I 

108TH CONGRESS 

1ST SESSION H. R. 2258

To provide for programs and activities to improve the health of Hispanic 

individuals, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 22, 2003

Mr. RODRIGUEZ (for himself, Ms. SOLIS, Mr. GONZALEZ, Mr. BACA, Mr. PASTOR, Mr. GUTIERREZ, Mrs. NAPOLITANO, Ms. ROYBAL-ALLARD, Mr. 

ORTIZ, Mr. BECERRA, Mr. CARDOZA, Mr. REYES, Mr. ACEVEDO-VILA ́, 

Mr. SERRANO, Ms. VELA ́ZQUEZ, Mr. HINOJOSA, Ms. LINDA T. SA ́NCHEZ

of California, Mr. MENENDEZ, Ms. DEGETTE, Mr. PALLONE, Mrs. 

CHRISTENSEN, and Mr. ISRAEL) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL

To provide for programs and activities to improve the health 

of Hispanic 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Hispanic Health Improvement Act of 2003’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 
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TITLE I—HEALTH CARE COVERAGE 

Subtitle A—Coverage for Children, Parents, and Pregnant Women 

Sec. 101. Coverage of parents and pregnant women under the medicaid program and title XXI. 

Sec. 102. Automatic enrollment of children born to title XXI parents. 

Sec. 103. Optional coverage of children through age 20 under the medicaid program and title XXI. 

Sec. 104. Technical and conforming amendments to authority to pay medicaid 

expansion costs from title XXI appropriation. 

Sec. 105. Extension of availability of SCHIP allotments for fiscal years 1998 

through 2001. 

Subtitle B—State Option to Provide Coverage to All Individual Below 100 

Percent of Poverty 

Sec. 111. State option to offer medicaid coverage based on need. 

Subtitle C—Outreach and Enrollment 

Sec. 121. Grants to promote innovative outreach and enrollment efforts under 

SCHIP. 

Subtitle D—Immigrant Children and Pregnant Women 

Sec. 131. Optional coverage of legal immigrants under the medicaid program 

and SCHIP. 

Sec. 132. Permitting States and localities to provide health care to all individuals. 

Subtitle E—Eligibility Simplification 

Sec. 141. State option to provide for simplified determinations of a child’s financial eligibility for medical assistance under medicaid or 

child health assistance under SCHIP. 

Sec. 142. Application of simplified title XXI procedures under the medicaid 

program. 

Subtitle F—SCHIP Wrap-Around Benefits 

Sec. 151. State option to provide wrap-around SCHIP coverage to children who 

have other health coverage. 

Subtitle G—Immunization Coverage Through SCHIP 

Sec. 161. Eligibility of children enrolled in the State children’s health insurance 

program for the pediatric vaccine distribution program. 

Subtitle H—Limited English Proficient Communities 

Sec. 171. Increased Federal reimbursement for language services under the 

medicaid program and the State children’s health insurance 

program. 

Subtitle I—Binational Public Health Infrastructure and Health Insurance 

Sec. 181. Binational public health infrastructure and health insurance. 

Subtitle J—Migrant Workers and Farmworkers Health 
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Sec. 191. Demonstration project regarding continuity of coverage of migrant 

workers and farmworkers under medicaid and SCHIP. 

TITLE II—HEALTH DISPARITIES 

Subtitle A—Report on Programs for Improving the Health Status of 

Hispanic Individuals 

Sec. 201. Annual report regarding Hispanic health disparities for chronic and 

communicable diseases. 

Subtitle B—Diabetes Research, Control, and Prevention 

Sec. 211. Treatment. 

Sec. 212. Education. 

Sec. 213. Health promotion, prevention activities, and access. 

Subtitle C—HIV Prevention Activities Regarding Hispanic Individuals 

Sec. 221. Programs of Centers for Disease Control and Prevention; representation of Hispanic individuals in membership of community planning groups. 

Sec. 222. AIDS education and training centers funded by Health Resources 

and Services Administration; establishment of center directed 

toward minority populations with HIV. 

Subtitle D—Prevention of Latina Adolescent Suicides 

Sec. 231. Short title. 

Sec. 232. Establishment of program for prevention of Latina adolescent suicides. 

Subtitle E—Cancer Research, Training, and Awareness 

Sec. 241. Redes En Accion: the National Hispanic/Latino Cancer Network and 

other NCI special populations networks initiatives targeting 

cancer; increased authorization of appropriations for activities 

regarding Hispanic individuals. 

Subtitle F—Tuberculosis Control, Prevention, and Treatment 

Sec. 251. Advisory Council for the Elimination of Tuberculosis. 

Sec. 252. National program for tuberculosis elimination. 

Sec. 253. Inclusion of inpatient hospital services for the treatment of TB-infected individuals. 

TITLE III—ACCESS AND AFFORDABILITY 

Subtitle A—Dental Health Services 

Sec. 301. Grants to improve the provision of dental health services through 

community health centers and public health departments. 

Sec. 302. School-based dental sealant program. 

Subtitle B—Border Health 

Sec. 311. Short title. 

Sec. 312. Definitions. 

Sec. 313. Border health services grants. 
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Sec. 314. Border bioterrorism preparedness grants. 

Sec. 315. United States-Mexico Border Health Commission Act amendments. 

Subtitle C—Patient Navigator, Outreach, and Chronic Disease Prevention 

Sec. 321. Short title. 

Sec. 322. HRSA grants for model community cancer and chronic disease care 

and prevention; HRSA grants for patient navigators. 

Sec. 323. NCI grants for model community cancer and chronic disease care and 

prevention; NCI grants for patient navigators. 

Sec. 324. IHS grants for model community cancer and chronic disease care and 

prevention; IHS grants for patient navigators. 

TITLE IV—STRENGTHENING OUR HEALTH CARE WORKFORCE 

Subtitle A—Hispanic-Serving Health Professions Schools 

Sec. 401. Hispanic-serving health professions schools. 

Subtitle B—Health Career Opportunity Program and Centers of Excellence 

Sec. 411. Educational assistance regarding undergraduates. 

Sec. 412. Centers of excellence. 

Subtitle C—Bilingual Health Professionals 

Sec. 421. Training of bilingual health professionals with respect to minority 

health conditions. 

Subtitle D—Cultural Competence 

Sec. 431. Definition. 

Sec. 432. Activities of Office of Minority Health; Center for Linguistic and Cultural Competence in Health Care. 

Sec. 433. Cultural competence demonstration projects. 

TITLE V—ADDITIONAL PROGRAMS 

Subtitle A—Data Regarding Race and Ethnicity 

Sec. 501. Collection of data. 

Sec. 502. Development of standards; study to measure patient outcomes under 

medicare and medicaid programs. 

Subtitle B—National Assessment of Status of Latino Health 

Sec. 511. National assessment of status of Latino health.

Subtitle C—Office of Minority Health

Sec. 521. Revision and extension of programs of Office of Minority Health. 

Sec. 522. Establishment of individual Offices of Minority Health within agencies of Public Health Service. 

Sec. 523. Assistant Secretary of Health and Human Services for Civil Rights.

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 
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1 (1) The uninsured rates of Hispanic adults and 

2 children is almost two to three times those for non3 Hispanic whites and more than one-third of all His4 panics lack any form of health insurance. 

5 (2) Hispanics disproportionately suffer from 

6 conditions like diabetes, cardiovascular disease, HIV/

7 AIDS, and other illnesses. 

8 (3) Hispanic communities are underserved and 

9 continue to have significantly less access to afford10 able quality medical care. 

11 (4) The under-representation of Hispanics in 

12 the health professions and the educational pipeline 

13 of the health professions affects the current and fu14 ture delivery of culturally competent and sensitive 

15 health care for Hispanics. 

16 (5) Therefore there is a need for a comprehen17 sive Federal effort to address the unique health 

18 needs of the Hispanic community.
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1 TITLE I—HEALTH CARE 

2 COVERAGE 

3 Subtitle A—Coverage for Children, 

4 Parents, and Pregnant Women 

5 SEC. 101. COVERAGE OF PARENTS AND PREGNANT WOMEN 

6 UNDER THE MEDICAID PROGRAM AND TITLE 

7 XXI. 

8 (a) INCENTIVES TO IMPLEMENT COVERAGE OF PAR9 ENTS AND PREGNANT WOMEN.—

10 (1) UNDER MEDICAID.—

11 (A) ESTABLISHMENT OF NEW OPTIONAL

12 ELIGIBILITY CATEGORY.—Section 

13 1902(a)(10)(A)(ii) of the Social Security Act 

14 (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—

15 (i) by striking ‘‘or’’ at the end of sub16 clause (XVII); 

17 (ii) by adding ‘‘or’’ at the end of sub18 clause (XVIII); and 

19 (iii) by adding at the end the fol20 lowing: 

21 ‘‘(XIX) who are individuals de22 scribed in subsection (k)(1) (relating 

23 to parents of categorically eligible chil24 dren);’’. 
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1 (B) PARENTS DESCRIBED.—Section 1902 

2 of the Social Security Act is further amended 

3 by inserting after subsection (j) the following: 

4 ‘‘(k)(1)(A) Individuals described in this paragraph 

5 are individuals—

6 ‘‘(i) who are the parents of an individual who 

7 is under 19 years of age (or such higher age as the 

8 State may have elected under section 1902(l)(1)(D)) 

9 and who is eligible for medical assistance under sub10 section (a)(10)(A); 

11 ‘‘(ii) who are not otherwise eligible for medical 

12 assistance under such subsection or under a waiver 

13 approved under section 1115 or otherwise (except 

14 under section 1931 or under subsection 

15 (a)(10)(A)(ii)(XIX)); and 

16 ‘‘(iii) whose family income exceeds the effective 

17 income level or resource level applicable under the 

18 State plan under part A of title IV as in effect as 

19 of July 16, 1996, but does not exceed the highest ef20 fective income level applicable to a child in the fam21 ily under this title. 

22 ‘‘(B) In establishing an income eligibility level for in23 dividuals described in this paragraph, a State may vary 

24 such level consistent with the various income levels estab25 lished under subsection (l)(2) based on the ages of chil-
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1 dren described in subsection (l)(1) in order to ensure, to 

2 the maximum extent possible, that such individuals shall 

3 be enrolled in the same program as their children. 

4 ‘‘(C) An individual may not be treated as being de5 scribed in this paragraph unless, at the time of the individ6 ual’s enrollment under this title, the child referred to in 

7 subparagraph (A)(i) of the individual is also enrolled 

8 under this title. 

9 ‘‘(D) In this subsection, the term ‘parent’ has the 

10 meaning given the term ‘caretaker relative’ for purposes 

11 of carrying out section 1931. 

12 ‘‘(2) In the case of a parent described in paragraph 

13 (1) who is also the parent of a child who is eligible for 

14 child health assistance under title XXI, the State may 

15 elect (on a uniform basis) to cover all such parents under 

16 section 2111 or under this title.’’. 

17 (C) ENHANCED MATCHING FUNDS AVAIL18 ABLE IF CERTAIN CONDITIONS MET.—Section 

19 1905 of the Social Security Act (42 U.S.C. 

20 1396d) is amended—

21 (i) in the fourth sentence of sub22 section (b), by striking ‘‘or subsection 

23 (u)(3)’’ and inserting ‘‘, (u)(3), or (u)(4)’’; 

24 and 

25 (ii) in subsection (u)—
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1 (I) by redesignating paragraph 

2 (4) as paragraph (6), and 

3 (II) by inserting after paragraph 

4 (3) the following:

5 ‘‘(4) For purposes of subsection (b) and section 

6 2105(a)(1): 

7 ‘‘(A) PARENTS AND PREGNANT WOMEN.—The 

8 expenditures described in this subparagraph are the 

9 expenditures described in the following clauses (i) 

10 and (ii): 

11 ‘‘(i) PARENTS.—If the conditions described 

12 in clause (iii) are met, expenditures for medical 

13 assistance for parents described in section 

14 1902(k)(1) and for parents who would be de15 scribed in such section but for the fact that 

16 they are eligible for medical assistance under 

17 section 1931 or under a waiver approved under 

18 section 1115. 

19 ‘‘(ii) CERTAIN PREGNANT WOMEN.—If the 

20 conditions described in clause (iv) are met, ex21 penditures for medical assistance for pregnant 

22 women described in subsection (n) or under sec23 tion 1902(l)(1)(A) in a family the income of 

24 which exceeds the effective income level applica25 ble under subsection (a)(10)(A)(i)(III) or 
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1 (l)(2)(A) of section 1902 to a family of the size 

2 involved as of January 1, 2003. 

3 ‘‘(iii) CONDITIONS FOR EXPENDITURES

4 FOR PARENTS.—The conditions described in 

5 this clause are the following: 

6 ‘‘(I) The State has a State child 

7 health plan under title XXI which (wheth8 er implemented under such title or under 

9 this title) has an effective income level for 

10 children that is at least 200 percent of the 

11 poverty line. 

12 ‘‘(II) State child health plan does not 

13 limit the acceptance of applications, does 

14 not use a waiting list for children who 

15 meet eligibility standards to qualify for as16 sistance, and provides benefits to all chil17 dren in the State who apply for and meet 

18 eligibility standards. 

19 ‘‘(III) The State plans under this title 

20 and title XXI do not provide coverage for 

21 parents with higher family income without 

22 covering parents with a lower family in23 come. 

24 ‘‘(IV) The State does not apply an in25 come level for parents that is lower than 
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1 the effective income level (expressed as a 

2 percent of the poverty line) that has been 

3 specified under the State plan under title 

4 XIX (including under a waiver authorized 

5 by the Secretary or under section 

6 1902(r)(2)), as of January 1, 2003, to be 

7 eligible for medical assistance as a parent 

8 under this title. 

9 ‘‘(iv) CONDITIONS FOR EXPENDITURES

10 FOR CERTAIN PREGNANT WOMEN.—The condi11 tions described in this clause are the following: 

12 ‘‘(I) The State plans under this title 

13 and title XXI do not provide coverage for 

14 pregnant women described in subpara15 graph (A)(ii) with higher family income 

16 without covering such pregnant women 

17 with a lower family income. 

18 ‘‘(II) The State does not apply an in19 come level for pregnant women that is 

20 lower than the effective income level (ex21 pressed as a percent of the poverty line 

22 and considering applicable income dis23 regards) that has been specified under the 

24 State plan under subsection 

25 (a)(10)(A)(i)(III) or (l)(2)(A) of section 
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1 1902, as of January 1, 2003, to be eligible 

2 for medical assistance as a pregnant 

3 woman. 

4 ‘‘(III) The State satisfies the condi5 tions described in subclauses (I) and (II) 

6 of clause (iii). 

7 ‘‘(v) DEFINITIONS.—For purposes of this 

8 subsection: 

9 ‘‘(I) The term ‘parent’ has the mean10 ing given such term for purposes of section 

11 1902(k)(1). 

12 ‘‘(II) The term ‘poverty line’ has the 

13 meaning given such term in section 

14 2110(c)(5).’’. 

15 (D) APPROPRIATION FROM TITLE XXI AL16 LOTMENT FOR MEDICAID EXPANSION COSTS

17 FOR PARENTS; ELIMINATION OF COUNTING

18 MEDICAID CHILD PRESUMPTIVE ELIGIBILITY

19 COSTS AGAINST TITLE XXI ALLOTMENT.—Sub20 paragraph (B) of section 2105(a)(1) of the So21 cial Security Act, as amended by section 

22 104(a), is amended to read as follows: 

23 ‘‘(B) PARENTS AND PREGNANT WOMEN.—

24 Expenditures for medical assistance that are at-
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1 tributable to expenditures described in section 

2 1905(u)(4)(A).’’. 

3 (E) ONLY COUNTING ENHANCED PORTION

4 FOR COVERAGE OF ADDITIONAL PREGNANT

5 WOMEN.—Section 1905 of the Social Security 

6 Act (42 U.S.C. 1396d) is amended—

7 (i) in the fourth sentence of sub8 section (b), by inserting ‘‘(except in the 

9 case of expenditures described in sub10 section (u)(5))’’ after ‘‘do not exceed’’; 

11 (ii) in subsection (u), by inserting 

12 after paragraph (4) (as inserted by sub13 paragraph (C)), the following: 

14 ‘‘(5) For purposes of the fourth sentence of sub15 section (b) and section 2105(a), the following payments 

16 under this title do not count against a State’s allotment 

17 under section 2104: 

18 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

19 PREGNANT WOMEN WITH INCOME ABOVE JANUARY

20 1, 2003 INCOME LEVEL.—The portion of the pay21 ments made for expenditures described in paragraph 

22 (4)(A)(ii) that represents the amount that would 

23 have been paid if the enhanced FMAP had not been 

24 substituted for the Federal medical assistance per25 centage.’’. 
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1 (2) UNDER TITLE XXI.—

2 (A) PARENTS AND PREGNANT WOMEN

3 COVERAGE.—Title XXI of the Social Security 

4 Act (42 U.S.C. 1397aa et seq.) is amended by 

5 adding at the end the following: 

6 ‘‘SEC. 2111. OPTIONAL COVERAGE OF PARENTS OF TAR7 GETED LOW-INCOME CHILDREN OR TAR8 GETED LOW-INCOME PREGNANT WOMEN. 

9 ‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 

10 other provision of this title, a State may provide for cov11 erage, through an amendment to its State child health 

12 plan under section 2102, of parent health assistance for 

13 targeted low-income parents, pregnancy-related assistance 

14 for targeted low-income pregnant women, or both, in ac15 cordance with this section, but only if—

16 ‘‘(1) with respect to the provision of parent 

17 health assistance, the State meets the conditions de18 scribed in clause (iii) of section 1905(u)(4)(A); 

19 ‘‘(2) with respect to the provision of pregnancy20 related assistance, the State meets the conditions de21 scribed in clause (iv) of section 1905(u)(4)(A); and 

22 ‘‘(3) in the case of parent health assistance for 

23 targeted low-income parents, the State elects to pro24 vide medical assistance under section 

25 1902(a)(10)(A)(ii)(XIX), under section 1931, or
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1 under a waiver under section 1115 to individuals de2 scribed in section 1902(k)(1)(A)(i) and elects an ef3 fective income level that, consistent with paragraphs 

4 (1)(B) and (2) of section 1902(k), ensures to the 

5 maximum extent possible, that such individuals shall 

6 be enrolled in the same program as their children 

7 if their children are eligible for coverage under title 

8 XIX (including under a waiver authorized by the 

9 Secretary or under section 1902(r)(2)).’’. 

10 ‘‘(b) DEFINITIONS.—For purposes of this title: 

11 ‘‘(1) PARENT HEALTH ASSISTANCE.—The term 

12 ‘parent health assistance’ has the meaning given the 

13 term child health assistance in section 2110(a) as if 

14 any reference to targeted low-income children were 

15 a reference to targeted low-income parents. 

16 ‘‘(2) PARENT.—The term ‘parent’ has the 

17 meaning given the term ‘caretaker relative’ for pur18 poses of carrying out section 1931. 

19 ‘‘(3) PREGNANCY-RELATED ASSISTANCE.—The 

20 term ‘pregnancy-related assistance’ has the meaning 

21 given the term child health assistance in section 

22 2110(a) as if any reference to targeted low-income 

23 children were a reference to targeted low-income 

24 pregnant women, except that the assistance shall be 

25 limited to services related to pregnancy (which in-
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1 clude prenatal, delivery, and postpartum services 

2 and services described in section 1905(a)(4)(C)) and 

3 to other conditions that may complicate pregnancy. 

4 ‘‘(4) TARGETED LOW-INCOME PARENT.—The 

5 term ‘targeted low-income parent’ has the meaning 

6 given the term targeted low-income child in section 

7 2110(b) as if the reference to a child were deemed 

8 a reference to a parent (as defined in paragraph (3)) 

9 of the child; except that in applying such section—

10 ‘‘(A) there shall be substituted for the in11 come level described in paragraph (1)(B)(ii)(I) 

12 the applicable income level in effect for a tar13 geted low-income child; 

14 ‘‘(B) in paragraph (3), January 1, 2003, 

15 shall be substituted for July 1, 1997; and 

16 ‘‘(C) in paragraph (4), January 1, 2003, 

17 shall be substituted for March 31, 1997. 

18 ‘‘(5) TARGETED LOW-INCOME PREGNANT

19 WOMAN.—The term ‘targeted low-income pregnant 

20 woman’ has the meaning given the term targeted 

21 low-income child in section 2110(b) as if any ref22 erence to a child were a reference to a woman dur23 ing pregnancy and through the end of the month in 

24 which the 60-day period beginning on the last day 
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1 of her pregnancy ends; except that in applying such 

2 section—

3 ‘‘(A) there shall be substituted for the in4 come level described in paragraph (1)(B)(ii)(I) 

5 the applicable income level in effect for a tar6 geted low-income child; 

7 ‘‘(B) in paragraph (3), January 1, 2003, 

8 shall be substituted for July 1, 1997; and 

9 ‘‘(C) in paragraph (4), January 1, 2003, 

10 shall be substituted for March 31, 1997. 

11 ‘‘(6) PARENT.—The term ‘parent’ has the 

12 meaning given the term ‘caretaker relative’ for pur13 poses of carrying out section 1931. 

14 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

15 RULES.—In the case of, and with respect to, a State pro16 viding for coverage of parent health assistance to targeted 

17 low-income parents or pregnancy-related assistance to tar18 geted low-income pregnant women under subsection (a), 

19 the following special rules apply: 

20 ‘‘(1) Any reference in this title (other than in 

21 subsection (b)) to a targeted low-income child is 

22 deemed to include a reference to a targeted low-in23 come parent or a targeted low-income pregnant 

24 woman (as applicable). 
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1 ‘‘(2) Any such reference to child health assist2 ance—

3 ‘‘(A) with respect to such parents is 

4 deemed a reference to parent health assistance; 

5 and 

6 ‘‘(B) with respect to such pregnant women, 

7 is deemed a reference to pregnancy-related as8 sistance.

9 ‘‘(3) In applying section 2103(e)(3)(B) in the 

10 case of a family or pregnant woman provided cov11 erage under this section, the limitation on total an12 nual aggregate cost-sharing shall be applied to the 

13 entire family or such pregnant woman. 

14 ‘‘(4) In applying section 2110(b)(4), any ref15 erence to ‘section 1902(l)(2) or 1905(n)(2) (as se16 lected by a State)’ is deemed a reference to the ef17 fective income level applicable to parents under sec18 tion 1931 or under a waiver approved under section 

19 1115, or, in the case of a pregnant woman, the in20 come level established under section 1902(l)(2)(A). 

21 ‘‘(5) In applying section 2102(b)(3)(B), any 

22 reference to children found through screening to be 

23 eligible for medical assistance under the State med24 icaid plan under title XIX is deemed a reference to 

25 parents and pregnant women.’’.
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1 (B) ADDITIONAL ALLOTMENT FOR STATES

2 PROVIDING COVERAGE OF PARENTS OR PREG3 NANT WOMEN.—

4 (i) IN GENERAL.—Section 2104 of the 

5 Social Security Act (42 U.S.C. 1397dd) is 

6 amended by inserting after subsection (c) 

7 the following: 

8 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE COV9 ERAGE OF PARENTS OR PREGNANT WOMEN.—

10 ‘‘(1) APPROPRIATION; TOTAL ALLOTMENT.—

11 For the purpose of providing additional allotments 

12 to States under this title, there is appropriated, out 

13 of any money in the Treasury not otherwise appro14 priated—

15 ‘‘(A) for fiscal year 2004, $3,000,000,000; 

16 ‘‘(B) for fiscal year 2005, $3,000,000,000; 

17 and 

18 ‘‘(C) for fiscal year 2006, $4,000,000,000; 

19 ‘‘(D) for fiscal year 2007, $5,000,000,000. 

20 ‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—

21 ‘‘(A) IN GENERAL.—In addition to the al22 lotments provided under subsections (b) and 

23 (c), subject to paragraphs (3) and (4), of the 

24 amount available for the additional allotments 

25 under paragraph (1) for a fiscal year, the Sec-
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1 retary shall allot to each State with a State 

2 child health plan approved under this title—

3 ‘‘(i) in the case of such a State other 

4 than a commonwealth or territory de5 scribed in subparagraph (B), the same pro6 portion as the proportion of the State’s al7 lotment under subsection (b) (determined 

8 without regard to subsection (f)) to the 

9 total amount of the allotments under sub10 section (b) for such States eligible for an 

11 allotment under this paragraph for such 

12 fiscal year; and 

13 ‘‘(ii) in the case of a commonwealth or 

14 territory described in subsection (c)(3), the 

15 same proportion as the proportion of the 

16 commonwealth’s or territory’s allotment 

17 under subsection (c) (determined without 

18 regard to subsection (f)) to the total 

19 amount of the allotments under subsection 

20 (c) for commonwealths and territories eligi21 ble for an allotment under this paragraph 

22 for such fiscal year. 

23 ‘‘(B) AVAILABILITY AND REDISTRIBUTION

24 OF UNUSED ALLOTMENTS.—In applying sub25 sections (e) and (f) with respect to additional 
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1 allotments made available under this subsection, 

2 the procedures established under such sub3 sections shall ensure such additional allotments 

4 are only made available to States which have 

5 elected to provide coverage under section 2111. 

6 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi7 tional allotments provided under this subsection are 

8 not available for amounts expended before October 

9 1, 2003. Such amounts are available for amounts ex10 pended on or after such date for child health assist11 ance for targeted low-income children, as well as for 

12 parent health assistance for targeted low-income 

13 parents, and pregnancy-related assistance for tar14 geted low-income pregnant women. 

15 ‘‘(4) REQUIRING ELECTION TO PROVIDE COV16 ERAGE.—No payments may be made to a State 

17 under this title from an allotment provided under 

18 this subsection unless the State has made an elec19 tion to provide parent health assistance for targeted 

20 low-income parents, or pregnancy-related assistance 

21 for targeted low-income pregnant women.’’. 

22 (ii) CONFORMING AMENDMENTS.—

23 Section 2104 of the Social Security Act 

24 (42 U.S.C. 1397dd) is amended—
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1 (I) in subsection (a), by inserting 

2 ‘‘subject to subsection (d),’’ after 

3 ‘‘under this section,’’; 

4 (II) in subsection (b)(1), by in5 serting ‘‘and subsection (d)’’ after 

6 ‘‘Subject to paragraph (4)’’; and 

7 (III) in subsection (c)(1), by in8 serting ‘‘subject to subsection (d),’’ 

9 after ‘‘for a fiscal year,’’. 

10 (C) NO COST-SHARING FOR PREGNANCY11 RELATED BENEFITS.—Section 2103(e)(2) of 

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

13 1397cc(e)(2)) is amended—

14 (i) in the heading, by inserting ‘‘AND

15 PREGNANCY-RELATED SERVICES’’ after 

16 ‘‘PREVENTIVE SERVICES’’; and 

17 (ii) by inserting before the period at 

18 the end the following: ‘‘and for pregnancy19 related services’’.

20 (b) OPTIONAL APPLICATION OF PRESUMPTIVE ELI21 GIBILITY PROVISIONS TO PARENTS.—Section 1920A of 

22 the Social Security Act (42 U.S.C. 1396r–1a) is amended 

23 by adding at the end the following: 

24 ‘‘(e) A State may elect to apply the previous provi25 sions of this section to provide for a period of presumptive
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1 eligibility for medical assistance for a parent (as defined 

2 for purposes of section 1902(k)(1)) of a child with respect 

3 to whom such a period is provided under this section.’’. 

4 (c) CONFORMING AMENDMENTS.—

5 (1) ELIGIBILITY CATEGORIES.—Section 

6 1905(a) of the Social Security Act (42 U.S.C. 

7 1396d(a)) is amended, in the matter before para8 graph (1)—

9 (A) by striking ‘‘or’’ at the end of clause 

10 (xii); 

11 (B) by inserting ‘‘or’’ at the end of clause 

12 (xiii); and 

13 (C) by inserting after clause (xiii) the fol14 lowing: 

15 ‘‘(xiv) who are parents described (or treated as 

16 if described) in section 1902(k)(1),’’. 

17 (2) INCOME LIMITATIONS.—Section 1903(f)(4) 

18 of the Social Security Act (42 U.S.C. 1396b(f)(4)) 

19 is amended by inserting ‘‘1902(a)(10)(A)(ii)(XIX),’’ 

20 after ‘‘1902(a)(10)(A)(ii)(XVIII),’’.

21 (3) CONFORMING AMENDMENT RELATING TO

22 NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec23 tion 2102(b)(1)(B) of the Social Security Act (42 

24 U.S.C. 1397bb(b)(1)(B)) is amended—
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•HR 2258 IH 

1 (A) by striking ‘‘, and’’ at the end of 

2 clause (i) and inserting a semicolon; 

3 (B) by striking the period at the end of 

4 clause (ii) and inserting ‘‘; and’’; and 

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

6 ‘‘(iii) may not apply a waiting period 

7 (including a waiting period to carry out 

8 paragraph (3)(C)) in the case of a targeted 

9 low-income parent who is pregnant.’’. 

10 (d) EXEMPTION FOR PUERTO RICO.—Section 

11 1108(g) of the Social Security Act (42 U.S.C. 1308(g)) 

12 is amended by adding at the end the following: 

13 ‘‘(3) CERTAIN PAYMENTS DISREGARDED.—

14 Paragraph (2) shall be applied without regard to 

15 any payments made under sections 

16 1902(a)(10)(A)(ii)(XIX) and 1903(v).’’. 

17 (e) EFFECTIVE DATE.—The amendments made by 

18 this section take effect on October 1, 2003, without regard 

19 to whether regulations implementing such amendments 

20 have been issued. 

21 SEC. 102. AUTOMATIC ENROLLMENT OF CHILDREN BORN 

22 TO TITLE XXI PARENTS. 

23 (a) TITLE XXI.—Section 2102(b)(1) of the Social 

24 Security Act (42 U.S.C. 1397bb(b)(1)) is amended by 

25 adding at the end the following: 
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•HR 2258 IH 

1 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL2 DREN BORN TO PREGNANT WOMEN.—Such eli3 gibility standards shall provide for automatic 

4 coverage of a child born to an individual who is 

5 provided assistance under this title in the same 

6 manner as medical assistance would be provided 

7 under section 1902(e)(4) to a child described in 

8 such section.’’. 

9 (b) CONFORMING AMENDMENT TO MEDICAID.—Sec10 tion 1902(e)(4) of the Social Security Act (42 U.S.C. 

11 1396a(e)(4)) is amended in the first sentence by striking 

12 ‘‘so long as the child is a member of the woman’s house13 hold and the woman remains (or would remain if preg14 nant) eligible for such assistance’’. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section take effect on October 1, 2003, without regard 

17 to whether regulations implementing such amendments 

18 have been issued. 

19 SEC. 103. OPTIONAL COVERAGE OF CHILDREN THROUGH 

20 AGE 20 UNDER THE MEDICAID PROGRAM AND 

21 TITLE XXI. 

22 (a) MEDICAID.—

23 (1) IN GENERAL.—Section 1902(l)(1)(D) of the 

24 Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 

25 amended by inserting ‘‘(or, at the election of a 
26

•HR 2258 IH 

1 State, 20 or 21 years of age)’’ after ‘‘19 years of 

2 age’’. 

3 (2) CONFORMING AMENDMENTS.—

4 (A) Section 1902(e)(3)(A) of the Social Se5 curity Act (42 U.S.C. 1396a(e)(3)(A)) is 

6 amended by inserting ‘‘(or 1 year less than the 

7 age the State has elected under subsection 

8 (l)(1)(D))’’ after ‘‘18 years of age’’. 

9 (B) Section 1902(e)(12) of the Social Se10 curity Act (42 U.S.C. 1396a(e)(12)) is amend11 ed by inserting ‘‘or such higher age as the State 

12 has elected under subsection (l)(1)(D)’’ after 

13 ‘‘19 years of age’’. 

14 (C) Section 1920A(b)(1) of the Social Se15 curity Act (42 U.S.C. 1396r–1a(b)(1)) is 

16 amended by inserting ‘‘or such higher age as 

17 the State has elected under section 

18 1902(l)(1)(D)’’ after ‘‘19 years of age’’. 

19 (D) Section 1928(h)(1) of the Social Secu20 rity Act (42 U.S.C. 1396s(h)(1)) is amended by 

21 inserting ‘‘or 1 year less than the age the State 

22 has elected under section 1902(l)(1)(D)’’ before 

23 the period at the end. 

24 (E) Section 1932(a)(2)(A) of the Social 

25 Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is
27

•HR 2258 IH 

1 amended by inserting ‘‘(or such higher age as 

2 the State has elected under section 

3 1902(l)(1)(D))’’ after ‘‘19 years of age’’. 

4 (b) TITLE XXI.—Section 2110(c)(1) of the Social 

5 Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in6 serting ‘‘(or such higher age as the State has elected under 

7 section 1902(l)(1)(D))’’. 

8 (c) EFFECTIVE DATE.—The amendments made by 

9 this section take effect on October 1, 2003, without regard 

10 to whether regulations implementing such amendments 

11 have been issued. 

12 SEC. 104. TECHNICAL AND CONFORMING AMENDMENTS TO 

13 AUTHORITY TO PAY MEDICAID EXPANSION 

14 COSTS FROM TITLE XXI APPROPRIATION. 

15 (a) AUTHORITY TO PAY MEDICAID EXPANSION

16 COSTS FROM TITLE XXI APPROPRIATION.—Section 

17 2105(a) of the Social Security Act (42 U.S.C. 1397ee(a)) 

18 is amended to read as follows: 

19 ‘‘(a) ALLOWABLE EXPENDITURES.—

20 ‘‘(1) IN GENERAL.—Subject to the succeeding 

21 provisions of this section, the Secretary shall pay to 

22 each State with a plan approved under this title, 

23 from its allotment under section 2104, an amount 

24 for each quarter equal to the enhanced FMAP of the 

25 following expenditures in the quarter: 
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•HR 2258 IH 

1 ‘‘(A) CHILD HEALTH ASSISTANCE UNDER

2 MEDICAID.—Expenditures for child health as3 sistance under the plan for targeted low-income 

4 children in the form of providing medical assist5 ance for expenditures described in the fourth 

6 sentence of section 1905(b). 

7 ‘‘(B) RESERVED.—[reserved]. 

8 ‘‘(C) CHILD HEALTH ASSISTANCE UNDER

9 THIS TITLE.—Expenditures for child health as10 sistance under the plan for targeted low-income 

11 children in the form of providing health benefits 

12 coverage that meets the requirements of section 

13 2103. 

14 ‘‘(D) ASSISTANCE AND ADMINISTRATIVE

15 EXPENDITURES SUBJECT TO LIMIT.—Expendi16 tures only to the extent permitted consistent 

17 with subsection (c)—

18 ‘‘(i) for other child health assistance 

19 for targeted low-income children; 

20 ‘‘(ii) for expenditures for health serv21 ices initiatives under the plan for improv22 ing the health of children (including tar23 geted low-income children and other low24 income children); 
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•HR 2258 IH 

1 ‘‘(iii) for expenditures for outreach ac2 tivities as provided in section 2102(c)(1) 

3 under the plan; and 

4 ‘‘(iv) for other reasonable costs in5 curred by the State to administer the plan. 

6 ‘‘(2) ORDER OF PAYMENTS.—Payments under a 

7 subparagraph of paragraph (1) from a State’s allot8 ment for expenditures described in each such sub9 paragraph shall be made on a quarterly basis in the 

10 order of such subparagraph in such paragraph. 

11 ‘‘(3) NO DUPLICATIVE PAYMENT.—In the case 

12 of expenditures for which payment is made under 

13 paragraph (1), no payment shall be made under title 

14 XIX.’’. 

15 (b) CONFORMING AMENDMENTS.—

16 (1) SECTION 1905(u).—Section 1905(u)(1)(B) 

17 of the Social Security Act (42 U.S.C. 

18 1396d(u)(1)(B)) is amended by inserting ‘‘and sec19 tion 2105(a)(1)’’ after ‘‘subsection (b)’’. 

20 (2) SECTION 2105(c).—Section 2105(c)(2)(A) of 

21 the Social Security Act (42 U.S.C. 1397ee(c)(2)(A)) 

22 is amended by striking ‘‘subparagraphs (A), (C), 

23 and (D) of’’. 

24 (c) EFFECTIVE DATE.—The amendments made by 

25 this section shall be effective as if included in the enact-
30

•HR 2258 IH 

1 ment of the Balanced Budget Act of 1997 (Public Law 

2 105–33; 111 Stat. 251), whether or not regulations imple3 menting such amendments have been issued. 

4 SEC. 105. EXTENSION OF AVAILABILITY OF SCHIP ALLOT5 MENTS FOR FISCAL YEARS 1998 THROUGH 

6 2001. 

7 (a) EXTENDING AVAILABILITY OF SCHIP ALLOT8 MENTS FOR FISCAL YEARS 1998 THROUGH 2001.—

9 (1) RETAINED AND REDISTRIBUTED ALLOT10 MENTS FOR FISCAL YEARS 1998 AND 1999.—Para11 graphs (2)(A)(i) and (2)(A)(ii) of section 2104(g) of 

12 the Social Security Act (42 U.S.C. 1397dd(g)) are 

13 each amended by striking ‘‘fiscal year 2002’’ and in14 serting ‘‘fiscal year 2004’’. 

15 (2) EXTENSION AND REVISION OF RETAINED

16 AND REDISTRIBUTED ALLOTMENTS FOR FISCAL

17 YEAR 2000.—

18 (A) PERMITTING AND EXTENDING RETEN19 TION OF PORTION OF FISCAL YEAR 2000 ALLOT20 MENT.—Paragraph (2) of such section 2104(g) 

21 is amended—

22 (i) in the heading, by striking ‘‘AND

23 1999’’ and inserting ‘‘THROUGH 2000’’; and 

24 (ii) by adding at the end of subpara25 graph (A) the following:
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•HR 2258 IH 

1 ‘‘(iii) FISCAL YEAR 2000 ALLOT2 MENT.—Of the amounts allotted to a State 

3 pursuant to this section for fiscal year 

4 2000 that were not expended by the State 

5 by the end of fiscal year 2002, 50 percent 

6 of that amount shall remain available for 

7 expenditure by the State through the end 

8 of fiscal year 2004.’’. 

9 (B) REDISTRIBUTED ALLOTMENTS.—Para10 graph (1) of such section 2104(g) is amended—

11 (i) in subparagraph (A), by inserting 

12 ‘‘or for fiscal year 2000 by the end of fis13 cal year 2002,’’ after ‘‘fiscal year 2001,’’; 

14 (ii) in subparagraph (A), by striking 

15 ‘‘1998 or 1999’’ and inserting ‘‘1998, 

16 1999, or 2000’’; 

17 (iii) in subparagraph (A)(i)—

18 (I) by striking ‘‘or’’ at the end of 

19 subclause (I), 

20 (II) by striking the period at the 

21 end of subclause (II) and inserting ‘‘; 

22 or’’; and 

23 (III) by adding at the end the 

24 following new subclause: 
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•HR 2258 IH 

1 ‘‘(III) the fiscal year 2000 allot2 ment, the amount specified in sub3 paragraph (C)(i) (less the total of the 

4 amounts under clause (ii) for such fis5 cal year), multiplied by the ratio of 

6 the amount specified in subparagraph 

7 (C)(ii) for the State to the amount 

8 specified in subparagraph (C)(iii).’’; 

9 (iv) in subparagraph (A)(ii), by strik10 ing ‘‘or 1999’’ and inserting ‘‘, 1999, or 

11 2000’’; 

12 (v) in subparagraph (B), by striking 

13 ‘‘with respect to fiscal year 1998 or 1999’’; 

14 (vi) in subparagraph (B)(ii)—

15 (I) by inserting ‘‘with respect to 

16 fiscal year 1998, 1999, or 2000,’’ 

17 after ‘‘subsection (e),’’; and 

18 (II) by striking ‘‘2002’’ and in19 serting ‘‘2004’’; and 

20 (vii) by adding at the end the fol21 lowing new subparagraph: 

22 ‘‘(C) AMOUNTS USED IN COMPUTING RE23 DISTRIBUTIONS FOR FISCAL YEAR 2000.—For 

24 purposes of subparagraph (A)(i)(III)—
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•HR 2258 IH 

1 ‘‘(i) the amount specified in this 

2 clause is the amount specified in para3 graph (2)(B)(i)(I) for fiscal year 2000, less 

4 the total amount remaining available pur5 suant to paragraph (2)(A)(iii); 

6 ‘‘(ii) the amount specified in this 

7 clause for a State is the amount by which 

8 the State’s expenditures under this title in 

9 fiscal years 2000, 2001, and 2002 exceed 

10 the State’s allotment for fiscal year 2000 

11 under subsection (b); and 

12 ‘‘(iii) the amount specified in this 

13 clause is the sum, for all States entitled to 

14 a redistribution under subparagraph (A) 

15 from the allotments for fiscal year 2000, of 

16 the amounts specified in clause (ii).’’. 

17 (C) CONFORMING AMENDMENTS.—Such 

18 section 2104(g) is further amended—

19 (i) in its heading, by striking ‘‘AND

20 1999’’ and inserting ‘‘, 1999, AND 2000’’; 

21 and 

22 (ii) in paragraph (3)—

23 (I) by striking ‘‘or fiscal year 

24 1999’’ and inserting ‘‘, fiscal year 

25 1999, or fiscal year 2000’’; and 
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•HR 2258 IH 

1 (II) by striking ‘‘or November 

2 30, 2001’’ and inserting ‘‘November 

3 30, 2001, or November 30, 2002’’, re4 spectively. 

5 (3) EXTENSION AND REVISION OF RETAINED

6 AND REDISTRIBUTED ALLOTMENTS FOR FISCAL

7 YEAR 2001.—

8 (A) PERMITTING AND EXTENDING RETEN9 TION OF PORTION OF FISCAL YEAR 2001 ALLOT10 MENT.—Paragraph (2) of such section 2104(g), 

11 as amended in paragraph (2)(A)(ii), is further 

12 amended—

13 (i) in the heading, by striking ‘‘2000’’ 

14 and inserting ‘‘2001’’; and 

15 (ii) by adding at the end of subpara16 graph (A) the following: 

17 ‘‘(iv) FISCAL YEAR 2001 ALLOT18 MENT.—Of the amounts allotted to a State 

19 pursuant to this section for fiscal year 

20 2001 that were not expended by the State 

21 by the end of fiscal year 2003, 50 percent 

22 of that amount shall remain available for 

23 expenditure by the State through the end 

24 of fiscal year 2005.’’.
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•HR 2258 IH 

1 (B) REDISTRIBUTED ALLOTMENTS.—Para2 graph (1) of such section 2104(g), as amended 

3 in paragraph (2)(B), is further amended—

4 (i) in subparagraph (A), by inserting 

5 ‘‘or for fiscal year 2001 by the end of fis6 cal year 2003,’’ after ‘‘fiscal year 2002,’’; 

7 (ii) in subparagraph (A), by striking 

8 ‘‘1999, or 2000’’ and inserting ‘‘1999, 

9 2000, or 2001’’; 

10 (iii) in subparagraph (A)(i)—

11 (I) by striking ‘‘or’’ at the end of 

12 subclause (II), 

13 (II) by striking the period at the 

14 end of subclause (III) and inserting ‘‘; 

15 or’’; and 

16 (III) by adding at the end the 

17 following new subclause: 

18 ‘‘(IV) the fiscal year 2001 allot19 ment, the amount specified in sub20 paragraph (D)(i) (less the total of the 

21 amounts under clause (ii) for such fis22 cal year), multiplied by the ratio of 

23 the amount specified in subparagraph 

24 (D)(ii) for the State to the amount 

25 specified in subparagraph (D)(iii).’’; 
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•HR 2258 IH 

1 (iv) in subparagraph (A)(ii), by strik2 ing ‘‘or 2000’’ and inserting ‘‘2000, or 

3 2001’’; 

4 (v) in subparagraph (B)—

5 (I) by striking ‘‘and’’ at the end 

6 of clause (ii); 

7 (II) by redesignating clause (iii) 

8 as clause (iv); and 

9 (III) by inserting after clause (ii) 

10 the following new clause: 

11 ‘‘(iii) notwithstanding subsection (e), 

12 with respect to fiscal year 2001, shall re13 main available for expenditure by the State 

14 through the end of fiscal year 2005; and’’; 

15 and 

16 (vi) by adding at the end the following 

17 new subparagraph: 

18 ‘‘(D) AMOUNTS USED IN COMPUTING RE19 DISTRIBUTIONS FOR FISCAL YEAR 2001.—For 

20 purposes of subparagraph (A)(i)(IV)—

21 ‘‘(i) the amount specified in this 

22 clause is the amount specified in para23 graph (2)(B)(i)(I) for fiscal year 2001, less 

24 the total amount remaining available pur25 suant to paragraph (2)(A)(iv); 
37

•HR 2258 IH 

1 ‘‘(ii) the amount specified in this 

2 clause for a State is the amount by which 

3 the State’s expenditures under this title in 

4 fiscal years 2001, 2002, and 2003 exceed 

5 the State’s allotment for fiscal year 2001 

6 under subsection (b); and 

7 ‘‘(iii) the amount specified in this 

8 clause is the sum, for all States entitled to 

9 a redistribution under subparagraph (A) 

10 from the allotments for fiscal year 2001, of 

11 the amounts specified in clause (ii).’’. 

12 (C) CONFORMING AMENDMENTS.—Such 

13 section 2104(g) is further amended—

14 (i) in its heading, by striking ‘‘AND

15 2000’’ and inserting ‘‘2000, AND 2001’’; 

16 and 

17 (ii) in paragraph (3)—

18 (I) by striking ‘‘or fiscal year 

19 2000’’ and inserting ‘‘fiscal year 

20 2000, or fiscal year 2001’’; and 

21 (II) by striking ‘‘or November 

22 30, 2002,’’ and inserting ‘‘November 

23 30, 2002, or November 30, 2003,’’, 

24 respectively. 
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•HR 2258 IH 

1 (4) EFFECTIVE DATE.—This subsection, and 

2 the amendments made by this subsection, shall be 

3 effective as if this subsection had been enacted on 

4 September 30, 2002, and amounts under title XXI 

5 of the Social Security Act (42 U.S.C. 1397aa et 

6 seq.) from allotments for fiscal years 1998 through 

7 2000 are available for expenditure on and after Oc8 tober 1, 2002, under the amendments made by this 

9 subsection as if this subsection had been enacted on 

10 September 30, 2002. 

11 (b) AUTHORITY FOR QUALIFYING STATES TO USE

12 PORTION OF SCHIP FUNDS FOR MEDICAID EXPENDI13 TURES.—Section 2105 of the Social Security Act (42 

14 U.S.C. 1397ee) is amended by adding at the end the fol15 lowing: 

16 ‘‘(g) AUTHORITY FOR QUALIFYING STATES TO USE

17 CERTAIN FUNDS FOR MEDICAID EXPENDITURES.—

18 ‘‘(1) STATE OPTION.—

19 ‘‘(A) IN GENERAL.—Notwithstanding any 

20 other provision of law, with respect to allot21 ments for fiscal years 1998, 1999, 2000, 2001, 

22 for fiscal years in which such allotments are 

23 available under subsections (e) and (g) of sec24 tion 2104, a qualifying State (as defined in 

25 paragraph (2)) may elect to use not more than
39

•HR 2258 IH 

1 20 percent of such allotments (instead of for 

2 expenditures under this title) for payments for 

3 such fiscal year under title XIX in accordance 

4 with subparagraph (B). 

5 ‘‘(B) PAYMENTS TO STATES.—

6 ‘‘(i) IN GENERAL.—In the case of a 

7 qualifying State that has elected the option 

8 described in subparagraph (A), subject to 

9 the total amount of funds described with 

10 respect to the State in subparagraph (A), 

11 the Secretary shall pay the State an 

12 amount each quarter equal to the addi13 tional amount that would have been paid 

14 to the State under title XIX for expendi15 tures of the State for the fiscal year de16 scribed in clause (ii) if the enhanced 

17 FMAP (as determined under subsection 

18 (b)) had been substituted for the Federal 

19 medical assistance percentage (as defined 

20 in section 1905(b)) of such expenditures. 

21 ‘‘(ii) EXPENDITURES DESCRIBED.—

22 For purposes of clause (i), the expendi23 tures described in this clause are expendi24 tures for such fiscal years for providing 

25 medical assistance under title XIX to indi-
40

•HR 2258 IH 

1 viduals who have not attained age 19 and 

2 whose family income exceeds 150 percent 

3 of the poverty line. 

4 ‘‘(iii) NO IMPACT ON DETERMINATION

5 OF BUDGET NEUTRALITY FOR WAIVERS.—

6 In the case of a qualifying State that uses 

7 amounts paid under this subsection for ex8 penditures described in clause (ii) that are 

9 incurred under a waiver approved for the 

10 State, any budget neutrality determina11 tions with respect to such waiver shall be 

12 determined without regard to such 

13 amounts paid. 

14 ‘‘(2) QUALIFYING STATE.—In this subsection, 

15 the term ‘qualifying State’ means a State that—

16 ‘‘(A) as of April 15, 1997, has an income 

17 eligibility standard with respect to any 1 or 

18 more categories of children (other than infants) 

19 who are eligible for medical assistance under 

20 section 1902(a)(10)(A) or under a waiver under 

21 section 1115 implemented on January 1, 1994, 

22 that is up to 185 percent of the poverty line or 

23 above; and 

24 ‘‘(B) satisfies the requirements described 

25 in paragraph (3). 
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•HR 2258 IH 

1 ‘‘(3) REQUIREMENTS.—The requirements de2 scribed in this paragraph are the following: 

3 ‘‘(A) SCHIP INCOME ELIGIBILITY.—The 

4 State has a State child health plan that (wheth5 er implemented under title XIX or this title)—

6 ‘‘(i) as of January 1, 2001, has an in7 come eligibility standard that is at least 

8 200 percent of the poverty line or has an 

9 income eligibility standard that exceeds 

10 200 percent of the poverty line under a 

11 waiver under section 1115 that is based on 

12 a child’s lack of health insurance; 

13 ‘‘(ii) subject to subparagraph (B), 

14 does not limit the acceptance of applica15 tions for children; and 

16 ‘‘(iii) provides benefits to all children 

17 in the State who apply for and meet eligi18 bility standards on a statewide basis. 

19 ‘‘(B) NO WAITING LIST IMPOSED.—With 

20 respect to children whose family income is at or 

21 below 200 percent of the poverty line, the State 

22 does not impose any numerical limitation, wait23 ing list, or similar limitation on the eligibility of 

24 such children for child health assistance under 

25 such State plan. 
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•HR 2258 IH 

1 ‘‘(C) ADDITIONAL REQUIREMENTS.—The 

2 State has implemented at least 3 of the fol3 lowing policies and procedures (relating to cov4 erage of children under title XIX and this title): 

5 ‘‘(i) UNIFORM, SIMPLIFIED APPLICA6 TION FORM.—With respect to children who 

7 are eligible for medical assistance under 

8 section 1902(a)(10)(A), the State uses the 

9 same uniform, simplified application form 

10 (including, if applicable, permitting appli11 cation other than in person) for purposes 

12 of establishing eligibility for benefits under 

13 title XIX and this title. 

14 ‘‘(ii) ELIMINATION OF ASSET TEST.—

15 The State does not apply any asset test for 

16 eligibility under section 1902(l) or this title 

17 with respect to children. 

18 ‘‘(iii) ADOPTION OF 12-MONTH CON19 TINUOUS ENROLLMENT.—The State pro20 vides that eligibility shall not be regularly 

21 redetermined more often than once every 

22 year under this title or for children de23 scribed in section 1902(a)(10)(A). 

24 ‘‘(iv) SAME VERIFICATION AND REDE25 TERMINATION POLICIES; AUTOMATIC REAS-
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•HR 2258 IH 

1 SESSMENT OF ELIGIBILITY.—With respect 

2 to children who are eligible for medical as3 sistance under section 1902(a)(10)(A), the 

4 State provides for initial eligibility deter5 minations and redeterminations of eligi6 bility using the same verification policies 

7 (including with respect to face-to-face 

8 interviews), forms, and frequency as the 

9 State uses for such purposes under this 

10 title, and, as part of such redetermina11 tions, provides for the automatic reassess12 ment of the eligibility of such children for 

13 assistance under title XIX and this title. 

14 ‘‘(v) OUTSTATIONING ENROLLMENT

15 STAFF.—The State provides for the receipt 

16 and initial processing of applications for 

17 benefits under this title and for children 

18 under title XIX at facilities defined as dis19 proportionate share hospitals under section 

20 1923(a)(1)(A) and Federally-qualified 

21 health centers described in section 

22 1905(l)(2)(B) consistent with section 

23 1902(a)(55).’’. 
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•HR 2258 IH 

1 Subtitle B—State Option To Pro2 vide Coverage to All Individuals 

3 Below 100 Percent of Poverty 

4 SEC. 111. STATE OPTION TO OFFER MEDICAID COVERAGE 

5 BASED ON NEED. 

6 (a) STATE OPTION TO PROVIDE COVERAGE.—Sec7 tion 1902(a)(10)(A)(ii) of the Social Security Act (42 

8 U.S.C. 1396a), as amended by section 531(a)(1)(A), is 

9 amended—

10 (1) by striking ‘‘or’’ at the end of subclause 

11 (XIX); 

12 (2) by adding ‘‘or’’ at the end of subclause 

13 (XX); and 

14 (3) by adding at the end the following: 

15 ‘‘(XXI) whose income does not 

16 exceed 100 percent of the income offi17 cial poverty line (as defined by the Of18 fice of Management and Budget, and 

19 revised annually in accordance with 

20 section 673(2) of the Omnibus Budget 

21 Reconciliation Act of 1981) applicable 

22 to a family of the size involved;’’. 

23 (b) CONFORMING AMENDMENTS.—Section 1905(a) 

24 of the Social Security Act (42 U.S.C. 1396d(a)), as
45

•HR 2258 IH 

1 amended by section 501(d)(1), is amended in the matter 

2 preceding paragraph (1)—

3 (1) by striking ‘‘or’’ at the end of clause (xiii); 

4 (2) by adding ‘‘or’’ at the end of clause (xiv); 

5 and 

6 (3) by inserting after clause (xiv) the following: 

7 ‘‘(xv) individuals who are eligible for medical 

8 assistance on the basis of section 

9 1902(a)(10)(A)(ii)(XXI);’’. 

10 (c) EFFECTIVE DATE.—The amendments made by 

11 this section apply to medical assistance provided on and 

12 after October 1, 2003. 

13 Subtitle C—Outreach and 

14 Enrollment 

15 SEC. 121. GRANTS TO PROMOTE INNOVATIVE OUTREACH 

16 AND ENROLLMENT EFFORTS UNDER SCHIP. 

17 (a) IN GENERAL.—Section 2104(f) of the Social Se18 curity Act (42 U.S.C. 1397dd(f)) is amended—

19 (1) by striking ‘‘The Secretary’’ and inserting 

20 the following: 

21 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

22 the Secretary’’; and 

23 (2) by adding at the end the following: 

24 ‘‘(2) GRANTS TO PROMOTE INNOVATIVE OUT25 REACH AND ENROLLMENT EFFORTS.—
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•HR 2258 IH 

1 ‘‘(A) IN GENERAL.—Prior to any redis2 tribution under paragraph (1) of unexpended 

3 allotments made to States under subsection (b) 

4 or (c) for fiscal year 2001 and any fiscal year 

5 thereafter, the Secretary shall—

6 ‘‘(i) reserve from such unexpended al7 lotments the lesser of $50,000,000 or the 

8 total amount of such unexpended allot9 ments for grants under this paragraph for 

10 the fiscal year in which the redistribution 

11 occurs; and 

12 ‘‘(ii) subject to subparagraph (B), use 

13 such reserved funds to make grants to na14 tional local and community-based public or 

15 nonprofit organizations (including organi16 zations involved in women’s health, pedi17 atric advocacy, local and county govern18 ments, public health departments, Feder19 ally-qualified health centers, children’s hos20 pitals, and hospitals defined as dispropor21 tionate share hospitals under the State 

22 plan under title XIX) to conduct innova23 tive outreach and enrollment efforts that 

24 are consistent with section 2102(c) and to 

25 promote understanding of the importance 
47

•HR 2258 IH 

1 of health insurance coverage for prenatal 

2 care and children. 

3 ‘‘(B) PRIORITY FOR GRANTS IN CERTAIN

4 AREAS.—In making grants under subparagraph 

5 (A)(ii), the Secretary shall give priority to grant 

6 applicants that propose to target the outreach 

7 and enrollment efforts funded under the grant 

8 to geographic areas—

9 ‘‘(i) with high rates of eligible but 

10 unenrolled children, including such chil11 dren who reside in rural areas; or 

12 ‘‘(ii) with high rates of families for 

13 whom English is not their primary lan14 guage. 

15 ‘‘(C) APPLICATIONS.—An organization 

16 that desires to receive a grant under this para17 graph shall submit an application to the Sec18 retary in such form and manner, and con19 taining such information, as the Secretary may 

20 decide.’’. 

21 (b) EXTENDING USE OF OUTSTATIONED WORKERS

22 TO ACCEPT TITLE XXI APPLICATIONS.—Section 

23 1902(a)(55) of such Act (42 U.S.C. 1396a(a)(55)) is 

24 amended by inserting ‘‘, and applications for child health 

25 assistance under title XXI’’ after ‘‘(a)(10)(A)(ii)(IX)’’. 
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1 Subtitle D—Immigrant Children 

2 and Pregnant Women 

3 SEC. 131. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 

4 UNDER THE MEDICAID PROGRAM AND SCHIP. 

5 (a) MEDICAID PROGRAM.—Section 1903(v) of the 

6 Social Security Act (42 U.S.C. 1396b(v)) is amended—

7 (1) in paragraph (1), by striking ‘‘paragraph 

8 (2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 

9 (2) by adding at the end the following: 

10 ‘‘(4)(A) A State may elect (in a plan amendment 

11 under this title) to provide medical assistance under this 

12 title for aliens who are lawfully residing in the United 

13 States (including battered aliens described in section 

14 431(c) of the Personal Responsibility and Work Oppor15 tunity Reconciliation Act of 1996) and who are otherwise 

16 eligible for such assistance, within any of the following eli17 gibility categories: 

18 ‘‘(i) PREGNANT WOMEN.—Women during preg19 nancy (and during the 60-day period beginning on 

20 the last day of the pregnancy). 

21 ‘‘(ii) CHILDREN.—Children (as defined under 

22 such plan), including optional targeted low-income 

23 children described in section 1905(u)(2)(B). 

24 ‘‘(B)(i) In the case of a State that has elected to pro25 vide medical assistance to a category of aliens under sub-
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•HR 2258 IH 

1 paragraph (A), no debt shall accrue under an affidavit of 

2 support against any sponsor of such an alien on the basis 

3 of provision of assistance to such category and the cost 

4 of such assistance shall not be considered as an unreim5 bursed cost. 

6 ‘‘(ii) The provisions of sections 401(a), 402(b), 403, 

7 and 421 of the Personal Responsibility and Work Oppor8 tunity Reconciliation Act of 1996 shall not apply to a 

9 State that makes an election under subparagraph (A).’’. 

10 (b) TITLE XXI.—Section 2107(e)(1) of the Social 

11 Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add12 ing at the end the following: 

13 ‘‘(E) Section 1903(v)(4) (relating to op14 tional coverage of permanent resident alien chil15 dren), but only if the State has elected to apply 

16 such section to that category of children under 

17 title XIX.’’.

18 (c) EFFECTIVE DATE.—The amendments made by 

19 this section take effect on October 1, 2003, and apply to 

20 medical assistance and child health assistance furnished 

21 on or after such date. 
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•HR 2258 IH 

1 SEC. 132. PERMITTING STATES AND LOCALITIES TO PRO2 VIDE HEALTH CARE TO ALL INDIVIDUALS. 

3 (a) IN GENERAL.—Section 411 of the Personal Re4 sponsibility and Work Opportunity Reconciliation Act of 

5 1996 (8 U.S.C. 1621) is amended—

6 (1) in subsection (b)—

7 (A) by striking paragraphs (1) and (3); 

8 and 

9 (B) by redesignating paragraphs (2) and 

10 (4) as paragraphs (1) and (2), respectively; and 

11 (2) in subsection (c)—

12 (A) in paragraph (1)—

13 (i) in the matter preceding subpara14 graph (A), by striking ‘‘(2) and (3)’’ and 

15 inserting ‘‘(2), (3), and (4)’’; and 

16 (ii) in subparagraph (B), by striking 

17 ‘‘health,’’; and 

18 (B) by adding at the end the following new 

19 paragraph 

20 ‘‘(4) Such term does not include any health 

21 benefit for which payments or assistance are pro22 vided to an individual, household, or family eligibility 

23 unit by an agency of a State or local government or 

24 by appropriated funds of a State or local govern25 ment.’’.
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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply to health care furnished before, 

3 on, or after the date of the enactment of this Act. 

4 Subtitle E—Eligibility 

5 Simplification 

6 SEC. 141. STATE OPTION TO PROVIDE FOR SIMPLIFIED DE7 TERMINATIONS OF A CHILD’S FINANCIAL ELI8 GIBILITY FOR MEDICAL ASSISTANCE UNDER 

9 MEDICAID OR CHILD HEALTH ASSISTANCE 

10 UNDER SCHIP. 

11 (a) MEDICAID.—Section 1902(e) of the Social Secu12 rity Act (42 U.S.C. 1396a(e)) is amended by adding at 

13 the end the following: 

14 ‘‘(13)(A) At the option of the State, the plan 

15 may provide that financial eligibility requirements 

16 for medical assistance are met for an individual who 

17 is under an age specified by the State (not to exceed 

18 21 years of age) by using a determination (made 

19 within a reasonable period, as found by the State, 

20 before its use for this purpose) of the individual’s 

21 family or household income or resources, notwith22 standing any differences in budget unit, disregard, 

23 deeming, or other methodology, by a Federal or 

24 State agency (or a public or private entity making 

25 such determination on behalf of such agency) speci-
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•HR 2258 IH 

1 fied by the plan, including but not limited to the 

2 agencies administering the Food Stamp Act of 1977, 

3 the Richard B. Russell National School Lunch Act, 

4 and the Child Nutrition Act of 1966, provided that 

5 such agency has fiscal liabilities or responsibilities 

6 affected or potentially affected by such determina7 tions and provided that all information furnished by 

8 such agency pursuant to this subparagraph is used 

9 solely for purposes of determining eligibility for med10 ical assistance under the State plan approved under 

11 this title or for child health assistance under a State 

12 plan approved under title XXI. 

13 ‘‘(B) Nothing in subparagraph (A) shall be con14 strued—

15 ‘‘(i) to authorize the denial of medical as16 sistance under a State plan approved under this 

17 title or of child health assistance under a State 

18 plan approved under title XXI to an individual 

19 who, without the application of this paragraph 

20 or an option exercised thereunder, would qualify 

21 for such assistance; 

22 ‘‘(ii) to relieve a State of the obligation 

23 under subsection (a)(8) to furnish assistance 

24 with reasonable promptness after the submis25 sion of an initial application that is evaluated or 
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•HR 2258 IH 

1 for which evaluation is requested pursuant to 

2 this paragraph; or 

3 ‘‘(iii) to relieve a State of the obligation to 

4 determine eligibility on other grounds for an in5 dividual found to be ineligible under this para6 graph. 

7 ‘‘(C) At the option of a State, the financial eli8 gibility process described in subparagraph (A) may 

9 apply to an individual who is older than age 21 if 

10 such individual’s eligibility for medical assistance is 

11 based on pregnancy or if such individual is a parent, 

12 guardian, or other caretaker relative of an individual 

13 found eligible under subparagraph (A).’’. 

14 (b) SCHIP.—Section 2107(e)(1) of the Social Secu15 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by adding 

16 at the end the following: 

17 ‘‘(E) Section 1902(e)(13) (relating to the 

18 State option to base a child’s eligibility for as19 sistance on financial determinations made by a 

20 program providing nutrition or other public as21 sistance).’’. 

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section take effect on October 1, 2003. 
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1 SEC. 142. APPLICATION OF SIMPLIFIED TITLE XXI PROCE2 DURES UNDER THE MEDICAID PROGRAM. 

3 (a) PRESUMPTIVE ELIGIBILITY.—

4 (1) IN GENERAL.—Section 1920A(b)(3)(A)(i) of 

5 the Social Security Act (42 U.S.C. 1396r–

6 1a(b)(3)(A)(i)) is amended by inserting ‘‘a child care 

7 resource and referral agency,’’ after ‘‘a State or trib8 al child support enforcement agency,’’. 

9 (2) APPLICATION TO PRESUMPTIVE ELIGIBILITY

10 FOR PREGNANT WOMEN UNDER MEDICAID.—Section 

11 1920(b) of the Social Security Act (42 U.S.C. 

12 1396r–1(b)) is amended by adding at the end after 

13 and below paragraph (2) the following flush sen14 tence: 

15 ‘‘The term ‘qualified provider’ includes a qualified entity 

16 as defined in section 1920A(b)(3).’’.

17 (3) APPLICATION UNDER TITLE XXI.—Section 

18 2107(e)(1)(D) of the Social Security Act (42 U.S.C. 

19 1397gg(e)(1)) is amended to read as follows: 

20 ‘‘(D) Sections 1920 and 1920A (relating to 

21 presumptive eligibility).’’. 

22 (b) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR

23 TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN

24 LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—
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1 (1) LOSS OF MEDICAID ELIGIBILITY.—Section 

2 1902(a) of the Social Security Act (42 U.S.C. 

3 1396a(a)) is amended—

4 (A) by striking the period at the end of 

5 paragraph (65) and inserting ‘‘; and’’, and 

6 (B) by inserting after paragraph (65) the 

7 following: 

8 ‘‘(66) provide, in the case of a State with a 

9 State child health plan under title XXI, that before 

10 medical assistance to a child (or a parent of a child) 

11 is discontinued under this title, a determination of 

12 whether the child (or parent) is eligible for benefits 

13 under title XXI shall be made and, if determined to 

14 be so eligible, the child (or parent) shall be auto15 matically enrolled in the program under such title 

16 without the need for a new application.’’. 

17 (2) LOSS OF TITLE XXI ELIGIBILITY AND CO18 ORDINATION WITH MEDICAID.—Section 2102(b) of 

19 the Social Security Act (42 U.S.C. 1397bb(b)) is 

20 amended—

21 (A) in paragraph (3), by redesignating 

22 subparagraphs (D) and (E) as subparagraphs 

23 (E) and (F), respectively, and by inserting after 

24 subparagraph (C) the following: 
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•HR 2258 IH 

1 ‘‘(D) that before health assistance to a 

2 child (or a parent of a child) is discontinued 

3 under this title, a determination of whether the 

4 child (or parent) is eligible for benefits under 

5 title XIX is made and, if determined to be so 

6 eligible, the child (or parent) is automatically 

7 enrolled in the program under such title with8 out the need for a new application;’’; 

9 (B) by redesignating paragraph (4) as 

10 paragraph (5); and 

11 (C) by inserting after paragraph (3) the 

12 following new paragraph: 

13 ‘‘(4) COORDINATION WITH MEDICAID.—The 

14 State shall coordinate the screening and enrollment 

15 of individuals under this title and under title XIX 

16 consistent with the following: 

17 ‘‘(A) Information that is collected under 

18 this title or under title XIX which is needed to 

19 make an eligibility determination under the 

20 other title shall be transmitted to the appro21 priate administering entity under such other 

22 title in a timely manner so that coverage is not 

23 delayed and families do not have to submit the 

24 same information twice. Families shall be pro25 vided the information they need to complete the 
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•HR 2258 IH 

1 application process for coverage under both ti2 tles and be given appropriate notice of any de3 terminations made on their applications for 

4 such coverage. 

5 ‘‘(B) If a State does not use a joint appli6 cation under this title and such title, the State 

7 shall—

8 ‘‘(i) promptly inform a child’s parent 

9 or caretaker in writing and, if appropriate, 

10 orally, that a child has been found likely to 

11 be eligible under title XIX; 

12 ‘‘(ii) provide the family with an appli13 cation for medical assistance under such 

14 title and offer information about what (if 

15 any) further information, documentation, 

16 or other steps are needed to complete such 

17 application process; 

18 ‘‘(iii) offer assistance in completing 

19 such application process; and 

20 ‘‘(iv) promptly transmit the separate 

21 application under this title or the informa22 tion obtained through such application, 

23 and all other relevant information and doc24 umentation, including the results of the 

25 screening process, to the State agency 
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1 under title XIX for a final determination 

2 on eligibility under such title. 

3 ‘‘(C) Applicants are notified in writing 

4 of—

5 ‘‘(i) benefits (including restrictions on 

6 cost-sharing) under title XIX; and 

7 ‘‘(ii) eligibility rules that prohibit chil8 dren who have been screened eligible for 

9 medical assistance under such title from 

10 being enrolled under this title, other than 

11 provisional temporary enrollment while a 

12 final eligibility determination is being made 

13 under such title. 

14 ‘‘(D) If the agency administering this title 

15 is different from the agency administering a 

16 State plan under title XIX, such agencies shall 

17 coordinate the screening and enrollment of ap18 plicants for such coverage under both titles. 

19 ‘‘(E) The coordination procedures estab20 lished between the program under this title and 

21 under title XIX shall apply not only to the ini22 tial eligibility determination of a family but also 

23 to any renewals or redeterminations of such eli24 gibility.’’.
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1 (3) EFFECTIVE DATE.—The amendments made 

2 by paragraphs (1) and (2) apply to individuals who 

3 lose eligibility under the medicaid program under 

4 title XIX, or under a State child health insurance 

5 plan under title XXI, respectively, of the Social Se6 curity Act on or after October 1, 2003, without re7 gard to whether regulations implementing such 

8 amendments have been issued. 

9 (c) PROVISION OF MEDICAID AND CHIP APPLICA10 TIONS AND INFORMATION UNDER THE SCHOOL LUNCH

11 PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell 

12 National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 

13 amended—

14 (1) by striking ‘‘(B) Applications’’ and inserting 

15 ‘‘(B)(i) Applications’’; and 

16 (2) by adding at the end the following:

17 ‘‘(ii)(I) Applications for free and reduced price 

18 lunches that are distributed pursuant to clause (i) to par19 ents or guardians of children in attendance at schools par20 ticipating in the school lunch program under this Act shall 

21 also contain information on the availability of medical as22 sistance under title XIX of the Social Security Act (42 

23 U.S.C. 1396 et seq.) and of child health and other assist24 ance under title XXI of such Act, including information 
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1 on how to obtain an application for assistance under such 

2 programs. 

3 ‘‘(II) Information on the programs referred to in sub4 clause (I) shall be provided on a form separate from the 

5 application form for free and reduced price lunches under 

6 clause (i).’’. 

7 Subtitle F—SCHIP Wrap-Around 

8 Benefits 

9 SEC. 151. STATE OPTION TO PROVIDE WRAP-AROUND 

10 SCHIP COVERAGE TO CHILDREN WHO HAVE 

11 OTHER HEALTH COVERAGE. 

12 (a) IN GENERAL.—

13 (1) SCHIP.—

14 (A) STATE OPTION TO PROVIDE WRAP15 AROUND COVERAGE.—Section 2110(b) of the 

16 Social Security Act (42 U.S.C. 1397jj(b)) is 

17 amended—

18 (i) in paragraph (1)(C), by inserting 

19 ‘‘, subject to paragraph (5),’’ after ‘‘under 

20 title XIX or’’; and 

21 (ii) by adding at the end the following 

22 new paragraph: 

23 ‘‘(5) STATE OPTION TO PROVIDE WRAP-AROUND

24 COVERAGE.—A State may waive the requirement of 

25 paragraph (1)(C) that a targeted low-income child 
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1 may not be covered under a group health plan or 

2 under health insurance coverage, if the State satis3 fies the conditions described in subsection (c)(8). 

4 The State may waive such requirement in order to 

5 provide—

6 ‘‘(A) dental services; 

7 ‘‘(B) cost-sharing protection; or 

8 ‘‘(C) all services.

9 In waiving such requirement, a State may limit the 

10 application of the waiver to children whose family in11 come does not exceed a level specified by the State, 

12 so long as the level so specified does not exceed the 

13 maximum income level otherwise established for 

14 other children under the State child health plan.’’; 

15 and 

16 (B) CONDITIONS DESCRIBED.—Section 

17 2105(c) of such Act (42 U.S.C. 1397ee(c)) is 

18 amended by adding at the end the following 

19 new paragraph: 

20 ‘‘(8) CONDITIONS FOR PROVISION OF WRAP

21 AROUND COVERAGE.—For purposes of section 

22 2110(b)(5), the conditions described in this para23 graph are the following: 
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1 ‘‘(A) INCOME ELIGIBILITY.—The State 

2 child health plan (whether implemented under 

3 title XIX or this XXI)—

4 ‘‘(i) has an income eligibility standard 

5 not less than that described in paragraph 

6 (4) of such section; 

7 ‘‘(ii) subject to subparagraph (B), 

8 does not limit the acceptance of applica9 tions for children; and 

10 ‘‘(iii) provides benefits to all children 

11 in the State who apply for and meet eligi12 bility standards. 

13 ‘‘(B) NO WAITING LIST IMPOSED.—With 

14 respect to children whose family income is at or 

15 below 200 percent of the poverty line, the State 

16 does not impose any numerical limitation, wait17 ing list, or similar limitation on the eligibility of 

18 such children for child health assistance under 

19 such State plan. 

20 ‘‘(C) NO MORE FAVORABLE TREATMENT.—

21 The State child health plan may not provide 

22 more favorable coverage of dental services to 

23 the children covered under section 2110(b)(5) 

24 than to children otherwise covered under this 

25 title.’’.
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1 (C) STATE OPTION TO WAIVE WAITING PE2 RIOD.—Section 2102(b)(1)(B) of such Act (42 

3 U.S.C. 1397bb(b)(1)(B)), as amended by sec4 tion 101(c)(3), is amended—

5 (i) in clause (ii), by striking ‘‘and’’ at 

6 the end; 

7 (ii) in clause (iii), by striking the pe8 riod and inserting ‘‘; and’’; and 

9 (iii) by adding at the end the fol10 lowing new clause: 

11 ‘‘(iv) at State option, may not apply a 

12 waiting period in the case of child de13 scribed in section 2110(b)(5), if the State 

14 satisfies the requirements of section 

15 2105(c)(8).’’. 

16 (2) APPLICATION OF ENHANCED MATCH UNDER

17 MEDICAID.—Section 1905 of such Act (42 U.S.C. 

18 1396d), as amended by section 101(a)(1)(C), is 

19 amended—

20 (A) in subsection (b), in the fourth sen21 tence, by striking ‘‘or (u)(4)’’ and inserting 

22 ‘‘(u)(4), or (u)(5)’’; and 

23 (B) in subsection (u), by inserting after 

24 paragraph (4) the following new paragraph: 
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•HR 2258 IH 

1 ‘‘(5) For purposes of subsection (b), the expenditures 

2 described in this paragraph are expenditures for items and 

3 services for children described in section 2110(b)(5), but 

4 only in the case of a State that satisfies the requirements 

5 of section 2105(c)(8).’’. 

6 (3) APPLICATION OF SECONDARY PAYOR PROVI7 SIONS.—Section 2107(e)(1) of such Act (42 U.S.C. 

8 1397gg(e)(1)), as amended by section 121(b), is 

9 amended—

10 (A) by redesignating subparagraphs (B) 

11 through (E) as subparagraphs (C) through (F), 

12 respectively; and 

13 (B) by inserting after subparagraph (A) 

14 the following new subparagraph: 

15 ‘‘(B) Section 1902(a)(25) (relating to co16 ordination of benefits and secondary payor pro17 visions) with respect to children covered under 

18 a waiver described in section 2110(b)(5).’’. 

19 (b) EFFECTIVE DATE.—The amendments made by 

20 subsection (a) shall take effect on January 1, 2004, and 

21 shall apply to child health assistance and medical assist22 ance provided on or after that date. 
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1 Subtitle G—Immunization 

2 Coverage Through SCHIP 

3 SEC. 161. ELIGIBILITY OF CHILDREN ENROLLED IN THE 

4 STATE CHILDREN’S HEALTH INSURANCE 

5 PROGRAM FOR THE PEDIATRIC VACCINE DIS6 TRIBUTION PROGRAM. 

7 (a) IN GENERAL.—Section 1928(b)(2)(B)(ii)(I) of 

8 the Social Security Act (42 U.S.C. 1396s(b)(2)(B)(ii)(I)) 

9 is amended by inserting ‘‘(other than a State child health 

10 plan under title XXI)’’ after ‘‘policy or plan’’. 

11 (b) EFFECTIVE DATE.—The amendment made by 

12 subsection (a) applies with respect to vaccines adminis13 tered on or after the date of the enactment of this Act. 

14 Subtitle H—Limited English 

15 Proficient Communities 

16 SEC. 171. INCREASED FEDERAL REIMBURSEMENT FOR 

17 LANGUAGE SERVICES UNDER THE MEDICAID 

18 PROGRAM AND THE STATE CHILDREN’S 

19 HEALTH INSURANCE PROGRAM. 

20 (a) MEDICAID.—Section 1903(a)(3) of the Social Se21 curity Act (42 U.S.C. 1396b(a)(3)) is amended—

22 (1) in subparagraph (D), by striking ‘‘plus’’ at 

23 the end and inserting ‘‘and’’; and 

24 (2) by adding at the end the following: 
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1 ‘‘(E) 90 percent of the sums expended with 

2 respect to costs incurred during such quarter as 

3 are attributable to the provision of language 

4 services, including oral interpretation, trans5 lations of written materials, and other language 

6 services, for individuals with limited English 

7 proficiency who apply for, or receive, medical 

8 assistance under the State plan; plus’’. 

9 (b) SCHIP.—Section 2105(a)(1) of the Social Secu10 rity Act (42 U.S.C. 1397ee(a)(1)), as amended by section 

11 104(a), is amended—

12 (1) in the matter preceding subparagraph (A), 

13 by inserting ‘‘or, in the case of expenditures de14 scribed in subparagraph (D)(iv), 90 percent’’ after 

15 ‘‘enhanced FMAP’’; and 

16 (2) in subparagraph (D)—

17 (A) in clause (iii), by striking ‘‘and’’ at the 

18 end; 

19 (B) be redesignating clause (iv) as clause 

20 (v); and 

21 (C) by inserting after clause (iii) the fol22 lowing: 

23 ‘‘(iv) for expenditures attributable to 

24 the provision of language services, includ25 ing oral interpretation, translations of
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1 written materials, and other language serv2 ices, for individuals with limited English 

3 proficiency who apply for, or receive, child 

4 health assistance under the plan; and’’. 

5 (c) EFFECTIVE DATE.—The amendments made by 

6 this section shall take effect on October 1, 2004. 

7 Subtitle I—Binational Public 

8 Health Infrastructure and 

9 Health Insurance 

10 SEC. 181. BINATIONAL PUBLIC HEALTH INFRASTRUCTURE 

11 AND HEALTH INSURANCE. 

12 (a) IN GENERAL.—The Secretary of Health and 

13 Human Services shall enter into a contract with the Insti14 tute of Medicine for the conduct of a study concerning 

15 binational public health infrastructure and health insur16 ance efforts. In conducting such study, the Institute shall 

17 solicit input from border health experts and health insur18 ance companies. 

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

20 on which the Secretary of Health and Human Services en21 ters into the contract under subsection (a), the Institute 

22 of Medicine shall submit to the Secretary and the appro23 priate committees of Congress a report concerning the 

24 study conducted under subsection (a). Such report shall 

25 include the recommendations of the Institute on ways to 
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1 expand or improve binational public health infrastructure 

2 and health insurance efforts. 

3 Subtitle J—Migrant Workers and 

4 Farmworkers Health 

5 SEC. 191. DEMONSTRATION PROJECT REGARDING CON6 TINUITY OF COVERAGE OF MIGRANT WORK7 ERS AND FARMWORKERS UNDER MEDICAID 

8 AND SCHIP. 

9 (a) AUTHORITY TO CONDUCT DEMONSTRATION

10 PROJECT.—

11 (1) IN GENERAL.—The Secretary of Health and 

12 Human Services shall conduct a demonstration 

13 project for the purpose of evaluating methods for 

14 strengthening the health coverage of, and continuity 

15 of coverage of, migrant workers and farmworkers 

16 under the medicaid and State children’s health in17 surance programs (42 U.S.C. 1396 et seq., 1397aa 

18 et seq.). 

19 (2) WAIVER AUTHORITY.—The Secretary of 

20 Health and Human Services shall waive compliance 

21 with the requirements of titles XI, XIX, and XXI of 

22 the Social Security Act (42 U.S.C. 1301 et seq, 

23 1396 et seq., 1397aa et seq.) to such extent and for 

24 such period as the Secretary determines is necessary 
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1 to conduct the demonstration project under this sec2 tion. 

3 (b) REQUIREMENTS.—The demonstration project 

4 conducted under this section shall provide for—

5 (1) uniform eligibility criteria under the med6 icaid and State children’s health insurance programs 

7 with respect to migrant workers and farmworkers; 

8 and 

9 (2) the portability of coverage of such workers 

10 under those programs between participating States. 

11 (c) REPORT.—Not later than March 31, 2005, the 

12 Secretary of Health and Human Services shall submit a 

13 report to Congress on the demonstration project con14 ducted under this section that contains such recommenda15 tions for legislative action as the Secretary determines is 

16 appropriate. 

17 TITLE II—HEALTH DISPARITIES 

18 Subtitle A—Report on Programs 

19 for Improving the Health Status 

20 of Hispanic Individuals 

21 SEC. 201. ANNUAL REPORT REGARDING HISPANIC HEALTH 

22 DISPARITIES FOR CHRONIC AND COMMU23 NICABLE DISEASES. 

24 (a) IN GENERAL.—The Secretary of Health and 

25 Human Services (in this Act referred to as the ‘‘Sec-
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1 retary’’) shall annually submit to Congress a report on 

2 programs carried out through the Public Health Service 

3 with respect to improving the health status of Hispanic 

4 individuals regarding diabetes, cancer, asthma, HIV infec5 tion, AIDS, tuberculosis, injuries (unintentional and in6 tentional), obesity, immunization rates, oral health, sub7 stance abuse, and mental health, including—

8 (1) prevention programs carried out through 

9 the Centers for Disease Control and Prevention and 

10 the Substance Abuse and Mental Health Services 

11 Administration; 

12 (2) treatment programs carried out through the 

13 Health Resources and Services Administration and 

14 the Substance Abuse and Mental Health Services 

15 Administration; 

16 (3) research programs carried out through the 

17 National Institutes of Health, the National Center 

18 on Minority Health and Health Disparities, the 

19 Agency for Healthcare Quality and Research, the 

20 Maternal Child Health Bureau, and the Centers for 

21 Medicare & Medicaid Services; and 

22 (4) activities of the Office of Public Health and 

23 Science, including activities of the Office of Minority 

24 Health.
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1 (b) DATA COLLECTION.—Each report under sub2 section (a) shall include information on programs carried 

3 out through the Public Health Service to collect data that 

4 relates to the health status of Hispanic individuals regard5 ing diabetes, cancer, asthma, HIV infection, AIDS, tuber6 culosis, injuries (unintentional and intentional), obesity, 

7 immunization rates, oral health, substance abuse, and 

8 mental health. 

9 Subtitle B—Diabetes Research, 

10 Control, and Prevention 

11 SEC. 211. TREATMENT. 

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. 399P. DIABETES; TREATMENT FOR MINORITY POPU16 LATIONS. 

17 ‘‘(a) IN GENERAL.—The Secretary shall conduct and 

18 support programs to treat diabetes in minority popu19 lations. 

20 ‘‘(b) NATIONAL INSTITUTES OF HEALTH.—With re21 spect to the National Institutes of Health, activities under 

22 subsection (a) regarding the treatment of diabetes in mi23 nority populations shall include the following: 

24 ‘‘(1) Through the National Institute of Mental 

25 Health, providing for comprehensive mental health 
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1 services and treatment for individuals within such 

2 populations who experience mental barriers to prop3 er diabetes care. 

4 ‘‘(2) Through the National Center on Minority 

5 Health and Health Disparities, recommending and 

6 disseminating the guidelines of the American Diabe7 tes Association for nutrition exercise and diet for di8 abetes treatment and prevention. 

9 ‘‘(c) OTHER AGENCIES.—Activities under subsection 

10 (a) regarding the treatment of diabetes in minority popu11 lations shall include the following: 

12 ‘‘(1) Through the Substance Abuse and Mental 

13 Health Services Administration and the National In14 stitute of Mental Health, providing for comprehen15 sive mental health services and treatment for minori16 ties who experience mental barriers to proper diabe17 tes care. 

18 ‘‘(2) Promoting early detection as a cost-saving 

19 mechanism, including making grants to community 

20 health centers and clinics to specifically treat type 2 

21 diabetes and complications, including eye disease, 

22 kidney failure, heart disease and stroke, nerve dam23 age, and limb amputations. 

24 ‘‘(3) Through the Health Resources and Serv25 ices Administration and the Centers for Disease 
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1 Control and Prevention, carrying out a collaborative 

2 program to encourage preventive care. Such pro3 gram shall not be limited to primary prevention, and 

4 shall include secondary and tertiary prevention. Such 

5 program shall include the award of grants to com6 munity health centers and clinics to specifically treat 

7 diabetes, with an emphasis on type 2 diabetes, and 

8 diabetic complications, including eye disease, kidney 

9 failure, heart disease and stroke, nerve damage, and 

10 limb amputation. 

11 ‘‘(d) DEFINITION.—For purposes of this section, the 

12 term ‘minority populations’ means racial and ethnic mi13 nority groups within the meaning of section 1707. 

14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—

15 ‘‘(1) IN GENERAL.—For the purpose of car16 rying out subsections (a) and (c), there are author17 ized to be appropriated such sums as may be nec18 essary for fiscal year 2003 and each subsequent fis19 cal year. 

20 ‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For 

21 the purpose of carrying out subsection (b), there are 

22 authorized to be appropriated such sums as may be 

23 necessary for fiscal year 2004 and each subsequent 

24 fiscal year.’’. 
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1 SEC. 212. EDUCATION. 

2 Part P of title III of the Public Health Service Act 

3 (42 U.S.C. 280g et seq.), as amended by section 211, is 

4 further amended by adding at the end the following: 

5 ‘‘SEC. 399Q. DIABETES; EDUCATION REGARDING MINORITY 

6 POPULATIONS. 

7 ‘‘(a) IN GENERAL.—The Secretary shall conduct and 

8 support programs to educate the public on the causes of 

9 effects of diabetes in minority populations. 

10 ‘‘(b) NATIONAL INSTITUTES OF HEALTH.—With re11 spect to the National Institutes of Health, activities under 

12 subsection (a) regarding education on diabetes in minority 

13 populations shall include the following: 

14 ‘‘(1) Through the National Center on Minority 

15 Health and Health Disparities—

16 ‘‘(A) making grants to programs funded 

17 under section 485F (relating to centers of ex18 cellence) for the purpose of establishing a men19 toring program for health care professionals to 

20 be more involved in weight counseling, obesity 

21 research, and nutrition; 

22 ‘‘(B) providing for the participation of mi23 nority health professionals in diabetes-focused 

24 research programs; and
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1 ‘‘(C) providing for the participation of mi2 nority health professionals in diabetes-focused 

3 research programs. 

4 ‘‘(2) Making grants for programs to establish a 

5 pipeline from high school to professional school that 

6 will increase minority representation in diabetes-fo7 cused health fields by expanding Minority Access to 

8 Research Careers (MARC) program internships and 

9 mentoring opportunities for recruitment. 

10 ‘‘(c) CENTERS FOR DISEASE CONTROL AND PREVEN11 TION.—With respect to the Centers for Disease Control 

12 and Prevention, activities under subsection (a) regarding 

13 education on diabetes in minority populations shall include 

14 the following: 

15 ‘‘(1) Making grants for diabetes-focused edu16 cation classes or training programs on cultural sen17 sitivity and patient care within such populations for 

18 health care providers. 

19 ‘‘(2) Carrying out public awareness campaigns 

20 directed toward such populations to aggressively em21 phasize the importance and impact of physical activ22 ity and diet in regard to diabetes and diabetes-re23 lated complications. 

24 ‘‘(d) HEALTH RESOURCES AND SERVICES ADMINIS25 TRATION.—With respect to the Health Resources and 
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•HR 2258 IH 

1 Services Administration, activities under subsection (a) re2 garding education on diabetes in minority populations 

3 shall include the following: 

4 ‘‘(1) Providing additional funds for the Health 

5 Careers Opportunity Program, Centers for Excel6 lence, and the Minority Faculty Fellowship Program

7 to partner with the Office of Minority Health under 

8 section 1707 and the National Institutes of Health 

9 to strengthen programs for career opportunities 

10 within minority populations focused on diabetes 

11 treatment and care. 

12 ‘‘(2) In partnership with the Health Resources 

13 and Services Administration, develop a diabetes 

14 focus within, and provide additional funds for, the 

15 National Health Service Corps Scholarship program 

16 to place individuals in areas that are disproportion17 ately affected by diabetes, to provide health care 

18 services. 

19 ‘‘(3) Establishing a diabetes ambassador pro20 gram for recruitment efforts to increase the number 

21 of underrepresented minorities currently serving in 

22 student, faculty, or administrative positions in insti23 tutions of higher learning, hospitals, and community 

24 health centers. 
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1 ‘‘(4) Establishing a loan repayment program 

2 that focuses on diabetes care and prevention. 

3 ‘‘(e) ADDITIONAL PROGRAMS.—Activities under sub4 section (a) regarding education on diabetes in minority 

5 populations shall include the following: 

6 ‘‘(1) Through collaboration between the Health 

7 Resources and Services Administration and the In8 dian Health Service, establishing a joint scholarship 

9 and loan-repayment program for American Indians 

10 health profession students. 

11 ‘‘(2) Providing funds for new and existing dia12 betes-focused education grants and programs for 

13 present and future students and clinicians in the 

14 medical field from minority populations, including 

15 the following: 

16 ‘‘(A) Federal and State loan repayment 

17 programs for health profession students within 

18 communities of color. 

19 ‘‘(B) Providing funds to the Office of Mi20 nority Health under section 1707 for training 

21 health profession students to focus on diabetes 

22 within such populations. 

23 ‘‘(C) Providing funds to State and local 

24 entities to establish diabetes awareness week or 

25 day every month in schools, nursing homes, and 
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•HR 2258 IH 

1 colleges through partnerships with the Office of 

2 Minority Health under section 1707 and the 

3 Health Resources and Services Administration. 

4 ‘‘(f) DEFINITION.—For purposes of this section, the 

5 term ‘minority populations’ means racial and ethnic mi6 nority groups within the meaning of section 1707. 

7 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

8 ‘‘(1) IN GENERAL.—For the purpose of car9 rying out subsections (a) and (e), there are author10 ized to be appropriated such sums as may be nec11 essary for fiscal year 2004 and each subsequent fis12 cal year. 

13 ‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For 

14 the purpose of carrying out subsection (b), there are 

15 authorized to be appropriated such sums as may be 

16 necessary for fiscal year 2004 and each subsequent 

17 fiscal year. 

18 ‘‘(3) CENTERS FOR DISEASE CONTROL AND

19 PREVENTION.—For the purpose of carrying out sub20 section (c), there are authorized to be appropriated 

21 such sums as may be necessary for fiscal year 2004 

22 and each subsequent fiscal year. 

23 ‘‘(4) HEALTH RESOURCES AND SERVICES AD24 MINISTRATION.—For the purpose of carrying out 

25 subsection (c), there are authorized to be appro-
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1 priated such sums as may be necessary for fiscal 

2 year 2004 and each subsequent fiscal year.’’. 

3 SEC. 213. HEALTH PROMOTION, PREVENTION ACTIVITIES, 

4 AND ACCESS. 

5 Part P of title III of the Public Health Service Act 

6 (42 U.S.C. 280g et seq.), as amended by section 212, is 

7 amended by adding at the end the following: 

8 ‘‘SEC. 399R. DIABETES; HEALTH PROMOTION, PREVENTION 

9 ACTIVITIES, AND ACCESS REGARDING MI10 NORITY POPULATIONS. 

11 ‘‘(a) NATIONAL INSTITUTES OF HEALTH. 

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

13 through the Director of the National Institutes of 

14 Health, shall provide access to proper care of diabe15 tes for minority populations. 

16 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

17 paragraph (1) regarding proper care of diabetes in 

18 minority populations shall include the following: 

19 ‘‘(A) Providing funds for research to as20 sess and identify the number of individuals af21 fected by socioeconomic and environmental bar22 riers to diabetes health care access, including 

23 research regarding language, transportation, 

24 daily routine, lifestyle, and housing.
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1 ‘‘(B) Through the National Center on Mi2 nority Health and Health Disparities, identi3 fying the manner in which health care pro4 viders, community health centers, and hospitals 

5 provide proper options and education on avail6 able services for diabetes care, management, 

7 and prevention, including identifying the effects 

8 of differences in the cultures of staff and pa9 tients on clinical and other workforce encoun10 ters. 

11 ‘‘(b) CENTERS FOR DISEASE CONTROL AND PREVEN12 TION. 

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

14 through the Director of the Centers for Disease 

15 Control and Prevention, shall carry out culturally 

16 appropriate diabetes health promotion and preven17 tion programs for minority populations. 

18 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

19 paragraph (1) regarding culturally appropriate dia20 betes health promotion and prevention programs for 

21 minority populations shall include the following: 

22 ‘‘(A) Expanding the Diabetes Control Pro23 gram (currently existing in all the States and 

24 territories).
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•HR 2258 IH 

1 ‘‘(B) Providing funds for the Diabetes 

2 Today program to adapt community planning 

3 tools within such populations. 

4 ‘‘(C) Providing funds for Racial and Eth5 nic Approaches to Community Health (REACH 

6 2010) grants to develop and evaluate diabetes 

7 prevention and control community programs fo8 cused on such populations. 

9 ‘‘(D) Providing funds to community health 

10 centers for a monthly diabetes week program of 

11 diabetes services, including screenings. 

12 ‘‘(E) Providing funds for free diabetes self13 management education classes in hospitals, clin14 ics, and community health centers. 

15 ‘‘(F) Providing funds for education and 

16 community outreach on diabetes. 

17 ‘‘(G) Providing funds for the United States 

18 and Mexico Border Diabetes project to develop 

19 culturally appropriate diabetes prevention and 

20 control interventions for Minority populations in 

21 the border region. 

22 ‘‘(H) Providing funds for an aggressive 

23 prevention campaign that focuses on physical 

24 inactivity and diet and its relation to type 2 di25 abetes within such populations. 
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1 ‘‘(I) Providing funds for surveillance sys2 tems and strategies for strengthening existing 

3 systems to improve the quality, accuracy, and 

4 timelines of morbidity and mortality diabetes 

5 data for such populations. 

6 ‘‘(c) DEFINITION.—For purposes of this section, the 

7 term ‘minority populations’ means racial and ethnic mi8 nority groups within the meaning of section 1707. 

9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—

10 ‘‘(1) NATIONAL INSTITUTES OF HEALTH.—For 

11 the purpose of carrying out subsection (b), there are 

12 authorized to be appropriated such sums as may be 

13 necessary for fiscal year 2004 and each subsequent 

14 fiscal year. 

15 ‘‘(2) CENTERS FOR DISEASE CONTROL AND

16 PREVENTION.—For the purpose of carrying out sub17 section (c), there are authorized to be appropriated 

18 such sums as may be necessary for fiscal year 2004 

19 and each subsequent fiscal year.’’. 
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1 Subtitle C—HIV Prevention Activi2 ties Regarding Hispanic Individ3 uals 

4 SEC. 221. PROGRAMS OF CENTERS FOR DISEASE CONTROL 

5 AND PREVENTION; REPRESENTATION OF HIS6 PANIC INDIVIDUALS IN MEMBERSHIP OF 

7 COMMUNITY PLANNING GROUPS. 

8 (a) IN GENERAL.—With respect to community plan9 ning groups that the Centers for Disease Control and Pre10 vention utilizes in carrying out programs for the preven11 tion of HIV infection, the Secretary, acting through the 

12 Director of such Centers, shall carry out the following: 

13 (1) The Secretary shall identify community 

14 planning groups for which Hispanic individuals are 

15 underrepresented as members in relation to the 

16 number of Hispanic individuals with HIV who reside 

17 in the communities involved. 

18 (2) The Secretary shall develop a plan to in19 crease the representation of Hispanic individuals in 

20 the membership of the community planning groups 

21 identified under paragraph (1). Such plan may pro22 vide for facilitating the participation of Hispanic in23 dividuals as members in such groups by assisting the 

24 individuals with the incidental costs incurred by the 
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1 individuals in being such members, such as the costs 

2 of transportation and child-care services. 

3 (3) The plan shall include a strategy and de4 tailed timeline for implementing the plan. 

5 (b) DEFINITION.—In this section, the term ‘‘commu6 nity planning group’’ has the meaning that applies for 

7 purposes of programs established pursuant to the Ryan 

8 White Comprehensive AIDS Resources Emergency Act of 

9 1990 (including title XXVI of the Public Health Service 

10 Act). 

11 SEC. 222. AIDS EDUCATION AND TRAINING CENTERS FUND12 ED BY HEALTH RESOURCES AND SERVICES 

13 ADMINISTRATION; ESTABLISHMENT OF CEN14 TER DIRECTED TOWARD MINORITY POPU15 LATIONS WITH HIV. 

16 (a) IN GENERAL.—In carrying out section 2692 of 

17 the Public Health Service Act (42 U.S.C. 300ff–111), the 

18 Secretary, acting through the Administrator of the Health 

19 Resources and Services Administration, shall make grants 

20 to eligible Hispanic-serving institutions for the purpose of 

21 carrying out projects under such section with respect to 

22 HIV in racial and ethnic minority groups. 

23 (b) CULTURAL COMPETENCE.—A condition for 

24 grants under subsection (a) is that the applicants involved 

25 agree that the education and training provided through
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1 projects under such subsection will be provided in a cul2 turally competent manner (as defined in section 331). 

3 (c) ELIGIBLE INSTITUTIONS.—In this section: 

4 (1) ELIGIBLE HISPANIC-SERVING INSTITU5 TION.—The term ‘‘eligible Hispanic-serving institu6 tion’’ means a Hispanic-serving institution that has 

7 a record of carrying out HIV-related activities with 

8 respect to Hispanic individuals. 

9 (2) HISPANIC-SERVING INSTITUTION.—The 

10 term ‘‘Hispanic-serving institution’’ has the meaning 

11 given such term in section 502 of the Higher Edu12 cation Act of 1965 (20 U.S.C. 1101a). 

13 Subtitle D—Prevention of Latina 

14 Adolescent Suicides 

15 SEC. 231. SHORT TITLE. 

16 This subtitle may be cited as the ‘‘Latina Adolescent 

17 Suicide Prevention Act’’. 

18 SEC. 232. ESTABLISHMENT OF PROGRAM FOR PREVENTION 

19 OF LATINA ADOLESCENT SUICIDES. 

20 Title V of the Public Health Service Act (42 U.S.C. 

21 290aa et seq.) is amended by inserting after section 520A 

22 the following section: 
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•HR 2258 IH 

1 ‘‘SEC. 520B. PREVENTION OF LATINA ADOLESCENT SUI2 CIDES. 

3 ‘‘(a) IN GENERAL.—The Secretary shall carry out a 

4 program to make awards of grants, cooperative agree5 ments, or contracts to public and nonprofit private entities 

6 for the purpose of reducing suicide attempts and deaths 

7 among Latina adolescents and for the purpose of dealing 

8 with depression and other related emotional conditions 

9 which may contribute to suicide. 

10 ‘‘(b) COLLABORATION.—The Secretary shall ensure 

11 that the program carried out under this section is devel12 oped in collaboration with the relevant institutes at the 

13 National Institutes of Health, the Health Resources and 

14 Services Administration, the Centers for Disease Control 

15 and Prevention, and the Administration on Children and 

16 Families. 

17 ‘‘(c) PREFERENCE.—In making awards under sub18 section (a), the Secretary shall give preference to appli19 cants that—

20 ‘‘(1) demonstrate a strong linkage with schools 

21 and are actually supported by and operated within 

22 a school facility or associated setting; 

23 ‘‘(2) provide direct services to Latina adoles24 cents and their family members when appropriate; 

25 and 
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1 ‘‘(3) serve geographic areas that already have a 

2 high concentration of underserved adolescent 

3 Latinas or a rapidly growing Hispanic population, 

4 based on the latest census data. 

5 ‘‘(d) REQUIREMENTS.—A condition for the receipt of 

6 an award under subsection (a) is that the applicant in7 volved demonstrate that the project to be carried out with 

8 the award will—

9 ‘‘(1) provide for the timely assessment and 

10 treatment of Latina adolescents at risk for suicide; 

11 ‘‘(2) use evidenced-based strategies;

12 ‘‘(3) be based on exemplary practices that are 

13 adapted to the unique characteristics and needs of 

14 the local community; 

15 ‘‘(4) be integrated into the existing health care 

16 system in the community, including primary health 

17 care, mental health services, and substance abuse 

18 services as appropriate; 

19 ‘‘(5) be integrated into other systems in the 

20 community to address the needs of Latina adoles21 cents including the educational system, juvenile jus22 tice, and recreation; 

23 ‘‘(6) provide support services to the families 

24 and friends of those who plan, attempt, or actually 

25 commit suicide; 
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1 ‘‘(7) provide culturally, linguistically, and devel2 opmentally appropriate services; 

3 ‘‘(8) agree to outcomes evaluation to determine 

4 the success of the program and the possibility of 

5 replication to other adolescent girls at risk of sui6 cide; 

7 ‘‘(9) provide or ensure referral for mental 

8 health and substance abuse services as needed; and 

9 ‘‘(10) ensure that staff used in the program are 

10 trained in suicide prevention and in the identifica11 tion of conditions which left untreated may lead to 

12 suicide, are capable of providing culturally and lin13 guistically appropriate services, and that profes14 sionals involved in the system of care are given 

15 training in identifying persons at risk of suicide. 

16 ‘‘(e) COORDINATION.—A condition for the receipt of 

17 an award under subsection (a) is that the applicant in18 volved demonstrate that—

19 ‘‘(1) the application has the support of the local 

20 communities and the approval of the political sub21 division to be served by the project to be carried out 

22 under the award; and 

23 ‘‘(2) the applicant has discussed the application 

24 with local and State mental health officials.
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1 ‘‘(f) MATCHING REQUIREMENT.—With respect to the 

2 costs to be incurred by an applicant in carrying out a 

3 project under subsection (a), the Secretary may require 

4 as a condition of the receipt of the award that the appli5 cant make available (directly or through donations from 

6 public or private entities) non-Federal contributions to7 ward such costs in an amount that is not less than 25 

8 percent of such costs ($1 for each $3 of Federal funds 

9 provided under the award). 

10 ‘‘(g) EVALUATION.—The Secretary shall ensure that 

11 entities receiving awards under subsection (a) submit an 

12 evaluation of the project carried out under the award that 

13 includes an evaluation of—

14 ‘‘(1) the efficacy of project strategies; and 

15 ‘‘(2) short, intermediate, and long-term out16 comes, including the overall impact of the project on 

17 the self-esteem of Latina adolescents, their emo18 tional well-being and development, ability to deal in 

19 a positive and confident manner with their families, 

20 peers, and social environment, and to make con21 structive and personally fulfilling life choices. 

22 ‘‘(h) DISSEMINATION AND EDUCATION.—The Sec23 retary shall ensure that the findings from the program 

24 carried out under this section are disseminated to State 
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1 and local governmental agencies and private providers of 

2 mental health and substance abuse services. 

3 ‘‘(i) DURATION OF PROJECTS.—With respect to an 

4 award under subsection (a), the period during which pay5 ments under such award are made may not exceed 5 years. 

6 ‘‘(j) DEFINITION.—In this section, the term ‘adoles7 cent’ means an individual between the ages of 11 and 17 

8 (inclusive). 

9 ‘‘(k) FUNDING.—

10 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

11 For the purpose of carrying out this section, there 

12 are authorized to be appropriated $10,000,000 for 

13 fiscal year 2004, and such sums as may be nec14 essary for each of the fiscal years 2005 and 2006. 

15 ‘‘(2) ALLOCATION FOR PROGRAM MANAGE16 MENT.—Of the amount appropriated under para17 graph (1) for a fiscal year, the Secretary may re18 serve not more than 1 percent for administering the 

19 program under this section.’’. 
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•HR 2258 IH 

1 Subtitle E—Cancer Research, 

2 Training, and Awareness 

3 SEC. 241. REDES EN ACCION: THE NATIONAL HISPANIC/

4 LATINO CANCER NETWORK AND OTHER NCI 

5 SPECIAL POPULATIONS NETWORKS INITIA6 TIVES TARGETING CANCER; INCREASED AU7 THORIZATION OF APPROPRIATIONS FOR AC8 TIVITIES REGARDING HISPANIC INDIVID9 UALS. 

10 (a) IN GENERAL.—For the purpose of carrying out 

11 and increasing the activities of the Special Populations 

12 Networks of the National Cancer Institute’s Center for 

13 Cancer Health Disparities, specifically Redes En Accion: 

14 The National Hispanic/Latino Cancer Network, and other 

15 programs in the Special Populations Network initiative 

16 promoting cancer research, cancer research training, and 

17 cancer awareness among the Hispanic/Latino population, 

18 there are authorized to be appropriated $2,500,000 for fis19 cal year 2004, and for each of the fiscal years 2005 

20 through 2008. Such authorization of appropriations is in 

21 addition to any other authorizations of appropriations that 

22 are available for such purposes. 

23 (b) PURPOSE.—Amounts appropriated under sub24 section (a) shall be used to continue to provide and in25 crease support of Redes En Accion: The National His-
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•HR 2258 IH 

1 panic/Latino Cancer Network and other Special Popu2 lations Network initiatives targeting cancer among His3 panics to achieve the following: 

4 (1) Prioritize cancer issues impacting His5 panics. 

6 (2) Foster cancer pilot and other research 

7 projects based on these priorities. 

8 (3) Establish cancer research training opportu9 nities for Hispanic undergraduate students, pre- and 

10 post-doctoral individuals and junior faculty mem11 bers. 

12 (4) Develop and support cancer awareness ac13 tivities among Hispanic communities. 

14 Subtitle F—Tuberculosis Control, 

15 Prevention, and Treatment 

16 SEC. 251. ADVISORY COUNCIL FOR THE ELIMINATION OF 

17 TUBERCULOSIS. 

18 Section 317E(f) of the Public Health Service Act (42 

19 U.S.C. 247b–6(f)) is amended—

20 (1) by redesignating paragraph (5) as para21 graph (6); and 

22 (2) by striking paragraphs (2) through (4), and 

23 inserting the following: 

24 ‘‘(2) DUTIES.—For the purpose of making 

25 progress toward the goal of eliminating tuberculosis
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1 from the United States, the Council shall provide to 

2 the Secretary and other appropriate Federal officials 

3 advice on coordinating the activities of the Public 

4 Health Service and other Federal agencies that re5 late to such disease and on efficiently utilizing the 

6 Federal resources involved. 

7 ‘‘(3) NATIONAL PLAN.—In carrying out para8 graph (2), the Council, in consultation with appro9 priate public and private entities, shall make rec10 ommendations on the development, revision, and im11 plementation of a national plan to eliminate tuber12 culosis in the United States. In carrying out this 

13 paragraph, the Council shall—

14 ‘‘(A) consider the recommendations of the 

15 Institute of Medicine regarding the elimination 

16 of tuberculosis; 

17 ‘‘(B) address the development and applica18 tion of new technologies; and 

19 ‘‘(C) review the extent to which progress 

20 has been made toward eliminating tuberculosis. 

21 ‘‘(4) GLOBAL ACTIVITIES.—In carrying out 

22 paragraph (2), the Council, in consultation with ap23 propriate public and private entities, shall make rec24 ommendations for the development and implementa25 tion of a plan to guide the involvement of the United 
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•HR 2258 IH 

1 States in global and cross border tuberculosis-control 

2 activities, including recommendations regarding poli3 cies, strategies, objectives, and priorities. Such rec4 ommendations for the plan shall have a focus on 

5 countries where a high incidence of tuberculosis di6 rectly affects the United States, such as Mexico, and 

7 on access to a comprehensive package of tuberculosis 

8 control measures, as defined by the World Health 

9 Organization directly observed treatment, short 

10 course strategy (commonly known as DOTS). 

11 ‘‘(5) COMPOSITION.—The Council shall be com12 posed of—

13 ‘‘(A) representatives from the Centers for 

14 Disease Control and Prevention, the National 

15 Institutes of Health, the Agency for Healthcare 

16 Research and Quality, the Health Resources 

17 and Services Administration, the U.S.-Mexico 

18 Border Health Commission, and other Federal 

19 departments and agencies that carry out signifi20 cant activities relating to tuberculosis; and 

21 ‘‘(B) members appointed from among indi22 viduals who are not officers or employees of the 

23 Federal Government.’’. 
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1 SEC. 252. NATIONAL PROGRAM FOR TUBERCULOSIS ELIMI2 NATION. 

3 Section 317E of the Public Health Service Act (42 

4 U.S.C. 247b–6) is amended—

5 (1) by striking the heading for the section and 

6 inserting the following: 

7 ‘‘NATIONAL PROGRAM FOR TUBERCULOSIS

8 ELIMINATION’’; 

9 (2) by amending subsection (b) to read as fol10 lows: 

11 ‘‘(b) RESEARCH, DEMONSTRATION PROJECTS, EDU12 CATION, AND TRAINING.—With respect to the prevention, 

13 control, and elimination of tuberculosis, the Secretary 

14 may, directly or through grants to public or nonprofit pri15 vate entities, carry out the following: 

16 ‘‘(1) Research, with priority given to research 

17 concerning—

18 ‘‘(A) diagnosis and treatment of latent in19 fection of tuberculosis; 

20 ‘‘(B) strains of tuberculosis resistant to 

21 drugs; 

22 ‘‘(C) cases of tuberculosis that affect cer23 tain high-risk populations; and 

24 ‘‘(D) clinical trials, including those con25 ducted through the Tuberculosis Trials Consor26 tium. 
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1 ‘‘(2) Demonstration projects, including for—

2 ‘‘(A) the development of regional capabili3 ties for the prevention, control, and elimination 

4 of tuberculosis particularly in low-incidence re5 gions; and 

6 ‘‘(B) collaboration with the Immigration 

7 and Naturalization Service to identify and treat 

8 immigrants with active or latent tuberculosis in9 fection. 

10 ‘‘(3) Public information and education pro11 grams. 

12 ‘‘(4) Education, training and clinical skills im13 provement activities for health professionals, includ14 ing allied health personnel. 

15 ‘‘(5) Support of model centers to carry out ac16 tivities under paragraphs (2) through (4). 

17 ‘‘(6) Collaboration with international organiza18 tions and foreign countries, including Mexico, in co19 ordination with the United States Agency for Inter20 national Development, in carrying out such activi21 ties, including coordinating activities through the 

22 Advisory Council for the Elimination of Tuber23 culosis.’’; and 

24 (3) by striking subsection (g) and inserting the 

25 following:
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1 ‘‘(g) REPORTS.—The Secretary, acting through the 

2 Director of the Centers for Disease Control and Preven3 tion and in consultation with the Advisory Council for the 

4 Elimination of Tuberculosis, shall biennially prepare and 

5 submit to the Committee on Health, Education, Labor, 

6 and Pensions of the Senate and the Committee on Energy 

7 and Commerce of the House of Representatives, a report 

8 on the activities carried out under this section. Each re9 port shall include the opinion of the Council on the extent 

10 to which its recommendations under section 317E(f)(3) 

11 regarding tuberculosis have been implemented.’’; and 

12 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 

13 purpose of carrying out this section, there are authorized 

14 to be appropriated $235,000,000 for fiscal year 2004, and 

15 such sums as may be necessary for each of the fiscal years 

16 2005 through 2008.’’. 

17 SEC. 253. INCLUSION OF INPATIENT HOSPITAL SERVICES 

18 FOR THE TREATMENT OF TB-INFECTED INDI19 VIDUALS. 

20 (a) IN GENERAL.—Section 1902(z)(2) of the Social 

21 Security Act (42 U.S.C. 1396a(z)(2)) is amended by add22 ing at the end the following: 

23 ‘‘(G) Inpatient hospital services.’’. 

24 (b) EFFECTIVE DATE.—The amendment made by 

25 subsection (a) takes effect on October 1, 2003. 
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1 TITLE III—ACCESS AND 

2 AFFORDABILITY 

3 Subtitle A—Dental Health Services 

4 SEC. 301. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

5 HEALTH SERVICES THROUGH COMMUNITY 

6 HEALTH CENTERS AND PUBLIC HEALTH DE7 PARTMENTS. 

8 Part D of title III of the Public Health Service Act 

9 (42 U.S.C. 254b et seq.) is amended by inserting before 

10 section 330, the following: 

11 ‘‘SEC. 329. GRANT PROGRAM TO EXPAND THE AVAIL12 ABILITY OF SERVICES. 

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

14 the Health Resources and Services Administration, shall 

15 establish a program under which the Secretary may award 

16 grants to eligible entities and eligible individuals to expand 

17 the availability of primary dental care services in dental 

18 health professional shortage areas or medically under19 served areas. 

20 ‘‘(b) ELIGIBILITY.—

21 ‘‘(1) ENTITIES.—To be eligible to receive a 

22 grant under this section an entity—

23 ‘‘(A) shall be—
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1 ‘‘(i) a health center receiving funds 

2 under section 330 or designated as a Fed3 erally qualified health center; 

4 ‘‘(ii) a county or local public health 

5 department, if located in a federally-des6 ignated dental health professional shortage 

7 area; 

8 ‘‘(iii) an Indian tribe or tribal organi9 zation (as defined in section 4 of the In10 dian Self-Determination and Education 

11 Assistance Act (25 U.S.C. 450b)); or 

12 ‘‘(iv) a dental education program ac13 credited by the Commission on Dental Ac14 creditation; and 

15 ‘‘(B) shall prepare and submit to the Sec16 retary an application at such time, in such 

17 manner, and containing such information as the 

18 Secretary may require. 

19 ‘‘(2) INDIVIDUALS.—To be eligible to receive a 

20 grant under this section an individual shall—

21 ‘‘(A) be a dental health professional li22 censed or certified in accordance with the laws

23 of State in which such individual provides den24 tal services; 
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1 ‘‘(B) prepare and submit to the Secretary 

2 an application at such time, in such manner, 

3 and containing such information as the Sec4 retary may require; and 

5 ‘‘(C) provide assurances that—

6 ‘‘(i) the individual will practice in a 

7 federally-designated dental health profes8 sional shortage area; and 

9 ‘‘(ii) not less than 33 percent of the 

10 patients of such individual are—

11 ‘‘(I) receiving assistance under a 

12 State plan under title XIX of the So13 cial Security Act (42 U.S.C. 1396 et 

14 seq.); 

15 ‘‘(II) receiving assistance under a 

16 State plan under title XXI of the So17 cial Security Act (42 U.S.C. 1397aa 

18 et seq.); or 

19 ‘‘(III) uninsured. 

20 ‘‘(c) USE OF FUNDS.—

21 ‘‘(1) ENTITIES.—An entity shall use amounts 

22 received under a grant under this section to provide 

23 for the increased availability of primary dental serv24 ices in the areas described in subsection (a). Such 

25 amounts may be used to supplement the salaries of-
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1 fered for individuals accepting employment as den2 tists in such areas. 

3 ‘‘(2) INDIVIDUALS.—A grant to an individual 

4 under subsection (a) shall be in the form of a 

5 $1,000 bonus payment for each month in which such 

6 individual is in compliance with the eligibility re7 quirements of subsection (b)(2)(C). 

8 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—

9 ‘‘(1) IN GENERAL.—Notwithstanding any other 

10 amounts appropriated under section 330 for health 

11 centers, there is authorized to be appropriated 

12 $40,000,000 for each of fiscal years 2004 through 

13 2008 to hire and retain dental health care providers 

14 under this section. 

15 ‘‘(2) USE OF FUNDS.—Of the amount appro16 priated for a fiscal year under paragraph (1), the 

17 Secretary shall use—

18 ‘‘(A) not less than 75 percent of such 

19 amount to make grants to eligible entities; and 

20 ‘‘(B) not more than 25 percent of such 

21 amount to make grants to eligible individuals.’’. 

22 SEC. 302. SCHOOL-BASED DENTAL SEALANT PROGRAM. 

23 Section 317M(c) of the Public Health Service Act (42 

24 U.S.C. 247b–14) is amended—
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1 (1) in paragraph (1), by inserting ‘‘and school2 linked’’ after ‘‘school-based’’; 

3 (2) in the first sentence of paragraph (2)—

4 (A) by inserting ‘‘and school-linked’’ after 

5 ‘‘school-based’’; and 

6 (B) by inserting ‘‘or Indian tribe’’ after 

7 ‘‘State’’; and 

8 (3) by striking paragraph (3) and inserting the 

9 following: 

10 ‘‘(3) ELIGIBILITY.—To be eligible to receive 

11 funds under paragraph (1), an entity shall—

12 ‘‘(A) prepare and submit to the State or 

13 Indian tribe an application at such time, in 

14 such manner and containing such information 

15 as the State or Indian tribe may require; and 

16 ‘‘(B) be a—

17 ‘‘(i) public elementary or secondary 

18 school—

19 ‘‘(I) that is located in an urban 

20 area in which and more than 50 per21 cent of the student population is par22 ticipating in Federal or State free or 

23 reduced meal programs; or 

24 ‘‘(II) that is located in a rural 

25 area and, with respect to the school
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1 district in which the school is located, 

2 the district involved has a median in3 come that is at or below 235 percent 

4 of the poverty line, as defined in sec5 tion 673(2) of the Community Serv6 ices Block Grant Act (42 U.S.C. 

7 9902(2)); or 

8 ‘‘(ii) public or non-profit health orga9 nization, including a grantee under section 

10 330, that is under contract with an ele11 mentary or secondary school described in 

12 subparagraph (B) to provide dental serv13 ices to school-age children.’’. 

14 Subtitle B—Border Health 

15 SEC. 311. SHORT TITLE. 

16 This subtitle may be cited as the ‘‘Border Health Se17 curity Act of 2003’’. 

18 SEC. 312. DEFINITIONS. 

19 In this subtitle: 

20 (1) BORDER AREA.—The term ‘‘border area’’ 

21 has the meaning given the term ‘‘United States22 Mexico Border Area’’ in section 8 of the United 

23 States-Mexico Border Health Commission Act (22 

24 U.S.C. 290n–6). 
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1 (2) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Health and Human Services. 

3 SEC. 313. BORDER HEALTH SERVICES GRANTS. 

4 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

5 the term ‘‘eligible entity’’ means a State, public institution 

6 of higher education, local government, tribal government, 

7 nonprofit health organization, or community health center 

8 receiving assistance under section 330 of the Public 

9 Health Service Act (42 U.S.C. 254b), that is located in 

10 the border area. 

11 (b) AUTHORIZATION.—From funds appropriated 

12 under subsection (f), the Secretary, acting through the 

13 United States members of the United States-Mexico Bor14 der Health Commission, shall award grants to eligible en15 tities to address priorities and recommendations to im16 prove the health of border area residents that are estab17 lished by—

18 (1) the United States members of the United 

19 States-Mexico Border Health Commission; 

20 (2) the State border health offices; and 

21 (3) the Secretary. 

22 (c) APPLICATION.—An eligible entity that desires a 

23 grant under subsection (b) shall submit an application to 

24 the Secretary at such time, in such manner, and con25 taining such information as the Secretary may require. 
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1 (d) USE OF FUNDS.—An eligible entity that receives 

2 a grant under subsection (b) shall use the grant funds 

3 for—

4 (1) programs relating to—

5 (A) maternal and child health; 

6 (B) primary care and preventative health; 

7 (C) public health and public health infra8 structure; 

9 (D) health promotion; 

10 (E) oral health; 

11 (F) behavioral and mental health; 

12 (G) substance abuse; 

13 (H) health conditions that have a high 

14 prevalence in the border area; 

15 (I) medical and health services research; 

16 (J) community health workers or 

17 promotoras; 

18 (K) health care infrastructure problems in 

19 the border area (including planning and con20 struction grants); 

21 (L) health disparities in the border area; 

22 (M) environmental health; 

23 (N) health education; and 

24 (O) outreach and enrollment services with 

25 respect to Federal programs (including pro-
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1 grams authorized under titles XIX and XXI of 

2 the Social Security Act (42 U.S.C. 1396 and 

3 1397aa)); 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 is 

12 authorized to be appropriated to carry out this section, 

13 $200,000,000 for fiscal year 2004, and such sums as may 

14 be necessary for each succeeding fiscal year. 

15 SEC. 314. BORDER BIOTERRORISM PREPAREDNESS 

16 GRANTS. 

17 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

18 the term ‘‘eligible entity’’ means a State, local govern19 ment, or public health entity. 

20 (b) AUTHORIZATION.—From funds appropriated 

21 under subsection (e), the Secretary shall award grants to 

22 eligible entities for bioterrorism preparedness in the bor23 der area. 

24 (c) APPLICATION.—An eligible entity that desires a 

25 grant under this section shall submit an application to the
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1 Secretary at such time, in such manner, and containing 

2 such information as the Secretary may require. 

3 (d) USES OF FUNDS.—An eligible entity that receives 

4 a grant under subsection (b) shall use the grant funds 

5 to—

6 (1) develop and implement bioterror prepared7 ness plans and readiness assessments and purchase 

8 items necessary for such plans; 

9 (2) coordinate bioterrorism and emergency pre10 paredness planning in the region; 

11 (3) improve infrastructure, including surveil12 lance and laboratory capacity; 

13 (4) create a health alert network, including risk 

14 communication and information dissemination; 

15 (5) educate and train clinicians, epidemiolo16 gists, laboratories, and emergency personnel; and 

17 (6) carry out such other activities identified by 

18 the Secretary, State and local public health offices, 

19 and border health offices. 

20 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

21 authorized to be appropriated to carry out this section 

22 $25,000,000 for fiscal year 2004 and such sums as may 

23 be necessary for each succeeding fiscal year. 
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1 SEC. 315. UNITED STATES-MEXICO BORDER HEALTH COM2 MISSION ACT AMENDMENTS. 

3 The United States-Mexico Border Health Commis4 sion Act (22 U.S.C. 290n et seq.) is amended by adding 

5 at the end the following: 

6 ‘‘SEC. 9. AUTHORIZATION OF APPROPRIATIONS. 

7 ‘‘There is authorized to be appropriated to carry out 

8 this Act $10,000,000 for fiscal year 2004 and such sums 

9 as may be necessary for each succeeding fiscal year.’’. 

10 Subtitle C—Patient Navigator, Out11 reach, and Chronic Disease Pre12 vention 

13 SEC. 321. SHORT TITLE. 

14 This title may be cited as the ‘‘Patient Navigator, 

15 Outreach, and Chronic Disease Prevention Act of 2003’’. 

16 SEC. 322. HRSA GRANTS FOR MODEL COMMUNITY CANCER 

17 AND CHRONIC DISEASE CARE AND PREVEN18 TION; HRSA GRANTS FOR PATIENT NAVIGA19 TORS. 

20 Subpart I of part D of title III of the Public Health 

21 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

22 at the end the following: 
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1 ‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC 

2 DISEASE CARE AND PREVENTION; PATIENT 

3 NAVIGATORS. 

4 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

5 DISEASE CARE AND PREVENTION.—

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

7 through the Administrator of the Health Resources 

8 and Services Administration, may make grants to 

9 public and nonprofit private health centers (includ10 ing health centers under section 330, Indian Health 

11 Service Centers, tribal governments, urban Indian 

12 organizations, tribal organizations, clinics serving 

13 Asian Americans and Pacific Islanders and Alaskan 

14 Natives, and rural health clinics and qualified non15 profit entities that partner with one or more centers 

16 providing health care to provide navigation services,

17 which demonstrate the ability to perform all of the 

18 functions outlined in this subsection and subsections 

19 (b) and (c)) for the development and operation of 

20 model programs that—

21 ‘‘(A) provide to individuals of health dis22 parity populations prevention, early detection, 

23 treatment, and appropriate follow-up care serv24 ices for cancer and chronic diseases; 
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1 ‘‘(B) ensure that the health services are 

2 provided to such individuals in a culturally com3 petent manner; 

4 ‘‘(C) assign patient navigators, in accord5 ance with applicable criteria of the Secretary, 

6 for managing the care of individuals of health 

7 disparity populations to—

8 ‘‘(i) accomplish, to the extent possible, 

9 the follow-up and diagnosis of an abnormal 

10 finding and the treatment and appropriate 

11 follow-up care of cancer or other chronic 

12 disease; and 

13 ‘‘(ii) facilitate access to appropriate 

14 health care services within the health care 

15 system to ensure optimal patient utiliza16 tion of such services, including aid in co17 ordinating and scheduling appointments 

18 and referrals, community outreach, assist19 ance with transportation arrangements, 

20 and assistance with insurance issues and 

21 other barriers to care and providing infor22 mation about clinical trials; 

23 ‘‘(D) require training for patient naviga24 tors employed through such model programs to 

25 ensure the ability of navigators to perform all
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1 of the duties required in this subsection and in 

2 subsection (b), including training to ensure that 

3 navigators are informed about health insurance 

4 systems and are able to aid patients in resolv5 ing access issues; and 

6 ‘‘(E) ensure that consumers have direct ac7 cess to patient navigators during regularly 

8 scheduled hours of business operation. 

9 ‘‘(2) OUTREACH SERVICES.—A condition for 

10 the receipt of a grant under paragraph (1) is that 

11 the applicant involved agree to provide ongoing out12 reach activities while receiving the grant, in a man13 ner that is culturally competent for the health dis14 parity population served by the program, to inform 

15 the public and the specific community that the pro16 gram is serving of the services of the model program 

17 under the grant. Such activities shall include facili18 tating access to appropriate health care services and 

19 patient navigators within the health care system to 

20 ensure optimal patient utilization of these services. 

21 ‘‘(3) DATA COLLECTION AND REPORT.—In 

22 order to allow for effective program evaluation, the 

23 grantee shall collect specific patient data recording 

24 services provided to each patient served by the pro25 gram and shall establish and implement procedures 
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1 and protocols, consistent with applicable Federal and 

2 State laws (including 45 C.F.R. 160 and 164) to en3 sure the confidentiality of all information shared by 

4 a participant in the program, or their personal rep5 resentative and their health care providers, group 

6 health plans, or health insurance insurers with the 

7 program. The program may, consistent with applica8 ble Federal and State confidentiality laws, collect, 

9 use or disclose aggregate information that is not in10 dividually identifiable (as defined in 45 C.F.R. 160 

11 and 164). With this data, the grantee shall submit 

12 an annual report to the Secretary that summarizes 

13 and analyzes these data, provides information on 

14 needs for navigation services, types of access difficul15 ties resolved, sources of repeated resolution and 

16 flaws in the system of access, including insurance 

17 barriers. 

18 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

19 be made under paragraph (1) only if an application 

20 for the grant is submitted to the Secretary and the 

21 application is in such form, is made in such manner, 

22 and contains such agreements, assurances, and in23 formation as the Secretary determines to be nec24 essary to carry out this section. 

25 ‘‘(5) EVALUATIONS.—
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1 ‘‘(A) IN GENERAL.—The Secretary, acting 

2 through the Administrator of the Health Re3 sources and Services Administration, shall, di4 rectly or through grants or contracts, provide 

5 for evaluations to determine which outreach ac6 tivities under paragraph (2) were most effective 

7 in informing the public and the specific commu8 nity that the program is serving of the model 

9 program services and to determine the extent to 

10 which such programs were effective in providing 

11 culturally competent services to the health dis12 parity population served by the programs. 

13 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

14 Secretary shall as appropriate disseminate to 

15 public and private entities the findings made in 

16 evaluations under subparagraph (A). 

17 ‘‘(6) COORDINATION WITH OTHER PRO18 GRAMS.—The Secretary shall coordinate the pro19 gram under this subsection with the program under 

20 subsection (b), with the program under section 

21 417D, and to the extent practicable, with programs 

22 for prevention centers that are carried out by the 

23 Director of the Centers for Disease Control and Pre24 vention. 

25 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Administrator of the Health Resources 

3 and Services Administration, may make grants to 

4 public and nonprofit private health centers (includ5 ing health centers under section 330, Indian Health 

6 Service Centers, tribal governments, urban Indian 

7 organizations, tribal organizations, clinics serving 

8 Asian Americans and Pacific Islanders and Alaskan 

9 Natives, and rural health clinics and qualified non10 profit entities that partner with one or more centers 

11 providing health care to provide navigation services, 

12 which demonstrate the ability to perform all of the 

13 functions outlined in this subsection and subsections 

14 (a) and (c)) for the development and operation of 

15 programs to pay the costs of such health centers 

16 in—

17 ‘‘(A) assigning patient navigators, in ac18 cordance with applicable criteria of the Sec19 retary, for managing the care of individuals of 

20 health disparity populations for the duration of 

21 receiving health services from the health cen22 ters, including aid in coordinating and sched23 uling appointments and referrals, community 

24 outreach, assistance with transportation ar25 rangements, and assistance with insurance
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1 issues and other barriers to care and providing 

2 information about clinical trials; 

3 ‘‘(B) ensuring that the services provided by 

4 the patient navigators to such individuals in5 clude case management and psychosocial as6 sessment and care or information and referral 

7 to such services; 

8 ‘‘(C) ensuring that patient navigators with 

9 direct knowledge of the communities they serve 

10 provide services to such individuals in a cul11 turally competent manner; 

12 ‘‘(D) developing model practices for patient 

13 navigators, including with respect to—

14 ‘‘(i) coordination of health services, 

15 including psychosocial assessment and 

16 care; 

17 ‘‘(ii) appropriate follow-up care, in18 cluding psychosocial assessment and care; 

19 ‘‘(iii) determining coverage under 

20 health insurance and health plans for all 

21 services; 

22 ‘‘(iv) ensuring the initiation, continu23 ation and/or sustained access to care pre24 scribed by the patients’ health care pro25 viders; and 
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1 ‘‘(v) aiding patients with health insur2 ance coverage issues; 

3 ‘‘(E) requiring training for patient naviga4 tors to ensure the ability of navigators to per5 form all of the duties required in this sub6 section and in subsection (a), including training 

7 to ensure that navigators are informed about 

8 health insurance systems and are able to aid 

9 patients in resolving access issues; and 

10 ‘‘(F) ensuring that consumers have direct 

11 access to patient navigators during regularly 

12 scheduled hours of business operation. 

13 ‘‘(2) OUTREACH SERVICES.—A condition for 

14 the receipt of a grant under paragraph (1) is that 

15 the applicant involved agree to provide ongoing out16 reach activities while receiving the grant, in a man17 ner that is culturally competent for the health dis18 parity population served by the program, to inform 

19 the public and the specific community that the pa20 tient navigator is serving of the services of the model 

21 program under the grant. 

22 ‘‘(3) DATA COLLECTION AND REPORT.—In 

23 order to allow for effective patient navigator pro24 gram evaluation, the grantee shall collect specific pa25 tient data recording navigation services provided to 
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1 each patient served by the program and shall estab2 lish and implement procedures and protocols, con3 sistent with applicable Federal and State laws (in4 cluding 45 C.F.R. 160 and 164) to ensure the con5 fidentiality of all information shared by a participant 

6 in the program, or their personal representative and 

7 their health care providers, group health plans, or 

8 health insurance insurers with the program. The pa9 tient navigator program may, consistent with appli10 cable Federal and State confidentiality laws, collect, 

11 use or disclose aggregate information that is not in12 dividually identifiable (as defined in 45 C.F.R. 160 

13 and 164). With this data, the grantee shall submit 

14 an annual report to the Secretary that summarizes 

15 and analyzes these data, provides information on 

16 needs for navigation services, types of access difficul17 ties resolved, sources of repeated resolution and 

18 flaws in the system of access, including insurance 

19 barriers. 

20 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

21 be made under paragraph (1) only if an application 

22 for the grant is submitted to the Secretary and the 

23 application is in such form, is made in such manner, 

24 and contains such agreements, assurances, and in-
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1 formation as the Secretary determines to be nec2 essary to carry out this section. 

3 ‘‘(5) EVALUATIONS.—

4 ‘‘(A) IN GENERAL.—The Secretary, acting 

5 through the Administrator of the Health Re6 sources and Services Administration, shall, di7 rectly or through grants or contracts, provide 

8 for evaluations to determine the effects of the 

9 services of patient navigators on the individuals 

10 of health disparity populations for whom the 

11 services were provided, taking into account the 

12 matters referred to in paragraph (1)(C). 

13 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

14 Secretary shall as appropriate disseminate to 

15 public and private entities the findings made in 

16 evaluations under subparagraph (A).

17 ‘‘(6) COORDINATION WITH OTHER PRO18 GRAMS.—The Secretary shall coordinate the pro19 gram under this subsection with the program under 

20 subsection (a) and with the program under section 

21 417D. 

22 ‘‘(c) REQUIREMENTS REGARDING FEES.—

23 ‘‘(1) IN GENERAL.—A condition for the receipt 

24 of a grant under subsection (a)(1) or (b)(1) is that
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1 the program for which the grant is made have in 

2 effect—

3 ‘‘(A) a schedule of fees or payments for 

4 the provision of its health care services related 

5 to the prevention and treatment of disease that 

6 is consistent with locally prevailing rates or 

7 charges and is designed to cover its reasonable 

8 costs of operation; and 

9 ‘‘(B) a corresponding schedule of discounts 

10 to be applied to the payment of such fees or 

11 payments, which discounts are adjusted on the 

12 basis of the ability of the patient to pay. 

13 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

14 this section shall be construed to require payment 

15 for navigation services or to require payment for 

16 health care services in cases where care is provided 

17 free of charge, including the case of services pro18 vided through programs of the Indian Health Serv19 ice. 

20 ‘‘(d) MODEL.—Not later than five years after the 

21 date of the enactment of this section, the Secretary shall 

22 develop a peer-reviewed model of systems for the services 

23 provided by this section. The Secretary shall update such 

24 model as may be necessary to ensure that the best prac25 tices are being utilized. 
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1 ‘‘(e) DURATION OF GRANT.—The period during 

2 which payments are made to an entity from a grant under 

3 subsection (a)(1) or (b)(1) may not exceed five years. The 

4 provision of such payments are subject to annual approval 

5 by the Secretary of the payments and subject to the avail6 ability of appropriations for the fiscal year involved to 

7 make the payments. This subsection may not be construed 

8 as establishing a limitation on the number of grants under 

9 such subsection that may be made to an entity. 

10 ‘‘(f) DEFINITIONS.—For purposes of this section: 

11 ‘‘(1) The term ‘culturally competent’, with re12 spect to providing health-related services, means 

13 services that, in accordance with standards and 

14 measures of the Secretary, are designed to effec15 tively and efficiently respond to the cultural and lin16 guistic needs of patients. 

17 ‘‘(2) The term ‘appropriate follow-up care’ in18 cludes palliative and end-of-life care. 

19 ‘‘(3) The term ‘health disparity population’ 

20 means a population where there exists a significant 

21 disparity in the overall rate of disease incidence, 

22 morbidity, mortality, or survival rates in the popu23 lation as compared to the health status of the gen24 eral population. Such term includes—
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1 ‘‘(A) racial and ethnic minority groups as 

2 defined in section 1707; and 

3 ‘‘(B) medically underserved groups, such 

4 as rural and low-income individuals and individ5 uals with low levels of literacy. 

6 ‘‘(4)(A) The term ‘patient navigator’ means an 

7 individual whose functions include—

8 ‘‘(i) assisting and guiding patients with a 

9 symptom or an abnormal finding or diagnosis of 

10 cancer or other chronic disease within the 

11 health care system to accomplish the follow-up 

12 and diagnosis of an abnormal finding as well as 

13 the treatment and appropriate follow-up care of 

14 cancer or other chronic disease including pro15 viding information about clinical trials; and 

16 ‘‘(ii) identifying, anticipating, and helping 

17 patients overcome barriers within the health 

18 care system to ensure prompt diagnostic and 

19 treatment resolution of an abnormal finding of 

20 cancer or other chronic disease. 

21 ‘‘(B) Such term includes representatives of the 

22 target health disparity population, such as nurses, 

23 social workers, cancer survivors, and patient advo24 cates. 

25 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
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1 ‘‘(1) IN GENERAL.—

2 ‘‘(A) MODEL PROGRAMS.—For the purpose 

3 of carrying out subsection (a) (other than the 

4 purpose described in paragraph (2)(A)), there 

5 are authorized to be appropriated such sums as 

6 may be necessary for each of the fiscal years 

7 2004 through 2008. 

8 ‘‘(B) PATIENT NAVIGATORS.—For the pur9 pose of carrying out subsection (b) (other than 

10 the purpose described in paragraph (2)(B)), 

11 there are authorized to be appropriated such 

12 sums as may be necessary for each of the fiscal 

13 years 2004 through 2008. 

14 ‘‘(C) BUREAU OF PRIMARY HEALTH

15 CARE.—Amounts appropriated under subpara16 graph (A) or (B) shall be administered through 

17 the Bureau of Primary Health Care. 

18 ‘‘(2) PROGRAMS IN RURAL AREAS.—

19 ‘‘(A) MODEL PROGRAMS.—For the purpose 

20 of carrying out subsection (a) by making grants 

21 under such subsection for model programs in 

22 rural areas, there are authorized to be appro23 priated such sums as may be necessary for each 

24 of the fiscal years 2004 through 2008.
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1 ‘‘(B) PATIENT NAVIGATORS.—For the pur2 pose of carrying out subsection (b) by making 

3 grants under such subsection for programs in 

4 rural areas, there are authorized to be appro5 priated such sums as may be necessary for each 

6 of the fiscal years 2004 through 2008. 

7 ‘‘(C) OFFICE OF RURAL HEALTH POL8 ICY.—Amounts appropriated under subpara9 graph (A) or (B) shall be administered through 

10 the Office of Rural Health Policy. 

11 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

12 Authorizations of appropriations under paragraphs 

13 (1) and (2) are in addition to other authorizations 

14 of appropriations that are available for the purposes 

15 described in such paragraphs.’’.

16 SEC. 323. NCI GRANTS FOR MODEL COMMUNITY CANCER 

17 AND CHRONIC DISEASE CARE AND PREVEN18 TION; NCI GRANTS FOR PATIENT NAVIGA19 TORS. 

20 Subpart 1 of part C of title IV of the Public Health 

21 Service Act (42 U.S.C. 285 et seq.) is amended by adding 

22 at the end following: 
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1 ‘‘SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC 

2 DISEASE CARE AND PREVENTION; PATIENT 

3 NAVIGATORS. 

4 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

5 DISEASE CARE AND PREVENTION.—

6 ‘‘(1) IN GENERAL.—The Director of the Insti7 tute may make grants to eligible entities for the de8 velopment and operation of model programs that—

9 ‘‘(A) provide to individuals of health dis10 parity populations prevention, early detection, 

11 treatment, and appropriate follow-up care serv12 ices for cancer and chronic diseases; 

13 ‘‘(B) ensure that the health services are 

14 provided to such individuals in a culturally com15 petent manner; 

16 ‘‘(C) assign patient navigators, in accord17 ance with applicable criteria of the Secretary, 

18 for managing the care of individuals of health 

19 disparity populations to—

20 ‘‘(i) accomplish, to the extent possible, 

21 the follow-up and diagnosis of an abnormal 

22 finding and the treatment and appropriate 

23 follow-up care of cancer or other chronic 

24 disease; and 

25 ‘‘(ii) facilitate access to appropriate 

26 health care services within the health care 
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•HR 2258 IH 

1 system to ensure optimal patient utiliza2 tion of such services, including aid in co3 ordinating and scheduling appointments 

4 and referrals, community outreach, assist5 ance with transportation arrangements, 

6 and assistance with insurance issues and 

7 other barriers to care and providing infor8 mation about clinical trials; 

9 ‘‘(D) require training for patient naviga10 tors employed through such model programs to 

11 ensure the ability of navigators to perform all 

12 of the duties required in this subsection and in 

13 subsection (b), including training to ensure that 

14 navigators are informed about health insurance 

15 systems and are able to aid patients in resolv16 ing access issues; and 

17 ‘‘(E) ensure that consumers have direct ac18 cess to patient navigators during regularly 

19 scheduled hours of business operation. 

20 ‘‘(2) ELIGIBLE ENTITIES.—For purposes of this 

21 section, an eligible entity is a designated cancer cen22 ter of the Institute, an academic institution, Indian 

23 Health Service Clinics, tribal governments, urban In24 dian organizations, tribal organizations, a hospital, a 

25 qualified nonprofit entity that partners with one or 
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1 more centers providing health care to provide navi2 gation services, which demonstrates the ability to 

3 perform all of the functions outlined in this sub4 section and subsections (b) and (c), or any other 

5 public or private entity determined to be appropriate 

6 by the Director of the Institute, that provides serv7 ices described in paragraph (1)(A) for cancer and 

8 chronic diseases. 

9 ‘‘(3) DATA COLLECTION AND REPORT.—In 

10 order to allow for effective program evaluation, the 

11 grantee shall collect specific patient data recording 

12 services provided to each patient served by the pro13 gram and shall establish and implement procedures 

14 and protocols, consistent with applicable Federal and 

15 State laws (including 45 C.F.R. 160 and 164) to en16 sure the confidentiality of all information shared by 

17 a participant in the program, or their personal rep18 resentative and their health care providers, group 

19 health plans, or health insurance insurers with the 

20 program. The program may, consistent with applica21 ble Federal and State confidentiality laws, collect, 

22 use or disclose aggregate information that is not in23 dividually identifiable (as defined in 45 CFR 160 

24 and 164). With this data, the grantee shall submit 

25 an annual report to the Secretary that summarizes
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1 and analyzes these data, provides information on 

2 needs for navigation services, types of access difficul3 ties resolved, sources of repeated resolution and 

4 flaws in the system of access, including insurance 

5 barriers. 

6 ‘‘(4) OUTREACH SERVICES.—A condition for 

7 the receipt of a grant under paragraph (1) is that 

8 the applicant involved agree to provide ongoing out9 reach activities while receiving the grant, in a man10 ner that is culturally competent for the health dis11 parity population served by the program, to inform 

12 the public and the specific community that the pro13 gram is serving of the services of the model program 

14 under the grant. Such activities shall include facili15 tating access to appropriate health care services and 

16 patient navigators within the health care system to 

17 ensure optimal patient utilization of these services. 

18 ‘‘(5) APPLICATION FOR GRANT.—A grant may 

19 be made under paragraph (1) only if an application 

20 for the grant is submitted to the Director of the In21 stitute and the application is in such form, is made 

22 in such manner, and contains such agreements, as23 surances, and information as the Director deter24 mines to be necessary to carry out this section. 

25 ‘‘(6) EVALUATIONS.—
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1 ‘‘(A) IN GENERAL.—The Director of the 

2 Institute, directly or through grants or con3 tracts, shall provide for evaluations to deter4 mine which outreach activities under paragraph 

5 (3) were most effective in informing the public 

6 and the specific community that the program is 

7 serving of the model program services and to 

8 determine the extent to which such programs 

9 were effective in providing culturally competent 

10 services to the health disparity population 

11 served by the programs. 

12 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

13 Director of the Institute shall as appropriate 

14 disseminate to public and private entities the 

15 findings made in evaluations under subpara16 graph (A). 

17 ‘‘(7) COORDINATION WITH OTHER PRO18 GRAMS.—The Secretary shall coordinate the pro19 gram under this subsection with the program under

20 subsection (b), with the program under section 330I, 

21 and to the extent practicable, with programs for pre22 vention centers that are carried out by the Director 

23 of the Centers for Disease Control and Prevention. 

24 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
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1 ‘‘(1) IN GENERAL.—The Director of the Insti2 tute may make grants to eligible entities for the de3 velopment and operation of programs to pay the 

4 costs of such entities in—

5 ‘‘(A) assigning patient navigators, in ac6 cordance with applicable criteria of the Sec7 retary, for managing the care of individuals of 

8 health disparity populations for the duration of 

9 receiving health services from the health cen10 ters, including aid in coordinating and sched11 uling appointments and referrals, community 

12 outreach, assistance with transportation ar13 rangements, and assistance with insurance 

14 issues and other barriers to care and providing 

15 information about clinical trials; 

16 ‘‘(B) ensuring that the services provided by 

17 the patient navigators to such individuals in18 clude case management and psychosocial as19 sessment and care or information and referral 

20 to such services; 

21 ‘‘(C) ensuring that the patient navigators 

22 with direct knowledge of the communities they 

23 serve provide services to such individuals in a 

24 culturally competent manner; 
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1 ‘‘(D) developing model practices for patient 

2 navigators, including with respect to—

3 ‘‘(i) coordination of health services, 

4 including psychosocial assessment and 

5 care; 

6 ‘‘(ii) follow-up services, including psy7 chosocial assessment and care; 

8 ‘‘(iii) determining coverage under 

9 health insurance and health plans for all 

10 services; 

11 ‘‘(iv) ensuring the initiation, continu12 ation and/or sustained access to care pre13 scribed by the patients’ health care pro14 viders; and 

15 ‘‘(v) aiding patients with health insur16 ance coverage issues; 

17 ‘‘(E) requiring training for patient naviga18 tors to ensure the ability of navigators to per19 form all of the duties required in this sub20 section and in subsection (a), including training 

21 to ensure that navigators are informed about 

22 health insurance systems and are able to aid 

23 patients in resolving access issues; and
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1 ‘‘(F) ensuring that consumers have direct 

2 access to patient navigators during regularly 

3 scheduled hours of business operation. 

4 ‘‘(2) OUTREACH SERVICES.—A condition for 

5 the receipt of a grant under paragraph (1) is that 

6 the applicant involved agree to provide ongoing out7 reach activities while receiving the grant, in a man8 ner that is culturally competent for the health dis9 parity population served by the program, to inform 

10 the public and the specific community that the pa11 tient navigator is serving of the services of the model 

12 program under the grant. 

13 ‘‘(3) DATA COLLECTION AND REPORT.—In 

14 order to allow for effective patient navigator pro15 gram evaluation, the grantee shall collect specific pa16 tient data recording navigation services provided to 

17 each patient served by the program and shall estab18 lish and implement procedures and protocols, con19 sistent with applicable Federal and State laws (in20 cluding 45 C.F.R. 160 and 164) to ensure the con21 fidentiality of all information shared by a participant 

22 in the program, or their personal representative and 

23 their health care providers, group health plans, or 

24 health insurance insurers with the program. The pa25 tient navigator program may, consistent with appli-
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1 cable Federal and State confidentiality laws, collect, 

2 use or disclose aggregate information that is not in3 dividually identifiable (as defined in 45 C.F.R. 160 

4 and 164). With this data, the grantee shall submit 

5 an annual report to the Secretary that summarizes 

6 and analyzes these data, provides information on 

7 needs for navigation services, types of access difficul8 ties resolved, sources of repeated resolution and 

9 flaws in the system of access, including insurance 

10 barriers. 

11 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

12 be made under paragraph (1) only if an application 

13 for the grant is submitted to the Director of the In14 stitute and the application is in such form, is made 

15 in such manner, and contains such agreements, as16 surances, and information as the Director deter17 mines to be necessary to carry out this section. 

18 ‘‘(5) EVALUATIONS.—

19 ‘‘(A) IN GENERAL.—The Director of the 

20 Institute, directly or through grants or con21 tracts, shall provide for evaluations to deter22 mine the effects of the services of patient navi23 gators on the health disparity population for 

24 whom the services were provided, taking into 
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1 account the matters referred to in paragraph 

2 (1)(C).

3 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

4 Director of the Institute shall as appropriate 

5 disseminate to public and private entities the 

6 findings made in evaluations under subpara7 graph (A). 

8 ‘‘(6) COORDINATION WITH OTHER PRO9 GRAMS.—The Secretary shall coordinate the pro10 gram under this subsection with the program under 

11 subsection (a) and with the program under section 

12 330I. 

13 ‘‘(c) REQUIREMENTS REGARDING FEES.—

14 ‘‘(1) IN GENERAL.—A condition for the receipt 

15 of a grant under subsection (a)(1) or (b)(1) is that 

16 the program for which the grant is made have in ef17 fect—

18 ‘‘(A) a schedule of fees or payments for 

19 the provision of its health care services related 

20 to the prevention and treatment of disease that 

21 is consistent with locally prevailing rates or 

22 charges and is designed to cover its reasonable 

23 costs of operation; and

24 ‘‘(B) a corresponding schedule of discounts 

25 to be applied to the payment of such fees or 
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1 payments, which discounts are adjusted on the 

2 basis of the ability of the patient to pay. 

3 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

4 this section shall be construed to require payment 

5 for navigation services or to require payment for 

6 health care services in cases where care is provided 

7 free of charge, including the case of services pro8 vided through programs of the Indian Health Serv9 ice. 

10 ‘‘(d) MODEL.—Not later than five years after the 

11 date of the enactment of this section, the Director of the 

12 Institute shall develop a peer-reviewed model of systems 

13 for the services provided by this section. The Director shall 

14 update such model as may be necessary to ensure that 

15 the best practices are being utilized. 

16 ‘‘(e) DURATION OF GRANT.—The period during 

17 which payments are made to an entity from a grant under 

18 subsection (a)(1) or (b)(1) may not exceed five years. The 

19 provision of such payments are subject to annual approval 

20 by the Director of the Institute of the payments and sub21 ject to the availability of appropriations for the fiscal year 

22 involved to make the payments. This subsection may not 

23 be construed as establishing a limitation on the number 

24 of grants under such subsection that may be made to an 

25 entity.
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1 ‘‘(f) DEFINITIONS.—For purposes of this section: 

2 ‘‘(1) The term ‘culturally competent’, with re3 spect to providing health-related services, means 

4 services that, in accordance with standards and 

5 measures of the Secretary, are designed to effec6 tively and efficiently respond to the cultural and lin7 guistic needs of patients. 

8 ‘‘(2) the term ‘appropriate follow-up care’ in9 cludes palliative and end-of-life care. 

10 ‘‘(3) the term ‘health disparity population’ 

11 means a population where there exists a significant 

12 disparity in the overall rate of disease incidence, 

13 morbidity, mortality, or survival rates in the popu14 lation as compared to the health status of the gen15 eral population. Such term includes—

16 ‘‘(A) racial and ethnic minority groups as 

17 defined in section 1707; and 

18 ‘‘(B) medically underserved groups, such 

19 as rural and low-income individuals and individ20 uals with low levels of literacy. 

21 ‘‘(4)(A) the term ‘patient navigator’ means an 

22 individual whose functions include—

23 ‘‘(i) assisting and guiding patients with a 

24 symptom or an abnormal finding or diagnosis of 

25 cancer or other chronic disease within the 
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1 health care system to accomplish the follow-up 

2 and diagnosis of an abnormal finding as well as 

3 the treatment and appropriate follow-up care of 

4 cancer or other chronic disease, including pro5 viding information about clinical trials; and 

6 ‘‘(ii) identifying, anticipating, and helping 

7 patients overcome barriers within the health 

8 care system to ensure prompt diagnostic and 

9 treatment resolution of an abnormal finding of 

10 cancer or other chronic disease. 

11 ‘‘(B) Such term includes representatives of the 

12 target health disparity population, such as nurses, 

13 social workers, cancer survivors, and patient advo14 cates. 

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

16 ‘‘(1) MODEL PROGRAMS.—For the purpose of 

17 carrying out subsection (a), there are authorized to 

18 be appropriated such sums as may be necessary for 

19 each of the fiscal years 2004 through 2008. 

20 ‘‘(2) PATIENT NAVIGATORS.—For the purpose 

21 of carrying out subsection (b), there are authorized 

22 to be appropriated such sums as may be necessary 

23 for each of the fiscal years 2004 through 2008. 

24 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

25 Authorizations of appropriations under paragraphs 
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•HR 2258 IH 

1 (1) and (2) are in addition to other authorizations 

2 of appropriations that are available for the purposes 

3 described in such paragraphs.’’. 

4 SEC. 324. IHS GRANTS FOR MODEL COMMUNITY CANCER 

5 AND CHRONIC DISEASE CARE AND PREVEN6 TION; IHS GRANTS FOR PATIENT NAVIGA7 TORS. 

8 (a) MODEL COMMUNITY CANCER AND CHRONIC DIS9 EASE CARE AND PREVENTION.—

10 (1) IN GENERAL.—The Director of the Indian 

11 Health Service may make grants to Indian Health 

12 Service Centers, tribal governments, urban Indian 

13 organizations, tribal organizations, and qualified 

14 nonprofit entities demonstrating the ability to per15 form all of the functions outlined in this subsection 

16 and subsections (b) and (c) that partner with pro17 viders or centers providing health care serving Na18 tive American populations to provide navigation 

19 services, for the development and operation of model 

20 programs that—

21 (A) provide to individuals of health dis22 parity populations prevention, early detection,

23 treatment, and appropriate follow-up care serv24 ices for cancer and chronic diseases; 
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1 (B) ensure that the health services are pro2 vided to such individuals in a culturally com3 petent manner; 

4 (C) assign patient navigators, in accord5 ance with applicable criteria of the Secretary, 

6 for managing the care of individuals of health 

7 disparity populations to—

8 (i) accomplish, to the extent possible, 

9 the follow-up and diagnosis of an abnormal 

10 finding and the treatment and appropriate 

11 follow-up care of cancer or other chronic 

12 disease; and 

13 (ii) facilitate access to appropriate 

14 health care services within the health care 

15 system to ensure optimal patient utiliza16 tion of such services, including aid in co17 ordinating and scheduling appointments 

18 and referrals, community outreach, assist19 ance with transportation arrangements, 

20 and assistance with insurance issues and 

21 other barriers to care and providing infor22 mation about clinical trials; 

23 (D) require training for patient navigators 

24 employed through such model programs to en25 sure the ability of navigators to perform all of
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1 the duties required in this subsection and in 

2 subsection (b), including training to ensure that 

3 navigators are informed about health insurance 

4 systems and are able to aid patients in resolv5 ing access issues; and 

6 (E) ensure that consumers have direct ac7 cess to patient navigators during regularly 

8 scheduled hours of business operation. 

9 (2) OUTREACH SERVICES.—A condition for the 

10 receipt of a grant under paragraph (1) is that the 

11 applicant involved agree to provide ongoing outreach 

12 activities while receiving the grant, in a manner that 

13 is culturally competent for the health disparity popu14 lation served by the program, to inform the public 

15 and the specific community that the program is 

16 serving of the services of the model program under 

17 the grant. Such activities shall include facilitating 

18 access to appropriate health care services and pa19 tient navigators within the health care system to en20 sure optimal patient utilization of these services. 

21 (3) DATA COLLECTION AND REPORT.—In order 

22 to allow for effective program evaluation, the grantee 

23 shall collect specific patient data recording services 

24 provided to each patient served by the program and 

25 shall establish and implement procedures and proto-
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•HR 2258 IH 

1 cols, consistent with applicable Federal and State 

2 laws (including 45 C.F.R. 160 and 164) to ensure 

3 the confidentiality of all information shared by a 

4 participant in the program, or their personal rep5 resentative and their health care providers, group 

6 health plans, or health insurance insurers with the 

7 program. The program may, consistent with applica8 ble Federal and State confidentiality laws, collect, 

9 use or disclose aggregate information that is not in10 dividually identifiable (as defined in 45 C.F.R. 160 

11 and 164). With this data, the grantee shall submit 

12 an annual report to the Secretary that summarizes 

13 and analyzes these data, provides information on 

14 needs for navigation services, types of access difficul15 ties resolved, sources of repeated resolution and 

16 flaws in the system of access, including insurance 

17 barriers. 

18 (4) APPLICATION FOR GRANT.—A grant may be 

19 made under paragraph (1) only if an application for 

20 the grant is submitted to the Secretary and the ap21 plication is in such form, is made in such manner, 

22 and contains such agreements, assurances, and in23 formation as the Secretary determines to be nec24 essary to carry out this section. 

25 (5) EVALUATIONS.—
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1 (A) IN GENERAL.—The Secretary, acting 

2 through the Director of the Indian Health Serv3 ice, shall, directly or through grants or con4 tracts, provide for evaluations to determine 

5 which outreach activities under paragraph (2) 

6 were most effective in informing the public and 

7 the specific community that the program is 

8 serving of the model program services and to 

9 determine the extent to which such programs 

10 were effective in providing culturally competent 

11 services to the health disparity population 

12 served by the programs. 

13 (B) DISSEMINATION OF FINDINGS.—The 

14 Secretary shall as appropriate disseminate to 

15 public and private entities the findings made in 

16 evaluations under subparagraph (A). 

17 (6) COORDINATION WITH OTHER PROGRAMS.—

18 The Secretary shall coordinate the program under 

19 this subsection with the program under subsection 

20 (b), with the program under section 417D, and to 

21 the extent practicable, with programs for prevention 

22 centers that are carried out by the Director of the 

23 Centers for Disease Control and Prevention. 

24 (b) PROGRAM FOR PATIENT NAVIGATORS.—
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1 (1) IN GENERAL.—The Secretary, acting 

2 through the Director of the Indian Health Service, 

3 may make grants to Indian Health Service Centers, 

4 tribal governments, urban Indian organizations, trib5 al organizations, and qualified nonprofit entities 

6 demonstrating the ability to perform all of the func7 tions outlined in this subsection and subsections (a) 

8 and (c) that partner with providers or centers pro9 viding health care serving Native American popu10 lations to provide navigation services, for the devel11 opment and operation of model programs to pay the 

12 costs of such organizations in—

13 (A) assigning patient navigators, in accord14 ance with applicable criteria of the Secretary, 

15 for individuals of health disparity populations 

16 for the duration of receiving health services 

17 from the health centers, including aid in coordi18 nating and scheduling appointments and refer19 rals, community outreach, assistance with 

20 transportation arrangements, and assistance 

21 with insurance issues and other barriers to care 

22 and providing information about clinical trials; 

23 (B) ensuring that the services provided by 

24 the patient navigators to such individuals in25 clude case management and psychosocial as-
143

•HR 2258 IH 

1 sessment and care or information and referral 

2 to such services; 

3 (C) ensuring that patient navigators with 

4 direct knowledge of the communities they serve 

5 provide services to such individuals in a cul6 turally competent manner; 

7 (D) developing model practices for patient 

8 navigators, including with respect to—

9 (i) coordination of health services, in10 cluding psychosocial assessment and care; 

11 (ii) appropriate follow-up care, includ12 ing psychosocial assessment and care; 

13 (iii) determining coverage under 

14 health insurance and health plans for all 

15 services; 

16 (iv) ensuring the initiation, continu17 ation and/or sustained access to care pre18 scribed by the patients’ health care pro19 viders; and 

20 (v) aiding patients with health insur21 ance coverage issues; 

22 (E) requiring training for patient naviga23 tors to ensure the ability of navigators to per24 form all of the duties required in this sub25 section and in subsection (a), including training 
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•HR 2258 IH 

1 to ensure that navigators are informed about 

2 health insurance systems and are able to aid 

3 patients in resolving access issues; and 

4 (F) ensuring that consumers have direct 

5 access to patient navigators during regularly 

6 scheduled hours of business operation. 

7 (2) OUTREACH SERVICES.—A condition for the 

8 receipt of a grant under paragraph (1) is that the 

9 applicant involved agree to provide ongoing outreach 

10 activities while receiving the grant, in a manner that 

11 is culturally competent for the health disparity popu12 lation served by the program, to inform the public 

13 and the specific community that the patient navi14 gator is serving of the services of the model program 

15 under the grant. 

16 (3) DATA COLLECTION AND REPORT.—In order 

17 to allow for effective patient navigator program eval18 uation, the grantee shall collect specific patient data 

19 recording navigation services provided to each pa20 tient served by the program and shall establish and 

21 implement procedures and protocols, consistent with 

22 applicable Federal and State laws (including 45 

23 C.F.R. 160 and 164) to ensure the confidentiality of 

24 all information shared by a participant in the pro25 gram, or their personal representative and their
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•HR 2258 IH 

1 health care providers, group health plans, or health 

2 insurance insurers with the program. The patient 

3 navigator program may, consistent with applicable 

4 Federal and State confidentiality laws, collect, use 

5 or disclose aggregate information that is not individ6 ually identifiable (as defined in 45 C.F.R. 160 and 

7 164). With this data, the grantee shall submit an 

8 annual report to the Secretary that summarizes and 

9 analyzes these data, provides information on needs 

10 for navigation services, types of access difficulties re11 solved, sources of repeated resolution and flaws in 

12 the system of access, including insurance barriers. 

13 (4) APPLICATION FOR GRANT.—A grant may be 

14 made under paragraph (1) only if an application for 

15 the grant is submitted to the Secretary and the ap16 plication is in such form, is made in such manner, 

17 and contains such agreements, assurances, and in18 formation as the Secretary determines to be nec19 essary to carry out this section. 

20 (5) EVALUATIONS.—

21 (A) IN GENERAL.—The Secretary, acting 

22 through the Director of the Indian Health Serv23 ice, shall, directly or through grants or con24 tracts, provide for evaluations to determine the 

25 effects of the services of patient navigators on 
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•HR 2258 IH 

1 the individuals of health disparity populations 

2 for whom the services were provided, taking 

3 into account the matters referred to in para4 graph (1)(C). 

5 (B) DISSEMINATION OF FINDINGS.—The 

6 Secretary shall as appropriate disseminate to 

7 public and private entities the findings made in 

8 evaluations under subparagraph (A). 

9 (6) COORDINATION WITH OTHER PROGRAMS.—

10 The Secretary shall coordinate the program under 

11 this subsection with the program under subsection 

12 (a) and with the program under section 417D. 

13 (c) REQUIREMENTS REGARDING FEES.—

14 (1) IN GENERAL.—A condition for the receipt 

15 of a grant under subsection (a)(1) or (b)(1) is that 

16 the program for which the grant is made have in ef17 fect—

18 (A) a schedule of fees or payments for the 

19 provision of its health care services related to 

20 the prevention and treatment of disease that is 

21 consistent with locally prevailing rates or 

22 charges and is designed to cover its reasonable 

23 costs of operation; and 

24 (B) a corresponding schedule of discounts 

25 to be applied to the payment of such fees or
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•HR 2258 IH 

1 payments, which discounts are adjusted on the 

2 basis of the ability of the patient to pay. 

3 (2) RULE OF CONSTRUCTION.—Nothing in this 

4 section shall be construed to require payment for 

5 navigation services or to require payment for health 

6 care services in cases, such as with the Indian 

7 Health Service, where care is provided free of 

8 charge. 

9 (d) MODEL.—Not later than five years after the date 

10 of the enactment of this section, the Secretary shall de11 velop a peer-reviewed model of systems for the services 

12 provided by this section. The Secretary shall update such 

13 model as may be necessary to ensure that the best prac14 tices are being utilized. 

15 (e) DURATION OF GRANT.—The period during which 

16 payments are made to an entity from a grant under sub17 section (a)(1) or (b)(1) may not exceed five years. The 

18 provision of such payments are subject to annual approval 

19 by the Secretary of the payments and subject to the avail20 ability of appropriations for the fiscal year involved to 

21 make the payments. This subsection may not be construed 

22 as establishing a limitation on the number of grants under 

23 such subsection that may be made to an entity. 

24 (f) DEFINITIONS.—For purposes of this section: 
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1 (1) The term ‘‘culturally competent’’, with re2 spect to providing health-related services, means 

3 services that, in accordance with standards and 

4 measures of the Secretary, are designed to effec5 tively and efficiently respond to the cultural and lin6 guistic needs of patients. 

7 (2) The term ‘‘appropriate follow-up care’’ in8 cludes palliative and end-of-life care. 

9 (3) The term ‘‘health disparity population’’ 

10 means a population where there exists a significant 

11 disparity in the overall rate of disease incidence, 

12 morbidity, mortality, or survival rates in the popu13 lation as compared to the health status of the gen14 eral population. Such term includes—

15 (A) racial and ethnic minority groups as 

16 defined in section 1707; and 

17 (B) medically underserved groups, such as 

18 rural and low-income individuals and individ19 uals with low levels of literacy. 

20 (4)(A) The term ‘‘patient navigator’’ means an 

21 individual whose functions include—

22 (i) assisting and guiding patients with a 

23 symptom or an abnormal finding or diagnosis of 

24 cancer or other chronic disease within the 

25 health care system to accomplish the follow-up 
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•HR 2258 IH 

1 and diagnosis of an abnormal finding as well as 

2 the treatment and appropriate follow-up care of 

3 cancer or other chronic disease, including pro4 viding information about clinical trials; and 

5 (ii) identifying, anticipating, and helping 

6 patients overcome barriers within the health 

7 care system to ensure prompt diagnostic and 

8 treatment resolution of an abnormal finding of 

9 cancer or other chronic disease. 

10 (B) Such term includes representatives of the 

11 target health disparity population, such as nurses, 

12 social workers, cancer survivors, and patient advo13 cates. 

14 (g) AUTHORIZATION OF APPROPRIATIONS.—

15 (1) IN GENERAL.—

16 (A) MODEL PROGRAMS.—For the purpose 

17 of carrying out subsection (a) (other than the 

18 purpose described in paragraph (2)(A)), there 

19 are authorized to be appropriated such sums as 

20 may be necessary for each of the fiscal years 

21 2004 through 2008. 

22 (B) PATIENT NAVIGATORS.—For the pur23 pose of carrying out subsection (b) (other than 

24 the purpose described in paragraph (2)(B)), 

25 there are authorized to be appropriated such 
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1 sums as may be necessary for each of the fiscal 

2 years 2004 through 2008. 

3 (C) BUREAU OF PRIMARY HEALTH

4 CARE.—Amounts appropriated under subpara5 graph (A) or (B) shall be administered through 

6 the Bureau of Primary Health Care. 

7 (2) PROGRAMS IN RURAL AREAS.—

8 (A) MODEL PROGRAMS.—For the purpose 

9 of carrying out subsection (a) by making grants 

10 under such subsection for model programs in 

11 rural areas, there are authorized to be appro12 priated such sums as may be necessary for each 

13 of the fiscal years 2004 through 2008. 

14 (B) PATIENT NAVIGATORS.—For the pur15 pose of carrying out subsection (b) by making 

16 grants under such subsection for programs in 

17 rural areas, there are authorized to be appro18 priated such sums as may be necessary for each 

19 of the fiscal years 2004 through 2008. 

20 (C) OFFICE OF RURAL HEALTH POLICY.—

21 Amounts appropriated under subparagraph (A) 

22 or (B) shall be administered through the Office 

23 of Rural Health Policy. 

24 (3) RELATION TO OTHER AUTHORIZATIONS.—

25 Authorizations of appropriations under paragraphs
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•HR 2258 IH 

1 (1) and (2) are in addition to other authorizations 

2 of appropriations that are available for the purposes 

3 described in such paragraphs. 

4 TITLE IV—STRENGTHENING OUR 

5 HEALTH CARE WORKFORCE 

6 Subtitle A—Hispanic-Serving 

7 Health Professions Schools 

8 SEC. 401. HISPANIC-SERVING HEALTH PROFESSIONS 

9 SCHOOLS. 

10 (a) IN GENERAL.—The Secretary, acting through the 

11 Administrator of the Health Resources and Services Ad12 ministration, shall make grants to Hispanic-serving health 

13 professions schools for the purpose of carrying out pro14 grams to recruit Hispanic individuals to enroll in and 

15 graduate from the schools, which may include providing 

16 scholarships and other financial assistance as appropriate. 

17 (b) ELIGIBILITY.—For purposes of subsection (a), an 

18 entity is a Hispanic-serving health professions school if the 

19 entity—

20 (1) is a school or program under section 799B 

21 of the Public Health Service Act (42 U.S.C. 295p); 

22 (2) has an enrollment of full-time equivalent 

23 students that is at least 9 percent Hispanic stu24 dents; 
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1 (3) has been effective in carrying out programs 

2 to recruit Hispanic individuals to enroll in and grad3 uate from the school; 

4 (4) has been effective in recruiting and retain5 ing Hispanic faculty members; and 

6 (5) has a significant number of graduates who 

7 are providing health services to medically under8 served populations or to individuals in health profes9 sional shortage areas. 

10 (c) AUTHORIZATION OF APPROPRIATIONS.—For the 

11 purpose of carrying out this section, there are authorized 

12 to be appropriated $80,000,000 for each of fiscal years 

13 2004 through 2008. 

14 Subtitle B—Health Career Oppor15 tunity Program and Centers of 

16 Excellence 

17 SEC. 411. EDUCATIONAL ASSISTANCE REGARDING UNDER18 GRADUATES. 

19 (a) IN GENERAL.—Subpart 2 of part E of title VII 

20 of the Public Health Service Act (42 U.S.C. 295 et seq) 

21 is amended by adding at the end the following: 

22 ‘‘SEC. 771. HEALTH CAREERS OPPORTUNITY PROGRAM. 

23 ‘‘(a) IN GENERAL.—Subject to the provisions of this 

24 section, the Secretary may make grants and enter into co-
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•HR 2258 IH 

1 operative agreements and contracts for any of the fol2 lowing purposes: 

3 ‘‘(1) Identifying and recruiting individuals 

4 who—

5 ‘‘(A) are students of elementary schools, or 

6 students or graduates of secondary schools or of 

7 institutions of higher education; 

8 ‘‘(B) are from disadvantaged backgrounds; 

9 and 

10 ‘‘(C) are interested in a career in the 

11 health professions. 

12 ‘‘(2) Facilitating the entry of such individuals 

13 into a health professions school. 

14 ‘‘(3) Providing counseling or other services de15 signed to assist such individuals in successfully com16 pleting their education at such a school. 

17 ‘‘(4) Providing, for a period prior to the entry 

18 of such individuals into the regular course of edu19 cation of such a school, preliminary education de20 signed to assist the individuals in successfully com21 pleting such regular course of education at such a 

22 school, or referring such individuals to institutions 

23 providing such preliminary education. 

24 ‘‘(5) Paying such stipends as the Secretary may 

25 approve for such individuals for any period of edu-
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•HR 2258 IH 

1 cation in student-enhancement programs (other than 

2 regular courses) at a health professions school, ex3 cept that such a stipend may not be provided to an 

4 individual for more than 12 months, and such a sti5 pend may not exceed $25 per day (notwithstanding 

6 any other provision of law regarding the amount of 

7 stipends). 

8 ‘‘(6) Carrying out programs under which such 

9 individuals both— 

10 ‘‘(A) gain experience regarding a career in 

11 a field of primary health care through working 

12 at facilities of nonprofit private community13 based providers of primary health services; and 

14 ‘‘(B) receive academic instruction to assist 

15 in preparing the individuals to enter health pro16 fessions schools in such fields. 

17 ‘‘(b) RECEIPT OF AWARD.—

18 ‘‘(1) ELIGIBLE ENTITIES; REQUIREMENT OF

19 CONSORTIUM.—The Secretary may make an award 

20 under subsection (a) only if the following conditions 

21 are met: 

22 ‘‘(A) The applicant for the award is a pub23 lic or nonprofit private entity, and the applicant 

24 has established a consortium consisting of non-
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1 profit private community-based organizations 

2 and health professions schools.

3 ‘‘(B) The health professions schools of the 

4 consortium are schools of medicine or osteo5 pathic medicine, public health, dentistry, veteri6 nary medicine, optometry, pharmacy, allied 

7 health, chiropractic, or podiatric medicine, or 

8 graduate programs in mental health practice 

9 (including such programs in clinical psy10 chology). 

11 ‘‘(C) Except as provided in subparagraph 

12 (D), the membership of the consortium includes 

13 not less than one nonprofit private community14 based organization and not less than three 

15 health professions schools. 

16 ‘‘(D) In the case of an applicant whose ex17 clusive activity under the award will be carrying 

18 out one or more programs described in sub19 section (a)(6), the membership of the consor20 tium includes not less than one nonprofit pri21 vate community-based organization and not less 

22 than one health professions schools. 

23 ‘‘(E) The members of the consortium have 

24 entered into an agreement specifying—
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1 ‘‘(i) that each of the members will 

2 comply with the conditions upon which the 

3 award is made; and 

4 ‘‘(ii) whether and to what extent the 

5 award will be allocated among the mem6 bers.

7 ‘‘(2) REQUIREMENT OF COMPETITIVE

8 AWARDS.—Awards under subsection (a) shall be 

9 made only on a competitive basis. 

10 ‘‘(c) FINANCIAL REQUIREMENTS.—

11 ‘‘(1) ASSURANCES REGARDING CAPACITY.—The 

12 Secretary may make an award under subsection (a) 

13 only if the Secretary determines that, in the case of 

14 activities carried out under the award that prove to 

15 be effective toward achieving the purposes of the

16 activities—

17 ‘‘(A) the members of the consortium in18 volved have or will have the financial capacity 

19 to continue the activities, regardless of whether 

20 financial assistance under subsection (a) con21 tinues to be available; and 

22 ‘‘(B) the members of the consortium dem23 onstrate to the satisfaction of the Secretary a 

24 commitment to continue such activities, regard-
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1 less of whether such assistance continues to be 

2 available. 

3 ‘‘(2) MATCHING FUNDS.—

4 ‘‘(A) IN GENERAL.—With respect to the 

5 costs of the activities to be carried out under 

6 subsection (a) by an applicant, the Secretary 

7 may make an award under such subsection only 

8 if the applicant agrees to make available in cash 

9 (directly or through donations from public or 

10 private entities) non-Federal contributions to11 ward such costs in an amount that, for any 

12 fourth or subsequent fiscal year for which the 

13 applicant receives such an award, is not less 

14 than 50 percent of such costs. 

15 ‘‘(B) FEDERAL AMOUNTS.—Amounts pro16 vided by the Federal Government may not be 

17 included in determining the amount of non-Fed18 eral contributions required in subparagraph 

19 (A). 

20 ‘‘(C) LIMITATION.—The Secretary may not 

21 require non-Federal contributions for the first 

22 three fiscal years for which an applicant re23 ceives a grant under subsection (a). 

24 ‘‘(d) PREFERENCE IN MAKING AWARDS.—

25 ‘‘(1) IN GENERAL.—
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1 ‘‘(A) REQUIREMENT.—In making awards 

2 under subsection (a), the Secretary shall, sub3 ject to paragraph (3), give preference to any

4 applicant that, for the purpose described in sub5 paragraph (B), has made an arrangement with 

6 not less than one entity from each of the fol7 lowing categories of entities: Community-based 

8 organizations, elementary schools, secondary 

9 schools, institutions of higher education, and 

10 health professions schools. 

11 ‘‘(B) PURPOSE.—The purpose of arrange12 ments under subparagraph (A) is to establish a 

13 program for individuals identified under sub14 section (a) under which—

15 ‘‘(i) the activities described in such 

16 subsection are carried out on behalf of the 

17 individuals; and 

18 ‘‘(ii) health professions schools make 

19 a commitment to admit as students of the 

20 schools such individuals who participate in 

21 the program, subject to the individuals 

22 meeting reasonable academic standards for 

23 admission to the schools. 

24 ‘‘(2) ADDITIONAL PREFERENCES.—Of the ap25 plicants under subsection (a) that are receiving pref-
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1 erence for purposes of paragraph (1), the Secretary 

2 shall, subject to paragraph (3), give additional pref3 erence to applicants whose consortium under sub4 section (b) includes as members one or more health 

5 professions schools that have not previously received 

6 any award under this section (including this section 

7 as in effect prior to fiscal year 1997). 

8 ‘‘(3) LIMITATION.—An applicant may not re9 ceive preference for purposes of paragraph (1) or (2) 

10 unless the consortium under subsection (b) includes 

11 not less than one health professions school that has 

12 demonstrated success in enrolling students from dis13 advantaged backgrounds. 

14 ‘‘(e) OBJECTIVES UNDER AWARDS.—

15 ‘‘(1) ESTABLISHMENT OF OBJECTIVES.—Before 

16 making a first award to an applicant under sub17 section (a), the Secretary shall establish objectives 

18 regarding the activities to be carried out under the 

19 award, which objectives are applicable until the next 

20 fiscal year for which such award is made after a 

21 competitive process of review. In making an award 

22 after such a review, the Secretary shall establish ad23 ditional objectives for the applicant. 

24 ‘‘(2) PRECONDITION FOR SUBSEQUENT

25 AWARDS.—In the case of an applicant seeking an 
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1 award under subsection (a) pursuant to a competi2 tive process of review, the Secretary may make the 

3 award only if the applicant demonstrates to the sat4 isfaction of the Secretary that the applicant has met 

5 the objectives that were applicable under paragraph 

6 (1) to the preceding awards under such subsection. 

7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the 

8 purpose of carrying out this section, there are authorized 

9 to be appropriated $33,000,000 for fiscal year 2004, 

10 $40,000,000 for fiscal year 2005, and such sums as may 

11 be necessary for each subsequent fiscal year.’’. 

12 (b) TECHNICAL AMENDMENT.—Section 770(a) of the 

13 Public Health Service Act (42 U.S.C. 295e(a)) is amended 

14 by inserting ‘‘(other than section 771)’’ after ‘‘this sub15 part’’. 

16 SEC. 412. CENTERS OF EXCELLENCE. 

17 For the purpose of establishing and operating health 

18 careers centers of excellence, there are authorized to be 

19 appropriated $80,000,000 for fiscal year 2004 and each 

20 subsequent fiscal year.
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1 Subtitle C—Bilingual Health 

2 Professionals 

3 SEC. 421. TRAINING OF BILINGUAL HEALTH PROFES4 SIONALS WITH RESPECT TO MINORITY 

5 HEALTH CONDITIONS. 

6 (a) IN GENERAL.—The Secretary, acting through the 

7 Administrator of the Health Resources and Services Ad8 ministration, shall (directly or through awards of grants 

9 or contracts to public or nonprofit private entities) carry 

10 out a program—

11 (1) to identify health professionals who speak 

12 both English and a language used by racial or ethnic 

13 minority groups in the United States; and 

14 (2) to train such health professionals with re15 spect to the treatment of health conditions known to 

16 disproportionately affect racial/ethnic minorities, 

17 such as diabetes, asthma, obesity, injuries, under-im18 munization, oral health, HIV infection, substance 

19 abuse, and conditions regarding mental health. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.—For the 

21 purpose of carrying out subsection (a), there are author22 ized to be appropriated such sums as may be necessary 

23 for each of the fiscal years 2004 through 2008. 
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1 Subtitle D—Cultural Competence 

2 SEC. 431. DEFINITION. 

3 (a) IN GENERAL.—In this Act, the term ‘‘culturally 

4 competent’’, with respect to the manner in which health5 related services, education, and training are provided, 

6 means providing the services, education, and training in 

7 the language and cultural context that is most appropriate 

8 for the individuals for whom the services, education, and 

9 training are intended, including as necessary the provision 

10 of bilingual services. 

11 (b) MODIFICATION.—The definition established in 

12 subsection (a) may be modified as needed at the discretion 

13 of the Secretary after providing a 30-day notice to Con14 gress. 

15 SEC. 432. ACTIVITIES OF OFFICE OF MINORITY HEALTH; 

16 CENTER FOR LINGUISTIC AND CULTURAL 

17 COMPETENCE IN HEALTH CARE. 

18 (a) EDUCATIONAL MATERIALS; TECHNICAL ASSIST19 ANCE.—

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

21 through the Office of Minority Health under section 

22 1707 of the Public Health Service Act (42 U.S.C. 

23 300u–6), shall—
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1 (A) provide for the development of edu2 cational materials on providing health services 

3 in a culturally competent manner; 

4 (B) provide technical assistance in carrying 

5 out programs that use such materials; and 

6 (C) provide technical assistance on other 

7 matters regarding the provision of health serv8 ices in a culturally competent manner. 

9 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

10 the purpose of carrying out paragraph (1), there are 

11 authorized to be appropriated $5,000,000 for fiscal 

12 year 2004, and such sums as may be necessary for 

13 each of the fiscal years 2005 through 2008.

14 (b) CENTER FOR LINGUISTIC AND CULTURAL COM15 PETENCE IN HEALTH CARE.—

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

17 through the Office of Minority Health under section 

18 1707 of the Public Health Service Act (42 U.S.C. 

19 300u–6), shall provide for a Center for Linguistic 

20 and Cultural Competence in Health Care to carry 

21 out programs to promote and facilitate the provision 

22 of health-related services, education, and training in 

23 a culturally competent manner. 

24 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

25 the purpose of carrying out paragraph (1), there are 
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1 authorized to be appropriated $5,000,000 for fiscal 

2 year 2004, and such sums as may be necessary for 

3 each of the fiscal years 2005 through 2008. 

4 SEC. 433. CULTURAL COMPETENCE DEMONSTRATION 

5 PROJECTS. 

6 (a) IN GENERAL.—The Secretary, acting through the 

7 Administrator of the Centers for Medicare & Medicaid 

8 Services, shall conduct a cultural competence demonstra9 tion project under which grants are made to two hospitals 

10 with a history in medicare, medicaid, and the uninsured 

11 to enable them to implement standards for the culturally 

12 competent provision of services to address the specific 

13 needs of any population that constitutes at least 5 percent 

14 of the population served by the hospital involved. 

15 (b) NUMBER AND TYPE.—Of the hospitals provided 

16 grants under this section, one shall be located in an urban 

17 and the other in a rural area (as defined in section 

18 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 

19 1395ww(d)(2)(d)). The urban hospital shall serve a sig20 nificant limited English proficient population and be with21 in 175 miles of the border with Mexico. In selecting such 

22 hospitals, the Secretary shall give preference to hospitals 

23 that serve large immigrant populations.
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1 (c) AMOUNT AND DURATION OF GRANT.—A grant 

2 under this section for a hospital shall be in the amount 

3 of $5,000,000 and shall be for a period of 5 years. 

4 (d) EVALUATION AND REPORT.—

5 (1) EVALUATION.—The Secretary shall also 

6 provide for a grant to an appropriate qualified entity 

7 in an amount not to exceed $1,000,000 to evaluate 

8 the demonstration projects conducted under this sec9 tion. 

10 (2) REPORT.—The Secretary shall submit to 

11 Congress a report on the projects conducted under 

12 this section. The Secretary shall include in such re13 port the results of the evaluation conducted under 

14 paragraph (1) and recommendations on whether on 

15 going medicare funding should be provided for im16 plementation of standards for cultural competency in 

17 hospitals. 

18 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated from the Federal Hos20 pital Insurance Trust Fund (under section 1817 of the 

21 Social Security Act (42 U.S.C. 1395i) to carry out this 

22 section, $11,000,000, which shall remain available until 

23 expended. 
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1 TITLE V—ADDITIONAL 

2 PROGRAMS 

3 Subtitle A—Data Regarding Race 

4 and Ethnicity 

5 SEC. 501. COLLECTION OF DATA. 

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

7 (42 U.S.C. 241 et seq.) is amended by inserting after sec8 tion 306 the following: 

9 ‘‘SEC. 306A. DATA ON RACE AND ETHNICITY. 

10 ‘‘(a) IN GENERAL.—The Secretary shall by regula11 tion provide for the following: 

12 ‘‘(1) Health data collected under programs car13 ried out by the Secretary (whether collected directly 

14 or pursuant to grants, cooperative agreements, or 

15 contracts) shall include data on race, ethnicity, and 

16 spoken and written language and shall, at a min17 imum, use the categories for race and ethnicity de18 scribed in OMB Directive 15. 

19 ‘‘(2) Data collected by the Secretary pursuant 

20 to title VI of the Civil Rights Act of 1964 shall in21 clude data on race and ethnicity and shall, at a min22 imum, use such categories. 

23 ‘‘(3) Data on race and ethnicity that is collected 

24 under paragraph (1) or (2) shall use the procedures 

25 described in such Directive for collecting data from 
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1 an individual, and shall be maintained and presented 

2 (including for reporting purposes) in accordance 

3 with such Directive. 

4 ‘‘(4) For health encounters that require the 

5 presence of a legal parent or guardian who does not 

6 speak English or who is limited English proficient, 

7 health data collected by the Secretary pursuant to 

8 this section shall also include data on the of the ac9 companying adult or guardian. 

10 ‘‘(5) Such other data as the Secretary may des11 ignate (including administrative records) shall be 

12 collected, maintained, and presented in accordance 

13 with such Directive, to the extent that such data are 

14 collected by the Secretary and relate to health-re15 lated programs that are carried out by the Sec16 retary. 

17 ‘‘(6) The Secretary is directed to include Puerto 

18 Rico in the collection of data provider under this 

19 section. 

20 ‘‘(b) DEFINITION.—In this section, the term ‘OMB 

21 Directive 15’ means Statistical Policy Directive No. 15, 

22 Race and Ethnic Standards for Federal Statistics and Ad23 ministrative Reporting, as established by the Director of 

24 the Office of Management and Budget through the notice 
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1 issued October 30, 1997 (62 FR 58782). Such term in2 cludes any subsequent revisions to such Directive.’’. 

3 SEC. 502. DEVELOPMENT OF STANDARDS; STUDY TO MEAS4 URE PATIENT OUTCOMES UNDER MEDICARE 

5 AND MEDICAID PROGRAMS. 

6 (a) DEVELOPMENT OF STANDARDS.—Not later than 

7 1 year after the date of the enactment of this Act, the 

8 Secretary, acting through the Administrator of the Health 

9 Care Financing Administration, shall develop outcome 

10 measures to evaluate, by race and ethnicity, the perform11 ance of health care programs and projects that provide 

12 health care to individuals under the medicare and med13 icaid programs (under titles XVIII and XIX, respectively, 

14 of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 

15 et seq.). 

16 (b) STUDY.—After the Secretary develops the out17 come measures under subsection (a), the Secretary shall 

18 conduct a study that evaluates, by race and ethnicity, the 

19 performance of health care programs and projects referred 

20 to in subsection (a). 

21 (c) REPORT TO CONGRESS.—Not later that 2 years 

22 after the date of the enactment of this Act, the Secretary

23 shall submit to Congress a report describing the outcome 

24 measures developed under subsection (a), and the results 

25 of the study conducted pursuant to subsection (b).
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1 Subtitle B—National Assessment of 

2 Status of Latino Health 

3 SEC. 511. NATIONAL ASSESSMENT OF STATUS OF LATINO 

4 HEALTH. 

5 (a) IN GENERAL.—The Secretary of Health and 

6 Human Services shall establish a national assessment of 

7 the status of Latino health to be known as the ‘‘Hispanic 

8 Health and Nutrition Examination Survey’’ or 

9 ‘‘HHANES II’’. 

10 (b) GOAL.—The goal of the national assessment, in11 cluding Puerto Rice, under subsection (a) shall be to 

12 produce estimates of health and nutritional status for 

13 Mexican Americans, Puerto Ricans, Cuban Americans, 

14 and other Hispanic subpopulations. 

15 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated such sums as may be nec17 essary in each of fiscal years 2004 through 2006 to carry 

18 out this section. 

19 Subtitle C—Office of Minority 

20 Health 

21 SEC. 521. REVISION AND EXTENSION OF PROGRAMS OF OF22 FICE OF MINORITY HEALTH. 

23 Section 1707 of the Public Health Service Act (42 

24 U.S.C. 300u–6) is amended by striking subsection (b) and 

25 all that follows and inserting the following: 
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•HR 2258 IH 

1 ‘‘(b) DUTIES.—With respect to improving the health 

2 of racial and ethnic minority groups, the Secretary, acting 

3 through the Deputy Assistant Secretary for Minority 

4 Health (in this section referred to as the ‘Deputy Assist5 ant Secretary’), shall carry out the following: 

6 ‘‘(1) Establish short-range and long-range goals 

7 and objectives and coordinate all other activities 

8 within the Public Health Service that relate to dis9 ease prevention, health promotion, service delivery, 

10 and research concerning such individuals. The heads 

11 of each of the agencies of the Service shall consult 

12 with the Deputy Assistant Secretary to ensure the 

13 coordination of such activities. 

14 ‘‘(2) Carry out the following types of activities 

15 by entering into interagency agreements with other 

16 agencies of the Public Health Service: 

17 ‘‘(A) Support research, demonstrations and 

18 evaluations to test new and innovative models. 

19 ‘‘(B) Increase knowledge and under20 standing of health risk factors. 

21 ‘‘(C) Develop mechanisms that support 

22 better information dissemination, education, 

23 prevention, and service delivery to individuals 

24 from disadvantaged backgrounds, including in-
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1 dividuals who are members of racial or ethnic 

2 minority groups. 

3 ‘‘(D) Ensure that the National Center for 

4 Health Statistics collects data on the health 

5 status of each minority group. 

6 ‘‘(E) With respect to individuals who lack 

7 proficiency in speaking the English language, 

8 enter into contracts with public and nonprofit 

9 private providers of primary health services for 

10 the purpose of increasing the access of the indi11 viduals to such services by developing and car12 rying out programs to provide bilingual or in13 terpretive services. 

14 ‘‘(3) Support a national minority health re15 source center to carry out the following: 

16 ‘‘(A) Facilitate the exchange of informa17 tion regarding matters relating to health infor18 mation and health promotion, preventive health 

19 services, and education in the appropriate use 

20 of health care. 

21 ‘‘(B) Facilitate access to such information. 

22 ‘‘(C) Assist in the analysis of issues and 

23 problems relating to such matters.

24 ‘‘(D) Provide technical assistance with re25 spect to the exchange of such information (in-
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1 cluding facilitating the development of materials 

2 for such technical assistance). 

3 ‘‘(4) Carry out programs to improve access to 

4 health care services for individuals with limited pro5 ficiency in speaking the English language by facili6 tating the removal of impediments to the receipt of 

7 health care that result from such limitation. Activi8 ties under the preceding sentence shall include con9 ducting research and developing and evaluating 

10 model projects. 

11 ‘‘(5) Not later than June 8 of each year, the 

12 Deputy Assistant Secretary shall submit to the Sec13 retary a report summarizing the activities of each of 

14 the minority health offices under section 1707A. 

15 ‘‘(c) ADVISORY COMMITTEE.—

16 ‘‘(1) IN GENERAL.—The Secretary shall estab17 lish an advisory committee to be known as the Advi18 sory Committee on Minority Health (in this sub19 section referred to as the ‘Committee’). The Deputy 

20 Assistant Secretary shall consult with the Committee 

21 in carrying out this section. 

22 ‘‘(2) DUTIES.—The Committee shall provide 

23 advice to the Secretary, including advice on the de24 velopment of goals and specific program activities
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1 under paragraphs (1) and (2) of subsection (b) for 

2 each racial and ethnic minority group. 

3 ‘‘(3) CHAIRPERSON.—The Deputy Assistant 

4 Secretary shall serve as the chairperson of the Com5 mittee. 

6 ‘‘(4) COMPOSITION.—

7 ‘‘(A) IN GENERAL.—The Committee shall 

8 be composed of 12 voting members appointed in 

9 accordance with subparagraph (B), and non10 voting, ex officio members designated under 

11 subparagraph (C). 

12 ‘‘(B) VOTING MEMBERS.—The voting 

13 members of the Committee shall be appointed 

14 by the Secretary from among individuals who 

15 are now officers or employees of the Federal 

16 Government and who have expertise regarding 

17 issues of minority health. The racial and ethnic 

18 minority groups shall be equally represented 

19 among such members. 

20 ‘‘(C) NONVOTING MEMBERS.—The non21 voting, ex officio members of the Committee 

22 shall be the directors of each of the minority 

23 health office established under section 707A, 

24 and such additional officials of the Department 
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1 of Health and Human Services as the Secretary 

2 determines to be appropriate. 

3 ‘‘(5) TERMS.—Each member of the Committee 

4 shall serve for a term of 4 years, except that the 

5 Secretary shall initially appoint a portion of the 

6 members to terms of 1 year, 2 years, and 3 years. 

7 ‘‘(6) VACANCIES.—If a vacancy occurs on the 

8 Committee, a new member shall be appointed by the 

9 Secretary within 90 days from the date on which the 

10 vacancy occurs, and shall serve for the remainder of 

11 the term for which the predecessor of such member 

12 was appointed. A vacancy shall not affect the power 

13 of the remaining members to execute the duties of 

14 the Committee. 

15 ‘‘(7) COMPENSATION.—Members of the Com16 mittee who are officers or employees of the United 

17 States shall serve without compensation. Members of 

18 the Committee who are not officers or employees of 

19 the United States shall receive, for each day (includ20 ing travel time) they are engaged in the performance 

21 of the functions of the Committee compensation in 

22 an amount that is not in excess of the daily equiva23 lent of the annual maximum rate of basic pay pay24 able under the General Schedule (under title 5, 

25 United States Code) for positions above GS-15. 
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1 ‘‘(d) CERTAIN REQUIREMENTS REGARDING DU2 TIES.—

3 ‘‘(1) RECOMMENDATIONS REGARDING LAN4 GUAGE AS IMPEDIMENT TO HEALTH CARE.—The di5 rectors of the offices of minority health within the 

6 Department of Health and Human Services, the Di7 rector of the Office of Civil Rights, and the Director 

8 of the Office of Refugee Health shall seek input 

9 from the State minority health offices and make rec10 ommendations to the Secretary regarding activities 

11 under subsection (b)(4). 

12 ‘‘(2) EQUITABLE ALLOCATION REGARDING AC13 TIVITIES.—

14 ‘‘(A) In making awards of grants, coopera15 tive agreements, or contracts under this section 

16 or section 338A, 338B, 724, 736, 737, 738, or 

17 740, the Secretary, acting as appropriate 

18 through the Deputy Assistant Secretary or the 

19 Administrator of the Health Resources and 

20 Services Administration, shall ensure that such 

21 awards are equitably allocated with respect to 

22 the various racial and minority populations. 

23 ‘‘(B) With respect to grants, cooperative 

24 agreements, and contracts that are available 
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1 under the sections specified in subparagraph 

2 (A), the Secretary shall—

3 ‘‘(i) carry out activities to inform enti4 ties, as appropriate, that the entities may 

5 be eligible for awards of such assistance; 

6 ‘‘(ii) provide technical assistance to 

7 such entities in the process of preparing 

8 and submitting applications for the awards 

9 in accordance with the policies of the Sec10 retary regarding such application; and 

11 ‘‘(iii) inform populations, as appro12 priate, that members of the populations 

13 may be eligible to receive services or other14 wise participate in the activities carried out 

15 with such awards. 

16 ‘‘(3) CULTURAL COMPETENCY OF SERVICES.—

17 The Secretary shall ensure that information and 

18 services provided pursuant to subsection (b) are pro19 vided in the language and cultural context that is 

20 most appropriate for the individuals for whom the 

21 information and services are intended.

22 ‘‘(e) GRANTS AND CONTRACTS REGARDING DU23 TIES.—

24 ‘‘(1) IN GENERAL.—In carrying out subsection 

25 (b), the Deputy Assistant Secretary may make
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1 awards of grants, cooperative agreements, and con2 tracts to public and nonprofit private entities. 

3 ‘‘(2) PROCESS FOR MAKING AWARDS.—The 

4 Deputy Assistant Secretary shall ensure that awards 

5 under paragraph (1) are made to the extent prac6 ticable on a competitive basis, and that an award is 

7 made for a proposal only if the proposal has been 

8 recommended for such an award through a process 

9 of peer review. 

10 ‘‘(3) EVALUATION AND DISSEMINATION.—The 

11 Deputy Assistant Secretary, directly or through con12 tracts with public and private entities, shall provide 

13 for evaluations of projects carried out with awards 

14 made under paragraph (1) during the preceding 2 

15 fiscal years. The report shall be included in the re16 port required under subsection (f) for the fiscal year 

17 involved. 

18 ‘‘(f) BIENNIAL REPORTS.—Not later than February 

19 1 of fiscal year 1998 and of each second year thereafter, 

20 the Deputy Assistant Secretary shall submit to the Com21 mittee on Energy and Commerce of the House of Rep22 resentatives, and to the Committee on Labor and Human 

23 Resources of the Senate, a report describing the activities 

24 carried out under this section during the preceding 2 fiscal 

25 years and evaluating the extent to which such activities 
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1 have been effective in improving the health of racial and 

2 ethnic minority groups. Each such report shall include the 

3 biennial reports submitted to the Deputy Assistant Sec4 retary under section 1707A(e) for such years by the heads 

5 of the minority health offices. 

6 ‘‘(g) DEFINITION.—For purposes of this section: 

7 ‘‘(1) RACIAL AND ETHNIC MINORITY GROUP.—

8 The term ‘racial and ethnic minority group’ means 

9 American Indians (including Alaskan Natives, Eski10 mos, and Aleuts); Asian Americans and Pacific Is11 landers; Blacks; and Hispanics/Latinos. 

12 ‘‘(2) HISPANIC/LATINOS.—The term ‘Hispanic/

13 Latinos’ means individuals whose origin is Mexican, 

14 Puerto Rican, Cuban, Central or South American, or 

15 any other Spanish-speaking country. 

16 ‘‘(h) FUNDING.—

17 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

18 For the purpose of carrying out this section, there 

19 are authorized to be appropriated $150,000,000 for 

20 each of fiscal years 2004 through 2006. 

21 ‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—

22 Of the amounts appropriated under paragraph (1) 

23 for a fiscal year in excess of $50,000,000, the Sec24 retary shall make available not less than $3,000,000 

25 for carrying out subsection (b)(2)(E).’’. 
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1 SEC. 522. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI2 NORITY HEALTH WITHIN AGENCIES OF PUB3 LIC HEALTH SERVICE. 

4 Title XVII of the Public Health Service Act (42 

5 U.S.C. 300u et seq.) is amended by inserting after section 

6 1707 the following section: 

7 ‘‘SEC. 1707A. INDIVIDUAL OFFICES OF MINORITY HEALTH 

8 WITHIN PUBLIC HEALTH SERVICE. 

9 ‘‘(a) IN GENERAL.—The head of each agency speci10 fied in subsection (b)(1) shall establish within the agency 

11 an office to be known as the Office of Minority Health. 

12 Each such Office shall be headed by a director, who shall 

13 be appointed by the head of the agency within which the 

14 Office is established, and who shall report directly to the 

15 head of the agency. The head of such agency shall carry 

16 out this section (as this section relates to the agency) act17 ing through such Director. 

18 ‘‘(b) SPECIFIED AGENCIES.—

19 ‘‘(1) IN GENERAL.—The agencies referred to in 

20 subsection (a) are the following: 

21 ‘‘(A) The Centers for Disease Control and 

22 Prevention. 

23 ‘‘(B) The Agency for Healthcare Research 

24 and Quality. 

25 ‘‘(C) The Health Resources and Services 

26 Administration. 
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1 ‘‘(D) The Substance Abuse and Mental 

2 Health Services Administration. 

3 ‘‘(E) The Centers for Medicare & Medicaid 

4 Services. 

5 ‘‘(F) The Agency for Toxic Substances and 

6 Disease Registry. 

7 ‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For 

8 purposes of subsection (c) and the subsequent provi9 sions of this section, the term ‘minority health office’ 

10 includes the National Center on Minority Health 

11 and Health Disparities established within the Na12 tional Institutes of Health. The Director of the Na13 tional Institutes of Health shall carry out this sec14 tion (as this section relates to the agency) acting 

15 through the Director of such Office. 

16 ‘‘(c) COMPOSITION.—The head of each specified 

17 agency shall ensure that the officers and employees of the 

18 minority health office of the agency are, collectively, expe19 rienced in carrying out community-based health programs 

20 for each of the various racial and ethnic minority groups 

21 that are present in significant numbers in the United

22 States. The head of such agency shall ensure that, of such 

23 officers and employees who are members of racial and eth24 nic minority groups, no one group is disproportionately 

25 represented in the overall office composition.
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1 ‘‘(d) DUTIES.—Each Director of a minority health of2 fice shall monitor the programs of the specified agency of 

3 such office in order to carry out the following: 

4 ‘‘(1) Determine the extent to which the pur5 poses of the programs are being carried out with re6 spect to racial and ethnic minority groups; 

7 ‘‘(2) Determine the extent to which members of 

8 such groups are represented among the Federal offi9 cers and employees who administer the programs; 

10 and 

11 ‘‘(3) Make recommendations to the head of 

12 such agency on carrying out the programs with re13 spect to such groups. In the case of programs that 

14 provide services, such recommendations shall include 

15 recommendations toward ensuring that—

16 ‘‘(A) the services are equitably delivered 

17 with respect to racial and ethnic minority 

18 groups; 

19 ‘‘(B) the programs provide the services in 

20 the language and cultural context that is most 

21 appropriate for the individuals for whom the 

22 services are intended; and 

23 ‘‘(C) the programs utilize racial and ethnic 

24 minority community-based organizations to de25 liver the services. 
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1 ‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head 

2 of each specified agency shall submit to the Secretary for 

3 inclusion in each biennial report under section 1707(g) 

4 (without change) a biennial report describing—

5 ‘‘(1) the extent to which the minority health of6 fice of the agency employs individuals who are mem7 bers of racial and ethnic minority groups, including 

8 a specification by minority group of the number, se9 ries, and grade levels of such individuals employed 

10 by such office; 

11 ‘‘(2) the manner in which the agency is com12 plying with Public Law 94–311 (relating to col13 lecting and reporting data on Americans of Spanish 

14 origin or descent); and 

15 ‘‘(3) the manner in which the agency is com16 plying with services for Limited English Proficient 

17 persons. 

18 ‘‘(f) DEFINITIONS.—For purposes of this section: 

19 ‘‘(1) MINORITY HEALTH OFFICE.—The term 

20 ‘minority health office’ means an office established 

21 under subsection (a), subject to subsection (b)(2). 

22 ‘‘(2) RACIAL AND ETHNIC MINORITY GROUP.—

23 The term ‘racial and ethnic minority group’ has the 

24 meaning given such term in section 1707(g). 
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•HR 2258 IH 

1 ‘‘(3) SPECIFIED AGENCY.—The term ‘specified 

2 agency’ means—

3 ‘‘(A) an agency specified in subsection 

4 (b)(1); and 

5 ‘‘(B) the National Institutes of Health. 

6 ‘‘(g) FUNDING.—

7 ‘‘(1) ALLOCATIONS.—Of the amounts appro8 priated for a specified agency for a fiscal year, the 

9 Secretary may reserve not more than 0.5 percent for 

10 the purpose of carrying out activities under this sec11 tion through the minority health office of the agen12 cy. In reserving an amount under the preceding sen13 tence for a minority health office for a fiscal year, 

14 the Secretary shall reduce, by substantially the same 

15 percentage, the amount that otherwise would be 

16 available for each of the programs of the designated 

17 agency involved. 

18 ‘‘(2) AVAILABILITY OF FUNDS FOR STAFF19 ING.—The purposes for which amounts made avail20 able under paragraph (1) may be expended by a mi21 nority health office include the costs of employing 

22 staff for such office.’’. 
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1 SEC. 523. ASSISTANT SECRETARY OF HEALTH AND HUMAN 

2 SERVICES FOR CIVIL RIGHTS. 

3 (a) IN GENERAL.—Part A of title II of the Public 

4 Health Service Act (42 U.S.C. 202 et seq.) is amended 

5 by adding at the end the following: 

6 ‘‘SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS. 

7 ‘‘(a) ESTABLISHMENT OF POSITION.—There shall be 

8 in the Department of Health and Human Services an As9 sistant Secretary for Civil Rights, who shall be appointed 

10 by the President, by and with the advice and consent of 

11 the Senate. 

12 ‘‘(b) RESPONSIBILITIES.—The Assistant Secretary 

13 shall perform such functions relating to civil rights as the 

14 Secretary may assign.’’. 

15 (b) CONFORMING AMENDMENT.—Section 5315 of 

16 title 5, United States Code, is amended, in the item relat17 ing to Assistant Secretaries of Health and Human Serv18 ices, by striking ‘‘(6)’’ and inserting ‘‘(7)’’.

Æ