Labor. 

15 (vii) The Department of Transpor16 tation. 

17 (viii) Any other Federal agency the 

18 Chair of the Council determines necessary. 

19 (B) DESIGNATION.— 

20 (i) IN GENERAL.—The head of each 

21 agency specified in subparagraph (A) shall 

22 designate at least one employee described 

23 in clause (ii) to serve as a member of the 

24 Council. 


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1 (ii) RESPONSIBILITIES.—An employee 

2 described in this subparagraph shall be a 

3 senior employee of the agency— 

4 (I) whose responsibilities relate 

5 to authorities, policies, and procedures 

6 with respect to the health and well7 being of individuals receiving medical 

8 assistance under a State plan (or a 

9 waiver of such plan) under title XIX 

10 of the Social Security Act (42 U.S.C. 

11 1396 et seq.); or 

12 (II) who has authority to imple13 ment and evaluate transformative ini14 tiatives that harness data or conducts 

15 rigorous evaluation to improve the im16 pact and cost-effectiveness of federally 

17 funded services and benefits. 

18 (C) HHS REPRESENTATION.—In addition 

19 to the designees under subparagraph (A), the 

20 Council shall include designees from at least 

21 three agencies within the Department of Health 

22 and Human Services, including the Centers for 

23 Medicare & Medicaid Services, at least one of 

24 whom shall meet the criteria under subpara25 graph (B)(ii). 


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1 (D) OMB ROLE.—The Director of the Of2 fice of Management and Budget shall facilitate 

3 the timely resolution of Governmentwide and 

4 multiagency issues to help the Council achieve 

5 consensus recommendations described under 

6 paragraph (3)(A). 

7 (E) NON-FEDERAL COMPOSITION.—The 

8 Comptroller General of the United States may 

9 designate up to 6 Council designees— 

10 (i) who have relevant subject matter 

11 expertise, including expertise implementing 

12 and evaluating transformative initiatives 

13 that harness data and conduct evaluations 

14 to improve the impact and cost-effective15 ness of Federal Government services; and 

16 (ii) that each represent— 

17 (I) State, local, and Tribal health 

18 and human services agencies; 

19 (II) public housing authorities or 

20 State housing finance agencies; 

21 (III) State and local government 

22 budget offices; 

23 (IV) State Medicaid agencies; or 

24 (V) national consumer advocacy 

25 organizations. 


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1 (F) CHAIR.— 

2 (i) IN GENERAL.—The Secretary shall 

3 select the Chair of the Council from among 

4 the members of the Council. 

5 (ii) INITIATING GUIDANCE.—The 

6 Chair, on behalf of the Council, shall iden7 tify and invite individuals from diverse en8 tities to provide the Council with advice 

9 and information pertaining to addressing 

10 social determinants of health, including— 

11 (I) individuals from State and 

12 local government health and human 

13 services agencies; 

14 (II) individuals from State Med15 icaid agencies; 

16 (III) individuals from State and 

17 local government budget offices; 

18 (IV) individuals from public 

19 housing authorities or State housing 

20 finance agencies; 

21 (V) individuals from nonprofit or22 ganizations, small businesses, and 

23 philanthropic organizations; 

24 (VI) advocates; 

25 (VII) researchers; and 


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1 (VIII) any other individuals the 

2 Chair determines to be appropriate. 

3 (3) DUTIES.—The duties of the Council are— 

4 (A) to make recommendations to the Sec5 retary and the Administrator regarding the cri6 teria for making awards under subsection (c); 

7 (B) to identify Federal authorities and op8 portunities for use by States or local govern9 ments to improve coordination of funding and 

10 administration of Federal programs, the bene11 ficiaries of whom include individuals described 

12 in subsection (a), and which may be unknown 

13 or underutilized and to make information on 

14 such authorities and opportunities publicly 

15 available; 

16 (C) to provide targeted technical assistance 

17 to States developing a social determinants ac18 celerator plan under subsection (c), including 

19 identifying potential statutory or regulatory 

20 pathways for implementation of the plan and 

21 assisting in identifying potential sources of 

22 funding to implement the plan; 

23 (D) to report to Congress annually on the 

24 subjects set forth in paragraph (4); 


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1 (E) to develop and disseminate evaluation 

2 guidelines and standards that can be used to 

3 reliably assess the impact of an intervention or 

4 approach that may be implemented pursuant to 

5 this section on outcomes, cost-effectiveness of, 

6 and return on investment from Federal, State, 

7 local, and Tribal governments, and to facilitate 

8 technical assistance, where needed, to help to 

9 improve State and local evaluation designs and 

10 implementation; 

11 (F) to seek feedback from State, local, and 

12 Tribal governments, including through an an13 nual survey by an independent third party, on 

14 how to improve the technical assistance the 

15 Council provides to better equip State, local, 

16 and Tribal governments to coordinate health 

17 and social service programs; 

18 (G) to solicit applications for grants under 

19 subsection (c); and 

20 (H) to coordinate with other cross-agency 

21 initiatives focused on improving the health and 

22 well-being of low-income and at-risk populations 

23 in order to prevent unnecessary duplication be24 tween agency initiatives. 


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1 (4) SCHEDULE.—Not later than 60 days after 

2 the date of enactment of this Act, the Council shall 

3 convene to develop a schedule and plan for carrying 

4 out the duties described in paragraph (3), including 

5 solicitation of applications for the grants under sub6 section (c). 

7 (5) REPORT TO CONGRESS.—The Council shall 

8 submit an annual report to Congress, which shall in9 clude— 

10 (A) a list of the Council members; 

11 (B) activities and expenditures of the 

12 Council; 

13 (C) summaries of the interventions and ap14 proaches that will be supported by State, local, 

15 and Tribal governments that received a grant 

16 under subsection (c), including— 

17 (i) the best practices and evidence18 based approaches such governments plan 

19 to employ to achieve the purposes listed in 

20 subsection (a)(2); and 

21 (ii) a description of how the practices 

22 and approaches will impact the outcomes, 

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1 al governments with respect to such pur2 poses; 

3 (D) the feedback received from State and 

4 local governments on ways to improve the tech5 nical assistance of the Council, including find6 ings from a third-party survey and actions the 

7 Council plans to take in response to such feed8 back; and 

9 (E) the major statutory, regulatory, and 

10 administrative challenges identified by State, 

11 local, and Tribal governments that received a 

12 grant under subsection (c), and the actions that 

13 Federal agencies are taking to address such 

14 challenges. 

15 (6) FACA APPLICABILITY.—The Federal Advi16 sory Committee Act (5 U.S.C. App.) shall not apply 

17 to the Council. 

18 (7) COUNCIL PROCEDURES.—The Secretary, in 

19 consultation with the Comptroller General of the 

20 United States and the Director of the Office of Man21 agement and Budget, shall establish procedures for 

22 the Council to— 

23 (A) ensure that adequate resources are 

24 available to effectively execute the responsibil25 ities of the Council; 


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1 (B) effectively coordinate with other rel2 evant advisory bodies and working groups to 

3 avoid unnecessary duplication; 

4 (C) create transparency to the public and 

5 Congress with regard to Council membership, 

6 costs, and activities, including through use of 

7 modern technology and social media to dissemi8 nate information; and 

9 (D) avoid conflicts of interest that would 

10 jeopardize the ability of the Council to make de11 cisions and provide recommendations. 

12 (c) SOCIAL DETERMINANTS ACCELERATOR GRANTS

13 TO STATES OR LOCAL GOVERNMENTS.— 

14 (1) GRANTS TO STATES, LOCAL GOVERNMENTS, 

15 AND TRIBES.—Not later than 180 days after the 

16 date of enactment of this Act, the Administrator, in 

17 consultation with the Secretary and the Council, 

18 shall award on a competitive basis not more than 25 

19 grants to eligible applicants described in paragraph 

20 (2), for the development of social determinants ac21 celerator plans, as described in paragraph (6). 

22 (2) ELIGIBLE APPLICANT.—An eligible appli23 cant described in this subsection is a State, local, or 

24 Tribal health or human services agency that— 


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1 (A) demonstrates the support of relevant 

2 parties across relevant State, local, or Tribal ju3 risdictions; and 

4 (B) in the case of an applicant that is a 

5 local government agency, provides to the Sec6 retary a letter of support from the lead State 

7 health or human services agency for the State 

8 in which the local government is located. 

9 (3) AMOUNT OF GRANT.—The Administrator, 

10 in coordination with the Council, shall determine the 

11 total amount that the Administrator will make avail12 able to each grantee under this subsection. 

13 (4) APPLICATION.—An eligible applicant seek14 ing a grant under this subsection shall include in the 

15 application the following information: 

16 (A) The target population (or populations) 

17 that would benefit from implementation of the 

18 social determinants accelerator plan proposed to 

19 be developed by the applicant. 

20 (B) A description of the objective or objec21 tives and outcome goals of such proposed plan, 

22 which shall include at least one health outcome 

23 and at least one other important social out24 come. 


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1 (C) The sources and scope of inefficiencies 

2 that, if addressed by the plan, could result in 

3 improved cost-effectiveness of or return on in4 vestment from Federal, State, local, and Tribal 

5 governments. 

6 (D) A description of potential interventions 

7 that could be designed or enabled using such 

8 proposed plan. 

9 (E) The State, local, Tribal, academic, 

10 nonprofit, community-based organizations, and 

11 other private sector partners that would partici12 pate in the development of the proposed plan 

13 and subsequent implementation of programs or 

14 initiatives included in such proposed plan. 

15 (F) Such other information as the Admin16 istrator, in consultation with the Secretary and 

17 the Council, determines necessary to achieve the 

18 purposes of this section. 

19 (5) USE OF FUNDS.—A recipient of a grant 

20 under this subsection may use funds received 

21 through the grant for the following purposes: 

22 (A) To convene and coordinate with rel23 evant government entities and other stake24 holders across sectors to assist in the develop25 ment of a social determinant accelerator plan. 


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1 (B) To identify populations of individuals 

2 receiving medical assistance under a State plan 

3 (or a waiver of such plan) under title XIX of 

4 the Social Security Act (42 U.S.C. 1396 et 

5 seq.) who may benefit from the proposed ap6 proaches to improving the health and well-being 

7 of such individuals through the implementation 

8 of the proposed social determinants accelerator 

9 plan. 

10 (C) To engage qualified research experts to 

11 advise on relevant research and to design a pro12 posed evaluation plan, in accordance with the 

13 standards and guidelines issued by the Admin14 istrator. 

15 (D) To collaborate with the Council to sup16 port the development of social determinants ac17 celerator plans. 

18 (E) To prepare and submit a final social 

19 determinants accelerator plan to the Council. 

20 (6) CONTENTS OF PLANS.—A social deter21 minant accelerator plan developed under this sub22 section shall include the following: 

23 (A) A description of the target population 

24 (or populations) that would benefit from imple25 mentation of the social determinants accelerator 


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1 plan, including an analysis describing the pro2 jected impact on the well-being of individuals 

3 described in paragraph (5)(B). 

4 (B) A description of the interventions or 

5 approaches designed under the social deter6 minants accelerator plan and the evidence for 

7 selecting such interventions or approaches. 

8 (C) The objectives and outcome goals of 

9 such interventions or approaches, including at 

10 least one health outcome and at least one other 

11 important social outcome. 

12 (D) A plan for accessing and linking rel13 evant data to enable coordinated benefits and 

14 services for the jurisdictions described in para15 graph (2)(A) and an evaluation of the proposed 

16 interventions and approaches. 

17 (E) A description of the State, local, Trib18 al, academic, nonprofit, or community-based or19 ganizations, or any other private sector organi20 zations that would participate in implementing 

21 the proposed interventions or approaches, and 

22 the role each would play to contribute to the 

23 success of the proposed interventions or ap24 proaches. 


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1 (F) The identification of the funding 

2 sources that would be used to finance the pro3 posed interventions or approaches. 

4 (G) A description of any financial incen5 tives that may be provided, including outcome6 focused contracting approaches to encourage 

7 service providers and other partners to improve 

8 outcomes of, cost-effectiveness of, and return on 

9 investment from, Federal, State, local, or Tribal 

10 government spending. 

11 (H) The identification of the applicable 

12 Federal, State, local, or Tribal statutory and 

13 regulatory authorities, including waiver authori14 ties, to be leveraged to implement the proposed 

15 interventions or approaches. 

16 (I) A description of potential consider17 ations that would enhance the impact, 

18 scalability, or sustainability of the proposed 

19 interventions or approaches and the actions the 

20 grant awardee would take to address such con21 siderations. 

22 (J) A proposed evaluation plan, to be car23 ried out by an independent evaluator, to meas24 ure the impact of the proposed interventions or 

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1 ness of, and return on investment from, Fed2 eral, State, local, and Tribal governments. 

3 (K) Precautions for ensuring that vulner4 able populations will not be denied access to 

5 Medicaid or other essential services as a result 

6 of implementing the proposed plan. 

7 (d) FUNDING.— 

8 (1) IN GENERAL.—Out of any money in the 

9 Treasury not otherwise appropriated, there is appro10 priated to carry out this section $25,000,000, of 

11 which up to $5,000,000 may be used to carry out 

12 this section, to remain available for obligation until 

13 the date that is 5 years after the date of enactment 

14 of this Act. 

15 (2) RESERVATION OF FUNDS.— 

16 (A) IN GENERAL.—Of the funds made 

17 available under paragraph (1), the Secretary 

18 shall reserve not less than 20 percent to award 

19 grants to eligible applicants for the development 

20 of social determinants accelerator plans under 

21 subsection (c) intended to serve rural popu22 lations. 

23 (B) EXCEPTION.—In the case of a fiscal 

24 year for which the Secretary determines that 

25 there are not sufficient eligible applicants to 


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1 award up to 25 grants under subsection (c) 

2 that are intended to serve rural populations and 

3 the Secretary cannot satisfy the 20-percent re4 quirement, the Secretary may reserve an 

5 amount that is less than 20 percent of amounts 

6 made available under paragraph (1) to award 

7 grants for such purpose. 

8 (3) RULE OF CONSTRUCTION.—Nothing in this 

9 section shall prevent Federal agencies represented 

10 on the Council from contributing additional funding 

11 from other sources to support activities to improve 

12 the effectiveness of the Council. 

13 SEC. 10016. IMPROVING SOCIAL DETERMINANTS OF 

14 HEALTH. 

15 (a) FINDINGS.—Congress finds as follows: 

16 (1) Healthy People 2030 defines social deter17 minants of health as conditions in the environments 

18 where people are born, live, learn, work, play, wor19 ship, and age that affect a wide range of health, 

20 functioning, and quality-of-life outcomes and risks. 

21 (2) One of the overarching goals of Healthy 

22 People 2030 is to ‘‘create social, physical, and eco23 nomic environments that promote attaining the full 

24 potential for health and well-being for all’’. 


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1 (3) Healthy People 2030 developed a ‘‘place2 based’’ organizing framework, reflecting five key 

3 areas of social determinants of health namely— 

4 (A) economic stability; 

5 (B) education access and quality; 

6 (C) social and community context; 

7 (D) health care access and quality; and 

8 (E) neighborhood and built environment. 

9 (4) It is estimated that medical care accounts 

10 for only 10 to 20 percent of the modifiable contribu11 tors to healthy outcomes for a population. 

12 (5) The Centers for Medicare & Medicaid Serv13 ices has indicated the importance of the social deter14 minants in its work stating that, ‘‘As we seek to fos15 ter innovation, rethink rural health, find solutions to 

16 the opioid epidemic, and continue to put patients 

17 first, we need to take into account social deter18 minants of health and recognize their importance.’’. 

19 (6) The Department of Health and Human 

20 Services’ Public Health 3.0 initiative recognizes the 

21 role of public health in working across sectors on so22 cial determinants of health, as well as the role of 

23 public health as chief health strategist in commu24 nities. 


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1 (7) Through its Health Impact in 5 Years ini2 tiative, the Centers for Disease Control and Preven3 tion has highlighted nonclinical, community-wide ap4 proaches that show positive health impacts, results 

5 within 5 years, and cost-effectiveness or cost-savings 

6 over the lifetime of the population or earlier. 

7 (8) Health departments and the Centers for 

8 Disease Control and Prevention are not funded for 

9 such cross-cutting work. 

10 (b) SOCIAL DETERMINANTS OF HEALTH PRO11 GRAM.— 

12 (1) PROGRAM.—To the extent and in the 

13 amounts made available in advance in appropriations 

14 Acts, the Director of the Centers for Disease Control 

15 and Prevention (in this section referred to as the 

16 ‘‘Director’’) shall carry out a program, to be known 

17 as the Social Determinants of Health Program (in 

18 this section referred to as the ‘‘Program’’), to 

19 achieve the following goals: 

20 (A) Improve health outcomes and reduce 

21 health inequities by coordinating social deter22 minants of health activities across the Centers 

23 for Disease Control and Prevention. 

24 (B) Improve the capacity of public health 

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1 dress social determinants of health in commu2 nities. 

3 (2) ACTIVITIES.—To achieve the goals listed in 

4 paragraph (1), the Director shall carry out activities 

5 including the following: 

6 (A) Coordinating across the Centers for 

7 Disease Control and Prevention to ensure that 

8 relevant programs consider and incorporate so9 cial determinants of health in grant awards and 

10 other activities. 

11 (B) Awarding grants under subsection (c) 

12 to State, local, territorial, and Tribal health 

13 agencies and organizations, and to other eligible 

14 entities, to address social determinants of 

15 health in target communities. 

16 (C) Awarding grants under subsection (d) 

17 to nonprofit organizations and public or other 

18 nonprofit institutions of higher education— 

19 (i) to conduct research on best prac20 tices to improve social determinants of 

21 health; 

22 (ii) to provide technical assistance, 

23 training, and evaluation assistance to 

24 grantees under subsection (c); and 


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1 (iii) to disseminate best practices to 

2 grantees under subsection (c). 

3 (D) Coordinating, supporting, and aligning 

4 activities of the Centers for Disease Control and 

5 Prevention related to social determinants of 

6 health with activities of other Federal agencies 

7 related to social determinants of health, includ8 ing such activities of agencies in the Depart9 ment of Health and Human Services such as 

10 the Centers for Medicare & Medicaid Services. 

11 (E) Collecting and analyzing data related 

12 to the social determinants of health. 

13 (c) GRANTS TO ADDRESS SOCIAL DETERMINANTS OF

14 HEALTH.— 

15 (1) IN GENERAL.—The Director, as part of the 

16 Program, shall award grants to eligible entities to 

17 address social determinants of health in their com18 munities. 

19 (2) ELIGIBILITY.—To be eligible to apply for a 

20 grant under this subsection, an entity shall be— 

21 (A) a State, local, territorial, or Tribal 

22 health agency or organization; 

23 (B) a qualified nongovernmental entity, as 

24 defined by the Director; or 


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1 (C) a consortium of entities that includes 

2 a State, local, territorial, or Tribal health agen3 cy or organization. 

4 (3) USE OF FUNDS.— 

5 (A) IN GENERAL.—A grant under this sub6 section shall be used to address social deter7 minants of health in a target community by de8 signing and implementing innovative, evidence9 based, cross-sector strategies. 

10 (B) TARGET COMMUNITY.—For purposes 

11 of this subsection, a target community shall be 

12 a State, county, city, or other municipality. 

13 (4) PRIORITY.—In awarding grants under this 

14 subsection, the Director shall prioritize applicants 

15 proposing to serve target communities with signifi16 cant unmet health and social needs, as defined by 

17 the Director. 

18 (5) APPLICATION.—To seek a grant under this 

19 subsection, an eligible entity shall— 

20 (A) submit an application at such time, in 

21 such manner, and containing such information 

22 as the Director may require; 

23 (B) propose a set of activities to address 

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1 based, cross-sector strategies, which activities 

2 may include— 

3 (i) collecting quantifiable data from 

4 health care, social services, and other enti5 ties regarding the most significant gaps in 

6 health-promoting social, economic, and en7 vironmental needs; 

8 (ii) identifying evidence-based ap9 proaches to meeting the nonmedical, social 

10 needs of populations identified by data col11 lection described in clause (i), such as un12 stable housing or food insecurity; 

13 (iii) developing scalable methods to 

14 meet patients’ social needs identified in 

15 clinical settings or other sites; 

16 (iv) convening entities such as local 

17 and State governmental and nongovern18 mental organizations, health systems, 

19 payors, and community-based organiza20 tions to review, plan, and implement com21 munity-wide interventions and strategies to 

22 advance health-promoting social conditions; 

23 (v) monitoring and evaluating the im24 pact of activities funded through the grant 

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1 dents of the target community and on the 

2 cost of health care; and 

3 (vi) such other activities as may be 

4 specified by the Director; 

5 (C) demonstrate how the eligible entity will 

6 collaborate with— 

7 (i) health systems; 

8 (ii) payors, including, as appropriate, 

9 Medicaid managed care organizations (as 

10 defined in section 1903(m)(1)(A) of the 

11 Social Security Act (42 U.S.C. 

12 1396b(m)(1)(A))), Medicare Advantage 

13 plans under part C of title XVIII of such 

14 Act (42 U.S.C. 1395w–21 et seq.), and 

15 health insurance issuers and group health 

16 plans (as such terms are defined in section 

17 2791 of the Public Health Service Act (42 

18 U.S.C. 300gg–91)); 

19 (iii) other relevant stakeholders and 

20 initiatives in areas of need, such as the Ac21 countable Health Communities Model of 

22 the Centers for Medicare & Medicaid Serv23 ices, health homes under the Medicaid pro24 gram under title XIX of the Social Secu25 rity Act (42 U.S.C. 1396 et seq.), commuVerDate Sep 11 2014 02:04 Aug 05, 2022 Jkt 029200 PO 00000 Frm 01803 Fmt 6652 Sfmt 6201 E:\BILLS\S4486.IS S4486

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1 nity-based organizations, and human serv2 ices organizations; 

3 (iv) other non-health care sector orga4 nizations, including organizations focusing 

5 on transportation, housing, or food access; 

6 and 

7 (v) local employers; and 

8 (D) identify key health inequities in the 

9 target community and demonstrate how the 

10 proposed efforts of the eligible entity would ad11 dress such inequities. 

12 (6) MONITORING AND EVALUATION.—As a con13 dition of receipt of a grant under this subsection, a 

14 grantee shall agree to submit an annual report to 

15 the Director describing the activities carried out 

16 through the grant and the outcomes of such activi17 ties. 

18 (7) INDEPENDENT NATIONAL EVALUATION.— 

19 (A) IN GENERAL.—Not later than 5 years 

20 after the first grants are awarded under this 

21 subsection, the Director shall provide for the 

22 commencement of an independent national eval23 uation of the program under this subsection. 

24 (B) REPORT TO CONGRESS.—Not later 

25 than 60 days after receiving the results of such 


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1 independent national evaluation, the Director 

2 shall report such results to Congress. 

3 (d) RESEARCH AND TRAINING.—The Director, as 

4 part of the Program— 

5 (1) shall award grants to nonprofit organiza6 tions and public or other nonprofit institutions of 

7 higher education— 

8 (A) to conduct research on best practices 

9 to improve social determinants of health; 

10 (B) to provide technical assistance, train11 ing, and evaluation assistance to grantees under 

12 subsection (c); and 

13 (C) to disseminate best practices to grant14 ees under subsection (c); and 

15 (2) may require a grantee under paragraph (1) 

16 to provide technical assistance and capacity building 

17 to entities that are eligible entities under subsection 

18 (c) but not receiving funds through such section. 

19 (e) FUNDING.— 

20 (1) IN GENERAL.—There is authorized to be 

21 appropriated to carry out this section, $50,000,000 

22 for each of fiscal years 2023 through 2028. 

23 (2) ALLOCATION.—Of the amount made avail24 able to carry out this section for a fiscal year, not 


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1 less than 75 percent shall be used for grants under 

2 subsections (c) and (d). 

3 Subtitle B—Gun Violence 

4 SEC. 10101. REAFFIRMING RESEARCH AUTHORITY OF THE 

5 CENTERS FOR DISEASE CONTROL AND PRE6 VENTION. 

7 (a) IN GENERAL.—Section 391 of the Public Health 

8 Service Act (42 U.S.C. 280b) is amended— 

9 (1) in subsection (a)(1), by striking ‘‘research 

10 relating to the causes, mechanisms, prevention, diag11 nosis, treatment of injuries, and rehabilitation from 

12 injuries;’’ and inserting the following: ‘‘research, in13 cluding data collection, relating to— 

14 ‘‘(A) the causes, mechanisms, prevention, 

15 diagnosis, and treatment of injuries, including 

16 with respect to gun violence; and 

17 ‘‘(B) rehabilitation from such injuries;’’; 

18 and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘(c) NO ADVOCACY OR PROMOTION OF GUN CON22 TROL.—Nothing in this section shall be construed to— 

23 ‘‘(1) authorize the Secretary to give assistance, 

24 make grants, or enter into cooperative agreements or 


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1 contracts for the purpose of advocating or promoting 

2 gun control; or 

3 ‘‘(2) permit a recipient of any assistance, grant, 

4 cooperative agreement, or contract under this section 

5 to use such assistance, grant, agreement, or contract 

6 for the purpose of advocating or promoting gun con7 trol.’’. 

8 SEC. 10102. NATIONAL VIOLENT DEATH REPORTING SYS9 TEM. 

10 The Secretary of Health and Human Services, acting 

11 through the Director of the Centers for Disease Control 

12 and Prevention, shall improve the National Violent Death 

13 Reporting System (as authorized by sections 301(a) and 

14 391(a) of the Public Service Health Act (42 U.S.C. 

15 241(a), 280b(a)), particularly through the inclusion of ad16 ditional States and activities to increase the quality, type, 

17 and timeliness of reported data. Participation in the Sys18 tem by the States shall be voluntary. 

19 SEC. 10103. REPORT ON EFFECTS OF GUN VIOLENCE ON 

20 PUBLIC HEALTH. 

21 Not later than one year after the date of enactment 

22 of this Act, and annually thereafter, the Surgeon General 

23 shall submit to Congress a report on the effects on public 

24 health, including mental health, of gun violence in the 


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1 United States during the preceding year, and the status 

2 of actions taken to address such effects. 

3 SEC. 10104. REPORT ON EFFECTS OF GUN VIOLENCE ON 

4 MENTAL HEALTH IN MINORITY COMMU5 NITIES. 

6 Not later than one year after the date of enactment 

7 of this Act, the Deputy Assistant Secretary for Minority 

8 Health in the Office of the Secretary of Health and 

9 Human Services shall submit to Congress a report on the 

10 effects of gun violence on public health, including mental 

11 health, in minority communities in the United States, and 

12 the status of actions taken to address such effects. 

Æ 


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