I 

109TH CONGRESS 

1ST SESSION H. R. 3561 

To improve the health of minority individuals. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 28, 2005 

Mr. HONDA (for himself, Mrs. NAPOLITANO, Mr. WATT, Mr. KILDEE, Ms. 

BORDALLO, Ms. SOLIS, Mrs. CHRISTENSEN, Mr. PALLONE, Ms. PELOSI, 

Mr. MENENDEZ, Mr. HOYER, and Mr. CLYBURN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, Resources, Judiciary, Ways and Means, and Agriculture, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To improve the health of minority individuals. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Healthcare Equality and Accountability Act’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings and purpose. 
2 

•HR 3561 IH 

TITLE I—COVERAGE OF THE UNINSURED 

Subtitle A—FamilyCare 

Sec. 101. Short title. 

Sec. 102. Renaming of title XXI Program. 

‘‘TITLE XXI—FAMILYCARE PROGRAM 

Sec. 103. FamilyCare coverage of parents under the Medicaid Program and 

title XXI. 

‘‘Sec. 2111. Optional FamilyCare coverage of parents of targeted low-income children. 

Sec. 104. Automatic enrollment of children born to title XXI parents. 

Sec. 105. Optional coverage of children through age 20 under the Medicaid 

Program and title XXI. 

Sec. 106. Allowing States to simplify rules for families. 

Sec. 107. Demonstration programs to improve Medicaid and CHIP outreach to 

homeless individuals and families. 

Sec. 108. Additional CHIP revisions. 

Sec. 109. Coordination of title XXI with the maternal and child Health Program. 

Subtitle B—State Option to Provide Coverage for All Residents With Income 

at or Below the Poverty Line 

Sec. 121. State option to provide coverage for all residents with income at or 

below the poverty line. 

Subtitle C—Optional Coverage of Legal Immigrants Under the Medicaid 

Program and Title XXI, and to Extend Eligibility to Certain Legal Residents 

Sec. 131. Equal access to Health coverage for legal immigrants. 

Sec. 132. Exception for citizens of freely associated States. 

Subtitle D—Indian Healthcare Funding 

CHAPTER 1—GUARANTEED FUNDING

Sec. 141. Guaranteed adequate funding for Indian Healthcare. 

‘‘Sec. 825. Funding. 

CHAPTER 2—INDIAN HEALTHCARE PROGRAMS

Sec. 145. Programs operated by Indian Tribes and Tribal organizations. 

Sec. 146. Licensing. 

Sec. 147. Authorization for emergency contract Health services. 

Sec. 148. Prompt action on Payment of claims. 

Sec. 149. Liability for Payment. 

Sec. 150. Health services for ineligible persons. 

Sec. 151. Definitions. 

Sec. 152. Authorization of appropriations. 

Subtitle E—Territories 

Sec. 161. Funding for territories. 

Subtitle F—Migrant Workers and Farmworkers Health 
3 

•HR 3561 IH 

Sec. 171. Demonstration project regarding continuity of coverage of migrant 

workers and farmworkers under Medicaid and CHIP. 

Subtitle G—Expanded Access to Health Care 

Sec. 181. National Commission for Expanded Access to Health Care. 

Sec. 182. Institute of Medicine evaluation and report on Health care performance measures. 

Subtitle H—FMAP Reimbursement for Native Hawaiians 

Sec. 191. 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally-qualified Health Center or a Native 

Hawaiian Health care system under the Medicaid Program. 

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTHCARE 

Sec. 201. Amendment to the Public Health Service Act. 

‘‘TITLE XXIX—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTHCARE 

‘‘Sec. 2900. Definitions. 

‘‘Sec. 2901. Improving access to services for individuals with Limited 

English proficiency. 

‘‘Sec. 2902. National Standards for culturally and linguistically appropriate services in Healthcare. 

‘‘Sec. 2903. Robert T. Matsui Center for Cultural and Linguistic Competence in Healthcare. 

‘‘Sec. 2904. Innovations in language access grants. 

‘‘Sec. 2905. Research on language access. 

‘‘Sec. 2906. Information about Federal Health programs for Limited 

English proficient populations. 

Sec. 202. Standards for language access services. 

Sec. 203. Federal reimbursement for culturally and linguistically appropriate 

services under the medicare, Medicaid and State Children’s 

Health Insurance Program. 

Sec. 204. Increasing understanding of Health literacy. 

Sec. 205. Report on Federal efforts to provide culturally and linguistically appropriate Healthcare services. 

Sec. 206. General Accounting Office report on impact of language access services. 

Sec. 207. Definitions. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

Sec. 301. Amendment to the Public Health Service Act. 

‘‘Subtitle A—Diversifying the Healthcare Workplace 

‘‘Sec. 2911. Report on workforce Diversity. 

‘‘Sec. 2912. National Working Group on Workforce Diversity. 

‘‘Sec. 2913. Technical Clearinghouse for Health workforce Diversity. 

‘‘Sec. 2914. Evaluation of workforce Diversity initiatives. 

‘‘Sec. 2915. Data collection and reporting by Health professional schools. 

‘‘Sec. 2916. Support for Institutions committed to workforce Diversity. 

‘‘Sec. 2917. Career development for scientists and researchers. 
4 

•HR 3561 IH 

‘‘Sec. 2918. Career support for non-research Health professionals. 

‘‘Sec. 2919. Research on the effect of workforce Diversity on quality. 

‘‘Sec. 2920. Health disparities education Program. 

‘‘Sec. 2920A. Cultural competence training for Healthcare professionals. 

Sec. 302. Health Careers Opportunity Program. 

Sec. 303. Program of excellence in Health professions education for underrepresented minorities. 

Sec. 304. Hispanic-Serving Health Professions Schools. 

‘‘Sec. 742. Hispanic-Serving Health Professions Schools. 

Sec. 305. Health professions student loan fund; authorizations of appropriations regarding students from disadvantaged backgrounds. 

Sec. 306. National Health Service Corps; recruitment and fellowships for individuals from disadvantaged backgrounds. 

Sec. 307. Loan repayment Program of Centers for Disease Control and Prevention. 

Sec. 308. Cooperative agreements for online degree programs at schools of Public Health and schools of allied Health. 

‘‘Sec. 743. Cooperative agreements for online degree programs. 

Sec. 309. Mid-career Health professions scholarship Program. 

‘‘Sec. 744. Mid-career Health professions scholarship Program. 

Sec. 310. Strengthening and expanding rural Health provider networks. 

Sec. 311. National report on the preparedness of Health professionals to care 

for diverse populations. 

Sec. 312. Scholarship and fellowship programs. 

‘‘Sec. 2920B. David Satcher Public Health and Health Services Corps. 

‘‘Sec. 2920C. Louis Stokes Public Health Scholars Program. 

‘‘Sec. 2920D. Patsy Mink Health and Gender Research Fellowship Program. 

‘‘Sec. 2920E. Paul David Wellstone International Health Fellowship Program. 

‘‘Sec. 2920F. Edward R. Roybal Healthcare Scholar Program. 

Sec. 313. Advisory Committee on Health Professions Training for Diversity. 

Sec. 314. Mcnair postbaccalaureate achievement Program. 

TITLE IV—REDUCING DISEASE AND DISEASE-RELATED 

COMPLICATIONS 

Subtitle A—Education and Outreach 

Sec. 401. Preventive Health services block grants; use of allotments. 

Sec. 402. Indigenous, racial and ethnic approaches to community Health. 

Sec. 403. Grants to promote positive Health behaviors in women. 

‘‘Sec. 399O. Grants to promote positive Health behaviors in women. 

Sec. 404. Provisions regarding National Asthma Education and Prevention 

Program of national heart, lung, and Blood Institute. 

Sec. 405. Asthma-related activities of Centers for Disease Control and Prevention. 

Sec. 406. Grants for community outreach regarding asthma information, education, and services. 

Sec. 407. Action plans of local educational agencies regarding asthma. 

Sec. 408. Programs of Centers for Disease Control and Prevention. 

‘‘Sec. 317H. Diabetes in children and youth. 

Sec. 409. Research with respect to uterine fibroids. 

Sec. 410. Information and education with respect to uterine fibroids. 

Subtitle B—Research and Training 
5 

•HR 3561 IH 

Sec. 431. Innovative chronic disease management programs. 

Sec. 432. Research funding for autoimmune disease in minority populations. 

‘‘Sec. 490E–1. Research funding for autoimmune disease in minority populations. 

Sec. 433. Research on effective messages for combatting stigma. 

Subtitle C—Innovative Treatment Modalities and Services Delivery Models 

Sec. 441. Guidelines for disease screening for minority patients. 

Sec. 442. Cancer reduction. 

‘‘Subtitle B—Reducing Disease and Disease-Related Complications 

‘‘Sec. 2921. Cancer prevention and treatment for underserved minority or 

other populations. 

Sec. 443. Monitoring the quality of and disparities in diabetes care. 

‘‘Sec. 904. Areas of special emphasis. 

Sec. 444. Diabetes prevention, treatment, and control. 

Sec. 445. Genetics of diabetes. 

‘‘Sec. 430A. Genetics of diabetes. 

Sec. 446. Research and training on diabetes in underserved and minority populations. 

‘‘Sec. 434B. Research on diabetes in underserved and minority populations. 

Sec. 447. Authorization of appropriations. 

‘‘Sec. 434C. Authorization of appropriations. 

Sec. 448. Prevention and control of sexually transmitted diseases. 

Sec. 449. Model community diabetes and chronic disease care and prevention 

among Pacific Islanders and Native Hawaiians. 

‘‘Sec. 399P. Model community diabetes and chronic disease care and prevention among Pacific Islanders and Native Hawaiians. 

Sec. 450. Grants to improve the provision of dental services under Medicaid 

and SCHIP. 

‘‘Sec. 511. Grants to improve the provision of dental services under Medicaid and SCHIP. 

Sec. 451. State option to provide wrap-around SCHIP coverage to children who 

have other Health coverage. 

Sec. 452. Grants to improve the provision of dental Health services through 

community Health Centers and public Health departments. 

‘‘Sec. 329. Grant Program to expand the availability of services. 

Sec. 453. Priority substance abuse treatment needs of regional and national 

significance. 

Sec. 454. Fetal Alcohol Syndrome. 

‘‘Sec. 2922. Fetal Alcohol Syndrome. 

Sec. 455. HIV/AIDS reduction. 

‘‘Sec. 2923. HIV/AIDS reduction in the minority community. 

Sec. 456. Systems for heart disease and stroke. 

‘‘Sec. 2924. Heart disease. 

‘‘Sec. 2925. Stroke education campaign. 

Subtitle D—Studies, Reports, and Plans 

Sec. 461. IOM study request. 

Sec. 462. Strategic plan. 

Sec. 463. Advisory Council for the Elimination of Tuberculosis. 

Sec. 464. National Program for tuberculosis elimination. 
6 

•HR 3561 IH 

Sec. 465. Inclusion of inpatient hospital services for the treatment of tb-infected individuals. 

Subtitle E—Miscellaneous Provisions 

Sec. 471. Health empowerment zones. 

Sec. 472. Overweight and obesity prevention and treatment. 

Sec. 473. Border Health grants. 

Sec. 474. United States-Mexico Border Health Commission Act amendments. 

‘‘Sec. 9. Authorization of appropriations. 

Sec. 475. Prevention and control of injuries. 

TITLE V—DATA COLLECTION AND REPORTING 

Sec. 501. Amendment to the Public Health Service Act. 

‘‘Subtitle C—Strengthening Data Collection, Improving Data Analysis, and 

Expanding Data Reporting 

‘‘Sec. 2931. Data on race, ethnicity, and primary language. 

‘‘Sec. 2932. Provisions relating to Native Americans. 

Sec. 502. Collection of race and ethnicity data by the Social Security Administration. 

‘‘Sec. 1150A. Collection of race and ethnicity data by the Social Security 

Administration. 

Sec. 503. Revision of HIPAA claims Standards. 

Sec. 504. National Center for Health Statistics. 

Sec. 505. Geo-access study. 

TITLE VI—ACCOUNTABILITY 

Subtitle A—General Provisions 

Sec. 601. Report on workforce Diversity. 

Sec. 602. Federal Agency plan to eliminate disparities and improve the Health 

of minority populations. 

Sec. 603. Accountability within the Department of Health and Human Services. 

‘‘Subtitle D—Strengthening Accountability 

‘‘Sec. 2941. Elevation of the Office of Civil Rights. 

‘‘Sec. 2942. Establishment of Health Program offices for Civil Rights 

within Federal Health and human services agencies. 

Sec. 604. Office of Minority Health. 

Sec. 605. Establishment of the Indian Health Service as an Agency of the public Health Service. 

Sec. 606. Establishment of individual offices of Minority Health within agencies 

of public Health Service. 

‘‘Sec. 1707A. Individual offices of Minority Health within public Health 

Service. 

Sec. 607. Office of Minority Health at the Centers for Medicare and Medicaid 

Services. 

Sec. 608. Office of Minority Affairs at the Food and Drug Administration. 

‘‘Sec. 908. Office of Minority Affairs. 

Sec. 609. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

‘‘Sec. 505C. Safety and effectiveness of drugs with respect to racial and 

ethnic background. 
7 

•HR 3561 IH 

Sec. 610. United States Commission on Civil Rights. 

Sec. 610A. Sense of Congress concerning full funding of activities to eliminate 

racial and ethnic Health disparities. 

Subtitle B—Minority Health and Genomics Commission 

Sec. 611. Short title. 

Sec. 612. Minority Health and Genomics Commission. 

Sec. 613. Report. 

Sec. 614. Membership. 

Sec. 615. Powers of Commission. 

Sec. 616. Termination. 

Subtitle C—Improving Environmental Justice 

Sec. 621. Definitions. 

Sec. 622. Environmental justice responsibilities of Federal agencies. 

Sec. 623. Interagency environmental justice Working Group. 

Sec. 624. Federal Agency strategies. 

Sec. 625. Federal Environmental Justice Advisory Committee. 

Sec. 626. Human Health and environmental research, data collection and analysis. 

TITLE VII—STRENGTHENING HEALTH INSTITUTIONS THAT 

PROVIDE HEALTHCARE TO MINORITY POPULATIONS 

Subtitle A—General Provisions 

Sec. 701. Amendment to the Public Health Service Act. 

‘‘Subtitle E—Strengthening Health Institutions that provide Healthcare to 

minority populations 

‘‘CHAPTER 1—GENERAL PROGRAMS

‘‘Sec. 2951. Grant support for quality improvement initiatives. 

‘‘Sec. 2951A. Centers of excellence. 

‘‘Sec. 2951B. Consultation, construction and renovation of American Indian and Alaska Native facilities; reports. 

‘‘Sec. 2951C. Reconstruction and improvement grants for Public Health 

care facilities serving Pacific Islanders and the insular 

areas. 

‘‘CHAPTER 2—NATIONAL HEALTH SAFETY NET INFRASTRUCTURE

‘‘SUBCHAPTER A—GENERAL PROVISIONS

‘‘Sec. 2952. Payments to Healthcare facilities. 

‘‘Sec. 2952A. Application for assistance. 

‘‘Sec. 2952B. Public Service responsibilities. 

‘‘Sec. 2952C. Health Safety Net Infrastructure Trust Fund. 

‘‘Sec. 2952D. Administration. 

‘‘SUBCHAPTER B—LOAN GUARANTEES

‘‘Sec. 2953. Provision of loan guarantees to safety net Healthcare facilities. 

‘‘Sec. 2953A. Eligible loans. 

‘‘Sec. 2953B. Guarantee allotments. 
8 

•HR 3561 IH 

‘‘Sec. 2953C. Terms and conditions of loan guarantees. 

‘‘Sec. 2953D. Premiums for loan guarantees. 

‘‘Sec. 2953E. Procedures in the event of loan default. 

‘‘SUBCHAPTER C—GRANTS FOR URGENT CAPITAL NEEDS

‘‘Sec. 2956. Provision of grants. 

‘‘Sec. 2956A. Eligible projects. 

Sec. 702. Establishment of Alejandro Garcia National Center for Social Work 

Research. 

‘‘PART J—ALEJANDRO GARCIA NATIONAL CENTER FOR SOCIAL WORK

RESEARCH

‘‘Sec. 597. Purpose of Center. 

‘‘Sec. 597A. Specific authorities. 

‘‘Sec. 597B. Advisory Council. 

‘‘Sec. 597C. Biennial report. 

‘‘Sec. 597D. Quarterly report. 

‘‘Sec. 597E. Authorization of appropriations. 

Sec. 703. Annie Dodge Wauneka and Susan Laflesche-Picotte Native American 

Health and Wellness Foundation. 

‘‘TITLE VIII—ANNIE DODGE WAUNEKA AND SUSAN LAFLESCHEPICOTTE NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION 

‘‘Sec. 801. Definitions. 

‘‘Sec. 802. Annie Dodge Wauneka and Susan Laflesche-Picotte Native 

American Health and Wellness Foundation. 

‘‘Sec. 803. Administrative services and support. 

Subtitle B—Rural and Underserved Urban America Telehealth Programs 

Sec. 711. Increasing types of originating telehealth sites and facilitating the 

provision of telehealth services across State lines. 

Sec. 712. Strengthening telehealth services in rural and underserved urban 

America. 

‘‘Sec. 330M. Integrative eldercare telehealth demonstration project. 

‘‘Sec. 330N. American Indian and Alaska Native telehealth demonstration 

project. 

‘‘Sec. 330O. Oral Health telehealth demonstration project. 

Sec. 713. Joint Working Group on Telehealth. 

TITLE VIII—MISCELLANEOUS PROVISIONS 

Sec. 801. Definitions. 

Sec. 802. Davis-Bacon Act. 

1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 
9 

•HR 3561 IH 

1 (1) Despite significant advances in public 

2 health and health care, the health status of racial 

3 and ethnic minority populations continues to lag be4 hind that of the white population. 

5 (2) The United States is becoming increasingly 

6 diverse. According to the 2000 United States Cen7 sus, African Americans, American Indians and Alas8 ka Natives, Asians, Hispanics, and Native Hawai9 ians and other Pacific Islanders comprise 30 percent 

10 of the United States population. Racial and ethnic 

11 minorities are expected to comprise 40 percent of 

12 the United States population by 2030. 

13 (3) To improve the health care of racial and 

14 ethnic minorities and to reduce and eliminate dis15 parities in health care and health outcomes, the fol16 lowing issues must be addressed: 

17 (A) NEED FOR INSURANCE COVERAGE.— 

18 (i) Disparities in health status can be 

19 attributed largely to underlying differences 

20 in socioeconomic status and insurance cov21 erage. Minorities are at a greater risk of 

22 being uninsured than their white counter23 parts. Lack of health insurance has con24 sistently been associated with worse health 

25 outcomes. 
10 

•HR 3561 IH 

1 (ii) Even after adjusting for dif2 ferences in socioeconomic and insurance 

3 status, however, racial and ethnic health 

4 and health care disparities remain. 

5 (iii) Through treaties and Federal 

6 statutes, the Federal Government has es7 tablished a trust responsibility to provide 

8 health care to American Indians and Alas9 ka Natives. In the Indian Health Amend10 ments of 1992, Congress specifically 

11 pledged to ‘‘assure the highest possible 

12 health status for Indians and urban Indi13 ans and to provide all resources necessary 

14 to effect that policy.’’ Despite those com15 mitments, the unmet health needs of 

16 American Indians and Alaska Natives re17 main alarmingly severe and their health 

18 status is far below the health status of the 

19 general population of the United States. 

20 The critical shortfall of funding for the In21 dian Health Service is a major source of 

22 this problem. 

23 (iv) At least 26,000,000 children in 

24 the United States lack dental coverage. 

25 These children include many from ‘‘work-
11 

•HR 3561 IH 

1 ing poor families’’ who cannot access 

2 SCHIP because they have some medical 

3 coverage. White children are 1.7 times 

4 more likely to have private dental coverage 

5 than non-white children. 

6 (v) As few as 7 States continue to 

7 provide reasonably comprehensive dental 

8 care to poor adults through Medicaid. 

9 About half the States provide no dental 

10 coverage or provide emergency services 

11 only. 

12 (B) NEED FOR CULTURALLY AND LINGUIS13 TICALLY APPROPRIATE CARE.— 

14 (i) Limited English proficiency ad15 versely affects the care of many racial and 

16 ethnic minority patients. The lack of avail17 able interpretation and translation services 

18 or bilingual providers contributes to racial 

19 and ethnic disparities in health and health 

20 care. The Federal Government provides 

21 and funds an array of services that should 

22 be made accessible to eligible persons who 

23 are not proficient in the English language. 

24 (ii) Title VI of the Civil Rights Act of 

25 1964 (42 U.S.C. 2000d et seq.) prohibits 
12 

•HR 3561 IH 

1 discrimination on the basis of race, color, 

2 and national origin in programs and activi3 ties receiving Federal financial assistance. 

4 Discrimination on the basis of primary lan5 guage has consistently been interpreted as 

6 discrimination on the basis of national ori7 gin. 

8 (iii) The provision of effective lan9 guage services has been shown to improve 

10 care for limited English proficient (re11 ferred to in this section as ‘‘LEP’’) pa12 tients by increasing patient satisfaction, 

13 access to care, compliance with rec14 ommended medical advice, and appropriate 

15 utilization. 

16 (iv) A 2002 study by the Office of 

17 Management and Budget found that lan18 guage assistance services can substantially 

19 improve the health and quality of life of 

20 LEP individuals and their families, in21 crease the efficiency of distribution of gov22 ernment services to LEP individuals, and 

23 measurably increase the effectiveness of 

24 public health and safety programs. 
13 

•HR 3561 IH 

1 (v) The same study estimated that 

2 language translation services would only 

3 increase the cost of the average health care 

4 visit by less than one percent. 

5 (vi) Increasing racial and ethnic diver6 sity among health professionals is vitally 

7 important because evidence indicates that 

8 diversity is associated with improved access 

9 to care for racial and ethnic minority pa10 tients, greater patient satisfaction, and 

11 better educational experiences for health 

12 profession students, among many other 

13 benefits. 

14 (C) NEED FOR HEALTH WORKFORCE DI15 VERSITY.— 

16 (i) Research has demonstrated that 

17 minority health professionals dramatically 

18 increase access to care for minority pa19 tients and improve the quality of care that 

20 they receive. African Americans, American 

21 Indians and Alaska Natives, Hispanics, 

22 Native Hawaiians and other Pacific Island23 ers, and Southeast Asians are significantly 

24 underrepresented in the health professions, 

25 exacerbating health disparities. 
14 

•HR 3561 IH 

1 (ii) Minority physicians are more like2 ly than white physicians to serve minority 

3 populations. Nearly 40 percent of all mi4 nority medical school graduates will prac5 tice medicine in underserved areas, com6 pared to 10 percent of their white col7 leagues. 

8 (iii) Minorities often report experi9 ences with discrimination when seeking 

10 health care. 

11 (iv) There is substantial evidence to 

12 demonstrate that race concordance be13 tween physicians and patients increases 

14 patient satisfaction and participation in 

15 health decisionmaking. 

16 (v) Minority health care providers can 

17 bridge linguistic, cultural, and other bar18 riers that hamper access to care. 

19 (vi) African Americans, Hispanics, 

20 and American Indians remain severely 

21 underrepresented in health professions 

22 schools. African Americans and Hispanics 

23 constitute 20 percent and 16 percent, re24 spectively, of the students in public health 

25 and baccalaureate nursing programs, and 
15 

•HR 3561 IH 

1 less than 15 percent of students in all 

2 other health professions. 

3 (vi) The number of minorities enroll4 ing in health professional schools has re5 mained stagnant. For example, in 1994, 

6 1,307 African American and 1,090 His7 panic students enrolled in American med8 ical colleges. In 2000, the figures were es9 sentially unchanged at 1,307 African 

10 American and 1,033 Hispanic students. 

11 (vii) While the need for a racially and 

12 ethnically diverse workforce is clear, the 

13 practitioners, faculty, and students of the 

14 fields of nursing, medicine, dentistry, psy15 chology, social work, behavioral science, 

16 and health education have yet to reflect the 

17 diversity of the Nation. 

18 (viii) In 2003, only 2 percent of prac19 ticing dentists and 3 percent of dental hy20 gienists were African-American, and only 4 

21 percent of practicing dentists and 1 per22 cent of hygienists were Hispanic. 

23 (ix) Underrepresented minority re24 cruitment into dental education is a seri25 ous problem. In 2003, the first-year enroll-
16 

•HR 3561 IH 

1 ment of underrepresented minority stu2 dents in dental school was only 11.6 per3 cent of the total first year enrollment. In 

4 1990, the percentage of underrepresented 

5 minority students in the first year class 

6 was 13.8 percent of the total first year en7 rollment. 

8 (x) Given the fact that the patients of 

9 Black dentists are 61.8 percent black and 

10 the patients of Hispanic dentists are 45.4 

11 percent Hispanic, increasing minority en12 rollment is an immediate and practical ap13 proach to addressing the problem. Only 

14 10.5 percent of Black patients are seen by 

15 white dentists. 

16 (D) NEED FOR REDUCTION OF DISEASE

17 OCCURRENCE AND DISEASE-RELATED COM18 PLICATIONS AMONG MINORITIES.— 

19 (i) Despite notable progress in the 

20 overall health of the Nation, there are con21 tinuing disparities in the burden of illness 

22 and death experienced by minorities com23 pared to the United States population as a 

24 whole. Minority populations are dispropor-
17 

•HR 3561 IH 

1 tionately impacted by acute and chronic 

2 diseases. 

3 (ii) In 2000, 6 of the 10 leading 

4 causes of death for all age groups in this 

5 country were behaviorally based. In addi6 tion, many modifiable behavioral factors 

7 are now known to increase an individual’s 

8 risk for disease and physical disability, rep9 resenting the largest amount of prevent10 able healthcare expenses. 

11 (iii) Despite suffering a greater bur12 den of acute and chronic disease, minori13 ties are less likely to receive needed health 

14 care. Numerous studies have documented 

15 that minorities receive less preventive care, 

16 medical therapy, and surgical interven17 tions. 

18 (iv) Culturally appropriate, commu19 nity-driven programs are essential to elimi20 nating health disparities. To be successful, 

21 these programs need to be based on sound 

22 prevention research and supported by new 

23 and innovative partnerships among govern24 ments, businesses, faith-based organiza25 tions, and communities. 
18 

•HR 3561 IH 

1 (v) Parents reported seeking care for 

2 relief of their child’s pain for 10 percent of 

3 white children, 16 percent of Black chil4 dren, and 17 percent of Hispanic children. 

5 Parents of American Indian and Alaska 

6 Native schoolchildren report that one third 

7 miss school because of dental pain each 

8 year. They also report that 1 in 4 avoid 

9 laughing or smiling and 1 in 5 avoid meet10 ing other people because of the way their 

11 teeth look. 

12 (vi) Five-year survival statistics for 

13 Blacks are poorer at 33 percent versus 55 

14 percent for whites. 

15 (vii) Hispanic adults are twice as like16 ly, Black adults 3 times as likely, and 

17 Asian adults 4 times as likely as whites to 

18 report missed work or missed school be19 cause of a dental problem. 

20 (E) NEED FOR MINORITY HEALTH DATA

21 COLLECTION AND REPORTING.— 

22 (i) Efforts to study disparities in 

23 health and health care for minorities have 

24 been hampered by the lack of available 
19 

•HR 3561 IH 

1 data on race, ethnicity, and primary lan2 guage. 

3 (ii) Data collection, analysis, and re4 porting by race, ethnicity, and primary lan5 guage is permissible under the law and 

6 necessary to assure equity and non7 discrimination in the quality of health care 

8 services. Collection, analysis, and reporting 

9 of such data is authorized under Title VI 

10 of the Civil Rights Act of 1964 (42 U.S.C. 

11 2000d et seq.). Such collection, analysis, 

12 and reporting should be conducted with ap13 propriate privacy protections in place. 

14 (F) NEED FOR GREATER ACCOUNTABILITY

15 IN GOVERNMENT INSTITUTIONS.—A number of 

16 studies have shown that differences in health 

17 care quality contribute to health disparities 

18 among minority populations. These differences 

19 may result from bias, stereotyping, and dis20 crimination. Government institutions must be 

21 held accountable for the quality of health care 

22 delivered to all patient populations and result23 ant health outcomes. 

24 (G) NEED FOR EQUITABLE SOCIO25 ECONOMIC POLICIES.—Literature suggests that 
20 

•HR 3561 IH 

1 equitable socioeconomic policies are needed to 

2 improve the health status of racial and ethnic 

3 minorities and economically disadvantaged pop4 ulations. 

5 (H) NEED FOR STRENGTHENING HEALTH

6 INSTITUTIONS THAT PROVIDE CARE TO MINOR7 ITY POPULATIONS.— 

8 (i) A small segment of health care in9 stitutions provide a disproportionate 

10 amount of health care to minority popu11 lations. 

12 (ii) Safety net institutions, including 

13 public hospitals, community health centers 

14 and community clinics, provide a dis15 proportionate share of health care to mi16 nority and underserved populations. 

17 (iii) Financial stress, negative oper18 ating margins, and the overall burden of 

19 caring for the uninsured and delivering 

20 high-cost specialty care to the entire com21 munity place undue pressure on core safety 

22 net providers. These providers are increas23 ingly challenged in their ability to meet the 

24 day-to-day needs of their patients. 
21 

•HR 3561 IH 

1 (b) PURPOSES.—It is the purpose of this Act to im2 prove the health and healthcare of minority populations 

3 and to eliminate racial and ethnic disparities in health and 

4 healthcare by— 

5 (1) increasing access to health care for all pop6 ulations; 

7 (2) expanding culturally and linguistically ap8 propriate health services for all populations; 

9 (3) promoting health workforce diversity; 

10 (4) supporting and expanding programs and ac11 tivities that will improve the prevention, diagnosis, 

12 and management of disease in minority populations; 

13 (5) enhancing racial, ethnic, and primary lan14 guage health data collection at the local, State, and 

15 Federal level; 

16 (6) ensuring accountability for the quality of 

17 health care and health outcomes for minority popu18 lations; and 

19 (7) strengthening the technical and financial re20 sources of the safety net institutions of the United 

21 States. 
22 

•HR 3561 IH 

1 TITLE I—COVERAGE OF THE 

2 UNINSURED 

3 Subtitle A—FamilyCare 

4 SEC. 101. SHORT TITLE. 

5 This subtitle may be cited as the ‘‘FamilyCare Act 

6 of 2005’’. 

7 SEC. 102. RENAMING OF TITLE XXI PROGRAM. 

8 (a) IN GENERAL.—The heading of title XXI of the 

9 Social Security Act (42 U.S.C. 1397aa et seq.) is amended 

10 to read as follows: 

11 ‘‘TITLE XXI—FAMILYCARE 

12 PROGRAM’’. 

13 (b) PROGRAM REFERENCES.—Any reference in any 

14 provision of Federal law or regulation to ‘‘SCHIP’’ or 

15 ‘‘State children’s health insurance program’’ under title 

16 XXI of the Social Security Act shall be deemed a reference 

17 to the FamilyCare program under such title. 

18 SEC. 103. FAMILYCARE COVERAGE OF PARENTS UNDER 

19 THE MEDICAID PROGRAM AND TITLE XXI. 

20 (a) INCENTIVES TO IMPLEMENT FAMILYCARE COV21 ERAGE.— 

22 (1) UNDER MEDICAID.— 

23 (A) ESTABLISHMENT OF NEW OPTIONAL

24 ELIGIBILITY CATEGORY.—Section 1902(a)(10) 
23 

•HR 3561 IH 

1 (A)(ii) of the Social Security Act (42 U.S.C. 

2 1396a(a)(10)(A)(ii)) is amended— 

3 (i) by striking ‘‘or’’ at the end of sub4 clause (XVII); 

5 (ii) by adding ‘‘or’’ at the end of sub6 clause (XVIII); and 

7 (iii) by adding at the end the fol8 lowing: 

9 ‘‘(XIX) who are individuals de10 scribed in subsection (k)(1) (relating 

11 to parents of categorically eligible chil12 dren);’’. 

13 (B) PARENTS DESCRIBED.—Section 1902 

14 of the Social Security Act is further amended 

15 by inserting after subsection (j) the following: 

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

17 are individuals— 

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

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

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

21 and who is eligible for medical assistance under sub22 section (a)(10)(A); 

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

24 assistance under such subsection or under a waiver 

25 approved under section 1115 or otherwise (except 
24 

•HR 3561 IH 

1 under section 1931 or under subsection 

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

3 ‘‘(iii) whose family income or resources exceeds 

4 the effective income level or resource level applicable 

5 under the State plan under part A of title IV as in 

6 effect as of July 16, 1996, but does not exceed the 

7 highest effective income or resource level (if any) ap8 plicable to a child in the family under this title. 

9 ‘‘(B) In establishing an income eligibility level for in10 dividuals described in this paragraph, a State may vary 

11 such level consistent with the various income levels estab12 lished under subsection (l)(2) in order to ensure, to the 

13 maximum extent possible, that such individuals shall be 

14 enrolled in the same program as their children. 

15 ‘‘(C) An individual may not be treated as being de16 scribed in this paragraph unless, at the time of the individ17 ual’s enrollment under this title, the child referred to in 

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

19 under this title or otherwise insured. 

20 ‘‘(D) In this subsection, the term ‘parent’ includes 

21 an individual treated as a caretaker for purposes of car22 rying out section 1931. 

23 ‘‘(E) In this subsection, the term ‘effective income 

24 level’ means the income level expressed as a percent of 
25 

•HR 3561 IH 

1 the poverty line and considering applicable income dis2 regards. 

3 ‘‘(2) The State shall provide for coverage of a parent 

4 described in paragraph (1) or section 2111 of a child who 

5 is covered under this title or title XXI under the same 

6 title as the title as such child is covered. In the case of 

7 a parent described in paragraph (1) who is also the parent 

8 of a child who is eligible for child health assistance under 

9 title XXI, the State may elect (on a uniform basis) to 

10 cover all such parents under section 2111 or under this 

11 title.’’. 

12 (C) ENHANCED MATCHING FUNDS AVAIL13 ABLE IF CERTAIN CONDITIONS MET.—Section 

14 1905 of the Social Security Act (42 U.S.C. 

15 1396d) is amended— 

16 (i) in the fourth sentence of sub17 section (b), by striking ‘‘or subsection 

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

19 and 

20 (ii) in subsection (u)— 

21 (I) by redesignating paragraph 

22 (4) as paragraph (6), and 

23 (II) by inserting after paragraph 

24 (3) the following: 
26 

•HR 3561 IH 

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

2 2105(a)(1): 

3 ‘‘(A) FAMILYCARE PARENTS.—The expendi4 tures described in this subparagraph are the expend5 itures described in the following clauses (i) and (ii): 

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

7 in clauses (iii) and (iv) are met, expenditures 

8 for medical assistance for parents described in 

9 section 1902(k)(1) and for parents who would 

10 be described in such section but for the fact 

11 that they are eligible for medical assistance 

12 under section 1931 or under a waiver approved 

13 under section 1115. 

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

15 conditions described in clause (v) are met, ex16 penditures for medical assistance for pregnant 

17 women described in subsection (n) or under sec18 tion 1902(l)(1)(A) in a family the income of 

19 which exceeds the effective income level applica20 ble under subsection (a)(10)(A)(i)(III) or 

21 (l)(2)(A) of section 1902 to a family of the size 

22 involved as of January 1, 2006. 

23 ‘‘(iii) CONDITIONS RELATING TO ENSURING

24 CHILDREN’S COVERAGE FOR ENHANCED MATCH
27 

•HR 3561 IH 

1 FOR PARENTS.—The conditions described in 

2 this clause are the following: 

3 ‘‘(I) The State has a State child 

4 health plan under title XXI which (wheth5 er implemented under such title or under 

6 this title) has an effective income level for 

7 children that is at least 200 percent of the 

8 poverty line. 

9 ‘‘(II) Such State child health plan 

10 does not limit the acceptance of applica11 tions, does not use a waiting list for chil12 dren who meet eligibility standards to 

13 qualify for assistance, and provides bene14 fits to all children in the State who apply 

15 for and meet eligibility standards. 

16 ‘‘(III) Effective for determinations of 

17 eligibility made on or after the date that is 

18 1 year after the date of the enactment of 

19 this clause, the application and renewal 

20 procedures for individuals under 19 years 

21 of age (or such higher age as the State has 

22 elected under section 1902(l)(1)(D)) for 

23 medical assistance under section 

24 1902(a)(10)(A) are not be more restrictive 

25 or burdensome than such procedures used 
28 

•HR 3561 IH 

1 for children with higher income under the 

2 State child health plan under title XXI. 

3 ‘‘(iv) CONDITIONS RELATING TO MINIMUM

4 COVERAGE FOR PARENTS FOR ENHANCED

5 MATCH FOR PARENTS.—The conditions de6 scribed in this clause are the following: 

7 ‘‘(I) The State does not apply an in8 come level for parents that is lower than 

9 the effective income level (expressed as a 

10 percent of the poverty line) that has been 

11 specified under the State plan under title 

12 XIX (including under a waiver authorized 

13 by the Secretary or under section 

14 1902(r)(2)), as of January 1, 2006, to be 

15 eligible for medical assistance as a parent 

16 under this title. 

17 ‘‘(II) The State plans under this title 

18 and title XXI do not provide coverage for 

19 parents with higher family income without 

20 covering parents with a lower family in21 come. 

22 ‘‘(v) CONDITIONS FOR ENHANCED MATCH

23 FOR CERTAIN PREGNANT WOMEN.—The condi24 tions described in this clause are the following: 
29 

•HR 3561 IH 

1 ‘‘(I) The State has established an ef2 fective income eligibility level for pregnant 

3 women under subsection (a)(10)(A)(i)(III) 

4 or (l)(2)(A) of section 1902 that is at least 

5 185 percent of the poverty line. 

6 ‘‘(II) The State plans under this title 

7 and title XXI do not provide coverage for 

8 pregnant women described in subpara9 graph (A)(ii) with higher family income 

10 without covering such pregnant women 

11 with a lower family income. 

12 ‘‘(III) The State does not apply an in13 come level for pregnant women that is 

14 lower than the effective income level that 

15 has been specified under the State plan 

16 under subsection (a)(10)(A)(i)(III) or 

17 (l)(2)(A) of section 1902, as of January 1, 

18 2006, to be eligible for medical assistance 

19 as a pregnant woman. 

20 ‘‘(IV) The State satisfies the condi21 tions described in subclauses (I) and (II) 

22 of clause (iii). 

23 ‘‘(vi) DEFINITIONS.—For purposes of this 

24 subsection: 
30 

•HR 3561 IH 

1 ‘‘(I) The term ‘parent’ has the mean2 ing given such term for purposes of section 

3 1902(k)(1). 

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

5 meaning given such term in section 

6 2110(c)(5).’’. 

7 (D) APPROPRIATION FROM TITLE XXI AL8 LOTMENT FOR CERTAIN MEDICAID EXPANSION

9 COSTS.—Section 2105(a) of the Social Security 

10 Act (42 U.S.C. 1397ee(a)) is amended— 

11 (i) in paragraph (1), by redesignating 

12 subparagraphs (B) through (D) as sub13 paragraphs (C) through (E), respectively, 

14 and by inserting after subparagraph (A) 

15 the following new subparagraph: 

16 ‘‘(B) for medical assistance that is attrib17 utable to expenditures described in section 

18 1905(u)(4)(A);’’; and 

19 (ii) in paragraph (2), by adding at the 

20 end the following new subparagraph: 

21 ‘‘(E) Fifth, for expenditures for items de22 scribed in paragraph (1)(E).’’. 

23 (2) UNDER TITLE XXI.— 

24 (A) FAMILYCARE COVERAGE.—Title XXI 

25 of the Social Security Act (42 U.S.C. 1397aa et 
31 

•HR 3561 IH 

1 seq.) is amended by adding at the end the fol2 lowing: 

3 ‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR4 ENTS OF TARGETED LOW-INCOME CHILDREN. 

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

6 other provision of this title, a State may provide for cov7 erage, through an amendment to its State child health 

8 plan under section 2102, of parent health assistance for 

9 targeted low-income parents, health care assistance for 

10 targeted low-income pregnant women, or both, in accord11 ance with this section, but only if— 

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

13 health assistance, the State meets the conditions de14 scribed in clause (iii) of section 1905(u)(4)(A); 

15 ‘‘(2) with respect to the provision of health care 

16 assistance for pregnant women, the State meets the 

17 conditions described in clause (iv) of section 

18 1905(u)(4)(A); and 

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

20 targeted low-income parents, the State elects to pro21 vide medical assistance under section 

22 1902(a)(10)(A)(ii)(XIX), under section 1931, or 

23 under a waiver under section 1115 to individuals de24 scribed in section 1902(k)(1)(A)(i) and elects an ef25 fective income level that, consistent with paragraphs 
32 

•HR 3561 IH 

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

2 maximum extent possible, that such individuals shall 

3 be enrolled in the same program as their children if 

4 their children are eligible for coverage under title 

5 XIX (including under a waiver authorized by the 

6 Secretary or under section 1902(r)(2)). 

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

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

9 ‘parent health assistance’ has the meaning given the 

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

11 any reference to targeted low-income children were 

12 a reference to targeted low-income parents. 

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

14 meaning given the term ‘caretaker relative’ for pur15 poses of carrying out section 1931. 

16 ‘‘(3) HEALTH CARE ASSISTANCE FOR PREG17 NANT WOMEN.—The term ‘health care assistance for 

18 pregnant women’ has the meaning given the term 

19 child health assistance in section 2110(a) as if any 

20 reference to targeted low-income children were a ref21 erence to targeted low-income pregnant women. 

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

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

24 given the term targeted low-income child in section 

25 2110(b) as if the reference to a child were deemed 
33 

•HR 3561 IH 

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

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

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

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

7 ‘‘(B) in paragraph (3), January 1, 2006, 

8 shall be substituted for July 1, 1997; and 

9 ‘‘(C) in paragraph (4), January 1, 2006, 

10 shall be substituted for March 31, 1997. 

11 ‘‘(5) TARGETED LOW-INCOME PREGNANT

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

13 woman’ has the meaning given the term targeted 

14 low-income child in section 2110(b) as if any ref15 erence to a child were a reference to a woman dur16 ing pregnancy and through the end of the month in 

17 which the 60-day period beginning on the last day 

18 of her pregnancy ends; except that in applying such 

19 section— 

20 ‘‘(A) there shall be substituted for the in21 come level described in paragraph (1)(B)(ii)(I) 

22 the applicable income level in effect for a tar23 geted low-income child; 

24 ‘‘(B) in paragraph (3), January 1, 2006, 

25 shall be substituted for July 1, 1997; and 
34 

•HR 3561 IH 

1 ‘‘(C) in paragraph (4), January 1, 2006, 

2 shall be substituted for March 31, 1997. 

3 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

4 RULES.—In the case of, and with respect to, a State pro5 viding for coverage of parent health assistance to targeted 

6 low-income parents or health care assistance to targeted 

7 low-income pregnant women under subsection (a), the fol8 lowing special rules apply: 

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

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

11 deemed to include a reference to a targeted low-in12 come parent or a targeted low-income pregnant 

13 woman (as applicable). 

14 ‘‘(2) Any such reference to child health assist15 ance— 

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

17 deemed a reference to parent health assistance; 

18 and 

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

20 is deemed a reference to health care assistance 

21 for pregnant women. 

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

23 case of a family (consisting of a parent and one or 

24 more children) provided coverage under this section 

25 or a pregnant woman provided coverage under this 
35 

•HR 3561 IH 

1 section without covering other family members, the 

2 limitation on total annual aggregate cost-sharing 

3 shall be applied to such entire family or such preg4 nant woman, respectively. 

5 ‘‘(4) In applying section 2110(b)(4), any ref6 erence to ‘section 1902(l)(2) or 1905(n)(2) (as se7 lected by a State)’ is deemed a reference to the ef8 fective income level applicable to parents under sec9 tion 1931 or under a waiver approved under section 

10 1115, or, in the case of a pregnant woman, the in11 come level established under section 1902(l)(2)(A). 

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

13 reference to children found through screening to be 

14 eligible for medical assistance under the State med15 icaid plan under title XIX is deemed a reference to 

16 parents and pregnant women.’’. 

17 (B) ADDITIONAL ALLOTMENT FOR STATES

18 PROVIDING FAMILYCARE.— 

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

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

21 amended by inserting after subsection (c) 

22 the following: 

23 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO24 VIDING FAMILYCARE.— 
36 

•HR 3561 IH 

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

2 For the purpose of providing additional allotments 

3 to States to provide FamilyCare coverage under sec4 tion 2111, there is appropriated, out of any money 

5 in the Treasury not otherwise appropriated— 

6 ‘‘(A) for fiscal year 2006, $2,000,000,000; 

7 ‘‘(B) for fiscal year 2007, $2,000,000,000; 

8 ‘‘(C) for fiscal year 2008, $3,000,000,000; 

9 and 

10 ‘‘(D) for fiscal year 2009, $3,000,000,000. 

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

12 ‘‘(A) IN GENERAL.—In addition to the al13 lotments provided under subsections (b) and 

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

15 amount available for the additional allotments 

16 under paragraph (1) for a fiscal year, the Sec17 retary shall allot to each State with a State 

18 child health plan approved under this title— 

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

20 than a commonwealth or territory de21 scribed in clause (ii), the same proportion 

22 as the proportion of the State’s allotment 

23 under subsection (b) (determined without 

24 regard to subsection (f)) to 98.95 percent 

25 of the total amount of the allotments 
37 

•HR 3561 IH 

1 under such section for such States eligible 

2 for an allotment under this subparagraph 

3 for such fiscal year; and 

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

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

6 same proportion as the proportion of the 

7 commonwealth’s or territory’s allotment 

8 under subsection (c) (determined without 

9 regard to subsection (f)) to 1.05 percent of 

10 the total amount of the allotments under 

11 such section for commonwealths and terri12 tories eligible for an allotment under this 

13 subparagraph for such fiscal year. 

14 ‘‘(B) AVAILABILITY AND REDISTRIBUTION

15 OF UNUSED ALLOTMENTS.—In applying sub16 sections (e) and (f) with respect to additional 

17 allotments made available under this subsection, 

18 the procedures established under such sub19 sections shall ensure such additional allotments 

20 are only made available to States which have 

21 elected to provide coverage under section 2111. 

22 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi23 tional allotments provided under this subsection are 

24 not available for amounts expended before October 

25 1, 2007. Such amounts are available for amounts ex-
38 

•HR 3561 IH 

1 pended on or after such date for child health assist2 ance for targeted low-income children, as well as for 

3 parent health assistance for targeted low-income 

4 parents, and health care assistance for targeted low5 income pregnant women. 

6 ‘‘(4) REQUIRING ELECTION TO PROVIDE COV7 ERAGE.—No payments may be made to a State 

8 under this title from an allotment provided under 

9 this subsection unless the State has made an elec10 tion to provide parent health assistance for targeted 

11 low-income parents, or health care assistance for 

12 targeted low-income pregnant women.’’. 

13 (ii) CONFORMING AMENDMENTS.— 

14 Section 2104 of the Social Security Act 

15 (42 U.S.C. 1397dd) is amended— 

16 (I) in subsection (a), by inserting 

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

18 ‘‘under this section,’’; 

19 (II) in subsection (b)(1), by in20 serting ‘‘and subsection (d)’’ after 

21 ‘‘Subject to paragraph (4)’’; and 

22 (III) in subsection (c)(1), by in23 serting ‘‘subject to subsection (d),’’ 

24 after ‘‘for a fiscal year,’’. 
39 

•HR 3561 IH 

1 (C) NO COST-SHARING FOR PREGNANCY2 RELATED BENEFITS.—Section 2103(e)(2) of 

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

4 1397cc(e)(2)) is amended— 

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

6 PREGNANCY-RELATED SERVICES’’ after 

7 ‘‘PREVENTIVE SERVICES’’; and 

8 (ii) by inserting before the period at 

9 the end the following: ‘‘and for pregnancy10 related services’’. 

11 (3) EFFECTIVE DATE.—The amendments made 

12 by this subsection apply to items and services fur13 nished on or after October 1, 2007, whether or not 

14 regulations implementing such amendments have 

15 been issued. 

16 (b) RULES FOR IMPLEMENTATION BEGINNING WITH

17 FISCAL YEAR 2007.— 

18 (1) EXPANSION OF AVAILABILITY OF EN19 HANCED MATCH UNDER MEDICAID FOR PRE-CHIP

20 EXPANSIONS.—Paragraph (4) of section 1905(u) of 

21 the Social Security Act (42 U.S.C. 1396d(u)), as in22 serted by subsection (a)(1)(C), is amended— 

23 (A) by amending clause (ii) of subpara24 graph (A) to read as follows: 
40 

•HR 3561 IH 

1 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex2 penditures for medical assistance for pregnant 

3 women under section 1902(l)(1)(A) in a family 

4 the income of which exceeds the 133 percent of 

5 the income official poverty line, but only if the 

6 income level established under section 

7 1902(l)(2) (or under a Statewide waiver under 

8 section 1115) for pregnant women is 185 per9 cent of the income official poverty line.’’; and 

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

11 ‘‘(B) CHILDREN IN FAMILIES WITH INCOME

12 ABOVE MEDICAID MANDATORY LEVEL NOT PRE13 VIOUSLY DESCRIBED.—The expenditures described 

14 in this subparagraph are expenditures (other than 

15 expenditures described in paragraph (2) or (3)) for 

16 medical assistance made available to any child who 

17 is eligible for assistance under section 

18 1902(a)(10)(A) (other than under clause (i)) and 

19 the income of whose family exceeds the minimum in20 come level required under subsection 1902(l)(2) (or, 

21 if higher, the minimum level required under section 

22 1931 for that State) for a child of the age involved 

23 (treating any child who is 19 or 20 years of age as 

24 being 18 years of age).’’. 
41 

•HR 3561 IH 

1 (2) OFFSET OF ADDITIONAL EXPENDITURES

2 FOR ENHANCED MATCH FOR PRE-CHIP EXPAN3 SION.—Section 1905 of the Social Security Act (42 

4 U.S.C. 1396d) is amended— 

5 (A) in the fourth sentence of subsection 

6 (b), by inserting ‘‘(except in the case of expend7 itures described in subsection (u)(5))’’ after ‘‘do 

8 not exceed’’; 

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

10 paragraph (4) (as inserted by subparagraph 

11 (C)), the following: 

12 ‘‘(5) For purposes of the fourth sentence of sub13 section (b) and section 2105(a), the following payments 

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

15 under section 2104: 

16 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

17 PREGNANT WOMEN WITH INCOME ABOVE 133 PER18 CENT OF POVERTY.—The portion of the payments 

19 made for expenditures described in paragraph 

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

21 have been paid if the enhanced FMAP had not been 

22 substituted for the Federal medical assistance per23 centage. 

24 ‘‘(B) FAMILYCARE PARENTS.—Payments for 

25 expenditures described in paragraph (4)(A)(i). 
42 

•HR 3561 IH 

1 ‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR

2 CERTAIN CHILDREN IN FAMILIES WITH INCOME

3 ABOVE MEDICAID MANDATORY LEVEL.—The portion 

4 of the payments made for expenditures described in 

5 paragraph (4)(B) that represents the amount that 

6 would have been paid if the enhanced FMAP had 

7 not been substituted for the Federal medical assist8 ance percentage.’’. 

9 (3) CONFORMING AMENDMENTS.—Subpara10 graph (B) of section 2105(a)(1) of the Social Secu11 rity Act, as amended by subsection (a)(1)(D), is 

12 amended to read as follows: 

13 ‘‘(B) CERTAIN FAMILYCARE PARENTS AND

14 OTHERS.—Expenditures for medical assistance 

15 that is attributable to expenditures described in 

16 section 1905(u)(4), except as provided in sec17 tion 1905(u)(5).’’. 

18 (4) EFFECTIVE DATE.—The amendments made 

19 by this subsection apply as of October 1, 2006, to 

20 fiscal years beginning on or after such date and to 

21 expenditures under the State plan on and after such 

22 date, whether or not regulations implementing such 

23 amendments have been issued. 

24 (c) GAO STUDY.— 
43 

•HR 3561 IH 

1 (1) STUDY.—The Comptroller General of the 

2 United States shall conduct a study regarding fund3 ing under title XXI of the Social Security Act that 

4 examines— 

5 (A) the adequacy of overall funding under 

6 such title; 

7 (B) the formula for determining allotments 

8 and for redistribution of unspent funds under 

9 such title; and 

10 (C) the effect of waiting lists and caps on 

11 enrollment under such title. 

12 (2) REPORT.—Not later than July 1, 2007, the 

13 Comptroller General shall submit a report on the 

14 study conducted under paragraph (1). Such report 

15 shall include recommendations regarding a better 

16 mechanism for determining State allotments and re17 distribution of unspent funds under such title in 

18 order to ensure all eligible families in need can ac19 cess coverage through such title. 

20 (d) CONFORMING AMENDMENTS.— 

21 (1) ELIGIBILITY CATEGORIES.—Section 

22 1905(a) of the Social Security Act (42 U.S.C. 

23 1396d(a)) is amended, in the matter before para24 graph (1)— 
44 

•HR 3561 IH 

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

2 (xii); 

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

4 (xiii); and 

5 (C) by inserting after clause (xiii) the fol6 lowing: 

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

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

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

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

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

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

13 (3) CONFORMING AMENDMENT RELATING TO

14 NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec15 tion 2102(b)(1)(B) of the Social Security Act (42 

16 U.S.C. 1397bb(b)(1)(B)) is amended— 

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

18 clause (i) and inserting a semicolon; 

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

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

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

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

23 (including a waiting period to carry out 

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

25 low-income parent who is pregnant.’’. 
45 

•HR 3561 IH 

1 SEC. 104. AUTOMATIC ENROLLMENT OF CHILDREN BORN 

2 TO TITLE XXI PARENTS. 

3 Section 2102(b)(1) of the Social Security Act (42 

4 U.S.C. 1397bb(b)(1)) is amended by adding at the end 

5 the following: 

6 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL7 DREN BORN TO A PARENT BEING PROVIDED

8 FAMILYCARE.—Such eligibility standards shall 

9 provide for automatic coverage of a child born 

10 to an individual who is provided assistance 

11 under this title in the same manner as medical 

12 assistance would be provided under section 

13 1902(e)(4) to a child described in such sec14 tion.’’. 

15 SEC. 105. OPTIONAL COVERAGE OF CHILDREN THROUGH 

16 AGE 20 UNDER THE MEDICAID PROGRAM AND 

17 TITLE XXI. 

18 (a) MEDICAID.— 

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

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

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

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

23 age’’. 

24 (2) CONFORMING AMENDMENTS.— 

25 (A) Section 1902(e)(3)(A) of the Social Se26 curity Act (42 U.S.C. 1396a(e)(3)(A)) is 
46 

•HR 3561 IH 

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

2 age the State has elected under subsection 

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

4 (B) Section 1902(e)(12) of the Social Se5 curity Act (42 U.S.C. 1396a(e)(12)) is amend6 ed by inserting ‘‘or such higher age as the State 

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

8 ‘‘19 years of age’’. 

9 (C) Section 1920A(b)(1) of the Social Se10 curity Act (42 U.S.C. 1396r–1a(b)(1)) is 

11 amended by inserting ‘‘or such higher age as 

12 the State has elected under section 

13 1902(l)(1)(D)’’ after ‘‘19 years of age’’. 

14 (D) Section 1928(h)(1) of the Social Secu15 rity Act (42 U.S.C. 1396s(h)(1)) is amended by 

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

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

18 the period at the end. 

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

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

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

22 the State has elected under section 

23 1902(l)(1)(D))’’ after ‘‘19 years of age’’. 

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

25 Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in-
47 

•HR 3561 IH 

1 serting ‘‘(or such higher age as the State has elected under 

2 section 1902(l)(1)(D))’’. 

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

4 this section take effect on January 1, 2006, and apply to 

5 medical assistance and child health assistance provided on 

6 or after such date, whether or not regulations imple7 menting such amendments have been issued. 

8 SEC. 106. ALLOWING STATES TO SIMPLIFY RULES FOR FAM9 ILIES. 

10 (a) PRESUMPTIVE ELIGIBILITY.— 

11 (1) APPLICATION TO PRESUMPTIVE ELIGIBILITY

12 FOR PREGNANT WOMEN UNDER MEDICAID.—Section 

13 1920(b) of the Social Security Act (42 U.S.C. 

14 1396r–1(b)) is amended by adding at the end after 

15 and below paragraph (2) the following flush sen16 tence: ‘‘The term ‘qualified provider’ includes a 

17 qualified entity as defined in section 1920A(b)(3).’’. 

18 (2) OPTIONAL APPLICATION OF PRESUMPTIVE

19 ELIGIBILITY PROVISIONS TO PARENTS.—Section 

20 1920A of the Social Security Act (42 U.S.C. 1396r– 

21 1a) is amended by adding at the end the following: 

22 ‘‘(e) A State may elect to apply the previous provi23 sions of this section to provide for a period of presumptive 

24 eligibility for medical assistance for a parent of a child 
48 

•HR 3561 IH 

1 with respect to whom such a period is provided under this 

2 section.’’. 

3 (3) APPLICATION UNDER TITLE XXI.—Section 

4 2107(e)(1)(D) of the Social Security Act (42 U.S.C. 

5 1397gg(e)(1)) is amended to read as follows: 

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

7 presumptive eligibility).’’. 

8 (b) 12-MONTHS CONTINUOUS ELIGIBILITY.— 

9 (1) MEDICAID.—Section 1902(e)(12) of the So10 cial Security Act (42 U.S.C. 1396a(e)(12)) is 

11 amended— 

12 (A) by striking ‘‘At the option of the State, 

13 the plan may’’ and inserting ‘‘The plan shall’’; 

14 (B) by striking ‘‘an age specified by the 

15 State (not to exceed 19 years of age)’’ and in16 serting ‘‘19 years of age (or such higher age as 

17 the State has elected under subsection 

18 (l)(1)(D)) or, at the option of the State, who is 

19 eligible for medical assistance as the parent of 

20 such a child’’; and 

21 (C) in subparagraph (A), by striking ‘‘a 

22 period (not to exceed 12 months) ’’ and insert23 ing ‘‘the 12-month period beginning on the 

24 date’’. 
49 

•HR 3561 IH 

1 (2) TITLE XXI.—Section 2102(b)(2) of such 

2 Act (42 U.S.C. 1397bb(b)(2)) is amended by adding 

3 at the end the following: ‘‘Such methods shall pro4 vide continuous eligibility for children under this 

5 title in a manner that is no less generous than the 

6 12-months continuous eligibility provided under sec7 tion 1902(e)(12) for children described in such sec8 tion under title XIX. If a State has elected to apply 

9 section 1902(e)(12) to parents, such methods may 

10 provide continuous eligibility for parents under this 

11 title in a manner that is no less generous than the 

12 12-months continuous eligibility provided under such 

13 section for parents described in such section under 

14 title XIX.’’. 

15 (3) EFFECTIVE DATE.—The amendments made 

16 by this subsection shall take effect on July 1, 2006 

17 (or, if later, 60 days after the date of the enactment 

18 of this Act), whether or not regulations imple19 menting such amendments have been issued. 

20 (c) PROVISION OF MEDICAID AND CHIP APPLICA21 TIONS AND INFORMATION UNDER THE SCHOOL LUNCH

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

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

24 amended— 
50 

•HR 3561 IH 

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

2 ‘‘(B)(i) Applications’’; and 

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

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

5 lunches that are distributed pursuant to clause (i) to par6 ents or guardians of children in attendance at schools par7 ticipating in the school lunch program under this Act shall 

8 also contain information on the availability of medical as9 sistance under title XIX of the Social Security Act (42 

10 U.S.C. 1396 et seq.) and of child health and FamilyCare 

11 assistance under title XXI of such Act, including informa12 tion on how to obtain an application for assistance under 

13 such programs. 

14 ‘‘(II) Information on the programs referred to in sub15 clause (I) shall be provided on a form separate from the 

16 application form for free and reduced price lunches under 

17 clause (i).’’. 

18 SEC. 107. DEMONSTRATION PROGRAMS TO IMPROVE MED19 ICAID AND CHIP OUTREACH TO HOMELESS 

20 INDIVIDUALS AND FAMILIES. 

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

22 Human Services may award demonstration grants to not 

23 more than 7 States (or other qualified entities) to conduct 

24 innovative programs that are designed to improve out25 reach to homeless individuals and families under the pro-
51 

•HR 3561 IH 

1 grams described in subsection (b) with respect to enroll2 ment of such individuals and families under such pro3 grams and the provision of services (and coordinating the 

4 provision of such services) under such programs. 

5 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The 

6 programs described in this subsection are as follows: 

7 (1) MEDICAID.—The program under title XIX 

8 of the Social Security Act (42 U.S.C. 1396 et seq.). 

9 (2) CHIP.—The program under title XXI of 

10 the Social Security Act (42 U.S.C. 1397aa et seq.). 

11 (3) TANF.—The program under part of A of 

12 title IV of the Social Security Act (42 U.S.C. 601 

13 et seq.). 

14 (4) SAMHSA BLOCK GRANTS.—The program 

15 of grants under part B of title XIX of the Public 

16 Health Service Act (42 U.S.C. 300x–1 et seq.). 

17 (5) FOOD STAMP PROGRAM.—The program 

18 under the Food Stamp Act of 1977 (7 U.S.C. 2011 

19 et seq.). 

20 (6) WORKFORCE INVESTMENT ACT.—The pro21 gram under the Workforce Investment Act of 1999 

22 (29 U.S.C. 2801 et seq.). 

23 (7) WELFARE-TO-WORK.—The welfare-to-work 

24 program under section 403(a)(5) of the Social Secu25 rity Act (42 U.S.C. 603(a)(5)). 
52 

•HR 3561 IH 

1 (8) OTHER PROGRAMS.—Other public and pri2 vate benefit programs that serve low-income individ3 uals. 

4 (c) APPROPRIATIONS.—For the purposes of carrying 

5 out this section, there is appropriated for fiscal year 2006, 

6 out of any funds in the Treasury not otherwise appro7 priated, $10,000,000, to remain available until expended. 

8 SEC. 108. ADDITIONAL CHIP REVISIONS. 

9 (a) LIMITING COST-SHARING TO 2.5 PERCENT FOR

10 FAMILIES WITH INCOME BELOW 150 PERCENT OF POV11 ERTY.—Section 2103(e)(3)(A) of the Social Security Act 

12 (42 U.S.C. 1397cc(e)(3)(A)) is amended— 

13 (1) by striking ‘‘and’’ at the end of clause (i); 

14 (2) by striking the period at the end of clause 

15 (ii) and inserting ‘‘; and’’; and 

16 (3) by adding at the end the following new 

17 clause: 

18 ‘‘(iii) total annual aggregate cost19 sharing described in clauses (i) and (ii) 

20 with respect to all such targeted low-in21 come children in a family under this title 

22 that exceeds 2.5 percent of such family’s 

23 income for the year involved.’’. 
53 

•HR 3561 IH 

1 (b) EMPLOYER COVERAGE WAIVER CHANGES.—Sec2 tion 2105(c)(3) of such Act (42 U.S.C. 1397ee(c)(3)) is 

3 amended— 

4 (1) by redesignating subparagraphs (A) and 

5 (B) as clauses (i) and (ii) and indenting appro6 priately; 

7 (2) by designating the matter beginning with 

8 ‘‘Payment may be made’’ as a subparagraph (A) 

9 with the heading ‘‘IN GENERAL’’ and indenting ap10 propriately; and 

11 (3) by adding at the end the following new sub12 paragraph: 

13 ‘‘(B) APPLICATION OF REQUIREMENTS.— 

14 In carrying out subparagraph (A)— 

15 ‘‘(i) in determining cost-effectiveness, 

16 the Secretary shall measure against family 

17 coverage costs to the extent that a State 

18 has expanded coverage to parents pursuant 

19 to section 2111; 

20 ‘‘(ii) subject to clause (iii), the State 

21 shall provide satisfactory assurances that 

22 the minimum benefits and cost-sharing 

23 protections established under this title are 

24 provided, either through the coverage 
54 

•HR 3561 IH 

1 under subparagraph (A) or as a supple2 ment to such coverage; and 

3 ‘‘(iii) coverage under such subpara4 graph shall not be considered to violate 

5 clause (ii) because it does not comply with 

6 requirements relating to reviews of health 

7 service decisions if the enrollee involved is 

8 provided the option of being provided bene9 fits directly under this title.’’. 

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

11 this section apply as of January 1, 2006, whether or not 

12 regulations implementing such amendments have been 

13 issued. 

14 SEC. 109. COORDINATION OF TITLE XXI WITH THE MATER15 NAL AND CHILD HEALTH PROGRAM. 

16 (a) IN GENERAL.—Section 2102(b)(3) of the Social 

17 Security Act (42 U.S.C. 1397bb(b)(3)) is amended— 

18 (1) in subparagraph (D), by striking ‘‘and’’ at 

19 the end; 

20 (2) in subparagraph (E), by striking the period 

21 and inserting ‘‘; and’’; and 

22 (3) by adding at the end the following new sub23 paragraph: 

24 ‘‘(F) that operations and activities under 

25 this title are developed and implemented in con-
55 

•HR 3561 IH 

1 sultation and coordination with the program op2 erated by the State under title V in areas in3 cluding outreach and enrollment, benefits and 

4 services, service delivery standards, public 

5 health and social service agency relationships, 

6 and quality assurance and data reporting.’’. 

7 (b) CONFORMING MEDICAID AMENDMENT.—Section 

8 1902(a)(11) of such Act (42 U.S.C. 1396a(a)(11)) is 

9 amended— 

10 (1) by striking ‘‘and’’ before ‘‘(C)’’; and 

11 (2) by inserting before the semicolon at the end 

12 the following: ‘‘, and (D) provide that operations and 

13 activities under this title are developed and imple14 mented in consultation and coordination with the 

15 program operated by the State under title V in areas 

16 including outreach and enrollment, benefits and 

17 services, service delivery standards, public health 

18 and social service agency relationships, and quality 

19 assurance and data reporting’’. 

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

21 this section take effect on January 1, 2006. 
56 

•HR 3561 IH 

1 Subtitle B—State Option to Pro2 vide Coverage for All Residents 

3 With Income at or Below the 

4 Poverty Line 

5 SEC. 121. STATE OPTION TO PROVIDE COVERAGE FOR ALL 

6 RESIDENTS WITH INCOME AT OR BELOW THE 

7 POVERTY LINE. 

8 (a) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the 

9 Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 

10 amended— 

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

12 (XVII); 

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

14 (XVIII); and 

15 (3) by adding at the end the following new sub16 clause: 

17 ‘‘(XIX) any individual whose 

18 family income does not exceed 100 

19 percent of the income official poverty 

20 line (as defined by the Office of Man21 agement and Budget, and revised an22 nually in accordance with section 

23 673(2) of the Omnibus Budget Rec24 onciliation Act of 1981) applicable to 

25 a family of the size involved and who 
57 

•HR 3561 IH 

1 is not otherwise eligible for medical 

2 assistance under this title;’’. 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) Section 1905(a) of such Act (42 U.S.C. 

5 1396d(a)) is amended, in the matter before para6 graph (1)— 

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

8 (xii); 

9 (B) by adding ‘‘or’’ at the end of clause 

10 (xiii); and 

11 (C) by inserting after clause (xiii) the fol12 lowing new clause: 

13 ‘‘(xii) individuals described in section 

14 1902(a)(10)(A)(ii)(XIX),’’. 

15 (2) Section 1903(f)(4) of such Act (42 U.S.C. 

16 1396b(f)(4)) is amended by inserting 

17 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

18 ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 

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

20 this section shall take effect on October 1, 2006. 
58 

•HR 3561 IH 

1 Subtitle C—Optional Coverage of 

2 Legal Immigrants Under the 

3 Medicaid Program and Title 

4 XXI, and to Extend Eligibility to 

5 Certain Legal Residents 

6 SEC. 131. EQUAL ACCESS TO HEALTH COVERAGE FOR 

7 LEGAL IMMIGRANTS. 

8 (a) IN GENERAL.—Section 401(b)(1) of the Personal 

9 Responsibility and Work Opportunity Reconciliation Act 

10 of 1996 (8 U.S.C. 1611(b)(1)) is amended— 

11 (1) by striking subparagraph (A) and inserting 

12 the following: 

13 ‘‘(A) Medical assistance under title XIX of 

14 the Social Security Act.’’; and 

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

16 ‘‘(F) Child health assistance under title 

17 XXI of the Social Security Act.’’. 

18 (b) CONFORMING AMENDMENTS.— 

19 (1) Section 402(b) of the Personal Responsi20 bility and Work Opportunity Reconciliation Act of 

21 1996 (8 U.S.C. 1612(b)) is amended— 

22 (A) in paragraph (2)— 

23 (i) in subparagraph (A)— 

24 (I) by striking clause (i); 
59 

•HR 3561 IH 

1 (II) by redesignating clause (ii) 

2 as subparagraph (A) and realigning 

3 the margins accordingly; and 

4 (III) by redesignating subclauses 

5 (I) through (V) of subparagraph (A), 

6 as so redesignated, as clauses (i) 

7 through (v), respectively and realign8 ing the margins accordingly; and 

9 (ii) by striking subparagraphs (E) and 

10 (F); and 

11 (B) in paragraph (3), by striking subpara12 graph (C). 

13 (2) Section 403 of the Personal Responsibility 

14 and Work Opportunity Reconciliation Act of 1996 (8 

15 U.S.C. 1613)) is amended— 

16 (A) in subsection (c), by adding at the end 

17 the following: 

18 ‘‘(M) Child health assistance provided 

19 under title XXI of the Social Security Act.’’; 

20 and 

21 (B) in subsection (d)(1), by striking ‘‘pro22 grams specified in subsections (a)(3) and 

23 (b)(3)(C)’’ and inserting ‘‘program specified in 

24 subsection (a)(3)’’. 
60 

•HR 3561 IH 

1 (3) Section 421 of the Personal Responsibility 

2 and Work Opportunity Reconciliation Act of 1996 (8 

3 U.S.C. 1631)) is amended by adding at the end the 

4 following: 

5 ‘‘(g) EXCEPTIONS.—This section shall not apply to— 

6 ‘‘(1) medical assistance provided under a State 

7 plan approved under title XIX of the Social Security 

8 Act; and 

9 ‘‘(2) child health assistance provided under title 

10 XXI of the Social Security Act.’’. 

11 (4) Section 423(d) of the Personal Responsi12 bility and Work Opportunity Reconciliation Act of 

13 1996 is amended by adding at the end the following: 

14 ‘‘(12) Child health assistance provided under 

15 title XXI of the Social Security Act.’’. 

16 (c) EFFECTIVE DATE.— 

17 (1) IN GENERAL.—Except as provided in para18 graph (2), the amendments made by this section 

19 take effect on the date of enactment of this Act and 

20 apply to medical assistance provided under title XIX 

21 of the Social Security Act and child health assist22 ance provided under title XXI of the Social Security 

23 Act on or after that date. 

24 (2) REQUIREMENTS FOR SPONSOR’S AFFIDAVIT

25 OF SUPPORT.—Section 423(d) of the Personal Re-
61 

•HR 3561 IH 

1 sponsibility and Work Opportunity Reconciliation 

2 Act of 1996 shall be applied as if the amendments 

3 made by this Act were enacted on December 1, 

4 2002. 

5 SEC. 132. EXCEPTION FOR CITIZENS OF FREELY ASSOCI6 ATED STATES. 

7 (a) IN GENERAL.—Section 402(a)(2) of the Personal 

8 Responsibility and Work Opportunity Reconciliation Act 

9 of 1996 (8 U.S.C. 1612(a)(2)) is amended by adding at 

10 the end the following: 

11 ‘‘(M) EXCEPTION FOR CITIZENS OF FREE12 LY ASSOCIATED STATES.—With respect to eligi13 bility for benefits for the specified Federal pro14 grams described in paragraph (3), paragraph 

15 (1) shall not apply to any individual who law16 fully resides in the United States (including ter17 ritories and possessions of the United States) in 

18 accordance with— 

19 ‘‘(i) section 141 of the Compact of 

20 Free Association between the Government 

21 of the United States and the Government 

22 of the Federated States of Micronesia, ap23 proved by Congress in the Compact of 

24 Free Association Amendments Act of 

25 2003; 
62 

•HR 3561 IH 

1 ‘‘(ii) section 141 of the Compact of 

2 Free Association between the Government 

3 of the United States and the Government 

4 of the Republic of the Marshall Islands, 

5 approved by Congress in the Compact of 

6 Free Association Amendments Act of 

7 2003; or 

8 ‘‘(iii) section 141 of the Compact of 

9 Free Association between the Government 

10 of the United States and the Government 

11 of Palau, approved by Congress in Public 

12 Law 99–658 (100 Stat. 3672).’’. 

13 (b) MEDICAID EXCEPTION.—Section 402(b)(2) of the 

14 Personal Responsibility and Work Opportunity Reconcili15 ation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by 

16 adding at the end the following: 

17 ‘‘(G) MEDICAID EXCEPTIONS FOR CITI18 ZENS OF FREELY ASSOCIATED STATES.—With 

19 respect to eligibility for benefits for the pro20 grams defined in subparagraphs (A) and (C) of 

21 paragraph (3) (relating to medicaid), paragraph 

22 (1) shall not apply to any individual who law23 fully resides in the United States (including ter24 ritories and possessions of the United States) in 
63 

•HR 3561 IH 

1 accordance with a Compact of Free Association 

2 referred to in subsection (a)(2)(M).’’. 

3 (c) QUALIFIED ALIEN.—Section 431(b) of the Per4 sonal Responsibility and Work Opportunity Reconciliation 

5 Act of 1996 (8 U.S.C. 1641(b)) is amended— 

6 (1) in paragraph (6), by striking ‘‘or’’ at the 

7 end; 

8 (2) in paragraph (7), by striking the period at 

9 the end and inserting ‘‘; or’’; and 

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

11 ‘‘(8) an individual who lawfully resides in the 

12 United States (including territories and possessions 

13 of the United States) in accordance with a Compact 

14 of Free Association referred to in section 

15 402(a)(2)(M).’’. 

16 (d) FINANCIAL TREATMENT UNDER MEDICAID.— 

17 Section 1108 of the Social Security Act (42 U.S.C. 1308) 

18 is amended— 

19 (1) in subsection (f), by striking ‘‘subsection 

20 (g)’’ and inserting ‘‘subsections (g) and (h)’’; and 

21 (2) by adding at the end the following new sub22 section: 

23 ‘‘(h) The limitations of subsections (f) and (g) shall 

24 not apply with respect to medical assistance provided to 

25 an individual described in section 431(b)(8) of the Per-
64 

•HR 3561 IH 

1 sonal Responsibility and Work Opportunity Reconciliation 

2 Act of 1996.’’. 

3 Subtitle D—Indian Healthcare 

4 Funding 

5 CHAPTER 1—GUARANTEED FUNDING 

6 SEC. 141. GUARANTEED ADEQUATE FUNDING FOR INDIAN 

7 HEALTHCARE. 

8 Section 825 of the Indian Health Care Improvement 

9 Act (25 U.S.C. 1680o) is amended to read as follows: 

10 ‘‘SEC. 825. FUNDING. 

11 ‘‘(a) IN GENERAL.—Notwithstanding any other pro12 vision of law, not later than 30 days after the date of en13 actment of this section, on October 1, 2007, and on each 

14 October 1 thereafter, out of any funds in the Treasury 

15 not otherwise appropriated, the Secretary of the Treasury 

16 shall transfer to the Secretary to carry out this title the 

17 amount determined under subsection (d). 

18 ‘‘(b) USE AND AVAILABILITY.— 

19 ‘‘(1) IN GENERAL.—An amount transferred 

20 under subsection (a)— 

21 ‘‘(A) shall remain available until expended; 

22 and 

23 ‘‘(B) shall be used to carry out any pro24 grams, functions, and activities relating to clin-
65 

•HR 3561 IH 

1 ical services (as defined in paragraph (2)) of 

2 the Service and Service units. 

3 ‘‘(2) CLINICAL SERVICES DEFINED.—For pur4 poses of paragraph (1)(B), the term ‘clinical serv5 ices’ includes all programs of the Indian Health 

6 Service which are funded directly or under the au7 thority of the Indian Self-Determination and Edu8 cation Assistance Act, for the purposes of— 

9 ‘‘(A) clinical care, including inpatient care, 

10 outpatient care (including audiology, clinical eye 

11 and vision care), primary care, secondary and 

12 tertiary care, and long term care; 

13 ‘‘(B) preventive health, including mam14 mography and other cancer screening; 

15 ‘‘(C) dental care; 

16 ‘‘(D) mental and behavioral health, includ17 ing community mental and behavioral health 

18 services, inpatient mental and behavioral health 

19 services, dormitory mental and behavioral 

20 health services, therapeutic and residential 

21 treatment centers; 

22 ‘‘(E) emergency medical services; 

23 ‘‘(F) treatment and control of, and reha24 bilitative care related to, alcoholism and drug 
66 

•HR 3561 IH 

1 abuse (including fetal alcohol syndrome) among 

2 Indians; 

3 ‘‘(G) accident prevention programs; 

4 ‘‘(H) home healthcare; 

5 ‘‘(I) community health representatives; 

6 ‘‘(J) maintenance and repair; and 

7 ‘‘(K) traditional healthcare practices and 

8 training of traditional healthcare practitioners. 

9 ‘‘(c) RECEIPT AND ACCEPTANCE.—The Secretary 

10 shall be entitled to receive, shall accept, and shall use to 

11 carry out this title the funds transferred under subsection 

12 (a), without further appropriation. 

13 ‘‘(d) AMOUNT.—The amount referred to in sub14 section (a) is— 

15 ‘‘(1) for fiscal year 2006, the amount equal to 

16 390 percent of the amount obligated by the Service 

17 during fiscal year 2002 for the purposes described in 

18 subsection (b)(2); and 

19 ‘‘(2) for fiscal year 2007 and each fiscal year 

20 thereafter, the amount equal to the product obtained 

21 by multiplying— 

22 ‘‘(A) the number of Indians served by the 

23 Service as of September 30 of the preceding the 

24 fiscal year; and 
67 

•HR 3561 IH 

1 ‘‘(B) the per capita baseline amount, as 

2 determined under subsection (e). 

3 ‘‘(e) PER CAPITA BASELINE AMOUNT.— 

4 ‘‘(1) IN GENERAL.—For the purpose of sub5 section (d)(2)(B), the per capita baseline amount 

6 shall be equal to the sum of— 

7 ‘‘(A) the quotient obtained by dividing— 

8 ‘‘(i) the amount specified in sub9 section (d)(1); by 

10 ‘‘(ii) the number of Indians served by 

11 the Service as of September 30, 2002; and 

12 ‘‘(B) any applicable increase under para13 graph (2). 

14 ‘‘(2) INCREASE.—For each fiscal year, the Sec15 retary shall provide a percentage increase (rounded 

16 to the nearest dollar) in the per capita baseline 

17 amount equal to the percentage by which— 

18 ‘‘(A) the Consumer Price Index for all 

19 Urban Consumers published by the Department 

20 of Labor (relating to the United States city av21 erage for medical care and not seasonally ad22 justed) for the 1-year period ending on the 

23 June 30 of the fiscal year preceding the fiscal 

24 year for which the increase is made; exceeds 
68 

•HR 3561 IH 

1 ‘‘(B) that Consumer Price Index for the 1- 

2 year period preceding the 1-year period de3 scribed in subparagraph (A).’’. 

4 CHAPTER 2—INDIAN HEALTHCARE 

5 PROGRAMS 

6 SEC. 145. PROGRAMS OPERATED BY INDIAN TRIBES AND 

7 TRIBAL ORGANIZATIONS. 

8 The Service shall provide funds for healthcare pro9 grams and facilities operated by Indian tribes and tribal 

10 organizations under funding agreements with the Service 

11 entered into under the Indian Self-Determination and 

12 Education Assistance Act on the same basis as such funds 

13 are provided to programs and facilities operated directly 

14 by the Service. 

15 SEC. 146. LICENSING. 

16 Healthcare professionals employed by Indian tribes 

17 and tribal organizations to carry out agreements under the 

18 Indian Self-Determination and Education Assistance Act, 

19 shall, if licensed in any State, be exempt from the licensing 

20 requirements of the State in which the agreement is per21 formed. 

22 SEC. 147. AUTHORIZATION FOR EMERGENCY CONTRACT 

23 HEALTH SERVICES. 

24 With respect to an elderly Indian or an Indian with 

25 a disability receiving emergency medical care or services 
69 

•HR 3561 IH 

1 from a non-Service provider or in a non-Service facility 

2 under the authority of the Indian Health Care Improve3 ment Act, the time limitation (as a condition of payment) 

4 for notifying the Service of such treatment or admission 

5 shall be 30 days. 

6 SEC. 148. PROMPT ACTION ON PAYMENT OF CLAIMS. 

7 (a) REQUIREMENT.—The Service shall respond to a 

8 notification of a claim by a provider of a contract care 

9 service with either an individual purchase order or a denial 

10 of the claim within 5 working days after the receipt of 

11 such notification. 

12 (b) FAILURE TO RESPOND.—If the Service fails to 

13 respond to a notification of a claim in accordance with 

14 subsection (a), the Service shall accept as valid the claim 

15 submitted by the provider of a contract care service. 

16 (c) PAYMENT.—The Service shall pay a valid contract 

17 care service claim within 30 days after the completion of 

18 the claim. 

19 SEC. 149. LIABILITY FOR PAYMENT. 

20 (a) NO LIABILITY.—A patient who receives contract 

21 healthcare services that are authorized by the Service shall 

22 not be liable for the payment of any charges or costs asso23 ciated with the provision of such services. 

24 (b) NOTIFICATION.—The Secretary shall notify a 

25 contract care provider and any patient who receives con-
70 

•HR 3561 IH 

1 tract healthcare services authorized by the Service that 

2 such patient is not liable for the payment of any charges 

3 or costs associated with the provision of such services. 

4 (c) LIMITATION.—Following receipt of the notice pro5 vided under subsection (b), or, if a claim has been deemed 

6 accepted under section 154(b), the provider shall have no 

7 further recourse against the patient who received the serv8 ices involved. 

9 SEC. 150. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

10 (a) INELIGIBLE PERSONS.— 

11 (1) IN GENERAL.—Any individual who— 

12 (A) has not attained 19 years of age; 

13 (B) is the natural or adopted child, step14 child, foster-child, legal ward, or orphan of an 

15 eligible Indian; and 

16 (C) is not otherwise eligible for the health 

17 services provided by the Service, shall be eligible 

18 for all health services provided by the Service 

19 on the same basis and subject to the same rules 

20 that apply to eligible Indians until such indi21 vidual attains 19 years of age. The existing and 

22 potential health needs of all such individuals 

23 shall be taken into consideration by the Service 

24 in determining the need for, or the allocation 

25 of, the health resources of the Service. If such 
71 

•HR 3561 IH 

1 an individual has been determined to be legally 

2 incompetent prior to attaining 19 years of age, 

3 such individual shall remain eligible for such 

4 services until one year after the date such dis5 ability has been removed. 

6 (2) SPOUSES.—Any spouse of an eligible Indian 

7 who is not an Indian, or who is of Indian descent 

8 but not otherwise eligible for the health services pro9 vided by the Service, shall be eligible for such health 

10 services if all of such spouses or spouses who are 

11 married to members of the Indian tribe being served 

12 are made eligible, as a class, by an appropriate reso13 lution of the governing body of the Indian tribe or 

14 tribal organization providing such services. The 

15 health needs of persons made eligible under this 

16 paragraph shall not be taken into consideration by 

17 the Service in determining the need for, or allocation 

18 of, its health resources. 

19 (b) PROGRAMS AND SERVICES.— 

20 (1) PROGRAMS.— 

21 (A) IN GENERAL.—The Secretary may 

22 provide health services under this subsection 

23 through health programs operated directly by 

24 the Service to individuals who reside within the 

25 service area of a service unit and who are not 
72 

•HR 3561 IH 

1 eligible for such health services under any other 

2 subsection of this section or under any other 

3 provision of law if— 

4 (i) the Indian tribe (or, in the case of 

5 a multi-tribal service area, all the Indian 

6 tribes) served by such service unit requests 

7 such provision of health services to such 

8 individuals; and 

9 (ii) the Secretary and the Indian tribe 

10 or tribes have jointly determined that— 

11 (I) the provision of such health 

12 services will not result in a denial or 

13 diminution of health services to eligi14 ble Indians; and 

15 (II) there is no reasonable alter16 native health program or services, 

17 within or without the service area of 

18 such service unit, available to meet 

19 the health needs of such individuals. 

20 (B) FUNDING AGREEMENTS.—In the case 

21 of health programs operated under a funding 

22 agreement entered into under the Indian Self23 Determination and Educational Assistance Act, 

24 the governing body of the Indian tribe or tribal 

25 organization providing health services under 
73 

•HR 3561 IH 

1 such funding agreement is authorized to deter2 mine whether health services should be provided 

3 under such funding agreement to individuals 

4 who are not eligible for such health services 

5 under any other subsection of this section or 

6 under any other provision of law. In making 

7 such determinations, the governing body of the 

8 Indian tribe or tribal organization shall take 

9 into account the considerations described in 

10 subparagraph (A)(ii). 

11 (2) LIABILITY FOR PAYMENT.— 

12 (A) IN GENERAL.—Persons receiving 

13 health services provided by the Service by rea14 son of this subsection shall be liable for pay15 ment of such health services under a schedule 

16 of charges prescribed by the Secretary which, in 

17 the judgment of the Secretary, results in reim18 bursement in an amount not less than the ac19 tual cost of providing the health services. Not20 withstanding section 1880 of the Social Secu21 rity Act or any other provision of law, amounts 

22 collected under this subsection, including medi23 care or medicaid reimbursements under titles 

24 XVIII and XIX of the Social Security Act, shall 

25 be credited to the account of the program pro-
74 

•HR 3561 IH 

1 viding the service and shall be used solely for 

2 the provision of health services within that pro3 gram. Amounts collected under this subsection 

4 shall be available for expenditure within such 

5 program for not to exceed 1 fiscal year after 

6 the fiscal year in which collected. 

7 (B) SERVICES FOR INDIGENT PERSONS.— 

8 Health services may be provided by the Sec9 retary through the Service under this sub10 section to an indigent person who would not be 

11 eligible for such health services but for the pro12 visions of paragraph (1) only if an agreement 

13 has been entered into with a State or local gov14 ernment under which the State or local govern15 ment agrees to reimburse the Service for the 

16 expenses incurred by the Service in providing 

17 such health services to such indigent person. 

18 (3) SERVICE AREAS.— 

19 (A) SERVICE TO ONLY ONE TRIBE.—In the 

20 case of a service area which serves only one In21 dian tribe, the authority of the Secretary to 

22 provide health services under paragraph (1)(A) 

23 shall terminate at the end of the fiscal year suc24 ceeding the fiscal year in which the governing 
75 

•HR 3561 IH 

1 body of the Indian tribe revokes its concurrence 

2 to the provision of such health services. 

3 (B) MULTI-TRIBAL AREAS.—In the case of 

4 a multi-tribal service area, the authority of the 

5 Secretary to provide health services under para6 graph (1)(A) shall terminate at the end of the 

7 fiscal year succeeding the fiscal year in which at 

8 least 51 percent of the number of Indian tribes 

9 in the service area revoke their concurrence to 

10 the provision of such health services. 

11 (c) PURPOSE FOR PROVIDING SERVICES.—The Serv12 ice may provide health services under this subsection to 

13 individuals who are not eligible for health services provided 

14 by the Service under any other subsection of this section 

15 or under any other provision of law in order to— 

16 (1) achieve stability in a medical emergency; 

17 (2) prevent the spread of a communicable dis18 ease or otherwise deal with a public health hazard; 

19 (3) provide care to non-Indian women pregnant 

20 with an eligible Indian’s child for the duration of the 

21 pregnancy through post partum; or 

22 (4) provide care to immediate family members 

23 of an eligible person if such care is directly related 

24 to the treatment of the eligible person. 
76 

•HR 3561 IH 

1 (d) HOSPITAL PRIVILEGES.—Hospital privileges in 

2 health facilities operated and maintained by the Service 

3 or operated under a contract entered into under the Indian 

4 Self-Determination Education Assistance Act may be ex5 tended to non-Service healthcare practitioners who provide 

6 services to persons described in subsection (a) or (b). Such 

7 non-Service healthcare practitioners may be regarded as 

8 employees of the Federal Government for purposes of sec9 tion 1346(b) and chapter 171 of title 28, United States 

10 Code (relating to Federal tort claims) only with respect 

11 to acts or omissions which occur in the course of providing 

12 services to eligible persons as a part of the conditions 

13 under which such hospital privileges are extended. 

14 (e) DEFINITION.—In this section, the term ‘‘eligible 

15 Indian’’ means any Indian who is eligible for health serv16 ices provided by the Service without regard to the provi17 sions of this section. 

18 SEC. 151. DEFINITIONS. 

19 For purposes of this chapter, the definitions con20 tained in section 4 of the Indian Health Care Improve21 ment Act shall apply. 

22 SEC. 152. AUTHORIZATION OF APPROPRIATIONS. 

23 There are authorized to be appropriated such sums 

24 as may be necessary for each fiscal year through fiscal 

25 year 2015 to carry out this chapter. 
77 

•HR 3561 IH 

1 Subtitle E—Territories 

2 SEC. 161. FUNDING FOR TERRITORIES. 

3 (a) TEMPORARY ELIMINATION OF SPENDING CAP.— 

4 Section 1108 of the Social Security Act (42 U.S.C. 1308) 

5 is amended— 

6 (1) in subsection (f), by striking ‘‘subsection 

7 (g)’’ and inserting ‘‘subsections (g) and (h)’’; and 

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

9 ‘‘(h) TEMPORARY ELIMINATION OF CAPS.—With re10 spect to each of fiscal years 2006 through 2009, the Sec11 retary shall make payments under title XIX to Puerto 

12 Rico, the Virgin Islands, Guam, the Northern Mariana Is13 lands, and American Samoa without regard to the limita14 tions on the amount of such payments imposed under sub15 sections (f) and (g).’’. 

16 (b) TEMPORARY INCREASE IN FMAP.—The first 

17 sentence of section 1905(b) of the Social Security Act (42 

18 U.S.C. 1396d(b)) is amended by inserting ‘‘(except that, 

19 only with respect to fiscal years 2006 through 2009 and 

20 only for purposes of expenditures under this title, such 

21 percentage shall be 77 percent)’’ after ‘‘50 per centum’’. 
78 

•HR 3561 IH 

1 Subtitle F—Migrant Workers and 

2 Farmworkers Health 

3 SEC. 171. DEMONSTRATION PROJECT REGARDING CON4 TINUITY OF COVERAGE OF MIGRANT WORK5 ERS AND FARMWORKERS UNDER MEDICAID 

6 AND CHIP. 

7 (a) AUTHORITY TO CONDUCT DEMONSTRATION

8 PROJECT.— 

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

10 Human Services shall conduct a demonstration 

11 project for the purpose of evaluating methods for 

12 strengthening the health coverage of, and continuity 

13 of coverage of, migrant workers and farmworkers 

14 under the medicaid and State children’s health in15 surance programs (42 U.S.C. 1396 et seq., 1397aa 

16 et seq.). 

17 (2) WAIVER AUTHORITY.—The Secretary of 

18 Health and Human Services shall waive compliance 

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

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

21 1396 et seq., 1397aa et seq.) to such extent and for 

22 such period as the Secretary determines is necessary 

23 to conduct the demonstration project under this sec24 tion. 
79 

•HR 3561 IH 

1 (b) REQUIREMENTS.—The demonstration project 

2 conducted under this section shall provide for— 

3 (1) uniform eligibility criteria under the med4 icaid and State children’s health insurance programs 

5 with respect to migrant workers and farmworkers; 

6 and 

7 (2) the portability of coverage of such workers 

8 under those programs between participating States. 

9 (c) REPORT.—Not later than March 31, 2007, the 

10 Secretary of Health and Human Services shall submit a 

11 report to Congress on the demonstration project con12 ducted under this section that contains such recommenda13 tions for legislative action as the Secretary determines is 

14 appropriate. 

15 Subtitle G—Expanded Access to 

16 Health Care 

17 SEC. 181. NATIONAL COMMISSION FOR EXPANDED ACCESS 

18 TO HEALTH CARE. 

19 (a) ESTABLISHMENT.—There is established a com20 mission to be known as the National Commission for Ex21 panded Access to Health Care (referred to in this section 

22 as the ‘‘Commission’’). 

23 (b) APPOINTMENT OF MEMBERS.— 

24 (1) IN GENERAL.—Not later than 45 days after 

25 the date of enactment of this Act— 
80 

•HR 3561 IH 

1 (A) the majority and minority leaders of 

2 the Senate and the Speaker and minority leader 

3 of the House of Representatives shall each ap4 point 7 members of the Commission; and 

5 (B) the Secretary of Health and Human 

6 Services (in this section referred to as the ‘‘Sec7 retary’’) shall appoint 1 member of the Com8 mission. 

9 (2) CRITERIA.—Members of the Commission 

10 shall include representatives of the following: 

11 (A) Consumers of health insurance. 

12 (B) Health care professionals. 

13 (C) State and territorial officials. 

14 (D) Health economists. 

15 (E) Health care providers. 

16 (F) Experts on health insurance. 

17 (G) Experts on expanding health care to 

18 individuals who are uninsured. 

19 (H) Experts on the elimination of racial 

20 and ethnic health disparities. 

21 (I) Experts on health care in the United 

22 States territories. 

23 (3) CHAIRPERSON.—At the first meeting of the 

24 Commission, the Commission shall select a Chair25 person from among its members. 
81 

•HR 3561 IH 

1 (c) MEETINGS.— 

2 (1) IN GENERAL.—After the initial meeting of 

3 the Commission, which shall be called by the Sec4 retary, the Commission shall meet at the call of the 

5 Chairperson. 

6 (2) QUORUM.—A majority of the members of 

7 the Commission shall constitute a quorum, but a 

8 lesser number of members may hold hearings. 

9 (3) SUPERMAJORITY VOTING REQUIREMENT.— 

10 To approve a report required under paragraph (1), 

11 (2), or (3) of subsection (e), at least 60 percent of 

12 the membership of the Commission must vote in 

13 favor of such a report. 

14 (d) DUTIES.—The Commission shall— 

15 (1) assess the effectiveness of programs de16 signed to expand health care coverage or make 

17 health care coverage affordable to uninsured individ18 uals by identifying the accomplishments and needed 

19 improvements of each program; 

20 (2) make recommendations regarding the bene21 fits and cost-sharing that should be included in 

22 health care coverage for various groups, taking into 

23 account— 

24 (A) the special health care needs of chil25 dren and individuals with disabilities; 
82 

•HR 3561 IH 

1 (B) the different ability of various popu2 lations to pay out-of-pocket costs for services; 

3 (C) incentives for efficiency and cost-con4 tainment; 

5 (D) racial and ethnic disparities in health 

6 status and health care; 

7 (E) incremental changes to the United 

8 States health care delivery system and changes 

9 to achieve fundamental restructuring of the sys10 tem; 

11 (F) populations who are traditionally more 

12 difficult to cover, including immigrants and 

13 homeless persons; 

14 (G) preventive care, diagnostic services, 

15 disease management services, and other factors; 

16 (H) quality improvement initiatives among 

17 health institutions serving disadvantaged pa18 tient populations; and 

19 (I) the feasibility of and barriers to the de20 velopment of a comprehensive system of health 

21 care; 

22 (3) recommend mechanisms to expand health 

23 care coverage to uninsured individuals; 

24 (4) recommend automatic enrollment and reten25 tion procedures and other measures to increase 
83 

•HR 3561 IH 

1 health care coverage among those eligible for assist2 ance; and 

3 (5) analyze the size, effectiveness, and efficiency 

4 of current tax and other subsidies for health care 

5 coverage and recommend improvements. 

6 (e) REPORTS.— 

7 (1) ANNUAL REPORTS.—The Commission shall 

8 submit annual reports to the President and the ap9 propriate committees of Congress addressing the 

10 matters identified in subsection (d). 

11 (2) BIENNIAL REPORT.—The Commission shall 

12 submit biennial reports to the President and the ap13 propriate committees of Congress containing— 

14 (A) recommendations concerning essential 

15 benefits and maximum out-of-pocket cost-shar16 ing for— 

17 (i) the general population; and 

18 (ii) individuals with limited ability to 

19 pay; and 

20 (B) proposed legislative language to imple21 ment such recommendations. 

22 (3) COMMISSION REPORT.—Not later than Jan23 uary 15, 2007, the Commission shall submit a re24 port to the President and the appropriate commit25 tees of Congress, which shall include— 
84 

•HR 3561 IH 

1 (A) recommendations on policies to provide 

2 health care coverage to uninsured individuals; 

3 (B) recommendations on changes to poli4 cies enacted under this Act; and 

5 (C) proposed legislative language to imple6 ment such recommendations. 

7 (f) ADMINISTRATION.— 

8 (1) POWERS.— 

9 (A) HEARINGS.—The Commission may 

10 hold such hearings, sit and act at such times 

11 and places, take such testimony, and receive 

12 such evidence as the Commission considers ad13 visable to carry out this section. 

14 (B) INFORMATION FROM FEDERAL AGEN15 CIES.—The Commission may secure directly 

16 from any Federal department or agency such 

17 information as the Commission considers nec18 essary to carry out this section. Upon request 

19 of the Chairperson of the Commission, the head 

20 of such department or agency shall furnish such 

21 information to the Commission. 

22 (C) POSTAL SERVICES.—The Commission 

23 may use the United States mails in the same 

24 manner and under the same conditions as other 
85 

•HR 3561 IH 

1 departments and agencies of the Federal Gov2 ernment. 

3 (D) GIFTS.—The Commission may accept, 

4 use, and dispose of donations of services or 

5 property. 

6 (2) COMPENSATION.— 

7 (A) IN GENERAL.—Each member of the 

8 Commission who is not an officer or employee 

9 of the Federal Government shall be com10 pensated at a rate equal to the daily equivalent 

11 of the annual rate of basic pay prescribed for 

12 level IV of the Executive Schedule under section 

13 5315 of title 5, United States Code, for each 

14 day (including travel time) during which such 

15 member is engaged in the performance of duties 

16 of the Commission. All members of the Com17 mission who are officers or employees of the 

18 United States shall serve without compensation 

19 in addition to that received for their services as 

20 officers or employees of the United States. 

21 (B) TRAVEL EXPENSES.—The members of 

22 the Commission shall be allowed travel ex23 penses, as authorized by the Chairperson of the 

24 Commission, including per diem in lieu of sub25 sistence, at rates authorized for employees of 
86 

•HR 3561 IH 

1 agencies under subchapter I of chapter 57 of 

2 title 5, United States Code, while away from 

3 their homes or regular places of business in the 

4 performance of services for the Commission. 

5 (3) STAFF.— 

6 (A) IN GENERAL.—The Chairperson of the 

7 Commission may appoint an executive director 

8 such other staff as may be necessary to enable 

9 the Commission to perform its duties. The em10 ployment of an executive director shall be sub11 ject to confirmation by the Commission. 

12 (B) STAFF COMPENSATION.—The Chair13 person of the Commission may fix the com14 pensation of personnel without regard to chap15 ter 51 and subchapter III of chapter 53 of title 

16 5, United States Code, relating to classification 

17 of positions and General Schedule pay rates, ex18 cept that the rate of pay for personnel may not 

19 exceed the rate payable for level V of the Exec20 utive Schedule under section 5316 of such title. 

21 (C) DETAIL OF GOVERNMENT EMPLOY22 EES.—Any Federal Government employee may 

23 be detailed to the Commission without reim24 bursement, and such detail shall be without 
87 

•HR 3561 IH 

1 interruption or loss of civil service status or 

2 privilege. 

3 (D) PROCUREMENT OF TEMPORARY AND

4 INTERMITTENT SERVICES.—The Chairperson of 

5 the Commission may procure temporary and 

6 intermittent services under section 3109(b) of 

7 title 5, United States Code, at rates for individ8 uals which do not exceed the daily equivalent of 

9 the annual rate of basic pay prescribed for level 

10 V of the Executive Schedule under section 5316 

11 of such title. 

12 (g) TERMINATION.—Except with respect to activities 

13 in connection with the ongoing biennial report required 

14 under subsection (e)(2), the Commission shall terminate 

15 90 days after the date on which the Commission submits 

16 the report required under subsection (e)(3). 

17 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section, 

19 such sums as may be necessary for fiscal year 2007 and 

20 each subsequent fiscal year. 

21 SEC. 182. INSTITUTE OF MEDICINE EVALUATION AND RE22 PORT ON HEALTH CARE PERFORMANCE 

23 MEASURES. 

24 (a) EVALUATION.— 
88 

•HR 3561 IH 

1 (1) IN GENERAL.—Not later than the date that 

2 is 2 months after the date of the enactment of this 

3 Act, the Secretary shall enter into an arrangement 

4 under which the Institute of Medicine of the Na5 tional Academy of Sciences (in this section referred 

6 to as the ‘‘Institute’’) shall conduct an evaluation of 

7 the Federal poverty line for purposes of access to 

8 health care services under any applicable Federal 

9 health care program. 

10 (2) POVERTY LINE DEFINED.—For purposes of 

11 paragraph (1), the term ‘‘poverty line’’ has the 

12 meaning given that term in section 673(2) of the 

13 Community Services Block Grant Act (42 U.S.C. 

14 9902(2)), including any revision required by such 

15 section. 

16 (b) REPORT.—Not later than the date that is 18 

17 months after the date of enactment of this Act, the Insti18 tute shall submit to the Secretary and appropriate com19 mittees of jurisdiction of the House of Representatives and 

20 Senate a report on the evaluation conducted under sub21 section (a)(1) describing the findings of such evaluation 

22 and recommendations for any adjustment of the Federal 

23 poverty line for appropriate access of individuals to such 

24 Federal health care programs. 
89 

•HR 3561 IH 

1 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary for purposes of conducting the evaluation and 

4 preparing the report required by this section. 

5 Subtitle H—FMAP Reimbursement 

6 for Native Hawaiians 

7 SEC. 191. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

8 PROVIDED TO A NATIVE HAWAIIAN THROUGH 

9 A FEDERALLY-QUALIFIED HEALTH CENTER 

10 OR A NATIVE HAWAIIAN HEALTH CARE SYS11 TEM UNDER THE MEDICAID PROGRAM. 

12 (a) MEDICAID.—The third sentence of section 

13 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 

14 is amended by inserting ‘‘, and with respect to medical 

15 assistance provided to a Native Hawaiian (as defined in 

16 section 12 of the Native Hawaiian Health Care Improve17 ment Act) through a federally-qualified health center or 

18 a Native Hawaiian health care system (as so defined) 

19 whether directly, by referral, or under contract or other 

20 arrangement between a federally-qualified health center or 

21 a Native Hawaiian health care system and another health 

22 care provider’’ before the period. 

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

24 this section applies to medical assistance provided on or 

25 after the date of enactment of this Act. 
90 

•HR 3561 IH 

1 TITLE II—CULTURALLY AND LIN2 GUISTICALLY APPROPRIATE 

3 HEALTHCARE 

4 SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

5 ACT. 

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

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

8 ‘‘TITLE XXIX—CULTURALLY AND 

9 LINGUISTICALLY APPRO10 PRIATE HEALTHCARE 

11 ‘‘SEC. 2900. DEFINITIONS. 

12 ‘‘In this title: 

13 ‘‘(1) APPROPRIATE HEALTHCARE SERVICES.— 

14 The term ‘appropriate healthcare services’ includes 

15 services or treatments to address physical, mental, 

16 and behavioral disorders or syndromes. 

17 ‘‘(2) INDIAN TRIBE.—The term ‘Indian tribe’ 

18 means any Indian tribe, band, nation, or other orga19 nized group or community, including any Alaska Na20 tive village or group or regional or village corpora21 tion as defined in or established pursuant to the 

22 Alaska Native Claims Settlement Act (85 Stat. 688) 

23 (43 U.S.C. 1601 et seq.), which is recognized as eli24 gible for the special programs and services provided 
91 

•HR 3561 IH 

1 by the United States to Indians because of their sta2 tus as Indians. 

3 ‘‘(3) LIMITED ENGLISH PROFICIENT.—The 

4 term ‘limited English proficient’ with respect to an 

5 individual means an individual who cannot speak, 

6 read, write, or understand the English language at 

7 a level that permits them to interact effectively with 

8 clinical or nonclinical staff at a healthcare organiza9 tion. 

10 ‘‘(4) MINORITY.— 

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

12 and ‘minorities’ refer to individuals from a mi13 nority group. 

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

15 with respect to populations, refers to racial and 

16 ethnic minority groups. 

17 ‘‘(5) MINORITY GROUP.—The term ‘minority 

18 group’ has the meaning given the term ‘racial and 

19 ethnic minority group’. 

20 ‘‘(6) RACIAL AND ETHNIC MINORITY GROUP.— 

21 The term ‘racial and ethnic minority group’ means 

22 American Indians and Alaska Natives, African 

23 Americans (including Caribbean Blacks and Afri24 cans), Asian Americans, Hispanics (including 
92 

•HR 3561 IH 

1 Latinos), and Native Hawaiians and other Pacific 

2 Islanders. 

3 ‘‘(7) STATE.—The term ‘State’ means each of 

4 the several states, the District of Columbia, the 

5 Commonwealth of Puerto Rico, the Indian tribes, 

6 the Virgin Islands, Guam, American Samoa, and the 

7 Commonwealth of the Northern Mariana Islands. 

8 ‘‘SEC. 2901. IMPROVING ACCESS TO SERVICES FOR INDIVID9 UALS WITH LIMITED ENGLISH PROFICIENCY. 

10 ‘‘(a) PURPOSE.—As provided in Executive Order 

11 13166, it is the purpose of this section— 

12 ‘‘(1) to improve access to Federally conducted 

13 and Federally assisted programs and activities for 

14 individuals who are limited in their English pro15 ficiency; 

16 ‘‘(2) to require each Federal agency to examine 

17 the services it provides and develop and implement 

18 a system by which limited English proficient individ19 uals can enjoy meaningful access to those services 

20 consistent with, and without substantially burdening, 

21 the fundamental mission of the agency; 

22 ‘‘(3) to require each Federal agency to ensure 

23 that recipients of Federal financial assistance pro24 vide meaningful access to their limited English pro25 ficient applicants and beneficiaries; 
93 

•HR 3561 IH 

1 ‘‘(4) to ensure that recipients of Federal finan2 cial assistance take reasonable steps, consistent with 

3 the guidelines set forth in the Limited English Pro4 ficient Guidance of the Department of Justice (as 

5 issued on June 12, 2002), to ensure meaningful ac6 cess to their programs and activities by limited 

7 English proficient individuals; and 

8 ‘‘(5) to ensure compliance with title VI of the 

9 Civil Rights Act of 1964 and that healthcare pro10 viders and organizations do not discriminate in the 

11 provision of services. 

12 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC13 TIVITIES.— 

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

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

16 agency that carries out health care-related activities 

17 shall prepare a plan to improve access to the feder18 ally conducted health care-related programs and ac19 tivities of the agency by limited English proficient 

20 individuals. 

21 ‘‘(2) PLAN REQUIREMENT.—Each plan under 

22 paragraph (1) shall be consistent with the standards 

23 set forth in section 204 of the Healthcare Equality 

24 and Accountability Act, and shall include the steps 

25 the agency will take to ensure that limited English 
94 

•HR 3561 IH 

1 proficient individuals have access to the agency’s 

2 health care-related programs and activities. Each 

3 agency shall send a copy of such plan to the Depart4 ment of Justice, which shall serve as the central re5 pository of the agencies’ plans. 

6 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI7 TIES.— 

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

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

10 agency providing health care-related Federal finan11 cial assistance shall ensure that the guidance for re12 cipients of Federal financial assistance developed by 

13 the agency to ensure compliance with title VI of the 

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

15 is specifically tailored to the recipients of such as16 sistance and is consistent with the standards de17 scribed in section 204 of the Healthcare Equality 

18 and Accountability Act. Each agency shall send a 

19 copy of such guidance to the Department of Justice 

20 which shall serve as the central repository of the 

21 agencies’ plans. After approval by the Department of 

22 Justice, each agency shall publish its guidance docu23 ment in the Federal Register for public comment. 

24 ‘‘(2) REQUIREMENTS.—The agency-specific 

25 guidance developed under paragraph (1) shall— 
95 

•HR 3561 IH 

1 ‘‘(A) detail how the general standards es2 tablished under section 204 of the Healthcare 

3 Equality and Accountability Act will be applied 

4 to the agency’s recipients; and 

5 ‘‘(B) take into account the types of health 

6 care services provided by the recipients, the in7 dividuals served by the recipients, and other 

8 factors set out in such standards. 

9 ‘‘(3) EXISTING GUIDANCES.—A Federal agency 

10 that has developed a guidance for purposes of title 

11 VI of the Civil Rights Act of 1964 that the Depart12 ment of Justice determines is consistent with the 

13 standards described in section 204 of the Healthcare 

14 Equality and Accountability Act shall examine such 

15 existing guidance, as well as the programs and ac16 tivities to which such guidance applies, to determine 

17 if modification of such guidance is necessary to com18 ply with this subsection. 

19 ‘‘(4) CONSULTATION.—Each Federal agency 

20 shall consult with the Department of Justice in es21 tablishing the guidances under this subsection. 

22 ‘‘(d) CONSULTATIONS.— 

23 ‘‘(1) IN GENERAL.—In carrying out this sec24 tion, each Federal agency that carriers out health 

25 care-related activities shall ensure that stakeholders, 
96 

•HR 3561 IH 

1 such as limited English proficient individuals and 

2 their representative organizations, recipients of Fed3 eral assistance, and other appropriate individuals or 

4 entities, have an adequate and comparable oppor5 tunity to provide input with respect to the actions of 

6 the agency. 

7 ‘‘(2) EVALUATION.—Each Federal agency de8 scribed in paragraph (1) shall evaluate the— 

9 ‘‘(A) particular needs of the limited 

10 English proficient individuals served by the 

11 agency, and by a recipient of assistance pro12 vided by the agency; 

13 ‘‘(B) burdens of compliance with the agen14 cy guidance and its recipients of the require15 ments of this section; and 

16 ‘‘(C) outcomes or effectiveness of services. 

17 ‘‘SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND 

18 LINGUISTICALLY APPROPRIATE SERVICES IN 

19 HEALTHCARE. 

20 ‘‘Recipients of Federal financial assistance from the 

21 Secretary shall, to the extent reasonable and practicable 

22 after applying the 4-factor analysis described in title V 

23 of the Guidance to Federal Financial Assistance Recipi24 ents Regarding Title VI Prohibition Against National Ori-
97 

•HR 3561 IH 

1 gin Discrimination Affecting Limited-English Proficient 

2 Persons (June 12, 2002)— 

3 ‘‘(1) implement strategies to recruit, retain, and 

4 promote individuals at all levels of the organization 

5 to maintain a diverse staff and leadership that can 

6 provide culturally and linguistically appropriate 

7 healthcare to patient populations of the service area 

8 of the organization; 

9 ‘‘(2) ensure that staff at all levels and across all 

10 disciplines of the organization receive ongoing edu11 cation and training in culturally and linguistically 

12 appropriate service delivery; 

13 ‘‘(3) offer and provide language assistance serv14 ices, including bilingual staff and interpreter serv15 ices, at no cost to each patient with limited English 

16 proficiency at all points of contact, in a timely man17 ner during all hours of operation; 

18 ‘‘(4) notify patients of their right to receive lan19 guage assistance services in their primary language; 

20 ‘‘(5) ensure the competence of language assist21 ance provided to limited English proficient patients 

22 by interpreters and bilingual staff, and ensure that 

23 family, particularly minor children, and friends are 

24 not used to provide interpretation services— 

25 ‘‘(A) except in case of emergency; or 
98 

•HR 3561 IH 

1 ‘‘(B) except on request of the patient, who 

2 has been informed in his or her preferred lan3 guage of the availability of free interpretation 

4 services; 

5 ‘‘(6) make available easily understood patient6 related materials, if such materials exist for non-lim7 ited English proficient patients, including informa8 tion or notices about termination of benefits and 

9 post signage in the languages of the commonly en10 countered groups or groups represented in the serv11 ice area of the organization; 

12 ‘‘(7) develop and implement clear goals, poli13 cies, operational plans, and management account14 ability and oversight mechanisms to provide cul15 turally and linguistically appropriate services; 

16 ‘‘(8) conduct initial and ongoing organizational 

17 assessments of culturally and linguistically appro18 priate services-related activities and integrate valid 

19 linguistic competence-related measures into the in20 ternal audits, performance improvement programs, 

21 patient satisfaction assessments, and outcomes-based 

22 evaluations of the organization; 

23 ‘‘(9) ensure that, consistent with the privacy 

24 protections provided for under the regulations pro25 mulgated under section 264(c) of the Health Insur-
99 

•HR 3561 IH 

1 ance Portability and Accountability Act of 1996 (42 

2 U.S.C. 1320d–2 note)— 

3 ‘‘(A) data on the individual patient’s race, 

4 ethnicity, and primary language are collected in 

5 health records, integrated into the organiza6 tion’s management information systems, and 

7 periodically updated; and 

8 ‘‘(B) if the patient is a minor or is inca9 pacitated, the primary language of the parent 

10 or legal guardian is collected; 

11 ‘‘(10) maintain a current demographic, cultural, 

12 and epidemiological profile of the community as well 

13 as a needs assessment to accurately plan for and im14 plement services that respond to the cultural and 

15 linguistic characteristics of the service area of the 

16 organization; 

17 ‘‘(11) develop participatory, collaborative part18 nerships with communities and utilize a variety of 

19 formal and informal mechanisms to facilitate com20 munity and patient involvement in designing and im21 plementing culturally and linguistically appropriate 

22 services-related activities; 

23 ‘‘(12) ensure that conflict and grievance resolu24 tion processes are culturally and linguistically sen25 sitive and capable of identifying, preventing, and re-
100 

•HR 3561 IH 

1 solving cross-cultural conflicts or complaints by pa2 tients; 

3 ‘‘(13) regularly make available to the public in4 formation about their progress and successful inno5 vations in implementing the standards under this 

6 section and provide public notice in their commu7 nities about the availability of this information; and 

8 ‘‘(14) if requested, regularly make available to 

9 the head of each Federal entity from which Federal 

10 funds are received, information about their progress 

11 and successful innovations in implementing the 

12 standards under this section as required by the head 

13 of such entity. 

14 ‘‘SEC. 2903. ROBERT T. MATSUI CENTER FOR CULTURAL 

15 AND LINGUISTIC COMPETENCE IN 

16 HEALTHCARE. 

17 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

18 through the Director of the Office of Minority Health, 

19 shall establish and support a center to be known as the 

20 ‘Robert T. Matsui Center for Cultural and Linguistic 

21 Competence in Healthcare’ (referred to in this section as 

22 the ‘Center’) to carry out the following activities: 

23 ‘‘(1) REMOTE MEDICAL INTERPRETING.—The 

24 Center shall provide remote medical interpreting, di25 rectly or through contracts, to healthcare providers 
101 

•HR 3561 IH 

1 who otherwise would be unable to provide language 

2 interpreting services, at reasonable or no cost as de3 termined appropriate by the Director of the Center. 

4 Methods of interpretation may include remote, si5 multaneous or consecutive interpreting through tele6 phonic systems, video conferencing, and other meth7 ods determined appropriate by the Secretary for pa8 tients with limited English proficiency. The quality 

9 of such interpreting shall be monitored and reported 

10 publicly. Nothing in this paragraph shall be con11 strued to limit the ability of healthcare providers or 

12 organizations to provide medical interpreting serv13 ices directly and obtain reimbursement for such 

14 services as provided for under the medicare, med15 icaid or SCHIP programs under titles XVIII, XIX, 

16 or XXI of the Social Security Act. 

17 ‘‘(2) MODEL LANGUAGE ASSISTANCE PRO18 GRAMS.—The Center shall provide for the collection 

19 and dissemination of information on current model 

20 language assistance programs and strategies to im21 prove language access to healthcare for individuals 

22 with limited English proficiency, including case stud23 ies using de-identified patient information, program 

24 summaries, and program evaluations. 

25 ‘‘(3) MEDICAL INTERPRETING GUIDELINES.— 
102 

•HR 3561 IH 

1 ‘‘(A) IN GENERAL.—The Center shall con2 vene a national working group to develop med3 ical interpreting and translation guidelines and 

4 standards for— 

5 ‘‘(i) the provision of services; 

6 ‘‘(ii) the actual practice of inter7 preting; 

8 ‘‘(iii) the training of medical inter9 preters and translators, developed by inter10 preters and translators. 

11 ‘‘(B) PUBLICATION.—Not later than 18 

12 months after the date of enactment of this Act, 

13 the Center shall publish guidelines and stand14 ards developed under this paragraph in the 

15 Federal Register. 

16 ‘‘(4) INTERNET HEALTH CLEARINGHOUSE.— 

17 The Center shall develop and maintain an Internet 

18 clearinghouse to reduce medical errors and improve 

19 medical outcomes and reduce healthcare costs 

20 caused by communication with individuals with lim21 ited English proficiency or low functional health lit22 eracy and reduce or eliminate the duplication of ef23 fort to translate materials by— 

24 ‘‘(A) developing and making available tem25 plates for standard documents that are nec-
103 

•HR 3561 IH 

1 essary for patients and consumers to access and 

2 make educated decisions about their healthcare, 

3 including— 

4 ‘‘(i) administrative and legal docu5 ments such as informed consent, advanced 

6 directives, and waivers of rights; 

7 ‘‘(ii) clinical information such as how 

8 to take medications, how to prevent trans9 mission of a contagious disease, and other 

10 prevention and treatment instructions; 

11 ‘‘(iii) patient education and outreach 

12 materials such as immunization notices, 

13 health warnings, or screening notices; and 

14 ‘‘(iv) additional health or healthcare15 related materials as determined appro16 priate by the Director of the Center; 

17 ‘‘(B) ensuring that the documents the 

18 posted in English and non-English languages 

19 and are culturally appropriate; 

20 ‘‘(C) allowing public review of the docu21 ments before dissemination in order to ensure 

22 that the documents are understandable and cul23 turally appropriate for the target populations; 

24 ‘‘(D) allowing healthcare providers to cus25 tomize the documents for their use; 
104 

•HR 3561 IH 

1 ‘‘(E) facilitating access to these docu2 ments; 

3 ‘‘(F) providing technical assistance with 

4 respect to the access and use of such informa5 tion; and 

6 ‘‘(G) carrying out any other activities the 

7 Secretary determines to be useful to fulfill the 

8 purposes of the Clearinghouse. 

9 ‘‘(5) PROVISION OF INFORMATION.—The Cen10 ter shall provide information relating to culturally 

11 and linguistically competent healthcare for minority 

12 populations residing in the United States to all 

13 healthcare providers and healthcare organizations at 

14 no cost. Such information shall include— 

15 ‘‘(A) tenets of culturally and linguistically 

16 competent care; 

17 ‘‘(B) cultural and linguistic competence 

18 self-assessment tools; 

19 ‘‘(C) cultural and linguistic competence 

20 training tools; 

21 ‘‘(D) strategic plans to increase cultural 

22 and linguistic competence in different types of 

23 healthcare organizations; and 
105 

•HR 3561 IH 

1 ‘‘(E) resources for cultural competence in2 formation for educators, practitioners and re3 searchers. 

4 ‘‘(b) DIRECTOR.—The Center shall be headed by a 

5 Director to be appointed by the Director of the Office of 

6 Minority Health who shall report to the Director of the 

7 Office of Minority Health. 

8 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di9 rector shall collaborate with the Administrator of the Cen10 ters for Medicare and Medicaid Services and the Adminis11 trator of the Health Resources and Services Administra12 tion, to notify healthcare providers and healthcare organi13 zations about the availability of language access services 

14 by the Center. 

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

16 is authorized to be appropriated to carry out this section 

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

18 2006 through 2011. 

19 ‘‘SEC. 2904. INNOVATIONS IN LANGUAGE ACCESS GRANTS. 

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

21 the Administrator of the Centers for Medicare and Med22 icaid Services, the Administrator of the Health Resources 

23 and Services Administration, the Secretary of Education, 

24 and the Director of the Office of Minority Health, shall 

25 award grants to eligible entities to enable such entities to 
106 

•HR 3561 IH 

1 design, implement, and evaluate innovative, cost-effective 

2 programs to improve language access to healthcare for in3 dividuals with limited English proficiency. 

4 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

5 under subsection (a) an entity shall— 

6 ‘‘(1) be a city, county, Indian tribe, State, terri7 tory, community-based and other nonprofit organiza8 tion, health center or community clinic, university, 

9 college, or other entity designated by the Secretary; 

10 and 

11 ‘‘(2) prepare and submit to the Secretary an 

12 application, at such time, in such manner, and ac13 companied by such additional information as the 

14 Secretary may require. 

15 ‘‘(c) USE OF FUNDS.—An entity shall use funds re16 ceived under a grant under this section to— 

17 ‘‘(1) develop, implement, and evaluate models of 

18 providing real-time interpretation services through 

19 in-person interpretation, communications, and com20 puter technology, including the Internet, teleconfer21 encing, or video conferencing; 

22 ‘‘(2) develop short-term medical interpretation 

23 training courses and incentives for bilingual 

24 healthcare staff who are asked to interpret in the 

25 workplace; 
107 

•HR 3561 IH 

1 ‘‘(3) develop formal training programs for indi2 viduals interested in becoming dedicated healthcare 

3 interpreters; 

4 ‘‘(4) provide staff language training instruction 

5 which shall include information on the practical limi6 tations of such instruction for non-native speakers; 

7 ‘‘(5) provide basic healthcare-related English 

8 language instruction for limited English proficient 

9 individuals; and 

10 ‘‘(6) develop other language assistance services 

11 as determined appropriate by the Secretary. 

12 ‘‘(d) PRIORITY.—In awarding grants under this sec13 tion, the Secretary shall give priority to entities that have 

14 developed partnerships with organizations or agencies with 

15 experience in language access services. 

16 ‘‘(e) EVALUATION.—An entity that receives a grant 

17 under this section shall submit to the Secretary an evalua18 tion that describes the activities carried out with funds 

19 received under the grant, and how such activities improved 

20 access to healthcare services and the quality of healthcare 

21 for individuals with limited English proficiency. Such eval22 uation shall be collected and disseminated through the 

23 Center for Linguistic and Cultural Competence in 

24 Healthcare established under section 2903. 
108 

•HR 3561 IH 

1 ‘‘(f) GRANTEE CONVENTION.—The Secretary, acting 

2 through the Director of the Center for Linguistic and Cul3 tural Competence in Healthcare, shall at the end of the 

4 grant cycle convene grantees under this section to share 

5 findings and develop and disseminate model programs and 

6 practices. 

7 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

8 is authorized to be appropriated to carry out this section, 

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

10 2006 through 2011. 

11 ‘‘SEC. 2905. RESEARCH ON LANGUAGE ACCESS. 

12 ‘‘(a) IN GENERAL.—The Director of the Agency for 

13 Healthcare Research and Quality, in collaboration with 

14 the Director of the Office of Minority Health, shall expand 

15 research concerning— 

16 ‘‘(1) the barriers to healthcare services includ17 ing mental and behavioral services that are faced by 

18 limited English proficient individuals; 

19 ‘‘(2) the impact of language barriers on the 

20 quality of healthcare and the health status of limited 

21 English proficient individuals and populations; 

22 ‘‘(3) healthcare provider attitudes, knowledge, 

23 and awareness of the barriers described in para24 graphs (1) and (2); 
109 

•HR 3561 IH 

1 ‘‘(4) the means by which language access serv2 ices are provided to limited English proficient indi3 viduals and how such services are effective in im4 proving the quality of care; 

5 ‘‘(5) the cost-effectiveness of providing language 

6 access; and 

7 ‘‘(6) optimal approaches for delivering language 

8 access. 

9 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

10 is authorized to be appropriated to carry out this section, 

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

12 2006 through 2011. 

13 ‘‘SEC. 2906. INFORMATION ABOUT FEDERAL HEALTH PRO14 GRAMS FOR LIMITED ENGLISH PROFICIENT 

15 POPULATIONS. 

16 ‘‘The Secretary shall provide for a means by which 

17 limited English proficient individuals who are seeking in18 formation about, or assistance with, Federal healthcare 

19 programs may obtain such information or assistance.’’. 

20 SEC. 202. STANDARDS FOR LANGUAGE ACCESS SERVICES. 

21 Not later than 120 days after the date of enactment 

22 of this Act, the head of each Federal agency that carries 

23 out health care-related activities shall develop and adopt 

24 a guidance on language services for those with limited 

25 English proficiency who attempt to have access to or par-
110 

•HR 3561 IH 

1 ticipate in such activities that provides at the minimum 

2 the factors and principles set forth in the Department of 

3 Justice guidance published on June 12, 2002. 

4 SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY 

5 AND LINGUISTICALLY APPROPRIATE SERV6 ICES UNDER THE MEDICARE, MEDICAID AND 

7 STATE CHILDREN’S HEALTH INSURANCE 

8 PROGRAM. 

9 (a) DEMONSTRATION PROJECT PROMOTING ACCESS

10 FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH

11 PROFICIENCY.— 

12 (1) IN GENERAL.—The Secretary shall conduct 

13 a demonstration project (in this section referred to 

14 as the ‘‘project’’) to demonstrate the impact on costs 

15 and health outcomes of providing reimbursement for 

16 interpreter services to certain medicare beneficiaries 

17 who are limited English proficient in urban and 

18 rural areas. 

19 (2) SCOPE.—The Secretary shall carry out the 

20 project in not less than 30 States through contracts 

21 with— 

22 (A) health plans (under part C of title 

23 XVIII of the Social Security Act); 

24 (B) small providers; 

25 (C) hospitals; and 
111 

•HR 3561 IH 

1 (D) community-based clinics. 

2 (3) DURATION.—Each contract entered into 

3 under the project shall extend over a period of not 

4 longer than 2 years. 

5 (4) REPORT.—Upon completion of the project, 

6 the Secretary shall submit a report to Congress on 

7 the project which shall include recommendations re8 garding the extension of such project to the entire 

9 medicare program. 

10 (5) EVALUATION.—The Director of the Agency 

11 for Healthcare Research and Quality shall award 

12 grants to public and private nonprofit entities for 

13 the evaluation of the project. Such evaluations shall 

14 focus on access, utilization, efficiency, cost-effective15 ness, patient satisfaction, and select health out16 comes. 

17 (b) MEDICAID.—Section 1903(a)(3) of the Social Se18 curity Act (42 U.S.C. 1396b(a)(3)) is amended— 

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

20 the end and inserting ‘‘and’’; and 

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

22 ‘‘(E) 90 percent of the sums expended with 

23 respect to costs incurred during such quarter as 

24 are attributable to the provision of culturally 

25 and linguistically appropriate services, including 
112 

•HR 3561 IH 

1 oral interpretation, translations of written ma2 terials, and other cultural and linguistic services 

3 for individuals with limited English proficiency 

4 and disabilities who apply for, or receive, med5 ical assistance under the State plan (including 

6 any waiver granted to the State plan); plus’’. 

7 (c) SCHIP.—Section 2105(a)(1) of the Social Secu8 rity Act (42 U.S.C.1397ee(a)), as amended by section 

9 515, is amended— 

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

11 by inserting ‘‘or, in the case of expenditures de12 scribed in subparagraph (D)(iv), 90 percent’’ after 

13 ‘‘enhanced FMAP’’; and 

14 (2) in subparagraph (D)— 

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

16 end; 

17 (B) by redesignating clause (iv) as clause 

18 (v); and 

19 (C) by inserting after clause (iii) the fol20 lowing: 

21 ‘‘(iv) for expenditures attributable to 

22 the provision of culturally and linguistically 

23 appropriate services, including oral inter24 pretation, translations of written materials, 

25 and other language services for individuals 
113 

•HR 3561 IH 

1 with limited English proficiency and dis2 abilities who apply for, or receive, child 

3 health assistance under the plan; and’’. 

4 (d) EFFECTIVE DATE.—The amendments made by 

5 this section take effect on October 1, 2006. 

6 SEC. 204. INCREASING UNDERSTANDING OF HEALTH LIT7 ERACY. 

8 (a) IN GENERAL.—The Secretary, acting through the 

9 Director of the Agency for Healthcare Research and Qual10 ity and the Administrator of the Health Resources and 

11 Services Administration, shall award grants to eligible en12 tities to improve healthcare for patient populations that 

13 have low functional health literacy. 

14 (b) ELIGIBILITY.—To be eligible to receive a grant 

15 under subsection (a), an entity shall— 

16 (1) be a hospital, health center or clinic, health 

17 plan, or other health entity; and 

18 (2) prepare and submit to the Secretary an ap19 plication at such time, in such manner, and con20 taining such information as the Secretary may re21 quire. 

22 (c) USE OF FUNDS.— 

23 (1) AGENCY FOR HEALTHCARE RESEARCH AND

24 QUALITY.—Grants awarded under subsection (a) 
114 

•HR 3561 IH 

1 through the Agency for Healthcare Research and 

2 Quality shall be used— 

3 (A) to define and increase the under4 standing of health literacy; 

5 (B) to investigate the correlation between 

6 low health literacy and health and healthcare; 

7 (C) to clarify which aspects of health lit8 eracy have an effect on health outcomes; and 

9 (D) for any other activity determined ap10 propriate by the Director of the Agency. 

11 (2) HEALTH RESOURCES AND SERVICES ADMIN12 ISTRATION.—Grants awarded under subsection (a) 

13 through the Health Resources and Services Adminis14 tration shall be used to conduct demonstration 

15 projects for interventions for patients with low 

16 health literacy that may include— 

17 (A) the development of new disease man18 agement programs for patients with low health 

19 literacy; 

20 (B) the tailoring of existing disease man21 agement programs addressing mental and phys22 ical health conditions for patients with low 

23 health literacy; 

24 (C) the translation of written health mate25 rials for patients with low health literacy; 
115 

•HR 3561 IH 

1 (D) the identification, implementation, and 

2 testing of low health literacy screening tools; 

3 (E) the conduct of educational campaigns 

4 for patients and providers about low health lit5 eracy; and 

6 (F) other activities determined appropriate 

7 by the Administrator of the Health Resources 

8 and Services Administration. 

9 (d) DEFINITIONS.—In this section, the term ‘‘low 

10 health literacy’’ means the inability of an individual to ob11 tain, process, and understand basic health information 

12 and services needed to make appropriate health decisions. 

13 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to carry out this section, 

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

16 2006 through 2011. 

17 SEC. 205. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL18 TURALLY AND LINGUISTICALLY APPRO19 PRIATE HEALTHCARE SERVICES. 

20 Not later than 1 year after the date of enactment 

21 of this Act and annually thereafter, the Secretary of 

22 Health and Human Services shall enter into a contract 

23 with the Institute of Medicine for the preparation and 

24 publication of a report that describes federal efforts to en25 sure that all individuals have meaningful access to cul-
116 

•HR 3561 IH 

1 turally and linguistically appropriate healthcare services. 

2 Such report shall include— 

3 (1) a description and evaluation of the activities 

4 carried out under this Act; and 

5 (2) a description of best practices, model pro6 grams, guidelines, and other effective strategies for 

7 providing access to culturally and linguistically ap8 propriate healthcare services. 

9 SEC. 206. GENERAL ACCOUNTING OFFICE REPORT ON IM10 PACT OF LANGUAGE ACCESS SERVICES. 

11 Not later than 3 years after the date of enactment 

12 of this Act, the Comptroller General of the United States 

13 shall examine, and prepare and publish a report on, the 

14 impact of language access services on the health and 

15 healthcare of limited English proficient populations. Such 

16 report shall include— 

17 (1) recommendations on the development and 

18 implementation of policies and practices by 

19 healthcare organizations and providers for limited 

20 English proficient patient populations; 

21 (2) a description of the effect of providing lan22 guage access services on quality of healthcare and 

23 access to care and reduced medical error; and 
117 

•HR 3561 IH 

1 (3) a description of the costs associated with or 

2 savings related to provision of language access serv3 ices. 

4 SEC. 207. DEFINITIONS. 

5 In this title: 

6 (1) INCORPORATED DEFINITIONS.—The defini7 tions contained in section 2900 of the Public Health 

8 Service Act, as added by section 201, shall apply. 

9 (2) SECRETARY.—The term ‘‘Secretary’’ means 

10 the Secretary of Health and Human Services. 

11 Subtitle B—Medicare and Medicaid 

12 Programs Requirements 

13 SEC. 211. TREATMENT OF THE MEDICARE PART B PRO14 GRAM UNDER TITLE VI OF CIVIL RIGHTS ACT 

15 OF 1964. 

16 A payment provider of services or physician or other 

17 supplier under part B of title XVIII of the Social Security 

18 Act shall be deemed a grant, and not a contract of insur19 ance or guaranty, for the purposes of title VI of the Civil 

20 Rights Act of 1964. 
118 

•HR 3561 IH 

1 TITLE III—HEALTH WORKFORCE 

2 DIVERSITY 

3 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

5 Title XXIX of the Public Health Service Act, as 

6 added by section 201, is amended by adding at the end 

7 the following: 

8 ‘‘Subtitle A—Diversifying the 

9 Healthcare Workplace 

10 ‘‘SEC. 2911. REPORT ON WORKFORCE DIVERSITY. 

11 ‘‘(a) IN GENERAL.—Not later than July 1, 2006, and 

12 biannually thereafter, the Secretary, acting through the 

13 director of each entity within the Department of Health 

14 and Human Services, shall prepare and submit to the 

15 Committee on Health, Education, Labor, and Pensions of 

16 the Senate and the Committee on Energy and Commerce 

17 of the House of Representatives a report on health work18 force diversity. 

19 ‘‘(b) REQUIREMENT.—The report under subsection 

20 (a) shall contain the following information: 

21 ‘‘(1) A description of any grant support that is 

22 provided by each entity for workforce diversity ini23 tiatives with the following information— 

24 ‘‘(A) the number of grants made; 

25 ‘‘(B) the purpose of the grants; 
119 

•HR 3561 IH 

1 ‘‘(C) the populations served through the 

2 grants; 

3 ‘‘(D) the organizations and institutions re4 ceiving the grants; and 

5 ‘‘(E) the tracking efforts that were used to 

6 follow the progress of participants. 

7 ‘‘(2) A description of the entity’s plan to 

8 achieve workforce diversity goals that includes, to 

9 the extent relevant to such entity— 

10 ‘‘(A) the number of underrepresented mi11 nority health professionals that will be needed 

12 in various disciplines over the next 10 years to 

13 achieve population parity; 

14 ‘‘(B) the level of funding needed to fully 

15 expand and adequately support health profes16 sions pipeline programs; 

17 ‘‘(C) the impact such programs have had 

18 on the admissions practices and policies of 

19 health professions schools; 

20 ‘‘(D) the management strategy necessary 

21 to effectively administer and institutionalize 

22 health profession pipeline programs; and 

23 ‘‘(E) the impact that the Government Per24 formance and Results Act (GPRA) has had on 

25 evaluating the performance of grantees and 
120 

•HR 3561 IH 

1 whether the GPRA is the best assessment tool 

2 for programs under titles VII and VIII. 

3 ‘‘(3) A description of measurable objectives of 

4 each entity relating to workforce diversity initiatives. 

5 ‘‘(c) PUBLIC AVAILABILITY.—The report under sub6 section (a) shall be made available for public review and 

7 comment. 

8 ‘‘SEC. 2912. NATIONAL WORKING GROUP ON WORKFORCE 

9 DIVERSITY. 

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

11 the Bureau of Health Professions within the Health Re12 sources and Services Administration, shall award a grant 

13 to an entity determined appropriate by the Secretary for 

14 the establishment of a national working group on work15 force diversity. 

16 ‘‘(b) REPRESENTATION.—In establishing the national 

17 working group under subsection (a), the grantee shall en18 sure that the group has representation from the following 

19 entities: 

20 ‘‘(1) The Health Resources and Services Ad21 ministration. 

22 ‘‘(2) The Department of Health and Human 

23 Services Data Council. 

24 ‘‘(3) The Office of Minority Health. 
121 

•HR 3561 IH 

1 ‘‘(4) The Bureau of Labor Statistics of the De2 partment of Labor. 

3 ‘‘(5) The Public Health Practice Program Of4 fice—Office of Workforce Policy and Planning. 

5 ‘‘(6) The National Center on Minority Health 

6 and Health Disparities. 

7 ‘‘(7) The Agency for Healthcare Research and 

8 Quality. 

9 ‘‘(8) The Institute of Medicine Study Com10 mittee for the 2004 workforce diversity report. 

11 ‘‘(9) The Indian Health Service. 

12 ‘‘(10) Academic institutions. 

13 ‘‘(11) Consumer organizations. 

14 ‘‘(12) Health professional associations, includ15 ing those that represent underrepresented minority 

16 populations. 

17 ‘‘(13) Researchers in the area of health work18 force. 

19 ‘‘(14) Health workforce accreditation entities. 

20 ‘‘(15) Private foundations that have sponsored 

21 workforce diversity initiatives. 

22 ‘‘(16) Not less than 5 health professions stu23 dents representing various health profession fields 

24 and levels of training. 
122 

•HR 3561 IH 

1 ‘‘(c) ACTIVITIES.—The working group established 

2 under subsection (a) shall convene at least twice each year 

3 to complete the following activities: 

4 ‘‘(1) Review current public and private health 

5 workforce diversity initiatives. 

6 ‘‘(2) Identify successful health workforce diver7 sity programs and practices. 

8 ‘‘(3) Examine challenges relating to the devel9 opment and implementation of health workforce di10 versity initiatives. 

11 ‘‘(4) Draft a national strategic work plan for 

12 health workforce diversity, including recommenda13 tions for public and private sector initiatives. 

14 ‘‘(5) Develop a framework and methods for the 

15 evaluation of current and future health workforce di16 versity initiatives. 

17 ‘‘(6) Develop recommended standards for work18 force diversity that could be applicable to all health 

19 professions programs and programs funded under 

20 this Act. 

21 ‘‘(7) Develop curriculum guidelines for diversity 

22 training. 

23 ‘‘(8) Develop a strategy for the inclusion of 

24 community members on admissions committees for 

25 health profession schools. 
123 

•HR 3561 IH 

1 ‘‘(9) Other activities determined appropriate by 

2 the Secretary. 

3 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

4 the establishment of the working group under subsection 

5 (a), and annually thereafter, the working group shall pre6 pare and make available to the general public for com7 ment, an annual report on the activities of the working 

8 group. Such report shall include the recommendations of 

9 the working group for improving health workforce diver10 sity. 

11 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section, 

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

14 2007 through 2012. 

15 ‘‘SEC. 2913. TECHNICAL CLEARINGHOUSE FOR HEALTH 

16 WORKFORCE DIVERSITY. 

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

18 the Office of Minority Health, and in collaboration with 

19 the Bureau of Health Professions within the Health Re20 sources and Services Administration, shall establish a 

21 technical clearinghouse on health workforce diversity with22 in the Office of Minority Health and coordinate current 

23 and future clearinghouses. 
124 

•HR 3561 IH 

1 ‘‘(b) INFORMATION AND SERVICES.—The clearing2 house established under subsection (a) shall offer the fol3 lowing information and services: 

4 ‘‘(1) Information on the importance of health 

5 workforce diversity. 

6 ‘‘(2) Statistical information relating to under7 represented minority representation in health and al8 lied health professions and occupations. 

9 ‘‘(3) Model health workforce diversity practices 

10 and programs. 

11 ‘‘(4) Admissions policies that promote health 

12 workforce diversity and are in compliance with Fed13 eral and State laws. 

14 ‘‘(5) Lists of scholarship, loan repayment, and 

15 loan cancellation grants as well as fellowship infor16 mation for underserved populations for health pro17 fessions schools. 

18 ‘‘(6) Foundation and other large organizational 

19 initiatives relating to health workforce diversity. 

20 ‘‘(c) CONSULTATION.—In carrying out this section, 

21 the Secretary shall consult with non-Federal entities which 

22 may include minority health professional associations to 

23 ensure the adequacy and accuracy of information. 

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

25 is authorized to be appropriated to carry out this section, 
125 

•HR 3561 IH 

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

2 2007 through 2012. 

3 ‘‘SEC. 2914. EVALUATION OF WORKFORCE DIVERSITY INI4 TIATIVES. 

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

6 the Bureau of Health Professions within the Health Re7 sources and Services Administration, shall award grants 

8 to eligible entities for the conduct of an evaluation of cur9 rent health workforce diversity initiatives funded by the 

10 Department of Health and Human Services. 

11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

12 under subsection (a) an entity shall— 

13 ‘‘(1) be a city, county, Indian tribe, State, terri14 tory, community-based nonprofit organization, 

15 health center, university, college, or other entity de16 termined appropriate by the Secretary; 

17 ‘‘(2) with respect to an entity that is not an 

18 academic medical center, university, or private re19 search institution, carry out activities under the 

20 grant in partnership with an academic medical cen21 ter, university, or private research institution; and 

22 ‘‘(3) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 
126 

•HR 3561 IH 

1 ‘‘(c) USE OF FUNDS.—Amounts awarded under a 

2 grant under subsection (a) shall be used to support the 

3 following evaluation activities: 

4 ‘‘(1) Determinations of measures of health 

5 workforce diversity success. 

6 ‘‘(2) The short- and long-term tracking of par7 ticipants in health workforce diversity pipeline pro8 grams funded by the Department of Health and 

9 Human Services. 

10 ‘‘(3) Assessments of partnerships formed 

11 through activities to increase health workforce diver12 sity. 

13 ‘‘(4) Assessments of barriers to health work14 force diversity. 

15 ‘‘(5) Assessments of policy changes at the Fed16 eral, State, and local levels. 

17 ‘‘(6) Assessments of coordination within and be18 tween Federal agencies and other institutions. 

19 ‘‘(7) Other activities determined appropriate by 

20 the Secretary and the Working Group established 

21 under section 2912. 

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

23 of enactment of this title, the Bureau of Health Profes24 sions within the Health Resources and Services Adminis25 tration shall prepare and make available for public com-
127 

•HR 3561 IH 

1 ment a report that summarizes the findings made by enti2 ties under grants under this section. 

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

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

6 2007 through 2012. 

7 ‘‘SEC. 2915. DATA COLLECTION AND REPORTING BY 

8 HEALTH PROFESSIONAL SCHOOLS. 

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

10 the Bureau of Health Professions of the Health Resources 

11 and Services Administration and the Office of Minority 

12 Health, shall establish an aggregated database on health 

13 professional students. 

14 ‘‘(b) REQUIREMENT TO COLLECT DATA.—Each 

15 health professional school (including medical, dental, and 

16 nursing schools) and allied health profession school and 

17 program that receives Federal funds shall collect race, eth18 nicity, and language proficiency data concerning those stu19 dents enrolled at such schools or in such programs. In col20 lecting such data, a school or program shall— 

21 ‘‘(1) at a minimum, use the categories for race 

22 and ethnicity described in the 1997 Office of Man23 agement and Budget Standards for Maintaining, 

24 Collecting, and Presenting Federal Data on Race 

25 and Ethnicity and available language standards; and 
128 

•HR 3561 IH 

1 ‘‘(2) if practicable, collect data on additional 

2 population groups if such data can be aggregated 

3 into the minimum race and ethnicity data categories. 

4 ‘‘(c) USE OF DATA.—Data on race, ethnicity, and 

5 primary language collected under this section shall be re6 ported to the database established under subsection (a) 

7 on an annual basis. Such data shall be available for public 

8 use. 

9 ‘‘(d) PRIVACY.—The Secretary shall ensure that all 

10 data collected under this section is protected from inap11 propriate internal and external use by any entity that col12 lects, stores, or receives the data and that such data is 

13 collected without personally identifiable information. 

14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section, 

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

17 2007 through 2012. 

18 ‘‘SEC. 2916. SUPPORT FOR INSTITUTIONS COMMITTED TO 

19 WORKFORCE DIVERSITY. 

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

21 the Administrator of the Health Resources and Services 

22 Administration, shall award grants to eligible entities that 

23 demonstrate a commitment to health workforce diversity. 

24 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

25 under subsection (a), an entity shall— 
129 

•HR 3561 IH 

1 ‘‘(1) be an educational institution or entity that 

2 historically produces or trains meaningful numbers 

3 of underrepresented minority health professionals, 

4 including— 

5 ‘‘(A) Historically Black Colleges and Uni6 versities; 

7 ‘‘(B) Hispanic-Serving Health Professions 

8 Schools; 

9 ‘‘(C) Hispanic-Serving Institutions; 

10 ‘‘(D) Tribal Colleges and Universities; 

11 ‘‘(E) Asian American and Pacific Islander12 serving institutions; 

13 ‘‘(F) institutions that have programs to re14 cruit and retain underrepresented minority 

15 health professionals, in which a significant 

16 number of the enrolled participants are under17 represented minorities; 

18 ‘‘(G) health professional associations, 

19 which may include underrepresented minority 

20 health professional associations; and 

21 ‘‘(H) institutions— 

22 ‘‘(i) located in communities with pre23 dominantly underrepresented minority pop24 ulations; 
130 

•HR 3561 IH 

1 ‘‘(ii) with whom partnerships have 

2 been formed for the purpose of increasing 

3 workforce diversity; and 

4 ‘‘(iii) in which at least 20 percent of 

5 the enrolled participants are underrep6 resented minorities; and 

7 ‘‘(2) submit to the Secretary an application at 

8 such time, in such manner, and containing such in9 formation as the Secretary may require. 

10 ‘‘(c) USE OF FUNDS.—Amounts received under a 

11 grant under subsection (a) shall be used to expand existing 

12 workforce diversity programs, implement new workforce 

13 diversity programs, or evaluate existing or new workforce 

14 diversity programs, including with respect to mental 

15 health care professions. Such programs shall enhance di16 versity by considering minority status as part of an indi17 vidualized consideration of qualifications. Possible activi18 ties may include— 

19 ‘‘(1) educational outreach programs relating to 

20 opportunities in the health professions; 

21 ‘‘(2) scholarship, fellowship, grant, loan repay22 ment, and loan cancellation programs; 

23 ‘‘(3) post-baccalaureate programs; 
131 

•HR 3561 IH 

1 ‘‘(4) academic enrichment programs, particu2 larly targeting those who would not be competitive 

3 for health professions schools; 

4 ‘‘(5) kindergarten through 12th grade and 

5 other health pipeline programs; 

6 ‘‘(6) mentoring programs; 

7 ‘‘(7) internship or rotation programs involving 

8 hospitals, health systems, health plans and other 

9 health entities; 

10 ‘‘(8) community partnership development for 

11 purposes relating to workforce diversity; or 

12 ‘‘(9) leadership training. 

13 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

14 a grant under this section, and annually for the term of 

15 the grant, a grantee shall submit to the Secretary a report 

16 that summarizes and evaluates all activities conducted 

17 under the grant. 

18 ‘‘(e) DEFINITION.—In this section, the term ‘Asian 

19 American and Pacific Islander-serving institutions’ means 

20 institutions— 

21 ‘‘(1) that are eligible institutions under section 

22 312(b) of the Higher Education Act of 1965; and 

23 ‘‘(2) that, at the time of their application, have 

24 an enrollment of undergraduate students that is 
132 

•HR 3561 IH 

1 made up of at least 10 percent Asian American and 

2 Pacific Islander students. 

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

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

6 2007 through 2012. 

7 ‘‘SEC. 2917. CAREER DEVELOPMENT FOR SCIENTISTS AND 

8 RESEARCHERS. 

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

10 the Director of the National Institutes of Health, the Di11 rector of the Centers for Disease Control and Prevention, 

12 the Commissioner of Food and Drugs, and the Director 

13 of the Agency for Healthcare Research and Quality, shall 

14 award grants that expand existing opportunities for sci15 entists and researchers and promote the inclusion of 

16 underrepresented minorities in the health professions. 

17 ‘‘(b) RESEARCH FUNDING.—The head of each entity 

18 within the Department of Health and Human Services 

19 shall establish or expand existing programs to provide re20 search funding to scientists and researchers in-training. 

21 Under such programs, the head of each such entity shall 

22 give priority in allocating research funding to support 

23 health research in traditionally underserved communities, 

24 including underrepresented minority communities, and re25 search classified as community or participatory. 
133 

•HR 3561 IH 

1 ‘‘(c) DATA COLLECTION.—The head of each entity 

2 within the Department of Health and Human Services 

3 shall collect data on the number (expressed as an absolute 

4 number and a percentage) of underrepresented minority 

5 and nonminority applicants who receive and are denied 

6 agency funding at every stage of review. Such data shall 

7 be reported annually to the Secretary and the appropriate 

8 committees of Congress. 

9 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec10 retary shall establish a student loan reimbursement pro11 gram to provide student loan reimbursement assistance to 

12 researchers who focus on racial and ethnic disparities in 

13 health. The Secretary shall promulgate regulations to de14 fine the scope and procedures for the program under this 

15 subsection. 

16 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec17 retary shall establish a student loan cancellation program 

18 to provide student loan cancellation assistance to research19 ers who focus on racial and ethnic disparities in health. 

20 Students participating in the program shall make a min21 imum 5-year commitment to work at an accredited health 

22 profession school. The Secretary shall promulgate addi23 tional regulations to define the scope and procedures for 

24 the program under this subsection. 
134 

•HR 3561 IH 

1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section, 

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

4 2007 through 2012. 

5 ‘‘SEC. 2918. CAREER SUPPORT FOR NON-RESEARCH 

6 HEALTH PROFESSIONALS. 

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

8 the Director of the Centers for Disease Control and Pre9 vention, the Administrator of the Substance Abuse and 

10 Mental Health Services Administration, the Administrator 

11 of the Health Resources and Services Administration, and 

12 the Administrator of the Centers for Medicare and Med13 icaid Services shall establish a program to award grants 

14 to eligible individuals for career support in non-research15 related healthcare. 

16 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

17 under subsection (a) an individual shall— 

18 ‘‘(1) be a student in a health professions school, 

19 a graduate of such a school who is working in a 

20 health profession, or a faculty member of such a 

21 school; and 

22 ‘‘(2) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 
135 

•HR 3561 IH 

1 ‘‘(c) USE OF FUNDS.—An individual shall use 

2 amounts received under a grant under this section to— 

3 ‘‘(1) support the individual’s health activities or 

4 projects that involve underserved communities, in5 cluding racial and ethnic minority communities; 

6 ‘‘(2) support health-related career advancement 

7 activities; and 

8 ‘‘(3) to pay, or as reimbursement for payments 

9 of, student loans for individuals who are health pro10 fessionals and are focused on health issues affecting 

11 underserved communities, including racial and eth12 nic minority communities. 

13 ‘‘(d) DEFINITION.—In this section, the term ‘career 

14 in non-research-related healthcare’ means employment or 

15 intended employment in the field of public health, health 

16 policy, health management, health administration, medi17 cine, nursing, pharmacy, allied health, community health, 

18 or other fields determined appropriate by the Secretary, 

19 other than in a position that involves research. 

20 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

21 is authorized to be appropriated to carry out this section, 

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

23 2007 through 2012. 
136 

•HR 3561 IH 

1 ‘‘SEC. 2919. RESEARCH ON THE EFFECT OF WORKFORCE DI2 VERSITY ON QUALITY. 

3 ‘‘(a) IN GENERAL.—The Director of the Agency for 

4 Healthcare Research and Quality, in collaboration with 

5 the Director of the Office of Minority Health and the Di6 rector of the National Center on Minority Health and 

7 Health Disparities, shall award grants to eligible entities 

8 to expand research on the link between health workforce 

9 diversity and quality healthcare. 

10 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

11 under subsection (a) an entity shall— 

12 ‘‘(1) be a clinical, public health, or health serv13 ices research entity or other entity determined ap14 propriate by the Director; and 

15 ‘‘(2) submit to the Secretary an application at 

16 such time, in such manner, and containing such in17 formation as the Secretary may require. 

18 ‘‘(c) USE OF FUNDS.—Amounts received under a 

19 grant awarded under subsection (a) shall be used to sup20 port research that investigates the effect of health work21 force diversity on— 

22 ‘‘(1) language access; 

23 ‘‘(2) cultural competence; 

24 ‘‘(3) patient satisfaction; 

25 ‘‘(4) timeliness of care; 

26 ‘‘(5) safety of care; 
137 

•HR 3561 IH 

1 ‘‘(6) effectiveness of care; 

2 ‘‘(7) efficiency of care; 

3 ‘‘(8) patient outcomes; 

4 ‘‘(9) community engagement; 

5 ‘‘(10) resource allocation; 

6 ‘‘(11) organizational structure; or 

7 ‘‘(12) other topics determined appropriate by 

8 the Director. 

9 ‘‘(d) PRIORITY.—In awarding grants under sub10 section (a), the Director shall give individualized consider11 ation to all relevant aspects of the applicant’s background. 

12 Consideration of prior research experience involving the 

13 health of underserved communities shall be such a factor. 

14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section, 

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

17 2007 through 2012. 

18 ‘‘SEC. 2920. HEALTH DISPARITIES EDUCATION PROGRAM. 

19 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

20 through the National Center on Minority Health and 

21 Health Disparities and in collaboration with the Office of 

22 Minority Health, the Office for Civil Rights, the Centers 

23 for Disease Control and Prevention, the Centers for Medi24 care and Medicaid Services, the Health Resources and 

25 Services Administration, and other appropriate public and 
138 

•HR 3561 IH 

1 private entities, shall establish and coordinate a health and 

2 healthcare disparities education program to support, de3 velop, and implement educational initiatives and outreach 

4 strategies that inform healthcare professionals and the 

5 public about the existence of and methods to reduce racial 

6 and ethnic disparities in health and healthcare. 

7 ‘‘(b) ACTIVITIES.—The Secretary, through the edu8 cation program established under subsection (a) shall, 

9 through the use of public awareness and outreach cam10 paigns targeting the general public and the medical com11 munity at large— 

12 ‘‘(1) disseminate scientific evidence for the ex13 istence and extent of racial and ethnic disparities in 

14 healthcare, including disparities that are not other15 wise attributable to known factors such as access to 

16 care, patient preferences, or appropriateness of 

17 intervention, as described in the 2002 Institute of 

18 Medicine Report, Unequal Treatment; 

19 ‘‘(2) disseminate new research findings to 

20 healthcare providers and patients to assist them in 

21 understanding, reducing, and eliminating health and 

22 healthcare disparities; 

23 ‘‘(3) disseminate information about the impact 

24 of linguistic and cultural barriers on healthcare qual25 ity and the obligation of health providers who receive 
139 

•HR 3561 IH 

1 Federal financial assistance to ensure that people 

2 with limited English proficiency have access to lan3 guage access services; 

4 ‘‘(4) disseminate information about the impor5 tance and legality of racial, ethnic, and primary lan6 guage data collection, analysis, and reporting; 

7 ‘‘(5) design and implement specific educational 

8 initiatives to health care providers relating to health 

9 and health care disparities; 

10 ‘‘(6) assess the impact of the programs estab11 lished under this section in raising awareness of 

12 health and healthcare disparities and providing in13 formation on available resources. 

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section, 

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

17 2007 through 2012. 

18 ‘‘SEC. 2920A. CULTURAL COMPETENCE TRAINING FOR 

19 HEALTHCARE PROFESSIONALS. 

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

21 the Administrator of the Health Resources and Services 

22 Administration, the Director of the Office of Minority 

23 Health, and the Director of the National Center for Mi24 nority Health and Health Disparities, shall award grants 

25 to eligible entities to test, implement, and evaluate models 
140 

•HR 3561 IH 

1 of cultural competence training, including continuing edu2 cation, for healthcare providers in coordination with the 

3 initiative under section 2920(a). 

4 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

5 under subsection (a), an entity shall— 

6 ‘‘(1) be an academic medical center, a health 

7 center or clinic, a hospital, a health plan, a health 

8 system, or a health care professional guild (including 

9 a mental health care professional guild); 

10 ‘‘(2) partner with a minority serving institution, 

11 minority professional association, or community12 based organization representing minority popu13 lations, in addition to a research institution to carry 

14 out activities under this grant; and 

15 ‘‘(3) prepare and submit to the Secretary an 

16 application at such time, in such manner, and con17 taining such information as the Secretary may re18 quire. 

19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

20 is authorized to be appropriated to carry out this section, 

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

22 2007 through 2012.’’. 

23 SEC. 302. HEALTH CAREERS OPPORTUNITY PROGRAM. 

24 (a) PURPOSE.—It is the purpose of this section to 

25 diversify the healthcare workforce by increasing the num-
141 

•HR 3561 IH 

1 ber of individuals from disadvantaged backgrounds in the 

2 health and allied health professions by enhancing the aca3 demic skills of students from disadvantaged backgrounds 

4 and supporting them in successfully competing, entering, 

5 and graduating from health professions training pro6 grams. 

7 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

8 740(c) of the Public Health Service Act (42 U.S.C. 

9 293d(c)) is amended by striking ‘‘$29,400,000’’ and all 

10 that follows through ‘‘2002’’ and inserting ‘‘$50,000,000 

11 for fiscal year 2007, and such sums as may be necessary 

12 for each of fiscal years 2008 through 2012’’. 

13 SEC. 303. PROGRAM OF EXCELLENCE IN HEALTH PROFES14 SIONS EDUCATION FOR UNDERREP15 RESENTED MINORITIES. 

16 (a) PURPOSE.—It is the purpose of this section to 

17 diversify the healthcare workforce by supporting programs 

18 of excellence in designated health professions schools that 

19 demonstrate a commitment to underrepresented minority 

20 populations with a focus on minority health issues, cul21 tural and linguistic competence, and eliminating health 

22 disparities. 

23 (b) AUTHORIZATION OF APPROPRIATION.—Section 

24 737(h)(1) of the Public Health Service Act (42 U.S.C. 

25 293(h)(1)) is amended to read as follows: 
142 

•HR 3561 IH 

1 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

2 For the purpose of making grants under subsection 

3 (a), there are authorized to be appropriated 

4 $50,000,000 for fiscal year 2007, and such sums as 

5 may be necessary for each of the fiscal years 2008 

6 through 2012.’’. 

7 SEC. 304. HISPANIC-SERVING HEALTH PROFESSIONS 

8 SCHOOLS. 

9 Part B of title VII of the Public Health Service Act 

10 (42 U.S.C. 293 et seq.) is amended by adding at the end 

11 the following: 

12 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 

13 SCHOOLS. 

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

15 the Administrator of the Health Resources and Services 

16 Administration, shall award grants to Hispanic-serving 

17 health professions schools for the purpose of carrying out 

18 programs to recruit Hispanic individuals to enroll in and 

19 graduate from such schools, which may include providing 

20 scholarships and other financial assistance as appropriate. 

21 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His22 panic-serving health professions school’ means an entity 

23 that— 

24 ‘‘(1) is a school or program under section 

25 799B; 
143 

•HR 3561 IH 

1 ‘‘(2) has an enrollment of full-time equivalent 

2 students that is made up of at least 9 percent His3 panic students; 

4 ‘‘(3) has been effective in carrying out pro5 grams to recruit Hispanic individuals to enroll in 

6 and graduate from the school; 

7 ‘‘(4) has been effective in recruiting and retain8 ing Hispanic faculty members; and 

9 ‘‘(5) has a significant number of graduates who 

10 are providing health services to medically under11 served populations or to individuals in health profes12 sional shortage areas.’’. 

13 SEC. 305. HEALTH PROFESSIONS STUDENT LOAN FUND; AU14 THORIZATIONS OF APPROPRIATIONS RE15 GARDING STUDENTS FROM DISADVANTAGED 

16 BACKGROUNDS. 

17 Section 724(f)(1) of the Public Health Service Act 

18 (42 U.S.C. 292t(f)(1)) is amended by striking 

19 ‘‘$8,000,000’’ and all that follows and inserting 

20 ‘‘$35,000,000 for fiscal year 2007, and such sums as may 

21 be necessary for each of the fiscal years 2008 through 

22 2012.’’. 
144 

•HR 3561 IH 

1 SEC. 306. NATIONAL HEALTH SERVICE CORPS; RECRUIT2 MENT AND FELLOWSHIPS FOR INDIVIDUALS 

3 FROM DISADVANTAGED BACKGROUNDS. 

4 (a) IN GENERAL.—Section 331(b) of the Public 

5 Health Service Act (42 U.S.C. 254d(b)) is amended by 

6 adding at the end the following: 

7 ‘‘(3) The Secretary shall ensure that the individuals 

8 with respect to whom activities under paragraphs (1) and 

9 (2) are carried out include individuals from disadvantaged 

10 backgrounds, including activities carried out to provide 

11 health professions students with information on the Schol12 arship and Repayment Programs.’’. 

13 (b) ASSIGNMENT OF CORPS PERSONNEL.—Section 

14 333(a) of the Public Health Service Act (42 U.S.C. 

15 254f(a)) is amended by adding at the end the following: 

16 ‘‘(4) In assigning Corps personnel under this section, 

17 the Secretary shall give preference to applicants who re18 quest assignment to a federally qualified health center (as 

19 defined in section 1905(l)(2)(B) of the Social Security 

20 Act) or to a provider organization that has a majority of 

21 patients who are minorities or individuals from low-income 

22 families (families with a family income that is less than 

23 200 percent of the Official Poverty Line).’’. 
145 

•HR 3561 IH 

1 SEC. 307. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

2 DISEASE CONTROL AND PREVENTION. 

3 Section 317F(c) of the Public Health Service Act (42 

4 U.S.C. 247b–7(c)) is amended— 

5 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 

6 (2) by inserting before the period the following: 

7 ‘‘$750,000 for fiscal year 2007, and such sums as 

8 may be necessary for each of the fiscal years 2008 

9 through 2012.’’. 

10 SEC. 308. COOPERATIVE AGREEMENTS FOR ONLINE DE11 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

12 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

13 Part B of title VII of the Public Health Service Act 

14 (42 U.S.C. 293 et seq.), as amended by section 304, is 

15 further amended by adding at the end the following: 

16 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE17 GREE PROGRAMS. 

18 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

19 acting through the Administrator of the Health Resources 

20 and Services Administration, in consultation with the Di21 rector of the Centers for Disease Control and Prevention, 

22 the Director of the Agency for Healthcare Research and 

23 Quality, and the Director of the Office of Minority Health, 

24 shall award cooperative agreements to schools of public 

25 health and schools of allied health to design and imple26 ment online degree programs. 
146 

•HR 3561 IH 

1 ‘‘(b) PRIORITY.—In awarding cooperative agreements 

2 under this section, the Secretary shall give priority to any 

3 school of public health or school of allied health that has 

4 an established track record of serving medically under5 served communities. 

6 ‘‘(c) REQUIREMENTS.—Awardees must design and 

7 implement an online degree program, that meet the fol8 lowing restrictions: 

9 ‘‘(1) Enrollment of individuals who have ob10 tained a secondary school diploma or its recognized 

11 equivalent. 

12 ‘‘(2) Maintaining a significant enrollment of 

13 underrepresented minority or disadvantaged stu14 dents. 

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

16 are authorized to be appropriated to carry out this section, 

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

18 2007 through 2012.’’. 

19 SEC. 309. MID-CAREER HEALTH PROFESSIONS SCHOLAR20 SHIP PROGRAM. 

21 Part B of title VII of the Public Health Service Act 

22 (as amended by section 308) is further amended by adding 

23 at the end the following: 
147 

•HR 3561 IH 

1 ‘‘SEC. 744. MID-CAREER HEALTH PROFESSIONS SCHOLAR2 SHIP PROGRAM. 

3 ‘‘(a) IN GENERAL.—The Secretary may make grants 

4 to eligible schools for awarding scholarships to eligible in5 dividuals to attend the school involved, for the purpose of 

6 enabling the individuals to make a career change from a 

7 non-health profession to a health profession. 

8 ‘‘(b) EXPENSES.—Amounts awarded as a scholarship 

9 under this section— 

10 ‘‘(1) subject to paragraph (2), may be expended 

11 only for tuition expenses, other reasonable edu12 cational expenses, and reasonable living expenses in13 curred in the attendance of the school involved; and 

14 ‘‘(2) may be expended for stipends to eligible 

15 individuals for the enrolled period at eligible schools, 

16 except that such a stipend may not be provided to 

17 an individual for more than 4 years, and such a sti18 pend may not exceed $35,000 per year (notwith19 standing any other provision of law regarding the 

20 amount of stipends). 

21 ‘‘(c) DEFINITIONS.—In this section: 

22 ‘‘(1) ELIGIBLE SCHOOL.—The term ‘eligible 

23 school’ means a school of medicine, osteopathic med24 icine, dentistry, nursing (as defined in section 801), 

25 pharmacy, podiatric medicine, optometry, veterinary 

26 medicine, public health, chiropractic, or allied health, 
148 

•HR 3561 IH 

1 a school offering a graduate program in mental and 

2 behavioral health practice, or an entity providing 

3 programs for the training of physician assistants. 

4 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

5 individual’ means an individual who has obtained a 

6 secondary school diploma or its recognized equiva7 lent. 

8 ‘‘(d) PRIORITY.—In providing scholarships to eligible 

9 individuals, eligible schools shall give to individuals from 

10 disadvantaged backgrounds. 

11 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to carry out this section, 

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

14 2007 through 2012.’’. 

15 SEC. 310. STRENGTHENING AND EXPANDING RURAL 

16 HEALTH PROVIDER NETWORKS. 

17 Section 330A of the Public Health Service Act (42 

18 U.S.C. 254c) is amended— 

19 (1) in subsection (h), by adding at the end the 

20 following: 

21 ‘‘(4) RURAL MINORITY, BORDER, AND INDIAN

22 POPULATIONS.—In making grants under this sec23 tion, the Director of the Office of Rural Health Pol24 icy of the Health Resources and Services Adminis25 tration, in coordination with the Director of the In-
149 

•HR 3561 IH 

1 dian Health Service and the Director of the Office 

2 of Minority Health, shall make grants to entities 

3 that serve rural minority, border, and Indian popu4 lations. 

5 ‘‘(5) DIVERSITY HEALTH TRAINING PRO6 GRAMS.—The Director of the Office of Rural Health 

7 Policy of the Health Resources and Services Admin8 istration, in coordination with the Director of the In9 dian Health Service and the Director of the Office 

10 of Minority Health, shall coordinate the awarding of 

11 grants under this section with the awarding of 

12 grants and contracts under section 765 to connect 

13 and integrate diversity health training programs.’’; 

14 and 

15 (2) in subsection (k), as redesignated by this 

16 section, by striking ‘‘and such sums as may be nec17 essary for each of fiscal years 2003 through 2006’’ 

18 and inserting ‘‘, such sums as may be necessary for 

19 each of fiscal years 2003 through 2005, and 

20 $60,000,000 for each of fiscal years 2006 through 

21 2010’’. 
150 

•HR 3561 IH 

1 SEC. 311. NATIONAL REPORT ON THE PREPAREDNESS OF 

2 HEALTH PROFESSIONALS TO CARE FOR DI3 VERSE POPULATIONS. 

4 The Secretary of Health and Human Services shall 

5 include in the report prepared under section 1707(c) of 

6 the Public Health Service Act (as added by section 603 

7 of this Act), information relating to the preparedness of 

8 health professionals to care for racially and ethnically di9 verse populations. Such information, which shall be col10 lected by the Bureau of Health Professions, shall in11 clude— 

12 (1) with respect to health professions education, 

13 the number and percentage of hours of classroom 

14 discussion relating to minority health issues, includ15 ing cultural competence; 

16 (2) a description of the coursework involved in 

17 such education; 

18 (3) a description of the results of an evaluation 

19 of the preparedness of students in such education; 

20 (4) a description of the types of exposure that 

21 students have during their education to minority pa22 tient populations; and 

23 (5) a description of model programs and prac24 tices. 
151 

•HR 3561 IH 

1 SEC. 312. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

2 Subtitle A–1 of title XXIX of the Public Health Serv3 ice Act, as amended by section 301, is further amended 

4 by adding at the end the following: 

5 ‘‘SEC. 2920B. DAVID SATCHER PUBLIC HEALTH AND 

6 HEALTH SERVICES CORPS. 

7 ‘‘(a) IN GENERAL.—The Administrator of the Health 

8 Resources and Services Administration and Director of 

9 the Centers for Disease Control and Prevention, in col10 laboration with the Director of the Office of Minority 

11 Health, shall award grants to eligible entities to increase 

12 awareness among post-primary and post-secondary stu13 dents of career opportunities in the health professions. 

14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

15 under subsection (a) an entity shall— 

16 ‘‘(1) be a clinical, public health or health serv17 ices organization, community-based or non-profit en18 tity, or other entity determined appropriate by the 

19 Director of the Centers for Disease Control and Pre20 vention; 

21 ‘‘(2) serve a health professional shortage area, 

22 as determined by the Secretary; 

23 ‘‘(3) work with students, including those from 

24 racial and ethnic minority backgrounds, that have 

25 expressed an interest in the health professions; and 
152 

•HR 3561 IH 

1 ‘‘(4) submit to the Secretary an application at 

2 such time, in such manner, and containing such in3 formation as the Secretary may require. 

4 ‘‘(c) USE OF FUNDS.—Grant awards under sub5 section (a) shall be used to support internships that will 

6 increase awareness among students of non-research based 

7 and career opportunities in the following health profes8 sions: 

9 ‘‘(1) Medicine. 

10 ‘‘(2) Nursing. 

11 ‘‘(3) Public Health. 

12 ‘‘(4) Pharmacy. 

13 ‘‘(5) Health Administration and Management. 

14 ‘‘(6) Health Policy. 

15 ‘‘(7) Psychology. 

16 ‘‘(8) Dentistry. 

17 ‘‘(9) International Health. 

18 ‘‘(10) Social Work. 

19 ‘‘(11) Allied Health. 

20 ‘‘(12) Other professions deemed appropriate by 

21 the Director of the Centers for Disease Control and 

22 Prevention. 

23 ‘‘(d) PRIORITY.—In awarding grants under sub24 section (a), the Director of the Centers for Disease Con-
153 

•HR 3561 IH 

1 trol and Prevention shall give priority to those entities 

2 that— 

3 ‘‘(1) serve a high proportion of individuals from 

4 disadvantaged backgrounds; 

5 ‘‘(2) have experience in health disparity elimi6 nation programs; 

7 ‘‘(3) facilitate the entry of disadvantaged indi8 viduals into institutions of higher education; and 

9 ‘‘(4) provide counseling or other services de10 signed to assist disadvantaged individuals in success11 fully completing their education at the post-sec12 ondary level. 

13 ‘‘(e) STIPENDS.—The Secretary may approve sti14 pends under this section for individuals for any period of 

15 education in student-enhancement programs (other than 

16 regular courses) at health professions schools, programs, 

17 or entities, except that such a stipend may not be provided 

18 to an individual for more than 6 months, and such a sti19 pend may not exceed $20 per day (notwithstanding any 

20 other provision of law regarding the amount of stipends). 

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

22 is authorized to be appropriated to carry out this section, 

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

24 2007 through 2012. 
154 

•HR 3561 IH 

1 ‘‘SEC. 2920C. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

2 PROGRAM. 

3 ‘‘(a) IN GENERAL.—The Director of the Centers for 

4 Disease Control and Prevention, in collaboration with the 

5 Director of the Office of Minority Health, shall award 

6 scholarships to postsecondary students who seek a career 

7 in public health. 

8 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol9 arship under subsection (a) an individual shall— 

10 ‘‘(1) have experience in public health research 

11 or public health practice, or other health professions 

12 as determined appropriate by the Director of the 

13 Centers for Disease Control and Prevention; 

14 ‘‘(2) reside in a health professional shortage 

15 area as determined by the Secretary; 

16 ‘‘(3) have expressed an interest in public health; 

17 ‘‘(4) demonstrate promise for becoming a leader 

18 in public health; 

19 ‘‘(5) secure admission to a 4-year institution of 

20 higher education; 

21 ‘‘(6) comply with subsection (f); and 

22 ‘‘(7) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 
155 

•HR 3561 IH 

1 ‘‘(c) USE OF FUNDS.—Amounts received under an 

2 award under subsection (a) shall be used to support oppor3 tunities for students to become public health professionals. 

4 ‘‘(d) PRIORITY.—In awarding grants under sub5 section (a), the Director shall give priority to those stu6 dents that— 

7 ‘‘(1) are from disadvantaged backgrounds; 

8 ‘‘(2) have secured admissions to a minority 

9 serving institution; and 

10 ‘‘(3) have identified a health professional as a 

11 mentor at their school or institution and an aca12 demic advisor to assist in the completion of their 

13 baccalaureate degree. 

14 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

15 payment of scholarships under this section for such indi16 viduals for any period of education in student under17 graduate tenure, except that such a scholarship may not 

18 be provided to an individual for more than 4 years, and 

19 such scholarships may not exceed $10,000 per academic 

20 year (notwithstanding any other provision of law regard21 ing the amount of scholarship). 

22 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

23 is authorized to be appropriated to carry out this section, 

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

25 2007 through 2012. 
156 

•HR 3561 IH 

1 ‘‘SEC. 2920D. PATSY MINK HEALTH AND GENDER RESEARCH 

2 FELLOWSHIP PROGRAM. 

3 ‘‘(a) IN GENERAL.—The Director of the Centers for 

4 Disease Control and Prevention, in collaboration with the 

5 Director of the Office of Minority Health, the Adminis6 trator of the Substance Abuse and Mental Health Services 

7 Administration, and the Director of the Indian Health 

8 Services, shall award research fellowships to post-bacca9 laureate students to conduct research that will examine 

10 gender and health disparities and to pursue a career in 

11 the health professions. 

12 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow13 ship under subsection (a) an individual shall— 

14 ‘‘(1) have experience in health research or pub15 lic health practice; 

16 ‘‘(2) reside in a health professional shortage 

17 area as determined by the Secretary; 

18 ‘‘(3) have expressed an interest in the health 

19 professions; 

20 ‘‘(4) demonstrate promise for becoming a leader 

21 in the field of women’s health; 

22 ‘‘(5) secure admission to a health professions 

23 school or graduate program with an emphasis in 

24 gender studies; 

25 ‘‘(6) comply with subsection (f); and 
157 

•HR 3561 IH 

1 ‘‘(7) submit to the Secretary an application at 

2 such time, in such manner, and containing such in3 formation as the Secretary may require. 

4 ‘‘(c) USE OF FUNDS.—Amounts received under an 

5 award under subsection (a) shall be used to support oppor6 tunities for students to become researchers and advance 

7 the research base on the intersection between gender and 

8 health. 

9 ‘‘(d) PRIORITY.—In awarding grants under sub10 section (a), the Director of the Centers for Disease Con11 trol and Prevention shall give priority to those applicants 

12 that— 

13 ‘‘(1) are from disadvantaged backgrounds; and 

14 ‘‘(2) have identified a mentor and academic ad15 visor who will assist in the completion of their grad16 uate or professional degree and have secured a re17 search assistant position with a researcher working 

18 in the area of gender and health. 

19 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

20 Disease Control and Prevention may approve fellowships 

21 for individuals under this section for any period of edu22 cation in the student’s graduate or health profession ten23 ure, except that such a fellowship may not be provided 

24 to an individual for more than 3 years, and such a fellow25 ship may not exceed $18,000 per academic year (notwith-
158 

•HR 3561 IH 

1 standing any other provision of law regarding the amount 

2 of fellowship). 

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

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

6 2007 through 2012. 

7 ‘‘SEC. 2920E. PAUL DAVID WELLSTONE INTERNATIONAL 

8 HEALTH FELLOWSHIP PROGRAM. 

9 ‘‘(a) IN GENERAL.—The Director of the Agency for 

10 Healthcare Research and Quality, in collaboration with 

11 the Director of the Office of Minority Health, shall award 

12 research fellowships to college students or recent grad13 uates to advance their understanding of international 

14 health. 

15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow16 ship under subsection (a) an individual shall— 

17 ‘‘(1) have educational experience in the field of 

18 international health; 

19 ‘‘(2) reside in a health professional shortage 

20 area as determined by the Secretary; 

21 ‘‘(3) demonstrate promise for becoming a leader 

22 in the field of international health; 

23 ‘‘(4) be a college senior or recent graduate of 

24 a four year higher education institution; 

25 ‘‘(5) comply with subsection (f); and 
159 

•HR 3561 IH 

1 ‘‘(6) submit to the Secretary an application at 

2 such time, in such manner, and containing such in3 formation as the Secretary may require. 

4 ‘‘(c) USE OF FUNDS.—Amounts received under an 

5 award under subsection (a) shall be used to support oppor6 tunities for students to become health professionals and 

7 to advance their knowledge about international issues re8 lating to healthcare access and quality. 

9 ‘‘(d) PRIORITY.—In awarding grants under sub10 section (a), the Director shall give priority to those appli11 cants that— 

12 ‘‘(1) are from a disadvantaged background; and 

13 ‘‘(2) have identified a mentor at a health pro14 fessions school or institution, an academic advisor to 

15 assist in the completion of their graduate or profes16 sional degree, and an advisor from an international 

17 health Non-Governmental Organization, Private Vol18 unteer Organization, or other international institu19 tion or program that focuses on increasing 

20 healthcare access and quality for residents in devel21 oping countries. 

22 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 

23 fellowships for college seniors or recent graduates, except 

24 that such a fellowship may not be provided to an indi25 vidual for more than 6 months, may not be awarded to 
160 

•HR 3561 IH 

1 a graduate that has not been enrolled in school for more 

2 than 1 year, and may not exceed $4,000 per academic year 

3 (notwithstanding any other provision of law regarding the 

4 amount of fellowship). 

5 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

6 is authorized to be appropriated to carry out this section, 

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

8 2007 through 2012. 

9 ‘‘SEC. 2920F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR 

10 PROGRAM. 

11 ‘‘(a) IN GENERAL.—The Director of the Agency for 

12 Healthcare Research and Quality, the Director of the Cen13 ters for Medicaid and Medicare, and the Administrator for 

14 Health Resources and Services Administration, in collabo15 ration with the Director of the Office of Minority Health, 

16 shall award grants to eligible entities to expose entering 

17 graduate students to the health professions. 

18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

19 under subsection (a) an entity shall— 

20 ‘‘(1) be a clinical, public health or health serv21 ices organization, community-based or non-profit en22 tity, or other entity determined appropriate by the 

23 Director of the Agency for Healthcare Research and 

24 Quality; 
161 

•HR 3561 IH 

1 ‘‘(2) serve in a health professional shortage 

2 area as determined by the Secretary; 

3 ‘‘(3) work with students obtaining a degree in 

4 the health professions; and 

5 ‘‘(4) submit to the Secretary an application at 

6 such time, in such manner, and containing such in7 formation as the Secretary may require. 

8 ‘‘(c) USE OF FUNDS.—Amounts received under a 

9 grant awarded under subsection (a) shall be used to sup10 port opportunities that expose students to non-research 

11 based health professions, including— 

12 ‘‘(1) public health policy; 

13 ‘‘(2) healthcare and pharmaceutical policy; 

14 ‘‘(3) healthcare administration and manage15 ment; 

16 ‘‘(4) health economics; and 

17 ‘‘(5) other professions determined appropriate 

18 by the Director of the Agency for Healthcare Re19 search and Quality. 

20 ‘‘(d) PRIORITY.—In awarding grants under sub21 section (a), the Director of the Agency for Healthcare Re22 search and Quality shall give priority to those entities 

23 that— 

24 ‘‘(1) have experience with health disparity elimi25 nation programs; 
162 

•HR 3561 IH 

1 ‘‘(2) facilitate training in the fields described in 

2 subsection (c); and 

3 ‘‘(3) provide counseling or other services de4 signed to assist such individuals in successfully com5 pleting their education at the post-secondary level. 

6 ‘‘(e) STIPENDS.—The Secretary may approve the 

7 payment of stipends for individuals under this section for 

8 any period of education in student-enhancement programs 

9 (other than regular courses) at health professions schools 

10 or entities, except that such a stipend may not be provided 

11 to an individual for more than 2 months, and such a sti12 pend may not exceed $100 per day (notwithstanding any 

13 other provision of law regarding the amount of stipends). 

14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section 

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

17 2007 through 2012.’’. 

18 SEC. 313. ADVISORY COMMITTEE ON HEALTH PROFES19 SIONS TRAINING FOR DIVERSITY. 

20 (a) ESTABLISHMENT.—The Secretary of Health and 

21 Human Services (referred to in this section as the ‘‘Sec22 retary’’) shall establish an advisory committee to be known 

23 as the Advisory Committee on Health Professions Train24 ing for Diversity (in this section referred to as the ‘‘Advi25 sory Committee’’). 
163 

•HR 3561 IH 

1 (b) COMPOSITION.— 

2 (1) IN GENERAL.—The Secretary shall deter3 mine the appropriate number of individuals to serve 

4 on the Advisory Committee. Such individuals shall 

5 not be officers or employees of the Federal Govern6 ment. 

7 (2) APPOINTMENT.—Not later than 60 days 

8 after the date of enactment of this section, the Sec9 retary shall appoint the members of the Advisory 

10 Committee from among individuals who are health 

11 professionals. In making such appointments, the 

12 Secretary shall ensure a fair balance between the 

13 health professions, that at least 75 percent of the 

14 members of the Advisory Committee are health pro15 fessionals, a broad geographic representation of 

16 members and a balance between urban and rural 

17 members. Members shall be appointed based on their 

18 competence, interest, and knowledge of the mission 

19 of the profession involved. 

20 (3) MINORITY REPRESENTATION.—In appoint21 ing the members of the Advisory Committee under 

22 paragraph (2), the Secretary shall ensure the ade23 quate representation of women and minorities. 

24 (c) TERMS.— 
164 

•HR 3561 IH 

1 (1) IN GENERAL.—A member of the Advisory 

2 Committee shall be appointed for a term of 3 years, 

3 except that of the members first appointed— 

(A) 1 4 ⁄3 of such members shall serve for a 

5 term of 1 year; 

(B) 1 6 ⁄3 of such members shall serve for a 

7 term of 2 years; and 

(C) 1 8 ⁄3 of such members shall serve for a 

9 term of 3 years. 

10 (2) VACANCIES.— 

11 (A) IN GENERAL.—A vacancy on the Advi12 sory Committee shall be filled in the manner in 

13 which the original appointment was made and 

14 shall be subject to any conditions which applied 

15 with respect to the original appointment. 

16 (B) FILLING UNEXPIRED TERM.—An indi17 vidual chosen to fill a vacancy shall be ap18 pointed for the unexpired term of the member 

19 replaced. 

20 (d) DUTIES.— 

21 (1) IN GENERAL.—The Advisory Committee 

22 shall— 

23 (A) provide advice and recommendations to 

24 the Secretary concerning policy and program 
165 

•HR 3561 IH 

1 development and other matters of significance 

2 concerning activities under this part; and 

3 (B) not later than 2 years after the date 

4 of enactment of this section, and annually 

5 thereafter, prepare and submit to the Secretary, 

6 and the Committee on Health, Education, 

7 Labor and Pensions of the Senate, and the 

8 Committee on Energy and Commerce of the 

9 House of Representatives, a report describing 

10 the activities of the Committee. 

11 (2) CONSULTATION WITH STUDENTS.—In car12 rying out duties under paragraph (1), the Advisory 

13 Committee shall consult with individuals who are at14 tending health professions schools with which this 

15 part is concerned. 

16 (e) MEETINGS AND DOCUMENTS.— 

17 (1) MEETINGS.—The Advisory Committee shall 

18 meet not less than 2 times each year. Such meetings 

19 shall be held jointly with other related entities estab20 lished under this title where appropriate. 

21 (2) DOCUMENTS.—Not later than 14 days prior 

22 to the convening of a meeting under paragraph (1), 

23 the Advisory Committee shall prepare and make 

24 available an agenda of the matters to be considered 

25 by the Advisory Committee at such meeting. At any 
166 

•HR 3561 IH 

1 such meeting, the Advisory Committee shall dis2 tribute materials with respect to the issues to be ad3 dressed at the meeting. Not later than 30 days after 

4 the adjourning of such a meeting, the Advisory Com5 mittee shall prepare and make available a summary 

6 of the meeting and any actions taken by the Com7 mittee based upon the meeting. 

8 (f) COMPENSATION AND EXPENSES.— 

9 (1) COMPENSATION.—Each member of the Ad10 visory Committee shall be compensated at a rate 

11 equal to the daily equivalent of the annual rate of 

12 basic pay prescribed for level IV of the Executive 

13 Schedule under section 5315 of title 5, United 

14 States Code, for each day (including travel time) 

15 during which such member is engaged in the per16 formance of the duties of the Committee. 

17 (2) EXPENSES.—The members of the Advisory 

18 Committee shall be allowed travel expenses, includ19 ing per diem in lieu of subsistence, at rates author20 ized for employees of agencies under subchapter I of 

21 chapter 57 of title 5, United States Code, while 

22 away from their homes or regular places of business 

23 in the performance of services for the Committee. 

24 (g) FACA.—The Federal Advisory Committee Act 

25 shall apply to the Advisory Committee under this section 
167 

•HR 3561 IH 

1 only to the extent that the provisions of such Act do not 

2 conflict with the requirements of this section. 

3 SEC. 314. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 

4 PROGRAM. 

5 Section 402E of the Higher Education Act of 1965 

6 (20 U.S.C. 1070a–15) is amended by striking subsection 

7 (f) and inserting the following: 

8 ‘‘(f) COLLABORATION IN HEALTH PROFESSION DI9 VERSITY TRAINING PROGRAMS.—The Secretary of Edu10 cation shall coordinate with the Secretary of Health and 

11 Human Services to ensure that there is collaboration be12 tween the goals of the program under this section and pro13 grams of the Health Resources and Services Administra14 tion that promote health workforce diversity. The Sec15 retary of Education shall take such measures as may be 

16 necessary to encourage participants in programs under 

17 this section to consider health profession careers. 

18 ‘‘(g) FUNDING.—From amounts appropriated pursu19 ant to the authority of section 402A(f), the Secretary 

20 shall, to the extent practicable, allocate funds for projects 

21 authorized by this section in an amount which is not less 

22 than $31,000,000 for each of the fiscal years 2006 

23 through 2012.’’. 
168 

•HR 3561 IH 

1 TITLE IV—REDUCING DISEASE 

2 AND DISEASE-RELATED COM3 PLICATIONS 

4 Subtitle A—Education and 

5 Outreach 

6 SEC. 401. PREVENTIVE HEALTH SERVICES BLOCK GRANTS; 

7 USE OF ALLOTMENTS. 

8 Section 1904(a)(1) of the Public Health Service Act 

9 (42 U.S.C. 300w–3(a)(1)) is amended— 

10 (1) in subparagraph (G)— 

11 (A) by striking ‘‘through (F)’’ and insert12 ing ‘‘through (G)’’; and 

13 (B) by redesignating such subparagraph as 

14 subparagraph (H); and 

15 (2) by inserting after subparagraph (F), the fol16 lowing: 

17 ‘‘(G) Community outreach and education pro18 grams and other activities designed to address and 

19 prevent minority health conditions (as defined in 

20 section 485E(c)(2)).’’. 

21 SEC. 402. INDIGENOUS, RACIAL AND ETHNIC APPROACHES 

22 TO COMMUNITY HEALTH. 

23 (a) PURPOSE.—It is the purpose of this section to 

24 provide for the awarding of grants to assist communities 

25 in mobilizing and organizing resources in support of effec-
169 

•HR 3561 IH 

1 tive and sustainable programs that will reduce or eliminate 

2 disparities in health and healthcare experienced by racial 

3 and ethnic minority individuals. 

4 (b) AUTHORITY TO AWARD GRANTS.—The Secretary, 

5 acting through the Centers for Disease Control and Pre6 vention and the Office of Minority Health, shall award 

7 planning, implementation, and evaluation grants to eligi8 ble entities to assist in designing, implementing, and eval9 uating culturally and linguistically appropriate, science10 based, and community-driven strategies to eliminate racial 

11 and ethnic health and healthcare disparities. 

12 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

13 grant under this section, an entity shall— 

14 (1) represent a coalition— 

15 (A) whose principal purpose is to develop 

16 and implement interventions to reduce or elimi17 nate a health or healthcare disparity in a tar18 geted racial or ethnic minority group in the 

19 community served by the coalition; and 

20 (B) that includes— 

21 (i) at least 3 members selected from 

22 among— 

23 (I) public health departments; 

24 (II) community-based organiza25 tions; 
170 

•HR 3561 IH 

1 (III) university and/or research 

2 organizations; 

3 (IV) Indian tribal organizations 

4 or national Indian organizations; 

5 (V) Native Hawaiian organiza6 tions (defined for purposes of this 

7 subclause as an organization that 

8 serves and represents the interests of 

9 Native Hawaiians and has as a pri10 mary and stated purpose the provision 

11 of services to Native Hawaiians); and 

12 (VI) interested public or private 

13 sector healthcare providers or organi14 zations; 

15 (ii) at least 1 member that is from a 

16 community-based organization that rep17 resents the targeted racial or ethnic minor18 ity group; and 

19 (iii) at least 1 member that is a Na20 tional Center for Minority Health and 

21 Health Disparities Center of Excellence 

22 (unless such a Center does not exist within 

23 the community involved, declines or refuses 

24 to participate, or the coalition dem25 onstrates to the Secretary that such par-
171 

•HR 3561 IH 

1 ticipation would not further the goals of 

2 the program or would be unduly burden3 some); and 

4 (2) submit to the Secretary an application, at 

5 such time, in such manner, and containing such in6 formation as the Secretary may require, including— 

7 (A) a description of the targeted racial or 

8 ethnic population in the community to be served 

9 under the grant; 

10 (B) a description of at least 1 health dis11 parity that exists in the racial or ethnic tar12 geted population; and 

13 (C) a demonstration of the proven record 

14 of accomplishment of the coalition members in 

15 serving and working with the targeted commu16 nity. 

17 (d) PLANNING GRANTS.— 

18 (1) IN GENERAL.—The Secretary shall award 

19 grants to eligible entities described in subsection (c) 

20 to support the planning and development of cul21 turally and linguistically appropriate programs that 

22 utilize science-based and community-driven strate23 gies to reduce or eliminate a health or healthcare 

24 disparity in the targeted population. Such grants 

25 may be used to— 
172 

•HR 3561 IH 

1 (A) expand the coalition that is rep2 resented by the entity through the identification 

3 of additional partners, particularly among the 

4 targeted community, and establish linkages with 

5 national and State public and private partners; 

6 (B) establish community working groups; 

7 (C) conduct a needs assessment for the 

8 targeted population in the area of the health 

9 disparity using input from the targeted commu10 nity; 

11 (D) participate in workshops sponsored by 

12 the Office of Minority Health or the Centers for 

13 Disease Control and Prevention for technical 

14 assistance, planning, evaluation, and other pro15 grammatic issues; 

16 (E) identify promising intervention strate17 gies; and 

18 (F) develop a plan with the input of the 

19 targeted community that includes strategies 

20 for— 

21 (i) implementing intervention strate22 gies that have the most promising potential 

23 for reducing the health disparity in the 

24 target population; 
173 

•HR 3561 IH 

1 (ii) identifying other sources of rev2 enue and integrating current and proposed 

3 funding sources to ensure long-term sus4 tainability of the program; and 

5 (iii) evaluating the program, including 

6 collecting data and measuring progress to7 ward reducing or eliminating the health 

8 disparity in the targeted population that 

9 takes into account the evaluation model de10 veloped by the Centers for Disease Control 

11 and Prevention in collaboration with the 

12 Office of Minority Health. 

13 (2) DURATION.—The period during which pay14 ments may be made under a grant under paragraph 

15 (1) shall not exceed 1 year, except where the Sec16 retary determines that extraordinary circumstances 

17 exist as described in section 340(c)(3) of the Public 

18 Health Service Act. 

19 (e) IMPLEMENTATION GRANTS.— 

20 (1) IN GENERAL.—The Secretary shall award 

21 grants to eligible entities that have received a plan22 ning grant under subsection (d) to enable such enti23 ty to— 
174 

•HR 3561 IH 

1 (A) implement a plan to address the se2 lected health disparity for the target population, 

3 in an effective and timely manner; 

4 (B) collect data appropriate for monitoring 

5 and evaluating the program carried out under 

6 the grant; 

7 (C) analyze and interpret data, or collabo8 rate with academic or other appropriate institu9 tions, for such analysis and collection; 

10 (D) participate in conferences and work11 shops for the purpose of informing and edu12 cating others regarding the experiences and les13 sons learned from the project; 

14 (E) collaborate with appropriate partners 

15 to publish the results of the project for the ben16 efit of the public health community; 

17 (F) establish mechanisms with other public 

18 or private groups to maintain financial support 

19 for the program after the grant terminates; and 

20 (G) maintain relationships with local part21 ners and continue to develop new relationships 

22 with State and national partners. 

23 (2) DURATION.—The period during which pay24 ments may be made under a grant under paragraph 

25 (1) shall not exceed 4 years. Such payments shall be 
175 

•HR 3561 IH 

1 subject to annual approval by the Secretary and to 

2 the availability of appropriations for the fiscal year 

3 involved. 

4 (f) EVALUATION GRANTS.— 

5 (1) IN GENERAL.—The Secretary shall award 

6 grants to eligible entities that have received an im7 plementation grant under subsection (e) that require 

8 additional assistance for the purpose of rigorous 

9 data analysis, program evaluation (including process 

10 and outcome measures), or dissemination of find11 ings. 

12 (2) PRIORITY.—In awarding grants under this 

13 subsection, the Secretary shall give priority to— 

14 (A) entities that in previous funding cy15 cles— 

16 (i) have received a planning grant 

17 under subsection (d); and 

18 (ii) implemented activities of the type 

19 described in subsection (e)(1); 

20 (B) entities that fulfilled the goals of their 

21 planning grant under subsection (d) in an espe22 cially timely manner; 

23 (C) entities that incorporate best practices 

24 or build on successful models in their action 
176 

•HR 3561 IH 

1 plan, including the use of community health 

2 workers; and 

3 (D) entities that would enable the Sec4 retary to provide for an equitable distribution of 

5 such grants among the 5 categories for race 

6 and ethnicity described in the 1997 Office of 

7 Management and Budget Standards for Main8 taining, Collecting, and Presenting Federal 

9 Data on Race and Ethnicity. 

10 (g) MAINTENANCE OF EFFORT.—The Secretary may 

11 not award a grant to an eligible entity under this section 

12 unless the entity agrees that, with respect to the costs to 

13 be incurred by the entity in carrying out the activities for 

14 which the grant was awarded, the entity (and each of the 

15 participating partners in the coalition represented by the 

16 entity) will maintain its expenditures of non-Federal funds 

17 for such activities at a level that is not less than the level 

18 of such expenditures during the fiscal year immediately 

19 preceding the first fiscal year for which the grant is 

20 awarded. 

21 (h) TECHNICAL ASSISTANCE.—The Secretary may, 

22 either directly or by grant or contract, provide any entity 

23 that receives a grant under this section with technical and 

24 other nonfinancial assistance necessary to meet the re25 quirements of this section. 
177 

•HR 3561 IH 

1 (i) ADMINISTRATIVE BURDENS.—The Secretary shall 

2 make every effort to minimize duplicative or unnecessary 

3 administrative burdens on grantees in the process of ap4 plying for grants under subsection (d), (e), or (f). 

5 (j) REPORT.—Not later than September 30, 2009, 

6 the Secretary shall publish a report that describes the ex7 tent to which the activities funded under this section have 

8 been successful in reducing and eliminating disparities in 

9 health and healthcare in targeted populations, and pro10 vides examples of best practices or model programs funded 

11 under this section. 

12 (k) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated such sums as may be nec14 essary to carry out this section for each of fiscal years 

15 2007 through 2012. 

16 SEC. 403. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV17 IORS IN WOMEN. 

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

19 (42 U.S.C. 280g et seq.) is amended by adding at the end 

20 the following: 

21 ‘‘SEC. 399O. GRANTS TO PROMOTE POSITIVE HEALTH BE22 HAVIORS IN WOMEN. 

23 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col24 laboration with the Director of the Centers for Disease 

25 Control and Prevention and other Federal officials deter-
178 

•HR 3561 IH 

1 mined appropriate by the Secretary, is authorized to 

2 award grants to States or local or tribal units, to promote 

3 positive health behaviors for women in target populations, 

4 especially racial and ethnic minority women in medically 

5 underserved communities. 

6 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

7 subsection (a) may be used to support community health 

8 workers— 

9 ‘‘(1) to educate, guide, and provide outreach in 

10 a community setting regarding health problems prev11 alent among women including racial and ethnic mi12 nority women; 

13 ‘‘(2) to educate, guide, and provide experiential 

14 learning opportunities that target behavioral risk 

15 factors; 

16 ‘‘(3) to educate and guide regarding effective 

17 strategies to promote positive health behaviors with18 in the family; 

19 ‘‘(4) to educate and provide outreach regarding 

20 enrollment in health insurance including the State 

21 Children’s Health Insurance Program under title 

22 XXI of the Social Security Act, medicare under title 

23 XVIII of such Act and medicaid under title XIX of 

24 such Act; 
179 

•HR 3561 IH 

1 ‘‘(5) to promote community wellness and aware2 ness; and 

3 ‘‘(6) to educate and refer target populations to 

4 appropriate health care agencies and community5 based programs and organizations in order to in6 crease access to quality health care services, includ7 ing preventive health services. 

8 ‘‘(c) APPLICATION.— 

9 ‘‘(1) IN GENERAL.—Each State or local or trib10 al unit (including federally recognized tribes and 

11 Alaska native villages) that desires to receive a grant 

12 under subsection (a) shall submit an application to 

13 the Secretary, at such time, in such manner, and ac14 companied by such additional information as the 

15 Secretary may require. 

16 ‘‘(2) CONTENTS.—Each application submitted 

17 pursuant to paragraph (1) shall— 

18 ‘‘(A) describe the activities for which as19 sistance under this section is sought; 

20 ‘‘(B) contain an assurance that with re21 spect to each community health worker pro22 gram receiving funds under the grant awarded, 

23 such program provides training and supervision 

24 to community health workers to enable such 

25 workers to provide authorized program services; 
180 

•HR 3561 IH 

1 ‘‘(C) contain an assurance that the appli2 cant will evaluate the effectiveness of commu3 nity health worker programs receiving funds 

4 under the grant; 

5 ‘‘(D) contain an assurance that each com6 munity health worker program receiving funds 

7 under the grant will provide services in the cul8 tural context most appropriate for the individ9 uals served by the program; 

10 ‘‘(E) contain a plan to document and dis11 seminate project description and results to 

12 other States and organizations as identified by 

13 the Secretary; and 

14 ‘‘(F) describe plans to enhance the capac15 ity of individuals to utilize health services and 

16 health-related social services under Federal, 

17 State, and local programs by— 

18 ‘‘(i) assisting individuals in estab19 lishing eligibility under the programs and 

20 in receiving the services or other benefits 

21 of the programs; and 

22 ‘‘(ii) providing other services as the 

23 Secretary determines to be appropriate, 

24 that may include transportation and trans25 lation services. 
181 

•HR 3561 IH 

1 ‘‘(d) PRIORITY.—In awarding grants under sub2 section (a), the Secretary shall give priority to those appli3 cants— 

4 ‘‘(1) who propose to target geographic areas— 

5 ‘‘(A) with a high percentage of residents 

6 who are eligible for health insurance but are 

7 uninsured or underinsured; 

8 ‘‘(B) with a high percentage of families for 

9 whom English is not their primary language; 

10 and 

11 ‘‘(C) that encompass the United States12 Mexico border region; 

13 ‘‘(2) with experience in providing health or 

14 health-related social services to individuals who are 

15 underserved with respect to such services; and 

16 ‘‘(3) with documented community activity and 

17 experience with community health workers. 

18 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU19 TIONS.—The Secretary shall encourage community health 

20 worker programs receiving funds under this section to col21 laborate with academic institutions. Nothing in this sec22 tion shall be construed to require such collaboration. 

23 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE24 NESS.—The Secretary shall establish guidelines for assur25 ing the quality of the training and supervision of commu-
182 

•HR 3561 IH 

1 nity health workers under the programs funded under this 

2 section and for assuring the cost-effectiveness of such pro3 grams. 

4 ‘‘(g) MONITORING.—The Secretary shall monitor 

5 community health worker programs identified in approved 

6 applications and shall determine whether such programs 

7 are in compliance with the guidelines established under 

8 subsection (e). 

9 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

10 provide technical assistance to community health worker 

11 programs identified in approved applications with respect 

12 to planning, developing, and operating programs under the 

13 grant. 

14 ‘‘(i) REPORT TO CONGRESS.— 

15 ‘‘(1) IN GENERAL.—Not later than 4 years 

16 after the date on which the Secretary first awards 

17 grants under subsection (a), the Secretary shall sub18 mit to Congress a report regarding the grant 

19 project. 

20 ‘‘(2) CONTENTS.—The report required under 

21 paragraph (1) shall include the following: 

22 ‘‘(A) A description of the programs for 

23 which grant funds were used. 

24 ‘‘(B) The number of individuals served. 

25 ‘‘(C) An evaluation of— 
183 

•HR 3561 IH 

1 ‘‘(i) the effectiveness of these pro2 grams; 

3 ‘‘(ii) the cost of these programs; and 

4 ‘‘(iii) the impact of the project on the 

5 health outcomes of the community resi6 dents. 

7 ‘‘(D) Recommendations for sustaining the 

8 community health worker programs developed 

9 or assisted under this section. 

10 ‘‘(E) Recommendations regarding training 

11 to enhance career opportunities for community 

12 health workers. 

13 ‘‘(j) DEFINITIONS.—In this section: 

14 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

15 ‘community health worker’ means an individual who 

16 promotes health or nutrition within the community 

17 in which the individual resides— 

18 ‘‘(A) by serving as a liaison between com19 munities and health care agencies; 

20 ‘‘(B) by providing guidance and social as21 sistance to community residents; 

22 ‘‘(C) by enhancing community residents’ 

23 ability to effectively communicate with health 

24 care providers; 
184 

•HR 3561 IH 

1 ‘‘(D) by providing culturally and linguis2 tically appropriate health or nutrition edu3 cation; 

4 ‘‘(E) by advocating for individual and com5 munity health or nutrition needs; and 

6 ‘‘(F) by providing referral and follow-up 

7 services. 

8 ‘‘(2) COMMUNITY SETTING.—The term ‘commu9 nity setting’ means a home or a community organi10 zation located in the neighborhood in which a partic11 ipant resides. 

12 ‘‘(3) MEDICALLY UNDERSERVED COMMUNITY.— 

13 The term ‘medically underserved community’ means 

14 a community identified by a State— 

15 ‘‘(A) that has a substantial number of in16 dividuals who are members of a medically un17 derserved population, as defined by section 

18 330(b)(3); and 

19 ‘‘(B) a significant portion of which is a 

20 health professional shortage area as designated 

21 under section 332. 

22 ‘‘(4) SUPPORT.—The term ‘support’ means the 

23 provision of training, supervision, and materials 

24 needed to effectively deliver the services described in 
185 

•HR 3561 IH 

1 subsection (b), reimbursement for services, and 

2 other benefits. 

3 ‘‘(5) TARGET POPULATION.—The term ‘target 

4 population’ means women of reproductive age, re5 gardless of their current childbearing status. 

6 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section, 

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

9 2007 through 2012.’’. 

10 SEC. 404. PROVISIONS REGARDING NATIONAL ASTHMA 

11 EDUCATION AND PREVENTION PROGRAM OF 

12 NATIONAL HEART, LUNG, AND BLOOD INSTI13 TUTE. 

14 In addition to any other authorization of appropria15 tions that is available to the National Heart, Lung, and 

16 Blood Institute for the purpose of carrying out the Na17 tional Asthma Education and Prevention Program, there 

18 is authorized to be appropriated to such Institute for such 

19 purpose such sums as may be necessary for each of fiscal 

20 years 2007 through 2012. Amounts appropriated under 

21 the preceding sentence shall be expended to expand such 

22 Program. 
186 

•HR 3561 IH 

1 SEC. 405. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR 

2 DISEASE CONTROL AND PREVENTION. 

3 (a) EXPANSION OF PUBLIC HEALTH SURVEILLANCE

4 ACTIVITIES; PROGRAM FOR PROVIDING INFORMATION

5 AND EDUCATION TO PUBLIC.—The Secretary of Health 

6 and Human Services, acting through the Director of the 

7 Centers for Disease Control and Prevention, shall collabo8 rate with the States to expand the scope of— 

9 (1) activities that are carried out to determine 

10 the incidence and prevalence of asthma; and 

11 (2) activities that are carried out to prevent the 

12 health consequences of asthma, including through 

13 the provision of information and education to the 

14 public regarding asthma, which may include the use 

15 of public service announcements through the media 

16 and such other means as such Director determines 

17 to be appropriate. 

18 (b) COMPILATION OF DATA.—The Secretary of 

19 Health and Human Services, acting through the Director 

20 of the Centers for Disease Control and Prevention and in 

21 consultation with the National Asthma Education Preven22 tion Program Coordinating Committee, shall— 

23 (1) conduct local asthma surveillance activities 

24 to collect data on the prevalence and severity of 

25 asthma and the quality of asthma management, in26 cluding— 
187 

•HR 3561 IH 

1 (A) telephone surveys to collect sample 

2 household data on the local burden of asthma; 

3 and 

4 (B) health care facility specific surveillance 

5 to collect asthma data on the prevalence and se6 verity of asthma, and on the quality of asthma 

7 care; and 

8 (2) compile and annually publish data on— 

9 (A) the prevalence of children suffering 

10 from asthma in each State; and 

11 (B) the childhood mortality rate associated 

12 with asthma nationally and in each State. 

13 (c) ADDITIONAL FUNDING.—In addition to any other 

14 authorization of appropriations that is available to the 

15 Centers for Disease Control and Prevention for the pur16 pose of carrying out this section, there is authorized to 

17 be appropriated to such Centers for such purpose such 

18 sums as may be necessary for each of fiscal years 2007 

19 through 2012. 

20 SEC. 406. GRANTS FOR COMMUNITY OUTREACH REGARD21 ING ASTHMA INFORMATION, EDUCATION, 

22 AND SERVICES. 

23 (a) IN GENERAL.—The Secretary may make grants 

24 to nonprofit private entities for projects to carry out, in 

25 communities identified by entities applying for the grants, 
188 

•HR 3561 IH 

1 outreach activities to provide for residents of the commu2 nities the following: 

3 (1) Information and education on asthma. 

4 (2) Referrals to health programs of public and 

5 nonprofit private entities that provide asthma-re6 lated services, including such services for low-income 

7 individuals. The grant may be expended to make ar8 rangements to coordinate the activities of such enti9 ties in order to establish and operate networks or 

10 consortia regarding such referrals. 

11 (b) PREFERENCES IN MAKING GRANTS.—In making 

12 grants under subsection (a), the Secretary shall give pref13 erence to applicants that will carry out projects under such 

14 subsection in communities that are disproportionately af15 fected by asthma or underserved with respect to the activi16 ties described in such subsection and in which a significant 

17 number of low-income individuals reside. 

18 (c) EVALUATIONS.—A condition for a grant under 

19 subsection (a) is that the applicant for the grant agree 

20 to provide for the evaluation of the projects carried out 

21 under such subsection by the applicant to determine the 

22 extent to which the projects have been effective in carrying 

23 out the activities referred to in such subsection. 

24 (d) FUNDING.—For the purpose of carrying out this 

25 section, there is authorized to be appropriated such sums 
189 

•HR 3561 IH 

1 as may be necessary for each of fiscal years 2007 through 

2 2012. 

3 SEC. 407. ACTION PLANS OF LOCAL EDUCATIONAL AGEN4 CIES REGARDING ASTHMA. 

5 (a) IN GENERAL.— 

6 (1) SCHOOL-BASED ASTHMA ACTIVITIES.—The 

7 Secretary of Education (in this section referred to as 

8 the ‘‘Secretary’’), in consultation with the Director 

9 of the Centers for Disease Control and Prevention 

10 and the Director of the National Institutes of 

11 Health, may make grants to local educational agen12 cies for programs to carry out at elementary and 

13 secondary schools specified in paragraph (2) asthma14 related activities for children who attend such 

15 schools. 

16 (2) ELIGIBLE SCHOOLS.—The elementary and 

17 secondary schools referred to in paragraph (1) are 

18 such schools that are located in communities with a 

19 significant number of low-income or underserved in20 dividuals (as defined by the Secretary). 

21 (b) DEVELOPMENT OF PROGRAMS.—Programs under 

22 subsection (a) shall include grants under which local edu23 cation agencies and State public health officials collabo24 rate to develop programs to improve the management of 

25 asthma in school settings. 
190 

•HR 3561 IH 

1 (c) CERTAIN GUIDELINES.—Programs under sub2 section (a) shall be carried out in accordance with applica3 ble guidelines or other recommendations of the National 

4 Institutes of Health (including the National Heart, Lung, 

5 and Blood Institute) and the Environmental Protection 

6 Agency. 

7 (d) CERTAIN ACTIVITIES.—Activities that may be 

8 carried out in programs under subsection (a) include the 

9 following: 

10 (1) Identifying and working directly with local 

11 hospitals, community clinics, advocacy organizations, 

12 parent-teacher associations, minority health organi13 zations, and asthma coalitions. 

14 (2) Identifying asthmatic children and training 

15 them and their families in asthma self-management. 

16 (3) Purchasing asthma equipment. 

17 (4) Hiring school nurses. 

18 (5) Training teachers, nurses, coaches, and 

19 other school personnel in asthma-symptom recogni20 tion and emergency responses. 

21 (6) Simplifying procedures to improve students’ 

22 safe access to their asthma medications. 

23 (7) Such other asthma-related activities as the 

24 Secretary determines to be appropriate. 
191 

•HR 3561 IH 

1 (e) DEFINITIONS.—For purposes of this section, the 

2 terms ‘‘elementary school’’, ‘‘local educational agency’’, 

3 and ‘‘secondary school’’ have the meanings given such 

4 terms in the Elementary and Secondary Education Act of 

5 1965. 

6 (f) FUNDING.—For the purpose of carrying out this 

7 section, there is authorized to be appropriated such sums 

8 as may be necessary for each of fiscal years 2007 through 

9 2012. 

10 SEC. 408. PROGRAMS OF CENTERS FOR DISEASE CONTROL 

11 AND PREVENTION. 

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

13 (42 U.S.C. 243 et seq.) is amended by striking section 

14 317H and inserting the following: 

15 ‘‘SEC. 317H. DIABETES IN CHILDREN AND YOUTH. 

16 ‘‘(a) SURVEILLANCE ON TYPE 1 DIABETES.—The 

17 Secretary, acting through the Director of the Centers for 

18 Disease Control and Prevention and in consultation with 

19 the Director of the National Institutes of Health, shall de20 velop a sentinel system to collect data on type 1 diabetes, 

21 including the incidence and prevalence of type 1 diabetes 

22 and shall establish a national database for such data. 

23 ‘‘(b) TYPE 2 DIABETES IN YOUTH.—The Secretary 

24 shall implement a national public health effort to address 

25 type 2 diabetes in youth, including— 
192 

•HR 3561 IH 

1 ‘‘(1) enhancing surveillance systems and ex2 panding research to better assess the prevalence and 

3 incidence of type 2 diabetes in youth and determine 

4 the extent to which type 2 diabetes is incorrectly di5 agnosed as type 1 diabetes among children; 

6 ‘‘(2) standardizing and improving methods to 

7 assist in diagnosis, treatment, and prevention of dia8 betes including developing less invasive ways to mon9 itor blood glucose to prevent hypoglycemia such as 

10 nonmydriatic retinal imaging and improving existing 

11 glucometers that measure blood glucose; and 

12 ‘‘(3) developing methods to identify obstacles 

13 facing children in traditionally underserved popu14 lations to obtain care to prevent or treat type 2 dia15 betes. 

16 ‘‘(c) LONG-TERM EPIDEMIOLOGICAL STUDIES ON DI17 ABETES IN CHILDREN.—The Secretary, acting through 

18 the Director of the Centers for Disease Control and Pre19 vention and the Director of the National Institute of Dia20 betes and Digestive and Kidney Diseases, shall conduct 

21 or support long-term epidemiology studies in children with 

22 diabetes or at risk for diabetes. Such studies shall inves23 tigate the causes and characteristics of the disease and 

24 its complications. 
193 

•HR 3561 IH 

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

2 are authorized to be appropriated to carry out this section, 

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

4 2007 through 2012.’’. 

5 SEC. 409. RESEARCH WITH RESPECT TO UTERINE 

6 FIBROIDS. 

7 (a) IN GENERAL.—The Director of the National In8 stitutes of Health (in this section referred to as the ‘‘Di9 rector of NIH’’) shall expand, intensify, and coordinate 

10 programs for the conduct and support of research with 

11 respect to uterine fibroids. 

12 (b) ADMINISTRATION.— 

13 (1) IN GENERAL.—The Director of NIH shall 

14 carry out this section through the appropriate insti15 tutes, offices, and centers, including the National In16 stitute of Child Health and Human Development, 

17 the National Institute of Environmental Health 

18 Sciences, the Office of Research on Women’s Health, 

19 the National Center on Minority Health and Health 

20 Disparities, and any other agencies that the Director 

21 of NIH determines to be appropriate. 

22 (2) COORDINATION OF ACTIVITIES.—The Office 

23 of Research on Women’s Health shall coordinate ac24 tivities under paragraph (1) among the institutes, 
194 

•HR 3561 IH 

1 offices, and centers of the National Institutes of 

2 Health. 

3 (c) AUTHORIZATION OF APPROPRIATIONS.—For the 

4 purpose of carrying out this section, there are authorized 

5 to be appropriated such sums as may be necessary for 

6 each of the fiscal years 2007 through 2012. 

7 SEC. 410. INFORMATION AND EDUCATION WITH RESPECT 

8 TO UTERINE FIBROIDS. 

9 (a) UTERINE FIBROIDS PUBLIC EDUCATION PRO10 GRAM.— 

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

12 Human Services (referred to in this section as the 

13 ‘‘Secretary’’), acting through the Director of the 

14 Centers for Disease Control and Prevention, shall 

15 develop and disseminate to the public information 

16 regarding uterine fibroids, including information 

17 on— 

18 (A) the incidence and prevalence of uterine 

19 fibroids; 

20 (B) the elevated risk for minority women; 

21 and 

22 (C) the availability, as medically appro23 priate, of a range of treatment options for 

24 symptomatic uterine fibroids. 
195 

•HR 3561 IH 

1 (2) DISSEMINATION.—The Secretary may dis2 seminate information under paragraph (1) directly, 

3 or through arrangements with nonprofit organiza4 tions, consumer groups, institutions of higher edu5 cation (as defined in section 101 of the Higher Edu6 cation Act of 1965 (20 U.S.C. 1001)), Federal, 

7 State, or local agencies, or the media. 

8 (3) AUTHORIZATION OF APPROPRIATIONS.—For 

9 the purpose of carrying out this subsection, there 

10 are authorized to be appropriated such sums as may 

11 be necessary for each of the fiscal years 2007 

12 through 2012. 

13 (b) UTERINE FIBROIDS INFORMATION PROGRAM FOR

14 HEALTH CARE PROVIDERS.— 

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

16 through the Administrator of the Health Resources 

17 and Services Administration, shall develop and dis18 seminate to health care providers information on 

19 uterine fibroids, including information on the ele20 vated risk for minority women and the range of 

21 available options for the treatment of symptomatic 

22 uterine fibroids. 

23 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

24 the purpose of carrying out this subsection, there 

25 are authorized to be appropriated such sums as may 
196 

•HR 3561 IH 

1 be necessary for each of the fiscal years 2007 

2 through 2012. 

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

4 term ‘‘minority’’, with respect to women, means women 

5 who are members of racial or ethnic minority groups with6 in the meaning of section 1707 of the Public Health Serv7 ice Act (42 U.S.C. 300u–6). 

8 Subtitle B—Research and Training 

9 SEC. 431. INNOVATIVE CHRONIC DISEASE MANAGEMENT 

10 PROGRAMS. 

11 (a) IN GENERAL.—The Secretary, acting in coordina12 tion with the Administrator of the Centers for Medicare 

13 and Medicaid Services, the Administrator of the Health 

14 Resources and Services Administration, the Director of 

15 the National Institutes of Health, the Director of the Cen16 ters for Disease Control and Prevention, and the Director 

17 of the Office of Minority Health, shall award grants to 

18 eligible entities for the identification, implementation, and 

19 evaluation of programs for patients with chronic disease. 

20 (b) ELIGIBILITY.—To be eligible to receive a grant 

21 under subsection (a), an entity shall— 

22 (1) be a health center or clinic, public health 

23 department, health plan, hospital, health system, 

24 community-based or non-profit organization, or 
197 

•HR 3561 IH 

1 other health entity determined appropriate by the 

2 Secretary; and 

3 (2) prepare and submit to the Secretary an ap4 plication at such time, in such manner, and con5 taining such information as the Secretary may re6 quire. 

7 (c) USE OF FUNDS.—An entity shall use amounts re8 ceived under a grant under subsection (a) to identify, im9 plement, and evaluate chronic disease management pro10 grams that are tailored for racially and ethnically diverse 

11 populations. In carrying out such activities, an entity shall 

12 focus on— 

13 (1) self-management training; 

14 (2) patient empowerment; 

15 (3) group visits; 

16 (4) community health workers; 

17 (5) case management; 

18 (6) work- and school-based interventions; 

19 (7) home visitation; or 

20 (8) other activities determined appropriate by 

21 the Secretary. 

22 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

23 authorized to be appropriated to carry out this section, 

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

25 2007 through 2012. 
198 

•HR 3561 IH 

1 SEC. 432. RESEARCH FUNDING FOR AUTOIMMUNE DISEASE 

2 IN MINORITY POPULATIONS. 

3 Part B of title IV of the Public Health Service Act 

4 is amended by inserting after section 409E (42 U.S.C. 

5 284i) the following: 

6 ‘‘SEC. 490E–1. RESEARCH FUNDING FOR AUTOIMMUNE DIS7 EASE IN MINORITY POPULATIONS. 

8 ‘‘(a) EXPANSION AND INTENSIFICATION OF ACTIVI9 TIES REGARDING AUTOIMMUNE DISEASES ON MINORI10 TIES.—With respect to the plan under section 409E(c)(1), 

11 the Coordinating Committee shall ensure that provisions 

12 of the plan developed under paragraph (2) of such sub13 section include provisions for the following: 

14 ‘‘(1)(A) Basic research, epidemiological re15 search, and other appropriate research concerning 

16 the etiology and causes of autoimmune diseases in 

17 all minorities, including genetic, hormonal, and envi18 ronmental factors. 

19 ‘‘(B)(i) Giving priority under subparagraph (A) 

20 to research regarding environmental factors. 

21 ‘‘(ii) The coordination of (to the extent prac22 ticable and appropriate), and providing additional 

23 support for, research described in clause (i) that is 

24 conducted by public or nonprofit private entities. 

25 ‘‘(2)(A) The development of information and 

26 education programs for patients, healthcare pro-
199 

•HR 3561 IH 

1 viders, and others as appropriate on genetic, hor2 monal, and environmental risk factors associated 

3 with autoimmune diseases in minorities, and on the 

4 importance of the prevention or control of such risk 

5 factors and timely referral with appropriate diag6 nosis and treatment. 

7 ‘‘(B) The inclusion in programs under subpara8 graph (A) of information and education on the prev9 alence and nature of autoimmune diseases, on risk 

10 factors, and on health-related behaviors that can im11 prove health status in minority populations. 

12 ‘‘(3) Outreach programs for purposes of para13 graphs (1) and (2) that— 

14 ‘‘(A) are directed toward minority individ15 uals, particularly those who are at-risk for auto16 immune diseases; and 

17 ‘‘(B) are carried out through community 

18 health centers, community clinics, or other 

19 health centers under section 330, through 

20 State, territory, or local health departments, In21 dian tribes, or through primary care physicians. 

22 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

23 is authorized to be appropriated to carry out this section, 

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

25 2007 through 2012.’’. 
200 

•HR 3561 IH 

1 SEC. 433. RESEARCH ON EFFECTIVE MESSAGES FOR COM2 BATTING STIGMA. 

3 (a) RESEARCH.—The Administrator of the Substance 

4 Abuse and Mental Health Services Administration (in this 

5 section referred to as the ‘‘Administrator’’) , in collabora6 tion with the Director of the National Institute of Mental 

7 Health, shall conduct research to determine— 

8 (1) the most effective messages for combating 

9 stigma in communities of color; and 

10 (2) the most effective media through which to 

11 convey those messages. 

12 (b) MEDIA.—In making a determination under sub13 section (a)(2), the Administrator shall consider a diverse 

14 selection of media, including— 

15 (1) newspapers; 

16 (2) radio and television stations, including sta17 tions in languages other than English; 

18 (3) posters or pamphlets in community health 

19 centers, emergency rooms, and primary health care 

20 settings; and 

21 (4) outreach in schools. 
201 

•HR 3561 IH 

1 Subtitle C—Innovative Treatment 

2 Modalities and Services Deliv3 ery Models 

4 SEC. 441. GUIDELINES FOR DISEASE SCREENING FOR MI5 NORITY PATIENTS. 

6 (a) IN GENERAL.—The Secretary, acting through the 

7 Director of the Agency for Healthcare Research and Qual8 ity, shall convene a series of meetings to develop guidelines 

9 for disease screening for minority patient populations 

10 which have a higher than average risk for many chronic 

11 diseases and cancers. 

12 (b) PARTICIPANTS.—In convening meetings under 

13 subsection (a), the Secretary shall ensure that meeting 

14 participants include representatives of— 

15 (1) professional societies and associations; 

16 (2) minority health organizations; 

17 (3) healthcare researchers and providers, in18 cluding those with expertise in minority health; 

19 (4) Federal health agencies, including the Of20 fice of Minority Health and the National Institutes 

21 of Health; and 

22 (5) other experts determined appropriate by the 

23 Secretary. 

24 (c) DISEASES.—Screening guidelines for minority 

25 populations shall be developed under subsection (a) for— 
202 

•HR 3561 IH 

1 (1) hypertension; 

2 (2) hypercholesterolemia; 

3 (3) diabetes; 

4 (4) cardiovascular disease; 

5 (5) prostate cancer; 

6 (6) breast cancer; 

7 (7) colon cancer; 

8 (8) kidney disease; 

9 (9) glaucoma; and 

10 (10) other diseases determined appropriate by 

11 the Secretary. 

12 (d) DISSEMINATION.—Not later than 24 months 

13 after the date of enactment of this title, the Secretary 

14 shall publish and disseminate to healthcare provider orga15 nizations the guidelines developed under subsection (a). 

16 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

17 authorized to be appropriated to carry out this section, 

18 sums as may be necessary for each of fiscal years 2007 

19 through 2012. 

20 SEC. 442. CANCER REDUCTION. 

21 (a) PREVENTIVE HEALTH MEASURES WITH RE22 SPECT TO BREAST AND CERVICAL CANCER.— 

23 (1) IN GENERAL.—Section 1510(a) of the Pub24 lic Health Service Act (42 U.S.C. 300n–5(a)) is 

25 amended by striking ‘‘2005’’ and inserting ‘‘2012’’. 
203 

•HR 3561 IH 

1 (2) SUPPLEMENTAL GRANTS FOR ADDITIONAL

2 PREVENTIVE HEALTH SERVICES.—Section 

3 1509(d)(1) of the Public Health Service Act (42 

4 U.S.C. 300n–4a(d)(1)) is amended by striking 

5 ‘‘2005’’ and inserting ‘‘2012’’. 

6 (b) TREATMENT AND PREVENTION.—Title XXIX of 

7 the Public Health Service Act, as amended by section 312, 

8 is further amended by adding at the end the following: 

9 ‘‘Subtitle B—Reducing Disease and 

10 Disease-related Complications 

11 ‘‘SEC. 2921. CANCER PREVENTION AND TREATMENT FOR 

12 UNDERSERVED MINORITY OR OTHER POPU13 LATIONS. 

14 ‘‘(a) GRANTS.—The Secretary may make grants to 

15 qualifying health centers, non-profit organizations, and 

16 public institutions for the development, expansion, or oper17 ation of programs that, for individuals otherwise served 

18 by such centers, provide— 

19 ‘‘(1) information and education on cancer pre20 vention; 

21 ‘‘(2) screenings for cancer; 

22 ‘‘(3) counseling on cancer, including counseling 

23 upon a diagnosis of cancer; and 

24 ‘‘(4) treatment for cancer. 
204 

•HR 3561 IH 

1 ‘‘(b) QUALIFYING HEALTH CENTERS AND PUBLIC

2 INSTITUTIONS.—For purposes of this section: 

3 ‘‘(1) QUALIFYING HEALTH CENTERS.—The 

4 term ‘qualifying health center’ includes community 

5 health centers, migrant health centers, health cen6 ters for the homeless, health centers for residents of 

7 public housing, and community clinics. 

8 ‘‘(2) QUALIFYING PUBLIC INSTITUTIONS.—The 

9 term ‘qualifying public institutions’ means an entity 

10 that meets the requirements of section 2971(b)(1). 

11 ‘‘(c) PREFERENCE IN MAKING GRANTS.—In making 

12 grants under subsection (a), the Secretary shall give pref13 erence to applicants that— 

14 ‘‘(1) have service populations that include a sig15 nificant number of low-income minority individuals 

16 who are at-risk for cancer; 

17 ‘‘(2) will, through programs under subsection 

18 (b)— 

19 ‘‘(A) emphasize early detection of and com20 prehensive treatment for cancer; 

21 ‘‘(B) provide comprehensive treatment 

22 services for cancer in its earliest stages; and 

23 ‘‘(C) carry out subparagraphs (A) and (B) 

24 for two or more types of cancer; and 
205 

•HR 3561 IH 

1 ‘‘(3) in order to provide treatment for cancer, 

2 have established or will establish referral arrange3 ments with entities that provide screenings for low4 income individuals. 

5 ‘‘(d) APPROPRIATE CULTURAL CONTEXT.—As a con6 dition for the receipt of a grant under subsection (a), the 

7 applicant shall agree that, in the program carried out with 

8 the grant, services will be provided in the languages most 

9 appropriate for, and with consideration for the cultural 

10 background of, the individuals for whom the services are 

11 provided. 

12 ‘‘(e) OUTREACH SERVICES.—As a condition for the 

13 receipt of a grant under subsection (a), the applicant shall 

14 agree to provide outreach activities to inform the public 

15 of the services of the program, and to provide information 

16 on cancer; and 

17 ‘‘(f) APPLICATION FOR GRANT.—A grant may be 

18 made under subsection (a) only if an application for the 

19 grant is submitted to the Secretary and the application 

20 is in such form, is made in such manner, and contains 

21 such agreements, assurances, and information as the Sec22 retary determines to be necessary to carry out this section. 

23 ‘‘(g) DESIGNATION OF TYPE OF CANCER.—In mak24 ing a grant under subsection (a), the Secretary shall des-
206 

•HR 3561 IH 

1 ignate the type or types of cancer with respect to which 

2 the grant is being made. 

3 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 

4 purpose of carrying out this section, there are authorized 

5 to be appropriated such sums as may be necessary for 

6 each of the fiscal years 2005 through 2010.’’. 

7 SEC. 443. MONITORING THE QUALITY OF AND DISPARITIES 

8 IN DIABETES CARE. 

9 Part A of title IX of the Public Health Service Act 

10 (42 U.S.C. 299 et seq.) is amended by adding at the end 

11 the following: 

12 ‘‘SEC. 904. AREAS OF SPECIAL EMPHASIS. 

13 ‘‘The Secretary, acting through the Director, shall in14 corporate within the annual quality report required under 

15 section 913(b)(2) and the annual disparities report re16 quired under section 903(a)(6), scientific evidence and in17 formation appropriate for monitoring the quality and safe18 ty of diabetes care and identifying, understanding, and re19 ducing disparities in care.’’. 

20 SEC. 444. DIABETES PREVENTION, TREATMENT, AND CON21 TROL. 

22 (a) DETERMINATION.—The Secretary, in consulta23 tion with Indian tribes and tribal organizations, shall de24 termine— 
207 

•HR 3561 IH 

1 (1) by tribe, tribal organization, and service 

2 unit of the Service, the prevalence of, and the types 

3 of complications resulting from, diabetes among In4 dians; and 

5 (2) based on paragraph (1), the measures (in6 cluding patient education) each service unit should 

7 take to reduce the prevalence of, and prevent, treat, 

8 and control the complications resulting from, diabe9 tes among Indian tribes within that service unit. 

10 (b) SCREENING.—The Secretary shall screen each In11 dian who receives services from the Service for diabetes 

12 and for conditions which indicate a high risk that the indi13 vidual will become diabetic. Such screening may be done 

14 by an Indian tribe or tribal organization operating 

15 healthcare programs or facilities with funds from the Serv16 ice under the Indian Self-Determination and Education 

17 Assistance Act. 

18 (c) CONTINUED FUNDING.—The Secretary shall con19 tinue to fund, through fiscal year 2015, each effective 

20 model diabetes project in existence on the date of the en21 actment of this Act and such other diabetes programs op22 erated by the Secretary or by Indian tribes and tribal or23 ganizations and any additional programs added to meet 

24 existing diabetes needs. Indian tribes and tribal organiza25 tions shall receive recurring funding for the diabetes pro-
208 

•HR 3561 IH 

1 grams which they operate pursuant to this section. Model 

2 diabetes projects shall consult, on a regular basis, with 

3 tribes and tribal organizations in their regions regarding 

4 diabetes needs and provide technical expertise as needed. 

5 (d) DIALYSIS PROGRAMS.—The Secretary shall pro6 vide funding through the Service, Indian tribes and tribal 

7 organizations to establish dialysis programs, including 

8 funds to purchase dialysis equipment and provide nec9 essary staffing. 

10 (e) OTHER ACTIVITIES.—The Secretary shall, to the 

11 extent funding is available— 

12 (1) in each area office of the Service, consult 

13 with Indian tribes and tribal organizations regarding 

14 programs for the prevention, treatment, and control 

15 of diabetes; 

16 (2) establish in each area office of the Service 

17 a registry of patients with diabetes to track the 

18 prevalence of diabetes and the complications from 

19 diabetes in that area; and 

20 (3) ensure that data collected in each area of21 fice regarding diabetes and related complications 

22 among Indians is disseminated to tribes, tribal orga23 nizations, and all other area offices. 
209 

•HR 3561 IH 

1 (f) DEFINITIONS.—For purposes of this section, the 

2 definitions contained in section 4 of the Indian Health 

3 Care Improvement Act shall apply. 

4 SEC. 445. GENETICS OF DIABETES. 

5 Title IV of the Public Health Service Act (42 U.S.C. 

6 281 et seq.) is amended by inserting after section 430 the 

7 following: 

8 ‘‘SEC. 430A. GENETICS OF DIABETES. 

9 ‘‘The Diabetes Mellitus Interagency Coordinating 

10 Committee, in collaboration with the Directors of the Na11 tional Human Genome Research Institute, the National 

12 Institute of Diabetes and Digestive and Kidney Diseases, 

13 and the National Institute of Environmental Health 

14 Sciences, and other voluntary organizations and interested 

15 parties, shall— 

16 ‘‘(1) coordinate and assist efforts of the Type 

17 1 Diabetes Genetics Consortium, which will collect 

18 and share valuable DNA information from type 1 di19 abetes patients from studies around the world; and 

20 ‘‘(2) provide continued coordination and sup21 port for the consortia of laboratories investigating 

22 the genomics of diabetes.’’. 
210 

•HR 3561 IH 

1 SEC. 446. RESEARCH AND TRAINING ON DIABETES IN UN2 DERSERVED AND MINORITY POPULATIONS. 

3 (a) RESEARCH.—Subpart 3 of part C of title IV of 

4 the Public Health Service Act (42 U.S.C. 285c et seq.) 

5 is amended by adding at the end the following: 

6 ‘‘SEC. 434B. RESEARCH ON DIABETES IN UNDERSERVED 

7 AND MINORITY POPULATIONS. 

8 ‘‘(a) IN GENERAL.—The Director of the Institute, in 

9 coordination with the Director of the National Center on 

10 Minority Health and Health Disparities, the Director of 

11 the Office of Minority Health, and other appropriate insti12 tutes and centers, shall expand, intensify, and coordinate 

13 research programs on pre-diabetes, type 1 diabetes and 

14 type 2 diabetes in underserved populations and minority 

15 groups. 

16 ‘‘(b) RESEARCH.—The research described in sub17 section (a) shall include research on— 

18 ‘‘(1) behavior, including diet and physical activ19 ity and other aspects of behavior; 

20 ‘‘(2) environmental factors related to type 2 di21 abetes that are unique to, more serious, or more 

22 prevalent, among underserved or high-risk popu23 lations; 

24 ‘‘(3) research on the prevention of complica25 tions, which are unique to, more serious, or more 

26 prevalent among minorities, as well as research on 
211 

•HR 3561 IH 

1 how to effectively translate the findings of clinical 

2 trials and research to improve methods for self-man3 agement and health-care delivery; and 

4 ‘‘(4) genetic studies of diabetes, consistent with 

5 research conducted under section 430A. 

6 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated for purposes of carrying 

8 out this section, such sums as may be necessary for each 

9 of fiscal years 2007 through 2012.’’. 

10 (b) DIVISION DIRECTORS.—Section 428(b)(1) of the 

11 Public Health Service Act (42 U.S.C. 285c–2(b)(1)) is 

12 amended by inserting ‘‘(including research training of 

13 members of minority populations in order to facilitate 

14 their conduct of diabetes-related research in underserved 

15 populations and minority groups)’’ after ‘‘research pro16 grams’’. 

17 SEC. 447. AUTHORIZATION OF APPROPRIATIONS. 

18 Subpart 3 of part C of title IV of the Public Health 

19 Service Act (42 U.S.C. 285c et seq.) (as amended by sec20 tion 448(a)) is amended by adding at the end the fol21 lowing: 

22 ‘‘SEC. 434C. AUTHORIZATION OF APPROPRIATIONS. 

23 ‘‘For the purpose of carrying out this subpart with 

24 respect to the programs of the National Institute of Diabe25 tes and Digestive and Kidney Diseases, other than section 
212 

•HR 3561 IH 

1 434B, there are authorized to be appropriated such sums 

2 as may be necessary for each of fiscal years 2007 through 

3 2012.’’. 

4 SEC. 448. PREVENTION AND CONTROL OF SEXUALLY 

5 TRANSMITTED DISEASES. 

6 (a) IN GENERAL.—Section 318(e)(1) of the Public 

7 Health Service Act (42 U.S.C. 247c(e)(1)) is amended by 

8 striking ‘‘1998’’ and inserting ‘‘2008’’. 

9 (b) PREVENTABLE CASES OF INFERTILITY.—Section 

10 318A of the Public Health Service Act (42 U.S.C. 247c– 

11 1) is amended— 

12 (1) in subsection (q), by striking ‘‘1998’’ and 

13 inserting ‘‘2012’’; and 

14 (2) in subsection (r)(2), by striking ‘‘1998’’ and 

15 inserting ‘‘2012’’. 

16 SEC. 449. MODEL COMMUNITY DIABETES AND CHRONIC 

17 DISEASE CARE AND PREVENTION AMONG PA18 CIFIC ISLANDERS AND NATIVE HAWAIIANS. 

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

20 (42 U.S.C. 280g et seq.), as amended by section 432, is 

21 further amended by adding at the end the following: 
213 

•HR 3561 IH 

1 ‘‘SEC. 399P. MODEL COMMUNITY DIABETES AND CHRONIC 

2 DISEASE CARE AND PREVENTION AMONG PA3 CIFIC ISLANDERS AND NATIVE HAWAIIANS. 

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

5 the Director of the Centers for Disease Control and Pre6 vention, may award grants and enter into cooperative 

7 agreements and contracts with eligible entities to establish 

8 a model community demonstration project to provide 

9 training and support for community-based prevention and 

10 control programs targeting diabetes, hypertension, cardio11 vascular disease, and other related health problems in 

12 American Samoa, the Commonwealth of the Northern 

13 Mariana Islands, Guam, the Federated States of Micro14 nesia, Hawaii, the Republic of the Marshall Islands, and 

15 the Republic of Palau. 

16 ‘‘(b) ELIGIBLE ENTITY DEFINED.—In this section 

17 the term ‘eligible entity’ means any organization described 

18 in section 501(c)(3) of the Internal Revenue Code of 1986 

19 and exempt from tax under section 501(a) of such Code. 

20 ‘‘(c) PRIORITY.—The Secretary shall give priority for 

21 grants, agreements, and contracts under this section to 

22 eligible entities that have previously administered cul23 turally appropriate Centers for Disease Control and Pre24 vention programs intended to prevent and control diabetes 

25 in the areas described in subsection (a). 
214 

•HR 3561 IH 

1 ‘‘(d) REGULATIONS.—The Secretary is authorized to 

2 promulgate such regulations as may be necessary to carry 

3 out this section. 

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

5 are authorized to be appropriated to carry out this section, 

6 such sums as may be necessary for fiscal years 2007 

7 through 2012.’’. 

8 SEC. 450. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

9 SERVICES UNDER MEDICAID AND SCHIP. 

10 Title V of the Social Security Act (42 U.S.C. 701 

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

12 ‘‘SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DEN13 TAL SERVICES UNDER MEDICAID AND SCHIP. 

14 ‘‘(a) AUTHORITY TO MAKE GRANTS.—In addition to 

15 any other payments made under this title to a State, the 

16 Secretary shall award grants to States that satisfy the re17 quirements of subsection (b) to improve the provision of 

18 dental services to children who are enrolled in a State plan 

19 under title XIX or a State child health plan under title 

20 XXI (in this section, collectively referred to as the ‘State 

21 plans’). 

22 ‘‘(b) REQUIREMENTS.—In order to be eligible for a 

23 grant under this section, a State shall provide the Sec24 retary with the following assurances: 
215 

•HR 3561 IH 

1 ‘‘(1) IMPROVED SERVICE DELIVERY.—The 

2 State shall have a plan to improve the delivery of 

3 dental services to children, including children with 

4 special health care needs, who are enrolled in the 

5 State plans, including providing outreach and ad6 ministrative case management, improving collection 

7 and reporting of claims data, and providing incen8 tives, in addition to raising reimbursement rates, to 

9 increase provider participation. 

10 ‘‘(2) ADEQUATE PAYMENT RATES.—The State 

11 has provided for payment under the State plans for 

12 dental services for children at levels consistent with 

13 the market-based rates and sufficient enough to en14 list providers to treat children in need of dental serv15 ices. 

16 ‘‘(3) ENSURED ACCESS.—The State shall en17 sure it will make dental services available to children 

18 enrolled in the State plans to the same extent as 

19 such services are available to the general population 

20 of the State. 

21 ‘‘(c) USE OF FUNDS.— 

22 ‘‘(1) IN GENERAL.—Funds provided under this 

23 section may be used to provide administrative re24 sources (such as program development, provider 

25 training, data collection and analysis, and research- 
216 

•HR 3561 IH 

1 related tasks) to assist States in providing and as2 sessing services that include preventive and thera3 peutic dental care regimens. 

4 ‘‘(2) LIMITATION.—Funds provided under this 

5 section may not be used for payment of direct den6 tal, medical, or other services or to obtain Federal 

7 matching funds under any Federal program. 

8 ‘‘(d) APPLICATION.—A State shall submit an applica9 tion to the Secretary for a grant under this section in such 

10 form and manner and containing such information as the 

11 Secretary may require. 

12 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to make grants under 

14 this section, such sums as may be necessary for fiscal year 

15 2007 and each fiscal year thereafter. 

16 ‘‘(f) APPLICATION OF OTHER PROVISIONS OF

17 TITLE.— 

18 ‘‘(1) IN GENERAL.—Except as provided in para19 graph (2), the other provisions of this title shall not 

20 apply to a grant made under this section. 

21 ‘‘(2) EXCEPTIONS.—The following provisions of 

22 this title shall apply to a grant made under sub23 section (a) to the same extent and in the same man24 ner as such provisions apply to allotments made 

25 under section 502(c): 
217 

•HR 3561 IH 

1 ‘‘(A) Section 504(b)(6) (relating to prohi2 bition on payments to excluded individuals and 

3 entities). 

4 ‘‘(B) Section 504(c) (relating to the use of 

5 funds for the purchase of technical assistance). 

6 ‘‘(C) Section 504(d) (relating to a limita7 tion on administrative expenditures). 

8 ‘‘(D) Section 506 (relating to reports and 

9 audits), but only to the extent determined by 

10 the Secretary to be appropriate for grants made 

11 under this section. 

12 ‘‘(E) Section 507 (relating to penalties for 

13 false statements). 

14 ‘‘(F) Section 508 (relating to non15 discrimination). 

16 ‘‘(G) Section 509 (relating to the adminis17 tration of the grant program).’’. 

18 SEC. 451. STATE OPTION TO PROVIDE WRAP-AROUND 

19 SCHIP COVERAGE TO CHILDREN WHO HAVE 

20 OTHER HEALTH COVERAGE. 

21 (a) IN GENERAL.— 

22 (1) SCHIP.— 

23 (A) STATE OPTION TO PROVIDE WRAP24 AROUND COVERAGE.—Section 2110(b) of the 
218 

•HR 3561 IH 

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

2 amended— 

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

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

5 title XIX or’’; and 

6 (ii) by adding at the end the fol7 lowing: 

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

9 COVERAGE.—A State may waive the requirement of 

10 paragraph (1)(C) that a targeted low-income child 

11 may not be covered under a group health plan or 

12 under health insurance coverage, if the State satis13 fies the conditions described in subsection (c)(8). 

14 The State may waive such requirement in order to 

15 provide— 

16 ‘‘(A) dental services; 

17 ‘‘(B) cost-sharing protection; or 

18 ‘‘(C) all services. 

19 In waiving such requirement, a State may limit the 

20 application of the waiver to children whose family in21 come does not exceed a level specified by the State, 

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

23 maximum income level otherwise established for 

24 other children under the State child health plan.’’. 
219 

•HR 3561 IH 

1 (B) CONDITIONS DESCRIBED.—Section 

2 2105(c) of the Social Security Act (42 U.S.C. 

3 1397ee(c)) is amended by adding at the end the 

4 following: 

5 ‘‘(8) CONDITIONS FOR PROVISION OF WRAP6 AROUND COVERAGE.—For purposes of section 

7 2110(b)(5), the conditions described in this para8 graph are the following: 

9 ‘‘(A) INCOME ELIGIBILITY.—The State 

10 child health plan (whether implemented under 

11 title XIX or this XXI)— 

12 ‘‘(i) has the highest income eligibility 

13 standard permitted under this title as of 

14 January 1, 2002; 

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

16 does not limit the acceptance of applica17 tions for children; and 

18 ‘‘(iii) provides benefits to all children 

19 in the State who apply for and meet eligi20 bility standards. 

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

22 respect to children whose family income is at or 

23 below 200 percent of the poverty line, the State 

24 does not impose any numerical limitation, wait25 ing list, or similar limitation on the eligibility of 
220 

•HR 3561 IH 

1 such children for child health assistance under 

2 such State plan. 

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

4 The State child health plan may not provide 

5 more favorable coverage of dental services to 

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

7 than to children otherwise covered under this 

8 title.’’. 

9 (C) STATE OPTION TO WAIVE WAITING PE10 RIOD.—Section 2102(b)(1)(B) of the Social Se11 curity Act (42 U.S.C. 1397bb(b)(1)(B)) is 

12 amended— 

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

14 the end; 

15 (ii) in clause (ii), by striking the pe16 riod and inserting ‘‘; and’’; and 

17 (iii) by adding at the end the fol18 lowing: 

19 ‘‘(iii) at State option, may not apply 

20 a waiting period in the case of a child de21 scribed in section 2110(b)(5), if the State 

22 satisfies the requirements of section 

23 2105(c)(8).’’. 
221 

•HR 3561 IH 

1 (2) APPLICATION OF ENHANCED MATCH UNDER

2 MEDICAID.—Section 1905 of the Social Security Act 

3 (42 U.S.C. 1396d) is amended— 

4 (A) in subsection (b), in the fourth sen5 tence, by striking ‘‘or subsection (u)(3)’’ and 

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

7 (B) in subsection (u)— 

8 (i) by redesignating paragraph (4) as 

9 paragraph (5); and 

10 (ii) by inserting after paragraph (3) 

11 the following: 

12 ‘‘(4) For purposes of subsection (b), the ex13 penditures described in this paragraph are expendi14 tures for items and services for children described in 

15 section 2110(b)(5), but only in the case of a State 

16 that satisfies the requirements of section 

17 2105(c)(8).’’. 

18 (3) APPLICATION OF SECONDARY PAYOR PROVI19 SIONS.—Section 2107(e)(1) of the Social Security 

20 Act (42 U.S.C. 1397gg(e)(1)) is amended— 

21 (A) by redesignating subparagraphs (B) 

22 through (D) as subparagraphs (C) through (E), 

23 respectively; and 

24 (B) by inserting after subparagraph (A) 

25 the following: 
222 

•HR 3561 IH 

1 ‘‘(B) Section 1902(a)(25) (relating to co2 ordination of benefits and secondary payor pro3 visions) with respect to children covered under 

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

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

6 subsection (a) shall take effect on January 1, 2006, and 

7 shall apply to child health assistance and medical assist8 ance provided on or after that date. 

9 SEC. 452. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

10 HEALTH SERVICES THROUGH COMMUNITY 

11 HEALTH CENTERS AND PUBLIC HEALTH DE12 PARTMENTS. 

13 Part D of title III of the Public Health Service Act 

14 (42 U.S.C. 254b et seq.) is amended by insert before sec15 tion 330, the following: 

16 ‘‘SEC. 329. GRANT PROGRAM TO EXPAND THE AVAIL17 ABILITY OF SERVICES. 

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

19 the Health Resources and Services Administration, shall 

20 establish a program under which the Secretary may award 

21 grants to eligible entities and eligible individuals to expand 

22 the availability of primary dental care services in dental 

23 health professional shortage areas or medically under24 served areas. 

25 ‘‘(b) ELIGIBILITY.— 
223 

•HR 3561 IH 

1 ‘‘(1) ENTITIES.—To be eligible to receive a 

2 grant under this section an entity— 

3 ‘‘(A) shall be— 

4 ‘‘(i) a health center receiving funds 

5 under section 330 or designated as a Fed6 erally qualified health center; 

7 ‘‘(ii) a county or local public health 

8 department, if located in a federally-des9 ignated dental health professional shortage 

10 area; 

11 ‘‘(iii) an Indian tribe or tribal organi12 zation (as defined in section 4 of the In13 dian Self-Determination and Education 

14 Assistance Act (25 U.S.C. 450b)); 

15 ‘‘(iv) a dental education program ac16 credited by the Commission on Dental Ac17 creditation; or 

18 ‘‘(v) a community-based program 

19 whose child service population is made up 

20 of at least 33 percent of children who are 

21 eligible children, including at least 25 per22 cent of such children being children with 

23 mental retardation or related develop24 mental disabilities, unless specific docu-
224 

•HR 3561 IH 

1 mentation of a lack of need for access by 

2 this sub-population is established; and 

3 ‘‘(B) shall prepare and submit to the Sec4 retary an application at such time, in such 

5 manner, and containing such information as the 

6 Secretary may require, including information 

7 concerning dental provider capacity to serve in8 dividuals with developmental disabilities. 

9 ‘‘(2) INDIVIDUALS.—To be eligible to receive a 

10 grant under this section an individual shall— 

11 ‘‘(A) be a dental health professional li12 censed or certified in accordance with the laws 

13 of State in which such individual provides den14 tal services; 

15 ‘‘(B) prepare and submit to the Secretary 

16 an application at such time, in such manner, 

17 and containing such information as the Sec18 retary may require; and 

19 ‘‘(C) provide assurances that— 

20 ‘‘(i) the individual will practice in a 

21 federally-designated dental health profes22 sional shortage area; or 

23 ‘‘(ii) not less than 25 percent of the 

24 patients of such individual are— 
225 

•HR 3561 IH 

1 ‘‘(I) receiving assistance under a 

2 State plan under title XIX of the So3 cial Security Act (42 U.S.C. 1396 et 

4 seq.); 

5 ‘‘(II) receiving assistance under a 

6 State plan under title XXI of the So7 cial Security Act (42 U.S.C. 1397aa 

8 et seq.); or 

9 ‘‘(III) uninsured. 

10 ‘‘(c) USE OF FUNDS.— 

11 ‘‘(1) ENTITIES.—An entity shall use amounts 

12 received under a grant under this section to provide 

13 for the increased availability of primary dental serv14 ices in the areas described in subsection (a). Such 

15 amounts may be used to supplement the salaries of16 fered for individuals accepting employment as den17 tists in such areas. 

18 ‘‘(2) INDIVIDUALS.—A grant to an individual 

19 under subsection (a) shall be in the form of a 

20 $1,000 bonus payment for each month in which such 

21 individual is in compliance with the eligibility re22 quirements of subsection (b)(2)(C). 

23 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 

24 ‘‘(1) IN GENERAL.—Notwithstanding any other 

25 amounts appropriated under section 330 for health 
226 

•HR 3561 IH 

1 centers, there is authorized to be appropriated such 

2 sums as may be necessary for each of fiscal years 

3 2007 through 2012 to hire and retain dental 

4 healthcare providers under this section. 

5 ‘‘(2) USE OF FUNDS.—Of the amount appro6 priated for a fiscal year under paragraph (1), the 

7 Secretary shall use— 

8 ‘‘(A) not less than 65 percent of such 

9 amount to make grants to eligible entities; and 

10 ‘‘(B) not more than 35 percent of such 

11 amount to make grants to eligible individuals.’’. 

12 SEC. 453. PRIORITY SUBSTANCE ABUSE TREATMENT NEEDS 

13 OF REGIONAL AND NATIONAL SIGNIFICANCE. 

14 Section 509 of the Public Health Service Act (42 

15 U.S.C. 290bb–2) is amended— 

16 (1) by redesignating subsection (f) as sub17 section (g); and 

18 (2) by inserting after subsection (d) the fol19 lowing: 

20 ‘‘(f) SPECIAL CONSIDERATION IN DEVELOPING PRO21 GRAM PRIORITIES.—The Secretary shall give special con22 sideration to promoting the integration of substance abuse 

23 treatment services into primary health care systems and 

24 the provision of culturally and linguistically appropriate 
227 

•HR 3561 IH 

1 substance abuse treatment services in health disparity 

2 populations.’’. 

3 SEC. 454. FETAL ALCOHOL SYNDROME. 

4 Subtitle B of title XXIX of the Public Health Service 

5 Act, as added by section 442, is amended by adding at 

6 the end the following: 

7 ‘‘SEC. 2922. FETAL ALCOHOL SYNDROME. 

8 ‘‘(a) SURVEILLANCE AND IDENTIFICATION RE9 SEARCH.—The Secretary shall direct the National Center 

10 for Birth Defects and Developmental Disabilities (referred 

11 to in this section as the ‘Center’) to— 

12 ‘‘(1) develop a uniform surveillance case defini13 tion for Fetal Alcohol Syndrome (referred to in this 

14 section as ‘FAS’) and a uniform surveillance defini15 tion for Alcohol Related Neurodevelopmental Dis16 order (referred to in this section as ‘ARND’); 

17 ‘‘(2) develop a comprehensive screening process 

18 for FAS and ARND to include all age groups; and 

19 ‘‘(3) disseminate the screening process devel20 oped under paragraph (2) to— 

21 ‘‘(A) hospitals, outpatient programs, and 

22 other healthcare providers; 

23 ‘‘(B) incarceration and detainment facili24 ties; 

25 ‘‘(C) primary and secondary schools; 
228 

•HR 3561 IH 

1 ‘‘(D) social work and child welfare offices; 

2 ‘‘(E) State offices and others providing 

3 services to individuals with disabilities; and 

4 ‘‘(F) others determined appropriate by the 

5 Secretary. 

6 ‘‘(b) CLINICAL CHARACTERIZATION OF FAS AND RE7 LATED DISEASES.—The Secretary shall direct the Na8 tional Institute of Alcohol Abuse and Alcoholism to— 

9 ‘‘(1) research methods to quantify the central 

10 nervous system impairments associated with fetal al11 cohol exposure and to develop clinical diagnostic 

12 tools for the intellectual and behavioral problems as13 sociated with FAS and related diseases; 

14 ‘‘(2) develop a neurocognitive phenotype for 

15 FAS and ARND; and 

16 ‘‘(3) include all relevant scientific and clinical 

17 characterizations of FAS and related diseases in rel18 evant diagnostic codes. 

19 ‘‘(c) COMMUNITY-BASED AND SUPPORT SERVICES

20 COORDINATION GRANTS.—The Secretary shall award 

21 grants to States, Indian tribes and tribal organizations, 

22 and nongovernmental organizations for the establishment 

23 of— 

24 ‘‘(1) pilot projects to identify and implement 

25 best practices for— 
229 

•HR 3561 IH 

1 ‘‘(A) educating children with fetal alcohol 

2 spectrum disorders, including— 

3 ‘‘(i) activities and programs designed 

4 specifically for the identification, treat5 ment, and education of such children; and 

6 ‘‘(ii) curricula development and 

7 credentialing of teachers, administrators, 

8 and social workers who implement such 

9 programs; 

10 ‘‘(B) educating judges, attorneys, child ad11 vocates, law enforcement officers, prison war12 dens, alternative incarceration administrators, 

13 and incarceration officials on how to treat and 

14 support individuals suffering from a fetal alco15 hol spectrum disorder within the criminal jus16 tice system, including— 

17 ‘‘(i) programs designed specifically for 

18 the identification, treatment, and education 

19 of those with a fetal alcohol spectrum dis20 order; and 

21 ‘‘(ii) curricula development and 

22 credentialing within justice system for indi23 viduals who implement such programs; and 

24 ‘‘(C) educating adoption or foster care 

25 agency officials about available and necessary 
230 

•HR 3561 IH 

1 services for children with fetal alcohol spectrum 

2 disorders, including— 

3 ‘‘(i) programs designed specifically for 

4 the identification, treatment, and education 

5 of those with a fetal alcohol spectrum dis6 order; and 

7 ‘‘(ii) education and training for poten8 tial parents of an adopted child with a 

9 fetal alcohol spectrum disorder; 

10 ‘‘(2) nationally coordinated systems that inte11 grate transitional services for those affected by pre12 natal alcohol exposure such as housing assistance, 

13 vocational training and placement, and medication 

14 monitoring by— 

15 ‘‘(A) providing training and support to 

16 family services programs, children’s mental 

17 health programs, and other local efforts; 

18 ‘‘(B) recruiting and training mentors for 

19 teenagers with a fetal alcohol spectrum dis20 order; and 

21 ‘‘(C) maintaining a clearinghouse including 

22 all relevant neurobehavioral information needed 

23 for supporting individuals with a fetal alcohol 

24 spectrum disorder; and 
231 

•HR 3561 IH 

1 ‘‘(3) programs to disseminate and coordinate 

2 fetal alcohol spectrum disorder awareness and iden3 tification efforts by community health centers, in4 cluding— 

5 ‘‘(A) education of health professionals re6 garding available support services; and 

7 ‘‘(B) implementation of a tracking system 

8 targeting the rates of fetal alcohol spectrum 

9 disorders among individuals from certain racial, 

10 ethnic, and economic backgrounds. 

11 ‘‘(d) APPLICATION.—To be eligible to receive a grant 

12 under subsection (g), an entity shall submit to the Sec13 retary an application in such form, in such manner, and 

14 containing such agreements, assurances, and information 

15 as the Secretary determines to be necessary to carry out 

16 this section. 

17 ‘‘(e) BUILDING STATE FASD SYSTEMS.— 

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

19 through the Administrator of the Substance Abuse 

20 and Mental Health Services Administration, shall 

21 award grants, contracts, or cooperative agreements 

22 to States for the purpose of establishing or expand23 ing statewide programs of surveillance, prevention, 

24 and treatment of individuals with Fetal Alcohol 

25 Spectrum Disorders. 
232 

•HR 3561 IH 

1 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

2 grant, contract, or cooperative agreement under 

3 paragraph (1) a State shall— 

4 ‘‘(A) prepare and submit to the Secretary 

5 an application at such time, in such manner, 

6 and containing such information as the Sec7 retary may reasonably require; 

8 ‘‘(B) develop and implement a statewide 

9 strategic plan for preventing and treating Fetal 

10 Alcohol Spectrum Disorders; 

11 ‘‘(C) consult with public and private non12 profit entities with relevant expertise on Fetal 

13 Alcohol Spectrum Disorders within the State, 

14 including— 

15 ‘‘(i) parent-led groups and other orga16 nizations that support and advocate for in17 dividuals with Fetal Alcohol Spectrum Dis18 orders; and 

19 ‘‘(ii) Indian tribes and tribal organiza20 tions; and 

21 ‘‘(D) designate an individual to serve as 

22 the coordinator of the State’s Fetal Alcohol 

23 Spectrum Disorders program. 
233 

•HR 3561 IH 

1 ‘‘(3) STRATEGIC PLAN.—The statewide stra2 tegic plan prepared under paragraph (2)(B) shall in3 clude— 

4 ‘‘(A) the identification of existing State 

5 programs and systems that could be used to 

6 identify and treat individuals with Fetal Alcohol 

7 Spectrum Disorders and prevent alcohol con8 sumption during pregnancy, such as— 

9 ‘‘(i) programs for the developmentally 

10 disabled, the mentally ill, and individuals 

11 with alcohol dependency; 

12 ‘‘(ii) primary and secondary edu13 cational systems; 

14 ‘‘(iii) judicial systems for juveniles 

15 and adults; 

16 ‘‘(iv) child welfare programs and so17 cial service programs; and 

18 ‘‘(v) other programs or systems the 

19 State determines to be appropriate; 

20 ‘‘(B) the identification of any barriers for 

21 individuals with Fetal Alcohol Spectrum Dis22 orders or women at risk for alcohol consump23 tion during pregnancy to access the programs 

24 identified under subparagraph (A); and 
234 

•HR 3561 IH 

1 ‘‘(C) proposals to eliminate barriers to pre2 vention and treatment programs and coordinate 

3 the activities of such programs. 

4 ‘‘(4) USE OF FUNDS.—Amounts received under 

5 a grant, contract, or cooperative agreement under 

6 paragraph (1) shall be used for one or more of the 

7 following activities: 

8 ‘‘(A) Establishing a statewide surveillance 

9 system. 

10 ‘‘(B) Collecting, analyzing and interpreting 

11 data. 

12 ‘‘(C) Establishing a diagnostic center. 

13 ‘‘(D) Developing, implementing, and evalu14 ating population-based and targeted prevention 

15 programs for Fetal Alcohol Spectrum Dis16 orders, including public awareness campaigns. 

17 ‘‘(E) Referring individuals with Fetal Alco18 hol Spectrum Disorders to appropriate support 

19 services. 

20 ‘‘(F) Developing and sharing best practices 

21 for the prevention, identification, and treatment 

22 of Fetal Alcohol Spectrum Disorders. 

23 ‘‘(G) Providing training to health care pro24 viders on the prevention, identification, and 

25 treatment of Fetal Alcohol Spectrum Disorders. 
235 

•HR 3561 IH 

1 ‘‘(H) Disseminating information about 

2 Fetal Alcohol Spectrum Disorders and the 

3 availability of support services to families of in4 dividuals with Fetal Alcohol Spectrum Dis5 orders. 

6 ‘‘(I) Other activities determined appro7 priate by the Secretary. 

8 ‘‘(5) MULTI-STATE PROGRAMS.—The Secretary 

9 shall permit the formation of multi-State Fetal Alco10 hol Spectrum Disorders programs under this sub11 section. 

12 ‘‘(6) OTHER CONTRACTS AND AGREEMENTS.— 

13 A State may carry out activities under paragraph 

14 (4) through contacts or cooperative agreements with 

15 public and private non-profit entities with a dem16 onstrated expertise in Fetal Alcohol Spectrum Dis17 orders. 

18 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

19 There are authorized to be appropriated to carry out 

20 this subsection, such sums as may be necessary for 

21 fiscal years 2006 through 2010. 

22 ‘‘(f) PROMOTING COMMUNITY PARTNERSHIPS.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall award 

24 grants, contracts, or cooperative agreements to eligi25 ble entities to enable such entities to establish, en-
236 

•HR 3561 IH 

1 hance, or improve community partnerships for the 

2 purpose of collaborating on common objectives and 

3 integrating the services available to individuals with 

4 Fetal Alcohol Spectrum Disorders, such as surveil5 lance, prevention, treatment, and provision of sup6 port services. 

7 ‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re8 ceive a grant, contract, or cooperative agreement 

9 under paragraph (1), an entity shall— 

10 ‘‘(A) be a public or private nonprofit enti11 ty, including— 

12 ‘‘(i) a health care provider or health 

13 professional; 

14 ‘‘(ii) a primary or secondary school; 

15 ‘‘(iii) a social work or child welfare of16 fice; 

17 ‘‘(iv) an incarceration or detainment 

18 facility; 

19 ‘‘(v) a parent-led group or other orga20 nization that supports and advocates for 

21 individuals with Fetal Alcohol Spectrum 

22 Disorders; 

23 ‘‘(vi) an Indian tribe or tribal organi24 zation; 
237 

•HR 3561 IH 

1 ‘‘(vii) any other entity the Secretary 

2 determines to be appropriate; or 

3 ‘‘(viii) a consortium of any of the enti4 ties described in clauses (i) through (vii); 

5 and 

6 ‘‘(B) prepare and submit to the Secretary 

7 an application at such time, in such manner, 

8 and containing such information as the Sec9 retary may reasonably require, including assur10 ances that the entity submitting the application 

11 does, at the time of application, or will, within 

12 a reasonable amount of time from the date of 

13 application, include substantive participation of 

14 a broad range of entities that work with or pro15 vide services for individuals with Fetal Alcohol 

16 Spectrum Disorders. 

17 ‘‘(3) ACTIVITIES.—An eligible entity shall use 

18 amounts received under a grant, contract, or cooper19 ative agreement under this subsection shall carry out 

20 1 or more of the following activities: 

21 ‘‘(A) Identifying and integrating existing 

22 programs and services available in the commu23 nity for individuals with Fetal Alcohol Spec24 trum Disorders. 
238 

•HR 3561 IH 

1 ‘‘(B) Conducting a needs assessment to 

2 identify services that are not available in a com3 munity. 

4 ‘‘(C) Developing and implementing com5 munity-based initiatives to prevent, diagnose, 

6 treat, and provide support services to individ7 uals with Fetal Alcohol Spectrum Disorders. 

8 ‘‘(D) Disseminating information about 

9 Fetal Alcohol Spectrum Disorders and the 

10 availability of support services. 

11 ‘‘(E) Developing and implementing a com12 munity-wide public awareness and outreach 

13 campaign focusing on the dangers of drinking 

14 alcohol while pregnant. 

15 ‘‘(F) Providing mentoring or other support 

16 to families of individuals with Fetal Alcohol 

17 Spectrum Disorders. 

18 ‘‘(G) Other activities determined appro19 priate by the Secretary. 

20 ‘‘(4) AUTHORIZATION OF APPROPRIATION.— 

21 There are authorized to be appropriated to carry out 

22 this subsection, such sums as may be necessary for 

23 each of fiscal years 2006 through 2010. 

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

25 is authorized to be appropriated to carry out this section 
239 

•HR 3561 IH 

1 (other than subsections (e) and (f)), such sums as may 

2 be necessary for each of fiscal years 2005 through 2010.’’. 

3 SEC. 455. HIV/AIDS REDUCTION. 

4 Subtitle B of title XXIX of the Public Health Service 

5 Act, as amended by section 454, is amended by adding 

6 at the end the following: 

7 ‘‘SEC. 2923. HIV/AIDS REDUCTION IN THE MINORITY COM8 MUNITY. 

9 ‘‘(a) EXPANDED FUNDING.—The Secretary, in col10 laboration with the Director of the Office of Minority 

11 Health, the Director of the Centers for Disease Control 

12 and Prevention, the Administrator of the Health Re13 sources and Services Administration, and the Adminis14 trator of the Substance Abuse and Mental Health Admin15 istration, shall provide funds and carry out activities to 

16 expand the Minority HIV/AIDS Initiative. 

17 ‘‘(b) USE OF FUNDS.—The additional funds made 

18 available under this section may be used, through the Mi19 nority HIV/AIDS Initiative, to support the following ac20 tivities: 

21 ‘‘(1) The provision of technical assistance and 

22 infrastructure support to reduce HIV/AIDS in mi23 nority populations. 

24 ‘‘(2) To increase minority populations’ access to 

25 HIV/AIDS prevention and care services. 
240 

•HR 3561 IH 

1 ‘‘(3) To build stronger community programs 

2 and partnerships to address HIV prevention and the 

3 healthcare needs of specific minority racial and eth4 nic populations. 

5 ‘‘(c) PRIORITY INTERVENTIONS.—Within the minor6 ity populations referred to in subsection (b), priority in 

7 conducting intervention services shall be given to— 

8 ‘‘(1) women; 

9 ‘‘(2) youth; 

10 ‘‘(3) men who engage in homosexual activity; 

11 ‘‘(4) persons who engage in intravenous drug 

12 abuse; 

13 ‘‘(5) homeless individuals; and 

14 ‘‘(6) individuals incarcerated or in the penal 

15 system. 

16 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the 

17 purpose of carrying out this section, there are authorized 

18 to be appropriated $610,000,000 for fiscal year 2005, and 

19 such sums as may be necessary for each of the fiscal years 

20 2006 through 2010.’’. 

21 SEC. 456. SYSTEMS FOR HEART DISEASE AND STROKE. 

22 Subtitle B of title XXIX of the Public Health Service 

23 Act, as amended by section 455, is further amended by 

24 adding at the end the following: 
241 

•HR 3561 IH 

1 ‘‘SEC. 2924. HEART DISEASE. 

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

3 the National Heart, Lung and Blood Institute and the 

4 Centers for Disease Control, shall award competitive 

5 grants to eligible entities to provide for community-based 

6 interventions to encourage healthy lifestyles to reduce 

7 morbidity and mortality from heart disease. 

8 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

9 a grant under subsection (a), an entity shall— 

10 ‘‘(1) be a community-based or non-profit orga11 nization, academic medical institution, hospital, 

12 health center, health plan, health department, or 

13 other health-related entity determined appropriate 

14 by the Secretary; and 

15 ‘‘(2) prepare and submit to the Secretary an 

16 application at such time, in such manner, and con17 taining such information as the Secretary may re18 quire. 

19 ‘‘(c) USE OF FUNDS.—An entity shall use amounts 

20 received under a grant under this section to— 

21 ‘‘(1) carry out interventions that address pri22 mary prevention of heart disease in the minority 

23 community, including educational outreach efforts 

24 concerning risk factors for, and the prevention of, 

25 heart disease; 
242 

•HR 3561 IH 

1 ‘‘(2) carry out activities to facilitate healthy 

2 lifestyles in minority populations through— 

3 ‘‘(A) behavioral change interventions to in4 crease physical activity and improve nutrition; 

5 ‘‘(B) the increased use of community facili6 ties and public spaces for exercise; 

7 ‘‘(C) school, after-school, or intramural 

8 physical activity or sports programs for children 

9 and youth; 

10 ‘‘(D) employment-based interventions to 

11 increase physical activity or nutrition; or 

12 ‘‘(3) expand or evaluate existing programs of 

13 the type described in paragraphs (1) and (2). 

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

15 is authorized to be appropriated to carry out this section, 

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

17 2006 through 2011. 

18 ‘‘SEC. 2925. STROKE EDUCATION CAMPAIGN. 

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

20 national education and information campaign to promote 

21 stroke prevention and increase the number of stroke pa22 tients who seek immediate treatment. In implementing 

23 such education and information campaign, the Secretary 

24 shall avoid duplicating existing stroke education efforts by 

25 other Federal Government agencies and may consult with 
243 

•HR 3561 IH 

1 national and local associations that are dedicated to in2 creasing the public awareness of stroke, consumers of 

3 stroke awareness products, and providers of stroke care. 

4 ‘‘(b) USE OF FUNDS.—The Secretary may use 

5 amounts appropriated to carry out the campaign described 

6 in subsection (a)— 

7 ‘‘(1) to make public service announcements 

8 about the warning signs of stroke and the impor9 tance of treating stroke as a medical emergency; 

10 ‘‘(2) to provide education regarding ways to 

11 prevent stroke and the effectiveness of stroke treat12 ment; 

13 ‘‘(3) to purchase media time and space; 

14 ‘‘(4) to pay for advertising production costs; 

15 ‘‘(5) to test and evaluate advertising and edu16 cational materials for effectiveness, especially among 

17 groups at high risk for stroke, including women, 

18 older adults, and African-Americans; 

19 ‘‘(6) to develop alternative campaigns that are 

20 targeted to unique communities, including rural and 

21 urban communities, and States with a particularly 

22 high incidence of stroke; 

23 ‘‘(7) to measure public awareness prior to the 

24 start of the campaign on a national level and in tar25 geted communities to provide baseline data that will 
244 

•HR 3561 IH 

1 be used to evaluate the effectiveness of the public 

2 awareness efforts; and 

3 ‘‘(8) to carry out other activities that the Sec4 retary determines will promote prevention practices 

5 among the general public and increase the number 

6 of stroke patients who seek immediate care. 

7 ‘‘(c) CONSULTATIONS.—In carrying out this section, 

8 the Secretary shall consult with medical, surgical, rehabili9 tation, and nursing specialty groups, hospital associations, 

10 voluntary health organizations, emergency medical serv11 ices, State directors, and associations, experts in the use 

12 of telecommunication technology to provide stroke care, 

13 national disability, minority health professional organiza14 tions and consumer organizations representing individuals 

15 with disabilities and chronic illnesses, concerned advo16 cates, and other interested parties. 

17 ‘‘(d) STROKE.—In this section, the term ‘stroke’ 

18 means a ‘brain attack’ in which blood flow to the brain 

19 is interrupted or in which a blood vessel or aneurysm in 

20 the brain breaks or ruptures. 

21 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to carry out subsection 

23 (b), such sums as may be necessary for each of fiscal years 

24 2006 through 2011.’’. 
245 

•HR 3561 IH 

1 Subtitle D—Studies, Reports, and 

2 Plans 

3 SEC. 461. IOM STUDY REQUEST. 

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

5 Human Services shall request that the Institute of Medi6 cine conduct, or contract with another entity to conduct, 

7 a study to investigate promising strategies for improving 

8 minority health and reducing and eliminating racial and 

9 ethnic disparities in health and healthcare. 

10 (b) CONTENT.—The study under subsection (a) 

11 shall— 

12 (1) identify key stakeholders for intervention in 

13 the public and private sector; 

14 (2) identify the barriers to eliminating racial 

15 and ethnic disparities in health and healthcare; 

16 (3) explore approaches for addressing dispari17 ties in health and healthcare using a quality im18 provement framework; 

19 (4) suggest an evaluation and research agenda 

20 that will advance effective strategies for reducing 

21 and eliminating racial and ethnic disparities in 

22 health and healthcare; and 

23 (5) assess the capacity of the Department of 

24 Health and Human Services, as currently struc25 tured, to implement and evaluate promising strate-
246 

•HR 3561 IH 

1 gies to improve minority health and reduce and 

2 eliminate racial and ethnic disparities in health and 

3 healthcare. 

4 (c) AGENDA.—The agenda described in subsection 

5 (b)(4) shall include a focus on the following: 

6 (1) Observational studies of race-discordant and 

7 race-concordant physician-patient clinical encoun8 ters. 

9 (2) Studies of the behaviors and expressed atti10 tudes toward race and ethnicity during education 

11 and training of health professionals. 

12 (3) Expansion of prospective studies of dispari13 ties in care, combining clinical data with qualitative 

14 interviews with patients and providers. 

15 (4) Studies of the natural history of social cat16 egorization in medical education and practice. 

17 (5) Studies of the effectiveness of standard clin18 ical guidelines in reducing disparities across disease 

19 categories. 

20 (6) Exploration of health system characteristics 

21 that may contribute to or mitigate disparities in 

22 health care. 

23 (7) Evaluation of cultural competency programs 

24 and their impact on the attitudes, knowledge, skills, 

25 and behaviors of healthcare providers. 
247 

•HR 3561 IH 

1 (8) Expansion of community-participatory re2 search with a focus on such topics as increasing 

3 trust and patient empowerment. 

4 (9) Studies on appropriate indicators of socio5 economic status, and methods for incorporating such 

6 indicators in patient records. 

7 (10) Interventional studies designed to elimi8 nate disparities. 

9 (d) REPORT.—Not later than 24 months after the 

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

11 Human Services shall submit to the appropriate commit12 tees of Congress a report containing the results of the 

13 study conducted under subsection (a). 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section, 

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

17 2007 and 2008. 

18 SEC. 462. STRATEGIC PLAN. 

19 (a) IN GENERAL.—The Secretary, acting through the 

20 Administrator of the Substance Abuse and Mental Health 

21 Services Administration, shall formulate a strategic plan 

22 for implementing the 2001 report by the Surgeon General 

23 of the Public Health Service entitled ‘‘Mental Health: Cul24 ture, Race, and Ethnicity—A Supplement to Mental 

25 Health: A Report of the Surgeon General’’ and the 2003 
248 

•HR 3561 IH 

1 report by the President’s New Freedom Commission on 

2 Mental Health entitled ‘‘Achieving the Promise: Trans3 forming Mental Health Care in America’’. 

4 (b) SUBMISSION.—Not later than 6 months after the 

5 date of the enactment of this title, the Secretary shall sub6 mit to the Congress the strategic plan formulated under 

7 this section. 

8 SEC. 463. ADVISORY COUNCIL FOR THE ELIMINATION OF 

9 TUBERCULOSIS. 

10 Section 317E(f) of the Public Health Service Act (42 

11 U.S.C. 247b–6(f)) is amended— 

12 (1) by redesignating paragraph (5) as para13 graph (6); and 

14 (2) by striking paragraphs (2) through (4), and 

15 inserting the following: 

16 ‘‘(2) DUTIES.—For the purpose of making 

17 progress toward the goal of eliminating tuberculosis 

18 from the United States, the Council shall provide to 

19 the Secretary and other appropriate Federal officials 

20 advice on coordinating the activities of the Public 

21 Health Service and other Federal agencies that re22 late to such disease and on efficiently utilizing the 

23 Federal resources involved. 

24 ‘‘(3) NATIONAL PLAN.—In carrying out para25 graph (2), the Council, in consultation with appro-
249 

•HR 3561 IH 

1 priate public and private entities, shall make rec2 ommendations on the development, revision, and im3 plementation of a national plan to eliminate tuber4 culosis in the United States. In carrying out this 

5 paragraph, the Council shall— 

6 ‘‘(A) consider the recommendations of the 

7 Institute of Medicine regarding the elimination 

8 of tuberculosis; 

9 ‘‘(B) address the development and applica10 tion of new technologies; and 

11 ‘‘(C) review the extent to which progress 

12 has been made toward eliminating tuberculosis. 

13 ‘‘(4) GLOBAL ACTIVITIES.—In carrying out 

14 paragraph (2), the Council, in consultation with ap15 propriate public and private entities, shall make rec16 ommendations for the development and implementa17 tion of a plan to guide the involvement of the United 

18 States in global and cross border tuberculosis-control 

19 activities, including recommendations regarding poli20 cies, strategies, objectives, and priorities. Such rec21 ommendations for the plan shall have a focus on 

22 countries where a high incidence of tuberculosis di23 rectly affects the United States, such as Mexico, and 

24 on access to a comprehensive package of tuberculosis 

25 control measures, as defined by the World Health 
250 

•HR 3561 IH 

1 Organization directly observed treatment, short 

2 course strategy (commonly known as DOTS). 

3 ‘‘(5) COMPOSITION.—The Council shall be com4 posed of— 

5 ‘‘(A) representatives from the Centers for 

6 Disease Control and Prevention, the National 

7 Institutes of Health, the Agency for Healthcare 

8 Research and Quality, the Health Resources 

9 and Services Administration, the U.S.-Mexico 

10 Border Health Commission, and other Federal 

11 departments and agencies that carry out signifi12 cant activities relating to tuberculosis; and 

13 ‘‘(B) members appointed from among indi14 viduals who are not officers or employees of the 

15 Federal Government.’’. 

16 SEC. 464. NATIONAL PROGRAM FOR TUBERCULOSIS ELIMI17 NATION. 

18 Section 317E of the Public Health Service Act (42 

19 U.S.C. 247b–6) is amended— 

20 (1) by striking the heading for the section and 

21 inserting the following: ‘‘NATIONAL PROGRAM

22 FOR TUBERCULOSIS ELIMINATION’’; 

23 (2) by amending subsection (b) to read as fol24 lows: 
251 

•HR 3561 IH 

1 ‘‘(b) RESEARCH, DEMONSTRATION PROJECTS, EDU2 CATION, AND TRAINING.—With respect to the prevention, 

3 control, and elimination of tuberculosis, the Secretary 

4 may, directly or through grants to public or nonprofit pri5 vate entities, carry out the following: 

6 ‘‘(1) Research, with priority given to research 

7 concerning— 

8 ‘‘(A) diagnosis and treatment of latent in9 fection of tuberculosis; 

10 ‘‘(B) strains of tuberculosis resistant to 

11 drugs; 

12 ‘‘(C) cases of tuberculosis that affect cer13 tain high-risk populations; and 

14 ‘‘(D) clinical trials, including those con15 ducted through the Tuberculosis Trials Consor16 tium. 

17 ‘‘(2) Demonstration projects, including for— 

18 ‘‘(A) the development of regional capabili19 ties for the prevention, control, and elimination 

20 of tuberculosis particularly in low-incidence re21 gions; and 

22 ‘‘(B) collaboration with the Immigration 

23 and Naturalization Service to identify and treat 

24 immigrants with active or latent tuberculosis in25 fection. 
252 

•HR 3561 IH 

1 ‘‘(3) Public information and education pro2 grams. 

3 ‘‘(4) Education, training and clinical skills im4 provement activities for health professionals, includ5 ing allied health personnel. 

6 ‘‘(5) Support of model centers to carry out ac7 tivities under paragraphs (2) through (4). 

8 ‘‘(6) Collaboration with international organiza9 tions and foreign countries, including Mexico, in co10 ordination with the United States Agency for Inter11 national Development, in carrying out such activi12 ties, including coordinating activities through the 

13 Advisory Council for the Elimination of Tuber14 culosis. 

15 ‘‘(7) Capacity support to States and large cities 

16 for strengthening tuberculosis programs.’’; and 

17 (3) by striking subsection (g) and inserting the 

18 following: 

19 ‘‘(g) REPORTS.—The Secretary, acting through the 

20 Director of the Centers for Disease Control and Preven21 tion and in consultation with the Advisory Council for the 

22 Elimination of Tuberculosis, shall biennially prepare and 

23 submit to the Committee on Health, Education, Labor, 

24 and Pensions of the Senate and the Committee on Energy 

25 and Commerce of the House of Representatives, a report 
253 

•HR 3561 IH 

1 on the activities carried out under this section. Each re2 port shall include the opinion of the Council on the extent 

3 to which its recommendations under section 317E(f)(3) 

4 regarding tuberculosis have been implemented. 

5 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 

6 purpose of carrying out this section, there are authorized 

7 to be appropriated such sums as may be necessary for 

8 each of the fiscal years 2007 through 2012.’’. 

9 SEC. 465. INCLUSION OF INPATIENT HOSPITAL SERVICES 

10 FOR THE TREATMENT OF TB-INFECTED INDI11 VIDUALS. 

12 (a) IN GENERAL.—Section 1902(z)(2) of the Social 

13 Security Act (42 U.S.C. 1396a(z)(2)) is amended by add14 ing at the end the following: 

15 ‘‘(G) Inpatient hospital services.’’. 

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

17 subsection (a) takes effect on October 1, 2006. 

18 Subtitle E—Miscellaneous 

19 Provisions 

20 SEC. 471. HEALTH EMPOWERMENT ZONES. 

21 (a) HEALTH EMPOWERMENT ZONE PROGRAMS.— 

22 (1) GRANTS.—The Secretary, acting through 

23 the Administrator of the Health Resources and Serv24 ices Administration and the Director of the Office of 

25 Minority Health, and in cooperation with the Direc-
254 

•HR 3561 IH 

1 tor of the Office of Community Services and the Di2 rector of the National Center for Minority Health 

3 and Health Disparities, shall make grants to part4 nerships of private and public entities to establish 

5 health empowerment zone programs in communities 

6 that disproportionately experience disparities in 

7 health status and healthcare for the purpose de8 scribed in paragraph (2). 

9 (2) USE OF FUNDS.— 

10 (A) IN GENERAL.—Subject to subpara11 graph (B), the purpose of a health empower12 ment zone program under this section shall be 

13 to assist individuals, businesses, schools, minor14 ity health associations, non-profit organizations, 

15 community-based organizations, hospitals, 

16 healthcare clinics, foundations, and other enti17 ties in communities that disproportionately ex18 perience disparities in health status and 

19 healthcare which are seeking— 

20 (i) to improve the health or environ21 ment of minority individuals in the com22 munity and to reduce disparities in health 

23 status and healthcare by assisting individ24 uals in accessing Federal programs; and 
255 

•HR 3561 IH 

1 (ii) to coordinate the efforts of gov2 ernmental and private entities regarding 

3 the elimination of racial and ethnic dispari4 ties in health status and healthcare. 

5 (B) MEDICARE AND MEDICAID.—A health 

6 empowerment zone program under this section 

7 shall not provide any assistance (other than re8 ferral and follow-up services) that is duplicative 

9 of programs under title XVIII or XIX of the 

10 Social Security Act (42 U.S.C. 1395 and 1396 

11 et seq.). 

12 (3) DISTRIBUTION.—The Secretary shall make 

13 at least 1 grant under this section to a partnership 

14 for a health empowerment zone program in commu15 nities that disproportionately experience disparities 

16 in health status and healthcare that is located in a 

17 territory or possession of the United States. 

18 (4) APPLICATION.—To obtain a grant under 

19 this section, a partnership shall submit to the Sec20 retary an application in such form and in such man21 ner as the Secretary may require. An application 

22 under this paragraph shall— 

23 (A) demonstrate that the communities to 

24 be served by the health empowerment zone pro-
256 

•HR 3561 IH 

1 gram are those that disproportionately experi2 ence disparities in health status and healthcare; 

3 (B) set forth a strategic plan for accom4 plishing the purpose described in paragraph (2), 

5 by— 

6 (i) describing the coordinated health, 

7 economic, human, community, and physical 

8 development plan and related activities 

9 proposed for the community; 

10 (ii) describing the extent to which 

11 local institutions and organizations have 

12 contributed and will contribute to the plan13 ning process and implementation; 

14 (iii) identifying the projected amount 

15 of Federal, State, local, and private re16 sources that will be available in the area 

17 and the private and public partnerships to 

18 be used (including any participation by or 

19 cooperation with universities, colleges, 

20 foundations, non-profit organizations, med21 ical centers, hospitals, health clinics, school 

22 districts, or other private and public enti23 ties); 
257 

•HR 3561 IH 

1 (iv) identifying the funding requested 

2 under any Federal program in support of 

3 the proposed activities; 

4 (v) identifying benchmarks for meas5 uring the success of carrying out the stra6 tegic plan; 

7 (vi) demonstrating the ability to reach 

8 and service the targeted underserved mi9 nority community populations in a cul10 turally appropriate and linguistically re11 sponsive manner; and 

12 (vii) demonstrating a capacity and in13 frastructure to provide long-term commu14 nity response that is culturally appropriate 

15 and linguistically responsive to commu16 nities that disproportionately experience 

17 disparities in health and healthcare; and 

18 (C) include such other information as the 

19 Secretary may require. 

20 (5) PREFERENCE.—In awarding grants under 

21 this subsection, the Secretary shall give preference 

22 to proposals from indigenous community entities 

23 that have an expertise in providing culturally appro24 priate and linguistically responsive services to com-
258 

•HR 3561 IH 

1 munities that disproportionately experience dispari2 ties in health and health care. 

3 (b) FEDERAL ASSISTANCE FOR HEALTH EMPOWER4 MENT ZONE GRANT PROGRAMS.—The Secretary, the Ad5 ministrator of the Small Business Administration, the 

6 Secretary of Agriculture, the Secretary of Education, the 

7 Secretary of Labor, and the Secretary of Housing and 

8 Urban Development shall each— 

9 (1) where appropriate, provide entity-specific 

10 technical assistance and evidence-based strategies to 

11 communities that disproportionately experience dis12 parities in health status and healthcare to further 

13 the purposes served by a health empowerment zone 

14 program established with a grant under subsection 

15 (a); 

16 (2) identify all programs administered by the 

17 Department of Health and Human Services, Small 

18 Business Administration, Department of Agri19 culture, Department of Education, Department of 

20 Labor, and the Department of Housing and Urban 

21 Development, respectively, that may be used to fur22 ther the purpose of a health empowerment zone pro23 gram established with a grant under subsection (a); 

24 and 
259 

•HR 3561 IH 

1 (3) in administering any program identified 

2 under paragraph (2), consider the appropriateness of 

3 giving priority to any individual or entity located in 

4 communities that disproportionately experience dis5 parities in health status and healthcare served by a 

6 health empowerment zone program established with 

7 a grant under subsection (a), if such priority would 

8 further the purpose of the health empowerment zone 

9 program. 

10 (c) HEALTH EMPOWERMENT ZONE COORDINATING

11 COMMITTEE.— 

12 (1) ESTABLISHMENT.—For each health em13 powerment zone program established with a grant 

14 under subsection (a), the Secretary acting through 

15 the Director of Office of Minority Health and the 

16 Administrator of the Health Resources and Services 

17 Administration shall establish a health empowerment 

18 zone coordinating committee. 

19 (2) DUTIES.—Each coordinating committee es20 tablished, in coordination with the Director of the 

21 Office of Minority Health and the Administrator of 

22 the Health Resources and Services Administration, 

23 shall provide technical assistance and evidence-based 

24 strategies to the grant recipient involved, including 

25 providing guidance on research, strategies, health 
260 

•HR 3561 IH 

1 outcomes, program goals, management, implementa2 tion, monitoring, assessment, and evaluation proc3 esses. 

4 (3) MEMBERSHIP.— 

5 (A) APPOINTMENT.—The Director of the 

6 Office of Minority Health and the Adminis7 trator of the Health Resources and Services Ad8 ministration, in consultation with the respective 

9 grant recipient shall appoint the members of 

10 each coordinating committee. 

11 (B) COMPOSITION.—The Director of the 

12 Office of Minority Health, and the Adminis13 trator of the Health Resources and Services Ad14 ministration shall ensure that each coordinating 

15 committee established— 

16 (i) has not more than 20 members; 

17 (ii) includes individuals from commu18 nities that disproportionately experience 

19 disparities in health status and healthcare; 

20 (iii) includes community leaders and 

21 leaders of community-based organizations; 

22 (iv) includes representatives of aca23 demia and lay and professional organiza24 tions and associations including those hav25 ing expertise in medicine, technical, social 
261 

•HR 3561 IH 

1 and behavioral science, health policy, advo2 cacy, cultural and linguistic competency, 

3 research management, and organization; 

4 and 

5 (v) represents a reasonable cross-sec6 tion of knowledge, views, and application 

7 of expertise on societal, ethical, behavioral, 

8 educational, policy, legal, cultural, lin9 guistic, and workforce issues related to 

10 eliminating disparities in health and 

11 healthcare. 

12 (C) INDIVIDUAL QUALIFICATIONS.—The 

13 Director of the Office of Minority Health and 

14 the Administrator of the Health Resources and 

15 Services Administration may not appoint an in16 dividual to serve on a coordinating committee 

17 unless the individual meets the following quali18 fications: 

19 (i) The individual is not employed by 

20 the Federal Government. 

21 (ii) The individual has appropriate ex22 perience, including experience in the areas 

23 of community development, cultural and 

24 linguistic competency, reducing and elimi-
262 

•HR 3561 IH 

1 nating racial and ethnic disparities in 

2 health and health care, or minority health. 

3 (D) SELECTION.—In selecting individuals 

4 to serve on a coordinating committee, the Di5 rector of Office of Minority Health and the Ad6 ministrator Health Resources and Services Ad7 ministration shall give due consideration to the 

8 recommendations of the Congress, industry 

9 leaders, the scientific community (including the 

10 Institute of Medicine), academia, community 

11 based non-profit organizations, minority health 

12 and related organizations, the education com13 munity, State and local governments, and other 

14 appropriate organizations. 

15 (E) CHAIRPERSON.—The Director of the 

16 Office of Minority Health and the Adminis17 trator of the Health Resources and Services Ad18 ministration, in consultation with the members 

19 of the coordinating committee involved, shall 

20 designate a chairperson of the coordinating 

21 committee, who shall serve for a term of 3 

22 years and who may be reappointed at the expi23 ration of each such term. 

24 (F) TERMS.—Each member of a coordi25 nating committee shall be appointed for a term 
263 

•HR 3561 IH 

1 of 1 to 3 years in overlapping staggered terms, 

2 as determined by the Director of the Office of 

3 Minority Health and the Administrator of the 

4 Health Resources and Services Administration 

5 at the time of appointment, and may be re6 appointed at the expiration of each such term. 

7 (G) VACANCIES.—A vacancy on a coordi8 nating committee shall be filled in the same 

9 manner in which the original appointment was 

10 made. 

11 (H) COMPENSATION.—Each member of a 

12 coordinating committee shall be compensated at 

13 a rate equal to the daily equivalent of the an14 nual rate of basic pay for level IV of the Execu15 tive Schedule for each day (including travel 

16 time) during which such member is engaged in 

17 the performance of the duties of the coordi18 nating committee. 

19 (I) TRAVEL EXPENSES.—Each member of 

20 a coordinating committee shall receive travel ex21 penses, including per diem in lieu of subsist22 ence, in accordance with applicable provisions 

23 under subchapter I of chapter 57 of title 5, 

24 United States Code. 
264 

•HR 3561 IH 

1 (4) MEETINGS.—A coordinating committee 

2 shall meet 3 to 5 times each year, at the call of the 

3 coordinating committee’s chairperson and in con4 sultation with the Director of Office of Minority 

5 Health and the Administrator Health Resources and 

6 Services Administration. 

7 (5) REPORT.—Each coordinating committee 

8 shall transmit to the Congress an annual report 

9 that, with respect to the health empowerment zone 

10 program involved, includes the following: 

11 (A) A review of the program’s effectiveness 

12 in achieving stated goals and outcomes. 

13 (B) A review of the program’s manage14 ment and the coordination of the entities in15 volved. 

16 (C) A review of the activities in the pro17 gram’s portfolio and components. 

18 (D) An identification of policy issues raised 

19 by the program. 

20 (E) An assessment of the program’s capac21 ity, infrastructure, and number of underserved 

22 minority communities reached. 

23 (F) Recommendations for new program 

24 goals, research areas, enhanced approaches, 

25 partnerships, coordination and management 
265 

•HR 3561 IH 

1 mechanisms, and projects to be established to 

2 achieve the program’s stated goals, to improve 

3 outcomes, monitoring, and evaluation. 

4 (G) A review of the degree of minority en5 tity participation in the program, and an identi6 fication of a strategy to increase such participa7 tion. 

8 (H) Any other reviews or recommendations 

9 determined to be appropriate by the coordi10 nating committee. 

11 (d) REPORT.—The Director of the Office of Minority 

12 Health and the Administrator of the Health Resources 

13 and Services Administration shall submit a joint annual 

14 report to the appropriate committees of Congress on the 

15 results of the implementation of programs under this sec16 tion. 

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to carry out this section, 

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

20 2007 through 2012. 

21 SEC. 472. OVERWEIGHT AND OBESITY PREVENTION AND 

22 TREATMENT. 

23 (a) IN GENERAL.—The Secretary, in collaboration 

24 with the Director of the Centers for Disease Control and 

25 Prevention, the Administrator of the National Center for 
266 

•HR 3561 IH 

1 Minority Health and Health Disparities, and the Adminis2 trator of the Health Resources and Services Administra3 tion, shall establish grant programs for the purpose of pre4 venting and treating overweight and obesity in under5 served minority populations. 

6 (b) DEFINITIONS.—In this section, with respect to an 

7 individual: 

8 (1) OBESITY.—The term ‘‘obesity’’ means a 

9 Body Mass Index greater than or equal to 30.0 kg/ 

m2 10 . 

11 (2) OVERWEIGHT.—The term ‘‘overweight’’ 

means a Body Mass Index of 25 to 29.9 kg/m2 12 . 

13 (c) CENTERS FOR DISEASE CONTROL AND PREVEN14 TION.—The Director of the Centers for Disease Control 

15 and Prevention shall expand overweight and obesity reduc16 tion activities that include the following: 

17 (1) Surveillance in minority racial and ethnic 

18 populations. 

19 (2) Communication strategies, including the use 

20 of social marketing for minority populations, about 

21 the dangers of obesity. 

22 (3) Creation of partnerships with State health 

23 departments in developing obesity prevention and 

24 treatment interventions. 
267 

•HR 3561 IH 

1 (4) Development of work-based wellness pro2 grams to encourage adoption of healthy lifestyles by 

3 employees. 

4 (d) NATIONAL CENTER FOR MINORITY HEALTH AND

5 HEALTH DISPARITIES.—The Director of the Centers for 

6 Disease Control and Prevention shall establish and imple7 ment a grant program to support research in the following 

8 areas: 

9 (1) Behavioral and environmental causes of 

10 overweight and obesity in minority populations. 

11 (2) Prevention and treatment interventions for 

12 overweight and obesity, tailored for minority popu13 lations. 

14 (3) Disparities in the prevalence of overweight 

15 and obesity among racial and ethnic minority 

16 groups. 

17 (4) Development and dissemination of best 

18 practice guidelines for treatment of overweight and 

19 obesity, tailored for gender and age groups within 

20 minority populations. 

21 (5) Data collection and reporting relating to 

22 overweight and obesity in minority populations. 

23 (e) HEALTH RESOURCES AND SERVICES ADMINIS24 TRATION.—The Administrator of the Health Resources 

25 and Services Administration, in collaboration with the Di-
268 

•HR 3561 IH 

1 rector of the Office of Minority Health, the Secretary of 

2 Education, and the Secretary of Agriculture, shall estab3 lish and implement a school-based obesity prevention and 

4 treatment program that may include the following activi5 ties: 

6 (1) Projects to change the perception of over7 weight and obesity of children from racially and eth8 nically diverse backgrounds at all ages. 

9 (2) Culturally appropriate student education 

10 about healthy eating habits, based on the Dietary 

11 Guidelines for Americans. 

12 (3) Student programs to increase knowledge, 

13 attitudes, skills, behaviors, and confidence needed to 

14 be physically active for life. 

15 (4) Student peer advisor programs to increase 

16 awareness and model healthy lifestyles among fellow 

17 students. 

18 (5) Teacher education using scientifically evalu19 ated physical education and nutrition curricula tai20 lored to minority populations. 

21 (6) Family-focused initiatives to encourage the 

22 adoption of strategies relating to healthy lifestyles 

23 for parents (or guardians) and children. 

24 (7) The creation of partnerships with commu25 nity, fitness, or health organizations that will pro-
269 

•HR 3561 IH 

1 mote healthy eating and physical activity among 

2 children. 

3 (8) Incentive programs to ensure the provision 

4 of healthful foods and beverages on school campuses 

5 and at school events. 

6 (f) EVALUATION.—A grantee under this section shall 

7 submit to the Secretary an evaluation, in collaboration 

8 with an academic health center or other qualified entity, 

9 that describes activities carried out with funds received 

10 under the grant and the effectiveness of such activities in 

11 preventing or treating overweight and obesity. 

12 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to carry out this section, 

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

15 2007 through 2012. 

16 SEC. 473. BORDER HEALTH GRANTS. 

17 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

18 the term ‘‘eligible entity’’ means a State, public institution 

19 of higher education, local government, tribal government, 

20 nonprofit health organization, community health center, or 

21 community clinic receiving assistance under section 330 

22 of the Public Health Service Act (42 U.S.C. 254b), that 

23 is located in the border area. 

24 (b) AUTHORIZATION.—From funds appropriated 

25 under subsection (f), the Secretary, acting through the 
270 

•HR 3561 IH 

1 United States members of the United States-Mexico Bor2 der Health Commission, shall award grants to eligible en3 tities to address priorities and recommendations to im4 prove the health of border area residents that are estab5 lished by— 

6 (1) the United States members of the United 

7 States-Mexico Border Health Commission; 

8 (2) the State border health offices; and 

9 (3) the Secretary. 

10 (c) APPLICATION.—An eligible entity that desires a 

11 grant under subsection (b) shall submit an application to 

12 the Secretary at such time, in such manner, and con13 taining such information as the Secretary may require. 

14 (d) USE OF FUNDS.—An eligible entity that receives 

15 a grant under subsection (b) shall use the grant funds 

16 for— 

17 (1) programs relating to— 

18 (A) maternal and child health; 

19 (B) primary care and preventative health; 

20 (C) public health and public health infra21 structure; 

22 (D) health education and promotion; 

23 (E) oral health; 

24 (F) mental and behavioral health; 

25 (G) substance abuse; 
271 

•HR 3561 IH 

1 (H) health conditions that have a high 

2 prevalence in the border area; 

3 (I) medical and health services research; 

4 (J) workforce training and development; 

5 (K) community health workers or 

6 promotoras; 

7 (L) health care infrastructure problems in 

8 the border area (including planning and con9 struction grants); 

10 (M) health disparities in the border area; 

11 (N) environmental health; and 

12 (O) outreach and enrollment services with 

13 respect to Federal programs (including pro14 grams authorized under titles XIX and XXI of 

15 the Social Security Act (42 U.S.C. 1396 and 

16 1397aa)); and 

17 (2) other programs determined appropriate by 

18 the Secretary. 

19 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro20 vided to an eligible entity awarded a grant under sub21 section (b) shall be used to supplement and not supplant 

22 other funds available to the eligible entity to carry out the 

23 activities described in subsection (d). 

24 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated to carry out this section, 
272 

•HR 3561 IH 

1 $200,000,000 for fiscal year 2007, and such sums as may 

2 be necessary for each succeeding fiscal year. 

3 SEC. 474. UNITED STATES-MEXICO BORDER HEALTH COM4 MISSION ACT AMENDMENTS. 

5 The United States-Mexico Border Health Commis6 sion Act (22 U.S.C. 290n et seq.) is amended by adding 

7 at the end the following: 

8 ‘‘SEC. 9. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There is authorized to be appropriated to carry out 

10 this Act $10,000,000 for fiscal year 2007 and such sums 

11 as may be necessary for each succeeding fiscal year.’’. 

12 SEC. 475. PREVENTION AND CONTROL OF INJURIES. 

13 (a) IN GENERAL.—Section 394A of the Public 

14 Health Service Act (42 U.S.C. 280b–3) is amended— 

15 (1) by striking ‘‘and’’ after ‘‘1994,’’; 

16 (2) by striking ‘‘and’’ after ‘‘1998,’’; and 

17 (3) by striking ‘‘through 2005’’ and all that fol18 lows and inserting the following: ‘‘through 2006, 

19 $300,000,000 for fiscal year 2007, and such sums 

20 as may be necessary for each of the fiscal years 

21 2008 through 2012.’’. 

22 (b) DEMONSTRATION PROJECTS IN URBAN AREAS.— 

23 Section 394A of the Public Health Service Act (42 U.S.C. 

24 280b–3) is amended by adding at the end the following 

25 sentence: ‘‘For the purpose of carrying out section 
273 

•HR 3561 IH 

1 393(a)(6) in urban areas, there are authorized to be ap2 propriated such sums as may be necessary for each of the 

3 fiscal years 2007 through 2012, in addition to amounts 

4 available for such purpose pursuant to the preceding sen5 tence.’’. 

6 (c) DEMONSTRATION PROJECTS REGARDING VIO7 LENCE.—Section 393 of the Public Health Service Act (42 

8 U.S.C. 280b–1a) is amended— 

9 (1) by redesignating subsection (b) as sub10 section (c); and 

11 (2) by inserting after subsection (a) the fol12 lowing subsection: 

13 ‘‘(b) Grants under subsection (a)(6) shall include 

14 grants to public or nonprofit private trauma centers for 

15 demonstration projects to reduce violence.’’. 

16 TITLE V—DATA COLLECTION 

17 AND REPORTING 

18 SEC. 501. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

19 ACT. 

20 (a) PURPOSE.—It is the purpose of this section to 

21 promote data collection, analysis, and reporting by race, 

22 ethnicity, and primary language among federally sup23 ported health programs. 
274 

•HR 3561 IH 

1 (b) AMENDMENT.—Title XXIX of the Public Health 

2 Service Act, as amended by titles II and III of this Act, 

3 is further amended by adding at the end the following: 

4 ‘‘Subtitle C—Strengthening Data 

5 Collection, Improving Data 

6 Analysis, and Expanding Data 

7 Reporting 

8 ‘‘SEC. 2931. DATA ON RACE, ETHNICITY, AND PRIMARY LAN9 GUAGE. 

10 ‘‘(a) REQUIREMENTS.— 

11 ‘‘(1) IN GENERAL.—Each health-related pro12 gram operated by or that receives funding or reim13 bursement, in whole or in part, either directly or in14 directly from the Department of Health and Human 

15 Services shall— 

16 ‘‘(A) require the collection, by the agency 

17 or program involved, of data on the race, eth18 nicity, and primary language of each applicant 

19 for and recipient of health-related assistance 

20 under such program— 

21 ‘‘(i) using, at a minimum, the cat22 egories for race and ethnicity described in 

23 the 1997 Office of Management and Budg24 et Standards for Maintaining, Collecting, 
275 

•HR 3561 IH 

1 and Presenting Federal Data on Race and 

2 Ethnicity; 

3 ‘‘(ii) using the standards developed 

4 under subsection (e) for the collection of 

5 language data; 

6 ‘‘(iii) where practicable, collecting 

7 data for additional population groups if 

8 such groups can be aggregated into the 

9 minimum race and ethnicity categories; 

10 and 

11 ‘‘(iv) where practicable, through self12 report; 

13 ‘‘(B) with respect to the collection of the 

14 data described in subparagraph (A) for appli15 cants and recipients who are minors or other16 wise legally incapacitated, require that— 

17 ‘‘(i) such data be collected from the 

18 parent or legal guardian of such an appli19 cant or recipient; and 

20 ‘‘(ii) the preferred language of the 

21 parent or legal guardian of such an appli22 cant or recipient be collected; 

23 ‘‘(C) systematically analyze such data 

24 using the smallest appropriate units of analysis 

25 feasible to detect racial and ethnic disparities in 
276 

•HR 3561 IH 

1 health and healthcare and when appropriate, 

2 for men and women separately, and report the 

3 results of such analysis to the Secretary, the 

4 Director of the Office for Civil Rights, the Com5 mittee on Health, Education, Labor, and Pen6 sions and the Committee on Finance of the 

7 Senate, and the Committee on Energy and 

8 Commerce and the Committee on Ways and 

9 Means of the House of Representatives; 

10 ‘‘(D) provide such data to the Secretary on 

11 at least an annual basis; and 

12 ‘‘(E) ensure that the provision of assist13 ance to an applicant or recipient of assistance 

14 is not denied or otherwise adversely affected be15 cause of the failure of the applicant or recipient 

16 to provide race, ethnicity, and primary language 

17 data. 

18 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 

19 this subsection shall be construed to— 

20 ‘‘(A) permit the use of information col21 lected under this subsection in a manner that 

22 would adversely affect any individual providing 

23 any such information; and 

24 ‘‘(B) require health care providers to col25 lect data. 
277 

•HR 3561 IH 

1 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 

2 ensure (through the promulgation of regulations or other3 wise) that all data collected pursuant to subsection (a) is 

4 protected— 

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

6 Secretary applies to other health data under the reg7 ulations promulgated under section 264(c) of the 

8 Health Insurance Portability and Accountability Act 

9 of 1996 (Public Law 104–191; 110 Stat. 2033) re10 lating to the privacy of individually identifiable 

11 health information and other protections; and 

12 ‘‘(2) from all inappropriate internal use by any 

13 entity that collects, stores, or receives the data, in14 cluding use of such data in determinations of eligi15 bility (or continued eligibility) in health plans, and 

16 from other inappropriate uses, as defined by the 

17 Secretary. 

18 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 

19 Secretary shall develop and implement a national plan to 

20 improve the collection, analysis, and reporting of racial, 

21 ethnic, and primary language data at the Federal, State, 

22 territorial, Tribal, and local levels, including data to be 

23 collected under subsection (a). The Data Council of the 

24 Department of Health and Human Services, in consulta25 tion with the National Committee on Vital Health Statis-
278 

•HR 3561 IH 

1 tics, the Office of Minority Health, and other appropriate 

2 public and private entities, shall make recommendations 

3 to the Secretary concerning the development, implementa4 tion, and revision of the national plan. Such plan shall 

5 include recommendations on how to— 

6 ‘‘(1) implement subsection (a) while minimizing 

7 the cost and administrative burdens of data collec8 tion and reporting; 

9 ‘‘(2) expand awareness among Federal agencies, 

10 States, territories, Indian tribes, health providers, 

11 health plans, health insurance issuers, and the gen12 eral public that data collection, analysis, and report13 ing by race, ethnicity, and primary language is legal 

14 and necessary to assure equity and non-discrimina15 tion in the quality of healthcare services; 

16 ‘‘(3) ensure that future patient record systems 

17 have data code sets for racial, ethnic, and primary 

18 language identifiers and that such identifiers can be 

19 retrieved from clinical records, including records 

20 transmitted electronically; 

21 ‘‘(4) improve health and healthcare data collec22 tion and analysis for more population groups if such 

23 groups can be aggregated into the minimum race 

24 and ethnicity categories, including exploring the fea25 sibility of enhancing collection efforts in States for 
279 

•HR 3561 IH 

1 racial and ethnic groups that comprise a significant 

2 proportion of the population of the State; 

3 ‘‘(5) provide researchers with greater access to 

4 racial, ethnic, and primary language data, subject to 

5 privacy and confidentiality regulations; and 

6 ‘‘(6) safeguard and prevent the misuse of data 

7 collected under subsection (a). 

8 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col9 lected under subsection (a) shall be obtained, maintained, 

10 and presented (including for reporting purposes) in ac11 cordance with the 1997 Office of Management and Budget 

12 Standards for Maintaining, Collecting, and Presenting 

13 Federal Data on Race and Ethnicity (at a minimum). 

14 ‘‘(e) LANGUAGE COLLECTION STANDARDS.—Not 

15 later than 1 year after the date of enactment of this title, 

16 the Director of the Office of Minority Health, in consulta17 tion with the Office for Civil Rights of the Department 

18 of Health and Human Services, shall develop and dissemi19 nate Standards for the Classification of Federal Data on 

20 Preferred Written and Spoken Language. 

21 ‘‘(f) TECHNICAL ASSISTANCE FOR THE COLLECTION

22 AND REPORTING OF DATA.— 

23 ‘‘(1) IN GENERAL.—The Secretary may, either 

24 directly or through grant or contract, provide tech25 nical assistance to enable a healthcare program or 
280 

•HR 3561 IH 

1 an entity operating under such program to comply 

2 with the requirements of this section. 

3 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro4 vided under this subsection may include assistance 

5 to— 

6 ‘‘(A) enhance or upgrade computer tech7 nology that will facilitate racial, ethnic, and pri8 mary language data collection and analysis; 

9 ‘‘(B) improve methods for health data col10 lection and analysis including additional popu11 lation groups beyond the Office of Management 

12 and Budget categories if such groups can be 

13 aggregated into the minimum race and ethnicity 

14 categories; 

15 ‘‘(C) develop mechanisms for submitting 

16 collected data subject to existing privacy and 

17 confidentiality regulations; and 

18 ‘‘(D) develop educational programs to in19 form health insurance issuers, health plans, 

20 health providers, health-related agencies, and 

21 the general public that data collection and re22 porting by race, ethnicity, and preferred lan23 guage are legal and essential for eliminating 

24 health and healthcare disparities. 
281 

•HR 3561 IH 

1 ‘‘(g) ANALYSIS OF RACIAL AND ETHNIC DATA.—The 

2 Secretary, acting through the Director of the Agency for 

3 Healthcare Research and Quality and in coordination with 

4 the Administrator of the Centers for Medicare and Med5 icaid Services, shall provide technical assistance to agen6 cies of the Department of Health and Human Services in 

7 meeting Federal standards for race, ethnicity, and pri8 mary language data collection and analysis of racial and 

9 ethnic disparities in health and healthcare in public pro10 grams by— 

11 ‘‘(1) identifying appropriate quality assurance 

12 mechanisms to monitor for health disparities; 

13 ‘‘(2) specifying the clinical, diagnostic, or thera14 peutic measures which should be monitored; 

15 ‘‘(3) developing new quality measures relating 

16 to racial and ethnic disparities in health and 

17 healthcare; 

18 ‘‘(4) identifying the level at which data analysis 

19 should be conducted; and 

20 ‘‘(5) sharing data with external organizations 

21 for research and quality improvement purposes. 

22 ‘‘(h) NATIONAL CONFERENCE.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall spon24 sor a biennial national conference on racial, ethnic, 

25 and primary language data collection to enhance co-
282 

•HR 3561 IH 

1 ordination, build partnerships, and share best prac2 tices in racial, ethnic, and primary language data 

3 collection, analysis, and reporting. 

4 ‘‘(2) REPORTS.—Not later than 6 months after 

5 the date on which a national conference has con6 vened under paragraph (1), the Secretary shall pub7 lish in the Federal Register and submit to the Com8 mittee on Health, Education, Labor, and Pensions 

9 and the Committee on Finance of the Senate and 

10 the Committee on Energy and Commerce and the 

11 Committee on Ways and Means of the House of 

12 Representatives a report concerning the proceedings 

13 and findings of the conference. 

14 ‘‘(i) REPORT.—Not later than 2 years after the date 

15 of enactment of this title, and biennially thereafter, the 

16 Secretary shall submit to the appropriate committees of 

17 Congress a report on the effectiveness of data collection, 

18 analysis, and reporting on race, ethnicity, and primary 

19 language under the programs and activities of the Depart20 ment of Health and Human Services and under other Fed21 eral data collection systems with which the Department 

22 interacts to collect relevant data on race and ethnicity. 

23 The report shall evaluate the progress made in the De24 partment with respect to the national plan under sub25 section (c) or subsequent revisions thereto. 
283 

•HR 3561 IH 

1 ‘‘(j) GRANTS FOR DATA COLLECTION BY HEALTH

2 PLANS, HEALTH CENTERS, AND HOSPITALS.— 

3 ‘‘(1) IN GENERAL.—The Secretary, in consulta4 tion with the Administrator of the Centers for Medi5 care and Medicaid Services, is authorized to award 

6 grants for the conduct of 20 demonstration pro7 grams by health plans, health centers, or hospitals 

8 to enhance their ability to collect, analyze, and re9 port the data required under subsection (a). 

10 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

11 grant under paragraph (1), a health plan or hospital 

12 shall— 

13 ‘‘(A) prepare and submit to the Secretary 

14 an application at such time, in such manner, 

15 and containing such information as the Sec16 retary may require, including a plan to elimi17 nate racial, ethnic, and primary language dis18 parities in health and healthcare through one or 

19 more of the activities described in paragraph 

20 (3); and 

21 ‘‘(B) provide assurances that the health 

22 plan or hospital will use, at a minimum, the ra23 cial and ethnic categories and the standards for 

24 collection described in the 1997 Office of Man25 agement and Budget Standards for Maintain-
284 

•HR 3561 IH 

1 ing, Collecting, and Presenting Federal Data on 

2 Race and Ethnicity and available standards for 

3 language. 

4 ‘‘(3) ACTIVITIES.—A grantee shall use amounts 

5 received under a grant under paragraph (1) to— 

6 ‘‘(A) collect, analyze, and report data by 

7 race, ethnicity, and primary language for pa8 tients served by the hospital (including emer9 gency room patients and patients served on an 

10 outpatient basis) or health center, or, in the 

11 case of a private health plan, such data for en12 rollees; 

13 ‘‘(B) enhance or upgrade computer tech14 nology that will facilitate racial, ethnic, and pri15 mary language data collection and analysis; 

16 ‘‘(C) provide analyses of racial and ethnic 

17 disparities in health and healthcare, including 

18 specific disease conditions, diagnostic and 

19 therapeutic procedures, or outcomes; 

20 ‘‘(D) improve health data collection and 

21 analysis for additional population groups be22 yond the Office of Management and Budget 

23 categories if such groups can be aggregated into 

24 the minimum race and ethnicity categories; 
285 

•HR 3561 IH 

1 ‘‘(E) develop mechanisms for sharing col2 lected data subject to privacy and confiden3 tiality regulations; 

4 ‘‘(F) develop educational programs to in5 form health insurance issuers, health plans, 

6 health providers, health-related agencies, pa7 tients, enrollees, and the general public that 

8 data collection, analysis, and reporting by race, 

9 ethnicity, and preferred language are legal and 

10 essential for eliminating disparities in health 

11 and healthcare; and 

12 ‘‘(G) develop quality assurance systems de13 signed to track disparities and quality improve14 ment systems designed to eliminate disparities. 

15 ‘‘(k) DEFINITION.—In this section, the term ‘health16 related program’ mean a program— 

17 ‘‘(1) under the Social Security Act (42 U.S.C. 

18 301 et seq.) that pay for healthcare and services; 

19 and 

20 ‘‘(2) under this Act that provide Federal finan21 cial assistance for healthcare, biomedical research, 

22 health services research, and programs designed to 

23 improve the public’s health. 

24 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated to carry out this section, 
286 

•HR 3561 IH 

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

2 2007 through 2012. 

3 ‘‘SEC. 2932. PROVISIONS RELATING TO NATIVE AMERICANS. 

4 ‘‘(a) EPIDEMIOLOGY CENTERS.— 

5 ‘‘(1) ESTABLISHMENT.— 

6 ‘‘(A) IN GENERAL.—In addition to those 

7 centers operating 1 day prior to the date of en8 actment of this title, (including those centers 

9 for which funding is currently being provided 

10 through funding agreements under the Indian 

11 Self-Determination and Education Assistance 

12 Act), the Secretary shall, not later than 180 

13 days after such date of enactment, establish 

14 and fund an epidemiology center in each service 

15 area which does not have such a center to carry 

16 out the functions described in subparagraph 

17 (B). Any centers established under the pre18 ceding sentence may be operated by Indian 

19 tribes or tribal organizations pursuant to fund20 ing agreements under the Indian Self-Deter21 mination and Education Assistance Act, but 

22 funding under such agreements may not be di23 visible. 

24 ‘‘(B) FUNCTIONS.—In consultation with 

25 and upon the request of Indian tribes, tribal or-
287 

•HR 3561 IH 

1 ganizations and urban Indian organizations, 

2 each area epidemiology center established under 

3 this subsection shall, with respect to such area 

4 shall— 

5 ‘‘(i) collect data related to the health 

6 status objective described in section 3(b) of 

7 the Indian Health Care Improvement Act, 

8 and monitor the progress that the Service, 

9 Indian tribes, tribal organizations, and 

10 urban Indian organizations have made in 

11 meeting such health status objective; 

12 ‘‘(ii) evaluate existing delivery sys13 tems, data systems, and other systems that 

14 impact the improvement of Indian health; 

15 ‘‘(iii) assist Indian tribes, tribal orga16 nizations, and urban Indian organizations 

17 in identifying their highest priority health 

18 status objectives and the services needed to 

19 achieve such objectives, based on epidemio20 logical data; 

21 ‘‘(iv) make recommendations for the 

22 targeting of services needed by tribal, 

23 urban, and other Indian communities; 
288 

•HR 3561 IH 

1 ‘‘(v) make recommendations to im2 prove healthcare delivery systems for Indi3 ans and urban Indians; 

4 ‘‘(vi) provide requested technical as5 sistance to Indian tribes and urban Indian 

6 organizations in the development of local 

7 health service priorities and incidence and 

8 prevalence rates of disease and other ill9 ness in the community; and 

10 ‘‘(vii) provide disease surveillance and 

11 assist Indian tribes, tribal organizations, 

12 and urban Indian organizations to promote 

13 public health. 

14 ‘‘(C) TECHNICAL ASSISTANCE.—The direc15 tor of the Centers for Disease Control and Pre16 vention shall provide technical assistance to the 

17 centers in carrying out the requirements of this 

18 subsection. 

19 ‘‘(2) FUNDING.—The Secretary may make 

20 funding available to Indian tribes, tribal organiza21 tions, and eligible intertribal consortia or urban In22 dian organizations to conduct epidemiological studies 

23 of Indian communities. 
289 

•HR 3561 IH 

1 ‘‘(b) DEFINITIONS.—For purposes of this section, the 

2 definitions contained in section 4 of the Indian Health 

3 Care Improvement Act shall apply.’’. 

4 SEC. 502. COLLECTION OF RACE AND ETHNICITY DATA BY 

5 THE SOCIAL SECURITY ADMINISTRATION. 

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

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

8 the following: 

9 ‘‘SEC. 1150A. COLLECTION OF RACE AND ETHNICITY DATA 

10 BY THE SOCIAL SECURITY ADMINISTRATION. 

11 ‘‘(a) REQUIREMENT.—The Commissioner of the So12 cial Security Administration in consultation with the Ad13 ministrator of the Centers for Medicare and Medicaid 

14 Services shall— 

15 ‘‘(1) require the collection of data on the race, 

16 ethnicity, and primary language of all applicants for 

17 social security numbers, social security income, so18 cial security disability, and medicare— 

19 ‘‘(A) using, at a minimum, the categories 

20 for race and ethnicity described in the 1997 Of21 fice of Management and Budget Standards for 

22 Maintaining, Collecting, and Presenting Federal 

23 Data on Race and Ethnicity and available lan24 guage standards; and 
290 

•HR 3561 IH 

1 ‘‘(B) where practicable, collecting data for 

2 additional population groups if such groups can 

3 be aggregated into the minimum race and eth4 nicity categories; 

5 ‘‘(2) with respect to the collection of the data 

6 described in paragraph (1) for applicants who are 

7 under 18 years of age or otherwise legally incapaci8 tated, require that— 

9 ‘‘(A) such data be collected from the par10 ent or legal guardian of such an applicant; and 

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

12 or legal guardian of such an applicant or recipi13 ent be used; 

14 ‘‘(3) require that such data be uniformly ana15 lyzed and reported at least annually to the Commis16 sioner of Social Security; 

17 ‘‘(4) be responsible for storing the data re18 ported under paragraph (3); 

19 ‘‘(5) ensure transmission to the Centers for 

20 Medicare and Medicaid Services and other Federal 

21 health agencies; 

22 ‘‘(6) provide such data to the Secretary on at 

23 least an annual basis; and 

24 ‘‘(7) ensure that the provision of assistance to 

25 an applicant is not denied or otherwise adversely af-
291 

•HR 3561 IH 

1 fected because of the failure of the applicant to pro2 vide race, ethnicity, and primary language data. 

3 ‘‘(b) PROTECTION OF DATA.—The Commissioner of 

4 Social Security shall ensure (through the promulgation of 

5 regulations or otherwise) that all data collected pursuant 

6 subsection (a) is protected— 

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

8 Secretary applies to other health data under the reg9 ulations promulgated under section 264(c) of the 

10 Health Insurance Portability and Accountability Act 

11 of 1996 (Public Law 104–191; 110 Stat. 2033) re12 lating to the privacy of individually identifiable 

13 health information and other protections; and 

14 ‘‘(2) from all inappropriate internal use by any 

15 entity that collects, stores, or receives the data, in16 cluding use of such data in determinations of eligi17 bility (or continued eligibility) in health plans, and 

18 from other inappropriate uses, as defined by the 

19 Secretary. 

20 ‘‘(c) NATIONAL EDUCATION PROGRAM.—Not later 

21 than 18 months after the date of enactment of this sec22 tion, the Secretary, acting through the Director of the Of23 fice of Minority Health and in collaboration with the Com24 missioner of the Social Security Administration, shall de25 velop and implement a program to educate all populations 
292 

•HR 3561 IH 

1 about the purpose and uses of racial, ethnic, and primary 

2 language health data collection. 

3 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec4 tion shall be construed to permit the use of information 

5 collected under this section in a manner that would ad6 versely affect any individual providing any such informa7 tion. 

8 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary may, 

9 either directly or by grant or contract, provide technical 

10 assistance to enable any health entity to comply with the 

11 requirements of this section. 

12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated to carry out this section, 

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

15 2007 through 2012.’’. 

16 SEC. 503. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

19 Human Services shall revise the regulations promulgated 

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

21 U.S.C. 1320d et seq.), as added by the Health Insurance 

22 Portability and Accountability Act of 1996 (Public Law 

23 104–191), relating to the collection of data on race, eth24 nicity, and primary language in a health-related trans25 action to require— 
293 

•HR 3561 IH 

1 (1) the use, at a minimum, of the categories for 

2 race and ethnicity described in the 1997 Office of 

3 Management and Budget Standards for Maintain4 ing, Collecting, and Presenting Federal Data on 

5 Race and Ethnicity; 

6 (2) the establishment of a new data code set for 

7 primary language; and 

8 (3) the designation of the racial, ethnic, and 

9 primary language code sets as ‘‘required’’ for claims 

10 and enrollment data. 

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

12 Human Services shall disseminate the new standards de13 veloped under subsection (a) to all health entities that are 

14 subject to the regulations described in such subsection and 

15 provide technical assistance with respect to the collection 

16 of the data involved. 

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

18 Human Services shall require that health entities comply 

19 with the new standards developed under subsection (a) not 

20 later than 2 years after the final promulgation of such 

21 standards. 

22 SEC. 504. NATIONAL CENTER FOR HEALTH STATISTICS. 

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

24 U.S.C. 242k(n)) is amended— 
294 

•HR 3561 IH 

1 (1) in paragraph (1), by striking ‘‘2005’’ and 

2 inserting ‘‘2012’’; 

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

4 striking ‘‘2005’’ and inserting ‘‘2012’’; and 

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

6 inserting ‘‘2012’’. 

7 SEC. 505. GEO-ACCESS STUDY. 

8 The Administrator of the Substance Abuse and Men9 tal Health Services Administration shall— 

10 (1) conduct a study to— 

11 (A) determine which geographic areas of 

12 the United States have shortages of specialty 

13 mental health providers; and 

14 (B) assess the preparedness of speciality 

15 mental health providers to deliver culturally and 

16 linguistically appropriate services; and 

17 (2) submit a report to the Congress on the re18 sults of such study. 

19 TITLE VI—ACCOUNTABILITY 

20 Subtitle A—General Provisions 

21 SEC. 601. REPORT ON WORKFORCE DIVERSITY. 

22 (a) IN GENERAL.—Not later than July 1, 2007, and 

23 annually thereafter, the Secretary, acting through the di24 rector of each entity within the Department of Health and 

25 Human Services, shall prepare and submit to the Com-
295 

•HR 3561 IH 

1 mittee on Health, Education, Labor, and Pensions of the 

2 Senate and the Committee on Energy and Commerce of 

3 the House of Representatives a report on healthcare work4 force diversity. 

5 (b) REQUIREMENT.—The report under subsection (a) 

6 shall contain the following information: 

7 (1) The response of the entity involved to the 

8 2004 Institute of Medicine report entitled ‘‘In the 

9 Nation’s Compelling Interest: Ensuring Diversity in 

10 the Health Care Workforce’’, the 2002 Institute of 

11 Medicine report entitled ‘‘The Future of the Public 

12 Health in the 21st Century’’, and the Healthy Peo13 ple 2010 initiative. 

14 (2) A description of the personnel in each such 

15 entity who are responsible for overseeing workforce 

16 diversity initiatives. 

17 (3) The level of workforce diversity achieved 

18 within each such entity, including absolute numbers 

19 and percentages of minority employees as well as the 

20 rank of such employees. 

21 (4) A description of any grant support that is 

22 provided by each entity for workforce diversity ini23 tiatives, including the amount of the grants and the 

24 percentage of grant funds as compared to overall en25 tity funding. 
296 

•HR 3561 IH 

1 (c) PUBLIC AVAILABILITY.—The report under sub2 section (a) shall be made available for public review and 

3 comment. 

4 SEC. 602. FEDERAL AGENCY PLAN TO ELIMINATE DISPARI5 TIES AND IMPROVE THE HEALTH OF MINOR6 ITY POPULATIONS. 

7 (a) IN GENERAL.—Not later than September 1, 

8 2007, each Federal health agency shall develop and imple9 ment a national strategic action plan to eliminate dispari10 ties on the basis of race, ethnicity, and primary language 

11 and improve the health and healthcare of minority popu12 lations, through programs relevant to the mission of the 

13 agency. 

14 (b) PUBLICATION.—Each action plan described in 

15 paragraph (1) shall— 

16 (1) be publicly reported in draft form for public 

17 review and comment; 

18 (2) include a response to the review and com19 ment described in paragraph (1) in the final plan; 

20 (3) include the agency response to the 2002 In21 stitute of Medicine report, Unequal Treatment— 

22 Confronting Racial and Ethnic Disparities in 

23 Healthcare; 

24 (4) demonstrate progress in meeting the 

25 Healthy People 2010 objectives; and 
297 

•HR 3561 IH 

1 (5) be updated, including progress reports, for 

2 inclusion in an annual report to Congress. 

3 SEC. 603. ACCOUNTABILITY WITHIN THE DEPARTMENT OF 

4 HEALTH AND HUMAN SERVICES. 

5 Title XXIX of the Public Health Service Act, as 

6 amended by titles II, III, and V of this Act, is further 

7 amended by adding at the end the following: 

8 ‘‘Subtitle D—Strengthening 

9 Accountability 

10 ‘‘SEC. 2941. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

11 ‘‘(a) IN GENERAL.—The Secretary shall establish 

12 within the Office for Civil Rights an Office of Health Dis13 parities, which shall be headed by a director to be ap14 pointed by the Secretary. 

15 ‘‘(b) PURPOSE.—The Office of Health Disparities 

16 shall ensure that the health programs, activities, and oper17 ations of health entities which receive Federal financial as18 sistance are in compliance with title VI of the Civil Rights 

19 Act, which prohibits discrimination on the basis of race, 

20 color, or national origin. The activities of the Office shall 

21 include the following: 

22 ‘‘(1) The development and implementation of 

23 an action plan to address racial and ethnic 

24 healthcare disparities, which shall address concerns 

25 relating to the Office for Civil Rights as released by 
298 

•HR 3561 IH 

1 the United States Commission on Civil Rights in the 

2 report entitled ‘Health Care Challenge: Acknowl3 edging Disparity, Confronting Discrimination, and 

4 Ensuring Equity’ (September, 1999). This plan shall 

5 be publicly disclosed for review and comment and 

6 the final plan shall address any comments or con7 cerns that are received by the Office. 

8 ‘‘(2) Investigative and enforcement actions 

9 against intentional discrimination and policies and 

10 practices that have a disparate impact on minorities. 

11 ‘‘(3) The review of racial, ethnic, and primary 

12 language health data collected by Federal health 

13 agencies to assess healthcare disparities related to 

14 intentional discrimination and policies and practices 

15 that have a disparate impact on minorities. 

16 ‘‘(4) Outreach and education activities relating 

17 to compliance with title VI of the Civil Rights Act. 

18 ‘‘(5) The provision of technical assistance for 

19 health entities to facilitate compliance with title VI 

20 of the Civil Rights Act. 

21 ‘‘(6) Coordination and oversight of activities of 

22 the civil rights compliance offices established under 

23 section 2942. 

24 ‘‘(7) Ensuring compliance with the 1997 Office 

25 of Management and Budget Standards for Maintain-
299 

•HR 3561 IH 

1 ing, Collecting, and Presenting Federal Data on 

2 Race, Ethnicity and the available language stand3 ards. 

4 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en5 sure the effectiveness of the Office of Health Disparities 

6 by ensuring that the Office is provided with— 

7 ‘‘(1) adequate funding to enable the Office to 

8 carry out its duties under this section; and 

9 ‘‘(2) staff with expertise in— 

10 ‘‘(A) epidemiology; 

11 ‘‘(B) statistics; 

12 ‘‘(C) health quality assurance; 

13 ‘‘(D) minority health and health dispari14 ties; and 

15 ‘‘(E) civil rights. 

16 ‘‘(d) REPORT.—Not later than December 31, 2007, 

17 and annually thereafter, the Secretary, in collaboration 

18 with the Director of the Office for Civil Rights, shall sub19 mit a report to the Committee on Health, Education, 

20 Labor, and Pensions of the Senate and the Committee on 

21 Energy and Commerce of the House of Representatives 

22 that includes— 

23 ‘‘(1) the number of cases filed, broken down by 

24 category; 
300 

•HR 3561 IH 

1 ‘‘(2) the number of cases investigated and 

2 closed by the office; 

3 ‘‘(3) the outcomes of cases investigated; and 

4 ‘‘(4) the staffing levels of the office including 

5 staff credentials. 

6 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section, 

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

9 2007 through 2012. 

10 ‘‘SEC. 2942. ESTABLISHMENT OF HEALTH PROGRAM OF11 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

12 HEALTH AND HUMAN SERVICES AGENCIES. 

13 ‘‘(a) IN GENERAL.—The Secretary shall establish 

14 civil rights compliance offices in each agency within the 

15 Department of Health and Human Services that admin16 isters health programs. 

17 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

18 under subsection (a) shall ensure that recipients of Fed19 eral financial assistance under Federal health programs 

20 administer their programs, services, and activities in a 

21 manner that— 

22 ‘‘(1) does not discriminate, either intentionally 

23 or in effect, on the basis of race, national origin, lan24 guage, ethnicity, sex, age, or disability; and 
301 

•HR 3561 IH 

1 ‘‘(2) promotes the reduction and elimination of 

2 disparities in health and healthcare based on race, 

3 national origin, language, ethnicity, sex, age, and 

4 disability. 

5 ‘‘(c) POWERS AND DUTIES.—The offices established 

6 in subsection (a) shall have the following powers and du7 ties: 

8 ‘‘(1) The establishment of compliance and pro9 gram participation standards for recipients of Fed10 eral financial assistance under each program admin11 istered by an agency within the Department of 

12 Health and Human Services including the establish13 ment of disparity reduction standards to encompass 

14 disparities in health and healthcare related to race, 

15 national origin, language, ethnicity, sex, age, and 

16 disability. 

17 ‘‘(2) The development and implementation of 

18 program-specific guidelines that interpret and apply 

19 Department of Health and Human Services guid20 ance under title VI of the Civil Rights Act of 1964 

21 to each Federal health program administered by the 

22 agency. 

23 ‘‘(3) The development of a disparity-reduction 

24 impact analysis methodology that shall be applied to 

25 every rule issued by the agency and published as 
302 

•HR 3561 IH 

1 part of the formal rulemaking process under sections 

2 555, 556, and 557 of title 5, United States Code. 

3 ‘‘(4) Oversight of data collection, analysis, and 

4 publication requirements for all recipients of Federal 

5 financial assistance under each Federal health pro6 gram administered by the agency, and compliance 

7 with the 1997 Office of Management and Budget 

8 Standards for Maintaining, Collecting, and Pre9 senting Federal Data on Race and Ethnicity and the 

10 available language standards. 

11 ‘‘(5) The conduct of publicly available studies 

12 regarding discrimination within Federal health pro13 grams administered by the agency as well as dis14 parity reduction initiatives by recipients of Federal 

15 financial assistance under Federal health programs. 

16 ‘‘(6) Annual reports to the Committee on 

17 Health, Education, Labor, and Pensions and the 

18 Committee on Finance of the Senate and the Com19 mittee on Energy and Commerce and the Committee 

20 on Ways and Means of the House of Representatives 

21 on the progress in reducing disparities in health and 

22 healthcare through the Federal programs adminis23 tered by the agency. 

24 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

25 IN THE DEPARTMENT OF JUSTICE.— 
303 

•HR 3561 IH 

1 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

2 SERVICES.—The Office for Civil Rights in the De3 partment of Health and Human Services shall pro4 vide standard-setting and compliance review inves5 tigation support services to the Civil Rights Compli6 ance Office for each agency. 

7 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

8 for Civil Rights in the Department of Justice shall 

9 continue to maintain the power to institute formal 

10 proceedings when an agency Office for Civil Rights 

11 determines that a recipient of Federal financial as12 sistance is not in compliance with the disparity re13 duction standards of the agency. 

14 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

15 health programs’ mean programs— 

16 ‘‘(1) under the Social Security Act (42 U.S.C. 

17 301 et seq.) that pay for healthcare and services; 

18 and 

19 ‘‘(2) under this Act that provide Federal finan20 cial assistance for healthcare, biomedical research, 

21 health services research, and programs designed to 

22 improve the public’s health.’’. 

23 SEC. 604. OFFICE OF MINORITY HEALTH. 

24 Section 1707 of the Public Health Service Act (42 

25 U.S.C. 300u–6) is amended— 
304 

•HR 3561 IH 

1 (1) by striking the section heading and insert2 ing the following: ‘‘OFFICE OF MINORITY

3 HEALTH AND RACIAL, ETHNIC, AND PRIMARY

4 LANGUAGE HEALTH DISPARITY ELIMINATION’’; 

5 (2) by striking ‘‘Office of Minority Health’’ 

6 each place such term appears and inserting ‘‘Office 

7 of Minority Health and Racial, Ethnic, and Primary 

8 Language Health Disparities Elimination’’; 

9 (3) by striking subsection (b) and inserting the 

10 following: 

11 ‘‘(b) DUTIES.—With respect to improving the health 

12 of racial and ethnic minority groups, the Secretary, acting 

13 through the Deputy Assistant Secretary for Minority 

14 Health and Racial, Ethnic, and Primary Language Health 

15 Disparities Elimination (in this section referred to as the 

16 ‘Deputy Assistant Secretary’), shall carry out the fol17 lowing: 

18 ‘‘(1) Establish, implement, monitor, and evalu19 ate short-range and long-range goals and objectives 

20 and oversee all other activities within the Public 

21 Health Service that relate to disease prevention, 

22 health promotion, service delivery, and research con23 cerning minority groups. The heads of each of the 

24 agencies of the Service shall consult with the Deputy 
305 

•HR 3561 IH 

1 Assistant Secretary to ensure the coordination of 

2 such activities. 

3 ‘‘(2) Oversee all activities within the Depart4 ment of Health and Human Services that relate to 

5 reducing or eliminating disparities in health and 

6 healthcare in racial and ethnic minority populations, 

7 including coordinating— 

8 ‘‘(A) the design of programs, support for 

9 programs, and the evaluation of programs; 

10 ‘‘(B) the monitoring of trends in health 

11 and healthcare; 

12 ‘‘(C) research efforts; 

13 ‘‘(D) the training of health providers; and 

14 ‘‘(E) information and education programs 

15 and campaigns. 

16 ‘‘(3) Enter into interagency and intra-agency 

17 agreements with other agencies of the Public Health 

18 Service. 

19 ‘‘(4) Ensure that the Federal health agencies 

20 and the National Center for Health Statistics collect 

21 data on the health status and healthcare of each mi22 nority group, using at a minimum the categories 

23 specified in the 1997 OMB Standards for Maintain24 ing, Collecting, and Presenting Federal Data on 
306 

•HR 3561 IH 

1 Race and Ethnicity as required under subtitle B and 

2 available language standards. 

3 ‘‘(5) Provide technical assistance to States, 

4 local agencies, territories, Indian tribes, and entities 

5 for activities relating to the elimination of racial and 

6 ethnic disparities in health and healthcare. 

7 ‘‘(6) Support a national minority health re8 source center to carry out the following: 

9 ‘‘(A) Facilitate the exchange of informa10 tion regarding matters relating to health infor11 mation, health promotion and wellness, preven12 tive health services, and education in the appro13 priate use of health services. 

14 ‘‘(B) Facilitate timely access to culturally 

15 and linguistically appropriate information. 

16 ‘‘(C) Assist in the analysis of such infor17 mation. 

18 ‘‘(D) Provide technical assistance with re19 spect to the exchange of such information (in20 cluding facilitating the development of materials 

21 for such technical assistance). 

22 ‘‘(7) Carry out programs to improve access to 

23 healthcare services for individuals with limited 

24 English proficiency, including developing and car25 rying out programs to provide bilingual or interpre-
307 

•HR 3561 IH 

1 tive services through the development and support of 

2 the Robert T. Matsui Center for Cultural and Lin3 guistic Competence in Healthcare as provided for in 

4 section 2903. 

5 ‘‘(8) Carry out programs to improve access to 

6 healthcare services and to improve the quality of 

7 healthcare services for individuals with low func8 tional health literacy. As used in the preceding sen9 tence, the term ‘functional health literacy’ means the 

10 ability to obtain, process, and understand basic 

11 health information and services needed to make ap12 propriate health decisions. 

13 ‘‘(9) Advise in matters related to the develop14 ment, implementation, and evaluation of health pro15 fessions education on decreasing disparities in 

16 healthcare outcomes, with focus on cultural com17 petency as a method of eliminating disparities in 

18 health and healthcare in racial and ethnic minority 

19 populations. 

20 ‘‘(10) Assist healthcare professionals, commu21 nity and advocacy organizations, academic centers 

22 and public health departments in the design and im23 plementation of programs that will improve the qual24 ity of health outcomes by strengthening the pro25 vider-patient relationship.’’. 
308 

•HR 3561 IH 

1 (4) by redesignating subsections (c) through (f) 

2 and subsections (g) and (h) as subsections (d) 

3 through (g) and subsections (j) and (k), respectively; 

4 (5) by inserting after subsection (b), the fol5 lowing: 

6 ‘‘(c) NATIONAL PLAN TO ELIMINATE RACIAL AND

7 ETHNIC HEALTH AND HEALTHCARE DISPARITIES.— 

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

9 through the Deputy Assistant Secretary, shall— 

10 ‘‘(A) not later than 1 year after the date 

11 of enactment of the Healthcare Equality and 

12 Accountability Act, establish and implement a 

13 comprehensive plan to achieve the goal of 

14 Healthy People 2010 to eliminate health dis15 parities in the United States; 

16 ‘‘(B) establish the plan referred to in sub17 paragraph (A) in consultation with— 

18 ‘‘(i) the Director of the Centers for 

19 Disease Control and Prevention; 

20 ‘‘(ii) the Director of the National In21 stitutes of Health; 

22 ‘‘(iii) the Director of the National 

23 Center on Minority Health and Health 

24 Disparities; 
309 

•HR 3561 IH 

1 ‘‘(iv) the Director of the Agency for 

2 Healthcare Research and Quality; 

3 ‘‘(v) the Administrator of the Health 

4 Resources and Services Administration; 

5 ‘‘(vi) the Administrator of the Centers 

6 for Medicare and Medicaid Services; 

7 ‘‘(vii) the Director of the Office for 

8 Civil Rights; 

9 ‘‘(viii) the Administrator of the Sub10 stance Abuse and Mental Health Services 

11 Administration; 

12 ‘‘(ix) the Commissioner of Food and 

13 Drugs; and 

14 ‘‘(x) the heads of other appropriate 

15 public and private entities; 

16 ‘‘(C) ensure that the plan includes measur17 able objectives, describes the means for achiev18 ing such objectives, and designates a date by 

19 which such objectives are expected to be 

20 achieved; 

21 ‘‘(D) ensure that all amounts appropriated 

22 for such activities are expended in accordance 

23 with the plan; 

24 ‘‘(E) review the plan on at least an annual 

25 basis and revise the plan as appropriate; 
310 

•HR 3561 IH 

1 ‘‘(F) ensure that the plan will serve as a 

2 binding statement of policy with respect to the 

3 agencies’ activities related to disparities in 

4 health and healthcare; and 

5 ‘‘(G) not later than March 1 of each year, 

6 submit the plan (or any revisions to the plan), 

7 to the Committee on Health, Education, Labor, 

8 and Pensions of the Senate and the Committee 

9 on Energy and Commerce of the House of Rep10 resentatives. 

11 ‘‘(2) COMPONENTS OF THE PLAN.—The Deputy 

12 Assistant Secretary shall ensure that the comprehen13 sive plan established under paragraph (1) address14 es— 

15 ‘‘(A) the recommendations of the 2002 In16 stitute of Medicine report (Unequal Treatment) 

17 with respect to racial and ethnic disparities in 

18 healthcare; 

19 ‘‘(B) health and disease prevention edu20 cation for racial, ethnic, and primary language 

21 health disparity populations; 

22 ‘‘(C) research to identify sources of health 

23 and healthcare disparities in minority groups; 

24 ‘‘(D) the implementation and assessment 

25 of promising intervention strategies; 
311 

•HR 3561 IH 

1 ‘‘(E) data collection and the monitoring of 

2 the healthcare and health status of health dis3 parity populations; 

4 ‘‘(F) care of individuals who lack pro5 ficiency with the English language; 

6 ‘‘(G) care of individuals with low func7 tional health literacy; 

8 ‘‘(H) the training, recruitment, and reten9 tion of minority health professionals; 

10 ‘‘(I) programs to expand and facilitate ac11 cess to healthcare services, including the use of 

12 telemedicine, National Health Service Scholars, 

13 community health workers, and case managers; 

14 ‘‘(J) public and health provider awareness 

15 of racial and ethnic disparities in healthcare; 

16 ‘‘(K) methods to evaluate and measure 

17 progress toward the goal of eliminating dispari18 ties in health and healthcare in racial and eth19 nic minority populations; 

20 ‘‘(L) the promotion of interagency and 

21 intra-agency coordination and collaboration and 

22 public-private and community partnerships; and 

23 ‘‘(M) the preparedness of health profes24 sionals to care for racially, ethnically, and lin25 guistically diverse populations and low func-
312 

•HR 3561 IH 

1 tional health literacy populations including eval2 uations.’’; 

3 (6) in subsection (d) (as so redesignated)— 

4 (A) in paragraph (1), by inserting ‘‘and 

5 Racial, Ethnic, and Primary Language Health 

6 Disparities Elimination’’ after ‘‘Minority 

7 Health’’; and 

8 (B) in paragraph (2)— 

9 (i) by striking ‘‘Deputy Assistant’’; 

10 and 

11 (ii) by striking ‘‘(10) of subsection 

12 (b)’’ and inserting ‘‘(9) of subsection (c)’’; 

13 (7) in subsection (e)(1) (as so redesignated)— 

14 (A) in subparagraph (A), by striking ‘‘sub15 section (b)(9)’’ and inserting ‘‘subsection 

16 (b)(7)’’; and 

17 (B) in subparagraph (B), by striking ‘‘sub18 section (b)(10)’’ and inserting ‘‘subsection 

19 (b)(8)’’; 

20 (8) in subsection (f)(3) (as so redesignated), by 

21 striking ‘‘subsection (f)’’ and inserting ‘‘subsection 

22 (g)’’; 

23 (9) in subsection (g)(1) (as so redesignated)— 

24 (A) by striking ‘‘1999 and each second’’ 

25 and inserting ‘‘2006 and each’’; 
313 

•HR 3561 IH 

1 (B) by striking ‘‘Labor and Human Re2 sources’’ and inserting ‘‘Health, Education, 

3 Labor, and Pensions’’; 

4 (C) by striking ‘‘2 fiscal years’’ and insert5 ing ‘‘fiscal year’’; and 

6 (D) by inserting after ‘‘improving the 

7 health of racial and ethnic minority groups’’ the 

8 following: ‘‘reducing and eliminating disparities 

9 in health and healthcare in racial and ethnic 

10 minority populations, in accordance with the 

11 national plan specified under subsection (c) and 

12 the goals of Healthy People 2010’’; 

13 (10) by inserting after subsection (g) (as so re14 designated) the following: 

15 ‘‘(h) FEDERAL PARTNERSHIP WITH ACCREDITATION

16 ENTITIES.— 

17 ‘‘(1) IN GENERAL.—Not later than 1 year after 

18 the date of enactment of the Healthcare Equality 

19 and Accountability Act, the Secretary, in collabora20 tion with the Director of the Agency for Healthcare 

21 Research and Quality, the Administrator of the Cen22 ters for Medicare and Medicaid Services, the Direc23 tor of the Office for Minority Health, and the heads 

24 of appropriate State agencies, shall convene a work25 ing group with members of accreditation organiza-
314 

•HR 3561 IH 

1 tions and other quality standard setting organiza2 tions to develop guidelines to evaluate and report on 

3 the health and healthcare of minority populations 

4 served by health centers, health plans, hospitals, and 

5 other federally funded health entities. 

6 ‘‘(2) REPORT.—Not later than 6 months after 

7 the convening of the working group under paragraph 

8 (1), the working group shall submit a report to the 

9 Secretary at such time, in such manner, and con10 taining such information as the Secretary may re11 quire, including guidelines and recommendations on 

12 how each accreditation body will work with con13 stituent members to ensure the adoption of such 

14 guidelines. 

15 ‘‘(3) DEMONSTRATION PROJECTS.—The Sec16 retary, acting through the Administrator of the Cen17 ters for Medicare and Medicaid Services, shall award 

18 grants for the establishment of demonstration 

19 projects to assess the impact of providing financial 

20 incentives for the reporting and analysis of the qual21 ity of minority healthcare by hospitals, health plans, 

22 health centers, and other healthcare entities. 

23 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

24 There are authorized to be appropriated to carry out 
315 

•HR 3561 IH 

1 this subsection, such sums as may be necessary for 

2 each of fiscal years 2007 through 2012. 

3 ‘‘(i) PREPARATION OF HEALTH PROFESSIONALS TO

4 PROVIDE HEALTHCARE TO MINORITY POPULATIONS.— 

5 The Secretary, in collaboration with the Director of the 

6 Bureau of Health Professions and the Director of the Of7 fice of Minority Health, shall require that health profes8 sional schools that receive Federal funds train future 

9 health professionals to provide culturally and linguistically 

10 appropriate healthcare to diverse populations.’’; and 

11 (11) by striking subsection (k) (as so redesig12 nated) and inserting the following: 

13 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—For the 

14 purpose of carrying out this section (other than subsection 

15 (h)), there is authorized to be appropriated $100,000,000 

16 for fiscal year 2006, and such sums as may be necessary 

17 for each of fiscal years 2007 through 2012.’’. 

18 SEC. 605. ESTABLISHMENT OF THE INDIAN HEALTH SERV19 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

20 SERVICE. 

21 (a) ESTABLISHMENT.— 

22 (1) IN GENERAL.—In order to more effectively 

23 and efficiently carry out the responsibilities, authori24 ties, and functions of the United States to provide 

25 healthcare services to Indians and Indian tribes, as 
316 

•HR 3561 IH 

1 are or may be hereafter provided by Federal statute 

2 or treaties, there is established within the Public 

3 Health Service of the Department of Health and 

4 Human Services the Indian Health Service. 

5 (2) ASSISTANT SECRETARY OF INDIAN

6 HEALTH.—The Service shall be administered by an 

7 Assistant Secretary of Indian Health, who shall be 

8 appointed by the President, by and with the advice 

9 and consent of the Senate. The Assistant Secretary 

10 shall report to the Secretary. Effective with respect 

11 to an individual appointed by the President, by and 

12 with the advice and consent of the Senate the term 

13 of service of the Assistant Secretary shall be 4 years. 

14 An Assistant Secretary may serve more than 1 term. 

15 (b) AGENCY.—The Service shall be an agency within 

16 the Public Health Service of the Department, and shall 

17 not be an office, component, or unit of any other agency 

18 of the Department. 

19 (c) FUNCTIONS AND DUTIES.—The Secretary shall 

20 carry out through the Assistant Secretary of the Service— 

21 (1) all functions which were, on the day before 

22 the date of enactment of the Indian Health Care 

23 Amendments of 1988, carried out by or under the 

24 direction of the individual serving as Director of the 

25 Service on such day; 
317 

•HR 3561 IH 

1 (2) all functions of the Secretary relating to the 

2 maintenance and operation of hospital and health fa3 cilities for Indians and the planning for, and provi4 sion and utilization of, health services for Indians; 

5 (3) all health programs under which healthcare 

6 is provided to Indians based upon their status as In7 dians which are administered by the Secretary, in8 cluding programs under— 

9 (A) the Indian Health Care Improvement 

10 Act; 

11 (B) the Act of November 2, 1921 (25 

12 U.S.C. 13); 

13 (C) the Act of August 5, 1954 (42 U.S.C. 

14 2001, et seq.); 

15 (D) the Act of August 16, 1957 (42 

16 U.S.C. 2005 et seq.); 

17 (E) the Indian Self-Determination Act (25 

18 U.S.C. 450f, et seq.); and 

19 (F) title XXIX of the Public Health Serv20 ice Act; and 

21 (4) all scholarship and loan functions carried 

22 out under title I of the Indian Health Care Improve23 ment Act. 

24 (d) AUTHORITY.— 
318 

•HR 3561 IH 

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

2 through the Assistant Secretary, shall have the au3 thority— 

4 (A) except to the extent provided for in 

5 paragraph (2), to appoint and compensate em6 ployees for the Service in accordance with title 

7 5, United States Code; 

8 (B) to enter into contracts for the procure9 ment of goods and services to carry out the 

10 functions of the Service; and 

11 (C) to manage, expend, and obligate all 

12 funds appropriated for the Service. 

13 (2) PERSONNEL ACTIONS.—Notwithstanding 

14 any other provision of law, the provisions of section 

15 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

16 U.S.C. 472), shall apply to all personnel actions 

17 taken with respect to new positions created within 

18 the Service as a result of its establishment under 

19 subsection (a). 

20 (e) RATE OF PAY.— 

21 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

22 title 5, United States Code, is amended by striking 

23 the following: ‘‘Assistant Secretaries of Health and 

24 Human Services (6).’’ and inserting ‘‘Assistant Sec25 retaries of Health and Human Services (7).’’. 
319 

•HR 3561 IH 

1 (2) POSITIONS AT LEVEL V.—Section 5316 of 

2 such title is amended by striking the following: ‘‘Di3 rector, Indian Health Service, Department of Health 

4 and Human Services.’’. 

5 (f) DUTIES OF ASSISTANT SECRETARY FOR INDIAN

6 HEALTH.—Section 601 of the Indian Health Care Im7 provement Act (25 U.S.C. 1661) is amended in subsection 

8 (a)— 

9 (1) by inserting ‘‘(1)’’ after ‘‘(a)’’; 

10 (2) in the second sentence of paragraph (1), as 

11 so designated, by striking ‘‘a Director,’’ and insert12 ing ‘‘the Assistant Secretary for Indian Health,’’; 

13 (3) by striking the third sentence of paragraph 

14 (1), as so designated, and all that follows through 

15 the end of the subsection (a) of such section and in16 serting the following: ‘‘The Assistant Secretary for 

17 Indian Health shall carry out the duties specified in 

18 paragraph (2).’’; and 

19 (4) by adding after paragraph (1) the following: 

20 ‘‘(2) The Assistant Secretary for Indian Health 

21 shall— 

22 ‘‘(A) report directly to the secretary con23 cerning all policy and budget-related matters 

24 affecting Indian health; 
320 

•HR 3561 IH 

1 ‘‘(B) collaborate with the Assistant Sec2 retary for Health concerning appropriate mat3 ters of Indian health that affect the agencies of 

4 the Public Health Service; 

5 ‘‘(C) advise each Assistant Secretary of the 

6 Department of Health and Human Services 

7 concerning matters of Indian health with re8 spect to which that Assistant Secretary has au9 thority and responsibility; 

10 ‘‘(D) advise the heads of other agencies 

11 and programs of the Department of Health and 

12 Human Services concerning matters of Indian 

13 health with respect to which those heads have 

14 authority and responsibility; and 

15 ‘‘(E) coordinate the activities of the De16 partment of Health and Human Services con17 cerning matters of Indian health.’’. 

18 (g) CONTINUED SERVICE BY INCUMBENT.—The indi19 vidual serving in the position of Director of the Indian 

20 Health Service on the date preceding the date of enact21 ment of this Act may serve as Assistant Secretary for In22 dian Health, at the pleasure of the President after the 

23 date of enactment of this Act. 

24 (h) CONFORMING AMENDMENTS.— 
321 

•HR 3561 IH 

1 (1) AMENDMENTS TO INDIAN HEALTH CARE IM2 PROVEMENT ACT.—The Indian Health Care Im3 provement Act (25 U.S.C. 1601 et seq.) is amend4 ed— 

5 (A) in section 601— 

6 (i) in subsection (c), by striking ‘‘Di7 rector of the Indian Health Service’’ both 

8 places it appears and inserting ‘‘Assistant 

9 Secretary for Indian Health’’; and 

10 (ii) in subsection (d), by striking ‘‘Di11 rector of the Indian Health Service’’ and 

12 inserting ‘‘Assistant Secretary for Indian 

13 Health’’; and 

14 (B) in section 816(c)(1), by striking ‘‘Di15 rector of the Indian Health Service’’ and insert16 ing ‘‘Assistant Secretary for Indian Health’’. 

17 (2) AMENDMENTS TO OTHER PROVISIONS OF

18 LAW.—The following provisions are each amended 

19 by striking ‘‘Director of the Indian Health Service’’ 

20 each place it appears and inserting ‘‘Assistant Sec21 retary for Indian Health’’: 

22 (A) Section 203(a)(1) of the Rehabilitation 

23 Act of 1973 (29 U.S.C. 761b(a)(1)). 
322 

•HR 3561 IH 

1 (B) Subsections (b) and (e) of section 518 

2 of the Federal Water Pollution Control Act (33 

3 U.S.C. 1377 (b) and (e)). 

4 (C) Section 803B(d)(1) of the Native 

5 American Programs Act of 1974 (42 U.S.C. 

6 2991b–2(d)(1)). 

7 (i) REFERENCES.—Reference in any other Federal 

8 law, Executive order, rule, regulation, or delegation of au9 thority, or any document of or relating to the Director 

10 of the Indian Health Service shall be deemed to refer to 

11 the Assistant Secretary for Indian Health. 

12 (j) DEFINITIONS.—For purposes of this section, the 

13 definitions contained in section 4 of the Indian Health 

14 Care Improvement Act shall apply. 

15 SEC. 606. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI16 NORITY HEALTH WITHIN AGENCIES OF PUB17 LIC HEALTH SERVICE. 

18 Title XVII of the Public Health Service Act (42 

19 U.S.C. 300u et seq.) is amended by inserting after section 

20 1707 the following section: 

21 ‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN

22 PUBLIC HEALTH SERVICE

23 ‘‘SEC. 1707A. (a) IN GENERAL.—The head of each 

24 agency specified in subsection (b)(1) shall establish within 

25 the agency an office to be known as the Office of Minority 

26 Health and Racial, Ethnic, and Primary Language Health 
323 

•HR 3561 IH 

1 Disparities Elimination. Each such Office shall be headed 

2 by a director, who shall be appointed by the head of the 

3 agency within which the Office is established, and who 

4 shall report directly to the head of the agency. The head 

5 of such agency shall carry out this section (as this section 

6 relates to the agency) acting through such Director. 

7 ‘‘(b) SPECIFIED AGENCIES.— 

8 ‘‘(1) IN GENERAL.—The agencies referred to in 

9 subsection (a) are the following: 

10 ‘‘(A) The Centers for Disease Control and 

11 Prevention. 

12 ‘‘(B) The Health Resources and Services 

13 Administration. 

14 ‘‘(C) The Substance Abuse and Mental 

15 Health Services Administration; and 

16 ‘‘(D) The Administration on Aging. 

17 ‘‘(c) COMPOSITION.—The head of each specified 

18 agency shall ensure that the officers and employees of the 

19 minority health office of the agency are, collectively, expe20 rienced in carrying out community-based health programs 

21 for each of the various racial and ethnic minority groups 

22 that are present in significant numbers in the United 

23 States. 

24 ‘‘(d) DUTIES.—Each Director of a minority health of25 fice shall establish and monitor the programs of the speci-
324 

•HR 3561 IH 

1 fied agency of such office in order to carry out the fol2 lowing: 

3 ‘‘(1) Determine the extent to which the pur4 poses of the programs are being carried out with re5 spect to racial and ethnic minority groups; 

6 ‘‘(2) Determine the extent to which members of 

7 such groups are represented among the Federal offi8 cers and employees who administer the programs; 

9 and 

10 ‘‘(3) Make recommendations to the head of 

11 such agency on carrying out the programs with re12 spect to such groups. In the case of programs that 

13 provide services, such recommendations shall include 

14 recommendations toward ensuring that— 

15 ‘‘(A) the services are equitably delivered 

16 with respect to racial and ethnic minority 

17 groups; 

18 ‘‘(B) the programs provide the services in 

19 the language and cultural context that is most 

20 appropriate for the individuals for whom the 

21 services are intended; and 

22 ‘‘(C) the programs utilize racial and ethnic 

23 minority community-based organizations to de24 liver services. 
325 

•HR 3561 IH 

1 ‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head 

2 of each specified agency shall submit to the Secretary for 

3 inclusion in each biennial report describing— 

4 ‘‘(1) the extent to which the minority health of5 fice of the agency employs individuals who are mem6 bers of racial and ethnic minority groups, including 

7 a specification by minority group of the number of 

8 such individuals employed by such office. 

9 ‘‘(f) FUNDING.— 

10 ‘‘(1) ALLOCATIONS.—Of the amounts appro11 priated for a specified agency for a fiscal year, the 

12 Secretary must designate an appropriate amount of 

13 funds for the purpose of carrying out activities 

14 under this section through the minority health office 

15 of the agency. In reserving an amount under the 

16 preceding sentence for a minority health office for a 

17 fiscal year, the Secretary shall reduce, by substan18 tially the same percentage, the amount that other19 wise would be available for each of the programs of 

20 the designated agency involved. 

21 ‘‘(2) AVAILABILITY OF FUNDS FOR STAFF22 ING.—The purposes for which amounts made avail23 able under paragraph may be expended by a minor24 ity health office include the costs of employing staff 

25 for such office.’’. 
326 

•HR 3561 IH 

1 SEC. 607. OFFICE OF MINORITY HEALTH AT THE CENTERS 

2 FOR MEDICARE AND MEDICAID SERVICES. 

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

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

5 Human Services shall establish within the Centers for 

6 Medicare and Medicaid Services an Office of Minority 

7 Health (referred to in this section as the ‘‘Office’’). 

8 (b) DUTIES.—The Office shall be responsible for the 

9 coordination and facilitation of activities of the Centers 

10 for Medicare and Medicaid Services to improve minority 

11 health and healthcare and to reduce racial and ethnic dis12 parities in health and healthcare, which shall include— 

13 (1) creating a strategic plan, which shall be 

14 made available for public review, to improve the 

15 health and healthcare of Medicare, Medicaid, and 

16 SCHIP beneficiaries; 

17 (2) promoting agency-wide policies relating to 

18 healthcare delivery and financing that could have a 

19 beneficial impact on the health and healthcare of mi20 nority populations; 

21 (3) assisting health plans, hospitals, and other 

22 health entities in providing culturally and linguis23 tically appropriate healthcare services; 

24 (4) increasing awareness and outreach activities 

25 for minority healthcare consumers and providers 
327 

•HR 3561 IH 

1 about the causes and remedies for health and 

2 healthcare disparities; 

3 (5) developing grant programs and demonstra4 tion projects to identify, implement and evaluate in5 novative approaches to improving the health and 

6 healthcare of minority beneficiaries in the Medicare, 

7 Medicaid, and SCHIP programs; 

8 (6) considering incentive programs relating to 

9 reimbursement that would reward health entities for 

10 providing quality healthcare for minority populations 

11 using established benchmarks for quality of care; 

12 (7) collaborating with the compliance office to 

13 ensure compliance with the anti-discrimination provi14 sions under title VI of the Civil Rights Act of 1964; 

15 (8) identifying barriers to enrollment in public 

16 programs under the jurisdiction of the Centers for 

17 Medicare and Medicaid Services; 

18 (9) monitoring and evaluating on a regular 

19 basis the success of minority health programs and 

20 initiatives; 

21 (10) publishing an annual report about the ac22 tivities of the Centers for Medicare and Medicaid 

23 Services relating to minority health improvement; 

24 and 
328 

•HR 3561 IH 

1 (11) other activities determined appropriate by 

2 the Secretary of Health and Human Services. 

3 (c) STAFF.—The staff at the Office shall include— 

4 (1) one or more individuals with expertise in 

5 minority health and racial and ethnic health dispari6 ties; and 

7 (2) one or more individuals with expertise in 

8 healthcare financing and delivery in underserved 

9 communities. 

10 (d) COORDINATION.—In carrying out its duties under 

11 this section, the Office shall coordinate with— 

12 (1) the Office of Minority Health in the Office 

13 of the Secretary of Health and Human Services; 

14 (2) the National Centers for Minority Health 

15 and Health Disparities in the National Institutes of 

16 Health; and 

17 (3) the Office of Minority Health in the Centers 

18 for Disease Control and Prevention. 

19 (e) AUTHORIZATION OF APPROPRIATIONS.—For the 

20 purpose of carrying out this section, there are authorized 

21 to be appropriated $10,000,000 for fiscal year 2006, and 

22 such sums may be necessary for each of fiscal years 2007 

23 through 2012. 
329 

•HR 3561 IH 

1 SEC. 608. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND 

2 DRUG ADMINISTRATION. 

3 Chapter IX of the Federal Food, Drug, and Cosmetic 

4 Act (21 U.S.C. 391 et seq.) is amended by adding at the 

5 end the following: 

6 ‘‘SEC. 908. OFFICE OF MINORITY AFFAIRS. 

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

8 date of enactment of this section, the Secretary shall es9 tablish within the Office of the Commissioner of Food and 

10 Drugs an Office of Minority Affairs (referred to in this 

11 section as the ‘Office’). 

12 ‘‘(b) DUTIES.—The Office shall be responsible for the 

13 coordination and facilitation of activities of the Food and 

14 Drug Administration to improve minority health and 

15 healthcare and to reduce racial and ethnic disparities in 

16 health and healthcare, which shall include— 

17 ‘‘(1) promoting policies in the development and 

18 review of medical products that reduce racial and 

19 ethnic disparities in health and healthcare; 

20 ‘‘(2) encouraging appropriate data collection, 

21 analysis, and dissemination of racial and ethnic dif22 ferences using, at a minimum, the categories de23 scribed in the 1997 Office of Management and 

24 Budget standards, in response to different therapies 

25 in both adult and pediatric populations; 
330 

•HR 3561 IH 

1 ‘‘(3) providing, in coordination with other ap2 propriate government agencies, education, training, 

3 and support to increase participation of minority pa4 tients and physicians in clinical trials; 

5 ‘‘(4) collecting and analyzing data using, at a 

6 minimum, the categories described in the 1997 Of7 fice of Management and Budget standards, on the 

8 number of participants from minority racial and eth9 nic backgrounds in clinical trials used to support 

10 medical product approvals; 

11 ‘‘(5) the identification of methods to reduce lan12 guage and literacy barriers; and 

13 ‘‘(6) publishing an annual report about the ac14 tivities of the Food and Drug Administration per15 taining to minority health. 

16 ‘‘(c) STAFF.—The staff of the Office shall include— 

17 ‘‘(1) one or more individuals with expertise in 

18 the design and conduct of clinical trials of drugs, bi19 ological products, and medical devices; and 

20 ‘‘(2) one or more individuals with expertise in 

21 therapeutic classes or disease states for which med22 ical evidence suggests a difference based on race or 

23 ethnicity. 

24 ‘‘(d) COORDINATION.—In carrying out its duties 

25 under this section, the Office shall coordinate with— 
331 

•HR 3561 IH 

1 ‘‘(1) the Office of Minority Health in the Office 

2 of the Secretary of Health and Human Services; 

3 ‘‘(2) the National Center for Minority Health 

4 and Health Disparities in the National Institutes of 

5 Health; and 

6 ‘‘(3) the Office of Minority Health in the Cen7 ters for Disease Control and Prevention. 

8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 

9 purpose of carrying out this section, there are authorized 

10 to be appropriated such sums as may be necessary for 

11 each of the fiscal years 2007 through 2012.’’. 

12 SEC. 609. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

13 RESPECT TO RACIAL AND ETHNIC BACK14 GROUND. 

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

16 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend17 ed by adding after section 505B the following: 

18 ‘‘SEC. 505C. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

19 RESPECT TO RACIAL AND ETHNIC BACK20 GROUND. 

21 ‘‘(a) PRE-APPROVAL STUDIES.—If there is evidence 

22 that there may be a disparity on the basis of racial or 

23 ethnic background as to the safety or effectiveness of a 

24 drug, then— 
332 

•HR 3561 IH 

1 ‘‘(1)(A) the investigations required under sec2 tion 505(b)(1)(A) shall include adequate and well3 controlled investigations of the disparity; or 

4 ‘‘(B) the evidence required under section 351(a) 

5 of the Public Health Service Act for approval of a 

6 biologics license application for the drug shall in7 clude adequate and well-controlled investigations of 

8 the disparity; and 

9 ‘‘(2) if the investigations confirm that there is 

10 a disparity, the labeling of the drug shall include ap11 propriate information about the disparity. 

12 ‘‘(b) POST-MARKET STUDIES.— 

13 ‘‘(1) IN GENERAL.—If there is evidence that 

14 there may be a disparity on the basis of racial or 

15 ethnic background as to the safety or effectiveness 

16 of a drug for which there is an approved application 

17 under section 505 or a license under section 351 of 

18 the Public Health Service Act, the Secretary may by 

19 order require the holder of the approved application 

20 or license to conduct, by a date specified by the Sec21 retary, post-marketing studies to investigate the dis22 parity. 

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

24 that the post-market studies confirm that there is a 

25 disparity described in paragraph (1), the labeling of 
333 

•HR 3561 IH 

1 the drug shall include appropriate information about 

2 the disparity. 

3 ‘‘(3) STUDY DESIGN.—The Secretary may 

4 specify all aspects of study design, including the 

5 number of studies and study participants, in the 

6 order requiring post-market studies of the drug. 

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

8 Secretary may by order modify any aspect of the 

9 study design as necessary after issuing an order 

10 under paragraph (1). 

11 ‘‘(5) STUDY RESULTS.—The results from stud12 ies required under paragraph (1) shall be submitted 

13 to the Secretary as supplements to the drug applica14 tion or biological license application. 

15 ‘‘(c) DISPARITY.—The term ‘evidence that there may 

16 be a disparity on the basis of racial or ethnic background 

17 for adult and pediatric populations as to the safety or ef18 fectiveness of a drug’ includes— 

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

20 basis of racial or ethnic background as to safety or 

21 effectiveness of a drug in the same chemical class as 

22 the drug; 

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

24 basis of racial or ethnic background in the way the 

25 drug is metabolized; and 
334 

•HR 3561 IH 

1 ‘‘(3) other evidence as the Secretary may deter2 mine. 

3 ‘‘(d) APPLICATIONS UNDER SECTION 505(b)(2) AND

4 505(J).— 

5 ‘‘(1) IN GENERAL.—A drug for which an appli6 cation has been submitted or approved under section 

7 505(j) shall not be considered ineligible for approval 

8 under that section or misbranded under section 502 

9 on the basis that the labeling of the drug omits in10 formation relating to a disparity on the basis of ra11 cial or ethnic background as to the safety or effec12 tiveness of the drug, whether derived from investiga13 tions or studies required under this section or de14 rived from other sources, when the omitted informa15 tion is protected by patent or by exclusivity under 

16 clause (iii) or (iv) of section 505(j)(5)(D). 

17 ‘‘(2) LABELING.—Notwithstanding clauses (iii) 

18 and (iv) of section 505(j)(5)(D), the Secretary may 

19 require that the labeling of a drug approved under 

20 section 505(j) that omits information relating to a 

21 disparity on the basis of racial or ethnic background 

22 as to the safety or effectiveness of the drug include 

23 a statement of any appropriate contraindications, 

24 warnings, or precautions related to the disparity 

25 that the Secretary considers necessary.’’. 
335 

•HR 3561 IH 

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

2 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend3 ed by adding at the end the following: 

4 ‘‘(w)(1) If it is a drug and the holder of the approved 

5 application under section 505 or license under section 351 

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

7 to complete the investigations or studies, or comply with 

8 any other requirement, of section 505C.’’. 

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

10 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379h) 

11 is amended by adding after ‘‘required’’ the following: ‘‘, 

12 including supplements required under section 505C of the 

13 Act’’. 

14 SEC. 610. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

15 (a) COORDINATION WITHIN DEPARTMENT OF JUS16 TICE OF ACTIVITIES REGARDING HEALTH DISPARI17 TIES.—Section 3 of the Civil Rights Commission Act of 

18 1983 (42 U.S.C. 1975a) is amended— 

19 (1) in paragraph (1)(B), by striking ‘‘and’’ at 

20 the end; 

21 (2) in paragraph (2), in the matter after and 

22 below subparagraph (D), by striking the period and 

23 inserting ‘‘; and’’; and 

24 (3) by adding at the end the following: 
336 

•HR 3561 IH 

1 ‘‘(3) shall, with respect to activities carried out 

2 in healthcare and correctional facilities toward the 

3 goal of eliminating health disparities between the 

4 general population and members of racial or ethnic 

5 minority groups, coordinate such activities of— 

6 ‘‘(A) the Office for Civil Rights within the 

7 Department of Justice; 

8 ‘‘(B) the Office of Justice Programs within 

9 the Department of Justice; 

10 ‘‘(C) the Office for Civil Rights within the 

11 Department of Health and Human Services; 

12 and 

13 ‘‘(D) the Office of Minority Health within 

14 the Department of Health and Human Services 

15 (headed by the Deputy Assistant Secretary for 

16 Minority Health).’’. 

17 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

18 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

19 1975c) is amended by striking the first sentence and in20 serting the following: ‘‘For the purpose of carrying out 

21 this Act, there are authorized to be appropriated 

22 $30,000,000 for fiscal year 2007, and such sums as may 

23 be necessary for each of the fiscal years 2008 through 

24 2012.’’. 
337 

•HR 3561 IH 

1 SEC. 610A. SENSE OF CONGRESS CONCERNING FULL FUND2 ING OF ACTIVITIES TO ELIMINATE RACIAL 

3 AND ETHNIC HEALTH DISPARITIES. 

4 (a) FINDINGS.—Congress makes the following find5 ings: 

6 (1) The health status of the American populace 

7 is declining and the United States currently ranks 

8 below most industrialized nations in health status 

9 measured by longevity, sickness, and mortality. 

10 (2) Racial and ethnic minority populations tend 

11 have the poorest health status and face substantial 

12 cultural, social, and economic barriers to obtaining 

13 quality healthcare. 

14 (3) Efforts to improve minority health have 

15 been limited by inadequate resources (funding, staff16 ing, and stewardship) and accountability. 

17 (b) SENSE OF CONGRESS.—It is the sense of Con18 gress that— 

19 (1) funding should be doubled by fiscal year 

20 2007 for the National Center for Minority Health 

21 Disparities, the Office of Civil Rights in the Depart22 ment of Health and Human Services, the National 

23 Institute of Nursing Research, and the Office of Mi24 nority Health; 

25 (2) adequate funding by fiscal year 2007, and 

26 subsequent funding increases, should be provided for 
338 

•HR 3561 IH 

1 health professions training programs, the Racial and 

2 Ethnic Approaches to Community Health (REACH) 

3 at the Center for Disease Control and Prevention, 

4 the Minority HIV/AIDS Initiative, and the Excel5 lence Centers to Eliminate Ethnic/Racial Disparities 

6 (EXCEED) Program at the Agency for Healthcare 

7 Research and Quality; 

8 (3) current and newly-created health disparity 

9 elimination incentives, programs, agencies, and de10 partments under this Act (and the amendments 

11 made by this Act) should receive adequate staffing 

12 and funding by fiscal year 2007; and 

13 (4) stewardship and accountability should be 

14 provided by Congress and the President for health 

15 disparity elimination. 

16 Subtitle B—Minority Health and 

17 Genomics Commission 

18 SEC. 611. SHORT TITLE. 

19 This subtitle may be cited as the ‘‘Minority Health 

20 and Genomics Act of 2005’’. 

21 SEC. 612. MINORITY HEALTH AND GENOMICS COMMISSION. 

22 (a) ESTABLISHMENT.—There is established a com23 mission to be known as the Minority Health and Genomics 

24 Commission (in this subtitle referred to as the ‘‘Commis25 sion’’). 
339 

•HR 3561 IH 

1 (b) DUTIES.— 

2 (1) STUDY.—The Commission shall conduct a 

3 thorough study of, and develop recommendations on, 

4 issues relating to genomic research as applied to mi5 nority groups and, under section 516, submit a re6 port to the appropriate committees of Congress that 

7 recommends policies that the Commission finds will 

8 ultimately improve healthcare and promote the elimi9 nation of health disparities. 

10 (2) ISSUES.—The study under paragraph (1) 

11 shall address specific issues and the needs of each 

12 minority group described in subparagraph (A) in ad13 dition to issues involving genomic research that af14 fect the groups as a whole. In conducting such study 

15 the Commission shall carry out the following: 

16 (A) Establish standards in genomic re17 search and services that will promote the im18 provement of health and health-related services 

19 for the following groups: American Indians and 

20 Alaska Natives, African Americans, Asian 

21 Americans, Hispanics, and Native Hawaiians 

22 and other Pacific Islanders. 

23 (B) Recommend minimum requirements 

24 and standards for the equitable use of genetics 
340 

•HR 3561 IH 

1 research in patient care and public health serv2 ices for racial and ethnic minority patients. 

3 (C) Examine the accessibility, effective4 ness, availability, and cost efficiency of genomic 

5 research, genetic testing, genetic counseling, 

6 and genetic screening to minority populations. 

7 (D) Determine and recommend procedures 

8 and policies to address the need for cultural, 

9 linguistic, and religious sensitivity training for 

10 genetic counselors and researchers who work 

11 with minority groups. 

12 (E) Evaluate whether minority persons are 

13 provided with informed consent that is cul14 turally and linguistically appropriate to allow a 

15 fully informed decision about their healthcare, 

16 availability of treatments or options, or partici17 pation in any clinical trial involving the collec18 tion of genetic material. 

19 (F) Recommend how population sampling 

20 studies of genetic information can be improved 

21 to aid in the elimination of health disparities 

22 and improve healthcare for minority commu23 nities. 

24 (G) Examine how genetic material or in25 formation derived from individual minorities is 
341 

•HR 3561 IH 

1 used the help minority groups with the use of 

2 highly specific drug therapies. 

3 (H) Identify the accessibility, effectiveness, 

4 availability, privacy, and benefit of genetic data5 bases and depositories to minority communities. 

6 (I) Identify the accessibility, effectiveness, 

7 and affordability of reproductive technologies to 

8 minority groups. 

9 (J) Recommend an incentives program for 

10 genomic researchers that will encourage the 

11 study of disease and genetic ailments that dis12 proportionately affect minority communities. 

13 SEC. 613. REPORT. 

14 Not later than 2 years after the date of the enact15 ment of this Act, the Commission shall prepare and sub16 mit to the appropriate committees of Congress, the Presi17 dent, and the general public a report containing a detailed 

18 statement of the findings and conclusions of the Commis19 sion with respect to matters described in section 

20 512(b)(2), together with such recommendations as the 

21 Commission considers appropriate that may be specific to 

22 each minority group. 
342 

•HR 3561 IH 

1 SEC. 614. MEMBERSHIP. 

2 (a) NUMBER AND APPOINTMENT.—The Commission 

3 shall be composed of 17 members to be appointed as fol4 lows: 

5 (1) Four members shall be appointed by the 

6 Speaker of the House of Representatives. 

7 (2) Four members shall be appointed by the mi8 nority leader of the House of Representatives. 

9 (3) Four members shall be appointed by the 

10 majority leader of the Senate. 

11 (4) Four members shall be appointed by the mi12 nority leader of the Senate. 

13 (5) One member shall be appointed by the 

14 President. 

15 (b) PERSONS ELIGIBLE.— 

16 (1) IN GENERAL.—The members of the Com17 mission shall be individuals who have knowledge or 

18 expertise, whether by experience or training, in mat19 ters to be studied by the Commission. The members 

20 may be from the public or private sector, and may 

21 include employees of the Federal Government or of 

22 State, territory, tribal, or local governments, mem23 bers of academia, legal scholars and practitioners, 

24 tribal leaders, representatives of nonprofit organiza25 tions, or other interested individuals who dem26 onstrate a dedication to the use of genomics to im-
343 

•HR 3561 IH 

1 prove minority healthcare and the elimination of 

2 health disparities among minorities. 

3 (2) DIVERSITY.—It is the intent of Congress 

4 that individuals appointed to the Commission rep5 resent diverse interests, ethnicities, various profes6 sional backgrounds, and are from different regions 

7 of the United States. 

8 (c) CONSULTATION AND APPOINTMENT.— 

9 (1) IN GENERAL.—The President, Speaker of 

10 the House of Representatives, minority leader of the 

11 House of Representatives, majority leader of the 

12 Senate, and minority leader of the Senate shall con13 sult among themselves before appointing the mem14 bers of the Commission in order to achieve, to the 

15 maximum extent practicable, fair and equitable rep16 resentation of various points of view with respect to 

17 matters studied by the Commission. 

18 (2) DATE OF APPOINTMENT.—The appoint19 ments of the members of the Commission shall be 

20 made not later than 90 days after the date of enact21 ment of this Act. 

22 (d) TERMS.— 

23 (1) IN GENERAL.—Each member of the Com24 mission shall be appointed for the life of the Com25 mission. 
344 

•HR 3561 IH 

1 (2) VACANCIES.—A vacancy in the Commission 

2 shall be filled in the manner in which the original 

3 appointment was made. 

4 (e) BASIC PAY.—Members of the Commission shall 

5 serve without pay. 

6 (f) TRAVEL EXPENSES.—Each member of the Com7 mission shall receive travel expenses, including per diem 

8 in lieu of subsistence, in accordance with applicable provi9 sions under subchapter I of chapter 57 of title 5, United 

10 States Code. 

11 (g) CHAIRPERSON AND VICE CHAIRPERSON.—The 

12 members of the Commission shall elect a Chairperson and 

13 Vice Chairperson of the Commission from among the 

14 members. 

15 (h) MEETINGS.— 

16 (1) IN GENERAL.—The Commission shall meet 

17 at the call of the Chairperson or a majority of its 

18 members. 

19 (2) INITIAL MEETING.—Not later than 30 days 

20 after the date on which all members of the Commis21 sion have been appointed, the Commission shall hold 

22 its first meeting. 

23 SEC. 615. POWERS OF COMMISSION. 

24 (a) HEARINGS AND SESSIONS.—The Commission 

25 may, for the purpose of carrying out this subtitle, hold 
345 

•HR 3561 IH 

1 hearings, sit and act at times and places, take testimony, 

2 and receive evidence as the Commission considers appro3 priate to carry out this subtitle. 

4 (b) POWERS OF MEMBERS AND AGENTS.—Any mem5 ber or agent of the Commission may, if authorized by the 

6 Commission, take any action that the Commission is au7 thorized to take by this section. 

8 (c) OBTAINING OFFICIAL DATA.—Notwithstanding 

9 sections 552 and 552a of title 5, United States Code, the 

10 Commission may secure directly from any department or 

11 agency of the United States information necessary to en12 able it to carry out this subtitle. Upon request of the Com13 mission, the head of that department or agency shall fur14 nish that information to the Commission. 

15 (d) POSTAL SERVICES.—The Commission may use 

16 the United States mails in the same manner and under 

17 the same conditions as other departments and agencies of 

18 the United States. 

19 (e) WEBSITE.—For purposes of conducting the study 

20 under section 512(b)(1), the Commission shall establish 

21 and maintain a website to facilitate public comment and 

22 participation. 

23 (f) STAFF OF FEDERAL AGENCIES.—Upon request 

24 of the Commission, the head of any Federal department 

25 or agency may detail, on a nonreimbursable basis, any of 
346 

•HR 3561 IH 

1 the personnel of that department or agency to the Com2 mission to assist it in carrying out its duties under this 

3 subtitle. 

4 (g) ADMINISTRATIVE SUPPORT SERVICES.—Upon 

5 the request of the Commission, the Administrator of Gen6 eral Services may provide to the Commission, on a non7 reimbursable basis, the administrative support services 

8 necessary for the Commission to carry out its responsibil9 ities under this subtitle. 

10 SEC. 616. TERMINATION. 

11 The Commission shall terminate 1 year after submit12 ting its final report pursuant to section 513. 

13 Subtitle C—Improving 

14 Environmental Justice 

15 SEC. 621. DEFINITIONS. 

16 For purposes of this subtitle: 

17 (1) ENVIRONMENTAL JUSTICE.— 

18 (A) IN GENERAL.—The term ‘‘environ19 mental justice’’ means the fair treatment of 

20 people of all races, cultures, and socioeconomic 

21 groups with respect to the development, adop22 tion, implementation, and enforcement of laws, 

23 regulations, and policies affecting the environ24 ment. 
347 

•HR 3561 IH 

1 (B) FAIR TREATMENT.—The term ‘‘fair 

2 treatment’’ means policies and practices that 

3 will minimize the likelihood that a minority, 

4 low-income, or Native American community will 

5 bear a disproportionate share of the adverse en6 vironmental consequences, or be denied reason7 able access to the environmental benefits, re8 sulting from implementation of a Federal pro9 gram or policy. 

10 (2) FEDERAL AGENCY.—The term ‘‘Federal 

11 agency’’ means— 

12 (A) each Federal entity represented on the 

13 Working Group; 

14 (B) any other entity that conducts any 

15 Federal program or activity that substantially 

16 affects human health or the environment; and 

17 (C) each Federal agency that implements 

18 any program, policy, or activity applicable to 

19 Native Americans. 

20 (3) WORKING GROUP.—The term ‘‘Working 

21 Group’’ means the interagency working group estab22 lished by section 413. 

23 (4) ADVISORY COMMITTEE.—The term ‘‘the Ad24 visory Committee’’ means the advisory committee es25 tablished by section 415. 
348 

•HR 3561 IH 

1 SEC. 622. ENVIRONMENTAL JUSTICE RESPONSIBILITIES OF 

2 FEDERAL AGENCIES. 

3 (a) ENVIRONMENTAL JUSTICE MISSION.—To the 

4 greatest extent practicable, the head of each Federal agen5 cy shall make achieving environmental justice part of its 

6 mission by identifying and addressing, as appropriate, dis7 proportionately high and adverse human health or envi8 ronmental effects of its programs, policies, and activities 

9 on minority and low-income populations in the United 

10 States and its territories and possessions, including the 

11 District of Columbia, the Commonwealth of Puerto Rico, 

12 Virgin Islands, Guam, and the Commonwealth of the Mar13 iana Islands. 

14 (b) NONDISCRIMINATION.—Each Federal agency 

15 shall conduct its programs, policies, and activities in a 

16 manner that ensures that such programs, policies, and ac17 tivities do not have the effect of excluding any person or 

18 group from participation in, denying any person or group 

19 the benefits of, or subjecting any person or group to dis20 crimination under, such programs, policies, and activities, 

21 because of race, color, national origin, or income. 

22 SEC. 623. INTERAGENCY ENVIRONMENTAL JUSTICE WORK23 ING GROUP. 

24 (a) CREATION AND COMPOSITION.—There is hereby 

25 established the Interagency Working Group on Environ-
349 

•HR 3561 IH 

1 mental Justice, comprising the heads of the following exec2 utive agencies and offices, or their designees: 

3 (1) The Department of Defense. 

4 (2) The Department of Health and Human 

5 Services. 

6 (3) The Department of Housing and Urban De7 velopment. 

8 (4) The Department of Homeland Security. 

9 (5) The Department of Labor. 

10 (6) The Department of Agriculture. 

11 (7) The Department of Transportation. 

12 (8) The Department of Justice; 

13 (9) The Department of the Interior. 

14 (10) The Department of Commerce. 

15 (11) The Department of Energy. 

16 (12) The Environmental Protection Agency. 

17 (13) The Office of Management and Budget. 

18 (14) Any other official of the United States 

19 that the President may designate. 

20 (b) FUNCTIONS.—The Working Group shall— 

21 (1) provide guidance to Federal agencies on cri22 teria for identifying disproportionately high and ad23 verse human health or environmental effects on mi24 nority, low-income, and Native American popu25 lations; 
350 

•HR 3561 IH 

1 (2) coordinate with, provide guidance to, and 

2 serve as a clearinghouse for, each Federal agency as 

3 it develops or revises an environmental justice strat4 egy as required by this subtitle, in order to ensure 

5 that the administration, interpretation and enforce6 ment of programs, activities, and policies are under7 taken in a consistent manner; 

8 (3) assist in coordinating research by, and stim9 ulating cooperation among, the Environmental Pro10 tection Agency, the Department of Health and 

11 Human Services, the Department of Housing and 

12 Urban Development, and other Federal agencies 

13 conducting research or other activities in accordance 

14 with section 7; 

15 (4) assist in coordinating data collection, main16 tenance, and analysis required by this subtitle; 

17 (5) examine existing data and studies on envi18 ronmental justice; 

19 (6) hold public meetings and otherwise solicit 

20 public participation and consider complaints as re21 quired under subsection (c); 

22 (7) develop interagency model projects on envi23 ronmental justice that evidence cooperation among 

24 Federal agencies; and 
351 

•HR 3561 IH 

1 (8) in coordination with the Department of the 

2 Interior and after consultation with tribal leaders, 

3 coordinate steps to be taken pursuant to this subtitle 

4 that affect or involve federally-recognized Indian 

5 Tribes. 

6 (c) PUBLIC PARTICIPATION.—The Working Group 

7 shall— 

8 (1) hold public meetings and otherwise solicit 

9 public participation, as appropriate, for the purpose 

10 of fact-finding with regard to implementation of this 

11 subtitle, and prepare for public review a summary of 

12 the comments and recommendations provided; and 

13 (2) receive, consider, and in appropriate in14 stances conduct inquiries concerning complaints re15 garding environmental justice and the implementa16 tion of this subtitle by Federal agencies. 

17 (d) ANNUAL REPORTS.— 

18 (1) IN GENERAL.—Each fiscal year following 

19 enactment of this Act, the Working Group shall sub20 mit to the President, through the Office of the Dep21 uty Assistant to the President for Environmental 

22 Policy and the Office of the Assistant to the Presi23 dent for Domestic Policy, a report that describes the 

24 implementation of this subtitle, including, but not 

25 limited to, a report of the final environmental justice 
352 

•HR 3561 IH 

1 strategies described in section 6 of this subtitle and 

2 annual progress made in implementing those strate3 gies. 

4 (2) COPY OF REPORT.—The President shall 

5 transmit to the Speaker of the House of Representa6 tives and the President of the Senate a copy of each 

7 report submitted to the President pursuant to para8 graph (1). 

9 (e) CONFORMING CHANGE.—The Interagency Work10 ing Group on Environmental Justice established under 

11 Executive Order No. 12898, dated February 11, 1994, is 

12 abolished. 

13 SEC. 624. FEDERAL AGENCY STRATEGIES. 

14 (a) AGENCY-WIDE STRATEGIES.—Each Federal 

15 agency shall develop an agency-wide environmental justice 

16 strategy that identifies and addresses disproportionally 

17 high and adverse human health or environmental effects 

18 or disproportionally low benefits of its programs, policies, 

19 and activities with respect to minority, low-income, and 

20 Native American populations. 

21 (b) REVISIONS.—Each strategy developed pursuant 

22 to subsection (a) shall identify programs, policies, plan23 ning, and public participation processes, rulemaking, and 

24 enforcement activities related to human health or the envi25 ronment that should be revised to— 
353 

•HR 3561 IH 

1 (1) promote enforcement of all health and envi2 ronmental statutes in areas with minority, low-in3 come, or Native American populations; 

4 (2) ensure greater public participation; 

5 (3) improve research and data collection relat6 ing to the health of and environment of minority, 

7 low-income, and Native American populations; and 

8 (4) identify differential patterns of use of nat9 ural resources among minority, low-income, and Na10 tive American populations. 

11 (c) TIMETABLES.—Each strategy developed pursuant 

12 to subsection (a) shall include, where appropriate, a time13 table for undertaking revisions identified pursuant to sub14 section (b). 

15 SEC. 625. FEDERAL ENVIRONMENTAL JUSTICE ADVISORY 

16 COMMITTEE. 

17 (a) ESTABLISHMENT.—There is established a com18 mittee to be known as the ‘‘Federal Environmental Justice 

19 Advisory Committee’’. 

20 (b) DUTIES.—The Advisory Committee shall provide 

21 independent advice and recommendations to the Environ22 mental Protection Agency and the Working Group on 

23 areas relating to environmental justice, which may include 

24 any of the following: 
354 

•HR 3561 IH 

1 (1) Advice on Federal agencies’ framework de2 velopment for integrating socioeconomic programs 

3 into strategic planning, annual planning, and man4 agement accountability for achieving environmental 

5 justice results agency-wide. 

6 (2) Advice on measuring and evaluating agen7 cies’ progress, quality, and adequacy in planning, de8 veloping, and implementing environmental justice 

9 strategies, projects, and programs. 

10 (3) Advice on agencies’ existing and future in11 formation management systems, technologies, and 

12 data collection, and the conduct of analyses that 

13 support and strengthen environmental justice pro14 grams in administrative and scientific areas. 

15 (4) Advice to help develop, facilitate, and con16 duct reviews of the direction, criteria, scope, and 

17 adequacy of the Federal agencies’ scientific research 

18 and demonstration projects relating to environ19 mental justice. 

20 (5) Advice for improving how the Environ21 mental Protection Agency and others participate, co22 operate, and communicate within that agency and 

23 between other Federal agencies, State or local gov24 ernments, federally recognized Tribes, environmental 

25 justice leaders, interest groups, and the public. 
355 

•HR 3561 IH 

1 (6) Advice regarding the Environmental Protec2 tion Agency’s administration of grant programs re3 lating to environmental justice assistance (not to in4 clude the review or recommendations of individual 

5 grant proposals or awards). 

6 (7) Advice regarding agencies’ awareness, edu7 cation, training, and other outreach activities involv8 ing environmental justice. 

9 (c) ADVISORY COMMITTEE.—The Advisory Com10 mittee shall be considered an advisory committee within 

11 the meaning of the Federal Advisory Committee Act (5 

12 U.S.C. App.). 

13 (d) MEMBERSHIP.— 

14 (1) IN GENERAL.—The Advisory Committee 

15 shall be composed of 21 members to be appointed in 

16 accordance with paragraph (2). Members shall in17 clude representatives of— 

18 (A) community-based groups; 

19 (B) industry and business; 

20 (C) academic and educational institutions; 

21 (D) minority health organizations; 

22 (E) State and local governments, federally 

23 recognized tribes, and indigenous groups; and 

24 (F) nongovernmental and environmental 

25 groups. 
356 

•HR 3561 IH 

1 (2) APPOINTMENTS.—Of the members of the 

2 Advisory Committee— 

3 (A) five members shall be appointed by the 

4 majority leader of the Senate; 

5 (B) five members shall be appointed by the 

6 minority leader of the Senate; 

7 (C) five members shall be appointed by the 

8 Speaker of the House of Representatives; 

9 (D) five members shall be appointed by the 

10 minority leader of the House of Representa11 tives; and 

12 (E) one member to be appointed by the 

13 President. 

14 (e) MEETINGS.—The Advisory Committee shall meet 

15 at least twice annually. Meetings shall occur as needed and 

16 approved by the Director of the Office of Environmental 

17 Justice of the Environmental Protection Agency, who shall 

18 serve as the officer required to be appointed under section 

19 10(e) of the Federal Advisory Committee Act (5 U.S.C. 

20 App.) with respect to the Committee (in this subsection 

21 referred to as the ‘‘Designated Federal Officer’’). The Ad22 ministrator of the Environmental Protection Agency may 

23 pay travel and per diem expenses of members of the Advi24 sory Committee when determined necessary and appro25 priate. The Designated Federal Officer or a designee of 
357 

•HR 3561 IH 

1 such Officer shall be present at all meetings, and each 

2 meeting will be conducted in accordance with an agenda 

3 approved in advance by such Officer. The Designated Fed4 eral Officer may adjourn any meeting when the Des5 ignated Federal Officer determines it is in the public inter6 est to do so. As required by the Federal Advisory Com7 mittee Act, meetings of the Advisory Committee shall be 

8 open to the public unless the President determines that 

9 a meeting or a portion of a meeting may be closed to the 

10 public in accordance with subsection (c) of section 552b 

11 of title 5, United States Code. Unless a meeting or portion 

12 thereof is closed to the public, the Designated Federal Of13 ficer shall provide an opportunity for interested persons 

14 to file comments before or after such meeting or to make 

15 statements to the extent that time permits. 

16 (f) DURATION.—The Advisory Committee shall re17 main in existence until otherwise provided by law. 

18 SEC. 626. HUMAN HEALTH AND ENVIRONMENTAL RE19 SEARCH, DATA COLLECTION AND ANALYSIS. 

20 (a) DISPROPORTIONATE IMPACT.—To the extent per21 mitted by other applicable law, including section 552a of 

22 title 5, United States Code, popularly known as the Pri23 vacy Act of 1974, the Administrator of the Environmental 

24 Protection Agency, or the head of such other Federal 

25 agency as the President may direct, shall collect, maintain, 
358 

•HR 3561 IH 

1 and analyze information assessing and comparing environ2 mental and human health risks borne by populations iden3 tified by race, national origin, or income. To the extent 

4 practical and appropriate, Federal agencies shall use this 

5 information to determine whether their programs, policies, 

6 and activities have disproportionally high and adverse 

7 human health or environmental effects on, or 

8 disproportionally low benefits for, minority, low-income, 

9 and Native American populations. 

10 (b) INFORMATION RELATED TO NON-FEDERAL FA11 CILITIES.—In connection with the development and imple12 mentation of agency strategies in section 4, the Adminis13 trator of the Environmental Protection Agency, or the 

14 head of such other Federal agency as the President may 

15 direct, shall collect, maintain, and analyze information on 

16 the race, national origin, and income level, and other read17 ily accessible and appropriate information, for areas sur18 rounding facilities or sites expected to have a substantial 

19 environmental, human health, or economic effect on the 

20 surrounding populations, if such facilities or sites become 

21 the subject of a substantial Federal environmental admin22 istrative or judicial action. 

23 (c) IMPACT FROM FEDERAL FACILITIES.—The Ad24 ministrator of the Environmental Protection Agency, or 

25 the head of such other Federal agency as the President 
359 

•HR 3561 IH 

1 may direct, shall collect, maintain, and analyze informa2 tion on the race, national origin, and income level, and 

3 other readily accessible and appropriate information, for 

4 areas surrounding Federal facilities that are— 

5 (1) subject to the reporting requirements under 

6 the Emergency Planning and Community Right-to7 Know Act (42 U.S.C. 11001 et seq.) as mandated 

8 in Executive Order No. 12856; and 

9 (2) expected to have a substantial environ10 mental, human health, or economic effect on sur11 rounding populations. 

12 (d) INFORMATION SHARING.— 

13 (1) IN GENERAL.—In carrying out the respon14 sibilities in this section, each Federal agency, to the 

15 extent practicable and appropriate, shall share infor16 mation and eliminate unnecessary duplication of ef17 forts through the use of existing data systems and 

18 cooperative agreements among Federal agencies and 

19 with State, local, and tribal governments. 

20 (2) PUBLIC AVAILABILITY.—Except as prohib21 ited by other applicable law, information collected or 

22 maintained pursuant to this section shall be made 

23 available to the public. 

24 (e) PUBLIC COMMENT.—Federal agencies shall pro25 vide minority, low-income, and Native American popu-
360 

•HR 3561 IH 

1 lations the opportunity to participate in the development, 

2 design, and conduct of activities undertaken pursuant to 

3 this section. 

4 TITLE VII—STRENGTHENING 

5 HEALTH INSTITUTIONS THAT 

6 PROVIDE HEALTHCARE TO 

7 MINORITY POPULATIONS 

8 Subtitle A—General Provisions 

9 SEC. 701. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

10 ACT. 

11 Title XXIX of the Public Health Service Act, as 

12 amended by titles II, III, V, and VI of this Act, is further 

13 amended by adding at the end the following: 

14 ‘‘Subtitle E—Strengthening Health 

15 Institutions That Provide 

16 Healthcare to Minority Popu17 lations 

18 ‘‘CHAPTER 1—GENERAL PROGRAMS 

19 ‘‘SEC. 2951. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

20 INITIATIVES. 

21 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

22 with the Administrator of the Health Resources and Serv23 ices Administration, the Director of the Agency for 

24 Healthcare Research and Quality, and the Administrator 

25 of the Centers for Medicare and Medicaid Services, shall 
361 

•HR 3561 IH 

1 award grants to eligible entities for the conduct of dem2 onstration projects to improve the quality of and access 

3 to healthcare. 

4 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

5 under subsection (a), an entity shall— 

6 ‘‘(1) be a health center, hospital, health plan, 

7 health system, community clinic. or other health en8 tity determined appropriate by the Secretary— 

9 ‘‘(A) that, by legal mandate or explicitly 

10 adopted mission, provides patients with access 

11 to services regardless of their ability to pay; 

12 ‘‘(B) that provides care or treatment for a 

13 substantial number of patients who are unin14 sured, are receiving assistance under a State 

15 program under title XIX of the Social Security 

16 Act, or are members of vulnerable populations, 

17 as determined by the Secretary; and 

18 ‘‘(C)(i) with respect to which, not less than 

19 50 percent of the entity’s patient population is 

20 made up of racial and ethnic minorities; or 

21 ‘‘(ii) that— 

22 ‘‘(I) serves a disproportionate percent23 age of local, minority racial and ethnic pa24 tients, or that has a patient population, at 
362 

•HR 3561 IH 

1 least 50 percent of which is limited English 

2 proficient; and 

3 ‘‘(II) provides an assurance that 

4 amounts received under the grant will be 

5 used only to support quality improvement 

6 activities in the racial and ethnic popu7 lation served; and 

8 ‘‘(2) prepare and submit to the Secretary an 

9 application at such time, in such manner, and con10 taining such information as the Secretary may re11 quire. 

12 ‘‘(c) PRIORITY.—In awarding grants under sub13 section (a), the Secretary shall give priority to applicants 

14 under subsection (b)(2) that— 

15 ‘‘(1) demonstrate an intent to operate as part 

16 of a healthcare partnership, network, collaborative, 

17 coalition, or alliance where each member entity con18 tributes to the design, implementation, and evalua19 tion of the proposed intervention; or 

20 ‘‘(2) intend to use funds to carry out system21 wide changes with respect to healthcare quality im22 provement, including— 

23 ‘‘(A) improved systems for data collection 

24 and reporting; 
363 

•HR 3561 IH 

1 ‘‘(B) innovative collaborative or similar 

2 processes; 

3 ‘‘(C) group programs with behavioral or 

4 self-management interventions; 

5 ‘‘(D) case management services; 

6 ‘‘(E) physician or patient reminder sys7 tems; 

8 ‘‘(F) educational interventions; or 

9 ‘‘(G) other activities determined appro10 priate by the Secretary. 

11 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

12 received under a grant under subsection (a) to support 

13 the implementation and evaluation of healthcare quality 

14 improvement activities or minority health and healthcare 

15 disparity reduction activities that include— 

16 ‘‘(1) with respect to healthcare systems, activi17 ties relating to improving— 

18 ‘‘(A) patient safety; 

19 ‘‘(B) timeliness of care; 

20 ‘‘(C) effectiveness of care; 

21 ‘‘(D) efficiency of care; and 

22 ‘‘(E) patient centeredness; and 

23 ‘‘(2) with respect to patients, activities relating 

24 to— 

25 ‘‘(A) staying healthy; 
364 

•HR 3561 IH 

1 ‘‘(B) getting well; 

2 ‘‘(C) living with illness or disability; and 

3 ‘‘(D) coping with end of life issues. 

4 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

5 provide financial and other technical assistance to grant6 ees under this section for the development of common data 

7 systems. 

8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to carry out this section, 

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

11 2007 through 2012. 

12 ‘‘SEC. 2951A. CENTERS OF EXCELLENCE. 

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

14 the Administrator of the Health Resources and Services 

15 Administration, shall designate centers of excellence at 

16 public hospitals, and other health systems serving large 

17 numbers of minority patients, that— 

18 ‘‘(1) meet the requirements of section 

19 2971(b)(1); 

20 ‘‘(2) demonstrate excellence in providing care to 

21 minority populations; and 

22 ‘‘(3) demonstrate excellence in reducing dispari23 ties in health and healthcare. 
365 

•HR 3561 IH 

1 ‘‘(b) REQUIREMENTS.—A hospital or health system 

2 that serves as a Center of Excellence under subsection (a) 

3 shall— 

4 ‘‘(1) design, implement, and evaluate programs 

5 and policies relating to the delivery of care in ra6 cially, ethnically, and linguistically diverse popu7 lations; 

8 ‘‘(2) provide training and technical assistance 

9 to other hospitals and health systems relating to the 

10 provision of quality healthcare to minority popu11 lations; and 

12 ‘‘(3) develop activities for graduate or con13 tinuing medical education that institutionalize a 

14 focus on cultural competence training for health care 

15 providers. 

16 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

17 is authorized to be appropriated to carry out this section, 

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

19 2007 through 2012. 

20 ‘‘SEC. 2951B. CONSULTATION, CONSTRUCTION AND REN21 OVATION OF AMERICAN INDIAN AND ALASKA 

22 NATIVE FACILITIES; REPORTS. 

23 ‘‘(a) CONSULTATION.—Prior to the expenditure of, or 

24 the making of any firm commitment to expend, any funds 

25 appropriated for the planning, design, construction, or 
366 

•HR 3561 IH 

1 renovation of facilities pursuant to the Act of November 

2 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder 

3 Act), the Secretary, acting through the Service, shall— 

4 ‘‘(1) consult with any Indian tribe that would 

5 be significantly affected by such expenditure for the 

6 purpose of determining and, whenever practicable, 

7 honoring tribal preferences concerning size, location, 

8 type, and other characteristics of any facility on 

9 which such expenditure is to be made; and 

10 ‘‘(2) ensure, whenever practicable, that such fa11 cility meets the construction standards of any na12 tionally recognized accrediting body by not later 

13 than 1 year after the date on which the construction 

14 or renovation of such facility is completed. 

15 ‘‘(b) CLOSURE OF FACILITIES.— 

16 ‘‘(1) IN GENERAL.—Notwithstanding any provi17 sion of law other than this subsection, no Service 

18 hospital or outpatient healthcare facility or any inpa19 tient service or special care facility operated by the 

20 Service, may be closed if the Secretary has not sub21 mitted to the Congress at least 1 year prior to the 

22 date such proposed closure an evaluation of the im23 pact of such proposed closure which specifies, in ad24 dition to other considerations— 
367 

•HR 3561 IH 

1 ‘‘(A) the accessibility of alternative 

2 healthcare resources for the population served 

3 by such hospital or facility; 

4 ‘‘(B) the cost effectiveness of such closure; 

5 ‘‘(C) the quality of healthcare to be pro6 vided to the population served by such hospital 

7 or facility after such closure; 

8 ‘‘(D) the availability of contract healthcare 

9 funds to maintain existing levels of service; 

10 ‘‘(E) the views of the Indian tribes served 

11 by such hospital or facility concerning such clo12 sure; 

13 ‘‘(F) the level of utilization of such hos14 pital or facility by all eligible Indians; and 

15 ‘‘(G) the distance between such hospital or 

16 facility and the nearest operating Service hos17 pital. 

18 ‘‘(2) TEMPORARY CLOSURE.—Paragraph (1) 

19 shall not apply to any temporary closure of a facility 

20 or of any portion of a facility if such closure is nec21 essary for medical, environmental, or safety reasons. 

22 ‘‘(c) PRIORITY SYSTEM.— 

23 ‘‘(1) ESTABLISHMENT.—The Secretary shall es24 tablish a healthcare facility priority system, that 

25 shall— 
368 

•HR 3561 IH 

1 ‘‘(A) be developed with Indian tribes and 

2 tribal organizations through negotiated rule3 making; 

4 ‘‘(B) give the needs of Indian tribes the 

5 highest priority, with additional priority being 

6 given to those service areas where the health 

7 status of Indians within the area, as measured 

8 by life expectancy based upon the most recent 

9 data available, is significantly lower than the 

10 average health status for Indians in all service 

11 areas; and 

12 ‘‘(C) at a minimum, include the lists re13 quired in paragraph (2)(B) and the method14 ology required in paragraph (2)(E); 

15 except that the priority of any project established 

16 under the construction priority system in effect on 

17 the date of this Act shall not be affected by any 

18 change in the construction priority system taking 

19 place thereafter if the project was identified as one 

20 of the top 10 priority inpatient projects or one of the 

21 top 10 outpatient projects in the Indian Health 

22 Service budget justification for fiscal year 2006, or 

23 if the project had completed both Phase I and Phase 

24 II of the construction priority system in effect on 

25 the date of this title. 
369 

•HR 3561 IH 

1 ‘‘(2) REPORT.—The Secretary shall submit to 

2 the President and Congress a report that includes— 

3 ‘‘(A) a description of the healthcare facility 

4 priority system of the Service, as established 

5 under paragraph (1); 

6 ‘‘(B) healthcare facility lists, including— 

7 ‘‘(i) the total healthcare facility plan8 ning, design, construction and renovation 

9 needs for Indians; 

10 ‘‘(ii) the 10 top-priority inpatient care 

11 facilities; 

12 ‘‘(iii) the 10 top-priority outpatient 

13 care facilities; 

14 ‘‘(iv) the 10 top-priority specialized 

15 care facilities (such as long-term care and 

16 alcohol and drug abuse treatment); and 

17 ‘‘(v) any staff quarters associated 

18 with such prioritized facilities; 

19 ‘‘(C) the justification for the order of pri20 ority among facilities; 

21 ‘‘(D) the projected cost of the projects in22 volved; and 

23 ‘‘(E) the methodology adopted by the Serv24 ice in establishing priorities under its healthcare 

25 facility priority system. 
370 

•HR 3561 IH 

1 ‘‘(3) CONSULTATION.—In preparing each report 

2 required under paragraph (2) (other than the initial 

3 report) the Secretary shall annually— 

4 ‘‘(A) consult with, and obtain information 

5 on all healthcare facilities needs from, Indian 

6 tribes and tribal organizations including those 

7 tribes or tribal organizations operating health 

8 programs or facilities under any funding agree9 ment entered into with the Service under the 

10 Indian Self-Determination and Education As11 sistance Act; and 

12 ‘‘(B) review the total unmet needs of all 

13 tribes and tribal organizations for healthcare 

14 facilities (including staff quarters), including 

15 needs for renovation and expansion of existing 

16 facilities. 

17 ‘‘(4) CRITERIA.—For purposes of this sub18 section, the Secretary shall, in evaluating the needs 

19 of facilities operated under any funding agreement 

20 entered into with the Service under the Indian Self21 Determination and Education Assistance Act, use 

22 the same criteria that the Secretary uses in evalu23 ating the needs of facilities operated directly by the 

24 Service. 
371 

•HR 3561 IH 

1 ‘‘(5) EQUITABLE INTEGRATION.—The Secretary 

2 shall ensure that the planning, design, construction, 

3 and renovation needs of Service and non-Service fa4 cilities, operated under funding agreements in ac5 cordance with the Indian Self-Determination and 

6 Education Assistance Act are fully and equitably in7 tegrated into the healthcare facility priority system. 

8 ‘‘(d) REVIEW OF NEED FOR FACILITIES.— 

9 ‘‘(1) REPORT.—Beginning in 2007, the Sec10 retary shall annually submit to the President and 

11 Congress a report which sets forth the needs of the 

12 Service and all Indian tribes and tribal organiza13 tions, including urban Indian organizations, for in14 patient, outpatient and specialized care facilities, in15 cluding the needs for renovation and expansion of 

16 existing facilities. 

17 ‘‘(2) CONSULTATION.—In preparing each report 

18 required under paragraph (1) (other than the initial 

19 report), the Secretary shall consult with Indian 

20 tribes and tribal organizations including those tribes 

21 or tribal organizations operating health programs or 

22 facilities under any funding agreement entered into 

23 with the Service under the Indian Self-Determina24 tion and Education Assistance Act, and with urban 

25 Indian organizations. 
372 

•HR 3561 IH 

1 ‘‘(3) CRITERIA.—For purposes of this sub2 section, the Secretary shall, in evaluating the needs 

3 of facilities operated under any funding agreement 

4 entered into with the Service under the Indian Self5 Determination and Education Assistance Act, use 

6 the same criteria that the Secretary uses in evalu7 ating the needs of facilities operated directly by the 

8 Service. 

9 ‘‘(4) EQUITABLE INTEGRATION.—The Secretary 

10 shall ensure that the planning, design, construction, 

11 and renovation needs of facilities operated under 

12 funding agreements, in accordance with the Indian 

13 Self-Determination and Education Assistance Act, 

14 are fully and equitably integrated into the develop15 ment of the health facility priority system. 

16 ‘‘(5) ANNUAL NOMINATIONS.—Each year the 

17 Secretary shall provide an opportunity for the nomi18 nation of planning, design, and construction projects 

19 by the Service and all Indian tribes and tribal orga20 nizations for consideration under the healthcare fa21 cility priority system. 

22 ‘‘(e) INCLUSION OF CERTAIN PROGRAMS.—All funds 

23 appropriated under the Act of November 2, 1921 (25 

24 U.S.C. 13), for the planning, design, construction, or ren25 ovation of health facilities for the benefit of an Indian 
373 

•HR 3561 IH 

1 tribe or tribes shall be subject to the provisions of section 

2 102 of the Indian Self-Determination and Education As3 sistance Act. 

4 ‘‘(f) INNOVATIVE APPROACHES.—The Secretary shall 

5 consult and cooperate with Indian tribes, tribal organiza6 tions and urban Indian organizations in developing inno7 vative approaches to address all or part of the total unmet 

8 need for construction of health facilities, including those 

9 provided for in other sections of this title and other ap10 proaches. 

11 ‘‘(g) LOCATION OF FACILITIES.— 

12 ‘‘(1) PRIORITY.—The Bureau of Indian Affairs 

13 and the Service shall, in all matters involving the re14 organization or development of Service facilities, or 

15 in the establishment of related employment projects 

16 to address unemployment conditions in economically 

17 depressed areas, give priority to locating such facili18 ties and projects on Indian lands if requested by the 

19 Indian owner and the Indian tribe with jurisdiction 

20 over such lands or other lands owned or leased by 

21 the Indian tribe or tribal organization so long as pri22 ority is given to Indian land owned by an Indian 

23 tribe or tribes. 

24 ‘‘(2) DEFINITION.—In this subsection, the term 

25 ‘Indian lands’ means— 
374 

•HR 3561 IH 

1 ‘‘(A) all lands within the exterior bound2 aries of any Indian reservation; 

3 ‘‘(B) any lands title to which is held in 

4 trust by the United States for the benefit of 

5 any Indian tribe or individual Indian, or held by 

6 any Indian tribe or individual Indian subject to 

7 restriction by the United States against alien8 ation and over which an Indian tribe exercises 

9 governmental power; and 

10 ‘‘(C) all lands in Alaska owned by any 

11 Alaska Native village, or any village or regional 

12 corporation under the Alaska Native Claims 

13 Settlement Act, or any land allotted to any 

14 Alaska Native. 

15 ‘‘(h) DEFINITIONS.—For purposes of this section, the 

16 definitions contained in section 4 of the Indian Health 

17 Care Improvement Act shall apply. 

18 ‘‘SEC. 2951C. RECONSTRUCTION AND IMPROVEMENT 

19 GRANTS FOR PUBLIC HEALTH CARE FACILI20 TIES SERVING PACIFIC ISLANDERS AND THE 

21 INSULAR AREAS. 

22 ‘‘(a) IN GENERAL.—The Secretary shall provide di23 rect financial assistance to designated healthcare providers 

24 and community health centers in American Samoa, Guam, 

25 the Commonwealth of the Northern Mariana Islands, the 
375 

•HR 3561 IH 

1 United States Virgin Islands, Puerto Rico, and Hawaii for 

2 the purposes of reconstructing and improving health care 

3 facilities and services. 

4 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi5 nancial assistance under subsection (a), an entity shall be 

6 a public health facility or community health center located 

7 in American Samoa, Guam, or the Commonwealth of the 

8 Northern Mariana Islands, the United States Virgin Is9 lands, Puerto Rico, and Hawaii that— 

10 ‘‘(1) is owned or operated by— 

11 ‘‘(A) the government of American Samoa, 

12 Guam, or the Commonwealth of the Northern 

13 Mariana Islands, the United States Virgin Is14 lands, Puerto Rico, and Hawaii or a unit of 

15 local government; or 

16 ‘‘(B) a nonprofit organization; and 

17 ‘‘(2)(A) provides care or treatment for a sub18 stantial number of patients who are uninsured, re19 ceiving assistance under a State program under a 

20 title XVIII of the Social Security Act, or a State 

21 program under title XIX of such Act, or who are 

22 members of a vulnerable population, as determined 

23 by the Secretary; or 

24 ‘‘(B) serves a disproportionate percentage of 

25 local, minority racial and ethnic patients. 
376 

•HR 3561 IH 

1 ‘‘(c) REPORT.—Not later than 180 days after the 

2 date of enactment of this title and annually thereafter, the 

3 Secretary shall submit to the Congress and the President 

4 a report that includes an assessment of health resources 

5 and facilities serving populations in American Samoa, 

6 Guam, and the Commonwealth of the Northern Mariana 

7 Islands, the United States Virgin Islands, Puerto Rico, 

8 and Hawaii. In preparing such report, the Secretary 

9 shall— 

10 ‘‘(1) consult with and obtain information on all 

11 healthcare facilities needs from the entities described 

12 in subsection (b); and 

13 ‘‘(2) include all amounts of Federal assistance 

14 received by each entity in the preceding fiscal year; 

15 ‘‘(3) review the total unmet needs of each juris16 diction for healthcare facilities, including needs for 

17 renovation and expansion of existing facilities; and 

18 ‘‘(4) include a strategic plan for addressing the 

19 needs of each jurisdiction identified in the report. 

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

21 is authorized to be appropriated such sums as necessary 

22 to carry out this section. 
377 

•HR 3561 IH 

1 ‘‘CHAPTER 2—NATIONAL HEALTH SAFETY 

2 NET INFRASTRUCTURE 

3 ‘‘Subchapter A—General Provisions 

4 ‘‘SEC. 2952. PAYMENTS TO HEALTHCARE FACILITIES. 

5 ‘‘(a) IN GENERAL.—The Secretary, with the approval 

6 of the Health Safety Net Infrastructure Trust Fund 

7 Board of Trustees described in section 2972C(d) (here8 after in this subtitle referred to as the ‘Trust Fund 

9 Board’), shall make payments, from amounts in the 

10 Health Safety Net Infrastructure Trust Fund established 

11 under section 2972C(a) (hereafter in this subtitle referred 

12 to as the ‘Trust Fund’), for capital financing assistance 

13 to eligible healthcare facilities whose applications for as14 sistance have been approved under this subtitle. 

15 ‘‘(b) GENERAL ELIGIBILITY REQUIREMENTS FOR AS16 SISTANCE.— 

17 ‘‘(1) ELIGIBLE HEALTHCARE FACILITIES DE18 SCRIBED.— 

19 ‘‘(A) IN GENERAL.—A healthcare facility 

20 shall be generally eligible for capital financing 

21 assistance under this subtitle if the healthcare 

22 facility— 

23 ‘‘(i) receives an additional payment 

24 under section 1886(d)(5)(F) of the Social 

25 Security Act and is described in clause 
378 

•HR 3561 IH 

1 (i)(II) or clause (vii)(I) of such section, or 

2 is deemed a disproportionate share hospital 

3 under a State plan for medical assistance 

4 under title XIX of the Social Security Act 

5 on the basis described in section 

6 1923(b)(1) of such Act; 

7 ‘‘(ii) is a hospital which meets the cri8 teria for designation by the Secretary as 

9 an essential access community hospital 

10 under section 1820(i)(1) of such Act or a 

11 rural primary care hospital under section 

12 1820(i)(2) of such Act (whether or not 

13 such hospital is actually designated under 

14 such section); 

15 ‘‘(iii) is a Federally qualified health 

16 center (as defined in section 1905(l)(2)(B) 

17 of such Act); 

18 ‘‘(iv) is a hospital which— 

19 ‘‘(I) is a sole community pro20 vider; or 

21 ‘‘(II) has closed within the pre22 ceding 12 months; 

23 ‘‘(v) is a facility which— 

24 ‘‘(I) provides service to ill or in25 jured individuals prior to the trans-
379 

•HR 3561 IH 

1 portation of such individuals to a hos2 pital or provides inpatient care to in3 dividuals needing such care for a pe4 riod not longer than 96 hours; 

5 ‘‘(II) is located in a county (or 

6 equivalent unit of local government) 

7 with fewer than 6 residents per 

8 square mile or is located more than 

9 35 road miles from the nearest hos10 pital; 

11 ‘‘(III) permits a physician assist12 ant or nurse practitioner to admit and 

13 treat patients under the supervision of 

14 a physician not present in such facil15 ity; and 

16 ‘‘(IV) has obtained a waiver from 

17 the Secretary permitting the facility 

18 to participate in the medicare pro19 gram under title XVIII of the Social 

20 Security Act; or 

21 ‘‘(vi) is a hospital that the Secretary 

22 otherwise determines to be an appropriate 

23 recipient of assistance under this subtitle 

24 on the basis of the existence of a patient 

25 care operating deficit, a demonstrated in-
380 

•HR 3561 IH 

1 ability to secure or repay financing for a 

2 qualifying project on reasonable terms, or 

3 such other criteria as the Secretary con4 siders appropriate. 

5 ‘‘(B) DEVELOPMENT OF CRITERIA.—For 

6 purposes of subparagraph (A)(vi), with respect 

7 to rural hospitals which are at risk or critical 

8 to healthcare access, the Prospective Payment 

9 Review Commission, not later than January 1, 

10 2006, shall develop criteria to assist the Sec11 retary in deciding if such hospitals deserve as12 sistance, after considering, at a minimum, the 

13 following factors: 

14 ‘‘(i) AT-RISK RURAL HOSPITALS.—In 

15 the case of rural hospitals the closure of 

16 which within the next year is imminent or 

17 the continued operation of which over a 2- 

18 to 5-year period is questionable, such fac19 tors as the level of health resources avail20 able in a community as measured by physi21 cian supply, the population base of the 

22 area served by the hospital and utilization 

23 of services by such population as measured 

24 by service area population, and financial 

25 indicators predictive of closure. 
381 

•HR 3561 IH 

1 ‘‘(ii) RURAL HOSPITALS CRITICAL TO

2 HEALTHCARE ACCESS.—In the case of 

3 rural hospitals which provide access to es4 sential health services within a service area 

5 where no other provider of such essential 

6 services exists, such factors as the market 

7 share of the hospital for an area or popu8 lation, the number of outpatient visits, the 

9 proximity of the next closest provider of 

10 such services, and the degree to which the 

11 area population is medically underserved. 

12 ‘‘(2) OWNERSHIP REQUIREMENTS.—In order to 

13 be eligible for assistance under this subtitle, a 

14 healthcare facility (other than a healthcare facility 

15 described in clauses (ii) and (v) of paragraph (1)) 

16 must— 

17 ‘‘(A) be owned or operated by a unit of 

18 State or local government; 

19 ‘‘(B) be a quasi-public corporation, defined 

20 as a private, nonprofit corporation or public 

21 benefit corporation which is formally granted 

22 one or more governmental powers by legislative 

23 action through (or is otherwise partially funded 

24 by) the State legislature, city or county council; 
382 

•HR 3561 IH 

1 ‘‘(C) be a private nonprofit healthcare fa2 cility which has contracted with, or is otherwise 

3 funded by, a governmental agency to provide 

4 healthcare services to low income individuals 

5 not eligible for assistance under title XVIII or 

6 title XIX of the Social Security Act, where rev7 enue from such contracts constitute at least 10 

8 percent of the facility’s operating revenues over 

9 the prior 3 fiscal years; or 

10 ‘‘(D) be a nonprofit small rural healthcare 

11 facility (as determined by the Secretary). 

12 ‘‘(3) PRIORITY.—In making payments under 

13 this section, the Secretary shall give priority to eligi14 ble healthcare entities that are federally qualified 

15 health centers (as defined in section 1905(l)(2)(B) 

16 of the Social Security Act), or other similar entities 

17 at least 50 percent of the patients of which are mi18 nority or low-income individuals. 

19 ‘‘(c) MEETING ADDITIONAL SPECIFIC CRITERIA.— 

20 Healthcare facilities that are generally eligible for assist21 ance under this subtitle under subsection (b) may apply 

22 for the specific programs described in this subtitle and 

23 must meet any additional criteria for participation in such 

24 programs. 
383 

•HR 3561 IH 

1 ‘‘(d) ASSISTANCE AVAILABLE.—Capital financing as2 sistance available under this subtitle shall include loan 

3 guarantees, interest rate subsidies, matching loans and di4 rect grants. Healthcare facilities determined to be gen5 erally eligible for assistance under this subtitle may apply 

6 for and receive more than one type of assistance under 

7 this subtitle. 

8 ‘‘SEC. 2952A. APPLICATION FOR ASSISTANCE. 

9 ‘‘(a) IN GENERAL.—No healthcare facilities may re10 ceive assistance for a qualifying project under this subtitle 

11 unless the healthcare facility— 

12 ‘‘(1) has filed with the Secretary, in a form and 

13 manner specified by the Secretary, with the advice 

14 and approval of the Trust Fund Board (as described 

15 in section 2972C(d)), an application for assistance 

16 under this subtitle; 

17 ‘‘(2) establishes in its application (for its most 

18 recent cost reporting period) that it meets the cri19 teria for general eligibility under this subtitle; 

20 ‘‘(3) includes a description of the project, in21 cluding the community in which it is located, and 

22 describes utilization and services characteristics of 

23 the project and the healthcare facility, and the pa24 tient population that is to be served; 
384 

•HR 3561 IH 

1 ‘‘(4) describes the extent to which the project 

2 will include the financial participation of State and 

3 local governments if assistance is granted under this 

4 subtitle, and all other sources of financing sought 

5 for the project; and 

6 ‘‘(5) establishes, to the satisfaction of the Sec7 retary and the Trust Fund Board, that the project 

8 meets the additional criteria for each type of capital 

9 financing assistance for which it is applying. 

10 ‘‘(b) CRITERIA FOR APPROVAL.—The Secretary, with 

11 the approval of the Trust Fund Board, shall determine 

12 for each application for assistance under this subtitle— 

13 ‘‘(1) whether the healthcare facility meets the 

14 general eligibility criteria under section 2972(b); 

15 ‘‘(2) whether the healthcare facility meets the 

16 specific eligibility criteria of each type of assistance 

17 for which it has applied, including whether the 

18 healthcare facility meets any criteria for priority 

19 consideration for the type of assistance for which it 

20 has applied; 

21 ‘‘(3) whether the capital project for which as22 sistance is being requested is a qualifying project 

23 under this subtitle; and 
385 

•HR 3561 IH 

1 ‘‘(4) whether funds are available, pursuant to 

2 the limitations of each program, to fully fund the re3 quest for assistance. 

4 ‘‘(c) PRIORITY OF APPLICATIONS.—In addition to 

5 meeting the criteria otherwise described in this subtitle, 

6 at the discretion of the Trust Fund Board, the Secretary 

7 shall give preference to those applications for qualifying 

8 projects that— 

9 ‘‘(1)(A) are necessary to bring existing safety 

10 net healthcare facilities into compliance with accredi11 tation standards of fire and life safety, seismic, or 

12 other related Federal, State or local regulatory 

13 standards; 

14 ‘‘(B) improve the provision of essential services 

15 such as emergency medical and trauma services, 

16 AIDS and infectious disease, perinatal, burn, pri17 mary care, and other services which the Trust Fund 

18 Board may designate; or 

19 ‘‘(C) provide access to otherwise unavailable es20 sential health services to the indigent and other 

21 needy persons within the healthcare facility’s terri22 torial area; 

23 ‘‘(2) include specific State or local governmental 

24 or other non-Federal assurances of financial support 
386 

•HR 3561 IH 

1 if assistance for a qualifying project is granted 

2 under this subtitle; and 

3 ‘‘(3) are unlikely to be financed without assist4 ance granted under this subtitle. 

5 ‘‘(d) SUBMISSION OF APPLICATIONS.—Applications 

6 under this subtitle shall be submitted to the Secretary 

7 through the Trust Fund Board. If two or more healthcare 

8 facilities join in the project, the application shall be sub9 mitted by all participating healthcare facilities jointly. 

10 Such applications shall set forth all of the descriptions, 

11 plans, specifications, and assurances as required by this 

12 subtitle and contain other such information as the Trust 

13 Fund Board shall require. 

14 ‘‘(e) OPPORTUNITY FOR APPEAL.—The Trust Fund 

15 Board shall afford a healthcare facility applying for a loan 

16 guarantee under this section an opportunity for a hearing 

17 if the guarantee is denied. 

18 ‘‘(f) APPLICATIONS FOR AMENDMENTS.—Amend19 ment of an approved application shall be subject to ap20 proval in the same manner as an original application. 

21 ‘‘SEC. 2952B. PUBLIC SERVICE RESPONSIBILITIES. 

22 ‘‘(a) IN GENERAL.—Any healthcare facility accepting 

23 capital financing assistance under this subtitle shall 

24 agree— 
387 

•HR 3561 IH 

1 ‘‘(1) to make the services of the facility or por2 tion thereof to be constructed, acquired, or modern3 ized available to all persons; and 

4 ‘‘(2) to provide a significant volume of services 

5 to persons unable to pay therefore, consistent with 

6 other provisions of this Act and the amount of as7 sistance received under this subtitle. 

8 ‘‘(b) ENFORCEMENT.—The Director of the Office for 

9 Civil Rights of the Department of Health and Human 

10 Services shall be given the power to enforce the public 

11 service responsibilities described in this section. 

12 ‘‘SEC. 2952C. HEALTH SAFETY NET INFRASTRUCTURE 

13 TRUST FUND. 

14 ‘‘(a) CREATION OF TRUST FUND.—There is estab15 lished in the Treasury of the United States a trust fund 

16 to be known as the Health Safety Net Infrastructure 

17 Trust Fund, consisting of such amounts as may be trans18 ferred, appropriated, or credited to such Trust Fund as 

19 provided in this subtitle. 

20 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS TO

21 TRUST FUND.—There are authorized to be appropriated 

22 to the Trust Fund such sums as may be necessary to carry 

23 out the purposes of this subtitle. 

24 ‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts 

25 in the Trust Fund shall be available, pursuant to appro-
388 

•HR 3561 IH 

1 priations Acts, only for making expenditures to carry out 

2 the purposes of this subtitle. 

3 ‘‘(d) BOARD OF TRUSTEES; COMPOSITION; MEET4 INGS; DUTIES.— 

5 ‘‘(1) IN GENERAL.—There shall be created a 

6 Health Safety Net Infrastructure Trust Fund Board 

7 of Trustees composed of the Secretary of Health and 

8 Human Services, the Secretary of the Treasury, the 

9 Assistant Secretary for Health, the Director of the 

10 Office of Minority Health, and the Administrator of 

11 the Centers for Medicare and Medicaid Services (all 

12 serving in their ex officio capacities), and 5 public 

13 members who shall be appointed for 4 year terms by 

14 the President, from the following categories— 

15 ‘‘(A) one chief health officer from a State; 

16 ‘‘(B) one chief executive officer of a 

17 healthcare facility that meets the general eligi18 bility criteria of this subtitle; 

19 ‘‘(C) one representative of the financial 

20 community; and 

21 ‘‘(D) two additional public or consumer 

22 representatives. 

23 ‘‘(2) DUTIES.—The Board of Trustees shall 

24 meet no less than quarterly and shall have the re25 sponsibility to approve implementing regulations, to 
389 

•HR 3561 IH 

1 establish criteria, and to recommend and approve ex2 penditures by the Secretary under the programs set 

3 forth in this subtitle. 

4 ‘‘(3) MANAGING TRUSTEE.—The Secretary of 

5 the Treasury shall serve as the Managing Trustee of 

6 the Trust Fund, and shall be responsible for the in7 vestment of funds. The provisions of subsections (b) 

8 through (e) of section 1817 of the Social Security 

9 Act shall apply to the Trust Fund and the Managing 

10 Trustee of the Trust Fund in the same manner as 

11 they apply to the Federal Hospital Insurance Trust 

12 Fund and the Managing Trustee of that Trust 

13 Fund. 

14 ‘‘SEC. 2952D. ADMINISTRATION. 

15 ‘‘(a) IN GENERAL.—The Administrator of the Cen16 ters for Medicare and Medicaid Services shall serve as Sec17 retary of the Board of Trustees and shall administer the 

18 programs under this subtitle. 

19 ‘‘(b) LIMITATION ON ADMINISTRATIVE EXPENSES.— 

20 Not more than 5 percent of the funds annually appro21 priated to the Trust Fund may be available for adminis22 tration of the Trust Fund or programs under this subtitle. 
390 

•HR 3561 IH 

1 ‘‘Subchapter B—Loan Guarantees 

2 ‘‘SEC. 2953. PROVISION OF LOAN GUARANTEES TO SAFETY 

3 NET HEALTHCARE FACILITIES. 

4 ‘‘(a) IN GENERAL.—The Safety Net Infrastructure 

5 Trust Fund will provide a Federal guarantee of loan re6 payment, including guarantees of repayment of refi7 nancing loans, to non-Federal lenders making loans to eli8 gible healthcare facilities for healthcare facility replace9 ment (either by construction or acquisition), moderniza10 tion and renovation projects, and capital equipment acqui11 sition. 

12 ‘‘(b) PURPOSES.—The loan guarantee program shall 

13 be designed by the Trust Fund Board with the goal of 

14 rebuilding and maintaining the essential health services of 

15 healthcare facilities eligible for assistance under this sub16 title. 

17 ‘‘SEC. 2953A. ELIGIBLE LOANS. 

18 ‘‘(a) IN GENERAL.—Loan guarantees under this 

19 chapter are available for loans made to eligible healthcare 

20 facilities for replacement facilities (either newly con21 structed or acquired), modernization and renovation of ex22 isting facilities, and for capital equipment acquisition. 

23 ‘‘(b) LOAN GUARANTEE MUST BE ESSENTIAL TO

24 BOND FINANCING.—Eligible healthcare facilities must 

25 demonstrate that a Federal loan guarantee is essential to 
391 

•HR 3561 IH 

1 obtaining bond financing from non-Federal lenders at a 

2 reasonably affordable rate of interest. 

3 ‘‘(c) ADDITIONAL ELIGIBILITY CRITERIA FOR LOAN

4 GUARANTEES.—In order to be eligible for assistance 

5 under this chapter, a healthcare facility must demonstrate 

6 that the following criteria are met: 

7 ‘‘(1) The healthcare facility has evidence of an 

8 ability to meet debt service. 

9 ‘‘(2) The assistance, when considered with other 

10 resources available to the project, is necessary and 

11 will restore, improve, or maintain the financial or 

12 physical soundness of the healthcare facility. 

13 ‘‘(3) The applicant agrees to assume the public 

14 service responsibilities described in section 2952B. 

15 ‘‘(4) The project is being, or will be, operated 

16 and managed in accordance with a management-im17 provement-and-operating plan which is designed to 

18 reduce the operating costs of the project, which has 

19 been approved by the Trust Fund Board, and which 

20 includes— 

21 ‘‘(A) a detailed maintenance schedule; 

22 ‘‘(B) a schedule for correcting past defi23 ciencies in maintenance, repairs, and replace24 ments; 
392 

•HR 3561 IH 

1 ‘‘(C) a plan to upgrade the project to meet 

2 cost-effective energy efficiency standards pre3 scribed by the Trust Fund Board; 

4 ‘‘(D) a plan to improve financial and man5 agement control systems; 

6 ‘‘(E) a detailed annual operating budget 

7 taking into account such standards for oper8 ating costs in the area as may be determined by 

9 the Trust Fund Board; and 

10 ‘‘(F) such other requirements as the Trust 

11 Fund Board may determine. 

12 ‘‘(5) The application includes stringent provi13 sions for continued State or local support of the pro14 gram, both with respect to operating and financial 

15 capital. 

16 ‘‘(6) The terms, conditions, maturity, security 

17 (if any), and schedule and amount of repayments 

18 with respect to the loan are sufficient to protect the 

19 financial interests of the United States and are oth20 erwise reasonable and in accord with regulation, in21 cluding a determination that the rate of interest 

22 does not exceed such annual percentage on the prin23 cipal obligation outstanding as the Trust Fund 

24 Board determines to be reasonable, taking into ac25 count the range of interest rates prevailing in the 
393 

•HR 3561 IH 

1 private market for similar loans and the risks as2 sumed by the United States. 

3 ‘‘(7) The healthcare facility must meet such 

4 other additional criteria as the Secretary may im5 pose. 

6 ‘‘(d) STATE OR LOCAL PARTICIPATION.—Projects in 

7 which State or local governmental entities participate in 

8 the form of first guarantees of part or all of the total loan 

9 value shall be given a preference for loan guarantees under 

10 this chapter. 

11 ‘‘SEC. 2953B. GUARANTEE ALLOTMENTS. 

12 ‘‘(a) IN GENERAL.—$150,000,000 shall be annually 

13 allocated within the Trust Fund to the loan guarantee pro14 gram established by this chapter in order to create a cu15 mulative reserve in support of loan guarantees. 

16 ‘‘(b) LOAN GUARANTEES FOR RURAL HEALTHCARE

17 FACILITIES.—At least 20 percent of the dollar value of 

18 loan guarantees made under this program during any 

19 given year shall be allocated for eligible rural healthcare 

20 facilities, to the extent a sufficient number of applications 

21 are made by such healthcare facilities. 

22 ‘‘(c) GUARANTEES FOR SMALL LOANS.—At least 

23 $200,000,000 of the annual dollar value of loan guaran24 tees made under the program shall be reserved for loans 
394 

•HR 3561 IH 

1 of under $50,000,000, if there are a sufficient number of 

2 applicants for loans of that size. 

3 ‘‘(d) SPECIAL RULE FOR REFINANCING LOANS.— 

4 Not more than 20 percent of the amount allocated each 

5 year to the loan guarantee program established by this 

6 chapter may be allocated to guarantee refinancing loans 

7 during the year. 

8 ‘‘SEC. 2953C. TERMS AND CONDITIONS OF LOAN GUARAN9 TEES. 

10 ‘‘(a) IN GENERAL.—The principal amount of the 

11 guaranteed loan, when added to any Federal grant assist12 ance made under this subtitle, may not exceed 95 percent 

13 of the total value of the project, including land. 

14 ‘‘(b) GUARANTEES PROVIDED MAY NOT SUPPLANT

15 OTHER FUNDS.—Guarantees provided under this chapter 

16 may not be used to supplant other forms of State or local 

17 support. 

18 ‘‘(c) RIGHT TO RECOVER FUNDS.—The United 

19 States shall be entitled to recover from any applicant 

20 healthcare facility the amount of payments made pursuant 

21 to any loan guarantee under this chapter, unless the Trust 

22 Fund Board for good cause waives its right of recovery, 

23 and the United States shall, upon making any such pay24 ment pursuant to any such loan guarantee be subrogated 

25 to all of the rights of the recipients of the payments. 
395 

•HR 3561 IH 

1 ‘‘(d) MODIFICATION OF TERMS.—Loan guarantees 

2 made under this chapter shall be subject to further terms 

3 and conditions as the Trust Fund Board determines to 

4 be necessary to assure that the purposes of this Act will 

5 be achieved, and any such terms and conditions may be 

6 modified by the Trust Fund Board to the extent that it 

7 determines such modifications to be consistent with the 

8 financial interest of the United States. 

9 ‘‘(e) TERMS ARE INCONTESTABLE ABSENT FRAUD

10 OR MISREPRESENTATION.—Any loan guarantee made by 

11 the Trust Fund Board pursuant to this chapter shall be 

12 incontestable in the hands of an applicant on whose behalf 

13 such guarantee is made, and as to any person who makes 

14 or contracts to make a loan to such applicant in reliance 

15 thereon, except for fraud or misrepresentation on the part 

16 of such applicant or other person. 

17 ‘‘SEC. 2953D. PREMIUMS FOR LOAN GUARANTEES. 

18 ‘‘(a) IN GENERAL.—The Trust Fund Board shall de19 termine a reasonable loan insurance premium which shall 

20 be charged for loan guarantees under this chapter, taking 

21 into account the availability of the reserves created under 

22 section 2953B. Premium charges shall be payable in cash 

23 to the Trust Fund Board, either in full upon issuance, 

24 or annually in advance. In addition to the premium charge 

25 herein provided for, the Trust Fund Board is authorized 
396 

•HR 3561 IH 

1 to charge and collect such amount as it may deem reason2 able for the appraisal of a property or project offered for 

3 insurance and for the inspection of such property or 

4 project. 

5 ‘‘(b) PAYMENT IN ADVANCE.—In the event that the 

6 principal obligation of any loan accepted for insurance 

7 under this chapter is paid in full prior to the maturity 

8 date, the Trust Fund Board is authorized in its discretion 

9 to require the payment by the borrower of an adjusted 

10 premium charge in such amount as the Board determines 

11 to be equitable, but not in excess of the aggregate amount 

12 of the premium charges that the healthcare facility would 

13 otherwise have been required to pay if the loan had contin14 ued to be insured until maturity date. 

15 ‘‘(c) TRUST FUND BOARD MAY WAIVE PREMIUMS.— 

16 The Trust Fund Board may in its discretion partially or 

17 totally waive premiums charged for loan insurance under 

18 this section for financially distressed healthcare facilities 

19 (as described by the Secretary). 

20 ‘‘SEC. 2953E. PROCEDURES IN THE EVENT OF LOAN DE21 FAULT. 

22 ‘‘(a) IN GENERAL.—Failure of the borrower to make 

23 payments due under or provided by the terms of a loan 

24 accepted for insurance under this chapter shall constitute 

25 a default. 
397 

•HR 3561 IH 

1 ‘‘(b) ASSIGNMENT OF DEFAULTED LOANS.—If a de2 fault continues for 30 days, then, upon the lender’s trans3 fer to the Trust Fund Board of all its rights and interests 

4 arising under the defaulted loan or in connection with the 

5 loan transaction, the lender shall be entitled to debentures 

6 which, together with a certificate of claim, are equal in 

7 value to the amount the lender would have received if, on 

8 the date of transfer, the borrower had repaid the loan in 

9 full, together with the amount of necessary expenses in10 curred by the lender in connection with the default. 

11 ‘‘(c) FORECLOSURE BY LENDER.—Subject to the ap12 proval of the Trust Fund Board, or as provided in regula13 tions, the lender may foreclose on the property securing 

14 the defaulted loan. 

15 ‘‘(d) FORECLOSURE BY TRUST FUND BOARD.—The 

16 Trust Fund Board is authorized to— 

17 ‘‘(1) acquire possession of and title to any prop18 erty securing a defaulted loan by voluntary convey19 ance in extinguishment of the indebtedness, or 

20 ‘‘(2) institute proceedings for foreclosure on the 

21 property securing any such defaulted loan and pros22 ecute such proceedings to conclusion. 

23 ‘‘(e) HANDLING AND DISPOSAL OF PROPERTY; SET24 TLEMENT OF CLAIMS.— 
398 

•HR 3561 IH 

1 ‘‘(1) PAYMENT FOR CERTAIN EXPENSES.—Not2 withstanding any other provision of law relating to 

3 the acquisition, handling, or disposal of real and 

4 other property by the United States, the Trust Fund 

5 Board shall also have power, for the protection of 

6 the interests of the Trust Fund, to pay out of the 

7 Trust Fund all expenses or charges in connection 

8 with, and to deal with, complete, reconstruct, rent, 

9 renovate, modernize, insure, make contracts for the 

10 management of, or establish suitable agencies for 

11 the management of, or sell for cash or credit or lease 

12 in its discretion, any property acquired by the Trust 

13 Fund under this section. 

14 ‘‘(2) SETTLEMENT OF CLAIMS.—Notwith15 standing any other provision of law, the Trust Fund 

16 Board shall also have the power to pursue to final 

17 collection by way of compromise or otherwise all 

18 claims assigned and transferred to the Trust Fund 

19 in connection with the assignment, transfer, and de20 livery provided for in this section, and at any time, 

21 upon default, to foreclose or refrain from foreclosing 

22 on any property secured by any defaulted loan as23 signed and transferred to or held by the Trust 

24 Fund. 
399 

•HR 3561 IH 

1 ‘‘(3) LIMITATIONS ON AUTHORITY.—Sub2 sections (a) and (b) shall not be construed to apply 

3 to any contract for hazard insurance, or to any pur4 chase or contract for services or supplies on account 

5 of such property if the amount thereof does not ex6 ceed $1,000. 

7 ‘‘(f) REGULATIONS.—The Trust Fund Board shall 

8 propose and the Secretary shall promulgate regulations 

9 governing procedures in the event of a default on a loan 

10 accepted for insurance under this chapter. 

11 ‘‘Subchapter C—Grants for Urgent Capital 

12 Needs 

13 ‘‘SEC. 2956. PROVISION OF GRANTS. 

14 ‘‘(a) IN GENERAL.—The Trust Fund Board shall 

15 make available $400,000,000 in direct grants annually. 

16 The Secretary, with the approval of the Trust Fund 

17 Board, shall make direct grants to eligible healthcare fa18 cilities with urgent capital needs. 

19 ‘‘(b) PURPOSES.—Direct grants shall be available to 

20 eligible healthcare facilities for 3 types of projects: 

21 ‘‘(1) Emergency certification and licensure 

22 grants would be available to eligible healthcare facili23 ties that are threatened with closure or loss of ac24 creditation or certification of a facility or of essential 

25 services as a result of life or safety code violations 
400 

•HR 3561 IH 

1 or similar facility or equipment failures. Such grants 

2 would provide limited funding for repair and renova3 tion where failure to fund would disrupt the provi4 sion of essential public health services such as emer5 gency care. 

6 ‘‘(2) Emergency grants would be available for 

7 capital renovation, expansion, or replacement nec8 essary to the maintenance or expansion of essential 

9 safety and health services such as obstetrics, 

10 perinatal, emergency and trauma, primary care and 

11 preventive health services. 

12 ‘‘(3) Planning grants would be available to eli13 gible healthcare facilities who require pre-approval 

14 assistance to meet regulatory requirements related 

15 to management and finance in order to apply for 

16 loans, loan guarantees, and interest subsidies under 

17 this subtitle. 

18 ‘‘(c) PRIORITY TO FINANCIALLY DISTRESSED

19 HEALTHCARE FACILITIES.—Priority for direct grants 

20 under this section would be given to financially distressed 

21 healthcare facilities (as described by the Secretary). 

22 ‘‘(d) APPLICATION PROCESS.—The Secretary, with 

23 the approval of the Trust Fund Board, shall create an 

24 expedited application process for direct grants. 
401 

•HR 3561 IH 

1 ‘‘SEC. 2956A. ELIGIBLE PROJECTS. 

2 ‘‘(a) MATCHING GRANTS.— 

3 ‘‘(1) LIMITATION ON AMOUNT.—Grants for cap4 ital expenditures by eligible healthcare facilities will 

5 be limited to $25,000,000. 

6 ‘‘(2) MATCHING REQUIREMENT.—At least half 

7 of the projects funded in a year must receive at least 

8 50 percent of their funding from State or local 

9 sources. The remaining projects funded during the 

10 year could be financed up to 90 percent with a com11 bination of Federal grants and loans. 

12 ‘‘(3) RESERVATION FOR RURAL HEALTHCARE

13 FACILITIES.—No less than 20 percent of the grant 

14 funds in any given year would be reserved for rural 

15 healthcare facilities, provided that a sufficient num16 ber of applications are approved. 

17 ‘‘(b) PLANNING GRANTS.—Applicants who can dem18 onstrate general qualification for the direct matching loan, 

19 loan guarantee, or interest subsidy programs under this 

20 subtitle or eligibility for mortgage insurance under section 

21 242 of the National Housing Act will be eligible for a 

22 grant of up to $500,000 to assist in implementation of 

23 key budgetary and financial systems as well as manage24 ment and governance restructuring.’’. 
402 

•HR 3561 IH 

1 SEC. 702. ESTABLISHMENT OF ALEJANDRO GARCIA NA2 TIONAL CENTER FOR SOCIAL WORK RE3 SEARCH. 

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

5 290aa et seq.) is amended by adding at the end the fol6 lowing: 

7 ‘‘PART J—ALEJANDRO GARCIA NATIONAL 

8 CENTER FOR SOCIAL WORK RESEARCH 

9 ‘‘SEC. 597. PURPOSE OF CENTER. 

10 ‘‘The general purpose of the Alejandro Garcia Na11 tional Center for Social Work Research (referred to in this 

12 part as the ‘Center’) is the conduct and support of, and 

13 dissemination of targeted research on social work methods 

14 and outcomes related to problems of significant social con15 cern. The Center shall promote research and training de16 signed to inform social work practice, thus increasing the 

17 knowledge base which promotes a healthier America. In 

18 addition, the Center shall provide policymakers with em19 pirically-based research information to better understand 

20 complex social issues and make informed funding decisions 

21 about service effectiveness and cost efficiency. 

22 ‘‘SEC. 597A. SPECIFIC AUTHORITIES. 

23 ‘‘(a) IN GENERAL.—To carry out the purpose de24 scribed in section 597, the Director of the Center may pro25 vide research training and instruction and establish, in the 

26 Center and in other nonprofit institutions, research 
403 

•HR 3561 IH 

1 traineeships and fellowships in the study and investigation 

2 of the prevention of disease, health promotion, the associa3 tion of socioeconomic status, gender, ethnicity, age, and 

4 geographical location and health, the social work care of 

5 persons with and families of individuals with acute and 

6 chronic illnesses, child abuse, neglect, and youth violence, 

7 and child and family care to address problems of signifi8 cant social concern especially in underserved populations 

9 and underserved geographical areas. 

10 ‘‘(b) STIPENDS AND ALLOWANCES.—The Director of 

11 the Center may provide individuals receiving training and 

12 instruction or traineeships or fellowships under subsection 

13 (a) with such stipends and allowances (including amounts 

14 for travel and subsistence and dependency allowances) as 

15 the Director determines necessary. 

16 ‘‘(c) GRANTS.—The Director of the Center may make 

17 grants to nonprofit institutions to provide training and in18 struction and traineeships and fellowships under sub19 section (a). 

20 ‘‘SEC. 597B. ADVISORY COUNCIL. 

21 ‘‘(a) DUTIES.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall estab23 lish an advisory council for the Center that shall ad24 vise, assist, consult with, and make recommenda25 tions to the Secretary and the Director of the Center 
404 

•HR 3561 IH 

1 on matters related to the activities carried out by 

2 and through the Center and the policies with respect 

3 to such activities. 

4 ‘‘(2) GIFTS.—The advisory council for the Cen5 ter may recommend to the Secretary the acceptance, 

6 in accordance with section 231, of conditional gifts 

7 for study, investigations, and research and for the 

8 acquisition of grounds or construction, equipment, or 

9 maintenance of facilities for the Center. 

10 ‘‘(3) OTHER DUTIES AND FUNCTIONS.—The 

11 advisory council for the Center— 

12 ‘‘(A)(i) may make recommendations to the 

13 Director of the Center with respect to research 

14 to be conducted by the Center; 

15 ‘‘(ii) may review applications for grants 

16 and cooperative agreements for research or 

17 training and recommend for approval applica18 tions for projects that demonstrate the prob19 ability of making valuable contributions to 

20 human knowledge; and 

21 ‘‘(iii) may review any grant, contract, or 

22 cooperative agreement proposed to be made or 

23 entered into by the Center; 

24 ‘‘(B) may collect, by correspondence or by 

25 personal investigation, information relating to 
405 

•HR 3561 IH 

1 studies that are being carried out in the United 

2 States or any other country and, with the ap3 proval of the Director of the Center, make such 

4 information available through appropriate publi5 cations; and 

6 ‘‘(C) may appoint subcommittees and con7 vene workshops and conferences. 

8 ‘‘(b) MEMBERSHIP.— 

9 ‘‘(1) IN GENERAL.—The advisory council shall 

10 be composed of the ex officio members described in 

11 paragraph (2) and not more than 18 individuals to 

12 be appointed by the Secretary under paragraph (3). 

13 ‘‘(2) EX OFFICIO MEMBERS.—The ex officio 

14 members of the advisory council shall include— 

15 ‘‘(A) the Secretary of Health and Human 

16 Services, the Director of NIH, the Director of 

17 the Center, the Director of the Office of Behav18 ioral and Social Sciences Research, the Chief 

19 Social Work Officer of the Veterans’ Adminis20 tration, the Assistant Secretary of Defense for 

21 Health Affairs, the Associate Director of Pre22 vention Research at the National Institute of 

23 Mental Health, the Director of the Centers for 

24 Disease Control and Prevention, the Director of 

25 the Division of Epidemiology and Services Re-
406 

•HR 3561 IH 

1 search, the Assistant Secretary of Health and 

2 Human Services for the Administration for 

3 Children and Families, the Assistant Secretary 

4 of Education for the Office of Educational Re5 search and Improvement, the Assistant Sec6 retary of Housing and Urban Development for 

7 Community Planning and Development, and the 

8 Assistant Attorney General for Office of Justice 

9 Programs (or the designees of such officers); 

10 and 

11 ‘‘(B) such additional officers or employees 

12 of the United States as the Secretary deter13 mines necessary for the advisory council to ef14 fectively carry out its functions. 

15 ‘‘(3) APPOINTED MEMBERS.—The Secretary 

16 shall appoint not to exceed 18 individuals to the ad17 visory council, of which— 

18 ‘‘(A) not more than two-thirds of such in19 dividual shall be appointed from among the 

20 leading representatives of the health and sci21 entific disciplines (including public health and 

22 the behavioral or social sciences) relevant to the 

23 activities of the Center, and at least 7 such in24 dividuals shall be professional social workers 
407 

•HR 3561 IH 

1 who are recognized experts in the area of clin2 ical practice, education, policy, or research; and 

3 ‘‘(B) not more than one-third of such indi4 viduals shall be appointed from the general 

5 public and shall include leaders in fields of pub6 lic policy, law, health policy, economics, and 

7 management. 

8 The Secretary shall make appointments to the advi9 sory council in such a manner as to ensure that the 

10 terms of the members do not all expire in the same 

11 year. 

12 ‘‘(4) COMPENSATION.—Members of the advi13 sory council who are officers or employees of the 

14 United States shall not receive any compensation for 

15 service on the advisory council. The remaining mem16 bers shall receive, for each day (including travel 

17 time) they are engaged in the performance of the 

18 functions of the advisory council, compensation at 

19 rates not to exceed the daily equivalent of the annual 

20 rate in effect for an individual at grade GS–18 of 

21 the General Schedule. 

22 ‘‘(c) TERMS.— 

23 ‘‘(1) IN GENERAL.—The term of office of an in24 dividual appointed to the advisory council under sub25 section (b)(3) shall be 4 years, except that any indi-
408 

•HR 3561 IH 

1 vidual appointed to fill a vacancy on the advisory 

2 council shall serve for the remainder of the unex3 pired term. A member may serve after the expiration 

4 of the member’s term until a successor has been ap5 pointed. 

6 ‘‘(2) REAPPOINTMENTS.—A member of the ad7 visory council who has been appointed under sub8 section (b)(3) for a term of 4 years may not be re9 appointed to the advisory council prior to the expira10 tion of the 2-year period beginning on the date on 

11 which the prior term expired. 

12 ‘‘(3) VACANCY.—If a vacancy occurs on the ad13 visory council among the members under subsection 

14 (b)(3), the Secretary shall make an appointment to 

15 fill that vacancy not later than 90 days after the 

16 date on which the vacancy occurs. 

17 ‘‘(d) CHAIRPERSON.—The chairperson of the advi18 sory council shall be selected by the Secretary from among 

19 the members appointed under subsection (b)(3), except 

20 that the Secretary may select the Director of the Center 

21 to be the chairperson of the advisory council. The term 

22 of office of the chairperson shall be 2 years. 

23 ‘‘(e) MEETINGS.—The advisory council shall meet at 

24 the call of the chairperson or upon the request of the Di25 rector of the Center, but not less than 3 times each fiscal 
409 

•HR 3561 IH 

1 year. The location of the meetings of the advisory council 

2 shall be subject to the approval of the Director of the Cen3 ter. 

4 ‘‘(f) ADMINISTRATIVE PROVISIONS.—The Director of 

5 the Center shall designate a member of the staff of the 

6 Center to serve as the executive secretary of the advisory 

7 council. The Director of the Center shall make available 

8 to the advisory council such staff, information, and other 

9 assistance as the council may require to carry out its func10 tions. The Director of the Center shall provide orientation 

11 and training for new members of the advisory council to 

12 provide such members with such information and training 

13 as may be appropriate for their effective participation in 

14 the functions of the advisory council. 

15 ‘‘(g) COMMENTS AND RECOMMENDATIONS.—The ad16 visory council may prepare, for inclusion in the biennial 

17 report under section 597C— 

18 ‘‘(1) comments with respect to the activities of 

19 the advisory council in the fiscal years for which the 

20 report is prepared; 

21 ‘‘(2) comments on the progress of the Center in 

22 meeting its objectives; and 

23 ‘‘(3) recommendations with respect to the fu24 ture direction and program and policy emphasis of 

25 the center. 
410 

•HR 3561 IH 

1 The advisory council may prepare such additional reports 

2 as it may determine appropriate. 

3 ‘‘SEC. 597C. BIENNIAL REPORT. 

4 ‘‘The Director of the Center, after consultation with 

5 the advisory council for the Center, shall prepare for inclu6 sion in the biennial report under section 403, a biennial 

7 report that shall consist of a description of the activities 

8 of the Center and program policies of the Director of the 

9 Center in the fiscal years for which the report is prepared. 

10 The Director of the Center may prepare such additional 

11 reports as the Director determines appropriate. The Di12 rector of the Center shall provide the advisory council of 

13 the Center an opportunity for the submission of the writ14 ten comments described in section 597B(g). 

15 ‘‘SEC. 597D. QUARTERLY REPORT. 

16 ‘‘The Director of the Center shall prepare a quarterly 

17 report to Congress with a summary of findings and policy 

18 implications from research conducted or supported 

19 through the Center. 

20 ‘‘SEC. 597E. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘For the purpose of carrying out this part, there is 

22 authorized to be appropriated $30,000,000 for each of the 

23 fiscal years 2006 through 2010.’’. 
411 

•HR 3561 IH 

1 SEC. 703. ANNIE DODGE WAUNEKA AND SUSAN LAFLESCHE2 PICOTTE NATIVE AMERICAN HEALTH AND 

3 WELLNESS FOUNDATION. 

4 (a) IN GENERAL.—The Indian Self-Determination 

5 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

6 amended by adding at the end the following: 

7 ‘‘TITLE VIII—ANNIE DODGE 

8 WAUNEKA AND SUSAN 

9 LAFLESCHE-PICOTTE NATIVE 

10 AMERICAN HEALTH AND 

11 WELLNESS FOUNDATION 

12 ‘‘SEC. 801. DEFINITIONS. 

13 ‘‘In this title: 

14 ‘‘(1) BOARD.—The term ‘Board’ means the 

15 Board of Directors of the Foundation. 

16 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

17 means the Committee for the Establishment of the 

18 Annie Dodge Wauneka and Susan Laflesche-Picotte 

19 Native American Health and Wellness Foundation 

20 established under section 802(f). 

21 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

22 means the Annie Dodge Wauneka and Susan 

23 Laflesche-Picotte Native American Health and 

24 Wellness Foundation established under section 802. 

25 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

26 the Secretary of Health and Human Services. 
412 

•HR 3561 IH 

1 ‘‘(5) SERVICE.—The term ‘Service’ means the 

2 Indian Health Service of the Department of Health 

3 and Human Services. 

4 ‘‘SEC. 802. ANNIE DODGE WAUNEKA AND SUSAN 

5 LAFLESCHE-PICOTTE NATIVE AMERICAN 

6 HEALTH AND WELLNESS FOUNDATION. 

7 ‘‘(a) IN GENERAL.—As soon as practicable after the 

8 date of enactment of this title, the Secretary shall estab9 lish, under the laws of the District of Columbia and in 

10 accordance with this title, the Annie Dodge Wauneka and 

11 Susan Laflesche-Picotte Native American Health and 

12 Wellness Foundation. 

13 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

14 shall have perpetual existence. 

15 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

16 ‘‘(1) shall be a charitable and nonprofit feder17 ally chartered corporation; and 

18 ‘‘(2) shall not be an agency or instrumentality 

19 of the United States. 

20 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

21 The Foundation shall be incorporated and domiciled in the 

22 District of Columbia. 

23 ‘‘(e) DUTIES.—The Foundation shall— 

24 ‘‘(1) encourage, accept, and administer private 

25 gifts of real and personal property, and any income 
413 

•HR 3561 IH 

1 from or interest in such gifts, for the benefit of, or 

2 in support of, the mission of the Service; 

3 ‘‘(2) undertake and conduct such other activi4 ties as will further the health and wellness activities 

5 and opportunities of Native Americans; and 

6 ‘‘(3) participate with and assist Federal, State, 

7 and tribal governments, agencies, entities, and indi8 viduals in undertaking and conducting activities that 

9 will further the health and wellness activities and op10 portunities of Native Americans. 

11 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF THE

12 ANNIE DODGE WAUNEKA AND SUSAN LAFLESCHE13 PICOTTE NATIVE AMERICAN HEALTH AND WELLNESS

14 FOUNDATION.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall estab16 lish the Committee for the Establishment of the 

17 Annie Dodge Wauneka and Susan Laflesche-Picotte 

18 Native American Health and Wellness Foundation 

19 to assist the Secretary in establishing the Founda20 tion. 

21 ‘‘(2) DUTIES.—Not later than 180 days after 

22 the date of enactment of this section, the Committee 

23 shall— 

24 ‘‘(A) carry out such activities as are nec25 essary to incorporate the Foundation under the 
414 

•HR 3561 IH 

1 laws of the District of Columbia, including act2 ing as incorporators of the Foundation; 

3 ‘‘(B) ensure that the Foundation qualifies 

4 for and maintains the status required to carry 

5 out this section, until the Board is established; 

6 ‘‘(C) establish the constitution and initial 

7 bylaws of the Foundation; 

8 ‘‘(D) provide for the initial operation of 

9 the Foundation, including providing for tem10 porary or interim quarters, equipment, and 

11 staff; and 

12 ‘‘(E) appoint the initial members of the 

13 Board in accordance with the constitution and 

14 initial bylaws of the Foundation. 

15 ‘‘(g) BOARD OF DIRECTORS.— 

16 ‘‘(1) IN GENERAL.—The Board of Directors 

17 shall be the governing body of the Foundation. 

18 ‘‘(2) POWERS.—The Board may exercise, or 

19 provide for the exercise of, the powers of the Foun20 dation. 

21 ‘‘(3) SELECTION.— 

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), the number of members of the 

24 Board, the manner of selection of the members 

25 (including the filling of vacancies), and the 
415 

•HR 3561 IH 

1 terms of office of the members shall be as pro2 vided in the constitution and bylaws of the 

3 Foundation. 

4 ‘‘(B) REQUIREMENTS.— 

5 ‘‘(i) NUMBER OF MEMBERS.—The 

6 Board shall have at least 11 members, who 

7 shall have staggered terms. 

8 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

9 initial voting members of the Board— 

10 ‘‘(I) shall be appointed by the 

11 Committee not later than 180 days 

12 after the date on which the Founda13 tion is established; and 

14 ‘‘(II) shall have staggered terms. 

15 ‘‘(iii) QUALIFICATION.—The members 

16 of the Board shall be United States citi17 zens who are knowledgeable or experienced 

18 in Native American health care and related 

19 matters. 

20 ‘‘(C) COMPENSATION.—A member of the 

21 Board shall not receive compensation for service 

22 as a member, but shall be reimbursed for actual 

23 and necessary travel and subsistence expenses 

24 incurred in the performance of the duties of the 

25 Foundation. 
416 

•HR 3561 IH 

1 ‘‘(h) OFFICERS.— 

2 ‘‘(1) IN GENERAL.—The officers of the Founda3 tion shall be— 

4 ‘‘(A) a secretary, elected from among the 

5 members of the Board; and 

6 ‘‘(B) any other officers provided for in the 

7 constitution and bylaws of the Foundation. 

8 ‘‘(2) SECRETARY.—The secretary of the Foun9 dation shall serve, at the direction of the Board, as 

10 the chief operating officer of the Foundation. 

11 ‘‘(3) ELECTION.—The manner of election, term 

12 of office, and duties of the officers of the Founda13 tion shall be as provided in the constitution and by14 laws of the Foundation. 

15 ‘‘(i) POWERS.—The Foundation— 

16 ‘‘(1) shall adopt a constitution and bylaws for 

17 the management of the property of the Foundation 

18 and the regulation of the affairs of the Foundation; 

19 ‘‘(2) may adopt and alter a corporate seal; 

20 ‘‘(3) may enter into contracts; 

21 ‘‘(4) may acquire (through a gift or otherwise), 

22 own, lease, encumber, and transfer real or personal 

23 property as necessary or convenient to carry out the 

24 purposes of the Foundation; 

25 ‘‘(5) may sue and be sued; and 
417 

•HR 3561 IH 

1 ‘‘(6) may perform any other act necessary and 

2 proper to carry out the purposes of the Foundation. 

3 ‘‘(j) PRINCIPAL OFFICE.— 

4 ‘‘(1) IN GENERAL.—The principal office of the 

5 Foundation shall be in the District of Columbia. 

6 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

7 the Foundation may be conducted, and offices may 

8 be maintained, throughout the United States in ac9 cordance with the constitution and bylaws of the 

10 Foundation. 

11 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

12 comply with the law on service of process of each State 

13 in which the Foundation is incorporated and of each State 

14 in which the Foundation carries on activities. 

15 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

16 AGENTS.— 

17 ‘‘(1) IN GENERAL.—The Foundation shall be 

18 liable for the acts of the officers, employees, and 

19 agents of the Foundation acting within the scope of 

20 their authority. 

21 ‘‘(2) PERSONAL LIABILITY.—A member of the 

22 Board shall be personally liable only for gross neg23 ligence in the performance of the duties of the mem24 ber. 

25 ‘‘(m) RESTRICTIONS.— 
418 

•HR 3561 IH 

1 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

2 with the fiscal year following the first full fiscal year 

3 during which the Foundation is in operation, the ad4 ministrative costs of the Foundation shall not exceed 

5 10 percent of the sum of— 

6 ‘‘(A) the amounts transferred to the Foun7 dation under subsection (o) during the pre8 ceding fiscal year; and 

9 ‘‘(B) donations received from private 

10 sources during the preceding fiscal year. 

11 ‘‘(2) APPOINTMENT AND HIRING.— 

12 ‘‘(A) IN GENERAL.—The appointment of 

13 officers and employees of the Foundation shall 

14 be subject to the availability of funds. 

15 ‘‘(B) KNOWLEDGE OF RESERVATION GOV16 ERNANCE AND SOCIAL LIFE.—The Secretary 

17 shall encourage the Foundation to hire individ18 uals who have an extensive knowledge of res19 ervation governance and social life. 

20 ‘‘(3) STATUS.—A member of the Board or offi21 cer, employee, or agent of the Foundation shall not 

22 by reason of association with the Foundation be con23 sidered to be an officer, employee, or agent of the 

24 United States. 
419 

•HR 3561 IH 

1 ‘‘(n) AUDITS.—The Foundation shall comply with 

2 section 10101 of title 36, United States Code, as if the 

3 Foundation were a corporation under part B of subtitle 

4 II of that title. 

5 ‘‘(o) FUNDING.— 

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

7 There is authorized to be appropriated to carry out 

8 subsection (e)(1) $1,000,000 for each fiscal year, as 

9 adjusted to reflect changes in the Consumer Price 

10 Index for all-urban consumers published by the De11 partment of Labor. 

12 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

13 Secretary shall transfer to the Foundation funds 

14 held by the Department of Health and Human Serv15 ices under the Act of August 5, 1954 (42 U.S.C. 

16 2001 et seq.), if the transfer or use of the funds is 

17 not prohibited by any term under which the funds 

18 were donated. 

19 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

20 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub21 ject to subsection (b), during the 5-year period beginning 

22 on the date on which the Foundation is established, the 

23 Secretary— 

24 ‘‘(1) may provide personnel, facilities, and other 

25 administrative support services to the Foundation; 
420 

•HR 3561 IH 

1 ‘‘(2) may provide funds to reimburse the travel 

2 expenses of the members of the Board; and 

3 ‘‘(3) shall require and accept reimbursements 

4 from the Foundation for— 

5 ‘‘(A) services provided under paragraph 

6 (1); and 

7 ‘‘(B) funds provided under paragraph (2). 

8 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

9 under subsection (a)(3)— 

10 ‘‘(1) shall be deposited in the Treasury of the 

11 United States to the credit of the applicable appro12 priations account; and 

13 ‘‘(2) shall be chargeable for the cost of pro14 viding services described in subsection (a)(1) and 

15 travel expenses described in subsection (a)(2). 

16 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

17 Secretary may continue to provide facilities and necessary 

18 support services to the Foundation after the termination 

19 of the 5-year period specified in subsection (a) if the facili20 ties and services— 

21 ‘‘(1) are available; and 

22 ‘‘(2) are provided on reimbursable cost basis.’’. 

23 (b) TECHNICAL AMENDMENTS.—The Indian Self-De24 termination and Education Assistance Act is amended— 
421 

•HR 3561 IH 

1 (1) by redesignating title V (as added by sec2 tion 1302 of the American Indian Education Foun3 dation Act of 2000) (25 U.S.C. 458bbb et seq.)) as 

4 title VII; 

5 (2) by redesignating sections 501, 502, and 503 

6 (as added by section 1302 of the American Indian 

7 Education Foundation Act of 2000) as sections 701, 

8 702, and 703, respectively; and 

9 (3) in subsection (a)(2) of section 702 and 

10 paragraph (2) of section 703 (as redesignated by 

11 paragraph (2)), by striking ‘‘section 501’’ and in12 serting ‘‘section 701’’. 

13 Subtitle B—Rural and Underserved 

14 Urban America Telehealth Pro15 grams 

16 SEC. 711. INCREASING TYPES OF ORIGINATING TELE17 HEALTH SITES AND FACILITATING THE PRO18 VISION OF TELEHEALTH SERVICES ACROSS 

19 STATE LINES. 

20 (a) INCREASING TYPES OF ORIGINATING SITES.— 

21 Section 1834(m)(4)(C)(ii) of the Social Security Act (42 

22 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 

23 end the following: 

24 ‘‘(VI) A skilled nursing facility 

25 (as defined in section 1819(a)). 
422 

•HR 3561 IH 

1 ‘‘(VII) An assisted-living facility 

2 (as defined by the Secretary). 

3 ‘‘(VIII) A board-and-care home 

4 (as defined by the Secretary). 

5 ‘‘(IX) A county or community 

6 health clinic (as defined by the Sec7 retary). 

8 ‘‘(X) A community mental health 

9 center (as described in section 

10 1861(ff)(2)(B)). 

11 ‘‘(XI) A facility operated by the 

12 Indian Health Service or by an Indian 

13 tribe, tribal organization, or an urban 

14 Indian organization (as such terms 

15 are defined in section 4 of the Indian 

16 Health Care Improvement Act (25 

17 U.S.C. 1603)) directly, or under con18 tract or other arrangement. 

19 ‘‘(XII) A site in a State in which 

20 the respective State medical board has 

21 adopted a formal policy regarding li22 censing or certification requirements 

23 for providers at distant sites who do 

24 not have a license to practice medicine 

25 at the originating site.’’. 
423 

•HR 3561 IH 

1 (b) EXPANDING ELIGIBILITY FOR REIMBURSE2 MENT.—Section 1834(m)(4)(C)(i)(I) of the Social Secu3 rity Act (42 U.S.C. 1395m(m)(4)(C)(i)(I)) is amended by 

4 striking ‘‘rural’’. 

5 SEC. 712. STRENGTHENING TELEHEALTH SERVICES IN 

6 RURAL AND UNDERSERVED URBAN AMERICA. 

7 Subpart I of part D of title III of the Public Health 

8 Service Act (42 U.S.C. 254b et seq.) is amended— 

9 (1) in section 330L— 

10 (A) by redesignating subsection (b) as sub11 section (c); and 

12 (B) by inserting after subsection (a) the 

13 following: 

14 ‘‘(b) CONFERENCE.—Within 1 year of the date of en15 actment of the Telehealth Improvement Act of 2004, the 

16 Secretary shall convene a conference of State licensing 

17 boards, local telehealth projects, health care practitioners, 

18 and patient advocates to promote interstate licensure for 

19 telehealth projects.’’; and 

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

21 ‘‘SEC. 330M. INTEGRATIVE ELDERCARE TELEHEALTH DEM22 ONSTRATION PROJECT. 

23 ‘‘(a) PURPOSES.—The purposes of this section are to 

24 encourage the creation of programs to— 
424 

•HR 3561 IH 

1 ‘‘(1) evaluate the use of telehealth services in 

2 an integrative eldercare setting; 

3 ‘‘(2) eliminate fragmented service delivery while 

4 promoting enhanced continuity of care and more 

5 simplified access to services; 

6 ‘‘(3) develop community-based options that pro7 mote patient independence and leverage telehealth 

8 services and equipment to enable the use of the most 

9 cost-effective, least restrictive care settings; and 

10 ‘‘(4) promote access for elderly patients in rural 

11 and underserved urban areas to improvements in 

12 medical technology and training across an integrated 

13 spectrum of care; and to make health care services 

14 more flexible and responsive to the diverse and 

15 changing needs of elderly patients in rural areas. 

16 ‘‘(b) GRANTS AUTHORIZED.— 

17 ‘‘(1) IN GENERAL.—The Director may award 

18 grants to eligible providers for projects to dem19 onstrate how telehealth technologies can be used 

20 through telehealth networks in rural areas, frontier 

21 communities, and medically underserved areas, and 

22 for medically underserved populations, to— 

23 ‘‘(A) expand access to, coordinate, and im24 prove the quality of health care services; 
425 

•HR 3561 IH 

1 ‘‘(B) improve and expand the training of 

2 health care providers; and 

3 ‘‘(C) expand and improve the quality of 

4 health information available to health care pro5 viders, and patients and their families, for deci6 sionmaking. 

7 ‘‘(2) GRANT PERIOD.—The Director shall 

8 award grants under this subsection for a period of 

9 up to 4 years. 

10 ‘‘(3) NUMBER OF GRANTS.—Not to exceed 20 

11 grants shall be awarded under this subsection, of 

which at least 1 12 ⁄2 shall be dedicated to providing 

13 services in rural communities. 

14 ‘‘(c) USE OF FUNDS.—Grants awarded pursuant to 

15 subsection (b) may be used for activities including— 

16 ‘‘(1) improving access to coordinated health 

17 care services at the lowest intensity and resource 

18 level of care consistent with quality health care serv19 ices and optimal patient outcomes, improving the 

20 quality of such care, increasing patient satisfaction 

21 with such care, and reducing the cost of such care 

22 through advanced telecommunication technologies; 

23 ‘‘(2) developing effective care management 

24 practices and educational curricula to train health 

25 care professionals, paraprofessionals, and caregivers, 
426 

•HR 3561 IH 

1 including family members, and to increase the gen2 eral level of competency of such individuals through 

3 such training; and 

4 ‘‘(3) developing curricula to train health care 

5 professionals, paraprofessionals, and caregivers, in6 cluding family members, serving integrative 

7 eldercare patients in the use of telecommunications. 

8 ‘‘(d) APPLICATIONS.—To be eligible to receive a 

9 grant under subsection (b), an eligible provider, in con10 sultation with the appropriate State office of rural health 

11 or another appropriate State entity, shall prepare and sub12 mit to the Director an application, at such time, in such 

13 manner, and containing such information as the Director 

14 may require, including— 

15 ‘‘(1) a description of the project that the eligi16 ble entity will carry out using the funds provided 

17 under the grant; 

18 ‘‘(2) a description of the manner in which the 

19 project funded under the grant will meet the health 

20 care needs of rural or other populations to be served 

21 through the project, or improve the access to serv22 ices of, and the quality of the services received by, 

23 those populations; 

24 ‘‘(3) evidence of local support for the project, 

25 and a description of how the areas, communities, or 
427 

•HR 3561 IH 

1 populations to be served will be involved in the devel2 opment and ongoing operations of the project; 

3 ‘‘(4) a plan for sustaining the project after Fed4 eral support for the project has ended; 

5 ‘‘(5) information on the source and amount of 

6 non-Federal funds that the entity will provide for 

7 the project; 

8 ‘‘(6) information demonstrating the long-term 

9 viability of the project, and other evidence of institu10 tional commitment of the entity to the project; 

11 ‘‘(7) in the case of an application for a project 

12 involving a telehealth network, information dem13 onstrating how the project will promote the integra14 tion of telehealth technologies into the operations of 

15 health care providers, to avoid redundancy, and im16 prove access to and the quality of care; and 

17 ‘‘(8) other such information as the Director de18 termines to be appropriate. 

19 ‘‘(e) REPORT.— 

20 ‘‘(1) FINAL REPORT.—Not later than 9 months 

21 after the date of termination of the last grant to be 

22 awarded under this section, the Director shall sub23 mit to Congress a final report— 
428 

•HR 3561 IH 

1 ‘‘(A) describing the results of the programs 

2 funded by grants awarded pursuant to this sec3 tion; and 

4 ‘‘(B) evaluating the impact of the use of 

5 telehealth services in an integrative eldercare 

6 setting on— 

7 ‘‘(i) access to care for patients served 

8 by integrative eldercare programs; and 

9 ‘‘(ii) the quality of, patient satisfac10 tion with, and the cost of, such care. 

11 ‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 

12 conducting the evaluation under paragraph (1)(B), 

13 the Director shall— 

14 ‘‘(A) give special consideration to the im15 pact of programs funded under this section on 

16 face-to-face access to medical providers; and 

17 ‘‘(B) develop specific measures to evaluate 

18 the quality of care provided to those partici19 pating in such programs to ensure that tele20 health augments the plan of care. 

21 ‘‘(f) ELIGIBLE PROVIDER.—The term ‘eligible pro22 vider’ means a consortia of home and facility-based care 

23 providers that includes providers from no less than 2 of 

24 the following: 

25 ‘‘(1) An adult congregate care facility. 
429 

•HR 3561 IH 

1 ‘‘(2) A continuing care retirement community. 

2 ‘‘(3) An assisted living facility. 

3 ‘‘(4) An Alzheimer’s facility. 

4 ‘‘(5) An institutional hospice facility. 

5 ‘‘(6) A residential care facility. 

6 ‘‘(7) An adult foster home. 

7 ‘‘(8) A State-licensed nursing home, including a 

8 skilled nursing facility, an intermediate care facility, 

9 licensed home health provider or other health care 

10 provider that the Director deems appropriate and 

11 consistent with the purposes of this section. 

12 ‘‘(g) DEFINITIONS.—In this section: 

13 ‘‘(1) DIRECTOR; OFFICE.—The terms ‘Director’ 

14 and ‘Office’ mean the Director of the Office for the 

15 Advancement of Telehealth and the Office for the 

16 Advancement of Telehealth. 

17 ‘‘(2) INTEGRATIVE ELDERCARE.—The term ‘in18 tegrative eldercare’ includes case management and 

19 coordination of care for elderly patients recovering 

20 from acute illness or coping with chronic disease at 

21 the lowest intensity and resource level of care con22 sistent with quality health care services and optimal 

23 patient outcomes. 
430 

•HR 3561 IH 

1 ‘‘(3) TELEHEALTH SERVICES.—The term ‘tele2 health services’ means services provided through 

3 telehealth technologies. 

4 ‘‘(4) TELEHEALTH TECHNOLOGIES.—The term 

5 ‘telehealth technologies’ means technologies relating 

6 to the use of electronic information, and tele7 communications technologies, to support and pro8 mote, at a distance, health care, patient and profes9 sional health-related education, health administra10 tion, and public health. 

11 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to the Office for the Ad13 vancement of Telehealth to carry out this section 

14 $30,000,000 for fiscal year 2006 and such sums as may 

15 be necessary for each of fiscal years 2007 through 2009. 

16 ‘‘SEC. 330N. AMERICAN INDIAN AND ALASKA NATIVE TELE17 HEALTH DEMONSTRATION PROJECT. 

18 ‘‘(a) PURPOSE.—The purpose of this section is to 

19 evaluate the use of telehealth services in areas under the 

20 jurisdiction of Indian tribes or tribal organizations, includ21 ing efforts to develop more effective case management for 

22 chronic and acute disease and preventive health care pro23 grams. 

24 ‘‘(b) GRANTS AUTHORIZED.— 
431 

•HR 3561 IH 

1 ‘‘(1) IN GENERAL.—The Director may award 

2 grants to eligible providers, individually or as part of 

3 a network of eligible providers, for the provision of 

4 telehealth services to improve patient care, prevent 

5 health care complications, improve patient outcomes, 

6 and achieve efficiencies in the delivery of care to pa7 tients who reside in areas under the jurisdiction of 

8 Indian tribes or tribal organizations. 

9 ‘‘(2) GRANT PERIOD.—The Director shall 

10 award grants under this section for a period of up 

11 to 4 years. 

12 ‘‘(3) NUMBER OF GRANTS.—Not to exceed 20 

13 grants shall be awarded under this section, of which 

at least 1 14 ⁄2 shall be dedicated to providing services 

15 in rural communities. 

16 ‘‘(c) USE OF FUNDS.—Grants awarded under this 

17 section may be used for activities including— 

18 ‘‘(1) improving access to care for home care pa19 tients served by eligible providers, improving the 

20 quality of such care, increasing patient satisfaction 

21 with such care, and reducing the cost of such care 

22 through advanced telecommunication technologies; 

23 ‘‘(2) developing effective telehealth management 

24 practices and educational curricula to train health 

25 professionals and paraprofessionals and increase 
432 

•HR 3561 IH 

1 their general level of competency through such train2 ing; and 

3 ‘‘(3) developing curricula to train health care 

4 professionals and paraprofessionals serving patients 

5 of eligible providers in the use of telecommuni6 cations. 

7 ‘‘(d) COLLABORATION.—The Director shall ensure 

8 that eligible providers receiving grants under this section 

9 collaborate to enable comparisons across programs and to 

10 share relevant, de-identified information to better facili11 tate program performance evaluation. 

12 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

13 under subsection (b), an eligible entity, in consultation 

14 with the appropriate State office of rural health or another 

15 appropriate State entity, shall prepare and submit to the 

16 Director an application, at such time, in such manner, and 

17 containing such information as the Director may require, 

18 including— 

19 ‘‘(1) a description of the project that the eligi20 ble entity will carry out using the funds provided 

21 under the grant; 

22 ‘‘(2) a description of the manner in which the 

23 project funded under the grant will meet the health 

24 care needs of rural or other populations to be served 

25 through the project, or improve the access to serv-
433 

•HR 3561 IH 

1 ices of, and the quality of the services received by, 

2 those populations; 

3 ‘‘(3) evidence of local support for the project, 

4 and a description of how the areas, communities, or 

5 populations to be served will be involved in the devel6 opment and ongoing operations of the project; 

7 ‘‘(4) a plan for sustaining the project after Fed8 eral support for the project has ended; 

9 ‘‘(5) information on the source and amount of 

10 non-Federal funds that the entity will provide for 

11 the project; 

12 ‘‘(6) information demonstrating the long-term 

13 viability of the project, and other evidence of institu14 tional commitment of the entity to the project; 

15 ‘‘(7) in the case of an application for a project 

16 involving a telehealth network, information dem17 onstrating how the project will promote the integra18 tion of telehealth technologies into the operations of 

19 health care providers, to avoid redundancy, and im20 prove access to and the quality of care; and 

21 ‘‘(8) other such information as the Director de22 termines to be appropriate. 

23 ‘‘(f) REPORT.— 

24 ‘‘(1) FINAL REPORT.—Not later than 9 months 

25 after the date of termination of the last grant to be 
434 

•HR 3561 IH 

1 awarded under this section, the Director shall sub2 mit to Congress a final report— 

3 ‘‘(A) describing the results of the programs 

4 funded by grants awarded pursuant to this sec5 tion; and 

6 ‘‘(B) evaluating the impact of telehealth 

7 services in an institutional long-term care set8 ting on— 

9 ‘‘(i) access to care for patients of eli10 gible providers; and 

11 ‘‘(ii) the quality of, patient satisfac12 tion with, and the cost of, such care. 

13 ‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 

14 conducting the evaluation under paragraph (1)(B), 

15 the Director shall— 

16 ‘‘(A) give special consideration to the im17 pact of programs funded under this section on 

18 face-to-face access to medical providers; and 

19 ‘‘(B) develop specific measures to evaluate 

20 the quality of care provided to those partici21 pating in such programs to ensure that tele22 medicine augments the plan of care. 

23 ‘‘(g) DEFINITIONS.—In this section: 

24 ‘‘(1) DIRECTOR; OFFICE.—The terms ‘Director’ 

25 and ‘Office’ mean the Director of the Office for the 
435 

•HR 3561 IH 

1 Advancement of Telehealth and the Office for the 

2 Advancement of Telehealth. 

3 ‘‘(2) ELIGIBLE PROVIDER.—The term ‘eligible 

4 provider’ includes any public or private nonprofit 

5 health care provider a majority of whose patient 

6 practice is Native American or any Indian tribe or 

7 tribal organization that provides health care services 

8 for its members. 

9 ‘‘(3) INDIAN TRIBE.—The term ‘Indian tribe’ 

10 has the meaning given such term in section 4 of the 

11 Indian Self-Determination and Education Assistance 

12 Act (25 U.S.C. 450b). 

13 ‘‘(4) NATIVE AMERICAN.—The term ‘Native 

14 American’ means a member of an Indian tribe, a 

15 Native Hawaiian (as defined in section 338K(c)), or 

16 a Native American Pacific Islander. 

17 ‘‘(5) NATIVE AMERICAN PACIFIC ISLANDER.— 

18 The term ‘Native American Pacific Islander’ means 

19 an individual who is indigenous to a United States 

20 territory or possession located in the Pacific Ocean. 

21 ‘‘(6) TRIBAL ORGANIZATION.—The term ‘tribal 

22 organization’ has the meaning given such term in 

23 section 4 of the Indian Self-Determination and Edu24 cation Assistance Act (25 U.S.C. 450b). 
436 

•HR 3561 IH 

1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $30,000,000 for fiscal year 2006 and such sums as may 

4 be necessary for each of fiscal years 2007 through 2009. 

5 ‘‘SEC. 330O. ORAL HEALTH TELEHEALTH DEMONSTRATION 

6 PROJECT. 

7 ‘‘(a) PURPOSE.—The purpose of this section is to 

8 evaluate the use of telehealth services to expand access 

9 to oral health services and improve oral health outcomes 

10 among rural and underserved urban patients. 

11 ‘‘(b) GRANTS AUTHORIZED.— 

12 ‘‘(1) IN GENERAL.—The Director is authorized 

13 to award competitive grants to eligible providers, in14 dividually or as part of a network of eligible pro15 viders, for the provision of oral health services to im16 prove patient care, prevent health care complica17 tions, improve patient outcomes, and achieve effi18 ciencies in the delivery of oral health care to patients 

19 who reside in rural areas. 

20 ‘‘(2) GRANT PERIOD.—The Director shall 

21 award grants under this section for a period of up 

22 to 4 years. 

23 ‘‘(3) NUMBER OF GRANTS.—The number of 

24 grants awarded under this section shall not exceed 

25 10 grants. 
437 

•HR 3561 IH 

1 ‘‘(c) USE OF FUNDS.—Grants awarded pursuant to 

2 subsection (b) may be used for activities including— 

3 ‘‘(1) improving access to care for rural and un4 derserved urban patients served by eligible providers, 

5 improving the quality of that care, increasing patient 

6 satisfaction with that care, and reducing the cost of 

7 that care through advanced telecommunication tech8 nologies; 

9 ‘‘(2) developing effective oral telehealth care 

10 management practices and educational curricula to 

11 train oral health professionals and paraprofessionals 

12 and increase their general level of competency 

13 through that training; and 

14 ‘‘(3) developing curricula to train health care 

15 professionals and paraprofessionals, serving rural 

16 and underserved urban patients in the use of tele17 communications. 

18 ‘‘(d) APPLICATIONS.—To be eligible to receive a 

19 grant under subsection (b), an eligible entity, in consulta20 tion with the appropriate State office of rural health or 

21 another appropriate State entity, shall prepare and submit 

22 to the Director an application, at such time, in such man23 ner, and containing such information as the Director may 

24 require, including— 
438 

•HR 3561 IH 

1 ‘‘(1) a description of the project that the eligi2 ble entity will carry out using the funds provided 

3 under the grant; 

4 ‘‘(2) a description of the manner in which the 

5 project funded under the grant will meet the health 

6 care needs of rural or other populations to be served 

7 through the project, or improve the access to serv8 ices of, and the quality of the services received by, 

9 those populations; 

10 ‘‘(3) evidence of local support for the project, 

11 and a description of how the areas, communities, or 

12 populations to be served will be involved in the devel13 opment and ongoing operations of the project; 

14 ‘‘(4) a plan for sustaining the project after Fed15 eral support for the project has ended; 

16 ‘‘(5) information on the source and amount of 

17 non-Federal funds that the entity will provide for 

18 the project; 

19 ‘‘(6) information demonstrating the long-term 

20 viability of the project, and other evidence of institu21 tional commitment of the entity to the project; 

22 ‘‘(7) in the case of an application for a project 

23 involving a telehealth network, information dem24 onstrating how the project will promote the integra25 tion of telehealth technologies into the operations of 
439 

•HR 3561 IH 

1 health care providers, to avoid redundancy, and im2 prove access to and the quality of care; and 

3 ‘‘(8) other such information as the Director de4 termines to be appropriate. 

5 ‘‘(e) REPORT.— 

6 ‘‘(1) FINAL REPORT.—Not later than 9 months 

7 after the date of termination of the last grant to be 

8 awarded under this section, the Director shall sub9 mit to Congress a final report— 

10 ‘‘(A) describing the results of the programs 

11 funded by grants awarded pursuant to this sec12 tion; and 

13 ‘‘(B) including an evaluation of the impact 

14 of the use of oral telehealth services on— 

15 ‘‘(i) access to oral health care for 

16 rural patients; and 

17 ‘‘(ii) the quality of, patient satisfac18 tion with, and the cost of, that care. 

19 ‘‘(2) ENSURING ACCESS TO QUALITY CARE.—In 

20 conducting the evaluation under paragraph (1)(B), 

21 the Director shall— 

22 ‘‘(A) give special consideration to the im23 pact of programs funded under this section on 

24 face-to-face access to medical providers; and 
440 

•HR 3561 IH 

1 ‘‘(B) develop specific measures to evaluate 

2 the quality of care provided to those partici3 pating in such programs to ensure that tele4 medicine augments the plan of care. 

5 ‘‘(f) DEFINITION OF ELIGIBLE PROVIDER.—In this 

6 section the term ‘eligible provider’ includes dentists, 

7 periodontists, orthodontists, dental and oral health clinics, 

8 and schools of dentistry and oral health, where a majority 

9 of the patient population resides in a rural area, and may 

10 include other rural oral health providers that the Director 

11 deems appropriate. 

12 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 $30,000,000 for fiscal year 2006 and such sums as may 

15 be necessary for each of fiscal years 2007 through 2009.’’. 

16 SEC. 713. JOINT WORKING GROUP ON TELEHEALTH. 

17 (a) IN GENERAL.— 

18 (1) REPRESENTATION OF RURAL AREAS.—The 

19 Secretary of Health and Human Services shall es20 tablish, within the Health Resources and Services 

21 Administration Office for the Advancement of Tele22 health, and under the leadership of the Director of 

23 the Office for the Advancement of Telehealth, a 

24 Joint Working Group on Telehealth. In establishing 

25 such Group, the Secretary shall ensure that all rel-
441 

•HR 3561 IH 

1 evant Federal agencies are represented and that 

2 input from relevant industry groups, including rep3 resentatives of rural areas and medically under4 served areas, is fully considered. 

5 (2) MISSION.—The mission of the Joint Work6 ing Group on Telehealth is— 

7 (A) to identify, monitor, and coordinate 

8 Federal telehealth projects, data sets, and pro9 grams; 

10 (B) to analyze— 

11 (i) how telehealth systems are expand12 ing access to health care services, edu13 cation, and information; 

14 (ii) the clinical, educational, or admin15 istrative efficacy and cost-effectiveness of 

16 telehealth applications; and 

17 (iii) the quality of the telehealth serv18 ices delivered; and 

19 (C) to make further recommendations for 

20 coordinating Federal and State efforts to in21 crease access to health services, education, and 

22 information in rural and medically underserved 

23 areas. 

24 (3) ANNUAL REPORTS.—Not later than 2 years 

25 after the date of enactment of this Act, and each 
442 

•HR 3561 IH 

1 January 1 thereafter, the Joint Working Group on 

2 Telehealth shall submit to Congress a report on the 

3 status of the Group’s mission and the state of the 

4 telehealth field generally. 

5 (b) REPORT SPECIFICS.—The annual report required 

6 under subsection (a)(3) shall provide— 

7 (1) an analysis of— 

8 (A) the matters described in subsection 

9 (a)(2)(B); 

10 (B) Federal activities with respect to tele11 health; and 

12 (C) the process of the Joint Working 

13 Group on Telehealth’s efforts to coordinate 

14 Federal telehealth programs; and 

15 (2) recommendations for a coordinated Federal 

16 strategy to increase health care access through tele17 health. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated such sums as may be 

20 necessary to enable the Joint Working Group on Tele21 health to carry out this section. 
443 

•HR 3561 IH 

1 TITLE VIII—MISCELLANEOUS 

2 PROVISIONS 

3 SEC. 801. DEFINITIONS. 

4 For purposes of this Act (including the amendments 

5 made by this Act other than the amendments made by 

6 subtitles A through G of title I): 

7 (1) APPROPRIATE HEALTHCARE SERVICES.— 

8 The term ‘‘appropriate healthcare services’’ includes 

9 services or treatments to address physical, mental, 

10 and behavioral diseases, conditions, or syndromes. 

11 The definition contained in this paragraph shall not 

12 apply for purposes of sections 206 and 606. 

13 (2) HEALTH.—The term ‘‘health’’ includes oral 

14 health and dental hygiene. 

15 (3) HEALTH PROFESSION.—The term ‘‘health 

16 profession’’ includes mental and behavioral health 

17 professions. 

18 (4) HISPANIC.—The term ‘‘Hispanic’’ means 

19 individuals whose origin is Mexican, Puerto Rican, 

20 Cuban, Central or South American, or any other 

21 Spanish-speaking country. 

22 (5) INDIAN.—The term ‘‘Indian’’, unless other23 wise designated, means any person who is a member 

24 of an Indian tribe 
444 

•HR 3561 IH 

1 (6) INDIAN TRIBE.—The term ‘‘Indian tribe’’ 

2 means any Indian tribe, band, nation, or other orga3 nized group or community, including any Alaska Na4 tive village or group or regional or village corpora5 tion as defined in or established pursuant to the 

6 Alaska Native Claims Settlement Act (85 Stat. 688) 

7 (43 U.S.C. 1601 et seq.), which is recognized as eli8 gible for the special programs and services provided 

9 by the United States to Indians because of their sta10 tus as Indians. 

11 (7) LIMITED ENGLISH PROFICIENT.—The term 

12 ‘‘limited English proficient’’ with respect to an indi13 vidual means an individual who cannot speak, read, 

14 write, or understand the English language at a level 

15 that permits them to interact effectively with clinical 

16 or nonclinical staff at a healthcare organization. 

17 (8) MINORITY.— 

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

19 and ‘‘minorities’’ refer to individuals from a mi20 nority group. 

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

22 with respect to populations, refers to racial and 

23 ethnic minority groups. 
445 

•HR 3561 IH 

1 (9) MINORITY GROUP.—The term ‘‘minority 

2 group’’ has the meaning given the term ‘‘racial and 

3 ethnic minority group’’. 

4 (10) RACIAL AND ETHNIC MINORITY GROUP.— 

5 The term ‘‘racial and ethnic minority group’’ means 

6 American Indians and Alaska Natives, African 

7 Americans (including Blacks), Asian Americans, 

8 Hispanics (including Latinos), and Native Hawai9 ians and other Pacific Islanders. 

10 (11) SECRETARY.—The term ‘‘Secretary’’ 

11 means the Secretary of Health and Human Services. 

12 (12) STATE.—The term ‘‘State’’ means each of 

13 the several states, the District of Columbia, the 

14 Commonwealth of Puerto Rico, the Indian tribes, 

15 the Virgin Islands, Guam, American Samoa, and the 

16 Commonwealth of the Northern Mariana Islands. 

17 (13) TRIBAL ORGANIZATION.—The term ‘‘tribal 

18 organization’’ means the elected governing body of 

19 any Indian tribe or any legally established organiza20 tion of Indians which is controlled by one or more 

21 such bodies or by a board of directors elected or se22 lected by one or more such bodies (or elected by the 

23 Indian population to be served by such organization) 

24 and which includes the maximum participation of 

25 Indians in all phases of its activities. 
446 

•HR 3561 IH 

1 (14) UNDERREPRESENTED MINORITY.—The 

2 terms ‘‘underrepresented minority’’ and ‘‘underrep3 resented minorities’’ refer to individuals who are 

4 members of racial or ethnic minority groups that are 

5 underrepresented in the health professions relative 

6 to their numbers in the general population. 

7 (15) UNDERSERVED POPULATIONS.—The term 

8 ‘‘underserved population’’ means the population of 

9 an urban or rural area designated by the Secretary 

10 as an area with a shortage of personal health serv11 ices or a population group designated by the Sec12 retary as having a shortage of such services. 

13 SEC. 802. DAVIS-BACON ACT. 

14 All laborers and mechanics employed by contractors 

15 or subcontractors in the performance of construction work 

16 financed in whole or in part with assistance under this 

17 Act (or an amendment made by this Act), including cap18 ital financing assistance, or grants or loan guarantees 

19 from the Safety Net Infrastructure Trust Fund (estab20 lished under section 2952C of the Public Health Service 

21 Act), shall be paid wages at rates not less than those pre22 vailing on similar work in the locality involved as deter23 mined by the Secretary of Labor in accordance with sub24 chapter IV of chapter 31 of title 40, United States Code 

25 (commonly referred to as the Davis-Bacon Act). The Sec-
447 

•HR 3561 IH 

1 retary of Labor shall have, with respect to such labor 

2 standards, the authority and functions set forth in Reor3 ganization Plan Numbered 14 of 1950 (15 F.R. 3176; 64 

4 Stat. 1267) and section 3145 of title 40, United States 

5 Code. 

Æ