89–006

106TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 106–986

HEALTH CARE FAIRNESS ACT OF 2000

OCTOBER 18, 2000.—Committed to the Committee of the Whole House on the State

of the Union and ordered to be printed

Mr. BLILEY, from the Committee on Commerce,

submitted the following

R E P O R T

[To accompany H.R. 3250]

[Including cost estimate of the Congressional Budget Office]

The Committee on Commerce, to whom was referred the bill

(H.R. 3250) to amend the Public Health Service Act to improve the

health of minority individuals, having considered the same, report

favorably thereon with an amendment and recommend that the bill

as amended do pass.

CONTENTS

Page

Amendment .............................................................................................................. 1

Purpose and Summary ............................................................................................ 15

Background and Need for Legislation .................................................................... 16

Hearings ................................................................................................................... 16

Committee Consideration ........................................................................................ 17

Committee Votes ...................................................................................................... 17

Committee Oversight Findings ............................................................................... 17

Committee on Government Reform Oversight Findings ...................................... 17

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 18

Committee Cost Estimate ....................................................................................... 18

Congressional Budget Office Estimate ................................................................... 18

Federal Mandates Statement ................................................................................. 20

Advisory Committee Statement .............................................................................. 20

Constitutional Authority Statement ...................................................................... 20

Applicability to Legislative Branch ........................................................................ 20

Section-by-Section Analysis of the Legislation ...................................................... 21

Changes in Existing Law Made by the Bill, as Reported ..................................... 30

AMENDMENT

The amendment is as follows:

Strike all after the enacting clause and insert the following:

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SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.—This Act may be cited as the ‘‘Health Care Fairness Act of

2000’’.

(b) TABLE OF CONTENTS.—The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.

TITLE I—IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF HEALTH;

ESTABLISHMENT OF NATIONAL CENTER

Sec. 101. Establishment of National Center for Research on Minority Health and Health Disparities.

Sec. 102. Centers of excellence for research education and training.

Sec. 103. Extramural loan repayment program for minority health research.

Sec. 104. General provisions regarding the Center.

Sec. 105. Report regarding resources of National Institutes of Health dedicated to research on minority health.

TITLE II—HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH AND

QUALITY

Sec. 201. Health disparities research by Agency for Healthcare Research and Quality.

TITLE III—DATA COLLECTION RELATING TO RACE OR ETHNICITY

Sec. 301. Study and report by National Academy of Sciences.

TITLE IV—MEDICAL EDUCATION AND OTHER HEALTH PROFESSIONS EDUCATION

Sec. 401. Grants for health care education curriculum development.

Sec. 402. National conference on continuing health professional education and disparities in health outcomes.

Sec. 403. Continuing medical education incentive program.

Sec. 404. Advisory committee.

Sec. 405. Cultural competency clearinghouse.

TITLE V—MISCELLANEOUS PROVISIONS

Sec. 501. Office for Civil Rights.

Sec. 502. Development of outcome measures; study to measure patient outcomes under the medicare and medicaid programs by race and ethnicity.

Sec. 503. Departmental definition regarding minority individuals.

Sec. 504. Conforming provision regarding definitions.

TITLE VI—EFFECTIVE DATE

Sec. 601. Effective date.

SEC. 2. FINDINGS.

The Congress finds as follows:

(1) Despite notable progress in the overall health of the Nation, there are continuing disparities in the burden of illness and death experienced by African

Americans, Indians, Alaska Natives, and Asian Pacific Islanders, compared to

the United States population as a whole.

(2) Minority Americans lag behind on nearly every health indicator, including

health care coverage, access to care, life expectancy, and disease rates. More detailed data on health disparities is needed to evaluate the impact that race, ethnicity, and socioeconomic status have on health status, access to care, and the

quality of care. More data is also needed to enforce existing protections for

equal access to care.

(3) Despite substantial overall improvements in Americans’ health, racial and

ethnic disparities persist across age, sex, and income categories. Some striking

examples are as follows: (A) The black infant mortality rate, which is twice that

of all U.S. infants. (B) A higher breast cancer mortality rate for black women

than white women (even though black women have a lower incidence rate). (C)

Nearly twice as many Hispanics adults report they do not have a regular doctor

compared to white adults.

(4) Minority adults are more likely to lack health insurance than are white

adults, a consistent trend over the past decade. Nearly two of five (38 percent)

Hispanic adults, one of four (24 percent) black adults, and one of four (24 percent) Asian American adults are uninsured, compared with one of seven (14 percent) white adults.

(5) Differences in the socioeconomic status among U.S. ethnic groups exist.

When examined collectively, African Americans and Hispanics are three times

as likely as whites to be poor. Low socioeconomic and ethnic minority status are

not synonymous, but many members of ethnic minority who also have low income comprise an important proportion of underserved populations in the

United States.

(6) The largest numbers of the medically underserved are white, and many

of them have the same health care access problems as do members of minority

groups. Nearly 20,000,000 white Americans live below the poverty line with

many living in non-metropolitan, rural areas. However, there is a higher proportion of racial and ethnic minorities in the United States represented among

the medically underserved.

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(7) Despite suffering disproportionate rates of illness, death and disability,

minorities have not been proportionately represented in many clinical trials, except in studies of behavioral risk factors associated with negative stereotypes.

(8) Many minority groups suffer disproportionately from cancer. Mortality

rates remain the most important measure of the overall progress against cancer. Decreasing rates of death from cancer reflect improvements in both prevention and treatment. Among all ethnic groups in the United States, African

American males have the highest overall rate of mortality from cancer. Some

specific forms of cancer affect other ethnic minority communities at rates up to

several times higher than the national averages (such as stomach and liver cancers among Asian American populations, colon and rectal cancer among Alaska

natives, and cervical cancer among Hispanic and Vietnamese-American women).

(9) In Appalachian Kentucky, a region characterized by high rates of poverty,

the incidence of lung cancer among white males was 127 per 100,000 in 1992,

a rate higher than that for any ethnic minority groups in the United States during the same period.

(10) Major disparities exist among population groups, with a disproportionate

burden of death and disability from cardiovascular disease in minority and lowincome populations. Compared with rates for whites, coronary heart disease

mortality was 40 percent lower for Asian Americans but 40 percent higher for

African-Americans.

(11) While racial and ethnic groups account only for about 25 percent of the

U.S. population, they account for more than 50 percent of all AIDS cases. While

overall AIDS deaths are down dramatically, AIDS remains the leading killer of

African-Americans age 25–44. The death rate from HIV/AIDS for African Americans is more than seven times that of whites.

(12) The prevalence of diabetes in African-Americans is approximately 70 percent higher than whites and the prevalence in Hispanics is nearly double that

of whites.

(13) American Indians and Alaska Natives have an infant mortality rate almost double that of whites. The rate of diabetes for this population group is

more than twice that for whites. The Pima of Arizona have one of the highest

rates of diabetes in the world. American Indians living in North and South Dakota have an average life expectancy that is 11 years less than that for the rest

of the U.S. population. Overall, the life expectancy for American Indians and

Alaska Native is 71 years of age-nearly five years less than the U.S. Races populations.

(14) Asian and Pacific Islanders, on average, have indicators of being one of

the healthiest population groups in the United States. However, there is great

diversity within this population group, and health disparities for some specific

groups are quite marked. Vietnamese women suffer from cervical cancer at

nearly five times the rate of white women. New cases of hepatitis and tuberculosis are also higher in Asian and Pacific Islanders living in the United States

than in whites.

(15) Minority populations have a disproportionately higher infection rate of

hepatitis C virus than the general United States Population. The prevalence

rate of hepatitis C virus among African Americans is more than twice that of

the general population (3.5 to 5 percent and 1.8 percent, respectively).

(16) There is a national need for minority scientists in the fields of biomedical, clinical, behavioral, and health services research. Ninety percent of minority physicians produced by Historically Black Medical Colleges live and serve

in minority communities.

(17) The proportion of minorities in high academic ranks, such as professors

and associate professors, decreased from 1980 to 1990. Only 1 percent of full

professors were minority persons in 1990.

(18) Demographic trends inspire concern about the Nation’s ability to meet its

future scientific, technological and engineering workforce needs. Historically,

non-Hispanic white males have made up the majority of the United States scientific, technological, and engineering workers.

(19) The Hispanic and Black population will increase significantly in the next

50 years. The scientific, technological, and engineering workforce may decrease

if participation by underepresented minorities remains the same.

(20) Increasing rates of Black and Hispanic workers must occur in order to

ensure strong scientific, technological, and engineering workforce.

(21) Individuals such as underepresented minorities and women in the scientific, technological, and engineering workforce enable society to address its diverse needs.

(22) If there had not been a substantial increase in the number of science and

engineering degrees awarded to women and underepresented minorities over

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the past few decades, the United States would be facing even greater shortages

in scientific, technological, and engineering workers.

(23) In order to effectively promote a diverse and strong 21st Century scientific, technological, and engineering workforce: agencies should expand or add

programs that effectively overcome barriers such as educational transition from

one level to the next and student requirements for financial resources.

(24) Federal agencies should work in concert with the private sector to emphasize the recruitment and retention of qualified individuals from ethnic and

gender groups that are currently underrepresented in the scientific, technological, and engineering workforce.

(25) Cultural competency training in medical schools and residency training

programs has the potential to reduce disparities in health care and health outcomes.

(26) Culturally sensitive approaches to research are needed to encourage participation of minorities and the socioeconomically disadvantages in research

studies.

(27) African Americans with identical complaints of chest pain are less likely

than white Americans to be referred by physicians for sophisticated cardiac

tests.

(28) Behavioral and social sciences research has increased awareness and understanding of factors associated with health care utilization and access, patient

attitudes toward health services, and risk and protective behaviors that affect

health and illness. These factors have the potential to then be modified to help

close the health disparities gap among ethnic minority populations. In addition,

there is a shortage of minority behavioral science researchers and behavioral

health care professionals. According to the National Science Foundation, only

15.5 percent of behavioral research-oriented psychology doctorate degrees were

awarded to minority students in 1997. In addition, only 17.9 percent of practiceoriented psychology doctorate degrees were awarded to ethnic minorities.

TITLE I—IMPROVING MINORITY HEALTH

THROUGH NATIONAL INSTITUTES OF

HEALTH; ESTABLISHMENT OF NATIONAL

CENTER

SEC. 101. ESTABLISHMENT OF NATIONAL CENTER FOR RESEARCH ON MINORITY HEALTH

AND HEALTH DISPARITIES.

(a) IN GENERAL.—Part E of title IV of the Public Health Service Act (42 U.S.C.

287 et seq.) is amended by adding at the end the following subpart:

‘‘Subpart 6—National Center for Research on Minority Health and Health

Disparities

‘‘SEC. 485E. PURPOSE OF CENTER.

‘‘(a) IN GENERAL.—The general purpose of the National Center for Research on

Minority Health and Health Disparities (in this subpart referred to as the ‘Center’)

is the conduct and support of basic and clinical research, training, the dissemination

of health information, and other programs with respect to the health of racial and

ethnic minority groups and other health disparity populations.

‘‘(b) PRIORITIES.—The Director of the Center shall in expending amounts appropriated under this section give priority to conducting and supporting minority

health research.

‘‘(c) MINORITY HEALTH RESEARCH.—For purposes of this subpart:

‘‘(1) The term ‘minority health research’ means research on minority health

conditions (as defined in paragraph (2)), including research on preventing such

conditions; research on access, outreach, treatment, and the quality of health

care; and research on cultural and linguistic services for decreasing the extent

of health problems associated with such conditions.

‘‘(2) The term ‘minority health conditions’, with respect to individuals who are

members of racial and ethnic minority groups, means all diseases, disorders,

and conditions (including with respect to mental health and substance abuse)—

‘‘(A) unique to, more serious, or more prevalent in such individuals;

‘‘(B) for which the factors of medical risk or types of medical intervention

are different for such individuals, or for which it is unknown whether such

factors or types are different for such individuals; or

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‘‘(C) with respect to which there has been insufficient research involving

such individuals as subjects or insufficient data on such individuals.

‘‘(3) The term ‘racial and ethnic minority group’ has the meaning given such

term in section 1707.

‘‘(4) The term ‘minorities’ means individuals from a racial or ethnic minority

group.

‘‘(d) HEALTH DISPARITY POPULATIONS.—

‘‘(1) IN GENERAL.—For purposes of this subpart:

‘‘(A) A population is a health disparity population if, as determined by the

Director of the Center after consultation with the Director of the Agency

for Healthcare Research and Quality, there is a significant disparity in the

overall rate of disease incidence, morbidity, mortality, or survival rates in

the population as compared to the health status of the general population.

‘‘(B) The term ‘health disparity populations’ includes racial and ethnic minority groups.

‘‘(C) The term ‘health disparities research’ means research on health disparity populations (and individual members and communities of such populations) that relates to the health disparities involved, including basic and

applied biomedical and behavioral research on the nature of health disparities, the causes of such disparities, and remedies for such disparities. Such

term includes minority health research.

‘‘(2) PRIORITY.—With amounts available under this section for a fiscal year

after providing for minority health research in accordance with subsection (b),

the Secretary shall conduct and support health disparities research on other

health disparity populations, with priority given to such research on health disparity populations for which socioeconomic status is one of the principal causal

factors with respect to being a health disparity population.

‘‘(e) COORDINATION OF ACTIVITIES.—The Director of the Center shall act as the primary Federal official with responsibility for overseeing all minority health and other

health disparities research conducted or supported by the National Institutes of

Health, and—

‘‘(1) shall represent the health disparities research program of the National

Institutes of Health, including the minority health research program, at all relevant Executive branch task forces, committees and planning activities; and

‘‘(2) shall maintain communications with all relevant Public Health Service

agencies and with various other departments of the Federal Government, to ensure the timely transmission of information concerning advances in minority

health and other health disparities research between these various agencies for

dissemination to affected communities and health care providers.

‘‘(f) COLLABORATIVE COMPREHENSIVE PLAN AND BUDGET.—

‘‘(1) IN GENERAL.—Subject to the provisions of this section and other applicable law, the Director of NIH, the Director of the Center, and the directors of

the national research institutes in collaboration (and in consultation with the

advisory council for the Center) shall—

‘‘(A) establish a comprehensive plan and budget for the conduct and support of all minority health and other health disparities research activities

of the agencies of the National Institutes of Health (which plan and budget

shall be first established under this subsection not later than 12 months

after the date of the enactment of this subpart);

‘‘(B) ensure that the plan and budget demonstrate how health disparities

research activities address the health needs of specific health disparity populations, taking into account socioeconomic status; the areas in which the

population involved resides; attitudes toward health; the language spoken,

the extent of formal education; and such other factors as the Director of the

Center determines to be appropriate;

‘‘(C) ensure that the plan and budget establish priorities among the

health disparities research activities that such agencies are authorized to

carry out;

‘‘(D) ensure that the plan and budget establish objectives regarding such

activities, describes the means for achieving the objectives, and designates

the date by which the objectives are expected to be achieved;

‘‘(E) ensure that, with respect to amounts appropriated for activities of

the Center, the plan and budget give priority in the expenditure of funds

to conducting and supporting minority health research;

‘‘(F) ensure that all amounts appropriated for such activities are expended in accordance with the plan and budget;

‘‘(G) review the plan and budget not less than annually, and revise the

plan and budget as appropriate; and

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‘‘(H) ensure that the plan and budget serve as a broad, binding statement

of policies regarding minority health and other health disparities research

activities of the agencies, but do not remove the responsibility of the heads

of the agencies for the approval of specific programs or projects, or for other

details of the daily administration of such activities, in accordance with the

plan and budget.

‘‘(2) CERTAIN COMPONENTS OF PLAN AND BUDGET.—With respect to health disparities research activities of the agencies of the National Institutes of Health,

the Director of the Center shall ensure that the plan and budget under paragraph (1) provide for—

‘‘(A) basic research and applied research, including research and development with respect to products;

‘‘(B) research that is conducted by the agencies;

‘‘(C) research that is supported by the agencies;

‘‘(D) proposals developed pursuant to solicitations by the agencies and for

proposals developed independently of such solicitations; and

‘‘(E) behavioral research and social sciences research, which may include

cultural and linguistic research in each of the agencies.

‘‘(3) MINORITY HEALTH RESEARCH.—The plan and budget under paragraph (1)

shall include a separate statement of the plan and budget for minority health

research.

‘‘(g) CLINICAL RESEARCH EQUITY.—The Director of the Center shall assist in the

administration of section 492B with respect to the inclusion of members of minority

groups as subjects in clinical research.

‘‘(h) RESEARCH ENDOWMENTS.—The Director of the Center may carry out a program to facilitate minority health research by providing for research endowments

at centers of excellence under section 736.

‘‘(i) CERTAIN ACTIVITIES.—In carrying out subsection (a), the Director of the

Center—

‘‘(1) shall assist the Director of the National Center for Research Resources

in carrying out section 481(c)(3) and in committing resources for construction

at Institutions of Emerging Excellence;

‘‘(2) shall establish projects to promote cooperation among Federal agencies,

State, local, and regional public health agencies, and private entities in health

disparities research;

‘‘(3) may conduct or support research on the use of service delivery models

(such as health centers under section 330) to reduce health disparities; and

‘‘(4) may utilize information from previous health initiatives concerning minorities and other health disparity populations.

‘‘(j) ADVISORY COUNCIL.—

‘‘(1) IN GENERAL.—The Secretary shall, in accordance with section 406, establish an advisory council to advise, assist, consult with, and make recommendations to the Director of the Center on matters relating to the activities described

in subsection (a), and with respect to such activities to carry out any other functions described in section 406 for advisory councils under such section. Functions under the preceding sentence shall include making recommendations on

budgetary allocations made in the plan under subsection (f), and shall include

reviewing reports under subjection (k) before the reports are submitted under

such subsection.

‘‘(2) MEMBERSHIP.—With respect to the membership of the advisory council

under paragraph (1), a majority of the members shall be representatives of the

various racial and ethnic minority groups; representatives of other health disparity populations shall be included; and a diversity of health professionals

shall be represented. The membership shall in addition include a representative

of the Office of Behavioral and Social Sciences Research under section 404A.

‘‘(k) ANNUAL REPORT.—The Director of the Center shall prepare an annual report

on the activities carried out or to be carried out by the Center, and shall submit

each such report to the Congress, the Secretary, and the Director of NIH. With respect to the fiscal year involved, the report shall—

‘‘(1) describe and evaluate the progress made in health disparities research

conducted or supported by the national research institutes;

‘‘(2) summarize and analyze expenditures made for activities with respect to

health disparities research conducted or supported by the National Institutes of

Health;

‘‘(3) include a separate statement applying the requirements of paragraphs (1)

and (2) specifically to minority health research; and

‘‘(4) contain such recommendations as the Director considers appropriate.

‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this

subpart, there are authorized to be appropriated $100,000,000 for fiscal year 2001,

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and such sums as may be necessary for each of the fiscal years 2002 through 2005.

Such authorization of appropriations is in addition to other authorizations of appropriations that are available for the conduct and support of minority health or other

health disparities research by the national research institutes and other agencies

of the National Institutes of Health.’’.

(b) CONFORMING AMENDMENT.—Part A of title IV of the Public Health Service Act

(42 U.S.C. 281 et seq.) is amended—

(1) in section 401(b)(2)—

(A) in subparagraph (F), by moving the subparagraph two ems to the left;

and

(B) by adding at the end the following subparagraph:

‘‘(G) The National Center for Research on Minority Health and Health Disparities.’’; and

(2) by striking section 404.

SEC. 102. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.

Subpart 6 of part E of title IV of the Public Health Service Act, as added by section 101 of this Act, is amended by adding at the end the following section:

‘‘SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.

‘‘(a) IN GENERAL.—The Director of the Center shall make awards of grants or contracts to designated biomedical and behavioral research institutions under paragraph (1) of subsection (c), or to consortia under paragraph (2) of such subsection,

for the purpose of assisting the institutions in supporting programs of excellence in

biomedical and behavioral research education for individuals who are members of

health disparity populations, including minorities.

‘‘(b) REQUIRED USE OF FUNDS.—An award may be made under subsection (a) only

if the applicant involved agrees that the grant will be expended—

‘‘(1) to conduct minority health research, including research on the use of

service delivery models (such as health centers under section 330) with respect

to minority health conditions;

‘‘(2) to train minorities and other members of health disparities populations

as professionals in the area of biomedical or behavioral research or both; or

‘‘(3) to expand, remodel, renovate, or alter existing research facilities or construct new research facilities for the purpose of conducting minority health research.

‘‘(c) CENTERS OF EXCELLENCE.— ‘‘(1) IN GENERAL.—For purposes of this section, a designated biomedical and

behavioral research institution is a biomedical and behavioral research institution that—

‘‘(A) has a significant number of health disparity students, including minorities, enrolled in the institution (including individuals accepted for enrollment in the institution);

‘‘(B) has been effective in assisting such students of the institution to

complete the program of education and receive the degree involved;

‘‘(C) has been effective in recruiting members of health disparity populations, including minorities, to enroll in and graduate from the institution,

including providing scholarships and other financial assistance to such individuals and encouraging health disparity students from all levels of the

educational pipeline to pursue biomedical research careers; and

‘‘(D) has made significant recruitment efforts to increase the number of

members of health disparities populations, including minorities, serving in

faculty or administrative positions at the institution.

‘‘(2) CONSORTIUM.—Any designated biomedical and behavioral research institution involved may, with other biomedical and behavioral institutions (designated or otherwise), form a consortium to receive an award under subsection

(a).

‘‘(3) APPLICATION OF CRITERIA TO OTHER PROGRAMS.—In the case of any criteria established by the Director of the Center for purposes of determining

whether institutions meet the conditions described in paragraph (1), this section

may not, with respect to minorities, be construed to authorize, require, or prohibit the use of such criteria in any program other than the program established in this section.

‘‘(d) DURATION OF GRANT.—The period during which payments are made under a

grant under subsection (a) may not exceed 5 years. Such payments shall be subject

to annual approval by the Director of the Center and to the availability of appropriations for the fiscal year involved to make the payments.

‘‘(e) MAINTENANCE OF EFFORT.—

‘‘(1) IN GENERAL.—With respect to activities for which an award under subsection (a) is authorized to be expended, the Director of the Center may not

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make such an award to a designated research institution or consortium for any

fiscal year unless the institution, or institutions in the consortium, as the case

may be, agree to maintain expenditures of non-Federal amounts for such activities at a level that is not less than the level of such expenditures maintained

by the institutions involved for the fiscal year preceding the fiscal year for

which such institutions receive such an award.

‘‘(2) USE OF FEDERAL FUNDS.—With respect to any Federal amounts received

by a designated research institution or consortium and available for carrying

out activities for which an award under subsection (a) is authorized to be expended, the Director of the Center may make such an award only if the institutions involved agree that the institutions will, before expending the award, expend the Federal amounts obtained from sources other than the award.

‘‘(f) CERTAIN EXPENDITURES.—The Director of the Center may authorize a designated biomedical and behavioral research institution to expend a portion of an

award under subsection (a) for research endowments.

‘‘(g) DEFINITIONS.—For purposes of this section:

‘‘(1) The term ‘designated biomedical and behavioral research institution’ has

the meaning indicated for such term in subsection (c)(1). Such term includes

any health professions school receiving an award of a grant or contract under

section 736.

‘‘(2) The term ‘program of excellence’ means any program carried out by a designated biomedical and behavioral research institution with an award under

subsection (a), if the program is for purposes for which the institution involved

is authorized in subsection (b) to expend the grant.

‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of making grants

under subsection (a), there are authorized to be appropriated such sums as may be

necessary for each of the fiscal years 2001 through 2005.’’.

SEC. 103. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH RESEARCH.

Subpart 6 of part E of title IV of the Public Health Service Act, as amended by

section 102 of this Act, is amended by adding at the end the following section:

‘‘SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH RESEARCH.

‘‘(a) IN GENERAL.—The Director of the Center shall establish a program of entering into contracts with qualified health professionals under which such health professionals agree to engage in minority health research in consideration of the Federal Government agreeing to repay, for each year of engaging in such research, not

more than $35,000 of the principal and interest of the educational loans of such

health professionals.

‘‘(b) SERVICE PROVISIONS.—The provisions of sections 338B, 338C, and 338E shall,

except as inconsistent with subsection (a), apply to the program established in such

subsection to the same extent and in the same manner as such provisions apply to

the National Health Service Corps Loan Repayment Program established in subpart

III of part D of title III.

‘‘(c) REQUIREMENT REGARDING HEALTH DISPARITY POPULATIONS.—The Director of

the Center shall ensure that not fewer than 50 percent of the contracts entered into

under subsection (a) are for appropriately qualified health professionals who are

members of a health disparity population.

‘‘(d) PRIORITY.—With respect to minority health research under subsection (a), the

Secretary shall ensure that priority is given to conducting projects of biomedical research.

‘‘(e) FUNDING.—

‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this

section, there are authorized to be appropriated such sums as may be necessary

for each of the fiscal years 2001 through 2005.

‘‘(2) AVAILABILITY OF APPROPRIATIONS.—Amounts available for carrying out

this section shall remain available until the expiration of the second fiscal year

beginning after the fiscal year for which the amounts were made available.’’.

SEC. 104. GENERAL PROVISIONS REGARDING THE CENTER.

Subpart 6 of part E of title IV of the Public Health Service Act, as amended by

section 103 of this Act, is amended by adding at the end the following section:

‘‘SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.

‘‘(a) ADMINISTRATIVE SUPPORT FOR CENTER.—The Secretary, acting through the

Director of the National Institutes of Health, shall provide administrative support

and support services to the Director of the Center and shall ensure that such support takes maximum advantage of existing administrative structures at the agencies

of the National Institutes of Health.

‘‘(b) EVALUATION AND REPORT.—

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‘‘(1) EVALUATION.—Not later than 5 years after the date of the enactment of

this part, the Secretary shall conduct an evaluation to—

‘‘(A) determine the effect of this section on the planning and coordination

of the health disparities research programs at the institutes, centers and

divisions of the National Institutes of Health;

‘‘(B) evaluate the extent to which this part has eliminated the duplication

of administrative resources among such Institutes, centers and divisions;

and

‘‘(C) provide recommendations concerning future legislative and administrative modifications with respect to this part, for both minority health research and research on other health disparity populations.

‘‘(2) MINORITY HEALTH RESEARCH.—The evaluation under paragraph (1) shall

include a separate statement that applies subparagraphs (A) and (B) of such

paragraph to minority health research.

‘‘(3) REPORT.—Not later than 1 year after the date on which the evaluation

is commenced under paragraph (1), the Secretary shall prepare and submit to

the Committee on Health, Education, Labor, and Pensions of the Senate, and

the Committee on Commerce of the House of Representatives, a report concerning the results of such evaluation.’’.

SEC. 105. REPORT REGARDING RESOURCES OF NATIONAL INSTITUTES OF HEALTH DEDICATED TO RESEARCH ON MINORITY HEALTH.

Not later than December 1, 2003, the Director of the National Center for Research

on Minority Health and Health Disparities (established by the amendment made by

section 101(a)), after consultation with the advisory council for such Center, shall

submit to the Congress, the Secretary of Health and Human Services, and the Director of the National Institutes of Health a report that provides the following:

(1) Recommendations for the methodology that should be used to determine

the extent of the resources of the National Institutes of Health that are dedicated to research on minority health, including determining the amount of

funds that are used to conduct and support such research. With respect to such

methodology, the report shall address the discrepancies between the methodology used by such Institutes as of the date of the enactment of this Act and

the methodology used by the Institute of Medicine as of such date.

(2) A determination of whether and to what extent, relative to fiscal year

1999, there has been an increase in the level of resources of the National Institutes of Health that are dedicated to research on minority health, including the

amount of funds used to conduct and support such research. The report shall

include provisions describing whether and to what extent there have been increases in the number and amount of awards to minority serving institutions.

TITLE II—HEALTH DISPARITIES RESEARCH BY

AGENCY FOR HEALTHCARE RESEARCH AND

QUALITY

SEC. 201. HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH AND

QUALITY.

(a) GENERAL.—Part A of title IX of the Public Health Service Act (42 U.S.C. 299

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

‘‘SEC. 903. RESEARCH ON HEALTH DISPARITIES.

‘‘(a) IN GENERAL.—The Director shall—

‘‘(1) conduct and support research to identify how to improve the quality and

outcomes of health care services for health disparity populations and the causes

of the health disparities involved, including identifying barriers to health care

access and environmental factors leading to health problems;

‘‘(2) conduct and support research and support demonstration projects to identify, test, and evaluate strategies for eliminating health disparities and promoting effective interventions;

‘‘(3) develop measures for the assessment and improvement of the quality and

appropriateness of health care services provided to health disparity populations;

and

‘‘(4) in carrying out 902(c), provide support to increase the number of researchers who are members of health disparity populations, and the health

services research capacity of institutions that train such researchers.

‘‘(b) RESEARCH AND DEMONSTRATION PROJECTS.—

‘‘(1) IN GENERAL.—In carrying out subsection (a), the Director shall conduct

and support research to—

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‘‘(A) identify the clinical, cultural, socioeconomic, and organizational factors that contribute to health disparities, including for minority populations, which factors include examination of patterns of clinical decisionmaking and of the availability of support services;

‘‘(B) identify and evaluate clinical and organizational strategies to improve the quality, outcomes, and access to care for health disparity populations, including minority populations;

‘‘(C) support demonstrations to test such strategies; and

‘‘(D) widely disseminate strategies for which there is scientific evidence

of effectiveness.

‘‘(2) USE OF CERTAIN STRATEGIES.—In carrying out this section, the Director

shall implement research strategies and mechanisms that will enhance the involvement of individuals who are members of health disparity populations (including minority populations), health services researchers who are such individuals, institutions that train such individuals as researchers, members of health

disparity populations (including minority populations) for whom the Agency is

attempting to improve the quality and outcomes of care, and representatives of

appropriate community-based organizations with respect to health disparity

populations. Such research strategies and mechanisms may include the use of—

‘‘(A) centers of excellence that can demonstrate, either individually or

through consortia, a combination of multi-disciplinary expertise in outcomes

or quality improvement research and a demonstrated capacity to engage

members and communities of health disparity populations, including minority populations, in the planning, conduct and translation of research, with

linkages to relevant sites of care;

‘‘(B) provider-based research networks, including health plans, facilities,

or delivery system sites of care (especially primary care), that make extensive use of health care providers who are members of health disparity populations or who serve patients in such populations and have the capacity to

evaluate and promote quality improvement;

‘‘(C) service delivery models (such as health centers under section 330) to

reduce health disparities; and

‘‘(D) other innovative mechanisms or strategies that will facilitate the

translation of past research investments into clinical practices that can reasonably be expected to benefit these populations.

‘‘(c) QUALITY MEASUREMENT DEVELOPMENT.—

‘‘(1) IN GENERAL.—To ensure that health disparity populations, including minority populations, benefit from the progress made in the ability of individuals

to measure the quality of health care delivery, the Director shall support the

development of quality of health care measures that assess the experience of

such populations with health care systems, such as measures that assess the

access of such populations to health care, the cultural competence of the care

provided, the quality of the care provided, the outcomes of care, or other aspects

of health care practice that the Director determines to be important. In carrying

out the preceding sentence, the Director shall in consultation with the Administrator of the Health Resources and Services Administration examine the practices of providers (such as health centers under section 330) that have a record

of reducing health disparities or have experience in providing culturally competent health services to minority or other health disparity populations.

‘‘(2) REPORT.—Not later than 24 months after the date of the enactment of

this section, the Secretary, acting through the Director, shall prepare and submit to the appropriate committees of Congress a report describing the state-ofthe-art of quality measurement for minority and other health disparity populations that will identify critical unmet needs, the current activities of the Department to address those needs, and a description of related activities in the

private sector.

‘‘(d) DEFINITION.—For purposes of this section:

‘‘(1) The term ‘health disparity population’ has the meaning given such term

in section 485E.

‘‘(2) The term ‘minority’, with respect to populations, refers to racial and ethnic minority groups as defined in section 1707.’’.

(b) FUNDING.—Section 927 of the Public Health Service Act (42 U.S.C. 299c–6) is

amended by adding at the end the following:

‘‘(d) HEALTH DISPARITIES RESEARCH.—For the purpose of carrying out the activities under section 903, there are authorized to be appropriated such sums as may

be necessary for each of the fiscal years 2001 through 2005.’’.

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TITLE III—DATA COLLECTION RELATING TO

RACE OR ETHNICITY

SEC. 301. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.

(a) STUDY.—The National Academy of Sciences shall conduct a comprehensive

study of the Department of Health and Human Services’ data collection systems and

practices, and any data collection or reporting systems required under any of the

programs or activities of the Department, relating to the collection of data on race

or ethnicity, including other Federal data collection systems (such as the Social Security Administration) with which the Department interacts to collect relevant data

on race and ethnicity.

(b) REPORT.—Not later than 1 year after the date of enactment of this Act, the

National Academy of Sciences shall prepare and submit to the Committee on

Health, Education, Labor, and Pensions of the Senate and the Committee on Commerce of the House of Representatives, a report that—

(1) identifies the data needed to support efforts to evaluate the effects of race

and ethnicity on access to health care and other services and on disparity in

health and other social outcomes and the data needed to enforce existing protections for equal access to health care;

(2) examines the effectiveness of the systems and practices of the Department

of Health and Human Services described in subsection (a), including pilot and

demonstration projects of the Department, and the effectiveness of selected systems and practices of other Federal and State agencies and the private sector,

in collecting and analyzing such data;

(3) contains recommendations for ensuring that the Department of Health

and Human Services, in administering its entire array of programs and activities, collects, or causes to be collected, reliable and complete information relating to race and ethnicity; and

(4) includes projections about the costs associated with the implementation of

the recommendations described in paragraph (3), and the possible effects of the

costs on program operations.

(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for

fiscal year 2001.

TITLE IV—MEDICAL EDUCATION AND OTHER

HEALTH PROFESSIONS EDUCATION

SEC. 401. GRANTS FOR HEALTH CARE EDUCATION CURRICULUM DEVELOPMENT.

Part F of title VII of the Public Health Service Act (42 U.S.C. 295j et seq.) is

amended by inserting after section 791 the following:

‘‘SEC. 791A. GRANTS FOR HEALTH PROFESSIONAL EDUCATION CURRICULUM DEVELOPMENT.

‘‘(a) GRANTS FOR GRADUATE EDUCATION CURRICULUM DEVELOPMENT.—

‘‘(1) IN GENERAL.—The Secretary, acting through the Administrator of the

Health Resources and Services Administration and in collaboration with the Director of the Agency for Healthcare Research and Quality and the Deputy Assistant Secretary for Minority Health, may make awards of grants, contracts,

or cooperative agreements to public and nonprofit private entities for the purpose of carrying out research projects and demonstration projects to develop

curricula to reduce disparities in health care outcomes, including curricula for

cultural competency in graduate health professions education.

‘‘(2) ELIGIBILITY.—To be eligible to receive an award under paragraph (1), an

entity shall—

‘‘(A) be a school of medicine, school of osteopathic medicine, school or dentistry, school of public health, school of nursing, graduate program in behavioral health and mental health practice, or other recognized health profession school; and

‘‘(B) prepare and submit to the Secretary an application at such time, in

such manner, and containing such information as the Secretary may require.

‘‘(3) USE OF FUNDS.—An entity shall use amounts received under an award

under paragraph (1) to carry out research projects and demonstration projects

to develop curricula to reduce disparity in health care outcomes, including curricula for cultural competency in graduate health professions education.

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‘‘(4) NUMBER OF GRANTS AND GRANT TERM.—The Secretary shall award grants,

contracts or cooperative agreements (or combination thereof) under paragraph

(1) in each of the first and second fiscal years for which funds are available

under subsection (f). The term of each such grant, contract or cooperative agreement shall be 3 years.

‘‘(b) GRANTS FOR CONTINUING HEALTH PROFESSIONAL EDUCATION CURRICULUM

DEVELOPMENT.—

‘‘(1) IN GENERAL.—The Secretary, acting through the Health Resources and

Services Administration and the Agency for Healthcare Research Quality and

in collaboration with the Office of Minority Health, shall award grants to eligible entities for the establishment of demonstration and pilot projects to develop

curricula to reduce disparity in health care and health outcomes, including curricula for cultural competency, in continuing health professions education.

‘‘(2) ELIGIBILITY.—To be eligible to receive a grant under paragraph (1) an entity shall—

‘‘(A) be a school of medicine, osteopathic medicine, public health, dentistry, optometry, pharmacy, allied health, chiropractic, podiatric medicine,

nursing, and public health and health administration, public or nonprofit

private school that offers a graduate program in clinical social work or

other graduate programs in behavioral health and mental health practice,

program for the training of physician assistants, health professional association, or other public or nonprofit health educational entity, or any consortium of entities described in this subparagraph; and

‘‘(B) prepare and submit to the Secretary an application at such time, in

such manner, and containing such information as the Secretary may require.

‘‘(3) USE OF FUNDS.—An entity shall use amounts received under a grant

under paragraph (1) to develop and evaluate the effect of curricula for continuing health professions education courses or programs to provide education

concerning issues relating to disparity in health care and health outcomes, including cultural competency of health professionals. Such curricula shall focus

on the need to remove bias from health care at a personal level as well as at

a systemic level.

‘‘(4) NUMBER OF GRANTS AND GRANT TERM.—The Secretary shall award grants

under paragraph (1) in each of the first and second fiscal years for which funds

are available under subsection (f). The term of each such grant shall be 3 years.

‘‘(c) DISTRIBUTION OF PROJECTS.—The Secretary shall ensure that, to the extent

practicable, projects under subsections (a) and (b) are carried out in each of the

principal geographic regions of the United States and involve different health disparity populations (as defined in section 485E) and health professions.

‘‘(d) MONITORING.—An entity that receives a grant, contract or cooperative agreement under subsection (a) or (b) shall ensure that procedures are in place to monitor

activities undertaken using grant, contract or cooperative agreement funds. Such

entity shall annually prepare and submit to the Secretary a report concerning the

effectiveness of curricula developed under the grant contract or cooperative agreement.

‘‘(e) REPORT TO CONGRESS.—Not later than January 1, 2002, the Secretary shall

prepare and submit to the appropriate committees of Congress, a report concerning

the effectiveness of programs funded under this section and a plan to encourage the

implementation and utilization of curricula to reduce disparities in health care and

health outcomes. A final report shall be submitted by the Secretary not later than

January 1, 2004.

‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated

to carry out this section, $3,500,000 for fiscal year 2001, $7,000,000 for fiscal year

2002, $7,000,000 for fiscal year 2003, and $3,500,000 for fiscal year 2004.’’.

SEC. 402. NATIONAL CONFERENCE ON CONTINUING HEALTH PROFESSIONAL EDUCATION AND

DISPARITIES IN HEALTH OUTCOMES.

(a) IN GENERAL.—Not later than 1 year after the date of enactment of this Act,

the Secretary of Health and Human Services shall convene a national conference

on continuing medical education as a method for reducing disparities in health care

and health outcomes, including continuing medical education on cultural competency. The conference shall include sessions to address measurements of outcomes

to assess the effectiveness of curricula in reducing disparities.

(b) PARTICIPANTS.—The Secretary of Health and Human Services shall invite minority and other health disparity populations advocacy groups, health education entities described in section 791A(b)(2)(A) of the Public Health Service Act (as added

by section 401), health centers under section 330 of such Act, and other interested

parties to attend the conference under subsection (a).

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(c) ISSUES.—The national conference convened under subsection (a) shall address

issues relating to the role of continuing medical education in the effort to reduce

disparities in health care and health outcomes, including the role of continuing medical education in improving the cultural competency of health professionals. The

conference shall focus on methods to achieve reductions in the disparities in health

care and health outcomes through continuing medical education courses or programs and on strategies for measuring the effectiveness of curricula to reduce disparities.

(d) PUBLICATION OF FINDINGS.—Not later than 6 months after the convening of

the national conference under subsection (a), the Secretary of Health and Human

Services shall publish in the Federal Register a summary of the proceedings and

the findings of the conference.

(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated

such sums as may be necessary to carry out this section.

SEC. 403. CONTINUING MEDICAL EDUCATION INCENTIVE PROGRAM.

(a) IN GENERAL.—The Secretary of Health and Human Services shall develop and

implement a program to provide incentives to health maintenance organizations,

community health centers, rural health centers, and other entities providing services under title XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq. or

1396 et seq.) to encourage health care professionals employed by, or under contract

with, such entities to participate in continuing medical education programs designed

to reduce health disparities.

(b) EFFECTIVE PROGRAMS.—In developing the program under subsection (a), the

Secretary of Health and Human Services shall ensure that incentives are targeted

at programs that address each of the following issues:

(1) Implementing new curricula or strategies for continuing medical education

programs designed to reduce health disparities, or continuing medical education

curricula or strategies that have been proven effective in reducing such disparities.

(2) Encouraging health professionals to participate in such curricula.

(3) Monitoring health care and health outcomes as a way to evaluate the effectiveness of continuing medical education programs in reducing health disparities.

(c) DEFINITION.—For purposes of this section, the term ‘‘health disparities’’ has the

meaning given such term in section 485E of the Public Health Service Act.

(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated

such sums as may be necessary to carry out this section.

SEC. 404. ADVISORY COMMITTEE.

(a) ESTABLISHMENT.—The Secretary of Health and Human Services shall establish

an advisory committee to provide advice to the Secretary on matters related to the

development, implementation, and evaluation of graduate and continuing education

curricula for health care professionals to decrease disparities in health care and

health outcomes, including curricula on cultural competency as a method of eliminating health disparities.

(b) MEMBERSHIP.—Not later than 3 months after the date on which amounts are

appropriated to carry out this section, the Secretary of Health and Human Services

shall appoint the members of the advisory committee. Such members shall be appointed from among individuals who—

(1) are not officers or employees of the Federal Government;

(2) are experienced in issues relating to health disparities;

(3) are minorities or representatives of racial and ethnic minority groups or

other health disparity populations; and

(4) meet such other requirements as the Secretary determines appropriate;

Such committee shall include individuals who are experienced in providing health

services to racial and ethnic minority groups or other health disparity populations,

including representatives of health centers under section 330 of the Public Health

Service Act. The committee shall in addition include a representative of the Office

of Minority Health under section 1707 of such Act, a representative of the Health

Resources and Services Administration, and such other representatives of offices

and agencies of the Public Health Service as the Secretary determines to be appropriate. Such representatives shall include one or more individuals who serve on the

advisory committee under section 1707(c) of such Act.

(c) COLLABORATION.—The advisory committee shall carry out its duties under this

section in collaboration with the Office of Minority Health of the Department of

Health and Human Services, and other offices, centers, and institutes of the Department of Health and Human Services, and other Federal agencies.

(d) TERMINATION.—The advisory committee shall terminate on the date that is 4

years after the date on which the first member of the committee is appointed.

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(e) EXISTING COMMITTEE.—The Secretary may designate an existing advisory committee operating under the authority of the Office of Minority Health of the Department of Health and Human Services to serve as the advisory committee under this

section.

SEC. 405. CULTURAL COMPETENCY CLEARINGHOUSE.

(a) ESTABLISHMENT.—The Director of the Office of Minority Health of the Department of Health and Human Services shall establish within the Resource Center of

the Office of Minority Health, or through the awarding of a grant provide for the

establishment of, an information clearinghouse for curricula to reduce disparities in

health care and health outcomes. The clearinghouse shall facilitate and enhance,

through the effective dissemination of information, knowledge and understanding of

practices that lead to reductions in health disparities (as defined in section 485E

of the Public Health Service Act), including curricula for continuing medical education to develop cultural competency in health care professionals.

(b) AVAILABILITY OF INFORMATION.—Information contained in the clearinghouse

shall be made available to minority health advocacy groups and other organizations

representing health disparity populations, health education entities described in section 791A(b)(2)(A) of the Public Health Service Act (as added by section 401), health

maintenance organizations, and other interested parties.

(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated

such sums as may be necessary to carry out this section.

TITLE V—MISCELLANEOUS PROVISIONS

SEC. 501. OFFICE FOR CIVIL RIGHTS.

(a) PUBLIC AWARENESS CAMPAIGN.—

(1) IN GENERAL.—The Secretary of Health and Human Services shall conduct

a national media campaign for the purpose of informing the public of the programs and activities of the Office for Civil Rights, Department of Health and

Human Services. The campaign shall—

(A) have a specific focus on racial and ethnic minority communities, as

well as the general public; and

(B) involve racial and ethnic minority media as participants in the design

and conduct of the campaign.

(2) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out

paragraph (1), there are authorized to be appropriated such sums as may be

necessary for fiscal year 2001.

(b) OMBUDSMAN DEMONSTRATION PROGRAM.—

(1) IN GENERAL.—The Secretary of Health and Human Services (in this subsection referred to as the ‘‘Secretary’’) shall carry out a demonstration program

under which the Secretary makes grants to States for the purpose of establishing and operating State offices to identify, investigate, and facilitate the resolution of complaints relating to civil rights, and to carry out functions authorized pursuant to paragraph (3) (which office is referred to in this subsection as

the ‘‘State Ombudsman Office’’).

(2) OMBUDSMAN.—The Secretary shall require that each State Ombudsman

Office under paragraph (1) be headed by an individual with expertise and experience in the field of civil rights and advocacy.

(3) CERTAIN REQUIREMENTS AND AUTHORITIES.—In carrying out paragraph (1),

the Secretary shall consider the requirements and authorities that apply to the

operation of State offices under chapter 2 of subtitle A of title VII of the Older

Americans Act of 1965 (relating to State Long-Term Care Ombudsman Programs). In providing for State Ombudsman Offices under paragraph (1), the

Secretary may establish requirements and authorities with respect to civil

rights that are the same as or similar to the requirements and authorities that

apply under such chapter 2 with respect to residents of long-term care facilities.

(c) FUNDING.—There are authorized to be appropriated for the Office for Civil

Rights, Department of Health and Human Services, $36,000,000 for fiscal year 2001

and each subsequent fiscal year.

SEC. 502. DEVELOPMENT OF OUTCOME MEASURES; STUDY TO MEASURE PATIENT OUTCOMES

UNDER THE MEDICARE AND MEDICAID PROGRAMS BY RACE AND ETHNICITY.

(a) DEVELOPMENT OF OUTCOME MEASURES.—Not later than 1 year after the date

of the enactment of this Act, the Secretary of Health and Human Services, acting

through the Administrator of the Health Care Financing Administration, shall develop outcome measures to evaluate, by race and ethnicity, and on an age-specific

and sex-specific basis, the performance of health care programs and projects that

15

provide health care to individuals under the medicare and medicaid programs

(under titles XVIII and XIX, respectively, of the Social Security Act (42 U.S.C. 1395

et seq. and 1396 et seq.).

(b) STUDY.—After the Secretary develops the outcome measures under subsection

(a), the Secretary shall conduct a study that evaluates, by race and ethnicity, and

on an age-specific and sex-specific basis, the performance of health care programs

and projects referred to in subsection (a) in relation to such outcome measures.

(c) REPORT TO CONGRESS.—Not later that 2 years after the date of the enactment

of this Act, the Secretary of Health and Human Services shall submit to Congress

a report describing the outcome measures developed under subsection (a), and the

results of the study conducted pursuant to subsection (b).

SEC. 503. DEPARTMENTAL DEFINITION REGARDING MINORITY INDIVIDUALS.

Section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6) is

amended—

(1) by striking ‘‘Asian Americans and’’ and inserting ‘‘Asian Americans;’’; and

(2) by inserting ‘‘Native Hawaiians and other’’ before ‘‘Pacific Islanders;’’.

SEC. 504. CONFORMING PROVISION REGARDING DEFINITIONS.

For purposes of this Act, the term ‘‘racial and ethnic minority group’’ has the

meaning given such term in section 1707 of the Public Health Service Act.

TITLE VI—EFFECTIVE DATE

SEC. 601. EFFECTIVE DATE.

This Act and the amendments made by this Act take effect October 1, 2000, or

upon the date of the enactment of this Act, whichever occurs later.

PURPOSE AND SUMMARY

The purpose of this legislation is to address disparities that exist

in biomedical and behavioral research, health education, and the

study and collection of date regarding health disparity populations.

Health disparity populations are defined as populations for which

there is a significant disparity in the overall rate of disease, morbidity, mortality or survival rates as compared to the health status

of the general population.

Among the activities authorized by the legislation is the establishment of a National Center for Research on Minority Health and

Health Disparities at the National Institute of Health (NIH) to

help coordinate research related to health disparities and develop

a comprehensive research agenda that seeks to address differences

in morbidity and mortality in minority and underserved populations. Further, the bill will authorize the Agency for Healthcare

Research and Quality (AHRQ) to conduct and support research related to quality and outcomes in health care for health disparity

populations. It will also require the National Academy of Sciences

to study and report to Congress on the Department of Health and

Human Services (HHS) data collection systems and practices relating to collection of data on race and ethnicity and create new

grants for health education curricula development on health disparities. The legislation also requires the Secretary to conduct a

national media campaign to inform the public of programs and activities of the Office of Civil Rights in the Department of HHS. Finally, the legislation requires the Secretary to develop outcomes

measures for the Medicare and Medicaid programs to address the

needs of health disparity populations.

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BACKGROUND AND NEED FOR LEGISLATION

Studies indicate that, despite overall improvement in the Nation’s health over the past two decades, disparities exist in incidence of disease, disability, and death due to health status for African Americans, Hispanics, American Indians, Alaskan Natives and

Asian Pacific Islanders, and other underserved Americans compared to the U.S. population as a whole.

For example, the infant mortality rate for African Americans is

almost twice that of white Americans. Deaths due to heart disease

are more than 40 percent higher for blacks than for whites. The

death rate for all cancers is almost 30 percent higher for blacks as

it is for whites. The death rate due to HIV/AIDs is more than seven

times greater for African Americans as it is for white Americans.

Hispanics are almost twice as likely to die from complications related to diabetes than whites. American Indians and Alaskan Natives have an infant mortality rate almost twice that of whites. Vietnamese women suffer from cervical cancer at nearly 5 times the

rate of white women.

H.R. 3250 will address the need for research, education, and data

collection regarding these and other health disparities. Important

changes were made to H.R. 3250 to address concerns raised by

some Committee Members. Chief among these concerns related to

the legislation’s sole focus on racial and ethnic minorities as opposed to medically underserved populations. The definition of

‘‘health disparity population’’ was added to ensure that all Americans who suffer disproportionate levels of disease incidence, morbidity, and mortality would be included in research, education, and

data collection programs under H.R. 3250.

Another significant change was made to the bill by removing the

provision that allowed for the new Center for Research on Minority

Health and Health Disparities to receive direct funding from the

appropriation for the Department of Health and Human Services.

This so-called ‘‘bypass budget’’ would have allowed funding for the

Center to bypass the Secretary of HHS and the Director of NIH,

removing any discretion they would have over budget issues for the

Center. The Committee amendment removed the bypass budget authority for the Center.

HEARINGS

The Subcommittee on Health and Environment held a hearing on

H.R. 3250, the Health Care Fairness Act of 1999 on May 11, 2000.

The Subcommittee received testimony from: The Honorable Jesse

Jackson, Jr., M.C., the Honorable J. C. Watts, M.C., the Honorable

John Lewis, M.C., the Honorable J. D. Hayworth, M.C., the Honorable Robert Underwood, M.C., and the Honorable Ciro Rodriguez,

M.C.

The Subcommittee also received testimony from: The Honorable

David Satcher, M.D., Surgeon General, accompanied by Kermit

Smith, M.D., Chief Medical Officer of the Indian Health Service

and John Ruffin, PhD., Associate Director, Office of Research on

Minority Health, National Institutes of Health; Louis Sullivan,

M.D., President, Morehouse School of Medicine; Gilbert Friedell,

M.D., Director for Cancer Control, Markey Cancer Center, University of Kentucky on behalf of the Institute of Medicine; Jordan

17

Cohen, M.D., President, Association of American Medical Colleges;

Kevin Schulman, M.D., Associate Professor of Medicine and Director, Center for Clinical and Genetic Economics, Duke University

Medical Center; E. Anne Peterson, MD, MPH, Health Commissioner, Commonwealth of Virginia; John Harley, M.D., Member of

Arthritis Immunology, Oklahoma Medical Research Foundation;

Elena Rios, M.D., President, National Hispanic Medical Association; and Mr. Ignatius Bau, Director of Health Policy, Asian Pacific-Islander American Health Forum.

COMMITTEE CONSIDERATION

On July 26, 2000, the Subcommittee on Health and Environment

was discharged from the further consideration of H.R. 3250. On

July 26, 2000, the Committee on Commerce met in open markup

session and ordered H.R. 3250 reported, with an amendment, by a

voice vote.

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion

to report legislation and amendments thereto. There were no

record votes taken in connection with ordering H.R. 3250 reported.

A motion by Mr. Bliley to order H.R. 3250 reported to the House,

with an amendment, was agreed to by a voice vote.

The following amendments were agreed to by a voice vote—

An amendment in the nature of a substitute by Mr.

Bilbray, No. 1, addressing disparities in health care research, education and data collection for health disparity

populations.

An amendment to the amendment in the nature of a

substitute by Ms. DeGette, No. 1a, including age-based

and sex-based criteria in developing health care outcomes

measures for health disparity populations in the Medicare

and Medicaid programs, (as modified by a unanimous consent request).

An amendment to the amendment in the nature of a

substitute by Mr. Engel, No. 1b, including consideration of

environmental factors when researching causes of health

disparities.

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House

of Representatives, the Committee held a legislative hearing and

made findings that are reflected in this report.

COMMITTEE ON GOVERNMENT REFORM OVERSIGHT FINDINGS

Pursuant to clause 3(c)(4) of rule XIII of the Rules of the House

of Representatives, no oversight findings have been submitted to

the Committee by the Committee on Government Reform.

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1 Health disparity populations are defined as populations with a significant disparity in the

overall rate of disease incidence, morbidity, mortality, and survival rates in the population as

compared to the health of the general population. Specific determinations of health disparity

populations would be made by the Director of the National Center for Research on Minority

Health and Health Disparities in consultation with the Director of the Agency for Healthcare

Research and Quality (AHRQ).

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the

House of Representatives, the Committee finds that H.R. 3250, the

Health Care Fairness Act of 2000, would result in no new or increased budget authority, entitlement authority, or tax expenditures or revenues.

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by

the Director of the Congressional Budget Office pursuant to section

402 of the Congressional Budget Act of 1974.

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House

of Representatives, the following is the cost estimate provided by

the Congressional Budget Office pursuant to section 402 of the

Congressional Budget Act of 1974:

U.S. CONGRESS

CONGRESSIONAL BUDGET OFFICE, Washington, DC, September 21, 2000.

Hon. TOM BLILEY,

Chairman, Committee on Commerce,

House of Representatives, Washington, DC.

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 3250, the Health Care

Fairness Act of 2000.

If you wish further details on this estimate, we will be pleased

to provide them. The CBO staff contact is Christopher J. Topoleski.

Sincerely,

BARRY B. ANDERSON

(For Dan L. Crippin, Director).

Enclosure.

H.R. 3250—Health Care Fairness Act of 2000

Summary: H.R. 3250 would expand the role of the federal government in supporting research on the health needs of racial and

ethnic minorities as well as health disparity populations.1

The Health Care Fairness Act of 2000 would affect the National

Institutes of Health (NIH), the Agency for Healthcare Research and

Quality (AHRQ), the Health Resources and Services Administration (HRSA), the Office of Civil Rights, and the Health Care Financing Administration (HCFA). The bill would replace the Office

of Research on Minority Health (ORMH) within the Office of the

Director of NIH with a new center focusing on the health needs of

racial and ethnic minorities and health disparity populations. The

center is designed to promote cooperation among federal, state and

19

local health agencies, and private entities in health disparity research.

AHRQ would be responsible for developing quality measurement

mechanisms to examine the extent to which the health needs of minority and health disparity populations are met, including examination and support of demonstration projects. HRSA, the Office of

Civil Rights, and HCFA, would be responsible for various initiatives, programs, incentives, and reports to better understand the

needs of minority and health disparity populations.

Assuming the appropriation of the necessary amounts, CBO esti- mates that implementing H.R. 3250 would cost $43 million in 2001

and $402 million over the 2001–2005 period, assuming annual adjustments for inflation for those activities without specified authorization levels. The five-year total would be $397 million if such inflation adjustments are not made. The legislation would not affect

direct spending or receipts; therefore, pay-as-you-go procedures

would not apply.

H.R. 3250 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA).

It would authorize a number of grant and assistance programs for

which state and other public entities, especially colleges and universities, could qualify.

Estimated cost to the Federal Government: The estimated budgetary impact of H.R. 3250 is shown in the following table. The costs

of this legislation fall within budget function 550 (health).

By fiscal year, in millions of dollars—

2000 2001 2002 2003 2004 2005

SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:

Estimated Authorization Level 1 .......................................... 1,548 1,580 1,612 1,643 1,676 1,709

Estimated Outlays ............................................................... 1,341 1,468 1,531 1,588 1,614 1,646

Proposed Changes 2

Estimated Authorization Level ............................................. 0 99 104 103 100 98

Estimated Outlays ............................................................... 0 43 72 91 98 98

Spending Under H.R. 3250:

Estimated Authorization Level ............................................. 1,548 1,679 1,716 1,746 1,776 1,807

Estimated Outlays ............................................................... 1,341 1,511 1,603 1,679 1,712 1,744

1 The 2000 level is the amount appropriated for that year for the agencies that would be affected by H.R. 3250. The 2001–2005 levels are

CBO baseline projections, including adjustments for anticipated inflation. 2 The amounts shown reflect adjustments for anticipated inflation for those activities for which the bill would authorize such sums as nec- essary. Without such inflation adjustments, the five-year changes in authorization levels would total $493 million (instead of $504 million)

and the changes in outlays would total $397 million (instead of $402 million).

Basis of estimate: For this estimate, CBO assumes that the bill

would have an effective date of October 1, 2000, and that outlays

would follow historical spending rates for the relevant agencies for

the authorized activities. Where specified in H.R. 3250, CBO assumes the authorized amounts would be appropriated. Where appropriations of such sums as necessary are authorized, CBO based

its estimates on amounts spent in the past for similar types of activities.

Many of the proposed activities under H.R. 3250 are currently

handled by the ORMH and are reflected in the estimated changes

to both budget authority and outlays. The estimates of changes in

budget authority and outlays of the proposal reflect the incremental cost of additional responsibilities of the NIH and other offices and agencies.

Pay-as-you-go considerations: None.

20

Estimated impact on state, local, and tribal governments: H.R.

3250 contains no intergovernmental mandates as defined in

UMRA. It would authorize a number of grant and assistance programs for which state and other public entities, especially colleges

and universities, could qualify. Among those programs are grants

and contracts for biomedical and behavioral education and research

targeting minorities and other populations that face high levels of

disease and mortality. The bill would also authorize grants for developing curricula in medical schools and continuing education programs that aim to reduce disparities in health care among racial

and ethnic groups. Finally, the bill would authorize grants to states

for establishing and operating ombudsman programs designed to

identify, investigate, and facilitate the resolution of civil rights

complaints.

Estimated impact on the private sector: The bill contains no private-sector mandates as defined in UMRA.

Estimate prepared by: Federal Costs: Christopher J. Topoleski.

Impact on State, Local, and Tribal Governments: Leo Lex. Impact

on the Private Sector: Rekha Ramesh.

Estimate approved by: Peter H. Fontaine, Deputy Assistant Director for Budget Analysis.

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office

pursuant to section 423 of the Unfunded Mandates Reform Act.

ADVISORY COMMITTEE STATEMENT

Section 404 of H.R. 3250 creates an advisory committee to advise

the Secretary on matters related to the development, implementation, and evaluation of curricula for graduate and continuing medical education for health care professionals to decrease disparities

in health care and health outcomes. Pursuant to the requirements

of subsection 5(b) of the Federal Advisory Committee Act, the Committee finds that the functions of the proposed advisory committee

are not and cannot be performed by an existing Federal agency or

advisory commission or by enlarging the mandate of an existing advisory committee.

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House

of Representatives, the Committee finds that the Constitutional authority for this legislation is provided in Article I, section 8, clause

3, which grants Congress the power to regulate commerce with foreign nations, among the several States, and with Indian tribes.

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the

terms and conditions of employment or access to public services or

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act.

21

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title; table of contents

This section provides the short title of the bill, the ‘‘Health Care

Fairness Act of 2000,’’ and includes a table of contents.

Section 2. Findings

This section provides certain Congressional findings.

TITLE I: IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF HEALTH; ESTABLISHMENT OF

NATIONAL CENTER

Section 101. Establishment of National Center for Research on Minority Health and Health Disparities

Subsection (a) amends part E of the title IV of the Public Health

Service Act (PHSA) by creating a new subpart 6 creating a National Center for Research on Minority Health and Health Disparities.

New section 485E(a) establishes the purpose of the National Center for Research on Minority Health and Health Disparities, which

is the conduct and support of basic and clinical research, training,

the dissemination of health information, and other programs with

respect to the health of racial and ethnic minority groups and other

health disparity populations.

New subsection (b) establishes priorities for the Center. With appropriated funds, the Director of the Center must give priority to

conducting and supporting minority health research.

New subsection (c) defines ‘‘Minority health research’’ as research

on minority health conditions, research on access, outreach, treatment, quality of health care, and research on cultural and linguistic services to decrease health problems of minorities. The term

‘‘Minority health conditions’’ is defined as all diseases, disorders,

and conditions (including mental health and substance abuse) (1)

that are unique to, more serious or prevalent in ethnic or minority

groups, (2) or for which factors of medical risk or medical interventions are different, or (3) for which insufficient research or data exists. The term ‘‘Racial and ethnic minority group’’ is defined as

American Indians (including Alaska Natives, Eskimos, and Aleuts);

Asian Americans, Native Hawaiians and other Pacific Islanders;

Blacks; and Hispanics. The term ‘‘Minorities’’ is defined as being

individuals from a racial or ethnic group.

New subsection (d) defines a ‘‘health disparity population’’ as one

determined by the Director of the Center, after consultation with

the Director of the Agency for Healthcare Research and Quality

(AHRQ), to have a significant disparity in the overall rate of disease incidences, morbidity, mortality, and survival rates within

that population as compared to the health status of the general

population. Health disparity populations include racial and ethnic

minority groups. The term ‘‘Health disparities research’’ is defined

as research on health disparity populations that relates to the

health disparities involved, including basic and applied biomedical

and behavioral research on the nature and causes of health disparities, and remedies for such disparities. Minority health research is

included in health disparities research. After providing for minority

22

health research with appropriated funds, the Secretary must conduct and support health disparities research on other health disparity populations, giving priority to health disparity populations

for which socioeconomic status is one of the principal causal factors

of health disparity.

New subsection (e) requires that the Director of the Center coordinate all minority health and other health disparities research

conducted or supported by the National Institutes of Health (NIH).

Also, the Director of the Center represents the health disparities

research program of NIH at all relevant Executive branch task

forces, committees and planning activities, and maintains communications with all relevant Public Health Service agencies and

other departments of the Federal government.

New subsection (f) provides that the Director of NIH, the Director of the Center, and the directors of the national research institutes must establish a comprehensive plan and budget for the conduct and support of all minority health and other health disparities

research activities of the agencies of the National Institutes of

Health. The first plan and budget must be established no later

than 12 months after the date of the enactment. The Directors

must: ensure that the plan and budget demonstrate how activities

in health disparities research will address the health needs of specific health disparity populations; establish priorities among the activities in health disparities research that such agencies are authorized to carry out; and establish objectives and action plans, including target dates, for carrying out health disparities research.

Also, the Directors must: ensure that the plan and budget give priority to conducting and supporting minority health research; ensure that all amounts appropriated for such activities are expended

in accordance with the plan and budget; review the plan and budget not less than annually; and revise the plan and budget as appropriate. The plan and budget must serve as a statement of policies

regarding minority health and other health disparities research activities of the agencies, but heads of the agencies are responsible

for the approval of specific programs or projects in accordance with

the plan and budget. The Director of the Center is required to include budget provisions for (1) basic and applied research; (2) research that is conducted by the agencies; (3) research that is supported by the agencies; (4) solicited and unsolicited proposals; and

(5) behavioral research and social sciences research. The collaborative comprehensive plan and budget must include a separate

statement of the plan and budget for minority health research.

New subsection (g) requires that the Director of the Center to assist in the administration of requirements to include women and

minorities in clinical research.

New subsection (h) authorizes the Director of the Center to provide for research endowments at centers of excellence (health professions schools with significant minority enrollment) to facilitate

minority health research.

New subsection (i) requires the Director of the Center to assist

the Director of the National Center for Research Resources in carrying out requirements and committing resources for institutions of

emerging excellence. Also, the Director of the Center must establish projects to promote cooperation in minority health disparities

research among governmental, regional and private entities. The

23

Director of the Center may conduct or support research on service

delivery models to reduce health disparities and may use information from earlier initiatives on minorities and other health disparity populations.

New subsection (j) directs the Secretary to establish an advisory

council to make recommendations to the Director of the Center on

matters related to the Center’s research mission, budgetary allocations, and report reviews. A majority of members of the advisory

council must be representatives of various racial and ethnic minority groups, other health disparity populations must be included,

and a diversity of health professions must be represented. A representative of the Office of Behavioral and Social Sciences Research

must also be a member of the advisory council.

New subsection (k) requires that the Director of the Center must

submit an annual report to Congress, the Secretary, and the Director of NIH describing and evaluating NIH health disparities research, and such research supported by the national research institutes, as well as a separate analysis of minority health research.

As part of that report, the Director may include recommendations. New subsection (l) authorizes appropriations of $100 million for

FY 2001, and such sums as necessary for each for the fiscal years

2002 through 2005. Authorization of appropriations made by this

subsection is in addition to other monies or funds available for the

conduct and support of minority health or other health disparities

research by the national research institutes and other agencies of

the NIH.

Section 101(b) makes a conforming amendment by repealing section 404 of the PHSA.

Section 102. Centers of excellence for research education and training

This section further amends subpart 6 of part E of title IV of the

PHSA (as added by section 101 of this bill) by adding at the end

a new section 485F, establishing a Center for Excellence for Research Education and Training.

New subsection (a) authorizes the Director of the Center to

award grants or contracts to biomedical and behavioral research institutions designated as centers of excellence, or to designated consortia, in support of programs of excellence in biomedical and behavioral research education for individuals who are members of

health disparity populations, including minorities.

New subsection (b) permits the Director to make an award to an

applicant only if the applicant agrees that the grant will be expended to: (1) conduct minority health research, including research

on the use of service delivery models (such as health centers under

section 330 of the PHSA) with respect to minority health conditions; (2) train minorities and other members of health disparities

populations as professionals in the area of biomedical or behavioral

research; or (3) alter existing research facilities or construct new

research facilities for the purpose of conducting minority health research.

New subsection (c) establishes that an institution is a designated

biomedical and behavioral research institution if it has a significant number of health disparity students, including minorities, enrolled in the institution, has a record of effectiveness in recruiting,

24

assisting, supporting and graduating such students from its educational programs. One or more designated biomedical and behavioral research institutions may form a consortium to receive a ‘‘center of excellence’’ grant or contract. Criteria established under this

section regarding minorities may not be applied to other programs.

New subsection (d) establishes the duration of the grant. The

grant period may not exceed 5 years. Grant payments are subject

to the availability of appropriations and to annual approval by the

Director.

New subsection (e) provides that, in order to receive an award,

the institution must agree to maintain expenditures of non-Federal

amounts for its activities at a level that is not less than what the

institution expended for the fiscal year preceding the year the

award is made. The Director may make awards to designated research institutions or consortia only if the institutions involved

agree that they will first expend federal amounts obtained from

sources other than the award.

New subsection (f) authorizes the Director to permit designated

research institutions or consortia to expend a portion of an award

for research endowments.

New subsection (g) defines certain terms. While ‘‘Designated biomedical and behavioral research institution,’’ is defined in new subsection (c), a ‘‘program of excellence’’ is defined as a program carried out by a designated biomedical research institution under new

subsection (b).

Finally, new subsection (h) authorizes such sums as necessary

for each of the fiscal years 2001 through 2005 for grants and contracts to centers of excellence.

Section 103. Loan Repayment Program for minority health research

Section 103 adds another section to subpart 6 of part E of title

IV of the PHSA by adding a new section 485G, establishing a Loan

Repayment Program for Minority Health Research.

New subsection (a) directs the Director of the Center to establish

a program of offering contracts to qualified health professionals to

conduct minority health research in exchange for repayment of up

to $35,000 for educational loans.

New subsection (b) ensures that provisions in current law for the

National Health Service Corps (338B), Obligated Service (338C),

and Breaches of Scholarship Contract or Loan Repayment Contract

(338E) apply to the proposed ‘‘Loan Repayment Program for Minority Health Research.’’

New subsection (c) requires the Director of the Center to ensure

that at least 50% of all contracts are for appropriately qualified

health professionals who are members of a health disparity population.

New subsection (d) requires the Secretary to ensure that priority

is given to biomedical research projects.

New subsection (e) authorizes to be appropriated such sums as

may be necessary for each of the fiscal years 2001 through 2005 for

this loan repayment program. Amounts available must remain

available for 2 fiscal years beyond the fiscal year when amounts

were made available.

25

Section 104. General provisions regarding the center

Section 104 amends subpart 6 of part E of title IV of the PHSA,

as amended by section 103 of this bill by adding a new section 485

H describing general provisions regarding the Center.

New subsection (a) requires that the Secretary, acting through

the Director of the NIH, provide administrative support and support services to the Director of the Center, and ensure that such

support takes maximum advantage of existing administrative

structures at NIH.

New subsection (b) directs the Secretary within 5 years to evaluate the effect of the Center for Research on Minority Health and

Health Disparities on the planning and coordination of health disparities research programs at the institutes, centers and divisions

of NIH. The report should include recommendations concerning future legislation and administrative modifications to the Center.

Within 1 year of completing the evaluation, the Secretary must

submit a report on the evaluation to the Senate Committee on

Health, Education, Labor, and Pensions and the House Committee

on Commerce.

Section 105. Report regarding resources of National Institutes of

Health dedicated to research on minority health

By December 1, 2003, the Director of the National Center for Research on Minority Health and Health Disparities must submit to

Congress, the Secretary of HHS, and the Director of NIH a report

on recommendations for the method that should be used to determine the level of resources that the NIH dedicates to research on

minority health. The report must determine the extent to which

there has been an increase in NIH resources dedicated to minority

health research since FY 1999, and in the number and amount of

awards to minority-serving institutions.

TITLE II: HEALTH DISPARITIES RESEARCH BY THE AGENCY

FOR HEALTHCARE RESEARCH AND QUALITY

Section 201. Health disparities research by Agency for Healthcare

Research and Quality

Subsection (a) amends Part A of Title IX of the PHSA by creating

a new section 903 for Research on Health Disparities.

New subsection (a) directs the Director of the Agency for

Healthcare Research and Quality (AHRO) to conduct and support

research for various purposes, including how to improve the quality

and outcomes of health care services for health disparity populations, developing measures for assessing and improving the quality and appropriateness of health care services provided to health

disparity populations, and providing support to increase the number of researchers who are members of health disparity populations.

New subsection (b) requires the Director to conduct and support

research to identify the clinical, cultural, socioeconomic, and organizational factors that contribute to health disparities; identify and

evaluate clinical and organizational strategies to improve quality,

outcomes, and access to care for health disparity populations; support demonstrations to test strategies for quality improvement; and

disseminate strategies for which there is evidence of effectiveness.

26

The Director must implement research strategies and mechanisms

that will enhance the involvement of members of health disparity

populations, health services researchers who are such individuals,

institutions that train such individuals as researchers, and others.

Such research strategies and mechanisms may include the use of

centers of excellence, provider-based research networks, service delivery models and other innovative mechanisms that will facilitate

the translation of past research investments into clinical practices

that can benefit these populations.

New subsection (c) requires the Director of AHRQ to support the

development of quality of health care measures that assess the experience of health disparity populations with health care systems.

The Administrator must, in consultation with the Administrator of

the Health Resources and Services Administration (HRSA) examine the practices of providers that have a record of reducing health

disparities or have experience in providing culturally competent

health services to minority or other health disparity populations.

Within two years of enactment, the Secretary must prepare and

submit to Congress a report describing the state-of-the-art of quality measurement for minority and other health disparity populations that will identify critical needs and the activities of the Department to meet those needs, together with a description of related activities in the private sector.

New subsection (d) references the definition given to ‘‘health disparity population’’ in section 485E.

Section 201(b) authorizes such sums as may be necessary for

each of the fiscal years 2001 through 2005 for research conducted

by AHRQ.

TITLE III: DATA COLLECTION RELATING TO RACE OR

ETHNICITY

Section 301. Study and report by National Academy of Sciences

Subsection (a) authorizes the National Academy of Sciences

(NAS) to conduct a comprehensive study of data collection systems

and practices on characteristics of race or ethnicity within the Department of HHS. The study must include other federal data collection systems with which the Department interacts to collect relevant data on race and ethnicity.

Subsection (b) requires the NAS to submit a report within one

year of enactment to the Senate Committee on Health, Education,

Labor, and Pensions and the House Committee on Commerce. The

report must identify data needed to evaluate the effects of race and

ethnicity on access to health care and disparities in health care; examine the effectiveness of the systems and practices of HHS and

other federal and state agencies in collecting and analyzing data on

race or ethnicity; recommend how the HHS may collect reliable and

complete information relating to race and ethnicity; and include

projections about the costs associated with the implementation of

the recommendations, and possible effects on the costs on program

operations.

Subsection (c) authorizes such sums as necessary for FY2001 for

the NAS study.

27

TITLE IV: MEDICAL EDUCATION AND OTHER HEALTH

PROFESSIONS EDUCATION

Section 401. Grants for health care education curriculum development

Section 401 amends part F of title VII of the PHSA by including

a new subsection for Grants for Health Professional Education Curriculum Development.

New subsection (a) authorizes the Secretary, acting through the

Administrator of the Health Resources and Services Administration, and in collaboration with the Director of AHRQ and the Deputy Assistant Secretary for Minority Health to award grants, contracts, or cooperative agreements to public and nonprofit private

entities for carrying out research and demonstration projects to develop curricula to reduce disparities in health care outcomes.

Schools of medicine, osteopathic medicine, dentistry, public health,

nursing, and others are eligible to apply for an award. Award periods for each grant, contract, or cooperative grant are limited to

three years. The Secretary must make awards in each of the first

and second fiscal years for which funds are available through authorized appropriations.

New subsection (b) allows the Secretary, acting through the Administrator of the Health Resources and Service Administration,

and in collaboration with the Director of the AHRQ and the Deputy

Assistant Secretary for Minority Health, to award grants for developing curricula in continuing education for health professions to reduce disparities in health care and health outcomes. The curricula

must focus on the need to remove bias from health care at personal

and systemic levels. Schools of medicine, osteopathic medicine, dentistry, public health, nursing, and others are eligible to apply for

those grants. The Secretary must make awards available the first

two years for which funds are available through authorized appropriations. Award periods for each grant are limited to three years.

New subsection (c) requires that projects initiated as part of this

grant program be carried out in each of the principal geographic regions of the United States and must involve different health disparity populations and health professions.

New subsection (d) requires grant recipients to ensure that procedures are in place to monitor the activities supported by the

grant, contract, or cooperative agreements. The award recipient

must submit to the Secretary an annual report on the effectiveness

of the curriculum that was developed under the agreement.

New subsection (e) directs the Secretary to submit a report to

Congress no later than January 1, 2002, detailing the effectiveness

of the grant’s program for curricula development to reduce disparities in health care and health care outcomes. The Secretary must

submit a final report no later than January 1, 2004.

New subsection (f) authorizes appropriations for curriculum development at the following levels: $3.5 million for FY2001; $7 million for FY2002; $7 million for FY2003; and, $3.5 million for

FY2004.

28

Section 402. National conference on continuing health professional

education and disparities in health outcomes

Subsection (a) requires the Secretary to convene within one year

of enactment a national conference on continuing medical education

as a method for reducing disparities in health outcomes. The conference must include sessions that address measurements of outcomes to assess the effectiveness of curricula in reducing disparities.

Subsection (b) directs the Secretary to invite to the conference

members of minority and other health disparity populations, advocacy groups, health education entities, health centers grantees, and

other interested parties.

Subsection (c) requires that the conference address various

issues, including the role of continuing medical education in reducing disparities in health care and health outcomes. A focus of the

conference will be methods and strategies to achieve reduction in

disparities in health and health care through continuing medical

education courses or programs.

Subsection (d) requires the Secretary to publish in the Federal

Register a summary of the proceedings and findings within 6

months of the national conference.

Subsection (e) authorizes to be appropriated such sums as may

be necessary for the conference.

Section 403. Continuing Medical Education Incentive Program

Subsection (a) requires the Secretary to develop and implement

a program to provide incentives to health maintenance organizations, community health centers, rural health centers and other entities that provide services under the Medicare or Medicaid program to encourage health professionals to participate in continuing

medical education programs designed to reduce health disparities.

Subsection (b) targets the Continuing Medical Education Incentive program incentives to programs that (1) implement new curricula or strategies for continuing medical education designed to reduce health disparities; (2) encourage health professionals to participate in such curricula, and (3) monitor health care and health

outcome to evaluate the effectiveness of continuing medical education programs in reducing health care disparities.

Subsection (c) references the definition given to ‘‘health disparity

population’’ in section 485E.

Subsection (d) authorizes to be appropriated such sums as necessary for the incentive program.

Section 404. Advisory Committee

Subsection (a) requires the Secretary to establish an Advisory

Committee to advise the Secretary on matters related to the development, implementation and evaluation of curricula for graduate

and continuing education for health care professionals to decrease

disparities in health care and health outcomes.

Subsection (b) directs the Secretary to approve members of the

Advisory Committee within three months of the date when appropriations are provided for the program. Advisory Committee members must (1) not be officers or employees of the Federal government; (2) be experienced in issues related to health disparities;

and, (3) be members and representatives of racial and ethnic miVerDate 11-MAY-2000 04:46 Oct 21, 2000 Jkt 089006 PO 00000 Frm 00028 Fmt 6659 Sfmt 6602 E:\HR\OC\HR986.XXX pfrm10 PsN: HR986
29

nority groups or health disparity populations. Also, the Advisory

Committee must include persons experienced in providing health

services to racial and ethnic minority groups or other health disparity populations including representatives of health centers, the

Office of Minority Health, the Health Resources and Services Administration, and other agencies of the PHS.

Subsection (c) requires the Advisory Committee to collaborate

with the Office of Minority Health of HHS and other offices, centers, and institutes of HHS and Federal agencies.

Subsection (d) terminates the Advisory Committee four years

from the date when the first member of the committee is appointed.

Subsection (e) allows the Secretary to appoint the existing advisory committee in the Office of Minority Health of HHS to serve

as the advisory committee established by this section.

Section 405. Cultural competency clearinghouse

Subsection (a) requires the Director of the Office of Minority

Health of HHS to establish an information clearinghouse for curricula to reduce disparities in health care and health outcomes. The

clearinghouse must facilitate and enhance knowledge and understanding of practices that lead to reductions in health disparities.

Subsection (b) establishes that information contained in the

clearinghouse be made available to minority health advocacy

groups and other organizations representing health disparity populations, health education entities, health maintenance organizations and other interested parties.

Subsection (c) authorizes to be appropriated such sums as may

be necessary for the clearinghouse.

TITLE V: MISCELLANEOUS PROVISIONS

Section 501. Office for Civil Rights

Subsection (a) requires the Secretary to conduct a national media

campaign to inform the public of programs and activities of the Office for Civil Rights in HHS. The campaign must focus on racial

and ethnic minority communities, and involve racial and ethnic minority media in the design and as participants. Such sums as may

be necessary for FY2001 are authorized to be appropriated.

Subsection (b) directs the Secretary to carry out a demonstration

program in which grants are made to states to establish and operate ‘‘State Ombudsman Offices,’’ which are modeled after State

Long-Term Care Ombudsman programs established in title VII of

the Older Americans Act of 1965. The offices are to identify, investigate, and facilitate the resolution of civil rights complaints.

Subsection (c) authorizes $36 million to be appropriated for the

Office for Civil Rights for fiscal year 2001 and each subsequent fiscal year.

Section 502. Development of outcome measures; study to measure

patient outcomes under the Medicare and Medicaid programs

by race and ethnicity

Subsection (a) requires the Secretary to develop, within one year

of enactment, outcome measures to evaluate, by race and ethnicity,

and on an age-specific and sex-specific basis, the performance of

30

health care programs and projects that provide health care to individuals under the Medicare and Medicaid programs.

Subsection (b) directs the Secretary to evaluate the performance

of health care programs and projects under the Medicare and Medicaid programs, using the specific outcome measures developed

under this section.

Subsection (c) requires the Secretary, within two years of enactment, to submit a report to Congress on the development of outcome measures and the results of the study evaluating the measures in the context of the Medicare and Medicaid programs.

Section 503. Departmental definition regarding minority individuals

This section amends section 1707(g)(1) of the Public Health Service Act to add ‘‘Native Hawaiian’’ to the current definition of ‘‘racial

and ethnic minority groups.’’

Section 504. Conforming provision regarding definitions

This section provides that the definition of ‘‘racial and ethnic minority groups,’’ as amended, conforms with provisions in the bill.

TITLE VI: EFFECTIVE DATE

Section 601. Effective date

This section provides that provisions of this bill take effect on October 1, 2000, or upon date of enactment, whichever occurs later.

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the

House of Representatives, changes in existing law made by the bill,

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic,

existing law in which no change is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

* * * * * * *

TITLE IV—NATIONAL RESEARCH INSTITUTES

PART A—NATIONAL INSTITUTES OF HEALTH

ORGANIZATION OF THE NATIONAL INSTITUTES OF HEALTH

SEC. 401. (a) * * *

(b)(1) * * *

* * * * * * *

(2) The following entities are agencies of the National Institutes

of Health:

(A) * * *

* * * * * * *

(F) The National Center for Complementary and Alternative

Medicine.

31

(G) The National Center for Research on Minority Health and

Health Disparities.

* * * * * * *

øOFFICE OF RESEARCH ON MINORITY HEALTH

øSEC. 404. (a) ESTABLISHMENT.—There is established within the

Office of the Director of NIH an office to be known as the Office

of Research on Minority Health (in this section referred to as the

‘‘Office’’). The Office shall be headed by a director, who shall be appointed by the Director of NIH.

ø(b) PURPOSE.—The Director of the Office shall—

ø(1) identify projects of research on minority health that

should be conducted or supported by the national research institutes;

ø(2) identify multidisciplinary research relating to research

on minority health that should be so conducted or supported;

ø(3) promote coordination and collaboration among entities

conducting research identified under paragraph (1) or (2);

ø(4) encourage the conduct of such research by entities receiving funds from the national research institutes;

ø(5) recommend an agenda for conducting and supporting

such research;

ø(6) promote the sufficient allocation of the resources of the

national research institutes for conducting and supporting such

research; and

ø(7) assist in the administration of section 492B with respect

to the inclusion of members of minority groups as subjects in

clinical research.¿

* * * * * * *

PART E—OTHER AGENCIES OF NIH

* * * * * * *

Subpart 6—National Center for Research on Minority Health and

Health Disparities

SEC. 485E. PURPOSE OF CENTER.

(a) IN GENERAL.—The general purpose of the National Center for

Research on Minority Health and Health Disparities (in this subpart referred to as the ‘‘Center’’) is the conduct and support of basic

and clinical research, training, the dissemination of health information, and other programs with respect to the health of racial and

ethnic minority groups and other health disparity populations.

(b) PRIORITIES.—The Director of the Center shall in expending

amounts appropriated under this section give priority to conducting

and supporting minority health research.

(c) MINORITY HEALTH RESEARCH.—For purposes of this subpart:

(1) The term ‘‘minority health research’’ means research on

minority health conditions (as defined in paragraph (2)), including research on preventing such conditions; research on access, outreach, treatment, and the quality of health care; and research on cultural and linguistic services for decreasing the extent of health problems associated with such conditions.

32

(2) The term ‘‘minority health conditions’’, with respect to individuals who are members of racial and ethnic minority

groups, means all diseases, disorders, and conditions (including

with respect to mental health and substance abuse)—

(A) unique to, more serious, or more prevalent in such individuals;

(B) for which the factors of medical risk or types of medical intervention are different for such individuals, or for

which it is unknown whether such factors or types are different for such individuals; or

(C) with respect to which there has been insufficient research involving such individuals as subjects or insufficient

data on such individuals.

(3) The term ‘‘racial and ethnic minority group’’ has the

meaning given such term in section 1707.

(4) The term ‘‘minorities’’ means individuals from a racial or

ethnic minority group.

(d) HEALTH DISPARITY POPULATIONS.— (1) IN GENERAL.—For purposes of this subpart:

(A) A population is a health disparity population if, as

determined by the Director of the Center after consultation

with the Director of the Agency for Healthcare Research

and Quality, there is a significant disparity in the overall

rate of disease incidence, morbidity, mortality, or survival

rates in the population as compared to the health status of

the general population.

(B) The term ‘‘health disparity populations’’ includes racial and ethnic minority groups.

(C) The term ‘‘health disparities research’’ means research on health disparity populations (and individual

members and communities of such populations) that relates

to the health disparities involved, including basic and applied biomedical and behavioral research on the nature of

health disparities, the causes of such disparities, and remedies for such disparities. Such term includes minority

health research.

(2) PRIORITY.—With amounts available under this section for

a fiscal year after providing for minority health research in accordance with subsection (b), the Secretary shall conduct and

support health disparities research on other health disparity

populations, with priority given to such research on health disparity populations for which socioeconomic status is one of the

principal causal factors with respect to being a health disparity

population.

(e) COORDINATION OF ACTIVITIES.—The Director of the Center

shall act as the primary Federal official with responsibility for overseeing all minority health and other health disparities research conducted or supported by the National Institutes of Health, and—

(1) shall represent the health disparities research program of

the National Institutes of Health, including the minority health

research program, at all relevant Executive branch task forces,

committees and planning activities; and

(2) shall maintain communications with all relevant Public

Health Service agencies and with various other departments of

the Federal Government, to ensure the timely transmission of

33

information concerning advances in minority health and other

health disparities research between these various agencies for

dissemination to affected communities and health care providers.

(f) COLLABORATIVE COMPREHENSIVE PLAN AND BUDGET.— (1) IN GENERAL.—Subject to the provisions of this section and

other applicable law, the Director of NIH, the Director of the

Center, and the directors of the national research institutes in

collaboration (and in consultation with the advisory council for

the Center) shall—

(A) establish a comprehensive plan and budget for the

conduct and support of all minority health and other

health disparities research activities of the agencies of the

National Institutes of Health (which plan and budget shall

be first established under this subsection not later than 12

months after the date of the enactment of this subpart);

(B) ensure that the plan and budget demonstrate how

health disparities research activities address the health

needs of specific health disparity populations, taking into

account socioeconomic status; the areas in which the population involved resides; attitudes toward health; the language spoken, the extent of formal education; and such

other factors as the Director of the Center determines to be

appropriate;

(C) ensure that the plan and budget establish priorities

among the health disparities research activities that such

agencies are authorized to carry out;

(D) ensure that the plan and budget establish objectives

regarding such activities, describes the means for achieving

the objectives, and designates the date by which the objectives are expected to be achieved;

(E) ensure that, with respect to amounts appropriated for

activities of the Center, the plan and budget give priority

in the expenditure of funds to conducting and supporting

minority health research;

(F) ensure that all amounts appropriated for such activities are expended in accordance with the plan and budget;

(G) review the plan and budget not less than annually,

and revise the plan and budget as appropriate; and

(H) ensure that the plan and budget serve as a broad,

binding statement of policies regarding minority health

and other health disparities research activities of the agencies, but do not remove the responsibility of the heads of the

agencies for the approval of specific programs or projects,

or for other details of the daily administration of such activities, in accordance with the plan and budget.

(2) CERTAIN COMPONENTS OF PLAN AND BUDGET.—With respect to health disparities research activities of the agencies of

the National Institutes of Health, the Director of the Center

shall ensure that the plan and budget under paragraph (1) provide for—

(A) basic research and applied research, including research and development with respect to products;

(B) research that is conducted by the agencies;

(C) research that is supported by the agencies;

34

(D) proposals developed pursuant to solicitations by the

agencies and for proposals developed independently of such

solicitations; and

(E) behavioral research and social sciences research,

which may include cultural and linguistic research in each

of the agencies.

(3) MINORITY HEALTH RESEARCH.—The plan and budget

under paragraph (1) shall include a separate statement of the

plan and budget for minority health research.

(g) CLINICAL RESEARCH EQUITY.—The Director of the Center shall

assist in the administration of section 492B with respect to the inclusion of members of minority groups as subjects in clinical research.

(h) RESEARCH ENDOWMENTS.—The Director of the Center may

carry out a program to facilitate minority health research by providing for research endowments at centers of excellence under section 736.

(i) CERTAIN ACTIVITIES.—In carrying out subsection (a), the Director of the Center—

(1) shall assist the Director of the National Center for Research Resources in carrying out section 481(c)(3) and in committing resources for construction at Institutions of Emerging

Excellence;

(2) shall establish projects to promote cooperation among Federal agencies, State, local, and regional public health agencies,

and private entities in health disparities research;

(3) may conduct or support research on the use of service delivery models (such as health centers under section 330) to reduce health disparities; and

(4) may utilize information from previous health initiatives

concerning minorities and other health disparity populations.

(j) ADVISORY COUNCIL.—

(1) IN GENERAL.—The Secretary shall, in accordance with section 406, establish an advisory council to advise, assist, consult

with, and make recommendations to the Director of the Center

on matters relating to the activities described in subsection (a),

and with respect to such activities to carry out any other functions described in section 406 for advisory councils under such

section. Functions under the preceding sentence shall include

making recommendations on budgetary allocations made in the

plan under subsection (f), and shall include reviewing reports

under subjection (k) before the reports are submitted under such

subsection.

(2) MEMBERSHIP.—With respect to the membership of the advisory council under paragraph (1), a majority of the members

shall be representatives of the various racial and ethnic minority groups; representatives of other health disparity populations

shall be included; and a diversity of health professionals shall

be represented. The membership shall in addition include a representative of the Office of Behavioral and Social Sciences Research under section 404A.

(k) ANNUAL REPORT.—The Director of the Center shall prepare an

annual report on the activities carried out or to be carried out by

the Center, and shall submit each such report to the Congress, the

35

Secretary, and the Director of NIH. With respect to the fiscal year

involved, the report shall—

(1) describe and evaluate the progress made in health disparities research conducted or supported by the national research institutes;

(2) summarize and analyze expenditures made for activities

with respect to health disparities research conducted or supported by the National Institutes of Health;

(3) include a separate statement applying the requirements of

paragraphs (1) and (2) specifically to minority health research;

and

(4) contain such recommendations as the Director considers

appropriate.

(l) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this subpart, there are authorized to be appropriated

$100,000,000 for fiscal year 2001, and such sums as may be necessary for each of the fiscal years 2002 through 2005. Such authorization of appropriations is in addition to other authorizations of

appropriations that are available for the conduct and support of minority health or other health disparities research by the national research institutes and other agencies of the National Institutes of

Health.

SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION

AND TRAINING.

(a) IN GENERAL.—The Director of the Center shall make awards

of grants or contracts to designated biomedical and behavioral research institutions under paragraph (1) of subsection (c), or to consortia under paragraph (2) of such subsection, for the purpose of assisting the institutions in supporting programs of excellence in biomedical and behavioral research education for individuals who are

members of health disparity populations, including minorities.

(b) REQUIRED USE OF FUNDS.—An award may be made under

subsection (a) only if the applicant involved agrees that the grant

will be expended—

(1) to conduct minority health research, including research on

the use of service delivery models (such as health centers under

section 330) with respect to minority health conditions;

(2) to train minorities and other members of health disparities populations as professionals in the area of biomedical or behavioral research or both; or

(3) to expand, remodel, renovate, or alter existing research facilities or construct new research facilities for the purpose of

conducting minority health research.

(c) CENTERS OF EXCELLENCE.—

(1) IN GENERAL.—For purposes of this section, a designated

biomedical and behavioral research institution is a biomedical

and behavioral research institution that—

(A) has a significant number of health disparity students,

including minorities, enrolled in the institution (including

individuals accepted for enrollment in the institution);

(B) has been effective in assisting such students of the institution to complete the program of education and receive

the degree involved;

(C) has been effective in recruiting members of health disparity populations, including minorities, to enroll in and

36

graduate from the institution, including providing scholarships and other financial assistance to such individuals

and encouraging health disparity students from all levels of

the educational pipeline to pursue biomedical research careers; and

(D) has made significant recruitment efforts to increase

the number of members of health disparities populations,

including minorities, serving in faculty or administrative

positions at the institution.

(2) CONSORTIUM.—Any designated biomedical and behavioral

research institution involved may, with other biomedical and

behavioral institutions (designated or otherwise), form a consortium to receive an award under subsection (a).

(3) APPLICATION OF CRITERIA TO OTHER PROGRAMS.—In the

case of any criteria established by the Director of the Center for

purposes of determining whether institutions meet the conditions described in paragraph (1), this section may not, with respect to minorities, be construed to authorize, require, or prohibit the use of such criteria in any program other than the program established in this section.

(d) DURATION OF GRANT.—The period during which payments are

made under a grant under subsection (a) may not exceed 5 years.

Such payments shall be subject to annual approval by the Director

of the Center and to the availability of appropriations for the fiscal

year involved to make the payments.

(e) MAINTENANCE OF EFFORT.— (1) IN GENERAL.—With respect to activities for which an

award under subsection (a) is authorized to be expended, the

Director of the Center may not make such an award to a designated research institution or consortium for any fiscal year

unless the institution, or institutions in the consortium, as the

case may be, agree to maintain expenditures of non-Federal

amounts for such activities at a level that is not less than the

level of such expenditures maintained by the institutions involved for the fiscal year preceding the fiscal year for which

such institutions receive such an award.

(2) USE OF FEDERAL FUNDS.—With respect to any Federal

amounts received by a designated research institution or consortium and available for carrying out activities for which an

award under subsection (a) is authorized to be expended, the

Director of the Center may make such an award only if the institutions involved agree that the institutions will, before expending the award, expend the Federal amounts obtained from

sources other than the award.

(f) CERTAIN EXPENDITURES.—The Director of the Center may authorize a designated biomedical and behavioral research institution

to expend a portion of an award under subsection (a) for research

endowments.

(g) DEFINITIONS.—For purposes of this section:

(1) The term ‘‘designated biomedical and behavioral research

institution’’ has the meaning indicated for such term in subsection (c)(1). Such term includes any health professions school

receiving an award of a grant or contract under section 736.

(2) The term ‘‘program of excellence’’ means any program carried out by a designated biomedical and behavioral research inVerDate 11-MAY-2000 04:46 Oct 21, 2000 Jkt 089006 PO 00000 Frm 00036 Fmt 6659 Sfmt 6603 E:\HR\OC\HR986.XXX pfrm10 PsN: HR986
37

stitution with an award under subsection (a), if the program is

for purposes for which the institution involved is authorized in

subsection (b) to expend the grant.

(h) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

making grants under subsection (a), there are authorized to be appropriated such sums as may be necessary for each of the fiscal

years 2001 through 2005.

SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH RESEARCH.

(a) IN GENERAL.—The Director of the Center shall establish a program of entering into contracts with qualified health professionals

under which such health professionals agree to engage in minority

health research in consideration of the Federal Government agreeing to repay, for each year of engaging in such research, not more

than $35,000 of the principal and interest of the educational loans

of such health professionals.

(b) SERVICE PROVISIONS.—The provisions of sections 338B, 338C,

and 338E shall, except as inconsistent with subsection (a), apply to

the program established in such subsection to the same extent and

in the same manner as such provisions apply to the National Health

Service Corps Loan Repayment Program established in subpart III

of part D of title III.

(c) REQUIREMENT REGARDING HEALTH DISPARITY POPULATIONS.—

The Director of the Center shall ensure that not fewer than 50 percent of the contracts entered into under subsection (a) are for appropriately qualified health professionals who are members of a health

disparity population.

(d) PRIORITY.—With respect to minority health research under

subsection (a), the Secretary shall ensure that priority is given to

conducting projects of biomedical research.

(e) FUNDING.—

(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal

years 2001 through 2005.

(2) AVAILABILITY OF APPROPRIATIONS.—Amounts available for

carrying out this section shall remain available until the expiration of the second fiscal year beginning after the fiscal year

for which the amounts were made available.

SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.

(a) ADMINISTRATIVE SUPPORT FOR CENTER.—The Secretary, acting through the Director of the National Institutes of Health, shall

provide administrative support and support services to the Director

of the Center and shall ensure that such support takes maximum

advantage of existing administrative structures at the agencies of

the National Institutes of Health.

(b) EVALUATION AND REPORT.—

(1) EVALUATION.—Not later than 5 years after the date of the

enactment of this part, the Secretary shall conduct an evaluation to—

(A) determine the effect of this section on the planning

and coordination of the health disparities research programs at the institutes, centers and divisions of the National Institutes of Health;

38

(B) evaluate the extent to which this part has eliminated

the duplication of administrative resources among such Institutes, centers and divisions; and

(C) provide recommendations concerning future legislative and administrative modifications with respect to this

part, for both minority health research and research on

other health disparity populations.

(2) MINORITY HEALTH RESEARCH.—The evaluation under

paragraph (1) shall include a separate statement that applies

subparagraphs (A) and (B) of such paragraph to minority

health research.

(3) REPORT.—Not later than 1 year after the date on which

the evaluation is commenced under paragraph (1), the Secretary

shall prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee

on Commerce of the House of Representatives, a report concerning the results of such evaluation.

* * * * * * *

TITLE VII—HEALTH PROFESSIONS

EDUCATION

* * * * * * *

PART F—GENERAL PROVISIONS

* * * * * * *

SEC. 791A. GRANTS FOR HEALTH PROFESSIONAL EDUCATION CURRICULUM DEVELOPMENT.

(a) GRANTS FOR GRADUATE EDUCATION CURRICULUM DEVELOP- MENT.—

(1) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration and

in collaboration with the Director of the Agency for Healthcare

Research and Quality and the Deputy Assistant Secretary for

Minority Health, may make awards of grants, contracts, or cooperative agreements to public and nonprofit private entities for

the purpose of carrying out research projects and demonstration

projects to develop curricula to reduce disparities in health care

outcomes, including curricula for cultural competency in graduate health professions education.

(2) ELIGIBILITY.—To be eligible to receive an award under

paragraph (1), an entity shall—

(A) be a school of medicine, school of osteopathic medicine, school or dentistry, school of public health, school of

nursing, graduate program in behavioral health and mental health practice, or other recognized health profession

school; and

(B) prepare and submit to the Secretary an application at

such time, in such manner, and containing such information as the Secretary may require.

(3) USE OF FUNDS.—An entity shall use amounts received

under an award under paragraph (1) to carry out research

39

projects and demonstration projects to develop curricula to reduce disparity in health care outcomes, including curricula for

cultural competency in graduate health professions education.

(4) NUMBER OF GRANTS AND GRANT TERM.—The Secretary

shall award grants, contracts or cooperative agreements (or

combination thereof) under paragraph (1) in each of the first

and second fiscal years for which funds are available under

subsection (f). The term of each such grant, contract or cooperative agreement shall be 3 years.

(b) GRANTS FOR CONTINUING HEALTH PROFESSIONAL EDUCATION

CURRICULUM DEVELOPMENT.— (1) IN GENERAL.—The Secretary, acting through the Health

Resources and Services Administration and the Agency for

Healthcare Research Quality and in collaboration with the Office of Minority Health, shall award grants to eligible entities

for the establishment of demonstration and pilot projects to develop curricula to reduce disparity in health care and health

outcomes, including curricula for cultural competency, in continuing health professions education.

(2) ELIGIBILITY.—To be eligible to receive a grant under paragraph (1) an entity shall—

(A) be a school of medicine, osteopathic medicine, public

health, dentistry, optometry, pharmacy, allied health, chiropractic, podiatric medicine, nursing, and public health and

health administration, public or nonprofit private school

that offers a graduate program in clinical social work or

other graduate programs in behavioral health and mental

health practice, program for the training of physician assistants, health professional association, or other public or

nonprofit health educational entity, or any consortium of

entities described in this subparagraph; and

(B) prepare and submit to the Secretary an application at

such time, in such manner, and containing such information as the Secretary may require.

(3) USE OF FUNDS.—An entity shall use amounts received

under a grant under paragraph (1) to develop and evaluate the

effect of curricula for continuing health professions education

courses or programs to provide education concerning issues relating to disparity in health care and health outcomes, including cultural competency of health professionals. Such curricula

shall focus on the need to remove bias from health care at a

personal level as well as at a systemic level.

(4) NUMBER OF GRANTS AND GRANT TERM.—The Secretary

shall award grants under paragraph (1) in each of the first and

second fiscal years for which funds are available under subsection (f). The term of each such grant shall be 3 years.

(c) DISTRIBUTION OF PROJECTS.—The Secretary shall ensure that,

to the extent practicable, projects under subsections (a) and (b) are

carried out in each of the principal geographic regions of the United

States and involve different health disparity populations (as defined

in section 485E) and health professions.

(d) MONITORING.—An entity that receives a grant, contract or cooperative agreement under subsection (a) or (b) shall ensure that

procedures are in place to monitor activities undertaken using

grant, contract or cooperative agreement funds. Such entity shall

40

annually prepare and submit to the Secretary a report concerning

the effectiveness of curricula developed under the grant contract or

cooperative agreement.

(e) REPORT TO CONGRESS.—Not later than January 1, 2002, the

Secretary shall prepare and submit to the appropriate committees of

Congress, a report concerning the effectiveness of programs funded

under this section and a plan to encourage the implementation and

utilization of curricula to reduce disparities in health care and

health outcomes. A final report shall be submitted by the Secretary

not later than January 1, 2004.

(f) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to

be appropriated to carry out this section, $3,500,000 for fiscal year

2001, $7,000,000 for fiscal year 2002, $7,000,000 for fiscal year

2003, and $3,500,000 for fiscal year 2004.

* * * * * * *

TITLE IX—AGENCY FOR HEALTHCARE

RESEARCH AND QUALITY

PART A—ESTABLISHMENT AND GENERAL

DUTIES

* * * * * * *

SEC. 903. RESEARCH ON HEALTH DISPARITIES.

(a) IN GENERAL.—The Director shall—

(1) conduct and support research to identify how to improve

the quality and outcomes of health care services for health disparity populations and the causes of the health disparities involved, including identifying barriers to health care access and

environmental factors leading to health problems;

(2) conduct and support research and support demonstration

projects to identify, test, and evaluate strategies for eliminating

health disparities and promoting effective interventions;

(3) develop measures for the assessment and improvement of

the quality and appropriateness of health care services provided

to health disparity populations; and

(4) in carrying out 902(c), provide support to increase the

number of researchers who are members of health disparity

populations, and the health services research capacity of institutions that train such researchers.

(b) RESEARCH AND DEMONSTRATION PROJECTS.—

(1) IN GENERAL.—In carrying out subsection (a), the Director

shall conduct and support research to—

(A) identify the clinical, cultural, socioeconomic, and organizational factors that contribute to health disparities,

including for minority populations, which factors include

examination of patterns of clinical decisionmaking and of

the availability of support services;

(B) identify and evaluate clinical and organizational

strategies to improve the quality, outcomes, and access to

care for health disparity populations, including minority

populations;

(C) support demonstrations to test such strategies; and

41

(D) widely disseminate strategies for which there is scientific evidence of effectiveness.

(2) USE OF CERTAIN STRATEGIES.—In carrying out this section, the Director shall implement research strategies and mechanisms that will enhance the involvement of individuals who

are members of health disparity populations (including minority populations), health services researchers who are such individuals, institutions that train such individuals as researchers,

members of health disparity populations (including minority

populations) for whom the Agency is attempting to improve the

quality and outcomes of care, and representatives of appropriate

community-based organizations with respect to health disparity

populations. Such research strategies and mechanisms may include the use of—

(A) centers of excellence that can demonstrate, either individually or through consortia, a combination of multi-disciplinary expertise in outcomes or quality improvement research and a demonstrated capacity to engage members

and communities of health disparity populations, including

minority populations, in the planning, conduct and translation of research, with linkages to relevant sites of care;

(B) provider-based research networks, including health

plans, facilities, or delivery system sites of care (especially

primary care), that make extensive use of health care providers who are members of health disparity populations or

who serve patients in such populations and have the capacity to evaluate and promote quality improvement;

(C) service delivery models (such as health centers under

section 330) to reduce health disparities; and

(D) other innovative mechanisms or strategies that will

facilitate the translation of past research investments into

clinical practices that can reasonably be expected to benefit

these populations.

(c) QUALITY MEASUREMENT DEVELOPMENT.—

(1) IN GENERAL.—To ensure that health disparity populations, including minority populations, benefit from the

progress made in the ability of individuals to measure the quality of health care delivery, the Director shall support the development of quality of health care measures that assess the experience of such populations with health care systems, such as

measures that assess the access of such populations to health

care, the cultural competence of the care provided, the quality

of the care provided, the outcomes of care, or other aspects of

health care practice that the Director determines to be important. In carrying out the preceding sentence, the Director shall

in consultation with the Administrator of the Health Resources

and Services Administration examine the practices of providers

(such as health centers under section 330) that have a record

of reducing health disparities or have experience in providing

culturally competent health services to minority or other health

disparity populations.

(2) REPORT.—Not later than 24 months after the date of the

enactment of this section, the Secretary, acting through the Director, shall prepare and submit to the appropriate committees

of Congress a report describing the state-of-the-art of quality

42

measurement for minority and other health disparity populations that will identify critical unmet needs, the current activities of the Department to address those needs, and a description of related activities in the private sector.

(d) DEFINITION.—For purposes of this section:

(1) The term ‘‘health disparity population’’ has the meaning

given such term in section 485E.

(2) The term ‘‘minority’’, with respect to populations, refers to

racial and ethnic minority groups as defined in section 1707.

* * * * * * *

PART C—GENERAL PROVISIONS

* * * * * * *

SEC. 927. FUNDING.

(a) * * *

* * * * * * *

(d) HEALTH DISPARITIES RESEARCH.—For the purpose of carrying

out the activities under section 903, there are authorized to be appropriated such sums as may be necessary for each of the fiscal

years 2001 through 2005.

* * * * * * *

TITLE XVII—HEALTH INFORMATION AND HEALTH

PROMOTION

* * * * * * *

OFFICE OF MINORITY HEALTH

SEC. 1707. (a) * * *

* * * * * * *

(g) DEFINITION.—For purposes of this section:

(1) The term ‘‘racial and ethnic minority group’’ means

American Indians (including Alaska Natives, Eskimos, and

Aleuts); øAsian Americans and¿ Asian Americans; Native Hawaiians and other Pacific Islanders; Blacks; and Hispanics.

* * * * * * *

Æ