I 

108TH CONGRESS 

1ST SESSION H. R. 3459

To improve the health of minority individuals. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 6, 2003

Mr. CUMMINGS (for himself, Mr. RODRIGUEZ, Mr. KILDEE, Mr. WU, Mrs. 

CHRISTENSEN, Ms. SOLIS, Mr. PALLONE, Mr. HONDA, Ms. BORDALLO, 

Ms. PELOSI, Mr. HOYER, Mr. MENENDEZ, Mr. CLYBURN, Mr. DINGELL, 

Mr. RANGEL, Mr. STARK, Mr. RAHALL, Mr. BROWN of Ohio, Ms. ROYBAL-ALLARD, and Mr. CASE) 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, the 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. 
2

•HR 3459 IH 

Sec. 2. Findings and purpose. 

TITLE I—COVERAGE OF THE UNINSURED 

Subtitle A—FamilyCare 

Sec. 101. Short title. 

Sec. 102. Renaming of title XXI program. 

Sec. 103. Familycare coverage of parents under the medicaid program and title 

XXI. 

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 

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

Subtitle D—Indian Healthcare Funding 

CHAPTER 1—GUARANTEED FUNDING

Sec. 141. Guaranteed adequate funding for Indian healthcare. 

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 

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

workers and farmworkers under medicaid and CHIP. 

Subtitle G—Expanded Access to Health Care 
3

•HR 3459 IH 

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

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTHCARE 

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

‘‘TITLE XXIX—MINORITY HEALTH 

‘‘Sec. 2900. Definitions. 

‘‘Subtitle A—Culturally and Linguistically Appropriate Healthcare 

‘‘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. Center for Cultural and Linguistic Competence in Healthcare. 

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

‘‘Sec. 2905. Research on language access. 

‘‘Sec. 2906. Toll-free telephone number. 

Sec. 203. Standards for language access services. 

Sec. 204. Federal reimbursement for culturally and linguistically appropriate 

services under the medicare, medicaid and State Children’s 

Health Insurance Program. 

Sec. 205. Increasing understanding of health literacy. 

Sec. 206. Report on Federal efforts to provide culturally and linguistically appropriate healthcare services. 

Sec. 207. General Accounting Office report on impact of language access services. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

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

‘‘Subtitle B—Workforce Diversity 

‘‘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. 

‘‘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. 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. 
4

•HR 3459 IH 

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. 309. Mid-career health professions scholarship program. 

Sec. 310. National report on the preparedness of health professionals to care 

for diverse populations. 

Sec. 311. 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. 

TITLE IV—REDUCING DISEASE AND DISEASE-RELATED 

COMPLICATIONS 

Subtitle A—Eliminating Disparities in Prevention, Detection, and Treatment 

of Disease 

CHAPTER 1—GENERAL PROVISIONS

Sec. 401. Guidelines for disease screening for minority patients. 

Sec. 402. Preventive health services block grants, use of allotments. 

Sec. 403. Program for increasing immunization rates for adults and adolescents; collection of additional immunization data. 

Sec. 404. Innovative chronic disease management programs. 

Sec. 405. Grants for racial and ethnic approaches to community health. 

Sec. 406. IOM study request. 

Sec. 407. Strategic plan. 

CHAPTER 2—ENVIRONMENTAL JUSTICE

Sec. 410. Short title; purposes. 

Sec. 411. Definitions. 

Sec. 412. Environmental justice responsibilities of Federal agencies. 

Sec. 413. Interagency environmental justice working group. 

Sec. 414. Federal agency strategies. 

Sec. 415. Federal Environmental Justice Advisory Committee. 

Sec. 416. Human health and environmental research, data collection and analysis. 

CHAPTER 3—BORDER HEALTH

Sec. 421. Short title.

Sec. 422. Definitions. 

Sec. 423. Border health grants. 

Sec. 424. United States-Mexico Border Health Commission Act Amendments. 

‘‘Sec. 9. Authorization of appropriations. 

CHAPTER 4—PATIENT NAVIGATOR, OUTREACH, AND CHRONIC DISEASE

PREVENTION

Sec. 425. Short title. 
5

•HR 3459 IH 

Sec. 426. HRSA grants for model community cancer and chronic disease care 

and prevention; HRSA grants for patient navigators. 

Sec. 427. NCI grants for model community cancer and chronic disease care and 

prevention; NCI grants for patient navigators. 

Sec. 428. IHS grants for model community cancer and chronic disease care and 

prevention; IHS grants for patient navigators. 

CHAPTER 5—COMMUNITY HEALTH WORKERS

Sec. 431. Short title. 

Sec. 432. Grants to promote positive health behaviors in women. 

CHAPTER 6—HEALTH EMPOWERMENT ZONES

Sec. 440. Health empowerment zones. 

Subtitle B—Targeting Diseases and Conditions with Particularly Disparate 

Impact 

CHAPTER 1—CANCER REDUCTION

Sec. 441. Cancer reduction. 

CHAPTER 2—HIV/AIDS REDUCTION

Sec. 442. HIV/AIDS reduction. 

CHAPTER 3—INFANT MORTALITY REDUCTION

Sec. 443. Infant mortality reduction. 

CHAPTER 4—FETAL ALCOHOL SYNDROME TREATMENT AND DIAGNOSIS

Sec. 444. Fetal alcohol syndrome. 

CHAPTER 5—DIABETES PREVENTION AND TREATMENT

Sec. 445. Monitoring the quality of and disparities in diabetes care. 

Sec. 446. Diabetes prevention, treatment, and control. 

Sec. 447. Genetics of diabetes. 

Sec. 448. Research and training on diabetes in underserved and minority populations. 

Sec. 449. Authorization of appropriations. 

Sec. 450. Model community diabetes and chronic disease care and prevention 

among Pacific Islanders and Native Hawaiians. 

Sec. 451. Programs of Centers for Disease Control and Prevention. 

CHAPTER 6—STROKE AND HEART DISEASE PREVENTION AND TREATMENT

Sec. 455. Systems for heart disease and stroke. 

‘‘Subtitle D—Systems for Heart Disease and Stroke 

‘‘CHAPTER 1—HEART DISEASE

‘‘Sec. 2941. Heart disease. 

‘‘CHAPTER 2—STROKE EDUCATION CAMPAIGN

‘‘Sec. 2945. Stroke education campaign. 
6

•HR 3459 IH 

CHAPTER 7—OBESITY AND OVERWEIGHT REDUCTION

Sec. 461. Overweight and obesity prevention and treatment. 

CHAPTER 8—TUBERCULOSIS CONTROL, PREVENTION, AND TREATMENT

Sec. 465. Advisory council for the elimination of tuberculosis. 

Sec. 466. National program for tuberculosis elimination. 

Sec. 467. Inclusion of inpatient hospital services for the treatment of TB-infected individuals. 

CHAPTER 9—ASTHMA

Sec. 471. Provisions regarding national asthma education and prevention program of National Heart, Lung, and Blood Institute. 

Sec. 472. Asthma-related activities of Centers for Disease Control and Prevention. 

Sec. 473. Grants for community outreach regarding asthma information, education, and services. 

Sec. 474. Action plans of local educational agencies regarding asthma. 

CHAPTER 10—SICKLE CELL DISEASE

Sec. 481. Demonstration program for the development and establishment of 

systemic mechanisms for the prevention and treatment of sickle 

cell disease. 

CHAPTER 11—AUTOIMMUNE DISEASE IN MINORITY POPULATIONS

Sec. 482. Research funding for autoimmune disease in minority populations. 

CHAPTER 12—PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED

DISEASES

Sec. 485. Prevention and control of sexually transmitted diseases. 

CHAPTER 13—DENTAL DISEASE

Sec. 486. Grants to improve the provision of dental services under medicaid 

and SCHIP. 

Sec. 487. State option to provide wrap-around SCHIP coverage to children who 

have other health coverage. 

Sec. 488. Grants to improve the provision of dental health services through 

community health centers and public health departments. 

CHAPTER 14—PREVENTION AND CONTROL OF INJURIES

Sec. 491. Prevention and control of injuries. 

CHAPTER 15—UTERINE FIBROID RESEARCH AND EDUCATION

Sec. 495. Research with respect to uterine fibroids. 

Sec. 496. Information and education with respect to uterine fibroids. 

TITLE V—DATA COLLECTION AND REPORTING 

Subtitle A—General Provisions 

Sec. 501. Amendment to the Public Health Service Act. 
7

•HR 3459 IH 

‘‘Subtitle E—Data Collection and Reporting 

‘‘Sec. 2951. Data on race, ethnicity and primary language. 

‘‘Sec. 2952. Provisions relating to Native Americans. 

Sec. 502. 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. 

Subtitle B—Minority Health and Genomics Commission 

Sec. 511. Short title. 

Sec. 512. Minority Health and Genomics Commission. 

Sec. 513. Report. 

Sec. 514. Membership. 

Sec. 515. Powers of Commission. 

Sec. 516. Termination. 

TITLE VI—ACCOUNTABILITY 

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 F—Accountability 

‘‘Sec. 2961. Elevation of the Office of Civil Rights. 

‘‘Sec. 2962. 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. Office of Minority Health at the Centers for Medicare and Medicaid 

Services. 

Sec. 607. Office of Minority Affairs at the Food and Drug Administration. 

Sec. 608. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 609. United States Commission on Civil Rights. 

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

racial and ethnic health disparities. 

TITLE VII—STRENGTHENING HEALTH INSTITUTIONS THAT 

PROVIDE HEALTHCARE TO MINORITY POPULATIONS 

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

‘‘Subtitle G—Strengthening Health Institutions that Provide Healthcare to 

Minority Populations 

‘‘CHAPTER 1—GENERAL PROGRAMS

‘‘Sec. 2971. Grant support for quality improvement initiatives. 

‘‘Sec. 2971A. Centers of excellence. 

‘‘Sec. 2971B. Consultation, construction and renovation of American Indian and Alaska Native facilities; reports. 
8

•HR 3459 IH 

‘‘Sec. 2971C. 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. 2972. Payments to healthcare facilities. 

‘‘Sec. 2972A. Application for assistance. 

‘‘Sec. 2972B. Public service responsibilities. 

‘‘Sec. 2972C. Health Safety Net Infrastructure Trust Fund. 

‘‘Sec. 2972D. Administration. 

‘‘SUBCHAPTER B—LOAN GUARANTEES

‘‘Sec. 2973. Provision of loan guarantees to safety net healthcare facilities. 

‘‘Sec. 2973A. Eligible loans. 

‘‘Sec. 2973B. Guarantee allotments. 

‘‘Sec. 2973C. Terms and conditions of loan guarantees. 

‘‘Sec. 2973D. Premiums for loan guarantees. 

‘‘Sec. 2973E. Procedures in the event of loan default. 

‘‘SUBCHAPTER C—GRANTS FOR URGENT CAPITAL NEEDS

‘‘Sec. 2976. Provision of grants. 

‘‘Sec. 2976B. Eligible projects. 

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: 

4 (1) Despite significant advances in public 

5 health and health care, the health status of racial 

6 and ethnic minority populations continues to lag be7 hind that of the white population. 

8 (2) The United States is becoming increasingly 

9 diverse. According to the 2000 United States Cen10 sus, African Americans, American Indians and Alas11 ka Natives, Asians, Hispanics, and Native Hawai12 ians and other Pacific Islanders comprise 30 percent 
9

•HR 3459 IH 

1 of the United States population. Racial and ethnic 

2 minorities are expected to comprise 40 percent of 

3 the United States population by 2030. 

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

5 ethnic minorities and to reduce and eliminate dis6 parities in health care and health outcomes, the fol7 lowing issues must be addressed: 

8 (A) NEED FOR INSURANCE COVERAGE.—

9 (i) Disparities in health status can be 

10 attributed largely to underlying differences 

11 in socioeconomic status and insurance cov12 erage. Minorities are at a greater risk of 

13 being uninsured than their white counter14 parts. Lack of health insurance has con15 sistently been associated with worse health 

16 outcomes. 

17 (ii) Even after adjusting for dif18 ferences in socioeconomic and insurance 

19 status, however, racial and ethnic health 

20 and health care disparities remain. 

21 (iii) Through treaties and Federal 

22 statutes, the Federal Government has es23 tablished a trust responsibility to provide 

24 health care to American Indians and Alas25 ka Natives. In the Indian Health Amend-
10

•HR 3459 IH 

1 ments of 1992, Congress specifically 

2 pledged to ‘‘assure the highest possible 

3 health status for Indians and urban Indi4 ans and to provide all resources necessary 

5 to effect that policy.’’ Despite those com6 mitments, the unmet health needs of 

7 American Indians and Alaska Natives re8 main alarmingly severe and their health 

9 status is far below the health status of the 

10 general population of the United States. 

11 The critical shortfall of funding for the In12 dian Health Service is a major source of 

13 this problem. 

14 (B) NEED FOR CULTURALLY AND LINGUIS15 TICALLY APPROPRIATE CARE.—

16 (i) Limited English proficiency ad17 versely affects the care of many racial and 

18 ethnic minority patients. The lack of avail19 able interpretation and translation services 

20 or bilingual providers contributes to racial 

21 and ethnic disparities in health and health 

22 care. The Federal Government provides 

23 and funds an array of services that should 

24 be made accessible to eligible persons who 

25 are not proficient in the English language. 
11

•HR 3459 IH 

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

2 1964 (42 U.S.C. 2000d et seq.) prohibits 

3 discrimination on the basis of race, color, 

4 and national origin in programs and activi5 ties receiving Federal financial assistance. 

6 Discrimination on the basis of primary lan7 guage has consistently been interpreted as 

8 discrimination on the basis of national ori9 gin. 

10 (iii) The provision of effective lan11 guage services has been shown to improve 

12 care for limited English proficient (re13 ferred to in this section as ‘‘LEP’’) pa14 tients by increasing patient satisfaction, 

15 access to care, compliance with rec16 ommended medical advice, and appropriate 

17 utilization. 

18 (iv) A 2002 study by the Office of 

19 Management and Budget found that lan20 guage assistance services can substantially 

21 improve the health and quality of life of 

22 LEP individuals and their families, in23 crease the efficiency of distribution of gov24 ernment services to LEP individuals, and 
12

•HR 3459 IH 

1 measurably increase the effectiveness of 

2 public health and safety programs. 

3 (v) The same study estimated that 

4 language translation services would only 

5 increase the cost of the average health care 

6 visit by less than one percent. 

7 (C) NEED FOR HEALTH WORKFORCE DI8 VERSITY.—

9 (i) Research has demonstrated that 

10 minority health professionals dramatically 

11 increase access to care for minority pa12 tients and improve the quality of care that 

13 they receive. African Americans, American 

14 Indians and Alaska Natives, Hispanics, 

15 Native Hawaiians and other Pacific Island16 ers, and Southeast Asians are significantly 

17 underrepresented in the health professions, 

18 exacerbating health disparities. 

19 (ii) Minority physicians are more like20 ly than white physicians to serve minority 

21 populations. Nearly 40 percent of all mi22 nority medical school graduates will prac23 tice medicine in underserved areas, com24 pared to 10 percent of their white col25 leagues. 
13

•HR 3459 IH 

1 (iii) Minorities often report experi2 ences with discrimination when seeking 

3 health care. 

4 (iv) There is substantial evidence to 

5 demonstrate that race concordance be6 tween physicians and patients increases 

7 patient satisfaction and participation in 

8 health decisionmaking. 

9 (v) Minority health care providers can 

10 bridge linguistic, cultural, and other bar11 riers that hamper access to care. 

12 (vi) African Americans, Hispanics, 

13 and American Indians remain severely 

14 underrepresented in health professions 

15 schools. African Americans and Hispanics 

16 constitute 20 percent and 16 percent, re17 spectively, of the students in public health 

18 and baccalaureate nursing programs, and 

19 less than 15 percent of students in all 

20 other health professions. 

21 (vi) The number of minorities enroll22 ing in health professional schools has re23 mained stagnant. For example, in 1994, 

24 1,307 African American and 1,090 His25 panic students enrolled in American med-
14

•HR 3459 IH 

1 ical colleges. In 2000, the figures were es2 sentially unchanged at 1,307 African 

3 American and 1,033 Hispanic students. 

4 (D) NEED FOR REDUCTION OF DISEASE

5 OCCURRENCE AND DISEASE-RELATED COM6 PLICATIONS AMONG MINORITIES.—

7 (i) Despite notable progress in the 

8 overall health of the Nation, there are con9 tinuing disparities in the burden of illness 

10 and death experienced by minorities com11 pared to the United States population as a 

12 whole. Minority populations are dispropor13 tionately impacted by acute and chronic 

14 diseases. 

15 (ii) Despite suffering a greater burden 

16 of acute and chronic disease, minorities are 

17 less likely to receive needed health care. 

18 Numerous studies have documented that 

19 minorities receive less preventive care, 

20 medical therapy, and surgical interven21 tions. 

22 (E) NEED FOR MINORITY HEALTH DATA

23 COLLECTION AND REPORTING.—

24 (i) Efforts to study disparities in 

25 health and health care for minorities have 
15

•HR 3459 IH 

1 been hampered by the lack of available 

2 data on race, ethnicity, and primary lan3 guage. 

4 (ii) Data collection, analysis, and re5 porting by race, ethnicity, and primary lan6 guage is permissible under the law and 

7 necessary to assure equity and non8 discrimination in the quality of health care 

9 services. Collection, analysis, and reporting 

10 of such data is authorized under Title VI 

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

12 2000d et seq.). Such collection, analysis, 

13 and reporting should be conducted with ap14 propriate privacy protections in place. 

15 (F) NEED FOR GREATER ACCOUNTABILITY

16 IN GOVERNMENT INSTITUTIONS.—A number of 

17 studies have shown that differences in health 

18 care quality contribute to health disparities 

19 among minority populations. These differences 

20 may result from bias, stereotyping, and dis21 crimination. Government institutions must be 

22 held accountable for the quality of healthcare 

23 delivered to all patient populations and result24 ant health outcomes. 
16

•HR 3459 IH 

1 (G) NEED FOR STRENGTHENING HEALTH

2 INSTITUTIONS THAT PROVIDE CARE TO MINOR3 ITY POPULATIONS.—

4 (i) A small segment of health care in5 stitutions provide a disproportionate 

6 amount of health care to minority popu7 lations. 

8 (ii) Safety net institutions, including 

9 public hospitals, community health centers 

10 and community clinics, provide a dis11 proportionate share of health care to mi12 nority and underserved populations. 

13 (iii) Financial stress, negative oper14 ating margins, and the overall burden of 

15 caring for the uninsured and delivering 

16 high-cost specialty care to the entire com17 munity place undue pressure on core safety 

18 net providers. These providers are increas19 ingly challenged in their ability to meet the 

20 day-to-day needs of their patients. 

21 (b) PURPOSES.—It is the purpose of this Act to im22 prove the health and healthcare of minority populations

23 and to eliminate racial and ethnic disparities in health and 

24 healthcare by—
17

•HR 3459 IH 

1 (1) increasing access to health care for all pop2 ulations; 

3 (2) expanding culturally and linguistically ap4 propriate health services for all populations; 

5 (3) promoting health workforce diversity; 

6 (4) supporting and expanding programs and ac7 tivities that will improve the prevention, diagnosis, 

8 and management of disease in minority populations; 

9 (5) enhancing racial, ethnic, and primary lan10 guage health data collection at the local, State, and 

11 Federal level; 

12 (6) ensuring accountability for the quality of 

13 health care and health outcomes for minority popu14 lations; and 

15 (7) strengthening the technical and financial re16 sources of the safety net institutions of the United 

17 States. 

18 TITLE I—COVERAGE OF THE 

19 UNINSURED 

20 Subtitle A—FamilyCare 

21 SEC 101. SHORT TITLE. 

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

23 of 2003’’. 
18

•HR 3459 IH 

1 SEC. 102. RENAMING OF TITLE XXI PROGRAM. 

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

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

4 to read as follows: 

5 ‘‘TITLE XXI—FAMILYCARE PROGRAM’’. 

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

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

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

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

10 to the FamilyCare program under such title. 

11 SEC. 103. FAMILYCARE COVERAGE OF PARENTS UNDER 

12 THE MEDICAID PROGRAM AND TITLE XXI. 

13 (a) INCENTIVES TO IMPLEMENT FAMILYCARE COV14 ERAGE.—

15 (1) UNDER MEDICAID.—

16 (A) ESTABLISHMENT OF NEW OPTIONAL

17 ELIGIBILITY CATEGORY.—Section 1902(a)(10) 

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

19 1396a(a)(10)(A)(ii)) is amended—

20 (i) by striking ‘‘or’’ at the end of sub21 clause (XVII); 

22 (ii) by adding ‘‘or’’ at the end of sub23 clause (XVIII); and 

24 (iii) by adding at the end the fol25 lowing: 
19

•HR 3459 IH 

1 ‘‘(XIX) who are individuals de2 scribed in subsection (k)(1) (relating 

3 to parents of categorically eligible chil4 dren);’’. 

5 (B) PARENTS DESCRIBED.—Section 1902 

6 of the Social Security Act is further amended 

7 by inserting after subsection (j) the following: 

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

9 are individuals—

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

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

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

13 and who is eligible for medical assistance under sub14 section (a)(10)(A); 

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

16 assistance under such subsection or under a waiver 

17 approved under section 1115 or otherwise (except 

18 under section 1931 or under subsection 

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

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

21 the effective income level or resource level applicable 

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

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

24 highest effective income or resource level (if any) ap25 plicable to a child in the family under this title. 
20

•HR 3459 IH 

1 ‘‘(B) In establishing an income eligibility level for in2 dividuals described in this paragraph, a State may vary 

3 such level consistent with the various income levels estab4 lished under subsection (l)(2) in order to ensure, to the 

5 maximum extent possible, that such individuals shall be 

6 enrolled in the same program as their children. 

7 ‘‘(C) An individual may not be treated as being de8 scribed in this paragraph unless, at the time of the individ9 ual’s enrollment under this title, the child referred to in 

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

11 under this title or otherwise insured. 

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

13 an individual treated as a caretaker for purposes of car14 rying out section 1931. 

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

16 level’ means the income level expressed as a percent of 

17 the poverty line and considering applicable income dis18 regards. 

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

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

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

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

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

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

25 title XXI, the State may elect (on a uniform basis) to
21

•HR 3459 IH 

1 cover all such parents under section 2111 or under this 

2 title.’’. 

3 (C) ENHANCED MATCHING FUNDS AVAIL4 ABLE IF CERTAIN CONDITIONS MET.—Section 

5 1905 of the Social Security Act (42 U.S.C. 

6 1396d) is amended—

7 (i) in the fourth sentence of sub8 section (b), by striking ‘‘or subsection 

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

10 and 

11 (ii) in subsection (u)—

12 (I) by redesignating paragraph 

13 (4) as paragraph (6), and 

14 (II) by inserting after paragraph 

15 (3) the following:

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

17 2105(a)(1): 

18 ‘‘(A) FAMILYCARE PARENTS.—The expendi19 tures described in this subparagraph are the expend20 itures described in the following clauses (i) and (ii): 

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

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

23 for medical assistance for parents described in 

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

25 be described in such section but for the fact 
22

•HR 3459 IH 

1 that they are eligible for medical assistance 

2 under section 1931 or under a waiver approved 

3 under section 1115. 

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

5 conditions described in clause (v) are met, ex6 penditures for medical assistance for pregnant 

7 women described in subsection (n) or under sec8 tion 1902(l)(1)(A) in a family the income of 

9 which exceeds the effective income level applica10 ble under subsection (a)(10)(A)(i)(III) or 

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

12 involved as of January 1, 2004. 

13 ‘‘(iii) CONDITIONS RELATING TO ENSURING

14 CHILDREN’S COVERAGE FOR ENHANCED MATCH

15 FOR PARENTS.—The conditions described in 

16 this clause are the following: 

17 ‘‘(I) The State has a State child 

18 health plan under title XXI which (wheth19 er implemented under such title or under 

20 this title) has an effective income level for 

21 children that is at least 200 percent of the 

22 poverty line. 

23 ‘‘(II) Such State child health plan 

24 does not limit the acceptance of applica25 tions, does not use a waiting list for chil-
23

•HR 3459 IH 

1 dren who meet eligibility standards to 

2 qualify for assistance, and provides bene3 fits to all children in the State who apply 

4 for and meet eligibility standards. 

5 ‘‘(III) Effective for determinations of 

6 eligibility made on or after the date that is 

7 1 year after the date of the enactment of 

8 this clause, the application and renewal 

9 procedures for individuals under 19 years 

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

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

12 medical assistance under section 

13 1902(a)(10)(A) are not be more restrictive 

14 or burdensome than such procedures used 

15 for children with higher income under the 

16 State child health plan under title XXI. 

17 ‘‘(iv) CONDITIONS RELATING TO MINIMUM

18 COVERAGE FOR PARENTS FOR ENHANCED

19 MATCH FOR PARENTS.—The conditions de20 scribed in this clause are the following: 

21 ‘‘(I) The State does not apply an in22 come level for parents that is lower than 

23 the effective income level (expressed as a 

24 percent of the poverty line) that has been 

25 specified under the State plan under title 
24

•HR 3459 IH 

1 XIX (including under a waiver authorized 

2 by the Secretary or under section 

3 1902(r)(2)), as of January 1, 2004, to be 

4 eligible for medical assistance as a parent 

5 under this title. 

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

7 and title XXI do not provide coverage for 

8 parents with higher family income without 

9 covering parents with a lower family in10 come. 

11 ‘‘(v) CONDITIONS FOR ENHANCED MATCH

12 FOR CERTAIN PREGNANT WOMEN.—The condi13 tions described in this clause are the following: 

14 ‘‘(I) The State has established an ef15 fective income eligibility level for pregnant 

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

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

18 185 percent of the poverty line. 

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

20 and title XXI do not provide coverage for 

21 pregnant women described in subpara22 graph (A)(ii) with higher family income 

23 without covering such pregnant women 

24 with a lower family income. 
25

•HR 3459 IH 

1 ‘‘(III) The State does not apply an in2 come level for pregnant women that is 

3 lower than the effective income level that 

4 has been specified under the State plan 

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

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

7 2004, to be eligible for medical assistance 

8 as a pregnant woman. 

9 ‘‘(IV) The State satisfies the condi10 tions described in subclauses (I) and (II) 

11 of clause (iii). 

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

13 subsection: 

14 ‘‘(I) The term ‘parent’ has the mean15 ing given such term for purposes of section 

16 1902(k)(1). 

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

18 meaning given such term in section 

19 2110(c)(5).’’. 

20 (D) APPROPRIATION FROM TITLE XXI AL21 LOTMENT FOR CERTAIN MEDICAID EXPANSION

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

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

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

25 subparagraphs (B) through (D) as sub-
26

•HR 3459 IH 

1 paragraphs (C) through (E), respectively, 

2 and by inserting after subparagraph (A) 

3 the following new subparagraph: 

4 ‘‘(B) for medical assistance that is attrib5 utable to expenditures described in section 

6 1905(u)(4)(A);’’; and 

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

8 end the following new subparagraph: 

9 ‘‘(E) Fifth, for expenditures for items de10 scribed in paragraph (1)(E).’’. 

11 (2) UNDER TITLE XXI.—

12 (A) FAMILYCARE COVERAGE.—Title XXI 

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

14 seq.) is amended by adding at the end the fol15 lowing: 

16 ‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR17 ENTS OF TARGETED LOW-INCOME CHILDREN. 

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

19 other provision of this title, a State may provide for cov20 erage, through an amendment to its State child health 

21 plan under section 2102, of parent health assistance for 

22 targeted low-income parents, health care assistance for 

23 targeted low-income pregnant women, or both, in accord24 ance with this section, but only if—
27

•HR 3459 IH 

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

2 health assistance, the State meets the conditions de3 scribed in clause (iii) of section 1905(u)(4)(A); 

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

5 assistance for pregnant women, the State meets the 

6 conditions described in clause (iv) of section 

7 1905(u)(4)(A); and 

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

9 targeted low-income parents, the State elects to pro10 vide medical assistance under section 

11 1902(a)(10)(A)(ii)(XIX), under section 1931, or 

12 under a waiver under section 1115 to individuals de13 scribed in section 1902(k)(1)(A)(i) and elects an ef14 fective income level that, consistent with paragraphs 

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

16 maximum extent possible, that such individuals shall 

17 be enrolled in the same program as their children if 

18 their children are eligible for coverage under title 

19 XIX (including under a waiver authorized by the 

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

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

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

23 ‘parent health assistance’ has the meaning given the 

24 term child health assistance in section 2110(a) as if 
28

•HR 3459 IH 

1 any reference to targeted low-income children were 

2 a reference to targeted low-income parents. 

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

4 meaning given the term ‘caretaker relative’ for pur5 poses of carrying out section 1931. 

6 ‘‘(3) HEALTH CARE ASSISTANCE FOR PREG7 NANT WOMEN.—The term ‘health care assistance for 

8 pregnant women’ has the meaning given the term 

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

10 reference to targeted low-income children were a ref11 erence to targeted low-income pregnant women. 

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

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

14 given the term targeted low-income child in section 

15 2110(b) as if the reference to a child were deemed 

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

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

18 ‘‘(A) there shall be substituted for the in19 come level described in paragraph (1)(B)(ii)(I) 

20 the applicable income level in effect for a tar21 geted low-income child; 

22 ‘‘(B) in paragraph (3), January 1, 2004, 

23 shall be substituted for July 1, 1997; and 

24 ‘‘(C) in paragraph (4), January 1, 2004, 

25 shall be substituted for March 31, 1997. 
29

•HR 3459 IH 

1 ‘‘(5) TARGETED LOW-INCOME PREGNANT

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

3 woman’ has the meaning given the term targeted 

4 low-income child in section 2110(b) as if any ref5 erence to a child were a reference to a woman dur6 ing pregnancy and through the end of the month in 

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

8 of her pregnancy ends; except that in applying such 

9 section—

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

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

14 ‘‘(B) in paragraph (3), January 1, 2004, 

15 shall be substituted for July 1, 1997; and 

16 ‘‘(C) in paragraph (4), January 1, 2004, 

17 shall be substituted for March 31, 1997. 

18 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

19 RULES.—In the case of, and with respect to, a State pro20 viding for coverage of parent health assistance to targeted 

21 low-income parents or health care assistance to targeted 

22 low-income pregnant women under subsection (a), the fol23 lowing special rules apply: 

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

25 subsection (b)) to a targeted low-income child is 
30

•HR 3459 IH 

1 deemed to include a reference to a targeted low-in2 come parent or a targeted low-income pregnant 

3 woman (as applicable). 

4 ‘‘(2) Any such reference to child health assist5 ance—

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

7 deemed a reference to parent health assistance; 

8 and 

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

10 is deemed a reference to health care assistance 

11 for pregnant women.

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

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

14 more children) provided coverage under this section 

15 or a pregnant woman provided coverage under this 

16 section without covering other family members, the 

17 limitation on total annual aggregate cost-sharing 

18 shall be applied to such entire family or such preg19 nant woman, respectively. 

20 ‘‘(4) In applying section 2110(b)(4), any ref21 erence to ‘section 1902(l)(2) or 1905(n)(2) (as se22 lected by a State)’ is deemed a reference to the ef23 fective income level applicable to parents under sec24 tion 1931 or under a waiver approved under section 
31

•HR 3459 IH 

1 1115, or, in the case of a pregnant woman, the in2 come level established under section 1902(l)(2)(A). 

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

4 reference to children found through screening to be 

5 eligible for medical assistance under the State med6 icaid plan under title XIX is deemed a reference to 

7 parents and pregnant women.’’. 

8 (B) ADDITIONAL ALLOTMENT FOR STATES

9 PROVIDING FAMILYCARE.—

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

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

12 amended by inserting after subsection (c) 

13 the following: 

14 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO15 VIDING FAMILYCARE.—

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

17 For the purpose of providing additional allotments 

18 to States to provide FamilyCare coverage under sec19 tion 2111, there is appropriated, out of any money 

20 in the Treasury not otherwise appropriated—

21 ‘‘(A) for fiscal year 2004, $2,000,000,000; 

22 ‘‘(B) for fiscal year 2005, $2,000,000,000; 

23 ‘‘(C) for fiscal year 2006, $3,000,000,000; 

24 and 

25 ‘‘(D) for fiscal year 2007, $3,000,000,000. 
32

•HR 3459 IH 

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

2 ‘‘(A) IN GENERAL.—In addition to the al3 lotments provided under subsections (b) and 

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

5 amount available for the additional allotments 

6 under paragraph (1) for a fiscal year, the Sec7 retary shall allot to each State with a State 

8 child health plan approved under this title—

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

10 than a commonwealth or territory de11 scribed in clause (ii), the same proportion 

12 as the proportion of the State’s allotment 

13 under subsection (b) (determined without 

14 regard to subsection (f)) to 98.95 percent 

15 of the total amount of the allotments 

16 under such section for such States eligible 

17 for an allotment under this subparagraph 

18 for such fiscal year; and 

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

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

21 same proportion as the proportion of the 

22 commonwealth’s or territory’s allotment 

23 under subsection (c) (determined without 

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

25 the total amount of the allotments under
33

•HR 3459 IH 

1 such section for commonwealths and terri2 tories eligible for an allotment under this 

3 subparagraph for such fiscal year. 

4 ‘‘(B) AVAILABILITY AND REDISTRIBUTION

5 OF UNUSED ALLOTMENTS.—In applying sub6 sections (e) and (f) with respect to additional 

7 allotments made available under this subsection, 

8 the procedures established under such sub9 sections shall ensure such additional allotments 

10 are only made available to States which have 

11 elected to provide coverage under section 2111. 

12 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi13 tional allotments provided under this subsection are 

14 not available for amounts expended before October 

15 1, 2003. Such amounts are available for amounts ex16 pended on or after such date for child health assist17 ance for targeted low-income children, as well as for 

18 parent health assistance for targeted low-income 

19 parents, and health care assistance for targeted low20 income pregnant women. 

21 ‘‘(4) REQUIRING ELECTION TO PROVIDE COV22 ERAGE.—No payments may be made to a State 

23 under this title from an allotment provided under 

24 this subsection unless the State has made an elec25 tion to provide parent health assistance for targeted 
34

•HR 3459 IH 

1 low-income parents, or health care assistance for 

2 targeted low-income pregnant women.’’. 

3 (ii) CONFORMING AMENDMENTS.—

4 Section 2104 of the Social Security Act 

5 (42 U.S.C. 1397dd) is amended—

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

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

8 ‘‘under this section,’’; 

9 (II) in subsection (b)(1), by in10 serting ‘‘and subsection (d)’’ after 

11 ‘‘Subject to paragraph (4)’’; and 

12 (III) in subsection (c)(1), by in13 serting ‘‘subject to subsection (d),’’ 

14 after ‘‘for a fiscal year,’’. 

15 (C) NO COST-SHARING FOR PREGNANCY16 RELATED BENEFITS.—Section 2103(e)(2) of 

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

18 1397cc(e)(2)) is amended—

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

20 PREGNANCY-RELATED SERVICES’’ after 

21 ‘‘PREVENTIVE SERVICES’’; and 

22 (ii) by inserting before the period at 

23 the end the following: ‘‘and for pregnancy24 related services’’. 
35

•HR 3459 IH 

1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection apply to items and services fur3 nished on or after October 1, 2003, whether or not 

4 regulations implementing such amendments have 

5 been issued. 

6 (b) RULES FOR IMPLEMENTATION BEGINNING WITH

7 FISCAL YEAR 2005.—

8 (1) EXPANSION OF AVAILABILITY OF EN9 HANCED MATCH UNDER MEDICAID FOR PRE-CHIP

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

11 the Social Security Act (42 U.S.C. 1396d(u)), as in12 serted by subsection (a)(1)(C), is amended—

13 (A) by amending clause (ii) of subpara14 graph (A) to read as follows: 

15 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex16 penditures for medical assistance for pregnant 

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

18 the income of which exceeds the 133 percent of 

19 the income official poverty line, but only if the 

20 income level established under section 

21 1902(l)(2) (or under a Statewide waiver under 

22 section 1115) for pregnant women is 185 per23 cent of the income official poverty line.’’; and 

24 (B) by adding at the end the following: 
36

•HR 3459 IH 

1 ‘‘(B) CHILDREN IN FAMILIES WITH INCOME

2 ABOVE MEDICAID MANDATORY LEVEL NOT PRE3 VIOUSLY DESCRIBED.—The expenditures described 

4 in this subparagraph are expenditures (other than 

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

6 medical assistance made available to any child who 

7 is eligible for assistance under section 

8 1902(a)(10)(A) (other than under clause (i)) and 

9 the income of whose family exceeds the minimum in10 come level required under subsection 1902(l)(2) (or, 

11 if higher, the minimum level required under section 

12 1931 for that State) for a child of the age involved 

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

14 being 18 years of age).’’. 

15 (2) OFFSET OF ADDITIONAL EXPENDITURES

16 FOR ENHANCED MATCH FOR PRE-CHIP EXPAN17 SION.—Section 1905 of the Social Security Act (42 

18 U.S.C. 1396d) is amended—

19 (A) in the fourth sentence of subsection 

20 (b), by inserting ‘‘(except in the case of expend21 itures described in subsection (u)(5))’’ after ‘‘do 

22 not exceed’’; 

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

24 paragraph (4) (as inserted by subparagraph 

25 (C)), the following: 
37

•HR 3459 IH 

1 ‘‘(5) For purposes of the fourth sentence of sub2 section (b) and section 2105(a), the following payments 

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

4 under section 2104: 

5 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

6 PREGNANT WOMEN WITH INCOME ABOVE 133 PER7 CENT OF POVERTY.—The portion of the payments 

8 made for expenditures described in paragraph 

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

10 have been paid if the enhanced FMAP had not been 

11 substituted for the Federal medical assistance per12 centage. 

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

14 expenditures described in paragraph (4)(A)(i). 

15 ‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR

16 CERTAIN CHILDREN IN FAMILIES WITH INCOME

17 ABOVE MEDICAID MANDATORY LEVEL.—The portion 

18 of the payments made for expenditures described in 

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

20 would have been paid if the enhanced FMAP had 

21 not been substituted for the Federal medical assist22 ance percentage.’’. 

23 (B) CONFORMING AMENDMENTS.—Sub24 paragraph (B) of section 2105(a)(1) of the So-
38

•HR 3459 IH 

1 cial Security Act, as amended by subsection 

2 (a)(1)(D), is amended to read as follows: 

3 ‘‘(B) CERTAIN FAMILYCARE PARENTS AND

4 OTHERS.—Expenditures for medical assistance 

5 that is attributable to expenditures described in 

6 section 1905(u)(4), except as provided in sec7 tion 1905(u)(5).’’.

8 (3) EFFECTIVE DATE.—The amendments made 

9 by this subsection apply as of October 1, 2004, to 

10 fiscal years beginning on or after such date and to 

11 expenditures under the State plan on and after such 

12 date, whether or not regulations implementing such 

13 amendments have been issued. 

14 (c) GAO STUDY.—

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

16 United States shall conduct a study regarding fund17 ing under title XXI of the Social Security Act that 

18 examines—

19 (A) the adequacy of overall funding under 

20 such title; 

21 (B) the formula for determining allotments 

22 and for redistribution of unspent funds under 

23 such title; and 

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

25 enrollment under such title.
39

•HR 3459 IH 

1 (2) REPORT.—Not later than July 1, 2005, the 

2 Comptroller General shall submit a report on the 

3 study conducted under paragraph (1). Such report 

4 shall include recommendations regarding a better 

5 mechanism for determining State allotments and re6 distribution of unspent funds under such title in 

7 order to ensure all eligible families in need can ac8 cess coverage through such title. 

9 (d) CONFORMING AMENDMENTS.—

10 (1) ELIGIBILITY CATEGORIES.—Section 

11 1905(a) of the Social Security Act (42 U.S.C. 

12 1396d(a)) is amended, in the matter before para13 graph (1)—

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

15 (xii); 

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

17 (xiii); and 

18 (C) by inserting after clause (xiii) the fol19 lowing: 

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

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

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

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

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

25 after ‘‘1902(a)(10)(A)(ii)(XVIII),’’.
40

•HR 3459 IH 

1 (3) CONFORMING AMENDMENT RELATING TO

2 NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec3 tion 2102(b)(1)(B) of the Social Security Act (42 

4 U.S.C. 1397bb(b)(1)(B)) is amended—

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

6 clause (i) and inserting a semicolon; 

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

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

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

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

11 (including a waiting period to carry out 

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

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

14 SEC. 104. AUTOMATIC ENROLLMENT OF CHILDREN BORN 

15 TO TITLE XXI PARENTS. 

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

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

18 the following: 

19 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL20 DREN BORN TO A PARENT BEING PROVIDED

21 FAMILYCARE.—Such eligibility standards shall 

22 provide for automatic coverage of a child born 

23 to an individual who is provided assistance 

24 under this title in the same manner as medical 

25 assistance would be provided under section 
41

•HR 3459 IH 

1 1902(e)(4) to a child described in such sec2 tion.’’. 

3 SEC. 105. OPTIONAL COVERAGE OF CHILDREN THROUGH 

4 AGE 20 UNDER THE MEDICAID PROGRAM AND 

5 TITLE XXI. 

6 (a) MEDICAID.—

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

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

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

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

11 age’’. 

12 (2) CONFORMING AMENDMENTS.—

13 (A) Section 1902(e)(3)(A) of the Social Se14 curity Act (42 U.S.C. 1396a(e)(3)(A)) is 

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

16 age the State has elected under subsection 

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

18 (B) Section 1902(e)(12) of the Social Se19 curity Act (42 U.S.C. 1396a(e)(12)) is amend20 ed by inserting ‘‘or such higher age as the State 

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

22 ‘‘19 years of age’’. 

23 (C) Section 1920A(b)(1) of the Social Se24 curity Act (42 U.S.C. 1396r–1a(b)(1)) is 

25 amended by inserting ‘‘or such higher age as 
42

•HR 3459 IH 

1 the State has elected under section 

2 1902(l)(1)(D)’’ after ‘‘19 years of age’’. 

3 (D) Section 1928(h)(1) of the Social Secu4 rity Act (42 U.S.C. 1396s(h)(1)) is amended by 

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

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

7 the period at the end. 

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

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

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

11 the State has elected under section 

12 1902(l)(1)(D))’’ after ‘‘19 years of age’’. 

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

14 Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in15 serting ‘‘(or such higher age as the State has elected under 

16 section 1902(l)(1)(D))’’. 

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

18 this section take effect on January 1, 2004, and apply to 

19 medical assistance and child health assistance provided on 

20 or after such date, whether or not regulations imple21 menting such amendments have been issued. 

22 SEC. 106. ALLOWING STATES TO SIMPLIFY RULES FOR FAM23 ILIES. 

24 (a) PRESUMPTIVE ELIGIBILITY.—
43

•HR 3459 IH 

1 (1) APPLICATION TO PRESUMPTIVE ELIGIBILITY

2 FOR PREGNANT WOMEN UNDER MEDICAID.—Section 

3 1920(b) of the Social Security Act (42 U.S.C. 

4 1396r–1(b)) is amended by adding at the end after 

5 and below paragraph (2) the following flush sen6 tence: 

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

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

9 (2) OPTIONAL APPLICATION OF PRESUMPTIVE

10 ELIGIBILITY PROVISIONS TO PARENTS.—Section 

11 1920A of the Social Security Act (42 U.S.C. 1396r–

12 1a) is amended by adding at the end the following: 

13 ‘‘(e) A State may elect to apply the previous provi14 sions of this section to provide for a period of presumptive 

15 eligibility for medical assistance for a parent of a child 

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

17 section.’’. 

18 (3) APPLICATION UNDER TITLE XXI.—Section 

19 2107(e)(1)(D) of the Social Security Act (42 U.S.C. 

20 1397gg(e)(1)) is amended to read as follows: 

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

22 presumptive eligibility).’’. 

23 (b) 12-MONTHS CONTINUOUS ELIGIBILITY.—
44

•HR 3459 IH 

1 (1) MEDICAID.—Section 1902(e)(12) of the So2 cial Security Act (42 U.S.C. 1396a(e)(12)) is 

3 amended—

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

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

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

7 State (not to exceed 19 years of age)’’ and in8 serting ‘‘19 years of age (or such higher age as 

9 the State has elected under subsection 

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

11 eligible for medical assistance as the parent of 

12 such a child’’; and 

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

14 period (not to exceed 12 months) ’’ and insert15 ing ‘‘the 12-month period beginning on the 

16 date’’. 

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

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

19 at the end the following: ‘‘Such methods shall pro20 vide continuous eligibility for children under this 

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

22 12-months continuous eligibility provided under sec23 tion 1902(e)(12) for children described in such sec24 tion under title XIX. If a State has elected to apply 

25 section 1902(e)(12) to parents, such methods may
45

•HR 3459 IH 

1 provide continuous eligibility for parents under this 

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

3 12-months continuous eligibility provided under such 

4 section for parents described in such section under 

5 title XIX.’’. 

6 (3) EFFECTIVE DATE.—The amendments made 

7 by this subsection shall take effect on July 1, 2004 

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

9 of this Act), whether or not regulations imple10 menting such amendments have been issued. 

11 (c) PROVISION OF MEDICAID AND CHIP APPLICA12 TIONS AND INFORMATION UNDER THE SCHOOL LUNCH

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

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

15 amended—

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

17 ‘‘(B)(i) Applications’’; and 

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

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

20 lunches that are distributed pursuant to clause (i) to par21 ents or guardians of children in attendance at schools par22 ticipating in the school lunch program under this Act shall 

23 also contain information on the availability of medical as24 sistance under title XIX of the Social Security Act (42 

25 U.S.C. 1396 et seq.) and of child health and FamilyCare 
46

•HR 3459 IH 

1 assistance under title XXI of such Act, including informa2 tion on how to obtain an application for assistance under 

3 such programs. 

4 ‘‘(II) Information on the programs referred to in sub5 clause (I) shall be provided on a form separate from the 

6 application form for free and reduced price lunches under 

7 clause (i).’’. 

8 SEC. 107. DEMONSTRATION PROGRAMS TO IMPROVE MED9 ICAID AND CHIP OUTREACH TO HOMELESS 

10 INDIVIDUALS AND FAMILIES. 

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

12 Human Services may award demonstration grants to not 

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

14 innovative programs that are designed to improve out15 reach to homeless individuals and families under the pro16 grams described in subsection (b) with respect to enroll17 ment of such individuals and families under such pro18 grams and the provision of services (and coordinating the 

19 provision of such services) under such programs. 

20 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The 

21 programs described in this subsection are as follows: 

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

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

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

25 the Social Security Act (42 U.S.C. 1397aa et seq.). 
47

•HR 3459 IH 

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

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

3 et seq.). 

4 (4) SAMHSA BLOCK GRANTS.—The program 

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

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

7 (5) FOOD STAMP PROGRAM.—The program 

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

9 et seq.). 

10 (6) WORKFORCE INVESTMENT ACT.—The pro11 gram under the Workforce Investment Act of 1999 

12 (29 U.S.C. 2801 et seq.). 

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

14 program under section 403(a)(5) of the Social Secu15 rity Act (42 U.S.C. 603(a)(5)). 

16 (8) OTHER PROGRAMS.—Other public and pri17 vate benefit programs that serve low-income individ18 uals. 

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

20 out this section, there is appropriated for fiscal year 2004, 

21 out of any funds in the Treasury not otherwise appro22 priated, $10,000,000, to remain available until expended. 

23 SEC. 108. ADDITIONAL CHIP REVISIONS.

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

25 FAMILIES WITH INCOME BELOW 150 PERCENT OF POV-
48

•HR 3459 IH 

1 ERTY.—Section 2103(e)(3)(A) of the Social Security Act 

2 (42 U.S.C. 1397cc(e)(3)(A)) is amended—

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

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

5 (ii) and inserting ‘‘; and’’; and 

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

7 clause: 

8 ‘‘(iii) total annual aggregate cost9 sharing described in clauses (i) and (ii) 

10 with respect to all such targeted low-in11 come children in a family under this title 

12 that exceeds 2.5 percent of such family’s 

13 income for the year involved.’’. 

14 (b) EMPLOYER COVERAGE WAIVER CHANGES.—Sec15 tion 2105(c)(3) of such Act (42 U.S.C. 1397ee(c)(3)) is 

16 amended—

17 (1) by redesignating subparagraphs (A) and 

18 (B) as clauses (i) and (ii) and indenting appro19 priately; 

20 (2) by designating the matter beginning with 

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

22 with the heading ‘‘IN GENERAL’’ and indenting ap23 propriately; and 

24 (3) by adding at the end the following new sub25 paragraph: 
49

•HR 3459 IH 

1 ‘‘(B) APPLICATION OF REQUIREMENTS.—

2 In carrying out subparagraph (A)—

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

4 the Secretary shall measure against family 

5 coverage costs to the extent that a State 

6 has expanded coverage to parents pursuant 

7 to section 2111; 

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

9 shall provide satisfactory assurances that 

10 the minimum benefits and cost-sharing 

11 protections established under this title are 

12 provided, either through the coverage 

13 under subparagraph (A) or as a supple14 ment to such coverage; and 

15 ‘‘(iii) coverage under such subpara16 graph shall not be considered to violate 

17 clause (ii) because it does not comply with 

18 requirements relating to reviews of health 

19 service decisions if the enrollee involved is 

20 provided the option of being provided bene21 fits directly under this title.’’. 

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

23 this section apply as of January 1, 2004, whether or not 

24 regulations implementing such amendments have been 

25 issued. 
50

•HR 3459 IH 

1 SEC. 109. COORDINATION OF TITLE XXI WITH THE MATER2 NAL AND CHILD HEALTH PROGRAM. 

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

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

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

6 the end; 

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

8 and inserting ‘‘; and’’; and 

9 (3) by adding at the end the following new sub10 paragraph: 

11 ‘‘(F) that operations and activities under 

12 this title are developed and implemented in con13 sultation and coordination with the program op14 erated by the State under title V in areas in15 cluding outreach and enrollment, benefits and 

16 services, service delivery standards, public 

17 health and social service agency relationships, 

18 and quality assurance and data reporting.’’. 

19 (b) CONFORMING MEDICAID AMENDMENT.—Section 

20 1902(a)(11) of such Act (42 U.S.C. 1396a(a)(11)) is 

21 amended—

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

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

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

25 activities under this title are developed and imple26 mented in consultation and coordination with the
51

•HR 3459 IH 

1 program operated by the State under title V in areas 

2 including outreach and enrollment, benefits and 

3 services, service delivery standards, public health 

4 and social service agency relationships, and quality 

5 assurance and data reporting’’. 

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

7 this section take effect on January 1, 2004. 

8 Subtitle B—State Option To Pro9 vide Coverage for All Residents 

10 With Income At or Below the 

11 Poverty Line 

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

13 RESIDENTS WITH INCOME AT OR BELOW THE 

14 POVERTY LINE. 

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

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

17 amended—

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

19 (XVII); 

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

21 (XVIII); and 

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

24 ‘‘(XIX) any individual whose 

25 family income does not exceed 100 
52

•HR 3459 IH 

1 percent of the income official poverty 

2 line (as defined by the Office of Man3 agement and Budget, and revised an4 nually in accordance with section 

5 673(2) of the Omnibus Budget Rec6 onciliation Act of 1981) applicable to 

7 a family of the size involved and who 

8 is not otherwise eligible for medical 

9 assistance under this title;’’. 

10 (b) CONFORMING AMENDMENTS.—

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

12 1396d(a)) is amended, in the matter before para13 graph (1)—

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

15 (xii); 

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

17 (xiii); and 

18 (C) by inserting after clause (xiii) the fol19 lowing new clause: 

20 ‘‘(xii) individuals described in section 

21 1902(a)(10)(A)(ii)(XIX),’’. 

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

23 1396b(f)(4)) is amended by inserting 

24 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

25 ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 
53

•HR 3459 IH 

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

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

3 Subtitle C—Optional Coverage of 

4 Legal Immigrants under the 

5 Medicaid Program and Title XXI 

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); 
54

•HR 3459 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)’’. 
55

•HR 3459 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-
56

•HR 3459 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 Subtitle D—Indian Healthcare 

6 Funding 

7 CHAPTER 1—GUARANTEED FUNDING 

8 SEC. 141. GUARANTEED ADEQUATE FUNDING FOR INDIAN 

9 HEALTHCARE. 

10 Section 825 of the Indian Health Care Improvement 

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

12 ‘‘SEC. 825. FUNDING. 

13 ‘‘(a) IN GENERAL.—Notwithstanding any other pro14 vision of law, not later than 30 days after the date of en15 actment of this section, on October 1, 2003, and on each 

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

17 not otherwise appropriated, the Secretary of the Treasury 

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

19 amount determined under subsection (d). 

20 ‘‘(b) USE AND AVAILABILITY.—

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

22 under subsection (a)—

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

24 and
57

•HR 3459 IH 

1 ‘‘(B) shall be used to carry out any pro2 grams, functions, and activities relating to clin3 ical services (as defined in paragraph (2)) of 

4 the Service and Service units. 

5 ‘‘(2) CLINICAL SERVICES DEFINED.—For pur6 poses of paragraph (1)(B), the term ‘clinical serv7 ices’ includes all programs of the Indian Health 

8 Service which are funded directly or under the au9 thority of the Indian Self-Determination and Edu10 cation Assistance Act, for the purposes of—

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

12 outpatient care (including audiology, clinical eye 

13 and vision care), primary care, secondary and 

14 tertiary care, and long term care; 

15 ‘‘(B) preventive health, including mam16 mography and other cancer screening; 

17 ‘‘(C) dental care; 

18 ‘‘(D) mental health, including community 

19 mental health services, inpatient mental health 

20 services, dormitory mental health services, 

21 therapeutic and residential treatment centers; 

22 ‘‘(E) emergency medical services; 

23 ‘‘(F) treatment and control of, and reha24 bilitative care related to, alcoholism and drug 
58

•HR 3459 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 2004, 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 2005 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 
59

•HR 3459 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 
60

•HR 3459 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 
61

•HR 3459 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-
62

•HR 3459 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, 

18 shall be eligible for all health services provided by 

19 the Service on the same basis and subject to the 

20 same rules that apply to eligible Indians until such 

21 individual attains 19 years of age. The existing and 

22 potential health needs of all such individuals shall be 

23 taken into consideration by the Service in deter24 mining the need for, or the allocation of, the health 

25 resources of the Service. If such an individual has
63

•HR 3459 IH 

1 been determined to be legally incompetent prior to 

2 attaining 19 years of age, such individual shall re3 main eligible for such services until one year after 

4 the date such disability has been removed. 

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

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

7 but not otherwise eligible for the health services pro8 vided by the Service, shall be eligible for such health 

9 services if all of such spouses or spouses who are 

10 married to members of the Indian tribe being served 

11 are made eligible, as a class, by an appropriate reso12 lution of the governing body of the Indian tribe or 

13 tribal organization providing such services. The 

14 health needs of persons made eligible under this 

15 paragraph shall not be taken into consideration by 

16 the Service in determining the need for, or allocation 

17 of, its health resources. 

18 (b) PROGRAMS AND SERVICES.—

19 (1) PROGRAMS.—

20 (A) IN GENERAL.—The Secretary may 

21 provide health services under this subsection 

22 through health programs operated directly by 

23 the Service to individuals who reside within the 

24 service area of a service unit and who are not 

25 eligible for such health services under any other 
64

•HR 3459 IH 

1 subsection of this section or under any other 

2 provision of law if—

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

4 a multi-tribal service area, all the Indian 

5 tribes) served by such service unit requests 

6 such provision of health services to such 

7 individuals; and 

8 (ii) the Secretary and the Indian tribe 

9 or tribes have jointly determined that—

10 (I) the provision of such health 

11 services will not result in a denial or 

12 diminution of health services to eligi13 ble Indians; and 

14 (II) there is no reasonable alter15 native health program or services, 

16 within or without the service area of 

17 such service unit, available to meet 

18 the health needs of such individuals. 

19 (B) FUNDING AGREEMENTS.—In the case 

20 of health programs operated under a funding 

21 agreement entered into under the Indian Self22 Determination and Educational Assistance Act, 

23 the governing body of the Indian tribe or tribal 

24 organization providing health services under 

25 such funding agreement is authorized to deter-
65

•HR 3459 IH 

1 mine whether health services should be provided 

2 under such funding agreement to individuals 

3 who are not eligible for such health services 

4 under any other subsection of this section or 

5 under any other provision of law. In making 

6 such determinations, the governing body of the 

7 Indian tribe or tribal organization shall take 

8 into account the considerations described in 

9 subparagraph (A)(ii). 

10 (2) LIABILITY FOR PAYMENT.—

11 (A) IN GENERAL.—Persons receiving 

12 health services provided by the Service by rea13 son of this subsection shall be liable for pay14 ment of such health services under a schedule 

15 of charges prescribed by the Secretary which, in 

16 the judgment of the Secretary, results in reim17 bursement in an amount not less than the ac18 tual cost of providing the health services. Not19 withstanding section 1880 of the Social Secu20 rity Act or any other provision of law, amounts 

21 collected under this subsection, including medi22 care or medicaid reimbursements under titles 

23 XVIII and XIX of the Social Security Act, shall 

24 be credited to the account of the program pro25 viding the service and shall be used solely for 
66

•HR 3459 IH 

1 the provision of health services within that pro2 gram. Amounts collected under this subsection 

3 shall be available for expenditure within such 

4 program for not to exceed 1 fiscal year after 

5 the fiscal year in which collected. 

6 (B) SERVICES FOR INDIGENT PERSONS.—

7 Health services may be provided by the Sec8 retary through the Service under this sub9 section to an indigent person who would not be 

10 eligible for such health services but for the pro11 visions of paragraph (1) only if an agreement 

12 has been entered into with a State or local gov13 ernment under which the State or local govern14 ment agrees to reimburse the Service for the 

15 expenses incurred by the Service in providing 

16 such health services to such indigent person. 

17 (3) SERVICE AREAS.—

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

19 case of a service area which serves only one In20 dian tribe, the authority of the Secretary to 

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

22 shall terminate at the end of the fiscal year suc23 ceeding the fiscal year in which the governing 

24 body of the Indian tribe revokes its concurrence 

25 to the provision of such health services. 
67

•HR 3459 IH 

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

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

3 Secretary to provide health services under para4 graph (1)(A) shall terminate at the end of the 

5 fiscal year succeeding the fiscal year in which at 

6 least 51 percent of the number of Indian tribes 

7 in the service area revoke their concurrence to 

8 the provision of such health services. 

9 (c) PURPOSE FOR PROVIDING SERVICES.—The Serv10 ice may provide health services under this subsection to 

11 individuals who are not eligible for health services provided 

12 by the Service under any other subsection of this section 

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

14 (1) achieve stability in a medical emergency; 

15 (2) prevent the spread of a communicable dis16 ease or otherwise deal with a public health hazard; 

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

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

19 pregnancy through post partum; or 

20 (4) provide care to immediate family members 

21 of an eligible person if such care is directly related 

22 to the treatment of the eligible person. 

23 (d) HOSPITAL PRIVILEGES.—Hospital privileges in 

24 health facilities operated and maintained by the Service 

25 or operated under a contract entered into under the Indian 
68

•HR 3459 IH 

1 Self-Determination Education Assistance Act may be ex2 tended to non-Service healthcare practitioners who provide 

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

4 non-Service healthcare practitioners may be regarded as 

5 employees of the Federal Government for purposes of sec6 tion 1346(b) and chapter 171 of title 28, United States 

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

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

9 services to eligible persons as a part of the conditions 

10 under which such hospital privileges are extended. 

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

12 Indian’’ means any Indian who is eligible for health serv13 ices provided by the Service without regard to the provi14 sions of this section. 

15 SEC. 151. DEFINITIONS. 

16 For purposes of this chapter, the definitions con17 tained in section 4 of the Indian Health Care Improve18 ment Act shall apply. 

19 SEC. 152. AUTHORIZATION OF APPROPRIATIONS. 

20 There are authorized to be appropriated such sums 

21 as may be necessary for each fiscal year through fiscal 

22 year 2015 to carry out this chapter.
69

•HR 3459 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 2004 through 2007, 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 2004 through 2007 and 

20 only for purposes of expenditures under this title, such 

21 percentage shall be 77 percent)’’ after ‘‘50 per centum’’. 
70

•HR 3459 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. 
71

•HR 3459 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, 2005, 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—
72

•HR 3459 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. 
73

•HR 3459 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; 
74

•HR 3459 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
75

•HR 3459 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—
76

•HR 3459 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 
77

•HR 3459 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 
78

•HR 3459 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 
79

•HR 3459 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 2005 and 

20 each subsequent fiscal year. 
80

•HR 3459 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—MINORITY HEALTH 

9 ‘‘SEC. 2900. DEFINITIONS. 

10 ‘‘In this title, the definitions contained in section 801 

11 of the Healthcare Equality and Accountability Act shall 

12 apply. 

13 ‘‘Subtitle A—Culturally and Lin14 guistically Appropriate 

15 Healthcare 

16 ‘‘SEC. 2901. IMPROVING ACCESS TO SERVICES FOR INDIVID17 UALS WITH LIMITED ENGLISH PROFICIENCY. 

18 ‘‘(a) PURPOSE.—As provided in Executive Order 

19 13166, it is the purpose of this section—

20 ‘‘(1) to improve access to Federally conducted 

21 and Federally assisted programs and activities for 

22 individuals who are limited in their English pro23 ficiency; 

24 ‘‘(2) to require each Federal agency to examine 

25 the services it provides and develop and implement
81

•HR 3459 IH 

1 a system by which limited English proficient individ2 uals can enjoy meaningful access to those services 

3 consistent with, and without substantially burdening, 

4 the fundamental mission of the agency; 

5 ‘‘(3) to require each Federal agency to ensure 

6 that recipients of Federal financial assistance pro7 vide meaningful access to their limited English pro8 ficient applicants and beneficiaries; 

9 ‘‘(4) to ensure that recipients of Federal finan10 cial assistance take reasonable steps, consistent with 

11 the guidelines set forth in the Limited English Pro12 ficient Guidance of the Department of Justice (as 

13 issued on June 12, 2002), to ensure meaningful ac14 cess to their programs and activities by limited 

15 English proficient individuals; and 

16 ‘‘(5) to ensure compliance with title VI of the 

17 Civil Rights Act of 1964 and that healthcare pro18 viders and organizations do not discriminate in the 

19 provision of services. 

20 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC21 TIVITIES.—

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

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

24 agency that carries out health care-related activities 

25 shall prepare a plan to improve access to the feder-
82

•HR 3459 IH 

1 ally conducted health care-related programs and ac2 tivities of the agency by limited English proficient 

3 individuals. 

4 ‘‘(2) PLAN REQUIREMENT.—Each plan under 

5 paragraph (1) shall be consistent with the standards 

6 set forth in section 204 of the Healthcare Equality 

7 and Accountability Act, and shall include the steps 

8 the agency will take to ensure that limited English 

9 proficient individuals have access to the agency’s 

10 health care-related programs and activities. Each 

11 agency shall send a copy of such plan to the Depart12 ment of Justice, which shall serve as the central re13 pository of the agencies’ plans. 

14 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI15 TIES.—

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

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

18 agency providing health care-related Federal finan19 cial assistance shall ensure that the guidance for re20 cipients of Federal financial assistance developed by 

21 the agency to ensure compliance with title VI of the 

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

23 is specifically tailored to the recipients of such as24 sistance and is consistent with the standards de25 scribed in section 204 of the Healthcare Equality 
83

•HR 3459 IH 

1 and Accountability Act. Each agency shall send a 

2 copy of such guidance to the Department of Justice 

3 which shall serve as the central repository of the 

4 agencies’ plans. After approval by the Department of 

5 Justice, each agency shall publish its guidance docu6 ment in the Federal Register for public comment. 

7 ‘‘(2) REQUIREMENTS.—The agency-specific 

8 guidance developed under paragraph (1) shall—

9 ‘‘(A) detail how the general standards es10 tablished under section 204 of the Healthcare 

11 Equality and Accountability Act will be applied 

12 to the agency’s recipients; and 

13 ‘‘(B) take into account the types of health 

14 care services provided by the recipients, the in15 dividuals served by the recipients, and other 

16 factors set out in such standards. 

17 ‘‘(3) EXISTING GUIDANCES.—A Federal agency 

18 that has developed a guidance for purposes of title 

19 VI of the Civil Rights Act of 1964 that the Depart20 ment of Justice determines is consistent with the 

21 standards described in section 204 of the Healthcare 

22 Equality and Accountability Act shall examine such 

23 existing guidance, as well as the programs and ac24 tivities to which such guidance applies, to determine 
84

•HR 3459 IH 

1 if modification of such guidance is necessary to com2 ply with this subsection. 

3 ‘‘(4) CONSULTATION.—Each Federal agency 

4 shall consult with the Department of Justice in es5 tablishing the guidances under this subsection. 

6 ‘‘(d) CONSULTATIONS.—

7 ‘‘(1) IN GENERAL.—In carrying out this sec8 tion, each Federal agency that carriers out health 

9 care-related activities shall ensure that stakeholders, 

10 such as limited English proficient individuals and 

11 their representative organizations, recipients of Fed12 eral assistance, and other appropriate individuals or 

13 entities, have an adequate and comparable oppor14 tunity to provide input with respect to the actions of 

15 the agency. 

16 ‘‘(2) EVALUATION OF NEEDS.—Each Federal 

17 agency described in paragraph (1) shall evaluate the 

18 particular needs of the limited English proficient in19 dividuals served by the agency, and by a recipient of 

20 assistance provided by the agency, and the burdens 

21 of compliance with the agency guidance and its re22 cipients of the requirements of this section.
85

•HR 3459 IH 

1 ‘‘SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND 

2 LINGUISTICALLY APPROPRIATE SERVICES IN 

3 HEALTHCARE. 

4 ‘‘Recipients of Federal financial assistance from the 

5 Secretary shall, to the extent reasonable and practicable 

6 after applying the 4-factor analysis described in title V 

7 of the Guidance to Federal Financial Assistance Recipi8 ents Regarding Title VI Prohibition Against National Ori9 gin Discrimination Affecting Limited-English Proficient 

10 Persons (June 12, 2002)—

11 ‘‘(1) implement strategies to recruit, retain, and 

12 promote individuals at all levels of the organization 

13 to maintain a diverse staff and leadership that can 

14 provide culturally and linguistically appropriate 

15 healthcare to patient populations of the service area 

16 of the organization; 

17 ‘‘(2) ensure that staff at all levels and across all 

18 disciplines of the organization receive ongoing edu19 cation and training in culturally and linguistically 

20 appropriate service delivery; 

21 ‘‘(3) offer and provide language assistance serv22 ices, including bilingual staff and interpreter serv23 ices, at no cost to each patient with limited English 

24 proficiency at all points of contact, in a timely man25 ner during all hours of operation; 
86

•HR 3459 IH 

1 ‘‘(4) notify patients of their right to receive lan2 guage assistance services in their primary language; 

3 ‘‘(5) ensure the competence of language assist4 ance provided to limited English proficient patients 

5 by interpreters and bilingual staff, and ensure that 

6 family and friends are not used to provide interpre7 tation services—

8 ‘‘(A) except in case of emergency; or 

9 ‘‘(B) except on request of the patient, who 

10 has been informed in his or her preferred lan11 guage of the availability of free interpretation 

12 services; 

13 ‘‘(6) make available easily understood patient14 related materials including information or notices 

15 about termination of benefits and post signage in 

16 the languages of the commonly encountered groups 

17 or groups represented in the service area of the or18 ganization; 

19 ‘‘(7) develop and implement clear goals, poli20 cies, operational plans, and management account21 ability and oversight mechanisms to provide cul22 turally and linguistically appropriate services; 

23 ‘‘(8) conduct initial and ongoing organizational 

24 self-assessments of culturally and linguistically ap25 propriate services-related activities and integrate cul-
87

•HR 3459 IH 

1 tural and linguistic competence-related measures 

2 into the internal audits, performance improvement 

3 programs, patient satisfaction assessments, and out4 comes-based evaluations of the organization; 

5 ‘‘(9) ensure that, consistent with the privacy 

6 protections provided for under the regulations pro7 mulgated under section 264(c) of the Health Insur8 ance Portability and Accountability Act of 1996 (42 

9 U.S.C. 1320d–2 note)—

10 ‘‘(A) data on the individual patient’s race, 

11 ethnicity, and primary language are collected in 

12 health records, integrated into the organiza13 tion’s management information systems, and 

14 periodically updated; and 

15 ‘‘(B) if the patient is a minor or is inca16 pacitated, the primary language of the parent 

17 or legal guardian is collected; 

18 ‘‘(10) maintain a current demographic, cultural, 

19 and epidemiological profile of the community as well 

20 as a needs assessment to accurately plan for and im21 plement services that respond to the cultural and 

22 linguistic characteristics of the service area of the 

23 organization; 

24 ‘‘(11) develop participatory, collaborative part25 nerships with communities and utilize a variety of 
88

•HR 3459 IH 

1 formal and informal mechanisms to facilitate com2 munity and patient involvement in designing and im3 plementing culturally and linguistically appropriate 

4 services-related activities; 

5 ‘‘(12) ensure that conflict and grievance resolu6 tion processes are culturally and linguistically sen7 sitive and capable of identifying, preventing, and re8 solving cross-cultural conflicts or complaints by pa9 tients; 

10 ‘‘(13) regularly make available to the public in11 formation about their progress and successful inno12 vations in implementing the standards under this 

13 section and provide public notice in their commu14 nities about the availability of this information; and 

15 ‘‘(14) regularly make available to the head of 

16 each Federal entity from which Federal funds are 

17 received, information about their progress and suc18 cessful innovations in implementing the standards 

19 under this section as required by the head of such 

20 entity. 

21 ‘‘SEC. 2903. CENTER FOR CULTURAL AND LINGUISTIC COM22 PETENCE IN HEALTHCARE. 

23 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

24 through the Director of the Office of Minority Health, 

25 shall establish and support a center to be known as the
89

•HR 3459 IH 

1 ‘Center for Cultural and Linguistic Competence in 

2 Healthcare’ (referred to in this section as the ‘Center’) 

3 to carry out the following activities: 

4 ‘‘(1) REMOTE MEDICAL INTERPRETATION.—

5 The Center shall provide remote medical interpreta6 tion, directly or through contract, at no cost to 

7 healthcare providers. Methods of interpretation may 

8 include remote, simultaneous or consecutive inter9 preting through telephonic systems, video confer10 encing, and other methods determined appropriate 

11 by the Secretary for patients with limited English 

12 proficiency. The quality of such interpretation shall 

13 be monitored and reported publicly. Nothing in this 

14 paragraph shall be construed to limit the ability of 

15 healthcare providers or organizations to provide 

16 medical interpretation services directly and obtain 

17 reimbursement for such services as provided for 

18 under the medicare, medicaid or SCHIP programs 

19 under titles XVIII, XIX, or XXI of the Social Secu20 rity Act. 

21 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.—

22 The Center shall provide, directly or through con23 tract, for the translation of written materials for 

24 healthcare providers and healthcare organizations 

25 (as defined in section 2902(b)) at no cost to such 
90

•HR 3459 IH 

1 providers and organizations. Materials may be sub2 mitted for translation into non-English languages. 

3 Translation services shall be provided in a timely 

4 and reasonable manner. The quality of such trans5 lation shall be monitored and reported publicly. 

6 ‘‘(3) MODEL LANGUAGE ASSISTANCE PRO7 GRAMS.—The Center shall provide for the collection 

8 and dissemination of information on current model 

9 language assistance programs and strategies to im10 prove language access to healthcare for individuals 

11 with limited English proficiency, including case stud12 ies using de-identified patient information, program 

13 summaries, and program evaluations. 

14 ‘‘(4) MEDICAL INTERPRETATION GUIDE15 LINES.—

16 ‘‘(A) IN GENERAL.—The Center shall con17 vene a working group to develop quality guide18 lines and standards for the training of medical 

19 interpreters and translators. Such group shall 

20 include—

21 ‘‘(i) representatives from the Office of 

22 Minority Health, the National Center on 

23 Minority Health and Health Disparities, 

24 the Agency for Healthcare Research and 

25 Quality, the Centers for Medicare and 
91

•HR 3459 IH 

1 Medicaid Services, the Office for Civil 

2 Rights of the Department of Health and 

3 Human Services, and other Federal agen4 cies determined appropriate by the Sec5 retary; and 

6 ‘‘(ii) representatives of communities 

7 with a significant proportion of limited 

8 English proficient individuals, professional 

9 interpreter associations, medical interpre10 tation service providers, and other public 

11 or private organizations determined appro12 priate by the Secretary. 

13 ‘‘(B) PUBLICATION.—Not later than 18 

14 months after the date of enactment of this Act, 

15 the Center shall publish guidelines and stand16 ards developed under this paragraph in the 

17 Federal Register. 

18 ‘‘(5) INTERNET HEALTH CLEARINGHOUSE.—

19 The Center shall develop and maintain an Internet 

20 clearinghouse to reduce medical errors and 

21 healthcare costs caused by communication with indi22 viduals with limited English proficiency or low func23 tional health literacy and reduce or eliminate the du24 plication of effort to translate materials by—
92

•HR 3459 IH 

1 ‘‘(A) developing and making available tem2 plates for standard documents that are nec3 essary for patients and consumers to access and 

4 make educated decisions about their healthcare, 

5 including—

6 ‘‘(i) administrative and legal docu7 ments such as informed consent, advanced 

8 directives, and waivers of rights; 

9 ‘‘(ii) clinical information such as how 

10 to take medications, how to prevent trans11 mission of a contagious disease, and other 

12 prevention and treatment instructions; and 

13 ‘‘(iii) patient education and outreach 

14 materials such as immunization notices, 

15 health warnings, or screening notices; 

16 ‘‘(B) ensuring that the documents are 

17 posted in English and non-English languages 

18 and are culturally appropriate; 

19 ‘‘(C) allowing public review of the docu20 ments before dissemination in order to ensure 

21 that the documents are understandable and cul22 turally appropriate for the target populations; 

23 ‘‘(D) allowing healthcare providers to cus24 tomize the documents for their use; 
93

•HR 3459 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 ‘‘(6) 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 
94

•HR 3459 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 2005 through 2010. 

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, and the Director of the Of24 fice of Minority Health, shall award grants to eligible enti25 ties to enable such entities to design, implement, and 
95

•HR 3459 IH 

1 evaluate innovative, cost-effective programs to improve lin2 guistic access to healthcare for individuals with limited 

3 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 nonprofit organization, 

8 health center or community clinic, university, col9 lege, 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; 
96

•HR 3459 IH 

1 ‘‘(3) develop formal training programs for indi2 viduals interested in becoming dedicated healthcare 

3 interpreters; 

4 ‘‘(4) provide language training courses for 

5 healthcare staff; 

6 ‘‘(5) provide basic healthcare-related English 

7 language instruction for limited English proficient 

8 individuals; and 

9 ‘‘(6) develop other language assistance services 

10 as determined appropriate by the Secretary. 

11 ‘‘(d) PRIORITY.—In awarding grants under this sec12 tion, the Secretary shall give priority to entities that have 

13 developed partnerships with organizations or agencies with 

14 experience in language access services. 

15 ‘‘(e) EVALUATION.—An entity that receives a grant 

16 under this section shall submit to the Secretary an evalua17 tion that describes the activities carried out with funds 

18 received under the grant, and how such activities improved 

19 access to healthcare services and the quality of healthcare 

20 for individuals with limited English proficiency. Such eval21 uation shall be collected and disseminated through the 

22 Center for Linguistic and Cultural Competence in 

23 Healthcare established under section 2903. 

24 ‘‘(f) GRANTEE CONVENTION.—The Secretary, acting 

25 through the Director of the Center for Linguistic and Cul-
97

•HR 3459 IH 

1 tural Competence in Healthcare, shall at the end of the 

2 grant cycle convene grantees under this section to share 

3 findings and develop and disseminate model programs and 

4 practices. 

5 ‘‘(g) 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 2005 through 2010. 

9 ‘‘SEC. 2905. RESEARCH ON LANGUAGE ACCESS. 

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

11 the Director of the Agency for Healthcare Research and 

12 Quality, shall expand research concerning—

13 ‘‘(1) the barriers to healthcare services that are 

14 faced by limited English proficient individuals; 

15 ‘‘(2) the impact of language barriers on the 

16 quality of healthcare and the health status of limited 

17 English proficient individuals and populations; 

18 ‘‘(3) healthcare provider attitudes, knowledge, 

19 and awareness of the barriers described in para20 graphs (1) and (2); and 

21 ‘‘(4) the means by which oral or written lan22 guage interpretation services are provided to limited 

23 English proficient individuals and whether such serv24 ices are effective in improving the quality of care. 
98

•HR 3459 IH 

1 ‘‘(b) 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 2005 through 2010. 

5 ‘‘SEC. 2906. TOLL-FREE TELEPHONE NUMBER. 

6 ‘‘The Secretary shall provide, through a toll-free 

7 number, for a means by which limited English proficient 

8 individuals who are seeking information about, or assist9 ance with, Federal healthcare programs who phone such 

10 toll-free number are transferred (without charge) to ap11 propriate translators for the provision of such information 

12 or assistance.’’. 

13 SEC. 203. STANDARDS FOR LANGUAGE ACCESS SERVICES. 

14 Not later than 120 days after the date of enactment 

15 of this Act, the head of each Federal agency that carries 

16 out health care-related activities shall develop and adopt 

17 a guidance on language services for those with limited 

18 English proficiency who attempt to have access to or par19 ticipate in such activities that provides at the minimum 

20 the factors and principles set forth in the Department of 

21 Justice guidance published on June 12, 2002.
99

•HR 3459 IH 

1 SEC. 204. FEDERAL REIMBURSEMENT FOR CULTURALLY 

2 AND LINGUISTICALLY APPROPRIATE SERV3 ICES UNDER THE MEDICARE, MEDICAID AND 

4 STATE CHILDREN’S HEALTH INSURANCE 

5 PROGRAM. 

6 (a) DEMONSTRATION PROJECT PROMOTING ACCESS

7 FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH

8 PROFICIENCY.—

9 (1) IN GENERAL.—The Secretary shall conduct 

10 a demonstration project (in this section referred to 

11 as the ‘project’) to demonstrate the impact on costs 

12 and health outcomes of providing reimbursement for 

13 interpreter services to certain medicare beneficiaries 

14 who are limited English proficient in urban and 

15 rural areas. 

16 (2) SCOPE.—The Secretary shall carry out the 

17 project in not less than 30 States through contracts 

18 with up to—

19 (A) ten health plans (under part C of title 

20 XVIII of the Social Security Act); 

21 (B) ten small providers; and 

22 (C) ten hospitals. 

23 (3) DURATION.—Each contract entered into 

24 under the project shall extend over a period of not 

25 longer than 2 years. 
100

•HR 3459 IH 

1 (4) REPORT.—Upon completion of the project, 

2 the Secretary shall submit a report to Congress on 

3 the project which shall include recommendations re4 garding the extension of such project to the entire 

5 medicare program. 

6 (5) EVALUATION.—The Director of the Agency 

7 for Healthcare Research and Quality shall award 

8 grants to public and private nonprofit entities for 

9 the evaluation of the project. Such evaluations shall 

10 focus on access, utilization, efficiency, cost-effective11 ness, patient satisfaction, and select health out12 comes. 

13 (b) MEDICAID.—Section 1903(a)(3) of the Social Se14 curity Act (42 U.S.C. 1396b(a)(3)) is amended—

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

16 the end and inserting ‘‘and’’; and 

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

18 ‘‘(E) 90 percent of the sums expended with 

19 respect to costs incurred during such quarter as 

20 are attributable to the provision of culturally 

21 and linguistically appropriate services, including 

22 oral interpretation, translations of written ma23 terials, and other cultural and linguistic services 

24 for individuals with limited English proficiency 

25 and disabilities who apply for, or receive, med-
101

•HR 3459 IH 

1 ical assistance under the State plan (including 

2 any waiver granted to the State plan); plus’’.

3 (c) SCHIP.—Section 2105(a)(1) of the Social Secu4 rity Act (42 U.S.C.1397ee(a)), as amended by section 

5 515, is amended—

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

7 by inserting ‘‘or, in the case of expenditures de8 scribed in subparagraph (D)(iv), 90 percent’’ after 

9 ‘‘enhanced FMAP’’; and 

10 (2) in subparagraph (D)—

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

12 end; 

13 (B) by redesignating clause (iv) as clause 

14 (v); and 

15 (C) by inserting after clause (iii) the fol16 lowing: 

17 ‘‘(iv) for expenditures attributable to 

18 the provision of culturally and linguistically 

19 appropriate services, including oral inter20 pretation, translations of written materials, 

21 and other language services for individuals 

22 with limited English proficiency and dis23 abilities who apply for, or receive, child 

24 health assistance under the plan; and’’. 
102

•HR 3459 IH 

1 (d) EFFECTIVE DATE.—The amendments made by 

2 this section take effect on October 1, 2005. 

3 SEC. 205. INCREASING UNDERSTANDING OF HEALTH LIT4 ERACY. 

5 (a) IN GENERAL.—The Secretary, acting through the 

6 Director of the Agency for Healthcare Research and Qual7 ity and the Administrator of the Health Resources and 

8 Services Administration, shall award grants to eligible en9 tities to improve healthcare for patient populations that 

10 have low functional health literacy. 

11 (b) ELIGIBILITY.—To be eligible to receive a grant 

12 under subsection (a), an entity shall—

13 (1) be a hospital, health center or clinic, health 

14 plan, or other health entity; and 

15 (2) prepare and submit to the Secretary an ap16 plication at such time, in such manner, and con17 taining such information as the Secretary may re18 quire. 

19 (c) USE OF FUNDS.—

20 (1) AGENCY FOR HEALTHCARE RESEARCH AND

21 QUALITY.—Grants awarded under subsection (a) 

22 through the Agency for Healthcare Research and 

23 Quality shall be used—

24 (A) to define and increase the under25 standing of health literacy; 
103

•HR 3459 IH 

1 (B) to investigate the correlation between 

2 low health literacy and health and healthcare; 

3 (C) to clarify which aspects of health lit4 eracy have an effect on health outcomes; and 

5 (D) for any other activity determined ap6 propriate by the Director of the Agency. 

7 (2) HEALTH RESOURCES AND SERVICES AD8 MINISTRATION.—Grants awarded under subsection 

9 (a) through the Health Resources and Services Ad10 ministration shall be used to conduct demonstration 

11 projects for interventions for patients with low 

12 health literacy that may include—

13 (A) the development of new disease man14 agement programs for patients with low health 

15 literacy; 

16 (B) the tailoring of existing disease man17 agement programs for patients with low health 

18 literacy; 

19 (C) the translation of written health mate20 rials for patients with low health literacy; 

21 (D) the identification, implementation, and 

22 testing of low health literacy screening tools; 

23 (E) the conduct of educational campaigns 

24 for patients and providers about low health lit25 eracy; and 
104

•HR 3459 IH 

1 (F) other activities determined appropriate 

2 by the Administrator of the Health Resources 

3 and Services Administration. 

4 (d) DEFINITIONS.—In this section, the term ‘‘low 

5 health literacy’’ means the inability of an individual to ob6 tain, process, and understand basic health information 

7 and services needed to make appropriate health decisions. 

8 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated to carry out this section, 

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

11 2005 through 2010. 

12 SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL13 TURALLY AND LINGUISTICALLY APPRO14 PRIATE HEALTHCARE SERVICES. 

15 Not later than 1 year after the date of enactment 

16 of this Act and annually thereafter, the Secretary of 

17 Health and Human Services shall enter into a contract 

18 with the Institute of Medicine for the preparation and 

19 publication of a report that describes federal efforts to en20 sure that all individuals have meaningful access to cul21 turally and linguistically appropriate healthcare services. 

22 Such report shall include—

23 (1) a description and evaluation of the activities 

24 carried out under this title; and
105

•HR 3459 IH 

1 (2) a description of best practices, model pro2 grams, guidelines, and other effective strategies for 

3 providing access to culturally and linguistically ap4 propriate healthcare services. 

5 SEC. 207. GENERAL ACCOUNTING OFFICE REPORT ON IM6 PACT OF LANGUAGE ACCESS SERVICES. 

7 Not later than 3 years after the date of enactment 

8 of this Act, the Comptroller General of the United States 

9 shall examine, and prepare and publish a report on, the 

10 impact of language access services on the health and 

11 healthcare of limited English proficient populations. Such 

12 report shall include—

13 (1) recommendations on the development and 

14 implementation of policies and practices by 

15 healthcare organizations and providers for limited 

16 English proficient patient populations; 

17 (2) a description of the effect of providing lan18 guage access services on quality of healthcare and 

19 access to care; and 

20 (3) a description of the costs associated with or 

21 savings related to provision of language access serv22 ices. 
106

•HR 3459 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 202, is amended by adding at the end 

7 the following: 

8 ‘‘Subtitle B—Workforce Diversity 

9 ‘‘SEC. 2911. REPORT ON WORKFORCE DIVERSITY. 

10 ‘‘(a) IN GENERAL.—Not later than July 1, 2006, and 

11 biannually thereafter, the Secretary, acting through the 

12 director of each entity within the Department of Health 

13 and Human Services, shall prepare and submit to the 

14 Committee on Health, Education, Labor, and Pensions of 

15 the Senate and the Committee on Energy and Commerce 

16 of the House of Representatives a report on health work17 force diversity. 

18 ‘‘(b) REQUIREMENT.—The report under subsection 

19 (a) shall contain the following information: 

20 ‘‘(1) A description of any grant support that is 

21 provided by each entity for workforce diversity ini22 tiatives with the following information—

23 ‘‘(A) the number of grants made; 

24 ‘‘(B) the purpose of the grants; 
107

•HR 3459 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 
108

•HR 3459 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 Bureau of Labor Statistics of the De25 partment of Labor. 
109

•HR 3459 IH 

1 ‘‘(4) The Public Health Practice Program Of2 fice—Office of Workforce Policy and Planning. 

3 ‘‘(5) The National Center on Minority Health 

4 and Health Disparities. 

5 ‘‘(6) The Agency for Healthcare Research and 

6 Quality. 

7 ‘‘(7) The Institute of Medicine Study Com8 mittee for the 2004 workforce diversity report. 

9 ‘‘(8) The Indian Health Service. 

10 ‘‘(9) Academic institutions. 

11 ‘‘(10) Consumer organizations. 

12 ‘‘(11) Health professional associations, includ13 ing those that represent underrepresented minority 

14 populations. 

15 ‘‘(12) Researchers in the area of health work16 force. 

17 ‘‘(13) Health workforce accreditation entities. 

18 ‘‘(14) Private foundations that have sponsored 

19 workforce diversity initiatives. 

20 ‘‘(15) Not less than 5 health professions stu21 dents representing various health profession fields 

22 and levels of training. 

23 ‘‘(c) ACTIVITIES.—The working group established 

24 under subsection (a) shall convene at least twice each year 

25 to complete the following activities: 
110

•HR 3459 IH 

1 ‘‘(1) Review current public and private health 

2 workforce diversity initiatives. 

3 ‘‘(2) Identify successful health workforce diver4 sity programs and practices. 

5 ‘‘(3) Examine challenges relating to the devel6 opment and implementation of health workforce di7 versity initiatives. 

8 ‘‘(4) Draft a national strategic work plan for 

9 health workforce diversity, including recommenda10 tions for public and private sector initiatives. 

11 ‘‘(5) Develop a framework and methods for the 

12 evaluation of current and future health workforce di13 versity initiatives. 

14 ‘‘(6) Develop recommended standards for work15 force diversity that could be applicable to all health 

16 professions programs and programs funded under 

17 this Act. 

18 ‘‘(7) Develop curriculum guidelines for diversity 

19 training. 

20 ‘‘(8) Develop a strategy for the inclusion of 

21 community members on admissions committees for 

22 health profession schools. 

23 ‘‘(9) Other activities determined appropriate by 

24 the Secretary.
111

•HR 3459 IH 

1 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

2 the establishment of the working group under subsection 

3 (a), and annually thereafter, the working group shall pre4 pare and make available to the general public for com5 ment, an annual report on the activities of the working 

6 group. Such report shall include the recommendations of 

7 the working group for improving health workforce diver8 sity. 

9 ‘‘(e) 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 2005 through 2010. 

13 ‘‘SEC. 2913. TECHNICAL CLEARINGHOUSE FOR HEALTH 

14 WORKFORCE DIVERSITY. 

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

16 the Office of Minority Health, and in collaboration with 

17 the Bureau of Health Professions within the Health Re18 sources and Services Administration, shall establish a 

19 technical clearinghouse on health workforce diversity with20 in the Office of Minority Health and coordinate current 

21 and future clearinghouses. 

22 ‘‘(b) INFORMATION AND SERVICES.—The clearing23 house established under subsection (a) shall offer the fol24 lowing information and services: 
112

•HR 3459 IH 

1 ‘‘(1) Information on the importance of health 

2 workforce diversity. 

3 ‘‘(2) Statistical information relating to under4 represented minority representation in health and al5 lied health professions and occupations. 

6 ‘‘(3) Model health workforce diversity practices 

7 and programs. 

8 ‘‘(4) Admissions policies that promote health 

9 workforce diversity and are in compliance with Fed10 eral and State laws. 

11 ‘‘(5) Lists of scholarship, loan repayment, and 

12 loan cancellation grants as well as fellowship infor13 mation for underserved populations for health pro14 fessions schools. 

15 ‘‘(6) Foundation and other large organizational 

16 initiatives relating to health workforce diversity. 

17 ‘‘(c) CONSULTATION.—In carrying out this section, 

18 the Secretary shall consult with non-Federal entities which 

19 may include minority health professional associations to 

20 ensure the adequacy and accuracy of information. 

21 ‘‘(d) 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 2005 through 2010. 
113

•HR 3459 IH 

1 ‘‘SEC. 2914. EVALUATION OF WORKFORCE DIVERSITY INI2 TIATIVES. 

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

4 the Bureau of Health Professions within the Health Re5 sources and Services Administration, shall award grants 

6 to eligible entities for the conduct of an evaluation of cur7 rent health workforce diversity initiatives funded by the 

8 Department of Health and Human Services. 

9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

10 under subsection (a) an entity shall—

11 ‘‘(1) be a city, county, Indian tribe, State, terri12 tory, community-based nonprofit organization, 

13 health center, university, college, or other entity de14 termined appropriate by the Secretary; 

15 ‘‘(2) with respect to an entity that is not an 

16 academic medical center, university, or private re17 search institution, carry out activities under the 

18 grant in partnership with an academic medical cen19 ter, university, or private research institution; and 

20 ‘‘(3) submit to the Secretary an application at 

21 such time, in such manner, and containing such in22 formation as the Secretary may require. 

23 ‘‘(c) USE OF FUNDS.—Amounts awarded under a 

24 grant under subsection (a) shall be used to support the 

25 following evaluation activities: 
114

•HR 3459 IH 

1 ‘‘(1) Determinations of measures of health 

2 workforce diversity success. 

3 ‘‘(2) The short- and long-term tracking of par4 ticipants in health workforce diversity pipeline pro5 grams funded by the Department of Health and 

6 Human Services. 

7 ‘‘(3) Assessments of partnerships formed 

8 through activities to increase health workforce diver9 sity. 

10 ‘‘(4) Assessments of barriers to health work11 force diversity. 

12 ‘‘(5) Assessments of policy changes at the Fed13 eral, State, and local levels. 

14 ‘‘(6) Assessments of coordination within and be15 tween Federal agencies and other institutions. 

16 ‘‘(7) Other activities determined appropriate by 

17 the Secretary and the Working Group established 

18 under section 2912. 

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

20 of enactment of this title, the Bureau of Health Profes21 sions within the Health Resources and Services Adminis22 tration shall prepare and make available for public com23 ment a report that summarizes the findings made by enti24 ties under grants under this section. 
115

•HR 3459 IH 

1 ‘‘(e) 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 2005 through 2010. 

5 ‘‘SEC. 2915. DATA COLLECTION AND REPORTING BY 

6 HEALTH PROFESSIONAL SCHOOLS. 

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

8 the Bureau of Health Professions of the Health Resources 

9 and Services Administration and the Office of Minority 

10 Health, shall establish an aggregated database on health 

11 professional students. 

12 ‘‘(b) REQUIREMENT TO COLLECT DATA.—Each 

13 health professional school (including medical, dental, and 

14 nursing schools) and allied health profession school and 

15 program that receives Federal funds shall collect race, eth16 nicity, and language proficiency data concerning those stu17 dents enrolled at such schools or in such programs. In col18 lecting such data, a school or program shall—

19 ‘‘(1) at a minimum, use the categories for race 

20 and ethnicity described in the 1997 Office of Man21 agement and Budget Standards for Maintaining, 

22 Collecting, and Presenting Federal Data on Race 

23 and Ethnicity and available language standards; and 
116

•HR 3459 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 2005 through 2010. 

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—
117

•HR 3459 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; 
118

•HR 3459 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. Such programs shall enhance diversity 

15 by considering minority status as part of an individualized 

16 consideration of qualifications. Possible activities may in17 clude—

18 ‘‘(1) educational outreach programs relating to 

19 opportunities in the health professions; 

20 ‘‘(2) scholarship, fellowship, grant, loan repay21 ment, and loan cancellation programs; 

22 ‘‘(3) post-baccalaureate programs; 

23 ‘‘(4) academic enrichment programs, particu24 larly targeting those who would not be competitive 

25 for health professions schools; 
119

•HR 3459 IH 

1 ‘‘(5) kindergarten through 12th grade and 

2 other health pipeline programs; 

3 ‘‘(6) mentoring programs; 

4 ‘‘(7) internship or rotation programs involving 

5 hospitals, health systems, health plans and other 

6 health entities; 

7 ‘‘(8) community partnership development for 

8 purposes relating to workforce diversity; or 

9 ‘‘(9) leadership training. 

10 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

11 a grant under this section, and annually for the term of 

12 the grant, a grantee shall submit to the Secretary a report 

13 that summarizes and evaluates all activities conducted 

14 under the grant. 

15 ‘‘(e) DEFINITION.—In this section, the term ‘Asian 

16 American and Pacific Islander-serving institutions’ means 

17 institutions—

18 ‘‘(1) that are eligible institutions under section 

19 312(b) of the Higher Education Act of 1965; and 

20 ‘‘(2) that, at the time of their application, have 

21 an enrollment of undergraduate students that is 

22 made up of at least 10 percent Asian American and 

23 Pacific Islander students. 

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

25 is authorized to be appropriated to carry out this section, 
120

•HR 3459 IH 

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

2 2005 through 2010. 

3 ‘‘SEC. 2917. CAREER DEVELOPMENT FOR SCIENTISTS AND 

4 RESEARCHERS. 

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

6 the Director of the National Institutes of Health, the Di7 rector of the Centers for Disease Control and Prevention, 

8 the Commissioner of the Food and Drug Administration, 

9 and the Director of the Agency for Healthcare Research 

10 and Quality, shall award grants that expand existing op11 portunities for scientists and researchers and promote the 

12 inclusion of underrepresented minorities in the health pro13 fessions. 

14 ‘‘(b) RESEARCH FUNDING.—The head of each entity 

15 within the Department of Health and Human Services 

16 shall establish or expand existing programs to provide re17 search funding to scientists and researchers in-training. 

18 Under such programs, the head of each such entity shall 

19 give priority in allocating research funding to support 

20 health research in traditionally underserved communities, 

21 including underrepresented minority communities, and re22 search classified as community or participatory. 

23 ‘‘(c) DATA COLLECTION.—The head of each entity 

24 within the Department of Health and Human Services 

25 shall collect data on the number (expressed as an absolute 
121

•HR 3459 IH 

1 number and a percentage) of underrepresented minority 

2 and nonminority applicants who receive and are denied 

3 agency funding at every stage of review. Such data shall 

4 be reported annually to the Secretary and the appropriate 

5 committees of Congress. 

6 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec7 retary shall establish a student loan reimbursement pro8 gram to provide student loan reimbursement assistance to 

9 researchers who focus on minority health issues or minor10 ity racial and ethnic disparities in health. The Secretary 

11 shall promulgate regulations to define the scope and pro12 cedures for the program under this subsection. 

13 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec14 retary shall establish a student loan cancellation program 

15 to provide student loan cancellation assistance to research16 ers who focus on minority health issues or minority racial 

17 and ethnic disparities in health. Students participating in 

18 the program shall make a minimum 5-year commitment 

19 to work at an accredited health profession school. The Sec20 retary shall promulgate additional regulations to define 

21 the scope and procedures for the program under this sub22 section. 

23 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

24 is authorized to be appropriated to carry out this section, 
122

•HR 3459 IH 

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

2 2005 through 2010. 

3 ‘‘SEC. 2918. CAREER SUPPORT FOR NON-RESEARCH 

4 HEALTH PROFESSIONALS. 

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

6 the Director of the Centers for Disease Control and Pre7 vention, the Administrator of the Substance Abuse and 

8 Mental Health Services Administration, the Administrator 

9 of the Health Resources and Services Administration, and 

10 the Administrator of the Centers for Medicare and Med11 icaid Services shall establish a program to award grants 

12 to eligible individuals for career support in non-research13 related healthcare. 

14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

15 under subsection (a) an individual shall—

16 ‘‘(1) be a student in a health professions school, 

17 a graduate of such a school who is working in a 

18 health profession, or a faculty member of such a 

19 school; and 

20 ‘‘(2) submit to the Secretary an application at 

21 such time, in such manner, and containing such in22 formation as the Secretary may require. 

23 ‘‘(c) USE OF FUNDS.—An individual shall use 

24 amounts received under a grant under this section to—
123

•HR 3459 IH 

1 ‘‘(1) support the individual’s health activities or 

2 projects that involve underserved communities, in3 cluding racial and ethnic minority communities; 

4 ‘‘(2) support health-related career advancement 

5 activities; and 

6 ‘‘(3) to pay, or as reimbursement for payments 

7 of, student loans for individuals who are health pro8 fessionals and are focused on health issues affecting 

9 underserved communities, including racial and eth10 nic minority communities. 

11 ‘‘(d) DEFINITION.—In this section, the term ‘career 

12 in non-research-related healthcare’ means employment or 

13 intended employment in the field of public health, health 

14 policy, health management, health administration, medi15 cine, nursing, pharmacy, allied health, community health, 

16 or other fields determined appropriate by the Secretary, 

17 other than in a position that involves research. 

18 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

19 is authorized to be appropriated to carry out this section, 

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

21 2005 through 2010. 

22 ‘‘SEC. 2919. RESEARCH ON THE EFFECT OF WORKFORCE DI23 VERSITY ON QUALITY. 

24 ‘‘(a) IN GENERAL.—The Director of the Agency for 

25 Healthcare Research and Quality, in collaboration with 
124

•HR 3459 IH 

1 the Director of the Office of Minority Health and the Di2 rector of the National Center on Minority Health and 

3 Health Disparities, shall award grants to eligible entities 

4 to expand research on the link between health workforce 

5 diversity and quality healthcare. 

6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

7 under subsection (a) an entity shall—

8 ‘‘(1) be a clinical, public health, or health serv9 ices research entity or other entity determined ap10 propriate by the Director; and 

11 ‘‘(2) submit to the Secretary an application at 

12 such time, in such manner, and containing such in13 formation as the Secretary may require. 

14 ‘‘(c) USE OF FUNDS.—Amounts received under a 

15 grant awarded under subsection (a) shall be used to sup16 port research that investigates the effect of health work17 force diversity on—

18 ‘‘(1) language access; 

19 ‘‘(2) cultural competence; 

20 ‘‘(3) patient satisfaction; 

21 ‘‘(4) timeliness of care; 

22 ‘‘(5) safety of care; 

23 ‘‘(6) effectiveness of care; 

24 ‘‘(7) efficiency of care; 

25 ‘‘(8) patient outcomes; 
125

•HR 3459 IH 

1 ‘‘(9) community engagement; 

2 ‘‘(10) resource allocation; 

3 ‘‘(11) organizational structure; or 

4 ‘‘(12) other topics determined appropriate by 

5 the Director. 

6 ‘‘(d) PRIORITY.—In awarding grants under sub7 section (a), the Director shall give individualized consider8 ation to all relevant aspects of the applicant’s background. 

9 Consideration of prior research experience involving the 

10 health of underserved communities shall be such a factor. 

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 2005 through 2010. 

15 ‘‘SEC. 2920. HEALTH DISPARITIES EDUCATION PROGRAM. 

16 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

17 through the National Center on Minority Health and 

18 Health Disparities and in collaboration with the Office of 

19 Minority Health, the Office for Civil Rights, the Centers 

20 for Disease Control and Prevention, the Centers for Medi21 care and Medicaid Services, the Health Resources and 

22 Services Administration, and other appropriate public and 

23 private entities, shall establish and coordinate a health and 

24 healthcare disparities education program to support, de25 velop, and implement educational initiatives and outreach 
126

•HR 3459 IH 

1 strategies that inform healthcare professionals and the 

2 public about the existence of and methods to reduce racial 

3 and ethnic disparities in health and healthcare. 

4 ‘‘(b) ACTIVITIES.—The Secretary, through the edu5 cation program established under subsection (a) shall, 

6 through the use of public awareness and outreach cam7 paigns targeting the general public and the medical com8 munity at large—

9 ‘‘(1) disseminate scientific evidence for the ex10 istence and extent of racial and ethnic disparities in 

11 healthcare, including disparities that are not other12 wise attributable to known factors such as access to 

13 care, patient preferences, or appropriateness of 

14 intervention, as described in the 2002 Institute of 

15 Medicine Report, Unequal Treatment; 

16 ‘‘(2) disseminate new research findings to 

17 healthcare providers and patients to assist them in 

18 understanding, reducing, and eliminating health and 

19 healthcare disparities; 

20 ‘‘(3) disseminate information about the impact 

21 of linguistic and cultural barriers on healthcare qual22 ity and the obligation of health providers who receive 

23 Federal financial assistance to ensure that people 

24 with limited English proficiency have access to lan25 guage access services; 
127

•HR 3459 IH 

1 ‘‘(4) disseminate information about the impor2 tance and legality of racial, ethnic, and primary lan3 guage data collection, analysis, and reporting; 

4 ‘‘(5) design and implement specific educational 

5 initiatives to health care providers relating to health 

6 and health care disparities; 

7 ‘‘(6) assess the impact of the programs estab8 lished under this section in raising awareness of 

9 health and healthcare disparities and providing in10 formation on available resources. 

11 ‘‘(c) 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 2005 through 2010. 

15 ‘‘SEC. 2920A. CULTURAL COMPETENCE TRAINING FOR 

16 HEALTHCARE PROFESSIONALS. 

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

18 the Administrator of the Health Resources and Services 

19 Administration, the Director of the Office of Minority 

20 Health, and the Director of the National Center for Mi21 nority Health and Health Disparities, shall award grants 

22 to eligible entities to test, implement, and evaluate models 

23 of cultural competence training for healthcare providers 

24 in coordination with the initiative under section 2920A(a). 
128

•HR 3459 IH 

1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a), an entity shall—

3 ‘‘(1) be an academic medical center, a health 

4 center or clinic, a hospital, a health plan, or a health 

5 system; 

6 ‘‘(2) partner with a minority serving institution, 

7 minority professional association, or community8 based organization representing minority popu9 lations, in addition to a research institution to carry 

10 out activities under this grant; and 

11 ‘‘(3) prepare and submit to the Secretary an 

12 application at such time, in such manner, and con13 taining such information as the Secretary may re14 quire. 

15 ‘‘(c) 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 2005 through 2010.’’. 

19 SEC. 302. HEALTH CAREERS OPPORTUNITY PROGRAM. 

20 (a) PURPOSE.—It is the purpose of this section to 

21 diversify the healthcare workforce by increasing the num22 ber of individuals from disadvantaged backgrounds in the 

23 health and allied health professions by enhancing the aca24 demic skills of students from disadvantaged backgrounds 

25 and supporting them in successfully competing, entering,
129

•HR 3459 IH 

1 and graduating from health professions training pro2 grams. 

3 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

4 740(c) of the Public Health Service Act (42 U.S.C. 

5 293d(c)) is amended by striking ‘‘$29,400,000’’ and all 

6 that follows through ‘‘2002’’ and inserting ‘‘$50,000,000 

7 for fiscal year 2005, and such sums as may be necessary 

8 for each of fiscal years 2006 through 2010’’. 

9 SEC. 303. PROGRAM OF EXCELLENCE IN HEALTH PROFES10 SIONS EDUCATION FOR UNDERREP11 RESENTED MINORITIES. 

12 (a) PURPOSE.—It is the purpose of this section to 

13 diversify the healthcare workforce by supporting programs 

14 of excellence in designated health professions schools that 

15 demonstrate a commitment to underrepresented minority 

16 populations with a focus on minority health issues, cul17 tural and linguistic competence, and eliminating health 

18 disparities. 

19 (b) AUTHORIZATION OF APPROPRIATION.—Section 

20 737(h)(1) of the Public Health Service Act (42 U.S.C. 

21 293(h)(1)) is amended to read as follows: 

22 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

23 For the purpose of making grants under subsection 

24 (a), there are authorized to be appropriated 

25 $50,000,000 for fiscal year 2005, and such sums as 
130

•HR 3459 IH 

1 may be necessary for each of the fiscal years 2006 

2 through 2010.’’. 

3 SEC. 304. HISPANIC-SERVING HEALTH PROFESSIONS 

4 SCHOOLS. 

5 Part B of title VII of the Public Health Service Act 

6 (42 U.S.C. 293 et seq.) is amended by adding at the end 

7 the following: 

8 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 

9 SCHOOLS. 

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

11 the Administrator of the Health Resources and Services 

12 Administration, shall award grants to Hispanic-serving 

13 health professions schools for the purpose of carrying out 

14 programs to recruit Hispanic individuals to enroll in and 

15 graduate from such schools, which may include providing 

16 scholarships and other financial assistance as appropriate. 

17 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His18 panic-serving health professions school’ means an entity 

19 that—

20 ‘‘(1) is a school or program under section 

21 799B; 

22 ‘‘(2) has an enrollment of full-time equivalent 

23 students that is made up of at least 9 percent His24 panic students; 
131

•HR 3459 IH 

1 ‘‘(3) has been effective in carrying out pro2 grams to recruit Hispanic individuals to enroll in 

3 and graduate from the school; 

4 ‘‘(4) has been effective in recruiting and retain5 ing Hispanic faculty members; and 

6 ‘‘(5) has a significant number of graduates who 

7 are providing health services to medically under8 served populations or to individuals in health profes9 sional shortage areas.’’. 

10 SEC. 305. HEALTH PROFESSIONS STUDENT LOAN FUND; AU11 THORIZATIONS OF APPROPRIATIONS RE12 GARDING STUDENTS FROM DISADVANTAGED 

13 BACKGROUNDS. 

14 Section 724(f)(1) of the Public Health Service Act 

15 (42 U.S.C. 292t(f)(1)) is amended by striking 

16 ‘‘$8,000,000’’ and all that follows and inserting 

17 ‘‘$35,000,000 for fiscal year 2005, and such sums as may 

18 be necessary for each of the fiscal years 2006 through 

19 2010.’’. 

20 SEC. 306. NATIONAL HEALTH SERVICE CORPS; RECRUIT21 MENT AND FELLOWSHIPS FOR INDIVIDUALS 

22 FROM DISADVANTAGED BACKGROUNDS. 

23 (a) IN GENERAL.—Section 331(b) of the Public 

24 Health Service Act (42 U.S.C. 254d(b)) is amended by 

25 adding at the end the following: 
132

•HR 3459 IH 

1 ‘‘(3) The Secretary shall ensure that the individuals 

2 with respect to whom activities under paragraphs (1) and 

3 (2) are carried out include individuals from disadvantaged 

4 backgrounds, including activities carried out to provide 

5 health professions students with information on the Schol6 arship and Repayment Programs.’’. 

7 (b) ASSIGNMENT OF CORPS PERSONNEL.—Section 

8 333(a) of the Public Health Service Act (42 U.S.C. 

9 254f(a)) is amended by adding at the end the following: 

10 ‘‘(4) In assigning Corps personnel under this section, 

11 the Secretary shall give preference to applicants who re12 quest assignment to a federally qualified health center (as 

13 defined in section 1905(l)(2)(B) of the Social Security 

14 Act) or to a provider organization that has a majority of 

15 patients who are minorities or individuals from low-income 

16 families (families with a family income that is less than 

17 200 percent of the Official Poverty Line).’’. 

18 SEC. 307. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

19 DISEASE CONTROL AND PREVENTION. 

20 Section 317F(c) of the Public Health Service Act (42 

21 U.S.C. 247b–7(c)) is amended—

22 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 

23 (2) by inserting before the period the following: 

24 ‘‘$750,000 for fiscal year 2005, and such sums as 
133

•HR 3459 IH 

1 may be necessary for each of the fiscal years 2006 

2 through 2010.’’. 

3 SEC. 308. COOPERATIVE AGREEMENTS FOR ONLINE DE4 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

5 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

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

7 (42 U.S.C. 293 et seq.), as amended by section 304, is 

8 further amended by adding at the end the following: 

9 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE10 GREE PROGRAMS. 

11 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

12 acting through the Administrator of the Health Resources 

13 and Services Administration, in consultation with the Di14 rector of the Centers for Disease Control and Prevention, 

15 the Director of the Agency for Healthcare Research and 

16 Quality, and the Director of the Office of Minority Health, 

17 shall award cooperative agreements to schools of public 

18 health and schools of allied health to design and imple19 ment online degree programs. 

20 ‘‘(b) PRIORITY.—In awarding cooperative agreements 

21 under this section, the Secretary shall give priority to any 

22 school of public health or school of allied health that is 

23 located in a medically underserved community. 
134

•HR 3459 IH 

1 ‘‘(c) REQUIREMENTS.—Awardees must design and 

2 implement an online degree program, that meet the fol3 lowing restrictions: 

4 ‘‘(1) Enrollment of individuals who have ob5 tained a secondary school diploma or its recognized 

6 equivalent. 

7 ‘‘(2) Maintaining a significant enrollment of 

8 underrepresented minority or disadvantaged stu9 dents. 

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

11 are authorized to be appropriated to carry out this section, 

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

13 2005 through 2010.’’. 

14 SEC. 309. MID-CAREER HEALTH PROFESSIONS SCHOLAR15 SHIP PROGRAM. 

16 Part B of title VII of the Public Health Service Act 

17 (as amended by section 308) is further amended by adding 

18 at the end the following: 

19 ‘‘SEC. 744. MID-CAREER HEALTH PROFESSIONS SCHOLAR20 SHIP PROGRAM. 

21 ‘‘(a) IN GENERAL.—The Secretary may make grants 

22 to eligible schools for awarding scholarships to eligible in23 dividuals to attend the school involved, for the purpose of 

24 enabling the individuals to make a career change from a 

25 non-health profession to a health profession.
135

•HR 3459 IH 

1 ‘‘(b) EXPENSES.—Amounts awarded as a scholarship 

2 under this section may be expended only for tuition ex3 penses, other reasonable educational expenses, and reason4 able living expenses incurred in the attendance of the 

5 school involved. 

6 ‘‘(c) DEFINITIONS.—In this section: 

7 ‘‘(1) ELIGIBLE SCHOOL.—The term ‘eligible 

8 school’ means a school of medicine, osteopathic med9 icine, dentistry, nursing (as defined in section 801), 

10 pharmacy, podiatric medicine, optometry, veterinary 

11 medicine, public health, chiropractic, or allied health, 

12 a school offering a graduate program in behavioral 

13 and mental health practice, or an entity providing 

14 programs for the training of physician assistants. 

15 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

16 individual’ means an individual who has obtained a 

17 secondary school diploma or its recognized equiva18 lent. 

19 ‘‘(d) PRIORITY.—In providing scholarships to eligible 

20 individuals, eligible schools shall give to individuals from 

21 disadvantaged backgrounds. 

22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section, 

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

25 2005 through 2010.’’. 
136

•HR 3459 IH 

1 SEC. 310. 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. 
137

•HR 3459 IH 

1 SEC. 311. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

2 Subtitle B of title XXIX of the Public Health Service 

3 Act, as amended by section 301, is further amended by 

4 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 
138

•HR 3459 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-
139

•HR 3459 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 ‘‘(f) 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 ‘‘(g) 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 2005 through 2010. 
140

•HR 3459 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.
141

•HR 3459 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) REQUIREMENTS.—To be eligible to receive as23 sistance under this section an individual shall—

24 ‘‘(1) have at minimum a grade point average of 

25 2.75 at the time of entry to an entity described in 
142

•HR 3459 IH 

1 subsection (d)(2) and maintain such 2.75 average or 

2 above throughout their tenure at such institutions; 

3 ‘‘(2) receive academic instruction that prepares 

4 the individual to enter the field of public health; 

5 ‘‘(3) gain experience in public health through 

6 working at non-profit, community-based health fa7 cilities or at Federal, State, or local governmental 

8 healthcare institutions; and 

9 ‘‘(4) meet at minimum twice a month with the 

10 identified health professions mentor. 

11 ‘‘(g) 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 2005 through 2010. 

15 ‘‘SEC. 2920D. PATSY MINK HEALTH AND GENDER RESEARCH 

16 FELLOWSHIP PROGRAM. 

17 ‘‘(a) IN GENERAL.—The Director of the Centers for 

18 Disease Control and Prevention, in collaboration with the 

19 Director of the Office of Minority Health, the Adminis20 trator of the Substance Abuse and Mental Health Services 

21 Administration, and the Director of the Indian Health 

22 Services, shall award research fellowships to post-bacca23 laureate students to conduct research that will examine 

24 gender and health disparities and to pursue a career in 

25 the health professions. 
143

•HR 3459 IH 

1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow2 ship under subsection (a) an individual shall—

3 ‘‘(1) have experience in health research or pub4 lic health practice; 

5 ‘‘(2) reside in a health professional shortage 

6 area as determined by the Secretary; 

7 ‘‘(3) have expressed an interest in the health 

8 professions; 

9 ‘‘(4) demonstrate promise for becoming a leader 

10 in the field of women’s health; 

11 ‘‘(5) secure admission to a health professions 

12 school or graduate program with an emphasis in 

13 gender studies; 

14 ‘‘(6) comply with subsection (f); and 

15 ‘‘(7) 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 an 

19 award under subsection (a) shall be used to support oppor20 tunities for students to become researchers and advance 

21 the research base on the intersection between gender and 

22 health. 

23 ‘‘(d) PRIORITY.—In awarding grants under sub24 section (a), the Director of the Centers for Disease Con-
144

•HR 3459 IH 

1 trol and Prevention shall give priority to those applicants 

2 that—

3 ‘‘(1) are from disadvantaged backgrounds; and 

4 ‘‘(2) have identified a mentor and academic ad5 visor who will assist in the completion of their grad6 uate or professional degree and have secured a re7 search assistant position with a researcher working 

8 in the area of gender and health. 

9 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

10 Disease Control and Prevention may approve fellowships 

11 for individuals under this section for any period of edu12 cation in the student’s graduate or health profession ten13 ure, except that such a fellowship may not be provided 

14 to an individual for more than 3 years, and such a fellow15 ship may not exceed $18,000 per academic year (notwith16 standing any other provision of law regarding the amount 

17 of fellowship). 

18 ‘‘(f) REQUIREMENTS.—To be eligible to receive as19 sistance under this section, an individual shall—

20 ‘‘(1) maintain a minimum a grade point aver21 age of 2.75 at the time of entry to an entity de22 scribed in subsection (b)(5) and maintain a grade 

23 point average of 3.25 or above throughout their ten24 ure at such institution; 
145

•HR 3459 IH 

1 ‘‘(2) undergo academic instruction to assist in 

2 completion of the health professions or graduate de3 gree; and 

4 ‘‘(3) attend twice-monthly meetings with an 

5 academic advisor throughout the tenure of the fel6 lowship. 

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 2005 through 2010. 

11 ‘‘SEC. 2920E. PAUL DAVID WELLSTONE INTERNATIONAL 

12 HEALTH FELLOWSHIP PROGRAM. 

13 ‘‘(a) IN GENERAL.—The Director of the Agency for 

14 Healthcare Research and Quality, in collaboration with 

15 the Director of the Office of Minority Health, shall award 

16 research fellowships to college students or recent grad17 uates to advance their understanding of international 

18 health. 

19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow20 ship under subsection (a) an individual shall—

21 ‘‘(1) have educational experience in the field of 

22 international health; 

23 ‘‘(2) reside in a health professional shortage 

24 area as determined by the Secretary; 
146

•HR 3459 IH 

1 ‘‘(3) demonstrate promise for becoming a leader 

2 in the field of international health; 

3 ‘‘(4) be a college senior or recent graduate of 

4 a four year higher education institution; 

5 ‘‘(5) comply with subsection (f); and 

6 ‘‘(6) submit to the Secretary an application at 

7 such time, in such manner, and containing such in8 formation as the Secretary may require. 

9 ‘‘(c) USE OF FUNDS.—Amounts received under an 

10 award under subsection (a) shall be used to support oppor11 tunities for students to become health professionals and 

12 to advance their knowledge about international issues re13 lating to healthcare access and quality. 

14 ‘‘(d) PRIORITY.—In awarding grants under sub15 section (a), the Director shall give priority to those appli16 cants that—

17 ‘‘(1) are from a disadvantaged background; and 

18 ‘‘(2) have identified a mentor at a health pro19 fessions school or institution, an academic advisor to 

20 assist in the completion of their graduate or profes21 sional degree, and an advisor from an international 

22 health Non-Governmental Organization, Private Vol23 unteer Organization, or other international institu24 tion or program that focuses on increasing
147

•HR 3459 IH 

1 healthcare access and quality for residents in devel2 oping countries. 

3 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 

4 fellowships for college seniors or recent graduates, except 

5 that such a fellowship may not be provided to an indi6 vidual for more than 6 months, may not be awarded to 

7 a graduate that has not been enrolled in school for more 

8 than 1 year, and may not exceed $4,000 per academic year 

9 (notwithstanding any other provision of law regarding the 

10 amount of fellowship). 

11 ‘‘(f) REQUIREMENTS.—To be eligible to receive as12 sistance under this section, an individual shall—

13 ‘‘(1) maintain a minimum grade point average 

14 of 2.75 at the time of application; and 

15 ‘‘(2) undergo academic instruction in global 

16 health, and issues relating to access and quality of 

17 healthcare; 

18 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

19 is authorized to be appropriated to carry out this section, 

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

21 2005 through 2010. 

22 ‘‘SEC. 2920F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR 

23 PROGRAM. 

24 ‘‘(a) IN GENERAL.—The Director of the Agency for 

25 Healthcare Research and Quality, the Director of the Cen-
148

•HR 3459 IH 

1 ters for Medicaid and Medicare, and the Administrator for 

2 Health Resources and Services Administration, in collabo3 ration with the Director of the Office of Minority Health, 

4 shall award grants to eligible entities to expose entering 

5 graduate students to the health professions. 

6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

7 under subsection (a) an entity shall—

8 ‘‘(1) be a clinical, public health or health serv9 ices organization, community-based or non-profit en10 tity, or other entity determined appropriate by the 

11 Director of the Agency for Healthcare Research and 

12 Quality; 

13 ‘‘(2) serve in a health professional shortage 

14 area as determined by the Secretary; 

15 ‘‘(3) work with students obtaining a degree in 

16 the health professions; and 

17 ‘‘(4) submit to the Secretary an application at 

18 such time, in such manner, and containing such in19 formation as the Secretary may require. 

20 ‘‘(c) USE OF FUNDS.—Amounts received under a 

21 grant awarded under subsection (a) shall be used to sup22 port opportunities that expose students to non-research 

23 based health professions, including—

24 ‘‘(1) public health policy; 

25 ‘‘(2) healthcare and pharmaceutical policy; 
149

•HR 3459 IH 

1 ‘‘(3) healthcare administration and manage2 ment; 

3 ‘‘(4) health economics; and 

4 ‘‘(5) other professions determined appropriate 

5 by the Director of the Agency for Healthcare Re6 search and Quality. 

7 ‘‘(d) PRIORITY.—In awarding grants under sub8 section (a), the Director of the Agency for Healthcare Re9 search and Quality shall give priority to those entities 

10 that—

11 ‘‘(1) have experience with health disparity elimi12 nation programs; 

13 ‘‘(2) facilitate training in the fields described in 

14 subsection (c); and 

15 ‘‘(3) provide counseling or other services de16 signed to assist such individuals in successfully com17 pleting their education at the post-secondary level. 

18 ‘‘(e) STIPENDS.—The Secretary may approve the 

19 payment of stipends for individuals under this section for 

20 any period of education in student-enhancement programs 

21 (other than regular courses) at health professions schools 

22 or entities, except that such a stipend may not be provided 

23 to an individual for more than 2 months, and such a sti24 pend may not exceed $100 per day (notwithstanding any 

25 other provision of law regarding the amount of stipends). 
150

•HR 3459 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 2005 through 2010.’’. 

5 TITLE IV—REDUCING DISEASE 

6 AND DISEASE-RELATED COM7 PLICATIONS 

8 Subtitle A—Eliminating Disparities 

9 in Prevention, Detection, and 

10 Treatment of Disease 

11 CHAPTER 1—GENERAL PROVISIONS 

12 SEC. 401. GUIDELINES FOR DISEASE SCREENING FOR MI13 NORITY PATIENTS. 

14 (a) IN GENERAL.—The Secretary, acting through the 

15 Director of the Agency for Healthcare Research and Qual16 ity, shall convene a series of meetings to develop guidelines 

17 for disease screening for minority patient populations 

18 which have a higher than average risk for many chronic 

19 diseases and cancers. 

20 (b) PARTICIPANTS.—In convening meetings under 

21 subsection (a), the Secretary shall ensure that meeting 

22 participants include representatives of—

23 (1) professional societies and associations; 

24 (2) minority health organizations; 
151

•HR 3459 IH 

1 (3) healthcare researchers and providers, in2 cluding those with expertise in minority health; 

3 (4) Federal health agencies, including the Of4 fice of Minority Health and the National Institutes 

5 of Health; and 

6 (5) other experts determined appropriate by the 

7 Secretary. 

8 (c) DISEASES.—Screening guidelines for minority 

9 populations shall be developed under subsection (a) for—

10 (1) hypertension; 

11 (2) hypercholesterolemia; 

12 (3) diabetes; 

13 (4) cardiovascular disease; 

14 (5) prostate cancer; 

15 (6) breast cancer; 

16 (7) colon cancer; 

17 (8) kidney disease; 

18 (9) glaucoma; and 

19 (10) other diseases determined appropriate by 

20 the Secretary. 

21 (d) DISSEMINATION.—Not later than 24 months 

22 after the date of enactment of this title, the Secretary 

23 shall publish and disseminate to healthcare provider orga24 nizations the guidelines developed under subsection (a). 
152

•HR 3459 IH 

1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section, 

3 sums as may be necessary for each of fiscal years 2005 

4 through 2010. 

5 SEC. 402. PREVENTIVE HEALTH SERVICES BLOCK GRANTS, 

6 USE OF ALLOTMENTS. 

7 Section 1904(a)(1) of the Public Health Service Act 

8 (42 U.S.C. 300w–3(a)(1)) is amended—

9 (1) in subparagraph (G)—

10 (A) by striking ‘‘through (F)’’ and insert11 ing ‘‘through (G)’’; and 

12 (B) by redesignating such subparagraph as 

13 subparagraph (H); and 

14 (2) by inserting after subparagraph (F), the fol15 lowing: 

16 ‘‘(G) Community outreach and education pro17 grams and other activities designed to address and 

18 prevent minority health conditions (as defined in 

19 section 485E(c)(2)).’’. 

20 SEC. 403. PROGRAM FOR INCREASING IMMUNIZATION 

21 RATES FOR ADULTS AND ADOLESCENTS; COL22 LECTION OF ADDITIONAL IMMUNIZATION 

23 DATA. 

24 (a) ACTIVITIES OF CENTERS FOR DISEASE CONTROL

25 AND PREVENTION.—Section 317(j) of the Public Health
153

•HR 3459 IH 

1 Service Act (42 U.S.C. 247b(j)) is amended by adding at 

2 the end the following paragraphs: 

3 ‘‘(3)(A) For the purpose of carrying out activities to4 ward increasing immunization rates for adults and adoles5 cents through the immunization program under this sub6 section, and for the purpose of carrying out subsection 

7 (k)(2), there are authorized to be appropriated such sums 

8 as may be necessary for each of the fiscal years 2004 

9 through 2010. Such authorization is in addition to 

10 amounts available under paragraphs (1) and (2) for such 

11 purposes. 

12 ‘‘(B) In expending amounts appropriated under sub13 paragraph (A), the Secretary shall give priority to adults 

14 and adolescents who are medically underserved and are 

15 at risk for vaccine-preventable diseases, including as ap16 propriate populations identified through projects under 

17 subsection (k)(2)(E). 

18 ‘‘(C) The purposes for which amounts appropriated 

19 under subparagraph (A) are available include (with re20 spect to immunizations for adults and adolescents) pay21 ment of the costs of storing vaccines, outreach activities 

22 to inform individuals of the availability of the immuniza23 tions, and other program expenses necessary for the estab24 lishment or operation of immunization programs carried 
154

•HR 3459 IH 

1 out or supported by States or other public entities pursu2 ant to this subsection. 

3 ‘‘(4) The Secretary shall annually submit to the Con4 gress a report that—

5 ‘‘(A) evaluates the extent to which the immuni6 zation system in the United States has been effective 

7 in providing for adequate immunization rates for 

8 adults and adolescents, taking into account the ap9 plicable year 2010 health objectives established by 

10 the Secretary regarding the health status of the peo11 ple of the United States; and 

12 ‘‘(B) describes any issues identified by the Sec13 retary that may affect such rates. 

14 ‘‘(5) In carrying out this subsection and paragraphs 

15 (1) and (2) of subsection (k), the Secretary shall consider 

16 recommendations regarding immunizations that are made 

17 in reports issued by the Institute of Medicine.’’. 

18 (b) RESEARCH, DEMONSTRATIONS, AND EDU19 CATION.—Section 317(k) of the Public Health Service Act 

20 (42 U.S.C. 247b(k)) is amended—

21 (1) by redesignating paragraphs (2) through 

22 (4) as paragraphs (3) through (5), respectively; and 

23 (2) by inserting after paragraph (1) the fol24 lowing paragraph: 
155

•HR 3459 IH 

1 ‘‘(2) The Secretary, directly and through grants 

2 under paragraph (1), shall provide for a program of 

3 research, demonstration projects, and education in 

4 accordance with the following: 

5 ‘‘(A) The Secretary shall coordinate with 

6 public and private entities (including nonprofit 

7 private entities), and develop and disseminate 

8 guidelines, toward the goal of ensuring that im9 munizations are routinely offered to adults and 

10 adolescents by public and private health care 

11 providers. 

12 ‘‘(B) The Secretary shall cooperate with 

13 public and private entities to obtain information 

14 for the annual evaluations required in sub15 section (j)(4)(A). 

16 ‘‘(C) The Secretary shall (relative to fiscal 

17 year 2001) increase the extent to which the 

18 Secretary collects data on the incidence, preva19 lence, and circumstances of diseases and ad20 verse events that are experienced by adults and 

21 adolescents and may be associated with immu22 nizations, including collecting data in coopera23 tion with commercial laboratories. 

24 ‘‘(D) The Secretary shall ensure that the 

25 entities with which the Secretary cooperates for 
156

•HR 3459 IH 

1 purposes of subparagraphs (A) through (C) in2 clude managed care organizations, community 

3 based organizations that provide health serv4 ices, and other health care providers. 

5 ‘‘(E) The Secretary shall provide for 

6 projects to identify racial and ethnic minority 

7 groups and other health disparity populations 

8 for which immunization rates for adults and 

9 adolescents are below such rates for the general 

10 population, and to determine the factors under11 lying such disparities.’’. 

12 SEC. 404. INNOVATIVE CHRONIC DISEASE MANAGEMENT 

13 PROGRAMS. 

14 (a) IN GENERAL.—The Secretary, acting in coordina15 tion with the Administrator of the Centers for Medicare 

16 and Medicaid Services, the Administrator of the Health 

17 Resources and Services Administration, the Director of 

18 the National Institutes of Health, the Director of the Cen19 ters for Disease Control and Prevention, and the Director 

20 of the Office of Minority Health, shall award grants to 

21 eligible entities for the identification, implementation, and 

22 evaluation of programs for patients with chronic disease. 

23 (b) ELIGIBILITY.—To be eligible to receive a grant 

24 under subsection (a), an entity shall—
157

•HR 3459 IH 

1 (1) be a health center or clinic, public health 

2 department, health plan, hospital, health system, 

3 community-based or non-profit organization, or 

4 other health entity determined appropriate by the 

5 Secretary; and 

6 (2) prepare and submit to the Secretary an ap7 plication at such time, in such manner, and con8 taining such information as the Secretary may re9 quire. 

10 (c) USE OF FUNDS.—An entity shall use amounts re11 ceived under a grant under subsection (a) to identify, im12 plement, and evaluate chronic disease management pro13 grams that are tailored for racially and ethnically diverse 

14 populations. In carrying out such activities, an entity shall 

15 focus on—

16 (1) self-management training; 

17 (2) patient empowerment; 

18 (3) group visits; 

19 (4) community health workers; 

20 (5) case management; 

21 (6) work- and school-based interventions; 

22 (7) home visitation; or 

23 (8) other activities determined appropriate by 

24 the Secretary. 
158

•HR 3459 IH 

1 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section, 

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

4 2004 through 2010. 

5 SEC. 405. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

6 TO COMMUNITY HEALTH. 

7 (a) PURPOSE.—It is the purpose of this section to 

8 provide for the awarding of grants to assist communities 

9 in mobilizing and organizing resources in support of effec10 tive and sustainable programs that will reduce or eliminate 

11 disparities in health and healthcare experienced by racial 

12 and ethnic minority individuals. 

13 (b) AUTHORITY TO AWARD GRANTS.—The Sec14 retary, acting through the Centers for Disease Control and 

15 Prevention and the Office of Minority Health, shall award 

16 planning, implementation, and evaluation grants to eligi17 ble entities to assist in designing, implementing, and eval18 uating culturally and linguistically appropriate, science19 based, and community-driven strategies to eliminate racial 

20 and ethnic health and healthcare disparities. 

21 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

22 grant under this section, an entity shall—

23 (1) represent a coalition—

24 (A) whose principal purpose is to develop 

25 and implement interventions to reduce or elimi-
159

•HR 3459 IH 

1 nate a health or healthcare disparity in a tar2 geted racial or ethnic minority group in the 

3 community served by the coalition; and 

4 (B) that includes—

5 (i) at least 3 members selected from 

6 among—

7 (I) public health departments; 

8 (II) community-based organiza9 tions; 

10 (III) university and/or research 

11 organizations; 

12 (IV) Indian tribal organizations 

13 or national Indian organizations; 

14 (V) Papa Ola Lokahi; and 

15 (VI) interested public or private 

16 sector healthcare providers or organi17 zations; 

18 (ii) at least 1 member that is from a 

19 community-based organization that rep20 resents the targeted racial or ethnic minor21 ity group; and 

22 (iii) at least 1 member that is a Na23 tional Center for Minority Health and 

24 Health Disparities Center of Excellence 

25 (unless such a Center does not exist within 
160

•HR 3459 IH 

1 the community involved, declines or refuses 

2 to participate, or the coalition dem3 onstrates to the Secretary that such par4 ticipation would not further the goals of 

5 the program or would be unduly burden6 some); 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, including—

10 (A) a description of the targeted racial or 

11 ethnic population in the community to be served 

12 under the grant; 

13 (B) a description of at least 1 health dis14 parity that exists in the racial or ethnic tar15 geted population; and 

16 (C) a demonstration of the proven record 

17 of accomplishment of the coalition members in 

18 serving and working with the targeted commu19 nity. 

20 (d) PLANNING GRANTS.—

21 (1) IN GENERAL.—The Secretary shall award 

22 grants to eligible entities described in subsection (c) 

23 to support the planning and development of cul24 turally and linguistically appropriate programs that 

25 utilize science-based and community-driven strate-
161

•HR 3459 IH 

1 gies to reduce or eliminate a health or healthcare 

2 disparity in the targeted population. Such grants 

3 may be used to—

4 (A) expand the coalition that is rep5 resented by the entity through the identification 

6 of additional partners, particularly among the 

7 targeted community, and establish linkages with 

8 national and State public and private partners; 

9 (B) establish community working groups; 

10 (C) conduct a needs assessment for the 

11 targeted population in the area of the health 

12 disparity using input from the targeted commu13 nity; 

14 (D) participate in workshops sponsored by 

15 the Office of Minority Health or the Centers for 

16 Disease Control and Prevention for technical 

17 assistance, planning, evaluation, and other pro18 grammatic issues; 

19 (E) identify promising intervention strate20 gies; and 

21 (F) develop a plan with the input of the 

22 targeted community that includes strategies 

23 for—

24 (i) implementing intervention strate25 gies that have the most promising potential 
162

•HR 3459 IH 

1 for reducing the health disparity in the 

2 target population; 

3 (ii) identifying other sources of rev4 enue and integrating current and proposed 

5 funding sources to ensure long-term sus6 tainability of the program; and 

7 (iii) evaluating the program, including 

8 collecting data and measuring progress to9 ward reducing or eliminating the health 

10 disparity in the targeted population that 

11 takes into account the evaluation model de12 veloped by the Centers for Disease Control 

13 and Prevention in collaboration with the 

14 Office of Minority Health. 

15 (2) DURATION.—The period during which pay16 ments may be made under a grant under paragraph 

17 (1) shall not exceed 1 year, except where the Sec18 retary determines that extraordinary circumstances 

19 exist as described in section 340(c)(3) of the Public 

20 Health Service Act. 

21 (e) IMPLEMENTATION GRANTS.—

22 (1) IN GENERAL.—The Secretary shall award 

23 grants to eligible entities that have received a plan24 ning grant under subsection (d) to enable such enti25 ty to—
163

•HR 3459 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 
164

•HR 3459 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 
165

•HR 3459 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. 
166

•HR 3459 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, 2007, 

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 2005 through 2010. 

16 SEC. 406. IOM STUDY REQUEST. 

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

18 Human Services shall request that the Institute of Medi19 cine conduct, or contract with another entity to conduct, 

20 a study to investigate promising strategies for improving 

21 minority health and reducing and eliminating racial and 

22 ethnic disparities in health and healthcare. 

23 (b) CONTENT.—The study under subsection (a) 

24 shall—
167

•HR 3459 IH 

1 (1) identify key stakeholders for intervention in 

2 the public and private sector; 

3 (2) identify the barriers to eliminating racial 

4 and ethnic disparities in health and healthcare; 

5 (3) explore approaches for addressing dispari6 ties in health and healthcare using a quality im7 provement framework; 

8 (4) suggest an evaluation and research agenda 

9 that will advance effective strategies for reducing 

10 and eliminating racial and ethnic disparities in 

11 health and healthcare; and 

12 (5) assess the capacity of the Department of 

13 Health and Human Services, as currently struc14 tured, to implement and evaluate promising strate15 gies to improve minority health and reduce and 

16 eliminate racial and ethnic disparities in health and 

17 healthcare. 

18 (c) AGENDA.—The agenda described in subsection 

19 (b)(4) shall include a focus on the following: 

20 (1) Observational studies of race-discordant and 

21 race-concordant physician-patient clinical encoun22 ters. 

23 (2) Studies of the behaviors and expressed atti24 tudes toward race and ethnicity during education 

25 and training of health professionals. 
168

•HR 3459 IH 

1 (3) Expansion of prospective studies of dispari2 ties in care, combining clinical data with qualitative 

3 interviews with patients and providers. 

4 (4) Studies of the natural history of social cat5 egorization in medical education and practice. 

6 (5) Studies of the effectiveness of standard clin7 ical guidelines in reducing disparities across disease 

8 categories. 

9 (6) Exploration of health system characteristics 

10 that may contribute to or mitigate disparities in 

11 health care. 

12 (7) Evaluation of cultural competency programs 

13 and their impact on the attitudes, knowledge, skills, 

14 and behaviors of healthcare providers. 

15 (8) Expansion of community-participatory re16 search with a focus on such topics as increasing 

17 trust and patient empowerment. 

18 (9) Studies on appropriate indicators of socio19 economic status, and methods for incorporating such 

20 indicators in patient records. 

21 (10) Interventional studies designed to elimi22 nate disparities. 

23 (d) REPORT.—Not later than 24 months after the 

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

25 Human Services shall submit to the appropriate commit-
169

•HR 3459 IH 

1 tees of Congress a report containing the results of the 

2 study conducted under subsection (a). 

3 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section, 

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

6 2005 and 2006. 

7 SEC. 407. STRATEGIC PLAN. 

8 (a) IN GENERAL.—The Secretary, acting through the 

9 Administrator of the Substance Abuse and Mental Health 

10 Services Administration, shall formulate a strategic plan 

11 for implementing the 2001 report by the Surgeon General 

12 of the Public Health Service entitled ‘Mental Health: Cul13 ture, Race, and Ethnicity—A Supplement to Mental 

14 Health: A Report of the Surgeon General’ and the 2003 

15 report by the President’s New Freedom Commission on 

16 Mental Health entitled ‘Achieving the Promise: Trans17 forming Mental Health Care in America’. 

18 (b) SUBMISSION.—Not later than 6 months after the 

19 date of the enactment of this title, the Secretary shall sub20 mit to the Congress the strategic plan formulated under 

21 this section. 

22 CHAPTER 2—ENVIRONMENTAL JUSTICE 

23 SEC. 410. SHORT TITLE; PURPOSES. 

24 (a) SHORT TITLE.—This chapter may be cited as the 

25 ‘‘Environmental Justice Act of 2003’’. 
170

•HR 3459 IH 

1 (b) PURPOSES.—The purposes of this chapter are—

2 (1) to ensure that all Federal health agencies 

3 develop practices that promote environmental jus4 tice; 

5 (2) to provide minority, low-income, and Native 

6 American communities greater access to public in7 formation and opportunity for participation in deci8 sionmaking affecting human health and the environ9 ment; and 

10 (3) to mitigate the inequitable distribution of 

11 the burdens and benefits of Federal programs hav12 ing significant impact on human health and the en13 vironment. 

14 SEC. 411. DEFINITIONS. 

15 For purposes of this chapter: 

16 (1) ENVIRONMENTAL JUSTICE.—

17 (A) IN GENERAL.—The term ‘‘environ18 mental justice’’ means the fair treatment of 

19 people of all races, cultures, and socioeconomic 

20 groups with respect to the development, adop21 tion, implementation, and enforcement of laws, 

22 regulations, and policies affecting the environ23 ment. 

24 (B) FAIR TREATMENT.—The term ‘‘fair 

25 treatment’’ means policies and practices that
171

•HR 3459 IH 

1 will minimize the likelihood that a minority, 

2 low-income, or Native American community will 

3 bear a disproportionate share of the adverse en4 vironmental consequences, or be denied reason5 able access to the environmental benefits, re6 sulting from implementation of a Federal pro7 gram or policy. 

8 (2) FEDERAL AGENCY.—The term ‘‘Federal 

9 agency’’ means—

10 (A) each Federal entity represented on the 

11 Working Group; 

12 (B) any other entity that conducts any 

13 Federal program or activity that substantially 

14 affects human health or the environment; and 

15 (C) each Federal agency that implements 

16 any program, policy, or activity applicable to 

17 Native Americans. 

18 (3) WORKING GROUP.—The term ‘‘Working 

19 Group’’ means the interagency working group estab20 lished by section 413. 

21 (4) ADVISORY COMMITTEE.—The term ‘‘the Ad22 visory Committee’’ means the advisory committee es23 tablished by section 415. 
172

•HR 3459 IH 

1 SEC. 412. 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. 413. INTERAGENCY ENVIRONMENTAL JUSTICE WORK23 ING GROUP. 

24 (a) CREATION AND COMPOSITION.—There is hereby 

25 established the Interagency Working Group on Environ-
173

•HR 3459 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; 
174

•HR 3459 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 chapter, 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 chapter; 

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 
175

•HR 3459 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 chap4 ter 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 chapter, 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 chapter 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 chapter, including, but not 

25 limited to, a report of the final environmental justice 
176

•HR 3459 IH 

1 strategies described in section 6 of this chapter 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. 414. 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—
177

•HR 3459 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. 415. 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: 
178

•HR 3459 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. 
179

•HR 3459 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. 
180

•HR 3459 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 
181

•HR 3459 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. 416. 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, 
182

•HR 3459 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
183

•HR 3459 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-
184

•HR 3459 IH 

1 lations the opportunity to participate in the development, 

2 design, and conduct of activities undertaken pursuant to 

3 this section. 

4 CHAPTER 3—BORDER HEALTH 

5 SEC. 421. SHORT TITLE. 

6 This chapter may be cited as the ‘‘Border Health Se7 curity Act of 2003’’. 

8 SEC. 422. DEFINITIONS. 

9 In this chapter: 

10 (1) BORDER AREA.—The term ‘‘border area’’ 

11 has the meaning given the term ‘‘United States12 Mexico Border Area’’ in section 8 of the United 

13 States-Mexico Border Health Commission Act (22 

14 U.S.C. 290n–6). 

15 (2) SECRETARY.—The term ‘‘Secretary’’ means 

16 the Secretary of Health and Human Services. 

17 SEC. 423. BORDER HEALTH GRANTS. 

18 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

19 the term ‘‘eligible entity’’ means a State, public institution 

20 of higher education, local government, tribal government, 

21 nonprofit health organization, community health center, or 

22 community clinic receiving assistance under section 330 

23 of the Public Health Service Act (42 U.S.C. 254b), that 

24 is located in the border area. 
185

•HR 3459 IH 

1 (b) AUTHORIZATION.—From funds appropriated 

2 under subsection (f), the Secretary, acting through the 

3 United States members of the United States-Mexico Bor4 der Health Commission, shall award grants to eligible en5 tities to address priorities and recommendations to im6 prove the health of border area residents that are estab7 lished by—

8 (1) the United States members of the United 

9 States-Mexico Border Health Commission; 

10 (2) the State border health offices; and 

11 (3) the Secretary. 

12 (c) APPLICATION.—An eligible entity that desires a 

13 grant under subsection (b) shall submit an application to 

14 the Secretary at such time, in such manner, and con15 taining such information as the Secretary may require. 

16 (d) USE OF FUNDS.—An eligible entity that receives 

17 a grant under subsection (b) shall use the grant funds 

18 for—

19 (1) programs relating to—

20 (A) maternal and child health; 

21 (B) primary care and preventative health; 

22 (C) public health and public health infra23 structure; 

24 (D) health education and promotion; 

25 (E) oral health; 
186

•HR 3459 IH 

1 (F) behavioral and mental health; 

2 (G) substance abuse; 

3 (H) health conditions that have a high 

4 prevalence in the border area; 

5 (I) medical and health services research; 

6 (J) workforce training and development; 

7 (K) community health workers or 

8 promotoras; 

9 (L) health care infrastructure problems in 

10 the border area (including planning and con11 struction grants); 

12 (M) health disparities in the border area; 

13 (N) environmental health; and 

14 (O) outreach and enrollment services with 

15 respect to Federal programs (including pro16 grams authorized under titles XIX and XXI of 

17 the Social Security Act (42 U.S.C. 1396 and 

18 1397aa)); and 

19 (2) other programs determined appropriate by 

20 the Secretary. 

21 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro22 vided to an eligible entity awarded a grant under sub23 section (b) shall be used to supplement and not supplant 

24 other funds available to the eligible entity to carry out the 

25 activities described in subsection (d). 
187

•HR 3459 IH 

1 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section, 

3 $200,000,000 for fiscal year 2005, and such sums as may 

4 be necessary for each succeeding fiscal year. 

5 SEC. 424. UNITED STATES-MEXICO BORDER HEALTH COM6 MISSION ACT AMENDMENTS. 

7 The United States-Mexico Border Health Commis8 sion Act (22 U.S.C. 290n et seq.) is amended by adding 

9 at the end the following: 

10 ‘‘SEC. 9. AUTHORIZATION OF APPROPRIATIONS. 

11 ‘‘There is authorized to be appropriated to carry out 

12 this Act $10,000,000 for fiscal year 2005 and such sums 

13 as may be necessary for each succeeding fiscal year.’’. 

14 CHAPTER 4—PATIENT NAVIGATOR, OUT15 REACH, AND CHRONIC DISEASE PRE16 VENTION 

17 SEC. 425. SHORT TITLE. 

18 This chapter may be cited as the ‘‘Patient Navigator, 

19 Outreach, and Chronic Disease Prevention Act of 2003’’. 
188

•HR 3459 IH 

1 SEC. 426. HRSA GRANTS FOR MODEL COMMUNITY CANCER 

2 AND CHRONIC DISEASE CARE AND PREVEN3 TION; HRSA GRANTS FOR PATIENT NAVIGA4 TORS. 

5 Subpart I of part D of title III of the Public Health 

6 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

7 at the end the following: 

8 ‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC 

9 DISEASE CARE AND PREVENTION; PATIENT 

10 NAVIGATORS. 

11 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

12 DISEASE CARE AND PREVENTION.—

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

14 through the Administrator of the Health Resources 

15 and Services Administration, may make grants to 

16 public and nonprofit private health centers (includ17 ing health centers under section 330, Indian Health 

18 Service Centers, tribal governments, urban Indian 

19 organizations, tribal organizations, clinics serving 

20 Asian Americans and Pacific Islanders and Alaska 

21 Natives, and rural health clinics and qualified non22 profit entities that partner with one or more centers 

23 providing healthcare to provide navigation services, 

24 which demonstrate the ability to perform all of the 

25 functions outlined in this subsection and subsections
189

•HR 3459 IH 

1 (b) and (c)) for the development and operation of 

2 model programs that—

3 ‘‘(A) provide to individuals of health dis4 parity populations prevention, early detection, 

5 treatment, and appropriate follow-up care serv6 ices for cancer and chronic diseases; 

7 ‘‘(B) ensure that the health services are 

8 provided to such individuals in a culturally com9 petent manner; 

10 ‘‘(C) assign patient navigators, in accord11 ance with applicable criteria of the Secretary, 

12 for managing the care of individuals of health 

13 disparity populations to—

14 ‘‘(i) accomplish, to the extent possible, 

15 the follow-up and diagnosis of an abnormal 

16 finding and the treatment and appropriate 

17 follow-up care of cancer or other chronic 

18 disease; and 

19 ‘‘(ii) facilitate access to appropriate 

20 healthcare services within the healthcare 

21 system to ensure optimal patient utiliza22 tion of such services, including aid in co23 ordinating and scheduling appointments 

24 and referrals, community outreach, assist25 ance with transportation arrangements, 
190

•HR 3459 IH 

1 and assistance with insurance issues and 

2 other barriers to care and providing infor3 mation about clinical trials; 

4 ‘‘(D) require training for patient naviga5 tors employed through such model programs to 

6 ensure the ability of navigators to perform all 

7 of the duties required in this subsection and in 

8 subsection (b), including training to ensure that 

9 navigators are informed about health insurance 

10 systems and are able to aid patients in resolv11 ing access issues; and 

12 ‘‘(E) ensure that consumers have direct ac13 cess to patient navigators during regularly 

14 scheduled hours of business operation. 

15 ‘‘(2) OUTREACH SERVICES.—A condition for 

16 the receipt of a grant under paragraph (1) is that 

17 the applicant involved agree to provide ongoing out18 reach activities while receiving the grant, in a man19 ner that is culturally competent for the health dis20 parity population served by the program, to inform 

21 the public and the specific community that the pro22 gram is serving, about the services of the model pro23 gram under the grant. Such activities shall include 

24 facilitating access to appropriate healthcare services 

25 and patient navigators within the healthcare system 
191

•HR 3459 IH 

1 to ensure optimal patient utilization of these serv2 ices. 

3 ‘‘(3) DATA COLLECTION AND REPORT.—In 

4 order to allow for effective program evaluation, the 

5 grantee shall collect specific patient data recording 

6 services provided to each patient served by the pro7 gram and shall establish and implement procedures 

8 and protocols, consistent with applicable Federal and 

9 State laws (including 45 C.F.R. 160 and 164) to en10 sure the confidentiality of all information shared by 

11 a participant in the program, or their personal rep12 resentative and their healthcare providers, group 

13 health plans, or health insurance insurers with the 

14 program. The program may, consistent with applica15 ble Federal and State confidentiality laws, collect, 

16 use or disclose aggregate information that is not in17 dividually identifiable (as defined in 45 C.F.R. 160 

18 and 164). With this data, the grantee shall submit 

19 an annual report to the Secretary that summarizes 

20 and analyzes these data, provides information on 

21 needs for navigation services, types of access difficul22 ties resolved, sources of repeated resolution and 

23 flaws in the system of access, including insurance 

24 barriers. 
192

•HR 3459 IH 

1 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

2 be made under paragraph (1) only if an application 

3 for the grant is submitted to the Secretary and the 

4 application is in such form, is made in such manner, 

5 and contains such agreements, assurances, and in6 formation as the Secretary determines to be nec7 essary to carry out this section. 

8 ‘‘(5) EVALUATIONS.—

9 ‘‘(A) IN GENERAL.—The Secretary, acting 

10 through the Administrator of the Health Re11 sources and Services Administration, shall, di12 rectly or through grants or contracts, provide 

13 for evaluations to determine which outreach ac14 tivities under paragraph (2) were most effective 

15 in informing the public and the specific commu16 nity that the program is serving, about the 

17 model program services and to determine the 

18 extent to which such programs were effective in 

19 providing culturally competent services to the 

20 health disparity population served by the pro21 grams. 

22 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

23 Secretary shall as appropriate disseminate to 

24 public and private entities the findings made in 

25 evaluations under subparagraph (A). 
193

•HR 3459 IH 

1 ‘‘(6) COORDINATION WITH OTHER PRO2 GRAMS.—The Secretary shall coordinate the pro3 gram under this subsection with the program under 

4 subsection (b), with the program under section 

5 417D, and to the extent practicable, with programs 

6 for prevention centers that are carried out by the 

7 Director of the Centers for Disease Control and Pre8 vention. 

9 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—

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

11 through the Administrator of the Health Resources 

12 and Services Administration, may make grants to 

13 public and nonprofit private health centers (includ14 ing health centers under section 330, Indian Health 

15 Service Centers, tribal governments, urban Indian 

16 organizations, tribal organizations, clinics serving 

17 Asian Americans and Pacific Islanders and Alaska 

18 Natives, and rural health clinics and qualified non19 profit entities that partner with one or more centers 

20 providing healthcare to provide navigation services, 

21 which demonstrate the ability to perform all of the 

22 functions outlined in this subsection and subsections 

23 (a) and (c)) for the development and operation of 

24 programs to pay the costs of such health centers 

25 in—
194

•HR 3459 IH 

1 ‘‘(A) assigning patient navigators, in ac2 cordance with applicable criteria of the Sec3 retary, for managing the care of individuals of 

4 health disparity populations for the duration of 

5 receiving health services from the health cen6 ters, including aid in coordinating and sched7 uling appointments and referrals, community 

8 outreach, assistance with transportation ar9 rangements, and assistance with insurance 

10 issues and other barriers to care and providing 

11 information about clinical trials; 

12 ‘‘(B) ensuring that the services provided by 

13 the patient navigators to such individuals in14 clude case management and psychosocial as15 sessment and care or information and referral 

16 to such services; 

17 ‘‘(C) ensuring that patient navigators with 

18 direct knowledge of the communities they serve 

19 provide services to such individuals in a cul20 turally competent manner; 

21 ‘‘(D) developing model practices for patient 

22 navigators, including with respect to—

23 ‘‘(i) coordination of health services, 

24 including psychosocial assessment and 

25 care;
195

•HR 3459 IH 

1 ‘‘(ii) appropriate follow-up care, in2 cluding psychosocial assessment and care; 

3 ‘‘(iii) determining coverage under 

4 health insurance and health plans for all 

5 services; 

6 ‘‘(iv) ensuring the initiation, continu7 ation and/or sustained access to care pre8 scribed by the patients’ healthcare pro9 viders; and 

10 ‘‘(v) aiding patients with health insur11 ance coverage issues; 

12 ‘‘(E) requiring training for patient naviga13 tors to ensure the ability of navigators to per14 form all of the duties required in this sub15 section and in subsection (a), including training 

16 to ensure that navigators are informed about 

17 health insurance systems and are able to aid 

18 patients in resolving access issues; and 

19 ‘‘(F) ensuring that consumers have direct 

20 access to patient navigators during regularly 

21 scheduled hours of business operation. 

22 ‘‘(2) OUTREACH SERVICES.—A condition for 

23 the receipt of a grant under paragraph (1) is that 

24 the applicant involved agree to provide ongoing out25 reach activities while receiving the grant, in a man-
196

•HR 3459 IH 

1 ner that is culturally competent for the health dis2 parity population served by the program, to inform 

3 the public and the specific community that the pa4 tient navigator is serving of the services of the model 

5 program under the grant. 

6 ‘‘(3) DATA COLLECTION AND REPORT.—In 

7 order to allow for effective patient navigator pro8 gram evaluation, the grantee shall collect specific pa9 tient data recording navigation services provided to 

10 each patient served by the program and shall estab11 lish and implement procedures and protocols, con12 sistent with applicable Federal and State laws (in13 cluding 45 C.F.R. 160 and 164) to ensure the con14 fidentiality of all information shared by a participant 

15 in the program, or their personal representative and 

16 their healthcare providers, group health plans, or 

17 health insurance insurers with the program. The pa18 tient navigator program may, consistent with appli19 cable Federal and State confidentiality laws, collect, 

20 use or disclose aggregate information that is not in21 dividually identifiable (as defined in 45 C.F.R. 160 

22 and 164). With this data, the grantee shall submit 

23 an annual report to the Secretary that summarizes 

24 and analyzes these data, provides information on 

25 needs for navigation services, types of access difficul-
197

•HR 3459 IH 

1 ties resolved, sources of repeated resolution and 

2 flaws in the system of access, including insurance 

3 barriers. 

4 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

5 be made under paragraph (1) only if an application 

6 for the grant is submitted to the Secretary and the 

7 application is in such form, is made in such manner, 

8 and contains such agreements, assurances, and in9 formation as the Secretary determines to be nec10 essary to carry out this section. 

11 ‘‘(5) EVALUATIONS.—

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

13 through the Administrator of the Health Re14 sources and Services Administration, shall, di15 rectly or through grants or contracts, provide 

16 for evaluations to determine the effects of the 

17 services of patient navigators on the individuals 

18 of health disparity populations for whom the 

19 services were provided, taking into account the 

20 matters referred to in paragraph (1)(C). 

21 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

22 Secretary shall as appropriate disseminate to 

23 public and private entities the findings made in 

24 evaluations under subparagraph (A).
198

•HR 3459 IH 

1 ‘‘(6) COORDINATION WITH OTHER PRO2 GRAMS.—The Secretary shall coordinate the pro3 gram under this subsection with the program under 

4 subsection (a) and with the program under section 

5 417D. 

6 ‘‘(c) REQUIREMENTS REGARDING FEES.—

7 ‘‘(1) IN GENERAL.—A condition for the receipt 

8 of a grant under subsection (a)(1) or (b)(1) is that 

9 the program for which the grant is made have in ef10 fect—

11 ‘‘(A) a schedule of fees or payments for 

12 the provision of its healthcare services related 

13 to the prevention and treatment of disease that 

14 is consistent with locally prevailing rates or 

15 charges and is designed to cover its reasonable 

16 costs of operation; and 

17 ‘‘(B) a corresponding schedule of discounts 

18 to be applied to the payment of such fees or 

19 payments, which discounts are adjusted on the 

20 basis of the ability of the patient to pay. 

21 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

22 this section shall be construed to require payment 

23 for navigation services or to require payment for 

24 healthcare services in cases where care is provided 

25 free of charge, including the case of services pro-
199

•HR 3459 IH 

1 vided through programs of the Indian Health Serv2 ice. 

3 ‘‘(d) MODEL.—Not later than five years after the 

4 date of the enactment of this section, the Secretary shall 

5 develop a peer-reviewed model of systems for the services 

6 provided by this section. The Secretary shall update such 

7 model as may be necessary to ensure that the best prac8 tices are being utilized. 

9 ‘‘(e) DURATION OF GRANT.—The period during 

10 which payments are made to an entity from a grant under 

11 subsection (a)(1) or (b)(1) may not exceed five years. The 

12 provision of such payments are subject to annual approval 

13 by the Secretary of the payments and subject to the avail14 ability of appropriations for the fiscal year involved to 

15 make the payments. This subsection may not be construed 

16 as establishing a limitation on the number of grants under 

17 such subsection that may be made to an entity. 

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

19 ‘‘(1) The term ‘culturally competent’, with re20 spect to providing health-related services, means 

21 services that, in accordance with standards and 

22 measures of the Secretary, are designed to effec23 tively and efficiently respond to the cultural and lin24 guistic needs of patients. 
200

•HR 3459 IH 

1 ‘‘(2) The term ‘appropriate follow-up care’ in2 cludes palliative and end-of-life care. 

3 ‘‘(3) The term ‘health disparity population’ 

4 means a population in which there exists a signifi5 cant disparity in the overall rate of disease inci6 dence, morbidity, mortality, or survival rates in the 

7 population as compared to the health status of the 

8 general population. Such term includes—

9 ‘‘(A) racial and ethnic minority groups as 

10 defined in section 1707; and 

11 ‘‘(B) medically underserved groups, such 

12 as rural and low-income individuals and individ13 uals with low levels of literacy. 

14 ‘‘(4)(A) The term ‘patient navigator’ means an 

15 individual whose functions include—

16 ‘‘(i) assisting and guiding patients with a 

17 symptom or an abnormal finding or diagnosis of 

18 cancer or other chronic disease within the 

19 healthcare system to accomplish the follow-up 

20 and diagnosis of an abnormal finding as well as 

21 the treatment and appropriate follow-up care of 

22 cancer or other chronic disease including pro23 viding information about clinical trials; and 

24 ‘‘(ii) identifying, anticipating, and helping 

25 patients overcome barriers within the healthcare
201

•HR 3459 IH 

1 system to ensure prompt diagnostic and treat2 ment resolution of an abnormal finding of can3 cer or other chronic disease. 

4 ‘‘(B) Such term includes representatives of the 

5 target health disparity population, such as nurses, 

6 social workers, cancer survivors, and patient advo7 cates. 

8 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

9 ‘‘(1) IN GENERAL.—

10 ‘‘(A) MODEL PROGRAMS.—For the purpose 

11 of carrying out subsection (a) (other than the 

12 purpose described in paragraph (2)(A)), there 

13 are authorized to be appropriated such sums as 

14 may be necessary for each of the fiscal years 

15 2005 through 2010. 

16 ‘‘(B) PATIENT NAVIGATORS.—For the pur17 pose of carrying out subsection (b) (other than 

18 the purpose described in paragraph (2)(B)), 

19 there are authorized to be appropriated such 

20 sums as may be necessary for each of the fiscal 

21 years 2005 through 2010. 

22 ‘‘(C) BUREAU OF PRIMARY

23 HEALTHCARE.—Amounts appropriated under 

24 subparagraph (A) or (B) shall be administered 

25 through the Bureau of Primary Health Care. 
202

•HR 3459 IH 

1 ‘‘(2) PROGRAMS IN RURAL AREAS.—

2 ‘‘(A) MODEL PROGRAMS.—For the purpose 

3 of carrying out subsection (a) by making grants 

4 under such subsection for model programs in 

5 rural areas, there are authorized to be appro6 priated such sums as may be necessary for each 

7 of the fiscal years 2005 through 2010. 

8 ‘‘(B) PATIENT NAVIGATORS.—For the pur9 pose of carrying out subsection (b) by making 

10 grants under such subsection for programs in 

11 rural areas, there are authorized to be appro12 priated such sums as may be necessary for each 

13 of the fiscal years 2005 through 2010. 

14 ‘‘(C) OFFICE OF RURAL HEALTH POL15 ICY.—Amounts appropriated under subpara16 graph (A) or (B) shall be administered through 

17 the Office of Rural Health Policy. 

18 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

19 Authorizations of appropriations under paragraphs 

20 (1) and (2) are in addition to other authorizations 

21 of appropriations that are available for the purposes 

22 described in such paragraphs.’’. 
203

•HR 3459 IH 

1 SEC. 427. NCI GRANTS FOR MODEL COMMUNITY CANCER 

2 AND CHRONIC DISEASE CARE AND PREVEN3 TION; NCI GRANTS FOR PATIENT NAVIGA4 TORS. 

5 Subpart 1 of part C of title IV of the Public Health 

6 Service Act (42 U.S.C. 285 et seq.) is amended by adding 

7 at the end the following section: 

8 ‘‘SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC 

9 DISEASE CARE AND PREVENTION; PATIENT 

10 NAVIGATORS. 

11 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

12 DISEASE CARE AND PREVENTION.—

13 ‘‘(1) IN GENERAL.—The Director of the Insti14 tute may make grants to eligible entities for the de15 velopment and operation of model programs that—

16 ‘‘(A) provide to individuals of health dis17 parity populations prevention, early detection, 

18 treatment, and appropriate follow-up care serv19 ices for cancer and chronic diseases; 

20 ‘‘(B) ensure that the health services are 

21 provided to such individuals in a culturally com22 petent manner; 

23 ‘‘(C) assign patient navigators, in accord24 ance with applicable criteria of the Secretary, 

25 for managing the care of individuals of health 

26 disparity populations to—
204

•HR 3459 IH 

1 ‘‘(i) accomplish, to the extent possible, 

2 the follow-up and diagnosis of an abnormal 

3 finding and the treatment and appropriate 

4 follow-up care of cancer or other chronic 

5 disease; and 

6 ‘‘(ii) facilitate access to appropriate 

7 healthcare services within the healthcare 

8 system to ensure optimal patient utiliza9 tion of such services, including aid in co10 ordinating and scheduling appointments 

11 and referrals, community outreach, assist12 ance with transportation arrangements, 

13 and assistance with insurance issues and 

14 other barriers to care and providing infor15 mation about clinical trials; 

16 ‘‘(D) require training for patient naviga17 tors employed through such model programs to 

18 ensure the ability of navigators to perform all 

19 of the duties required in this subsection and in 

20 subsection (b), including training to ensure that 

21 navigators are informed about health insurance 

22 systems and are able to aid patients in resolv23 ing access issues; and 
205

•HR 3459 IH 

1 ‘‘(E) ensure that consumers have direct ac2 cess to patient navigators during regularly 

3 scheduled hours of business operation. 

4 ‘‘(2) ELIGIBLE ENTITIES.—For purposes of this 

5 section, an eligible entity is a designated cancer cen6 ter of the Institute, an academic institution, Indian 

7 Health Service Clinics, tribal governments, urban In8 dian organizations, tribal organizations, a hospital, a 

9 qualified nonprofit entity that partners with one or 

10 more centers providing healthcare to provide naviga11 tion services, which demonstrates the ability to per12 form all of the functions outlined in this subsection 

13 and subsections (b) and (c), or any other public or 

14 private entity determined to be appropriate by the 

15 Director of the Institute, that provides services de16 scribed in paragraph (1)(A) for cancer and chronic 

17 diseases. 

18 ‘‘(3) DATA COLLECTION AND REPORT.—In 

19 order to allow for effective program evaluation, the 

20 grantee shall collect specific patient data recording 

21 services provided to each patient served by the pro22 gram and shall establish and implement procedures 

23 and protocols, consistent with applicable Federal and 

24 State laws (including 45 C.F.R. 160 and 164) to en25 sure the confidentiality of all information shared by 
206

•HR 3459 IH 

1 a participant in the program, or their personal rep2 resentative and their healthcare providers, group 

3 health plans, or health insurance insurers with the 

4 program. The program may, consistent with applica5 ble Federal and State confidentiality laws, collect, 

6 use or disclose aggregate information that is not in7 dividually identifiable (as defined in 45 C.F.R. 160 

8 and 164). With this data, the grantee shall submit 

9 an annual report to the Secretary that summarizes 

10 and analyzes these data, provides information on 

11 needs for navigation services, types of access difficul12 ties resolved, sources of repeated resolution and 

13 flaws in the system of access, including insurance 

14 barriers. 

15 ‘‘(4) OUTREACH SERVICES.—A condition for 

16 the receipt of a grant under paragraph (1) is that 

17 the applicant involved agree to provide ongoing out18 reach activities while receiving the grant, in a man19 ner that is culturally competent for the health dis20 parity population served by the program, to inform 

21 the public and the specific community that the pro22 gram is serving of the services of the model program 

23 under the grant. Such activities shall include facili24 tating access to appropriate healthcare services and
207

•HR 3459 IH 

1 patient navigators within the healthcare system to 

2 ensure optimal patient utilization of these services. 

3 ‘‘(5) APPLICATION FOR GRANT.—A grant may 

4 be made under paragraph (1) only if an application 

5 for the grant is submitted to the Director of the In6 stitute and the application is in such form, is made 

7 in such manner, and contains such agreements, as8 surances, and information as the Director deter9 mines to be necessary to carry out this section. 

10 ‘‘(6) EVALUATIONS.—

11 ‘‘(A) IN GENERAL.—The Director of the 

12 Institute, directly or through grants or con13 tracts, shall provide for evaluations to deter14 mine which outreach activities under paragraph 

15 (3) were most effective in informing the public 

16 and the specific community that the program is 

17 serving of the model program services and to 

18 determine the extent to which such programs 

19 were effective in providing culturally competent 

20 services to the health disparity population 

21 served by the programs. 

22 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

23 Director of the Institute shall as appropriate 

24 disseminate to public and private entities the 
208

•HR 3459 IH 

1 findings made in evaluations under subpara2 graph (A). 

3 ‘‘(7) COORDINATION WITH OTHER PRO4 GRAMS.—The Secretary shall coordinate the pro5 gram under this subsection with the program under 

6 subsection (b), with the program under section 330I, 

7 and to the extent practicable, with programs for pre8 vention centers that are carried out by the Director 

9 of the Centers for Disease Control and Prevention. 

10 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—

11 ‘‘(1) IN GENERAL.—The Director of the Insti12 tute may make grants to eligible entities for the de13 velopment and operation of programs to pay the 

14 costs of such entities in—

15 ‘‘(A) assigning patient navigators, in ac16 cordance with applicable criteria of the Sec17 retary, for managing the care of individuals of 

18 health disparity populations for the duration of 

19 receiving health services from the health cen20 ters, including aid in coordinating and sched21 uling appointments and referrals, community 

22 outreach, assistance with transportation ar23 rangements, and assistance with insurance 

24 issues and other barriers to care and providing 

25 information about clinical trials; 
209

•HR 3459 IH 

1 ‘‘(B) ensuring that the services provided by 

2 the patient navigators to such individuals in3 clude case management and psychosocial as4 sessment and care or information and referral 

5 to such services; 

6 ‘‘(C) ensuring that the patient navigators 

7 with direct knowledge of the communities they 

8 serve provide services to such individuals in a 

9 culturally competent manner; 

10 ‘‘(D) developing model practices for patient 

11 navigators, including with respect to—

12 ‘‘(i) coordination of health services, 

13 including psychosocial assessment and 

14 care; 

15 ‘‘(ii) follow-up services, including psy16 chosocial assessment and care; 

17 ‘‘(iii) determining coverage under 

18 health insurance and health plans for all 

19 services; 

20 ‘‘(iv) ensuring the initiation, continu21 ation and/or sustained access to care pre22 scribed by the patients’ healthcare pro23 viders; and 

24 ‘‘(v) aiding patients with health insur25 ance coverage issues; 
210

•HR 3459 IH 

1 ‘‘(E) requiring training for patient naviga2 tors to ensure the ability of navigators to per3 form all of the duties required in this sub4 section and in subsection (a), including training 

5 to ensure that navigators are informed about 

6 health insurance systems and are able to aid 

7 patients in resolving access issues; and 

8 ‘‘(F) ensuring that consumers have direct 

9 access to patient navigators during regularly 

10 scheduled hours of business operation. 

11 ‘‘(2) OUTREACH SERVICES.—A condition for 

12 the receipt of a grant under paragraph (1) is that 

13 the applicant involved agree to provide ongoing out14 reach activities while receiving the grant, in a man15 ner that is culturally competent for the health dis16 parity population served by the program, to inform 

17 the public and the specific community that the pa18 tient navigator is serving of the services of the model 

19 program under the grant. 

20 ‘‘(3) DATA COLLECTION AND REPORT.—In 

21 order to allow for effective patient navigator pro22 gram evaluation, the grantee shall collect specific pa23 tient data recording navigation services provided to 

24 each patient served by the program and shall estab25 lish and implement procedures and protocols, con-
211

•HR 3459 IH 

1 sistent with applicable Federal and State laws (in2 cluding 45 C.F.R. 160 and 164) to ensure the con3 fidentiality of all information shared by a participant 

4 in the program, or their personal representative and 

5 their healthcare providers, group health plans, or 

6 health insurance insurers with the program. The pa7 tient navigator program may, consistent with appli8 cable Federal and State confidentiality laws, collect, 

9 use or disclose aggregate information that is not in10 dividually identifiable (as defined in 45 C.F.R. 160 

11 and 164). With this data, the grantee shall submit 

12 an annual report to the Secretary that summarizes 

13 and analyzes these data, provides information on 

14 needs for navigation services, types of access difficul15 ties resolved, sources of repeated resolution and 

16 flaws in the system of access, including insurance 

17 barriers. 

18 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

19 be made under paragraph (1) only if an application 

20 for the grant is submitted to the Director of the In21 stitute and the application is in such form, is made 

22 in such manner, and contains such agreements, as23 surances, and information as the Director deter24 mines to be necessary to carry out this section. 

25 ‘‘(5) EVALUATIONS.—
212

•HR 3459 IH 

1 ‘‘(A) IN GENERAL.—The Director of the 

2 Institute, directly or through grants or con3 tracts, shall provide for evaluations to deter4 mine the effects of the services of patient navi5 gators on the health disparity population for 

6 whom the services were provided, taking into 

7 account the matters referred to in paragraph 

8 (1)(C).

9 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

10 Director of the Institute shall as appropriate 

11 disseminate to public and private entities the 

12 findings made in evaluations under subpara13 graph (A). 

14 ‘‘(6) COORDINATION WITH OTHER PRO15 GRAMS.—The Secretary shall coordinate the pro16 gram under this subsection with the program under 

17 subsection (a) and with the program under section 

18 330I. 

19 ‘‘(c) REQUIREMENTS REGARDING FEES.—

20 ‘‘(1) IN GENERAL.—A condition for the receipt 

21 of a grant under subsection (a)(1) or (b)(1) is that 

22 the program for which the grant is made have in ef23 fect—

24 ‘‘(A) a schedule of fees or payments for 

25 the provision of its healthcare services related
213

•HR 3459 IH 

1 to the prevention and treatment of disease that 

2 is consistent with locally prevailing rates or 

3 charges and is designed to cover its reasonable 

4 costs of operation; and

5 ‘‘(B) a corresponding schedule of discounts 

6 to be applied to the payment of such fees or 

7 payments, which discounts are adjusted on the 

8 basis of the ability of the patient to pay. 

9 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

10 this section shall be construed to require payment 

11 for navigation services or to require payment for 

12 healthcare services in cases where care is provided 

13 free of charge, including the case of services pro14 vided through programs of the Indian Health Serv15 ice. 

16 ‘‘(d) MODEL.—Not later than five years after the 

17 date of the enactment of this section, the Director of the 

18 Institute shall develop a peer-reviewed model of systems 

19 for the services provided by this section. The Director shall 

20 update such model as may be necessary to ensure that 

21 the best practices are being utilized. 

22 ‘‘(e) DURATION OF GRANT.—The period during 

23 which payments are made to an entity from a grant under 

24 subsection (a)(1) or (b)(1) may not exceed five years. The 

25 provision of such payments are subject to annual approval 
214

•HR 3459 IH 

1 by the Director of the Institute of the payments and sub2 ject to the availability of appropriations for the fiscal year 

3 involved to make the payments. This subsection may not 

4 be construed as establishing a limitation on the number 

5 of grants under such subsection that may be made to an 

6 entity. 

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

8 ‘‘(1) The term ‘culturally competent’, with re9 spect to providing health-related services, means 

10 services that, in accordance with standards and 

11 measures of the Secretary, are designed to effec12 tively and efficiently respond to the cultural and lin13 guistic needs of patients. 

14 ‘‘(2) the term ‘appropriate follow-up care’ in15 cludes palliative and end-of-life care. 

16 ‘‘(3) the term ‘health disparity population’ 

17 means a population where there exists a significant 

18 disparity in the overall rate of disease incidence, 

19 morbidity, mortality, or survival rates in the popu20 lation as compared to the health status of the gen21 eral population. Such term includes—

22 ‘‘(A) racial and ethnic minority groups as 

23 defined in section 1707; and 
215

•HR 3459 IH 

1 ‘‘(B) medically underserved groups, such 

2 as rural and low-income individuals and individ3 uals with low levels of literacy. 

4 ‘‘(4)(A) the term ‘patient navigator’ means an 

5 individual whose functions include—

6 ‘‘(i) assisting and guiding patients with a 

7 symptom or an abnormal finding or diagnosis of 

8 cancer or other chronic disease within the 

9 healthcare system to accomplish the follow-up 

10 and diagnosis of an abnormal finding as well as 

11 the treatment and appropriate follow-up care of 

12 cancer or other chronic disease, including pro13 viding information about clinical trials; and 

14 ‘‘(ii) identifying, anticipating, and helping 

15 patients overcome barriers within the healthcare 

16 system to ensure prompt diagnostic and treat17 ment resolution of an abnormal finding of can18 cer or other chronic disease. 

19 ‘‘(B) Such term includes representatives of the 

20 target health disparity population, such as nurses, 

21 social workers, cancer survivors, and patient advo22 cates. 

23 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

24 ‘‘(1) MODEL PROGRAMS.—For the purpose of 

25 carrying out subsection (a), there are authorized to 
216

•HR 3459 IH 

1 be appropriated such sums as may be necessary for 

2 each of the fiscal years 2005 through 2010. 

3 ‘‘(2) PATIENT NAVIGATORS.—For the purpose 

4 of carrying out subsection (b), there are authorized 

5 to be appropriated such sums as may be necessary 

6 for each of the fiscal years 2005 through 2010. 

7 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

8 Authorizations of appropriations under paragraphs 

9 (1) and (2) are in addition to other authorizations 

10 of appropriations that are available for the purposes 

11 described in such paragraphs.’’. 

12 SEC. 428. IHS GRANTS FOR MODEL COMMUNITY CANCER 

13 AND CHRONIC DISEASE CARE AND PREVEN14 TION; IHS GRANTS FOR PATIENT NAVIGA15 TORS. 

16 (a) MODEL COMMUNITY CANCER AND CHRONIC DIS17 EASE CARE AND PREVENTION.—

18 (1) IN GENERAL.—The Director of the Indian 

19 Health Service may make grants to Indian Health 

20 Service Centers, tribal governments, urban Indian 

21 organizations, tribal organizations, and qualified 

22 nonprofit entities demonstrating the ability to per23 form all of the functions outlined in this subsection 

24 and subsections (b) and (c) that partner with pro25 viders or centers providing healthcare serving Native 
217

•HR 3459 IH 

1 American populations to provide navigation services, 

2 for the development and operation of model pro3 grams that—

4 (A) provide to individuals of health dis5 parity populations prevention, early detection, 

6 treatment, and appropriate follow-up care serv7 ices for cancer and chronic diseases; 

8 (B) ensure that the health services are pro9 vided to such individuals in a culturally com10 petent manner; 

11 (C) assign patient navigators, in accord12 ance with applicable criteria of the Secretary, 

13 for managing the care of individuals of health 

14 disparity populations to—

15 (i) accomplish, to the extent possible, 

16 the follow-up and diagnosis of an abnormal 

17 finding and the treatment and appropriate 

18 follow-up care of cancer or other chronic 

19 disease; and 

20 (ii) facilitate access to appropriate 

21 healthcare services within the healthcare 

22 system to ensure optimal patient utiliza23 tion of such services, including aid in co24 ordinating and scheduling appointments 

25 and referrals, community outreach, assist-
218

•HR 3459 IH 

1 ance with transportation arrangements, 

2 and assistance with insurance issues and 

3 other barriers to care and providing infor4 mation about clinical trials; 

5 (D) require training for patient navigators 

6 employed through such model programs to en7 sure the ability of navigators to perform all of 

8 the duties required in this subsection and in 

9 subsection (b), including training to ensure that 

10 navigators are informed about health insurance 

11 systems and are able to aid patients in resolv12 ing access issues; and 

13 (E) ensure that consumers have direct ac14 cess to patient navigators during regularly 

15 scheduled hours of business operation. 

16 (2) OUTREACH SERVICES.—A condition for the 

17 receipt of a grant under paragraph (1) is that the 

18 applicant involved agree to provide ongoing outreach 

19 activities while receiving the grant, in a manner that 

20 is culturally competent for the health disparity popu21 lation served by the program, to inform the public 

22 and the specific community that the program is 

23 serving of the services of the model program under 

24 the grant. Such activities shall include facilitating 

25 access to appropriate healthcare services and patient
219

•HR 3459 IH 

1 navigators within the healthcare system to ensure 

2 optimal patient utilization of these services. 

3 (3) DATA COLLECTION AND REPORT.—In order 

4 to allow for effective program evaluation, the grantee 

5 shall collect specific patient data recording services 

6 provided to each patient served by the program and 

7 shall establish and implement procedures and proto8 cols, consistent with applicable Federal and State 

9 laws (including 45 C.F.R. 160 and 164) to ensure 

10 the confidentiality of all information shared by a 

11 participant in the program, or their personal rep12 resentative and their healthcare providers, group 

13 health plans, or health insurance insurers with the 

14 program. The program may, consistent with applica15 ble Federal and State confidentiality laws, collect, 

16 use or disclose aggregate information that is not in17 dividually identifiable (as defined in 45 C.F.R. 160 

18 and 164). With this data, the grantee shall submit 

19 an annual report to the Secretary that summarizes 

20 and analyzes these data, provides information on 

21 needs for navigation services, types of access difficul22 ties resolved, sources of repeated resolution and 

23 flaws in the system of access, including insurance 

24 barriers. 
220

•HR 3459 IH 

1 (4) APPLICATION FOR GRANT.—A grant may be 

2 made under paragraph (1) only if an application for 

3 the grant is submitted to the Secretary and the ap4 plication is in such form, is made in such manner, 

5 and contains such agreements, assurances, and in6 formation as the Secretary determines to be nec7 essary to carry out this section. 

8 (5) EVALUATIONS.—

9 (A) IN GENERAL.—The Secretary, acting 

10 through the Director of the Indian Health Serv11 ice, shall, directly or through grants or con12 tracts, provide for evaluations to determine 

13 which outreach activities under paragraph (2) 

14 were most effective in informing the public and 

15 the specific community that the program is 

16 serving of the model program services and to 

17 determine the extent to which such programs 

18 were effective in providing culturally competent 

19 services to the health disparity population 

20 served by the programs. 

21 (B) DISSEMINATION OF FINDINGS.—The 

22 Secretary shall as appropriate disseminate to 

23 public and private entities the findings made in 

24 evaluations under subparagraph (A). 
221

•HR 3459 IH 

1 (6) COORDINATION WITH OTHER PROGRAMS.—

2 The Secretary shall coordinate the program under 

3 this subsection with the program under subsection 

4 (b), with the program under section 417D, and to 

5 the extent practicable, with programs for prevention 

6 centers that are carried out by the Director of the 

7 Centers for Disease Control and Prevention. 

8 (b) PROGRAM FOR PATIENT NAVIGATORS.—

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

10 through the Director of the Indian Health Service, 

11 may make grants to Indian Health Service Centers, 

12 tribal governments, urban Indian organizations, trib13 al organizations, and qualified nonprofit entities 

14 demonstrating the ability to perform all of the func15 tions outlined in this subsection and subsections (a) 

16 and (c) that partner with providers or centers pro17 viding healthcare serving Native American popu18 lations to provide navigation services, for the devel19 opment and operation of model programs to pay the 

20 costs of such organizations in—

21 (A) assigning patient navigators, in accord22 ance with applicable criteria of the Secretary, 

23 for individuals of health disparity populations 

24 for the duration of receiving health services 

25 from the health centers, including aid in coordi-
222

•HR 3459 IH 

1 nating and scheduling appointments and refer2 rals, community outreach, assistance with 

3 transportation arrangements, and assistance 

4 with insurance issues and other barriers to care 

5 and providing information about clinical trials; 

6 (B) ensuring that the services provided by 

7 the patient navigators to such individuals in8 clude case management and psychosocial as9 sessment and care or information and referral 

10 to such services; 

11 (C) ensuring that patient navigators with 

12 direct knowledge of the communities they serve 

13 provide services to such individuals in a cul14 turally competent manner; 

15 (D) developing model practices for patient 

16 navigators, including with respect to—

17 (i) coordination of health services, in18 cluding psychosocial assessment and care; 

19 (ii) appropriate follow-up care, includ20 ing psychosocial assessment and care; 

21 (iii) determining coverage under 

22 health insurance and health plans for all 

23 services; 

24 (iv) ensuring the initiation, continu25 ation and/or sustained access to care pre-
223

•HR 3459 IH 

1 scribed by the patients’ healthcare pro2 viders; and 

3 (v) aiding patients with health insur4 ance coverage issues; 

5 (E) requiring training for patient naviga6 tors to ensure the ability of navigators to per7 form all of the duties required in this sub8 section and in subsection (a), including training 

9 to ensure that navigators are informed about 

10 health insurance systems and are able to aid 

11 patients in resolving access issues; and 

12 (F) ensuring that consumers have direct 

13 access to patient navigators during regularly 

14 scheduled hours of business operation. 

15 (2) OUTREACH SERVICES.—A condition for the 

16 receipt of a grant under paragraph (1) is that the 

17 applicant involved agree to provide ongoing outreach 

18 activities while receiving the grant, in a manner that 

19 is culturally competent for the health disparity popu20 lation served by the program, to inform the public 

21 and the specific community that the patient navi22 gator is serving of the services of the model program 

23 under the grant. 

24 (3) DATA COLLECTION AND REPORT.—In order 

25 to allow for effective patient navigator program eval-
224

•HR 3459 IH 

1 uation, the grantee shall collect specific patient data 

2 recording navigation services provided to each pa3 tient served by the program and shall establish and 

4 implement procedures and protocols, consistent with 

5 applicable Federal and State laws (including 45 

6 C.F.R. 160 and 164) to ensure the confidentiality of 

7 all information shared by a participant in the pro8 gram, or their personal representative and their 

9 healthcare providers, group health plans, or health 

10 insurance insurers with the program. The patient 

11 navigator program may, consistent with applicable 

12 Federal and State confidentiality laws, collect, use or 

13 disclose aggregate information that is not individ14 ually identifiable (as defined in 45 C.F.R. 160 and 

15 164). With this data, the grantee shall submit an 

16 annual report to the Secretary that summarizes and 

17 analyzes these data, provides information on needs 

18 for navigation services, types of access difficulties re19 solved, sources of repeated resolution and flaws in 

20 the system of access, including insurance barriers. 

21 (4) APPLICATION FOR GRANT.—A grant may be 

22 made under paragraph (1) only if an application for 

23 the grant is submitted to the Secretary and the ap24 plication is in such form, is made in such manner, 

25 and contains such agreements, assurances, and in-
225

•HR 3459 IH 

1 formation as the Secretary determines to be nec2 essary to carry out this section. 

3 (5) EVALUATIONS.—

4 (A) IN GENERAL.—The Secretary, acting 

5 through the Director of the Indian Health Serv6 ice, shall, directly or through grants or con7 tracts, provide for evaluations to determine the 

8 effects of the services of patient navigators on 

9 the individuals of health disparity populations 

10 for whom the services were provided, taking 

11 into account the matters referred to in para12 graph (1)(C). 

13 (B) DISSEMINATION OF FINDINGS.—The 

14 Secretary shall as appropriate disseminate to 

15 public and private entities the findings made in 

16 evaluations under subparagraph (A). 

17 (6) COORDINATION WITH OTHER PROGRAMS.—

18 The Secretary shall coordinate the program under 

19 this subsection with the program under subsection 

20 (a) and with the program under section 417D. 

21 (c) REQUIREMENTS REGARDING FEES.—

22 (1) IN GENERAL.—A condition for the receipt 

23 of a grant under subsection (a)(1) or (b)(1) is that 

24 the program for which the grant is made have in ef25 fect—
226

•HR 3459 IH 

1 (A) a schedule of fees or payments for the 

2 provision of its healthcare services related to 

3 the prevention and treatment of disease that is 

4 consistent with locally prevailing rates or 

5 charges and is designed to cover its reasonable 

6 costs of operation; and 

7 (B) a corresponding schedule of discounts 

8 to be applied to the payment of such fees or 

9 payments, which discounts are adjusted on the 

10 basis of the ability of the patient to pay. 

11 (2) RULE OF CONSTRUCTION.—Nothing in this 

12 section shall be construed to require payment for 

13 navigation services or to require payment for 

14 healthcare services in cases, such as with the Indian 

15 Health Service, where care is provided free of 

16 charge. 

17 (d) MODEL.—Not later than five years after the date 

18 of the enactment of this section, the Secretary shall de19 velop a peer-reviewed model of systems for the services 

20 provided by this section. The Secretary shall update such 

21 model as may be necessary to ensure that the best prac22 tices are being utilized. 

23 (e) DURATION OF GRANT.—The period during which 

24 payments are made to an entity from a grant under sub25 section (a)(1) or (b)(1) may not exceed five years. The 
227

•HR 3459 IH 

1 provision of such payments are subject to annual approval 

2 by the Secretary of the payments and subject to the avail3 ability of appropriations for the fiscal year involved to 

4 make the payments. This subsection may not be construed 

5 as establishing a limitation on the number of grants under 

6 such subsection that may be made to an entity. 

7 (f) DEFINITIONS.—For purposes of this section: 

8 (1) The term ‘‘culturally competent’’, with re9 spect to providing health-related services, means 

10 services that, in accordance with standards and 

11 measures of the Secretary, are designed to effec12 tively and efficiently respond to the cultural and lin13 guistic needs of patients. 

14 (2) The term ‘‘appropriate follow-up care’’ in15 cludes palliative and end-of-life care. 

16 (3) The term ‘‘health disparity population’’ 

17 means a population where there exists a significant 

18 disparity in the overall rate of disease incidence, 

19 morbidity, mortality, or survival rates in the popu20 lation as compared to the health status of the gen21 eral population. Such term includes—

22 (A) racial and ethnic minority groups as 

23 defined in section 1707; and 
228

•HR 3459 IH 

1 (B) medically underserved groups, such as 

2 rural and low-income individuals and individ3 uals with low levels of literacy. 

4 (4)(A) The term ‘‘patient navigator’’ means an 

5 individual whose functions include—

6 (i) assisting and guiding patients with a 

7 symptom or an abnormal finding or diagnosis of 

8 cancer or other chronic disease within the 

9 healthcare system to accomplish the follow-up 

10 and diagnosis of an abnormal finding as well as 

11 the treatment and appropriate follow-up care of 

12 cancer or other chronic disease, including pro13 viding information about clinical trials; and 

14 (ii) identifying, anticipating, and helping 

15 patients overcome barriers within the healthcare 

16 system to ensure prompt diagnostic and treat17 ment resolution of an abnormal finding of can18 cer or other chronic disease. 

19 (B) Such term includes representatives of the 

20 target health disparity population, such as nurses, 

21 social workers, cancer survivors, and patient advo22 cates. 

23 (g) AUTHORIZATION OF APPROPRIATIONS.—

24 (1) IN GENERAL.—
229

•HR 3459 IH 

1 (A) MODEL PROGRAMS.—For the purpose 

2 of carrying out subsection (a) (other than the 

3 purpose described in paragraph (2)(A)), there 

4 are authorized to be appropriated such sums as 

5 may be necessary for each of the fiscal years 

6 2005 through 2010. 

7 (B) PATIENT NAVIGATORS.—For the pur8 pose of carrying out subsection (b) (other than 

9 the purpose described in paragraph (2)(B)), 

10 there are authorized to be appropriated such 

11 sums as may be necessary for each of the fiscal 

12 years 2005 through 2010. 

13 (C) BUREAU OF PRIMARY HEALTH 13

14 CARE.—Amounts appropriated under subpara15 graph (A) or (B) shall be administered through 

16 the Bureau of Primary Health Care. 

17 (2) PROGRAMS IN RURAL AREAS.—

18 (A) MODEL PROGRAMS.—For the purpose 

19 of carrying out subsection (a) by making grants 

20 under such subsection for model programs in 

21 rural areas, there are authorized to be appro22 priated such sums as may be necessary for each 

23 of the fiscal years 2005 through 2010. 

24 (B) PATIENT NAVIGATORS.—For the pur25 pose of carrying out subsection (b) by making 
230

•HR 3459 IH 

1 grants under such subsection for programs in 

2 rural areas, there are authorized to be appro3 priated such sums as may be necessary for each 

4 of the fiscal years 2005 through 2010. 

5 (C) OFFICE OF RURAL HEALTH POLICY.—

6 Amounts appropriated under subparagraph (A) 

7 or (B) shall be administered through the Office 

8 of Rural Health Policy. 

9 (3) RELATION TO OTHER AUTHORIZATIONS.—

10 Authorizations of appropriations under paragraphs 

11 (1) and (2) are in addition to other authorizations 

12 of appropriations that are available for the purposes 

13 described in such paragraphs. 

14 CHAPTER 5—COMMUNITY HEALTH 

15 WORKERS

16 SEC. 431. SHORT TITLE. 

17 This chapter may be cited as the ‘‘Community Health 

18 Workers Act of 2003’’. 

19 SEC. 432. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV20 IORS IN WOMEN. 

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

22 (42 U.S.C. 280g et seq.) is amended by adding at the end 

23 the following:
231

•HR 3459 IH 

1 ‘‘SEC. 399O. GRANTS TO PROMOTE POSITIVE HEALTH BE2 HAVIORS IN WOMEN. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col4 laboration with the Director of the Centers for Disease 

5 Control and Prevention and other Federal officials deter6 mined appropriate by the Secretary, is authorized to 

7 award grants to States or local or tribal units, to promote 

8 positive health behaviors for women in target populations, 

9 especially racial and ethnic minority women in medically 

10 underserved communities.

11 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

12 subsection (a) may be used to support community health 

13 workers—

14 ‘‘(1) to educate, guide, and provide outreach in 

15 a community setting regarding health problems prev16 alent among women and especially among racial and 

17 ethnic minority women; 

18 ‘‘(2) to educate, guide, and provide experiential 

19 learning opportunities that target behavioral risk 

20 factors; 

21 ‘‘(3) to educate and guide regarding effective 

22 strategies to promote positive health behaviors with23 in the family; 

24 ‘‘(4) to educate and provide outreach regarding 

25 enrollment in health insurance including the State 

26 Children’s Health Insurance Program under title 
232

•HR 3459 IH 

1 XXI of the Social Security Act, medicare under title 

2 XVIII of such Act and medicaid under title XIX of 

3 such Act; 

4 ‘‘(5) to promote community wellness and aware5 ness; and 

6 ‘‘(6) to educate and refer target populations to 

7 appropriate health care agencies and community8 based programs and organizations in order to in9 crease access to quality health care services, includ10 ing preventive health services. 

11 ‘‘(c) APPLICATION.—

12 ‘‘(1) IN GENERAL.—Each State or local or trib13 al unit (including federally recognized tribes and 

14 Alaska native villages) that desires to receive a grant 

15 under subsection (a) shall submit an application to 

16 the Secretary, at such time, in such manner, and ac17 companied by such additional information as the 

18 Secretary may require. 

19 ‘‘(2) CONTENTS.—Each application submitted 

20 pursuant to paragraph (1) shall—

21 ‘‘(A) describe the activities for which as22 sistance under this section is sought; 

23 ‘‘(B) contain an assurance that with re24 spect to each community health worker pro25 gram receiving funds under the grant awarded, 
233

•HR 3459 IH 

1 such program provides training and supervision 

2 to community health workers to enable such 

3 workers to provide authorized program services; 

4 ‘‘(C) contain an assurance that the appli5 cant will evaluate the effectiveness of commu6 nity health worker programs receiving funds 

7 under the grant; 

8 ‘‘(D) contain an assurance that each com9 munity health worker program receiving funds 

10 under the grant will provide services in the cul11 tural context most appropriate for the individ12 uals served by the program; 

13 ‘‘(E) contain a plan to document and dis14 seminate project description and results to 

15 other States and organizations as identified by 

16 the Secretary; and 

17 ‘‘(F) describe plans to enhance the capac18 ity of individuals to utilize health services and 

19 health-related social services under Federal, 

20 State, and local programs by—

21 ‘‘(i) assisting individuals in estab22 lishing eligibility under the programs and 

23 in receiving the services or other benefits 

24 of the programs; and 
234

•HR 3459 IH 

1 ‘‘(ii) providing other services as the 

2 Secretary determines to be appropriate, 

3 that may include transportation and trans4 lation services. 

5 ‘‘(d) PRIORITY.—In awarding grants under sub6 section (a), the Secretary shall give priority to those appli7 cants—

8 ‘‘(1) who propose to target geographic areas—

9 ‘‘(A) with a high percentage of residents 

10 who are eligible for health insurance but are 

11 uninsured or underinsured; 

12 ‘‘(B) with a high percentage of families for 

13 whom English is not their primary language; 

14 and 

15 ‘‘(C) that encompass the United States16 Mexico border region; 

17 ‘‘(2) with experience in providing health or 

18 health-related social services to individuals who are 

19 underserved with respect to such services; and 

20 ‘‘(3) with documented community activity and 

21 experience with community health workers. 

22 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU23 TIONS.—The Secretary shall encourage community health 

24 worker programs receiving funds under this section to col-
235

•HR 3459 IH 

1 laborate with academic institutions. Nothing in this sec2 tion shall be construed to require such collaboration.

3 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE4 NESS.—The Secretary shall establish guidelines for assur5 ing the quality of the training and supervision of commu6 nity health workers under the programs funded under this 

7 section and for assuring the cost-effectiveness of such pro8 grams. 

9 ‘‘(g) MONITORING.—The Secretary shall monitor 

10 community health worker programs identified in approved 

11 applications and shall determine whether such programs 

12 are in compliance with the guidelines established under 

13 subsection (e). 

14 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

15 provide technical assistance to community health worker 

16 programs identified in approved applications with respect 

17 to planning, developing, and operating programs under the 

18 grant. 

19 ‘‘(i) REPORT TO CONGRESS.— 

20 ‘‘(1) IN GENERAL.—Not later than 4 years 

21 after the date on which the Secretary first awards 

22 grants under subsection (a), the Secretary shall sub23 mit to Congress a report regarding the grant 

24 project. 
236

•HR 3459 IH 

1 ‘‘(2) CONTENTS.—The report required under 

2 paragraph (1) shall include the following: 

3 ‘‘(A) A description of the programs for 

4 which grant funds were used. 

5 ‘‘(B) The number of individuals served. 

6 ‘‘(C) An evaluation of—

7 ‘‘(i) the effectiveness of these pro8 grams; 

9 ‘‘(ii) the cost of these programs; and 

10 ‘‘(iii) the impact of the project on the 

11 health outcomes of the community resi12 dents. 

13 ‘‘(D) Recommendations for sustaining the 

14 community health worker programs developed 

15 or assisted under this section. 

16 ‘‘(E) Recommendations regarding training 

17 to enhance career opportunities for community 

18 health workers. 

19 ‘‘(j) DEFINITIONS.—In this section: 

20 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

21 ‘community health worker’ means an individual who 

22 promotes health or nutrition within the community 

23 in which the individual resides—

24 ‘‘(A) by serving as a liaison between com25 munities and health care agencies;
237

•HR 3459 IH 

1 ‘‘(B) by providing guidance and social as2 sistance to community residents; 

3 ‘‘(C) by enhancing community residents’ 

4 ability to effectively communicate with health 

5 care providers; 

6 ‘‘(D) by providing culturally and linguis7 tically appropriate health or nutrition edu8 cation; 

9 ‘‘(E) by advocating for individual and com10 munity health or nutrition needs; and 

11 ‘‘(F) by providing referral and followup 

12 services. 

13 ‘‘(2) COMMUNITY SETTING.—The term ‘commu14 nity setting’ means a home or a community organi15 zation located in the neighborhood in which a partic16 ipant resides. 

17 ‘‘(3) MEDICALLY UNDERSERVED COMMUNITY.—

18 The term ‘medically underserved community’ means 

19 a community identified by a State—

20 ‘‘(A) that has a substantial number of in21 dividuals who are members of a medically un22 derserved population, as defined by section 

23 330(b)(3); and 
238

•HR 3459 IH 

1 ‘‘(B) a significant portion of which is a 

2 health professional shortage area as designated 

3 under section 332. 

4 ‘‘(4) SUPPORT.—The term ‘support’ means the 

5 provision of training, supervision, and materials 

6 needed to effectively deliver the services described in 

7 subsection (b), reimbursement for services, and 

8 other benefits. 

9 ‘‘(5) TARGET POPULATION.—The term ‘target 

10 population’ means women of reproductive age, re11 gardless of their current childbearing status. 

12 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section, 

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

15 2005 through 2010.’’. 

16 CHAPTER 6—HEALTH EMPOWERMENT 

17 ZONES 

18 SEC. 440. HEALTH EMPOWERMENT ZONES. 

19 (a) HEALTH EMPOWERMENT ZONE PROGRAMS.—

20 (1) GRANTS.—The Secretary, acting through 

21 the Administrator of the Health Resources and Serv22 ices Administration and the Director of the Office of 

23 Minority Health, and in cooperation with the Direc24 tor of the Office of Community Services and the Di25 rector of the National Center for Minority Health 
239

•HR 3459 IH 

1 and Health Disparities, shall make grants to part2 nerships of private and public entities to establish 

3 health empowerment zone programs in communities 

4 that disproportionately experience disparities in 

5 health status and healthcare for the purpose de6 scribed in paragraph (2). 

7 (2) USE OF FUNDS.—

8 (A) IN GENERAL.—Subject to subpara9 graph (B), the purpose of a health empower10 ment zone program under this section shall be 

11 to assist individuals, businesses, schools, minor12 ity health associations, non-profit organizations, 

13 community-based organizations, hospitals, 

14 healthcare clinics, foundations, and other enti15 ties in communities that disproportionately ex16 perience disparities in health status and 

17 healthcare which are seeking—

18 (i) to improve the health or environ19 ment of minority individuals in the com20 munity and to reduce disparities in health 

21 status and healthcare by assisting individ22 uals in accessing Federal programs; and 

23 (ii) to coordinate the efforts of gov24 ernmental and private entities regarding 
240

•HR 3459 IH 

1 the elimination of racial and ethnic dispari2 ties in health status and healthcare. 

3 (B) MEDICARE AND MEDICAID.—A health 

4 empowerment zone program under this section 

5 shall not provide any assistance (other than re6 ferral and follow-up services) that is duplicative 

7 of programs under title XVIII or XIX of the 

8 Social Security Act (42 U.S.C. 1395 and 1396 

9 et seq.). 

10 (3) DISTRIBUTION.—The Secretary shall make 

11 at least 1 grant under this section to a partnership 

12 for a health empowerment zone program in commu13 nities that disproportionately experience disparities 

14 in health status and healthcare that is located in a 

15 territory or possession of the United States. 

16 (4) APPLICATION.—To obtain a grant under 

17 this section, a partnership shall submit to the Sec18 retary an application in such form and in such man19 ner as the Secretary may require. An application 

20 under this paragraph shall—

21 (A) demonstrate that the communities to 

22 be served by the health empowerment zone pro23 gram are those that disproportionately experi24 ence disparities in health status and healthcare;
241

•HR 3459 IH 

1 (B) set forth a strategic plan for accom2 plishing the purpose described in paragraph (2), 

3 by—

4 (i) describing the coordinated health, 

5 economic, human, community, and physical 

6 development plan and related activities 

7 proposed for the community; 

8 (ii) describing the extent to which 

9 local institutions and organizations have 

10 contributed and will contribute to the plan11 ning process and implementation; 

12 (iii) identifying the projected amount 

13 of Federal, State, local, and private re14 sources that will be available in the area 

15 and the private and public partnerships to 

16 be used (including any participation by or 

17 cooperation with universities, colleges, 

18 foundations, non-profit organizations, med19 ical centers, hospitals, health clinics, school 

20 districts, or other private and public enti21 ties); 

22 (iv) identifying the funding requested 

23 under any Federal program in support of 

24 the proposed activities; 
242

•HR 3459 IH 

1 (v) identifying benchmarks for meas2 uring the success of carrying out the stra3 tegic plan; 

4 (vi) demonstrating the ability to reach 

5 and service the targeted underserved mi6 nority community populations in a cul7 turally appropriate and linguistically re8 sponsive manner; and 

9 (vii) demonstrating a capacity and in10 frastructure to provide long-term commu11 nity response that is culturally appropriate 

12 and linguistically responsive to commu13 nities that disproportionately experience 

14 disparities in health and healthcare; and 

15 (C) include such other information as the 

16 Secretary may require. 

17 (5) PREFERENCE.—In awarding grants under 

18 this subsection, the Secretary shall give preference 

19 to proposals from indigenous community entities 

20 that have an expertise in providing culturally appro21 priate and linguistically responsive services to com22 munities that disproportionately experience dispari23 ties in health and health care. 

24 (b) FEDERAL ASSISTANCE FOR HEALTH EMPOWER25 MENT ZONE GRANT PROGRAMS.—The Secretary, the Ad-
243

•HR 3459 IH 

1 ministrator of the Small Business Administration, the 

2 Secretary of Agriculture, the Secretary of Education, the 

3 Secretary of Labor, and the Secretary of Housing and 

4 Urban Development shall each—

5 (1) where appropriate, provide entity-specific 

6 technical assistance and evidence-based strategies to 

7 communities that disproportionately experience dis8 parities in health status and healthcare to further 

9 the purposes served by a health empowerment zone 

10 program established with a grant under subsection 

11 (a); 

12 (2) identify all programs administered by the 

13 Department of Health and Human Services, Small 

14 Business Administration, Department of Agri15 culture, Department of Education, Department of 

16 Labor, and the Department of Housing and Urban 

17 Development, respectively, that may be used to fur18 ther the purpose of a health empowerment zone pro19 gram established with a grant under subsection (a); 

20 and 

21 (3) in administering any program identified 

22 under paragraph (2), consider the appropriateness of 

23 giving priority to any individual or entity located in 

24 communities that disproportionately experience dis25 parities in health status and healthcare served by a 
244

•HR 3459 IH 

1 health empowerment zone program established with 

2 a grant under subsection (a), if such priority would 

3 further the purpose of the health empowerment zone 

4 program. 

5 (c) HEALTH EMPOWERMENT ZONE COORDINATING

6 COMMITTEE.—

7 (1) ESTABLISHMENT.—For each health em8 powerment zone program established with a grant 

9 under subsection (a), the Secretary acting through 

10 the Director of Office of Minority Health and the 

11 Administrator of the Health Resources and Services 

12 Administration shall establish a health empowerment 

13 zone coordinating committee. 

14 (2) DUTIES.—Each coordinating committee es15 tablished, in coordination with the Director of the 

16 Office of Minority Health and the Administrator of 

17 the Health Resources and Services Administration, 

18 shall provide technical assistance and evidence-based 

19 strategies to the grant recipient involved, including 

20 providing guidance on research, strategies, health 

21 outcomes, program goals, management, implementa22 tion, monitoring, assessment, and evaluation proc23 esses. 

24 (3) MEMBERSHIP.—
245

•HR 3459 IH 

1 (A) APPOINTMENT.—The Director of the 

2 Office of Minority Health and the Adminis3 trator of the Health Resources and Services Ad4 ministration, in consultation with the respective 

5 grant recipient shall appoint the members of 

6 each coordinating committee. 

7 (B) COMPOSITION.—The Director of the 

8 Office of Minority Health, and the Adminis9 trator of the Health Resources and Services Ad10 ministration shall ensure that each coordinating 

11 committee established—

12 (i) has not more than 20 members; 

13 (ii) includes individuals from commu14 nities that disproportionately experience 

15 disparities in health status and healthcare; 

16 (iii) includes community leaders and 

17 leaders of community-based organizations; 

18 (iv) includes representatives of aca19 demia and lay and professional organiza20 tions and associations including those hav21 ing expertise in medicine, technical, social 

22 and behavioral science, health policy, advo23 cacy, cultural and linguistic competency, 

24 research management, and organization; 

25 and 
246

•HR 3459 IH 

1 (v) represents a reasonable cross-sec2 tion of knowledge, views, and application 

3 of expertise on societal, ethical, behavioral, 

4 educational, policy, legal, cultural, lin5 guistic, and workforce issues related to 

6 eliminating disparities in health and 

7 healthcare. 

8 (C) INDIVIDUAL QUALIFICATIONS.—The 

9 Director of the Office of Minority Health and 

10 the Administrator of the Health Resources and 

11 Services Administration may not appoint an in12 dividual to serve on a coordinating committee 

13 unless the individual meets the following quali14 fications: 

15 (i) The individual is not employed by 

16 the Federal Government. 

17 (ii) The individual has appropriate ex18 perience, including experience in the areas 

19 of community development, cultural and 

20 linguistic competency, reducing and elimi21 nating racial and ethnic disparities in 

22 health and health care, or minority health. 

23 (D) SELECTION.—In selecting individuals 

24 to serve on a coordinating committee, the Di25 rector of Office of Minority Health and the Ad-
247

•HR 3459 IH 

1 ministrator Health Resources and Services Ad2 ministration shall give due consideration to the 

3 recommendations of the Congress, industry 

4 leaders, the scientific community (including the 

5 Institute of Medicine), academia, community 

6 based non-profit organizations, minority health 

7 and related organizations, the education com8 munity, State and local governments, and other 

9 appropriate organizations. 

10 (E) CHAIRPERSON.—The Director of the 

11 Office of Minority Health and the Adminis12 trator of the Health Resources and Services Ad13 ministration, in consultation with the members 

14 of the coordinating committee involved, shall 

15 designate a chairperson of the coordinating 

16 committee, who shall serve for a term of 3 

17 years and who may be reappointed at the expi18 ration of each such term. 

19 (F) TERMS.—Each member of a coordi20 nating committee shall be appointed for a term 

21 of 1 to 3 years in overlapping staggered terms, 

22 as determined by the Director of the Office of 

23 Minority Health and the Administrator of the 

24 Health Resources and Services Administration 
248

•HR 3459 IH 

1 at the time of appointment, and may be re2 appointed at the expiration of each such term. 

3 (G) VACANCIES.—A vacancy on a coordi4 nating committee shall be filled in the same 

5 manner in which the original appointment was 

6 made. 

7 (H) COMPENSATION.—Each member of a 

8 coordinating committee shall be compensated at 

9 a rate equal to the daily equivalent of the an10 nual rate of basic pay for level IV of the Execu11 tive Schedule for each day (including travel 

12 time) during which such member is engaged in 

13 the performance of the duties of the coordi14 nating committee. 

15 (I) TRAVEL EXPENSES.—Each member of 

16 a coordinating committee shall receive travel ex17 penses, including per diem in lieu of subsist18 ence, in accordance with applicable provisions 

19 under subchapter I of chapter 57 of title 5, 

20 United States Code. 

21 (4) MEETINGS.—A coordinating committee 

22 shall meet 3 to 5 times each year, at the call of the 

23 coordinating committee’s chairperson and in con24 sultation with the Director of Office of Minority 
249

•HR 3459 IH 

1 Health and the Administrator Health Resources and 

2 Services Administration. 

3 (5) REPORT.—Each coordinating committee 

4 shall transmit to the Congress an annual report 

5 that, with respect to the health empowerment zone 

6 program involved, includes the following: 

7 (A) A review of the program’s effectiveness 

8 in achieving stated goals and outcomes. 

9 (B) A review of the program’s manage10 ment and the coordination of the entities in11 volved. 

12 (C) A review of the activities in the pro13 gram’s portfolio and components. 

14 (D) An identification of policy issues raised 

15 by the program. 

16 (E) An assessment of the program’s capac17 ity, infrastructure, and number of underserved 

18 minority communities reached. 

19 (F) Recommendations for new program 

20 goals, research areas, enhanced approaches, 

21 partnerships, coordination and management 

22 mechanisms, and projects to be established to 

23 achieve the program’s stated goals, to improve 

24 outcomes, monitoring, and evaluation. 
250

•HR 3459 IH 

1 (G) A review of the degree of minority en2 tity participation in the program, and an identi3 fication of a strategy to increase such participa4 tion. 

5 (H) Any other reviews or recommendations 

6 determined to be appropriate by the coordi7 nating committee. 

8 (d) REPORT.—The Director of the Office of Minority 

9 Health and the Administrator of the Health Resources 

10 and Services Administration shall submit a joint annual 

11 report to the appropriate committees of Congress on the 

12 results of the implementation of programs under this sec13 tion. 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section, 

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

17 2005 through 2010. 

18 Subtitle B—Targeting Diseases and 

19 Conditions with Particularly 

20 Disparate Impact 

21 CHAPTER 1—CANCER REDUCTION 

22 SEC. 441. CANCER REDUCTION. 

23 (a) PREVENTIVE HEALTH MEASURES WITH RE24 SPECT TO BREAST AND CERVICAL CANCER.—
251

•HR 3459 IH 

1 (1) IN GENERAL.—Section 1510(a) of the Pub2 lic Health Service Act (42 U.S.C. 300n–5(a)) is 

3 amended by striking ‘‘2003’’ and inserting ‘‘2008’’. 

4 (2) SUPPLEMENTAL GRANTS FOR ADDITIONAL

5 PREVENTIVE HEALTH SERVICES.—Section 

6 1509(d)(1) of the Public Health Service Act (42 

7 U.S.C. 300n–4a(d)(1)) is amended by striking 

8 ‘‘2003’’ and inserting ‘‘2008’’. 

9 (b) TREATMENT AND PREVENTION.—Title XXIX of 

10 the Public Health Service Act, as amended by section 302, 

11 is further amended by adding at the end the following: 

12 ‘‘Subtitle C—Reducing Disease and 

13 Disease-Related Complications 

14 ‘‘CHAPTER 1—CANCER REDUCTION 

15 ‘‘SEC. 2921. CANCER PREVENTION AND TREATMENT FOR 

16 UNDERSERVED MINORITY OR OTHER POPU17 LATIONS. 

18 ‘‘(a) GRANTS.—The Secretary may make grants to 

19 qualifying health centers, non-profit organizations, and 

20 public institutions for the development, expansion, or oper21 ation of programs that, for individuals otherwise served 

22 by such centers, provide—

23 ‘‘(1) information and education on cancer pre24 vention; 

25 ‘‘(2) screenings for cancer; 
252

•HR 3459 IH 

1 ‘‘(3) counseling on cancer, including counseling 

2 upon a diagnosis of cancer; and 

3 ‘‘(4) treatment for cancer. 

4 ‘‘(b) QUALIFYING HEALTH CENTERS AND PUBLIC

5 INSTITUTIONS.—For purposes of this section: 

6 ‘‘(1) QUALIFYING HEALTH CENTERS.—The 

7 term ‘qualifying health center’ includes community 

8 health centers, migrant health centers, health cen9 ters for the homeless, health centers for residents of 

10 public housing, and community clinics. 

11 ‘‘(2) QUALIFYING PUBLIC INSTITUTIONS.—The 

12 term ‘qualifying public institutions’ means an entity 

13 that meets the requirements of section 2971(b)(1). 

14 ‘‘(c) PREFERENCE IN MAKING GRANTS.—In making 

15 grants under subsection (a), the Secretary shall give pref16 erence to applicants that—

17 ‘‘(1) have service populations that include a sig18 nificant number of low-income minority individuals 

19 who are at-risk for cancer; 

20 ‘‘(2) will, through programs under subsection 

21 (b)—

22 ‘‘(A) emphasize early detection of and com23 prehensive treatment for cancer; 

24 ‘‘(B) provide comprehensive treatment 

25 services for cancer in its earliest stages; and 
253

•HR 3459 IH 

1 ‘‘(C) carry out subparagraphs (A) and (B) 

2 for two or more types of cancer; and 

3 ‘‘(3) in order to provide treatment for cancer, 

4 have established or will establish referral arrange5 ments with entities that provide screenings for low6 income individuals. 

7 ‘‘(d) APPROPRIATE CULTURAL CONTEXT.—As a con8 dition for the receipt of a grant under subsection (a), the 

9 applicant shall agree that, in the program carried out with 

10 the grant, services will be provided in the languages most 

11 appropriate for, and with consideration for the cultural 

12 background of, the individuals for whom the services are 

13 provided. 

14 ‘‘(e) OUTREACH SERVICES.—As a condition for the 

15 receipt of a grant under subsection (a), the applicant shall 

16 agree to provide outreach activities to inform the public 

17 of the services of the program, and to provide information 

18 on cancer; and 

19 ‘‘(f) APPLICATION FOR GRANT.—A grant may be 

20 made under subsection (a) only if an application for the 

21 grant is submitted to the Secretary and the application 

22 is in such form, is made in such manner, and contains 

23 such agreements, assurances, and information as the Sec24 retary determines to be necessary to carry out this section. 
254

•HR 3459 IH 

1 ‘‘(g) DESIGNATION OF TYPE OF CANCER.—In mak2 ing a grant under subsection (a), the Secretary shall des3 ignate the type or types of cancer with respect to which 

4 the grant is being made. 

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 2005 through 2010.’’. 

9 CHAPTER 2—HIV/AIDS REDUCTION 

10 SEC. 442. HIV/AIDS REDUCTION. 

11 Subtitle C of title XXIX of the Public Health Service 

12 Act, as added by section 441, is amended by adding at 

13 the end the following: 

14 ‘‘CHAPTER 2—HIV/AIDS REDUCTION 

15 ‘‘SEC. 2922. HIV/AIDS REDUCTION IN THE MINORITY COM16 MUNITY. 

17 ‘‘(a) EXPANDED FUNDING.—The Secretary, in col18 laboration with the Director of the Office of Minority 

19 Health, the Director of the Centers for Disease Control 

20 and Prevention, the Administrator of the Health Re21 sources and Services Administration, and the Adminis22 trator of the Substance Abuse and Mental Health Admin23 istration, shall provide funds and carry out activities to 

24 expand the Minority HIV/AIDS Initiative.
255

•HR 3459 IH 

1 ‘‘(b) USE OF FUNDS.—The additional funds made 

2 available under this section may be used, through the Mi3 nority HIV/AIDS Initiative, to support the following ac4 tivities: 

5 ‘‘(1) The provision of technical assistance and 

6 infrastructure support to reduce HIV/AIDS in mi7 nority populations. 

8 ‘‘(2) To increase minority populations’ access to 

9 HIV/AIDS prevention and care services. 

10 ‘‘(3) To build stronger community programs 

11 and partnerships to address HIV prevention and the 

12 healthcare needs of specific minority racial and eth13 nic populations. 

14 ‘‘(c) PRIORITY INTERVENTIONS.—Within the minor15 ity populations referred to in subsection (b), priority in 

16 conducting intervention services shall be given to—

17 ‘‘(1) women; 

18 ‘‘(2) youth; 

19 ‘‘(3) men who engage in homosexual activity; 

20 ‘‘(4) persons who engage in intravenous drug 

21 abuse; 

22 ‘‘(5) homeless individuals; and 

23 ‘‘(6) individuals incarcerated or in the penal 

24 system. 
256

•HR 3459 IH 

1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out this section, there are authorized 

3 to be appropriated $610,000,000 for fiscal year 2005, and 

4 such sums as may be necessary for each of the fiscal years 

5 2006 through 2010.’’. 

6 CHAPTER 3—INFANT MORTALITY 

7 REDUCTION 

8 SEC. 443. INFANT MORTALITY REDUCTION. 

9 Subtitle C of title XXIX of the Public Health Service 

10 Act, as amended by section 442, is further amended by 

11 adding at the end the following: 

12 ‘‘CHAPTER 3—INFANT MORTALITY 

13 REDUCTION 

14 ‘‘SEC. 2923. INFANT MORTALITY REDUCTION. 

15 ‘‘(a) BACK TO SLEEP CAMPAIGN.—

16 ‘‘(1) IN GENERAL.—The Secretary shall sup17 port collaborations through the National Institute of 

18 Child Health and Human Development. 

19 ‘‘(2) USE OF FUNDS.—Collaborations funded 

20 under paragraph (1) shall be directed towards the 

21 goal of reducing the incidence of Sudden Infant 

22 Death Syndrome in minority communities, particu23 larly the African American and American Indian and 

24 Native Alaskan communities, through increased edu25 cation on the importance of back sleeping for in-
257

•HR 3459 IH 

1 fants. Such increased education shall include child 

2 care centers and other secondary child caregivers. 

3 ‘‘(b) GUIDELINES FOR CHILD CARE LICENSURE.—

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

5 through the Director of the National Institute of 

6 Child Health and Human Development, shall con7 vene a working group to develop health guidelines 

8 relating to infant mortality reduction for use by 

9 child care licensing entities, including State, terri10 torial, tribal, and local governments. 

11 ‘‘(2) FOCUS.—The guidelines developed under 

12 paragraph (1) shall focus specifically on appropriate 

13 actions to reduce the incidence of Sudden Infant 

14 Death Syndrome in child care settings. 

15 ‘‘(3) REPORT.—Not later than 1 year after the 

16 date of enactment of this title, the Secretary shall 

17 submit to the appropriate committees of Congress 

18 and the States a report that describes the guidelines 

19 developed under this subsection. 

20 ‘‘(c) 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 2005 through 2010.’’. 
258

•HR 3459 IH 

1 CHAPTER 4—FETAL ALCOHOL SYNDROME 

2 TREATMENT AND DIAGNOSIS 

3 SEC. 444. FETAL ALCOHOL SYNDROME. 

4 Subtitle C of title XXIX of the Public Health Service 

5 Act, as amended added by section 443, is further amended 

6 by adding at the end the following: 

7 ‘‘CHAPTER 4—FETAL ALCOHOL 

8 SYNDROME TREATMENT AND DIAGNOSIS 

9 ‘‘SEC. 2924. FETAL ALCOHOL SYNDROME. 

10 ‘‘(a) SURVEILLANCE AND IDENTIFICATION RE11 SEARCH.—The Secretary shall direct the National Center 

12 for Birth Defects and Developmental Disabilities (referred 

13 to in this section as the ‘Center’) to—

14 ‘‘(1) develop a uniform surveillance case defini15 tion for Fetal Alcohol Syndrome (referred to in this 

16 section as ‘FAS’) and a uniform surveillance defini17 tion for Alcohol Related Neurodevelopmental Dis18 order (referred to in this section as ‘ARND’); 

19 ‘‘(2) develop a comprehensive screening process 

20 for FAS and ARND to include all age groups; and 

21 ‘‘(3) disseminate the screening process devel22 oped under paragraph (2) to—

23 ‘‘(A) hospitals, outpatient programs, and 

24 other healthcare providers; 
259

•HR 3459 IH 

1 ‘‘(B) incarceration and detainment facili2 ties; 

3 ‘‘(C) primary and secondary schools; 

4 ‘‘(D) social work and child welfare offices; 

5 ‘‘(E) State offices and others providing 

6 services to individuals with disabilities; and 

7 ‘‘(F) others determined appropriate by the 

8 Secretary. 

9 ‘‘(b) CLINICAL CHARACTERIZATION OF FAS AND RE10 LATED DISEASES.—The Secretary shall direct the Na11 tional Institute of Alcohol Abuse and Alcoholism to—

12 ‘‘(1) research methods to quantify the central 

13 nervous system impairments associated with fetal al14 cohol exposure and to develop clinical diagnostic 

15 tools for the intellectual and behavioral problems as16 sociated with FAS and related diseases; 

17 ‘‘(2) develop a neurocognitive phenotype for 

18 FAS and ARND; and 

19 ‘‘(3) include all relevant scientific and clinical 

20 characterizations of FAS and related diseases in rel21 evant diagnostic codes. 

22 ‘‘(c) COMMUNITY-BASED AND SUPPORT SERVICES

23 COORDINATION GRANTS.—The Secretary shall award 

24 grants to States, Indian tribes and tribal organizations, 
260

•HR 3459 IH 

1 and nongovernmental organizations for the establishment 

2 of—

3 ‘‘(1) pilot projects to identify and implement 

4 best practices for—

5 ‘‘(A) educating children with fetal alcohol 

6 spectrum disorders, including—

7 ‘‘(i) activities and programs designed 

8 specifically for the identification, treat9 ment, and education of such children; and 

10 ‘‘(ii) curricula development and 

11 credentialing of teachers, administrators, 

12 and social workers who implement such 

13 programs; 

14 ‘‘(B) educating judges, attorneys, child ad15 vocates, law enforcement officers, prison war16 dens, alternative incarceration administrators, 

17 and incarceration officials on how to treat and 

18 support individuals suffering from a fetal alco19 hol spectrum disorder within the criminal jus20 tice system, including—

21 ‘‘(i) programs designed specifically for 

22 the identification, treatment, and education 

23 of those with a fetal alcohol spectrum dis24 order; and
261

•HR 3459 IH 

1 ‘‘(ii) curricula development and 

2 credentialing within justice system for indi3 viduals who implement such programs; and 

4 ‘‘(C) educating adoption or foster care 

5 agency officials about available and necessary 

6 services for children with fetal alcohol spectrum 

7 disorders, including—

8 ‘‘(i) programs designed specifically for 

9 the identification, treatment, and education 

10 of those with a fetal alcohol spectrum dis11 order; and 

12 ‘‘(ii) education and training for poten13 tial parents of an adopted child with a 

14 fetal alcohol spectrum disorder; 

15 ‘‘(2) nationally coordinated systems that inte16 grate transitional services for those affected by pre17 natal alcohol exposure such as housing assistance, 

18 vocational training and placement, and medication 

19 monitoring by—

20 ‘‘(A) providing training and support to 

21 family services programs, children’s mental 

22 health programs, and other local efforts; 

23 ‘‘(B) recruiting and training mentors for 

24 teenagers with a fetal alcohol spectrum dis25 order; and 
262

•HR 3459 IH 

1 ‘‘(C) maintaining a clearinghouse including 

2 all relevant neurobehavioral information needed 

3 for supporting individuals with a fetal alcohol 

4 spectrum disorder; and 

5 ‘‘(3) programs to disseminate and coordinate 

6 fetal alcohol spectrum disorder awareness and iden7 tification efforts by community health centers, in8 cluding—

9 ‘‘(A) education of health professionals re10 garding available support services; and 

11 ‘‘(B) implementation of a tracking system 

12 targeting the rates of fetal alcohol spectrum 

13 disorders among individuals from certain racial, 

14 ethnic, and economic backgrounds. 

15 ‘‘(d) APPLICATION.—To be eligible to receive a grant 

16 under subsection (d), an entity shall submit to the Sec17 retary an application in such form, in such manner, and 

18 containing such agreements, assurances, and information 

19 as the Secretary determines to be necessary to carry out 

20 this section. 

21 ‘‘(e) 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 2005 through 2010.’’. 
263

•HR 3459 IH 

1 CHAPTER 5—DIABETES PREVENTION AND 

2 TREATMENT 

3 SEC 445. MONITORING THE QUALITY OF AND DISPARITIES 

4 IN DIABETES CARE. 

5 Part A of title IX of the Public Health Service Act 

6 (42 U.S.C. 299 et seq.) is amended by adding at the end 

7 the following: 

8 ‘‘SEC. 904. AREAS OF SPECIAL EMPHASIS. 

9 ‘‘The Secretary, acting through the Director, shall in10 corporate within the annual quality report required under 

11 section 913(b)(2) and the annual disparities report re12 quired under section 903(a)(6), scientific evidence and in13 formation appropriate for monitoring the quality and safe14 ty of diabetes care and identifying, understanding, and re15 ducing disparities in care.’’. 

16 SEC. 446. DIABETES PREVENTION, TREATMENT, AND CON17 TROL. 

18 (a) DETERMINATION.—The Secretary, in consulta19 tion with Indian tribes and tribal organizations, shall de20 termine—

21 (1) by tribe, tribal organization, and service 

22 unit of the Service, the prevalence of, and the types 

23 of complications resulting from, diabetes among In24 dians; and 
264

•HR 3459 IH 

1 (2) based on paragraph (1), the measures (in2 cluding patient education) each service unit should 

3 take to reduce the prevalence of, and prevent, treat, 

4 and control the complications resulting from, diabe5 tes among Indian tribes within that service unit. 

6 (b) SCREENING.—The Secretary shall screen each In7 dian who receives services from the Service for diabetes 

8 and for conditions which indicate a high risk that the indi9 vidual will become diabetic. Such screening may be done 

10 by an Indian tribe or tribal organization operating 

11 healthcare programs or facilities with funds from the Serv12 ice under the Indian Self-Determination and Education 

13 Assistance Act. 

14 (c) CONTINUED FUNDING.—The Secretary shall con15 tinue to fund, through fiscal year 2015, each effective 

16 model diabetes project in existence on the date of the en17 actment of this Act and such other diabetes programs op18 erated by the Secretary or by Indian tribes and tribal or19 ganizations and any additional programs added to meet 

20 existing diabetes needs. Indian tribes and tribal organiza21 tions shall receive recurring funding for the diabetes pro22 grams which they operate pursuant to this section. Model 

23 diabetes projects shall consult, on a regular basis, with 

24 tribes and tribal organizations in their regions regarding 

25 diabetes needs and provide technical expertise as needed.
265

•HR 3459 IH 

1 (d) DIALYSIS PROGRAMS.—The Secretary shall pro2 vide funding through the Service, Indian tribes and tribal 

3 organizations to establish dialysis programs, including 

4 funds to purchase dialysis equipment and provide nec5 essary staffing. 

6 (e) OTHER ACTIVITIES.—The Secretary shall, to the 

7 extent funding is available—

8 (1) in each area office of the Service, consult 

9 with Indian tribes and tribal organizations regarding 

10 programs for the prevention, treatment, and control 

11 of diabetes; 

12 (2) establish in each area office of the Service 

13 a registry of patients with diabetes to track the 

14 prevalence of diabetes and the complications from 

15 diabetes in that area; and 

16 (3) ensure that data collected in each area of17 fice regarding diabetes and related complications 

18 among Indians is disseminated to tribes, tribal orga19 nizations, and all other area offices. 

20 (f) DEFINITIONS.—For purposes of this section, the 

21 definitions contained in section 4 of the Indian Health 

22 Care Improvement Act shall apply. 
266

•HR 3459 IH 

1 SEC. 447. GENETICS OF DIABETES. 

2 Title IV of the Public Health Service Act (42 U.S.C. 

3 281 et seq.) is amended by inserting after section 430 the 

4 following: 

5 ‘‘SEC. 430A. GENETICS OF DIABETES. 

6 ‘‘The Diabetes Mellitus Interagency Coordinating 

7 Committee, in collaboration with the Directors of the Na8 tional Human Genome Research Institute, the National 

9 Institute of Diabetes and Digestive and Kidney Diseases, 

10 and the National Institute of Environmental Health 

11 Sciences, and other voluntary organizations and interested 

12 parties, shall—

13 ‘‘(1) coordinate and assist efforts of the Type 

14 1 Diabetes Genetics Consortium, which will collect 

15 and share valuable DNA information from type 1 di16 abetes patients from studies around the world; and 

17 ‘‘(2) provide continued coordination and sup18 port for the consortia of laboratories investigating 

19 the genomics of diabetes.’’. 

20 SEC. 448. RESEARCH AND TRAINING ON DIABETES IN UN21 DERSERVED AND MINORITY POPULATIONS. 

22 (a) RESEARCH.—Subpart 3 of part C of title IV of 

23 the Public Health Service Act (42 U.S.C. 285c et seq.) 

24 is amended by adding at the end the following:
267

•HR 3459 IH 

1 ‘‘SEC. 434B. RESEARCH ON DIABETES IN UNDERSERVED 

2 AND MINORITY POPULATIONS. 

3 ‘‘(a) IN GENERAL.—The Director of the Institute, in 

4 coordination with the Director of the National Center on 

5 Minority Health and Health Disparities, the Director of 

6 the Office of Minority Health, and other appropriate insti7 tutes and centers, shall expand, intensify, and coordinate 

8 research programs on pre-diabetes, type 1 diabetes and 

9 type 2 diabetes in underserved populations and minority 

10 groups. 

11 ‘‘(b) RESEARCH.—The research described in sub12 section (a) shall include research on—

13 ‘‘(1) behavior, including diet and physical activ14 ity and other aspects of behavior; 

15 ‘‘(2) environmental factors related to type 2 di16 abetes that are unique to, more serious, or more 

17 prevalent, among underserved or high-risk popu18 lations; 

19 ‘‘(3) research on the prevention of complica20 tions, which are unique to, more serious, or more 

21 prevalent among minorities, as well as research on 

22 how to effectively translate the findings of clinical 

23 trials and research to improve methods for self-man24 agement and health-care delivery; and 

25 ‘‘(4) genetic studies of diabetes, consistent with 

26 research conducted under section 430A. 
268

•HR 3459 IH 

1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated for purposes of carrying 

3 out this section, such sums as may be necessary for each 

4 of fiscal years 2005 through 2010.’’. 

5 (b) DIVISION DIRECTORS.—Section 428(b)(1) of the 

6 Public Health Service Act (42 U.S.C. 285c–2(b)(1)) is 

7 amended by inserting ‘‘(including research training of 

8 members of minority populations in order to facilitate 

9 their conduct of diabetes-related research in underserved 

10 populations and minority groups)’’ after ‘‘research pro11 grams’’. 

12 SEC. 449. AUTHORIZATION OF APPROPRIATIONS. 

13 Subpart 3 of part C of title IV of the Public Health 

14 Service Act (42 U.S.C. 285c et seq.) (as amended by sec15 tion 448(a)) is amended by adding at the end the fol16 lowing: 

17 ‘‘SEC. 434C. AUTHORIZATION OF APPROPRIATIONS. 

18 ‘‘For the purpose of carrying out this subpart with 

19 respect to the programs of the National Institute of Diabe20 tes and Digestive and Kidney Diseases, other than section 

21 434B, there are authorized to be appropriated such sums 

22 as may be necessary for each of fiscal years 2005 through 

23 2010.’’. 
269

•HR 3459 IH 

1 SEC. 450. MODEL COMMUNITY DIABETES AND CHRONIC 

2 DISEASE CARE AND PREVENTION AMONG PA3 CIFIC ISLANDERS AND NATIVE HAWAIIANS. 

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

5 (42 U.S.C. 280g et seq.), as amended by section 432, is 

6 further amended by adding at the end the following: 

7 ‘‘SEC. 399P. MODEL COMMUNITY DIABETES AND CHRONIC 

8 DISEASE CARE AND PREVENTION AMONG PA9 CIFIC ISLANDERS AND NATIVE HAWAIIANS. 

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

11 the Director of the Centers for Disease Control and Pre12 vention, may award grants and enter into cooperative 

13 agreements and contracts with eligible entities to establish 

14 a model community demonstration project to provide 

15 training and support for community-based prevention and 

16 control programs targeting diabetes, hypertension, cardio17 vascular disease, and other related health problems in 

18 American Samoa, the Commonwealth of the Northern 

19 Mariana Islands, Guam, the Federated States of Micro20 nesia, Hawaii, the Republic of the Marshall Islands, and 

21 the Republic of Palau. 

22 ‘‘(b) ELIGIBLE ENTITY DEFINED.—In this section 

23 the term ‘eligible entity’ means any organization described 

24 in section 501(c)(3) of the Internal Revenue Code of 1986 

25 and exempt from tax under section 501(a) of such Code. 
270

•HR 3459 IH 

1 ‘‘(c) PRIORITY.—The Secretary shall give priority for 

2 grants, agreements, and contracts under this section to 

3 eligible entities that have previously administered cul4 turally appropriate Centers for Disease Control and Pre5 vention programs intended to prevent and control diabetes 

6 in the areas described in subsection (a). 

7 ‘‘(d) REGULATIONS.—The Secretary is authorized to 

8 promulgate such regulations as may be necessary to carry 

9 out this section. 

10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated to carry out this section, 

12 such sums as may be necessary for fiscal years 2005 

13 through 2010.’’. 

14 SEC. 451. PROGRAMS OF CENTERS FOR DISEASE CONTROL 

15 AND PREVENTION. 

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

17 (42 U.S.C. 243 et seq.) is amended by striking section 

18 317H and inserting the following: 

19 ‘‘SEC. 317H. DIABETES IN CHILDREN AND YOUTH. 

20 ‘‘(a) SURVEILLANCE ON TYPE 1 DIABETES.—The 

21 Secretary, acting through the Director of the Centers for 

22 Disease Control and Prevention and in consultation with 

23 the Director of the National Institutes of Health, shall de24 velop a sentinel system to collect data on type 1 diabetes, 
271

•HR 3459 IH 

1 including the incidence and prevalence of type 1 diabetes 

2 and shall establish a national database for such data. 

3 ‘‘(b) TYPE 2 DIABETES IN YOUTH.—The Secretary 

4 shall implement a national public health effort to address 

5 type 2 diabetes in youth, including—

6 ‘‘(1) enhancing surveillance systems and ex7 panding research to better assess the prevalence and 

8 incidence of type 2 diabetes in youth and determine 

9 the extent to which type 2 diabetes is incorrectly di10 agnosed as type 1 diabetes among children; 

11 ‘‘(2) standardizing and improving methods to 

12 assist in diagnosis, treatment, and prevention of dia13 betes including developing less invasive ways to mon14 itor blood glucose to prevent hypoglycemia such as 

15 nonmydriatic retinal imaging and improving existing 

16 glucometers that measure blood glucose; and 

17 ‘‘(3) developing methods to identify obstacles 

18 facing children in traditionally underserved popu19 lations to obtain care to prevent or treat type 2 dia20 betes. 

21 ‘‘(c) LONG-TERM EPIDEMIOLOGICAL STUDIES ON DI22 ABETES IN CHILDREN.—The Secretary, acting through 

23 the Director of the Centers for Disease Control and Pre24 vention and the Director of the National Institute of Dia25 betes and Digestive and Kidney Diseases, shall conduct 
272

•HR 3459 IH 

1 or support long-term epidemiology studies in children with 

2 diabetes or at risk for diabetes. Such studies shall inves3 tigate the causes and characteristics of the disease and 

4 its complications. 

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

6 are authorized to be appropriated to carry out this section, 

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

8 2005 through 2010.’’. 

9 CHAPTER 6—HEART DISEASE AND 

10 STROKE PREVENTION AND TREATMENT 

11 SEC. 455. SYSTEMS FOR HEART DISEASE AND STROKE. 

12 Title XXIX of the Public Health Service Act, as 

13 amended by section 443, is further amended by adding 

14 at the end the following: 

15 ‘‘Subtitle D—Systems for Heart 

16 Disease and Stroke 

17 ‘‘CHAPTER 1—HEART DISEASE 

18 ‘‘SEC. 2941. HEART DISEASE. 

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

20 the National Heart, Lung and Blood Institute and the 

21 Centers for Disease Control, shall award competitive 

22 grants to eligible entities to provide for community-based 

23 interventions to encourage healthy lifestyles to reduce 

24 morbidity and mortality from heart disease.
273

•HR 3459 IH 

1 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

2 a grant under subsection (a), an entity shall—

3 ‘‘(1) be a community-based or non-profit orga4 nization, academic medical institution, hospital, 

5 health center, health plan, health department, or 

6 other health-related entity determined appropriate 

7 by the Secretary; 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) USE OF FUNDS.—An entity shall use amounts 

13 received under a grant under this section to—

14 ‘‘(1) carry out interventions that address pri15 mary prevention of heart disease in the minority 

16 community, including educational outreach efforts 

17 concerning risk factors for, and the prevention of, 

18 heart disease; 

19 ‘‘(2) carry out activities to facilitate healthy 

20 lifestyles in minority populations through—

21 ‘‘(A) behavioral change interventions to in22 crease physical activity and improve nutrition; 

23 ‘‘(B) the increased use of community facili24 ties and public spaces for exercise; 
274

•HR 3459 IH 

1 ‘‘(C) school, after-school, or intramural 

2 physical activity or sports programs for children 

3 and youth; 

4 ‘‘(D) employment-based interventions to 

5 increase physical activity or nutrition; or 

6 ‘‘(3) expand or evaluate existing programs of 

7 the type described in paragraphs (1) and (2). 

8 ‘‘(d) 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 2005 through 2010. 

12 ‘‘CHAPTER 2—STROKE EDUCATION 

13 CAMPAIGN 

14 ‘‘SEC. 2945. STROKE EDUCATION CAMPAIGN. 

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

16 national education and information campaign to promote 

17 stroke prevention and increase the number of stroke pa18 tients who seek immediate treatment. In implementing 

19 such education and information campaign, the Secretary 

20 shall avoid duplicating existing stroke education efforts by 

21 other Federal Government agencies and may consult with 

22 national and local associations that are dedicated to in23 creasing the public awareness of stroke, consumers of 

24 stroke awareness products, and providers of stroke care. 
275

•HR 3459 IH 

1 ‘‘(b) USE OF FUNDS.—The Secretary may use 

2 amounts appropriated to carry out the campaign described 

3 in subsection (a)—

4 ‘‘(1) to make public service announcements 

5 about the warning signs of stroke and the impor6 tance of treating stroke as a medical emergency; 

7 ‘‘(2) to provide education regarding ways to 

8 prevent stroke and the effectiveness of stroke treat9 ment; 

10 ‘‘(3) to purchase media time and space; 

11 ‘‘(4) to pay for advertising production costs; 

12 ‘‘(5) to test and evaluate advertising and edu13 cational materials for effectiveness, especially among 

14 groups at high risk for stroke, including women, 

15 older adults, and African-Americans; 

16 ‘‘(6) to develop alternative campaigns that are 

17 targeted to unique communities, including rural and 

18 urban communities, and States with a particularly 

19 high incidence of stroke; 

20 ‘‘(7) to measure public awareness prior to the 

21 start of the campaign on a national level and in tar22 geted communities to provide baseline data that will 

23 be used to evaluate the effectiveness of the public 

24 awareness efforts; and 
276

•HR 3459 IH 

1 ‘‘(8) to carry out other activities that the Sec2 retary determines will promote prevention practices 

3 among the general public and increase the number 

4 of stroke patients who seek immediate care. 

5 ‘‘(c) CONSULTATIONS.—In carrying out this section, 

6 the Secretary shall consult with medical, surgical, rehabili7 tation, and nursing specialty groups, hospital associations, 

8 voluntary health organizations, emergency medical serv9 ices, State directors, and associations, experts in the use 

10 of telecommunication technology to provide stroke care, 

11 national disability, minority health professional organiza12 tions and consumer organizations representing individuals 

13 with disabilities and chronic illnesses, concerned advo14 cates, and other interested parties. 

15 ‘‘(d) STROKE.—In this section, the term ‘stroke’ 

16 means a ‘brain attack’ in which blood flow to the brain 

17 is interrupted or in which a blood vessel or aneurysm in 

18 the brain breaks or ruptures. 

19 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

20 is authorized to be appropriated to carry out subsection 

21 (b), such sums as may be necessary for each of fiscal years 

22 2005 through 2010.’’. 
277

•HR 3459 IH 

1 CHAPTER 7—OBESITY AND OVERWEIGHT 

2 REDUCTION 

3 SEC. 461. OVERWEIGHT AND OBESITY PREVENTION AND 

4 TREATMENT. 

5 (a) IN GENERAL.—The Secretary, in collaboration 

6 with the Director of the Centers for Disease Control and 

7 Prevention, the Administrator of the National Center for 

8 Minority Health and Health Disparities, and the Adminis9 trator of the Health Resources and Services Administra10 tion, shall establish grant programs for the purpose of pre11 venting and treating overweight and obesity in under12 served minority populations. 

13 (b) DEFINITIONS.—In this section, with respect to an 

14 individual: 

15 (1) OBESITY.—The term ‘‘obesity’’ means a 

16 Body Mass Index greater than or equal to 30.0 kg/

m2 17 . 

18 (2) OVERWEIGHT.—The term ‘‘overweight’’ 

means a Body Mass Index of 25 to 29.9 kg/m2 19 . 

20 (c) CENTERS FOR DISEASE CONTROL AND PREVEN21 TION.—The Director of the Centers for Disease Control 

22 and Prevention shall expand overweight and obesity reduc23 tion activities that include the following: 

24 (1) Surveillance in minority racial and ethnic 

25 populations. 
278

•HR 3459 IH 

1 (2) Communication strategies, including the use 

2 of social marketing for minority populations, about 

3 the dangers of obesity. 

4 (3) Creation of partnerships with State health 

5 departments in developing obesity prevention and 

6 treatment interventions. 

7 (4) Development of work-based wellness pro8 grams to encourage adoption of healthy lifestyles by 

9 employees. 

10 (d) NATIONAL CENTER FOR MINORITY HEALTH AND

11 HEALTH DISPARITIES.—The Director of the Centers for 

12 Disease Control and Prevention shall establish and imple13 ment a grant program to support research in the following 

14 areas: 

15 (1) Behavioral and environmental causes of 

16 overweight and obesity in minority populations. 

17 (2) Prevention and treatment interventions for 

18 overweight and obesity, tailored for minority popu19 lations. 

20 (3) Disparities in the prevalence of overweight 

21 and obesity among racial and ethnic minority 

22 groups. 

23 (4) Development and dissemination of best 

24 practice guidelines for treatment of overweight and
279

•HR 3459 IH 

1 obesity, tailored for gender and age groups within 

2 minority populations. 

3 (5) Data collection and reporting relating to 

4 overweight and obesity in minority populations. 

5 (e) HEALTH RESOURCES AND SERVICES ADMINIS6 TRATION.—The Administrator of the Health Resources 

7 and Services Administration, in collaboration with the Di8 rector of the Office of Minority Health, the Secretary of 

9 Education, and the Secretary of Agriculture, shall estab10 lish and implement a school-based obesity prevention and 

11 treatment program that may include the following activi12 ties: 

13 (1) Projects to change the perception of over14 weight and obesity of children from racially and eth15 nically diverse backgrounds at all ages. 

16 (2) Culturally appropriate student education 

17 about healthy eating habits, based on the Dietary 

18 Guidelines for Americans. 

19 (3) Student programs to increase knowledge, 

20 attitudes, skills, behaviors, and confidence needed to 

21 be physically active for life. 

22 (4) Student peer advisor programs to increase 

23 awareness and model healthy lifestyles among fellow 

24 students. 
280

•HR 3459 IH 

1 (5) Teacher education using scientifically evalu2 ated physical education and nutrition curricula tai3 lored to minority populations. 

4 (6) Family-focused initiatives to encourage the 

5 adoption of strategies relating to healthy lifestyles 

6 for parents (or guardians) and children. 

7 (7) The creation of partnerships with commu8 nity, fitness, or health organizations that will pro9 mote healthy eating and physical activity among 

10 children. 

11 (8) Incentive programs to ensure the provision 

12 of healthful foods and beverages on school campuses 

13 and at school events. 

14 (f) EVALUATION.—A grantee under this section shall 

15 submit to the Secretary an evaluation, in collaboration 

16 with an academic health center or other qualified entity, 

17 that describes activities carried out with funds received 

18 under the grant and the effectiveness of such activities in 

19 preventing or treating overweight and obesity. 

20 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

21 authorized to be appropriated to carry out this section, 

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

23 2005 through 2010. 
281

•HR 3459 IH 

1 CHAPTER 8—TUBERCULOSIS CONTROL, 

2 PREVENTION, AND TREATMENT 

3 SEC. 465. ADVISORY COUNCIL FOR THE ELIMINATION OF 

4 TUBERCULOSIS. 

5 Section 317E(f) of the Public Health Service Act (42 

6 U.S.C. 247b–6(f)) is amended—

7 (1) by redesignating paragraph (5) as para8 graph (6); and 

9 (2) by striking paragraphs (2) through (4), and 

10 inserting the following: 

11 ‘‘(2) DUTIES.—For the purpose of making 

12 progress toward the goal of eliminating tuberculosis 

13 from the United States, the Council shall provide to 

14 the Secretary and other appropriate Federal officials 

15 advice on coordinating the activities of the Public 

16 Health Service and other Federal agencies that re17 late to such disease and on efficiently utilizing the 

18 Federal resources involved. 

19 ‘‘(3) NATIONAL PLAN.—In carrying out para20 graph (2), the Council, in consultation with appro21 priate public and private entities, shall make rec22 ommendations on the development, revision, and im23 plementation of a national plan to eliminate tuber24 culosis in the United States. In carrying out this 

25 paragraph, the Council shall—
282

•HR 3459 IH 

1 ‘‘(A) consider the recommendations of the 

2 Institute of Medicine regarding the elimination 

3 of tuberculosis; 

4 ‘‘(B) address the development and applica5 tion of new technologies; and 

6 ‘‘(C) review the extent to which progress 

7 has been made toward eliminating tuberculosis. 

8 ‘‘(4) GLOBAL ACTIVITIES.—In carrying out 

9 paragraph (2), the Council, in consultation with ap10 propriate public and private entities, shall make rec11 ommendations for the development and implementa12 tion of a plan to guide the involvement of the United 

13 States in global and cross border tuberculosis-control 

14 activities, including recommendations regarding poli15 cies, strategies, objectives, and priorities. Such rec16 ommendations for the plan shall have a focus on 

17 countries where a high incidence of tuberculosis di18 rectly affects the United States, such as Mexico, and 

19 on access to a comprehensive package of tuberculosis 

20 control measures, as defined by the World Health 

21 Organization directly observed treatment, short 

22 course strategy (commonly known as DOTS). 

23 ‘‘(5) COMPOSITION.—The Council shall be com24 posed of—
283

•HR 3459 IH 

1 ‘‘(A) representatives from the Centers for 

2 Disease Control and Prevention, the National 

3 Institutes of Health, the Agency for Healthcare 

4 Research and Quality, the Health Resources 

5 and Services Administration, the U.S.-Mexico 

6 Border Health Commission, and other Federal 

7 departments and agencies that carry out signifi8 cant activities relating to tuberculosis; and 

9 ‘‘(B) members appointed from among indi10 viduals who are not officers or employees of the 

11 Federal Government.’’. 

12 SEC. 466. NATIONAL PROGRAM FOR TUBERCULOSIS ELIMI13 NATION. 

14 Section 317E of the Public Health Service Act (42 

15 U.S.C. 247b–6) is amended—

16 (1) by striking the heading for the section and 

17 inserting the following: 

18 ‘‘NATIONAL PROGRAM FOR TUBERCULOSIS

19 ELIMINATION’’; 

20 (2) by amending subsection (b) to read as fol21 lows: 

22 ‘‘(b) RESEARCH, DEMONSTRATION PROJECTS, EDU23 CATION, AND TRAINING.—With respect to the prevention, 

24 control, and elimination of tuberculosis, the Secretary 

25 may, directly or through grants to public or nonprofit pri26 vate entities, carry out the following: 
284

•HR 3459 IH 

1 ‘‘(1) Research, with priority given to research 

2 concerning—

3 ‘‘(A) diagnosis and treatment of latent in4 fection of tuberculosis; 

5 ‘‘(B) strains of tuberculosis resistant to 

6 drugs; 

7 ‘‘(C) cases of tuberculosis that affect cer8 tain high-risk populations; and 

9 ‘‘(D) clinical trials, including those con10 ducted through the Tuberculosis Trials Consor11 tium. 

12 ‘‘(2) Demonstration projects, including for—

13 ‘‘(A) the development of regional capabili14 ties for the prevention, control, and elimination 

15 of tuberculosis particularly in low-incidence re16 gions; and 

17 ‘‘(B) collaboration with the Immigration 

18 and Naturalization Service to identify and treat 

19 immigrants with active or latent tuberculosis in20 fection. 

21 ‘‘(3) Public information and education pro22 grams. 

23 ‘‘(4) Education, training and clinical skills im24 provement activities for health professionals, includ25 ing allied health personnel.
285

•HR 3459 IH 

1 ‘‘(5) Support of model centers to carry out ac2 tivities under paragraphs (2) through (4). 

3 ‘‘(6) Collaboration with international organiza4 tions and foreign countries, including Mexico, in co5 ordination with the United States Agency for Inter6 national Development, in carrying out such activi7 ties, including coordinating activities through the 

8 Advisory Council for the Elimination of Tuber9 culosis. 

10 ‘‘(7) Capacity support to States and large cities 

11 for strengthening tuberculosis programs.’’; and 

12 (3) by striking subsection (g) and inserting the 

13 following: 

14 ‘‘(g) REPORTS.—The Secretary, acting through the 

15 Director of the Centers for Disease Control and Preven16 tion and in consultation with the Advisory Council for the 

17 Elimination of Tuberculosis, shall biennially prepare and 

18 submit to the Committee on Health, Education, Labor, 

19 and Pensions of the Senate and the Committee on Energy 

20 and Commerce of the House of Representatives, a report 

21 on the activities carried out under this section. Each re22 port shall include the opinion of the Council on the extent 

23 to which its recommendations under section 317E(f)(3) 

24 regarding tuberculosis have been implemented. 
286

•HR 3459 IH 

1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out this section, there are authorized 

3 to be appropriated such sums as may be necessary for 

4 each of the fiscal years 2005 through 2010.’’. 

5 SEC. 467. INCLUSION OF INPATIENT HOSPITAL SERVICES 

6 FOR THE TREATMENT OF TB-INFECTED INDI7 VIDUALS. 

8 (a) IN GENERAL.—Section 1902(z)(2) of the Social 

9 Security Act (42 U.S.C. 1396a(z)(2)) is amended by add10 ing at the end the following: 

11 ‘‘(G) Inpatient hospital services.’’. 

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

13 subsection (a) takes effect on October 1, 2004. 

14 CHAPTER 9—ASTHMA 

15 SEC. 471. PROVISIONS REGARDING NATIONAL ASTHMA 

16 EDUCATION AND PREVENTION PROGRAM OF 

17 NATIONAL HEART, LUNG, AND BLOOD INSTI18 TUTE. 

19 In addition to any other authorization of appropria20 tions that is available to the National Heart, Lung, and 

21 Blood Institute for the purpose of carrying out the Na22 tional Asthma Education and Prevention Program, there 

23 is authorized to be appropriated to such Institute for such 

24 purpose such sums as may be necessary for each of fiscal 

25 years 2005 through 2010. Amounts appropriated under 
287

•HR 3459 IH 

1 the preceding sentence shall be expended to expand such 

2 Program. 

3 SEC. 472. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR 

4 DISEASE CONTROL AND PREVENTION. 

5 (a) EXPANSION OF PUBLIC HEALTH SURVEILLANCE

6 ACTIVITIES; PROGRAM FOR PROVIDING INFORMATION

7 AND EDUCATION TO PUBLIC.—The Secretary of Health 

8 and Human Services, acting through the Director of the 

9 Centers for Disease Control and Prevention, shall collabo10 rate with the States to expand the scope of—

11 (1) activities that are carried out to determine 

12 the incidence and prevalence of asthma; and 

13 (2) activities that are carried out to prevent the 

14 health consequences of asthma, including through 

15 the provision of information and education to the 

16 public regarding asthma, which may include the use 

17 of public service announcements through the media 

18 and such other means as such Director determines 

19 to be appropriate. 

20 (b) COMPILATION OF DATA.—The Secretary of 

21 Health and Human Services, acting through the Director 

22 of the Centers for Disease Control and Prevention and in 

23 consultation with the National Asthma Education Preven24 tion Program Coordinating Committee, shall—
288

•HR 3459 IH 

1 (1) conduct local asthma surveillance activities 

2 to collect data on the prevalence and severity of 

3 asthma and the quality of asthma management, in4 cluding—

5 (A) telephone surveys to collect sample 

6 household data on the local burden of asthma; 

7 and 

8 (B) health care facility specific surveillance 

9 to collect asthma data on the prevalence and se10 verity of asthma, and on the quality of asthma 

11 care; and 

12 (2) compile and annually publish data on—

13 (A) the prevalence of children suffering 

14 from asthma in each State; and 

15 (B) the childhood mortality rate associated 

16 with asthma nationally and in each State. 

17 (c) ADDITIONAL FUNDING.—In addition to any other 

18 authorization of appropriations that is available to the 

19 Centers for Disease Control and Prevention for the pur20 pose of carrying out this section, there is authorized to 

21 be appropriated to such Centers for such purpose such 

22 sums as may be necessary for each of fiscal years 2005 

23 through 2010. 
289

•HR 3459 IH 

1 SEC. 473. GRANTS FOR COMMUNITY OUTREACH REGARD2 ING ASTHMA INFORMATION, EDUCATION, 

3 AND SERVICES. 

4 (a) IN GENERAL.—The Secretary may make grants 

5 to nonprofit private entities for projects to carry out, in 

6 communities identified by entities applying for the grants, 

7 outreach activities to provide for residents of the commu8 nities the following: 

9 (1) Information and education on asthma. 

10 (2) Referrals to health programs of public and 

11 nonprofit private entities that provide asthma-re12 lated services, including such services for low-income 

13 individuals. The grant may be expended to make ar14 rangements to coordinate the activities of such enti15 ties in order to establish and operate networks or 

16 consortia regarding such referrals. 

17 (b) PREFERENCES IN MAKING GRANTS.—In making 

18 grants under subsection (a), the Secretary shall give pref19 erence to applicants that will carry out projects under such 

20 subsection in communities that are disproportionately af21 fected by asthma or underserved with respect to the activi22 ties described in such subsection and in which a significant 

23 number of low-income individuals reside. 

24 (c) EVALUATIONS.—A condition for a grant under 

25 subsection (a) is that the applicant for the grant agree 

26 to provide for the evaluation of the projects carried out 
290

•HR 3459 IH 

1 under such subsection by the applicant to determine the 

2 extent to which the projects have been effective in carrying 

3 out the activities referred to in such subsection. 

4 (d) FUNDING.—For the purpose of carrying out this 

5 section, there is authorized to be appropriated such sums 

6 as may be necessary for each of fiscal years 2005 through 

7 2010. 

8 SEC. 474. ACTION PLANS OF LOCAL EDUCATIONAL AGEN9 CIES REGARDING ASTHMA. 

10 (a) IN GENERAL.—

11 (1) SCHOOL-BASED ASTHMA ACTIVITIES.—The 

12 Secretary of Education (in this section referred to as 

13 the ‘‘Secretary’’), in consultation with the Director 

14 of the Centers for Disease Control and Prevention 

15 and the Director of the National Institutes of 

16 Health, may make grants to local educational agen17 cies for programs to carry out at elementary and 

18 secondary schools specified in paragraph (2) asthma19 related activities for children who attend such 

20 schools. 

21 (2) ELIGIBLE SCHOOLS.—The elementary and 

22 secondary schools referred to in paragraph (1) are 

23 such schools that are located in communities with a 

24 significant number of low-income or underserved in25 dividuals (as defined by the Secretary).
291

•HR 3459 IH 

1 (b) DEVELOPMENT OF PROGRAMS.—Programs under 

2 subsection (a) shall include grants under which local edu3 cation agencies and State public health officials collabo4 rate to develop programs to improve the management of 

5 asthma in school settings. 

6 (c) CERTAIN GUIDELINES.—Programs under sub7 section (a) shall be carried out in accordance with applica8 ble guidelines or other recommendations of the National 

9 Institutes of Health (including the National Heart, Lung, 

10 and Blood Institute) and the Environmental Protection 

11 Agency. 

12 (d) CERTAIN ACTIVITIES.—Activities that may be 

13 carried out in programs under subsection (a) include the 

14 following: 

15 (1) Identifying and working directly with local 

16 hospitals, community clinics, advocacy organizations, 

17 parent-teacher associations, minority health organi18 zations, and asthma coalitions. 

19 (2) Identifying asthmatic children and training 

20 them and their families in asthma self-management. 

21 (3) Purchasing asthma equipment. 

22 (4) Hiring school nurses. 

23 (5) Training teachers, nurses, coaches, and 

24 other school personnel in asthma-symptom recogni25 tion and emergency responses. 
292

•HR 3459 IH 

1 (6) Simplifying procedures to improve students’ 

2 safe access to their asthma medications. 

3 (7) Such other asthma-related activities as the 

4 Secretary determines to be appropriate. 

5 (e) DEFINITIONS.—For purposes of this section, the 

6 terms ‘‘elementary school’’, ‘‘local educational agency’’, 

7 and ‘‘secondary school’’ have the meanings given such 

8 terms in the Elementary and Secondary Education Act of 

9 1965. 

10 (f) FUNDING.—For the purpose of carrying out this 

11 section, there is authorized to be appropriated such sums 

12 as may be necessary for each of fiscal years 2005 through 

13 2010. 

14 CHAPTER 10—SICKLE CELL DISEASE 

15 SEC. 481. DEMONSTRATION PROGRAM FOR THE DEVELOP16 MENT AND ESTABLISHMENT OF SYSTEMIC 

17 MECHANISMS FOR THE PREVENTION AND 

18 TREATMENT OF SICKLE CELL DISEASE. 

19 (a) AUTHORITY TO CONDUCT DEMONSTRATION PRO20 GRAM.—

21 (1) IN GENERAL.—The Administrator, through 

22 the Bureau of Primary Health Care and the Mater23 nal and Child Health Bureau, shall conduct a dem24 onstration program by making grants to up to 40 el25 igible entities for each fiscal year in which the pro-
293

•HR 3459 IH 

1 gram is conducted under this section for the purpose 

2 of developing and establishing systemic mechanisms 

3 to improve the prevention and treatment of Sickle 

4 Cell Disease, including through—

5 (A) the coordination of service delivery for 

6 individuals with Sickle Cell Disease; 

7 (B) genetic counseling and testing; 

8 (C) bundling of technical services related 

9 to the prevention and treatment of Sickle Cell 

10 Disease; 

11 (D) training of health professionals; and 

12 (E) identifying and establishing other ef13 forts related to the expansion and coordination 

14 of education, treatment, pain management, and 

15 continuity of care programs for individuals with 

16 Sickle Cell Disease. 

17 (2) GRANT AWARD REQUIREMENTS.—

18 (A) GEOGRAPHIC DIVERSITY.—The Ad19 ministrator shall, to the extent practicable, 

20 award grants under this section to eligible enti21 ties located in different regions of the United 

22 States. 

23 (B) PRIORITY.—In awarding grants under 

24 this section, the Administrator shall give pri-
294

•HR 3459 IH 

1 ority to awarding grants to eligible entities that 

2 are—

3 (i) Federally-qualified health centers 

4 that have a partnership or other arrange5 ment with a comprehensive Sickle Cell Dis6 ease treatment center that does not receive 

7 funds from the National Institutes of 

8 Health; or 

9 (ii) Federally-qualified health centers 

10 that intend to develop a partnership or 

11 other arrangement with a comprehensive 

12 Sickle Cell Disease treatment center that 

13 does not receive funds from the National 

14 Institutes of Health. 

15 (b) ADDITIONAL REQUIREMENTS.—An eligible entity 

16 awarded a grant under this section shall use funds made 

17 available under the grant to carry out, in addition to the 

18 activities described in subsection (a)(1), the following ac19 tivities: 

20 (1) To facilitate and coordinate the delivery of 

21 education, treatment, and continuity of care for indi22 viduals with Sickle Cell Disease under—

23 (A) the entity’s collaborative agreement 

24 with a community-based Sickle Cell Disease or-
295

•HR 3459 IH 

1 ganization or a nonprofit entity that works with 

2 individuals who have Sickle Cell Disease; 

3 (B) the Sickle Cell Disease newborn 

4 screening program for the State in which the 

5 entity is located; and 

6 (C) the maternal and child health program 

7 under title V of the Social Security Act (42 

8 U.S.C. 701 et seq.) for the State in which the 

9 entity is located. 

10 (2) To train nursing and other health staff who 

11 specialize in pediatrics, obstetrics, internal medicine, 

12 or family practice to provide healthcare and genetic 

13 counseling for individuals with the sickle cell trait. 

14 (3) To enter into a partnership with adult or 

15 pediatric hematologists in the region and other re16 gional experts in Sickle Cell Disease at tertiary and 

17 academic health centers and State and county health 

18 offices. 

19 (c) NATIONAL COORDINATING CENTER.—

20 (1) ESTABLISHMENT.—The Administrator shall 

21 enter into a contract with an entity to serve as the 

22 National Coordinating Center for the demonstration 

23 program conducted under this section. 

24 (2) ACTIVITIES DESCRIBED.—The National Co25 ordinating Center shall—
296

•HR 3459 IH 

1 (A) collect, coordinate, monitor, and dis2 tribute data, best practices, and findings re3 garding the activities funded under grants made 

4 to eligible entities under the demonstration pro5 gram; 

6 (B) develop a model protocol for eligible 

7 entities with respect to the prevention and 

8 treatment of Sickle Cell Disease; 

9 (C) develop educational materials regard10 ing the prevention and treatment of Sickle Cell 

11 Disease; and 

12 (D) prepare and submit to Congress a 

13 final report that includes recommendations re14 garding the effectiveness of the demonstration 

15 program conducted under this section and such 

16 direct outcome measures as—

17 (i) the number and type of healthcare 

18 resources utilized (such as emergency room 

19 visits, hospital visits, length of stay, and 

20 physician visits for individuals with Sickle 

21 Cell Disease); and 

22 (ii) the number of individuals that 

23 were tested and subsequently received ge24 netic counseling for the sickle cell trait.
297

•HR 3459 IH 

1 (d) APPLICATION.—An eligible entity desiring a 

2 grant under this section shall submit an application to the 

3 Administrator at such time, in such manner, and con4 taining such information as the Administrator may re5 quire. 

6 (e) DEFINITIONS.—In this section: 

7 (1) ADMINISTRATOR.—The term ‘‘Adminis8 trator’’ means the Administrator of the Health Re9 sources and Services Administration. 

10 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti11 ty’’ means a Federally-qualified health center, a non12 profit hospital or clinic, or a university health center 

13 that provides primary healthcare, that—

14 (A) has a collaborative agreement with a 

15 community-based Sickle Cell Disease organiza16 tion or a nonprofit entity with experience in 

17 working with individuals who have Sickle Cell 

18 Disease; and 

19 (B) demonstrates to the Administrator 

20 that either the Federally-qualified health center, 

21 the nonprofit hospital or clinic, the university 

22 health center, the organization or entity de23 scribed in subparagraph (A), or the experts de24 scribed in subsection (b)(3), has at least 5 
298

•HR 3459 IH 

1 years of experience in working with individuals 

2 who have Sickle Cell Disease. 

3 (3) FEDERALLY-QUALIFIED HEALTH CEN4 TER.—The term ‘‘Federally-qualified health center’’ 

5 has the meaning given that term in section 

6 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 

7 1396d(l)(2)(B)). 

8 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated to carry out this section, 

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

11 2005 through 2010. 

12 CHAPTER 11—AUTOIMMUNE DISEASE IN 

13 MINORITY POPULATIONS 

14 SEC. 482. RESEARCH FUNDING FOR AUTOIMMUNE DISEASE 

15 IN MINORITY POPULATIONS. 

16 Part B of title IV of the Public Health Service Act 

17 is amended by inserting after section 409E (42 U.S.C. 

18 284i) the following: 

19 ‘‘SEC. 490E–1. RESEARCH FUNDING FOR AUTOIMMUNE DIS20 EASE IN MINORITY POPULATIONS. 

21 ‘‘(a) EXPANSION AND INTENSIFICATION OF ACTIVI22 TIES REGARDING AUTOIMMUNE DISEASES ON MINORI23 TIES.—With respect to the plan under section 409E(c)(1), 

24 the Coordinating Committee shall ensure that provisions 
299

•HR 3459 IH 

1 of the plan developed under paragraph (2) of such sub2 section include provisions for the following: 

3 ‘‘(1)(A) Basic research, epidemiological re4 search, and other appropriate research concerning 

5 the etiology and causes of autoimmune diseases in 

6 all minorities, including genetic, hormonal, and envi7 ronmental factors. 

8 ‘‘(B)(i) Giving priority under subparagraph (A) 

9 to research regarding environmental factors. 

10 ‘‘(ii) The coordination of (to the extent prac11 ticable and appropriate), and providing additional 

12 support for, research described in clause (i) that is 

13 conducted by public or nonprofit private entities. 

14 ‘‘(2)(A) The development of information and 

15 education programs for patients, healthcare pro16 viders, and others as appropriate on genetic, hor17 monal, and environmental risk factors associated 

18 with autoimmune diseases in minorities, and on the 

19 importance of the prevention or control of such risk 

20 factors and timely referral with appropriate diag21 nosis and treatment. 

22 ‘‘(B) The inclusion in programs under subpara23 graph (A) of information and education on the prev24 alence and nature of autoimmune diseases, on risk 
300

•HR 3459 IH 

1 factors, and on health-related behaviors that can im2 prove health status in minority populations. 

3 ‘‘(3) Outreach programs for purposes of para4 graphs (1) and (2) that—

5 ‘‘(A) are directed toward minority individ6 uals, particularly those who are at-risk for auto7 immune diseases; and 

8 ‘‘(B) are carried out through community 

9 health centers, community clinics, or other 

10 health centers under section 330, through 

11 State, territory, or local health departments, In12 dian tribes, or through primary care physicians. 

13 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

14 is authorized to be appropriated to carry out this section, 

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

16 2005 through 2010.’’. 

17 CHAPTER 12—PREVENTION AND CON18 TROL OF SEXUALLY TRANSMITTED 

19 DISEASES 

20 SEC. 485. PREVENTION AND CONTROL OF SEXUALLY 

21 TRANSMITTED DISEASES. 

22 (a) IN GENERAL.—Section 318(e)(1) of the Public 

23 Health Service Act (42 U.S.C. 247c(e)(1)) is amended by 

24 striking ‘‘1998’’ and inserting ‘‘2008’’.
301

•HR 3459 IH 

1 (b) PREVENTABLE CASES OF INFERTILITY.—Section 

2 318A of the Public Health Service Act (42 U.S.C. 247c–

3 1) is amended—

4 (1) in subsection (q), by striking ‘‘1998’’ and 

5 inserting ‘‘2010’’; and 

6 (2) in subsection (r)(2), by striking ‘‘1998’’ and 

7 inserting ‘‘2010’’. 

8 CHAPTER 13—DENTAL DISEASE 

9 SEC. 486. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

10 SERVICES UNDER MEDICAID AND SCHIP. 

11 Title V of the Social Security Act (42 U.S.C. 701 

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

13 ‘‘SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DEN14 TAL SERVICES UNDER MEDICAID AND SCHIP. 

15 ‘‘(a) AUTHORITY TO MAKE GRANTS.—In addition to 

16 any other payments made under this title to a State, the 

17 Secretary shall award grants to States that satisfy the re18 quirements of subsection (b) to improve the provision of 

19 dental services to children who are enrolled in a State plan 

20 under title XIX or a State child health plan under title 

21 XXI (in this section, collectively referred to as the ‘State 

22 plans’). 

23 ‘‘(b) REQUIREMENTS.—In order to be eligible for a 

24 grant under this section, a State shall provide the Sec25 retary with the following assurances: 
302

•HR 3459 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-
303

•HR 3459 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 2005 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): 
304

•HR 3459 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. 487. 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 
305

•HR 3459 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.’’. 
306

•HR 3459 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
307

•HR 3459 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).’’. 
308

•HR 3459 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: 
309

•HR 3459 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, 2004, and 

7 shall apply to child health assistance and medical assist8 ance provided on or after that date. 

9 SEC. 488. 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.—
310

•HR 3459 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-
311

•HR 3459 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—
312

•HR 3459 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
313

•HR 3459 IH 

1 centers, there is authorized to be appropriated such 

2 sums as may be necessary for each of fiscal years 

3 2005 through 2010 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 CHAPTER 14—PREVENTION AND 

13 CONTROL OF INJURIES 

14 SEC. 491. PREVENTION AND CONTROL OF INJURIES. 

15 (a) IN GENERAL.—Section 394A of the Public 

16 Health Service Act (42 U.S.C. 280b–3) is amended—

17 (1) by striking ‘‘and’’ after ‘‘1994,’’; 

18 (2) by striking ‘‘and’’ after ‘‘1998,’’; and 

19 (3) by striking ‘‘through 2005’’ and all that fol20 lows and inserting the following: ‘‘through 2004, 

21 $300,000,000 for fiscal year 2005, and such sums 

22 as may be necessary for each of the fiscal years 

23 2006 through 2010.’’. 

24 (b) DEMONSTRATION PROJECTS IN URBAN AREAS.—

25 Section 394A of the Public Health Service Act (42 U.S.C. 
314

•HR 3459 IH 

1 280b–3) is amended by adding at the end the following 

2 sentence: ‘‘For the purpose of carrying out section 

3 393(a)(6) in urban areas, there are authorized to be ap4 propriated such sums as may be necessary for each of the 

5 fiscal years 2005 through 2010, in addition to amounts 

6 available for such purpose pursuant to the preceding sen7 tence.’’. 

8 (c) DEMONSTRATION PROJECTS REGARDING VIO9 LENCE.—Section 393 of the Public Health Service Act (42 

10 U.S.C. 280b–1a) is amended—

11 (1) by redesignating subsection (b) as sub12 section (c); and 

13 (2) by inserting after subsection (a) the fol14 lowing subsection: 

15 ‘‘(b) Grants under subsection (a)(6) shall include 

16 grants to public or nonprofit private trauma centers for 

17 demonstration projects to reduce violence.’’. 

18 CHAPTER 15—UTERINE FIBROID 

19 RESEARCH AND EDUCATION 

20 SEC. 495. RESEARCH WITH RESPECT TO UTERINE 

21 FIBROIDS. 

22 (a) IN GENERAL.—The Director of the National In23 stitutes of Health (in this section referred to as the ‘‘Di24 rector of NIH’’) shall expand, intensify, and coordinate 
315

•HR 3459 IH 

1 programs for the conduct and support of research with 

2 respect to uterine fibroids. 

3 (b) ADMINISTRATION.—

4 (1) IN GENERAL.—The Director of NIH shall 

5 carry out this section through the appropriate insti6 tutes, offices, and centers, including the National In7 stitute of Child Health and Human Development, 

8 the National Institute of Environmental Health 

9 Sciences, the Office of Research on Women’s Health, 

10 the National Center on Minority Health and Health 

11 Disparities, and any other agencies that the Director 

12 of NIH determines to be appropriate. 

13 (2) COORDINATION OF ACTIVITIES.—The Office 

14 of Research on Women’s Health shall coordinate ac15 tivities under paragraph (1) among the institutes, 

16 offices, and centers of the National Institutes of 

17 Health. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—For the 

19 purpose of carrying out this section, there are authorized 

20 to be appropriated such sums as may be necessary for 

21 each of the fiscal years 2005 through 2010. 

22 SEC. 496. INFORMATION AND EDUCATION WITH RESPECT 

23 TO UTERINE FIBROIDS. 

24 (a) UTERINE FIBROIDS PUBLIC EDUCATION PRO25 GRAM.—
316

•HR 3459 IH 

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

2 Human Services (referred to in this section as the 

3 ‘‘Secretary’’), acting through the Director of the 

4 Centers for Disease Control and Prevention, shall 

5 develop and disseminate to the public information 

6 regarding uterine fibroids, including information 

7 on—

8 (A) the incidence and prevalence of uterine 

9 fibroids; 

10 (B) the elevated risk for minority women; 

11 and 

12 (C) the availability, as medically appro13 priate, of a range of treatment options for 

14 symptomatic uterine fibroids. 

15 (2) DISSEMINATION.—The Secretary may dis16 seminate information under paragraph (1) directly, 

17 or through arrangements with nonprofit organiza18 tions, consumer groups, institutions of higher edu19 cation (as defined in section 101 of the Higher Edu20 cation Act of 1965 (20 U.S.C. 1001)), Federal, 

21 State, or local agencies, or the media. 

22 (3) AUTHORIZATION OF APPROPRIATIONS.—For 

23 the purpose of carrying out this subsection, there 

24 are authorized to be appropriated such sums as may 
317

•HR 3459 IH 

1 be necessary for each of the fiscal years 2005 

2 through 2010. 

3 (b) UTERINE FIBROIDS INFORMATION PROGRAM FOR

4 HEALTH CARE PROVIDERS.—

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

6 through the Administrator of the Health Resources 

7 and Services Administration, shall develop and dis8 seminate to health care providers information on 

9 uterine fibroids, including information on the ele10 vated risk for minority women and the range of 

11 available options for the treatment of symptomatic 

12 uterine fibroids. 

13 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

14 the purpose of carrying out this subsection, there 

15 are authorized to be appropriated such sums as may 

16 be necessary for each of the fiscal years 2005 

17 through 2010. 

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

19 term ‘‘minority’’, with respect to women, means women 

20 who are members of racial or ethnic minority groups with21 in the meaning of section 1707 of the Public Health Serv22 ice Act (42 U.S.C. 300u–6). 
318

•HR 3459 IH 

1 TITLE V—DATA COLLECTION 

2 AND REPORTING. 

3 Subtitle A—General Provisions 

4 SEC. 501. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

5 ACT. 

6 (a) PURPOSE.—It is the purpose of this section to 

7 promote data collection, analysis, and reporting by race, 

8 ethnicity, and primary language among federally sup9 ported health programs. 

10 (b) AMENDMENT.—Title XXIX of the Public Health 

11 Service Act, as amended by section 463, is further amend12 ed by adding at the end the following: 

13 ‘‘Subtitle E—Data Collection and 

14 Reporting 

15 ‘‘SEC. 2951. DATA ON RACE, ETHNICITY AND PRIMARY LAN16 GUAGE. 

17 ‘‘(a) REQUIREMENTS.—

18 ‘‘(1) IN GENERAL.—Each health-related pro19 gram operated by or that receives funding or reim20 bursement, in whole or in part, either directly or in21 directly from the Department of Health and Human 

22 Services shall—

23 ‘‘(A) require the collection, by the agency 

24 or program involved, of data on the race, eth25 nicity, and primary language of each applicant
319

•HR 3459 IH 

1 for and recipient of health-related assistance 

2 under such program—

3 ‘‘(i) using, at a minimum, the cat4 egories for race and ethnicity described in 

5 the 1997 Office of Management and Budg6 et Standards for Maintaining, Collecting, 

7 and Presenting Federal Data on Race and 

8 Ethnicity; 

9 ‘‘(ii) using the standards developed 

10 under subsection (e) for the collection of 

11 language data; 

12 ‘‘(iii) where practicable, collecting 

13 data for additional population groups if 

14 such groups can be aggregated into the 

15 minimum race and ethnicity categories; 

16 and 

17 ‘‘(iv) where practicable, through self18 report; 

19 ‘‘(B) with respect to the collection of the 

20 data described in subparagraph (A) for appli21 cants and recipients who are minors or other22 wise legally incapacitated, require that—

23 ‘‘(i) such data be collected from the 

24 parent or legal guardian of such an appli25 cant or recipient; and 
320

•HR 3459 IH 

1 ‘‘(ii) the preferred language of the 

2 parent or legal guardian of such an appli3 cant or recipient be collected; 

4 ‘‘(C) systematically analyze such data 

5 using the smallest appropriate units of analysis 

6 feasible to detect racial and ethnic disparities in 

7 health and healthcare and when appropriate, 

8 for men and women separately, and report the 

9 results of such analysis to the Secretary, the 

10 Director of the Office for Civil Rights, the Com11 mittee on Health, Education, Labor, and Pen12 sions and the Committee on Finance of the 

13 Senate, and the Committee on Energy and 

14 Commerce and the Committee on Ways and 

15 Means of the House of Representatives; 

16 ‘‘(D) provide such data to the Secretary on 

17 at least an annual basis; and 

18 ‘‘(E) ensure that the provision of assist19 ance to an applicant or recipient of assistance 

20 is not denied or otherwise adversely affected be21 cause of the failure of the applicant or recipient 

22 to provide race, ethnicity, and primary language 

23 data. 

24 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 

25 this subsection shall be construed to—
321

•HR 3459 IH 

1 ‘‘(A) permit the use of information col2 lected under this subsection in a manner that 

3 would adversely affect any individual providing 

4 any such information; and 

5 ‘‘(B) require health care providers to col6 lect data. 

7 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 

8 ensure (through the promulgation of regulations or other9 wise) that all data collected pursuant to subsection (a) is 

10 protected—

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

12 Secretary applies to other health data under the reg13 ulations promulgated under section 264(c) of the 

14 Health Insurance Portability and Accountability Act 

15 of 1996 (Public Law 104–191; 110 Stat. 2033) re16 lating to the privacy of individually identifiable 

17 health information and other protections; and 

18 ‘‘(2) from all inappropriate internal use by any 

19 entity that collects, stores, or receives the data, in20 cluding use of such data in determinations of eligi21 bility (or continued eligibility) in health plans, and 

22 from other inappropriate uses, as defined by the 

23 Secretary. 

24 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 

25 Secretary shall develop and implement a national plan to 
322

•HR 3459 IH 

1 improve the collection, analysis, and reporting of racial, 

2 ethnic, and primary language data at the Federal, State, 

3 territorial, Tribal, and local levels, including data to be 

4 collected under subsection (a). The Data Council of the 

5 Department of Health and Human Services, in consulta6 tion with the National Committee on Vital Health Statis7 tics, the Office of Minority Health, and other appropriate 

8 public and private entities, shall make recommendations 

9 to the Secretary concerning the development, implementa10 tion, and revision of the national plan. Such plan shall 

11 include recommendations on how to—

12 ‘‘(1) implement subsection (a) while minimizing 

13 the cost and administrative burdens of data collec14 tion and reporting; 

15 ‘‘(2) expand awareness among Federal agencies, 

16 States, territories, Indian tribes, health providers, 

17 health plans, health insurance issuers, and the gen18 eral public that data collection, analysis, and report19 ing by race, ethnicity, and primary language is legal 

20 and necessary to assure equity and non-discrimina21 tion in the quality of healthcare services; 

22 ‘‘(3) ensure that future patient record systems 

23 have data code sets for racial, ethnic, and primary 

24 language identifiers and that such identifiers can be 
323

•HR 3459 IH 

1 retrieved from clinical records, including records 

2 transmitted electronically; 

3 ‘‘(4) improve health and healthcare data collec4 tion and analysis for more population groups if such 

5 groups can be aggregated into the minimum race 

6 and ethnicity categories, including exploring the fea7 sibility of enhancing collection efforts in States for 

8 racial and ethnic groups that comprise a significant 

9 proportion of the population of the State; 

10 ‘‘(5) provide researchers with greater access to 

11 racial, ethnic, and primary language data, subject to 

12 privacy and confidentiality regulations; and 

13 ‘‘(6) safeguard and prevent the misuse of data 

14 collected under subsection (a). 

15 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col16 lected under subsection (a) shall be obtained, maintained, 

17 and presented (including for reporting purposes) in ac18 cordance with the 1997 Office of Management and Budget 

19 Standards for Maintaining, Collecting, and Presenting 

20 Federal Data on Race and Ethnicity (at a minimum). 

21 ‘‘(e) LANGUAGE COLLECTION STANDARDS.—Not 

22 later than 1 year after the date of enactment of this title, 

23 the Director of the Office of Minority Health, in consulta24 tion with the Office for Civil Rights of the Department 

25 of Health and Human Services, shall develop and dissemi-
324

•HR 3459 IH 

1 nate Standards for the Classification of Federal Data on 

2 Preferred Written and Spoken Language. 

3 ‘‘(f) TECHNICAL ASSISTANCE FOR THE COLLECTION

4 AND REPORTING OF DATA.—

5 ‘‘(1) IN GENERAL.—The Secretary may, either 

6 directly or through grant or contract, provide tech7 nical assistance to enable a healthcare program or 

8 an entity operating under such program to comply 

9 with the requirements of this section. 

10 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro11 vided under this subsection may include assistance 

12 to—

13 ‘‘(A) enhance or upgrade computer tech14 nology that will facilitate racial, ethnic, and pri15 mary language data collection and analysis; 

16 ‘‘(B) improve methods for health data col17 lection and analysis including additional popu18 lation groups beyond the Office of Management 

19 and Budget categories if such groups can be 

20 aggregated into the minimum race and ethnicity 

21 categories; 

22 ‘‘(C) develop mechanisms for submitting 

23 collected data subject to existing privacy and 

24 confidentiality regulations; and
325

•HR 3459 IH 

1 ‘‘(D) develop educational programs to in2 form health insurance issuers, health plans, 

3 health providers, health-related agencies, and 

4 the general public that data collection and re5 porting by race, ethnicity, and preferred lan6 guage are legal and essential for eliminating 

7 health and healthcare disparities. 

8 ‘‘(g) ANALYSIS OF RACIAL AND ETHNIC DATA.—The 

9 Secretary, acting through the Director of the Agency for 

10 Healthcare Research and Quality and in coordination with 

11 the Administrator of the Centers for Medicare and Med12 icaid Services, shall provide technical assistance to agen13 cies of the Department of Health and Human Services in 

14 meeting Federal standards for race, ethnicity, and pri15 mary language data collection and analysis of racial and 

16 ethnic disparities in health and healthcare in public pro17 grams by—

18 ‘‘(1) identifying appropriate quality assurance 

19 mechanisms to monitor for health disparities; 

20 ‘‘(2) specifying the clinical, diagnostic, or thera21 peutic measures which should be monitored; 

22 ‘‘(3) developing new quality measures relating 

23 to racial and ethnic disparities in health and 

24 healthcare; 
326

•HR 3459 IH 

1 ‘‘(4) identifying the level at which data analysis 

2 should be conducted; and 

3 ‘‘(5) sharing data with external organizations 

4 for research and quality improvement purposes. 

5 ‘‘(h) NATIONAL CONFERENCE.—

6 ‘‘(1) IN GENERAL.—The Secretary shall spon7 sor a biennial national conference on racial, ethnic, 

8 and primary language data collection to enhance co9 ordination, build partnerships, and share best prac10 tices in racial, ethnic, and primary language data 

11 collection, analysis, and reporting. 

12 ‘‘(2) REPORTS.—Not later than 6 months after 

13 the date on which a national conference has con14 vened under paragraph (1), the Secretary shall pub15 lish in the Federal Register and submit to the Com16 mittee on Health, Education, Labor, and Pensions 

17 and the Committee on Finance of the Senate and 

18 the Committee on Energy and Commerce and the 

19 Committee on Ways and Means of the House of 

20 Representatives a report concerning the proceedings 

21 and findings of the conference. 

22 ‘‘(i) REPORT.—Not later than 2 years after the date 

23 of enactment of this title, and biennially thereafter, the 

24 Secretary shall submit to the appropriate committees of 

25 Congress a report on the effectiveness of data collection, 
327

•HR 3459 IH 

1 analysis, and reporting on race, ethnicity, and primary 

2 language under the programs and activities of the Depart3 ment of Health and Human Services and under other Fed4 eral data collection systems with which the Department 

5 interacts to collect relevant data on race and ethnicity. 

6 The report shall evaluate the progress made in the De7 partment with respect to the national plan under sub8 section (c) or subsequent revisions thereto. 

9 ‘‘(j) GRANTS FOR DATA COLLECTION BY HEALTH

10 PLANS, HEALTH CENTERS, AND HOSPITALS.—

11 ‘‘(1) IN GENERAL.—The Secretary, in consulta12 tion with the Administrator of the Centers for Medi13 care and Medicaid Services, is authorized to award 

14 grants for the conduct of 20 demonstration pro15 grams by health plans, health centers, or hospitals 

16 to enhance their ability to collect, analyze, and re17 port the data required under subsection (a). 

18 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

19 grant under paragraph (1), a health plan or hospital 

20 shall—

21 ‘‘(A) prepare and submit to the Secretary 

22 an application at such time, in such manner, 

23 and containing such information as the Sec24 retary may require, including a plan to elimi25 nate racial, ethnic, and primary language dis-
328

•HR 3459 IH 

1 parities in health and healthcare through one or 

2 more of the activities described in paragraph 

3 (3); and 

4 ‘‘(B) provide assurances that the health 

5 plan or hospital will use, at a minimum, the ra6 cial and ethnic categories and the standards for 

7 collection described in the 1997 Office of Man8 agement and Budget Standards for Maintain9 ing, Collecting, and Presenting Federal Data on 

10 Race and Ethnicity and available standards for 

11 language. 

12 ‘‘(3) ACTIVITIES.—A grantee shall use amounts 

13 received under a grant under paragraph (1) to—

14 ‘‘(A) collect, analyze, and report data by 

15 race, ethnicity, and primary language for pa16 tients served by the hospital (including emer17 gency room patients and patients served on an 

18 outpatient basis) or health center, or, in the 

19 case of a private health plan, such data for en20 rollees; 

21 ‘‘(B) enhance or upgrade computer tech22 nology that will facilitate racial, ethnic, and pri23 mary language data collection and analysis; 

24 ‘‘(C) provide analyses of racial and ethnic 

25 disparities in health and healthcare, including 
329

•HR 3459 IH 

1 specific disease conditions, diagnostic and 

2 therapeutic procedures, or outcomes; 

3 ‘‘(D) improve health data collection and 

4 analysis for additional population groups be5 yond the Office of Management and Budget 

6 categories if such groups can be aggregated into 

7 the minimum race and ethnicity categories; 

8 ‘‘(E) develop mechanisms for sharing col9 lected data subject to privacy and confiden10 tiality regulations; 

11 ‘‘(F) develop educational programs to in12 form health insurance issuers, health plans, 

13 health providers, health-related agencies, pa14 tients, enrollees, and the general public that 

15 data collection, analysis, and reporting by race, 

16 ethnicity, and preferred language are legal and 

17 essential for eliminating disparities in health 

18 and healthcare; and 

19 ‘‘(G) develop quality assurance systems de20 signed to track disparities and quality improve21 ment systems designed to eliminate disparities. 

22 ‘‘(l) DEFINITION.—In this section, the term ‘health23 related program’ mean a program—
330

•HR 3459 IH 

1 ‘‘(1) under the Social Security Act (42 U.S.C. 

2 301 et seq.) that pay for healthcare and services; 

3 and 

4 ‘‘(2) under this Act that provide Federal finan5 cial assistance for healthcare, biomedical research, 

6 health services research, and programs designed to 

7 improve the public’s health. 

8 ‘‘(m) 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 2005 through 2010. 

12 ‘‘SEC. 2952. PROVISIONS RELATING TO NATIVE AMERICANS. 

13 ‘‘(a) EPIDEMIOLOGY CENTERS.—

14 ‘‘(1) ESTABLISHMENT.—

15 ‘‘(A) IN GENERAL.—In addition to those 

16 centers operating 1 day prior to the date of en17 actment of this title, (including those centers 

18 for which funding is currently being provided 

19 through funding agreements under the Indian 

20 Self-Determination and Education Assistance 

21 Act), the Secretary shall, not later than 180 

22 days after such date of enactment, establish 

23 and fund an epidemiology center in each service 

24 area which does not have such a center to carry 

25 out the functions described in subparagraph
331

•HR 3459 IH 

1 (B). Any centers established under the pre2 ceding sentence may be operated by Indian 

3 tribes or tribal organizations pursuant to fund4 ing agreements under the Indian Self-Deter5 mination and Education Assistance Act, but 

6 funding under such agreements may not be di7 visible. 

8 ‘‘(B) FUNCTIONS.—In consultation with 

9 and upon the request of Indian tribes, tribal or10 ganizations and urban Indian organizations, 

11 each area epidemiology center established under 

12 this subsection shall, with respect to such area 

13 shall—

14 ‘‘(i) collect data related to the health 

15 status objective described in section 3(b) of 

16 the Indian Health Care Improvement Act, 

17 and monitor the progress that the Service, 

18 Indian tribes, tribal organizations, and 

19 urban Indian organizations have made in 

20 meeting such health status objective; 

21 ‘‘(ii) evaluate existing delivery sys22 tems, data systems, and other systems that 

23 impact the improvement of Indian health; 

24 ‘‘(iii) assist Indian tribes, tribal orga25 nizations, and urban Indian organizations 
332

•HR 3459 IH 

1 in identifying their highest priority health 

2 status objectives and the services needed to 

3 achieve such objectives, based on epidemio4 logical data; 

5 ‘‘(iv) make recommendations for the 

6 targeting of services needed by tribal, 

7 urban, and other Indian communities; 

8 ‘‘(v) make recommendations to im9 prove healthcare delivery systems for Indi10 ans and urban Indians; 

11 ‘‘(vi) provide requested technical as12 sistance to Indian tribes and urban Indian 

13 organizations in the development of local 

14 health service priorities and incidence and 

15 prevalence rates of disease and other ill16 ness in the community; and 

17 ‘‘(vii) provide disease surveillance and 

18 assist Indian tribes, tribal organizations, 

19 and urban Indian organizations to promote 

20 public health. 

21 ‘‘(C) TECHNICAL ASSISTANCE.—The direc22 tor of the Centers for Disease Control and Pre23 vention shall provide technical assistance to the 

24 centers in carrying out the requirements of this 

25 subsection. 
333

•HR 3459 IH 

1 ‘‘(2) FUNDING.—The Secretary may make 

2 funding available to Indian tribes, tribal organiza3 tions, and eligible intertribal consortia or urban In4 dian organizations to conduct epidemiological studies 

5 of Indian communities. 

6 ‘‘(b) DEFINITIONS.—For purposes of this section, the 

7 definitions contained in section 4 of the Indian Health 

8 Care Improvement Act shall apply.’’. 

9 SEC. 502. COLLECTION OF RACE AND ETHNICITY DATA BY 

10 THE SOCIAL SECURITY ADMINISTRATION. 

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

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

13 the following: 

14 ‘‘SEC. 1150A. COLLECTION OF RACE AND ETHNICITY DATA 

15 BY THE SOCIAL SECURITY ADMINISTRATION. 

16 ‘‘(a) REQUIREMENT.—The Commissioner of the So17 cial Security Administration in consultation with the Ad18 ministrator of the Centers for Medicare and Medicaid 

19 Services shall—

20 ‘‘(1) require the collection of data on the race, 

21 ethnicity, and primary language of all applicants for 

22 social security numbers, social security income, so23 cial security disability, and medicare—

24 ‘‘(A) using, at a minimum, the categories 

25 for race and ethnicity described in the 1997 Of-
334

•HR 3459 IH 

1 fice of Management and Budget Standards for 

2 Maintaining, Collecting, and Presenting Federal 

3 Data on Race and Ethnicity and available lan4 guage standards; and 

5 ‘‘(B) where practicable, collecting data for 

6 additional population groups if such groups can 

7 be aggregated into the minimum race and eth8 nicity categories; 

9 ‘‘(2) with respect to the collection of the data 

10 described in paragraph (1) for applicants who are 

11 under 18 years of age or otherwise legally incapaci12 tated, require that—

13 ‘‘(A) such data be collected from the par14 ent or legal guardian of such an applicant; and 

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

16 or legal guardian of such an applicant or recipi17 ent be used; 

18 ‘‘(3) require that such data be uniformly ana19 lyzed and reported at least annually to the Commis20 sioner of Social Security; 

21 ‘‘(4) be responsible for storing the data re22 ported under paragraph (3); 

23 ‘‘(5) ensure transmission to the Centers for 

24 Medicare and Medicaid Services and other Federal 

25 health agencies; 
335

•HR 3459 IH 

1 ‘‘(6) provide such data to the Secretary on at 

2 least an annual basis; and 

3 ‘‘(7) ensure that the provision of assistance to 

4 an applicant is not denied or otherwise adversely af5 fected because of the failure of the applicant to pro6 vide race, ethnicity, and primary language data. 

7 ‘‘(b) PROTECTION OF DATA.—The Commissioner of 

8 Social Security shall ensure (through the promulgation of 

9 regulations or otherwise) that all data collected pursuant 

10 subsection (a) is protected—

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

12 Secretary applies to other health data under the reg13 ulations promulgated under section 264(c) of the 

14 Health Insurance Portability and Accountability Act 

15 of 1996 (Public Law 104–191; 110 Stat. 2033) re16 lating to the privacy of individually identifiable 

17 health information and other protections; and 

18 ‘‘(2) from all inappropriate internal use by any 

19 entity that collects, stores, or receives the data, in20 cluding use of such data in determinations of eligi21 bility (or continued eligibility) in health plans, and 

22 from other inappropriate uses, as defined by the 

23 Secretary. 

24 ‘‘(c) NATIONAL EDUCATION PROGRAM.—Not later 

25 than 18 months after the date of enactment of this sec-
336

•HR 3459 IH 

1 tion, the Secretary, acting through the Director of the Of2 fice of Minority Health and in collaboration with the Com3 missioner of the Social Security Administration, shall de4 velop and implement a program to educate all populations 

5 about the purpose and uses of racial, ethnic, and primary 

6 language health data collection. 

7 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec8 tion shall be construed to permit the use of information 

9 collected under this section in a manner that would ad10 versely affect any individual providing any such informa11 tion. 

12 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary may, 

13 either directly or by grant or contract, provide technical 

14 assistance to enable any health entity to comply with the 

15 requirements of this section. 

16 ‘‘(f) 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 2005 through 2010.’’. 

20 SEC. 503. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

23 Human Services shall revise the regulations promulgated 

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

25 U.S.C. 1320d et seq.), as added by the Health Insurance
337

•HR 3459 IH 

1 Portability and Accountability Act of 1996 (Public Law 

2 104–191), relating to the collection of data on race, eth3 nicity, and primary language in a health-related trans4 action to require—

5 (1) the use, at a minimum, of the categories for 

6 race and ethnicity described in the 1997 Office of 

7 Management and Budget Standards for Maintain8 ing, Collecting, and Presenting Federal Data on 

9 Race and Ethnicity; 

10 (2) the establishment of a new data code set for 

11 primary language; and 

12 (3) the designation of the racial, ethnic, and 

13 primary language code sets as ‘‘required’’ for claims 

14 and enrollment data. 

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

16 Human Services shall disseminate the new standards de17 veloped under subsection (a) to all health entities that are 

18 subject to the regulations described in such subsection and 

19 provide technical assistance with respect to the collection 

20 of the data involved. 

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

22 Human Services shall require that health entities comply 

23 with the new standards developed under subsection (a) not 

24 later than 2 years after the final promulgation of such 

25 standards. 
338

•HR 3459 IH 

1 SEC. 504. NATIONAL CENTER FOR HEALTH STATISTICS. 

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

3 U.S.C. 242k(n)) is amended—

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

5 inserting ‘‘2010’’; 

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

7 striking ‘‘2003’’ and inserting ‘‘2010’’; and 

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

9 inserting ‘‘2010’’. 

10 Subtitle B—Minority Health and 

11 Genomics Commission 

12 SEC. 511. SHORT TITLE. 

13 This subtitle may be cited as the ‘‘Minority Health 

14 and Genomics Act of 2003’’. 

15 SEC. 512. MINORITY HEALTH AND GENOMICS COMMISSION. 

16 (a) ESTABLISHMENT.—There is established a com17 mission to be known as the Minority Health and Genomics 

18 Commission (in this subtitle referred to as the ‘‘Commis19 sion’’). 

20 (b) DUTIES.—

21 (1) STUDY.—The Commission shall conduct a 

22 thorough study of, and develop recommendations on, 

23 issues relating to genomic research as applied to mi24 nority groups and, under section 516, submit a re25 port to the appropriate committees of Congress that 

26 recommends policies that the Commission finds will 
339

•HR 3459 IH 

1 ultimately improve healthcare and promote the elimi2 nation of health disparities. 

3 (2) ISSUES.—The study under paragraph (1) 

4 shall address specific issues and the needs of each 

5 minority group described in subparagraph (A) in ad6 dition to issues involving genomic research that af7 fect the groups as a whole. In conducting such study 

8 the Commission shall carry out the following: 

9 (A) Establish standards in genomic re10 search and services that will promote the im11 provement of health and health-related services 

12 for the following groups: American Indians and 

13 Alaska Natives, African Americans, Asian 

14 Americans, Hispanics, and Native Hawaiians 

15 and other Pacific Islanders. 

16 (B) Recommend minimum requirements 

17 and standards for the equitable use of genetics 

18 research in patient care and public health serv19 ices for racial and ethnic minority patients. 

20 (C) Examine the accessibility, effective21 ness, availability, and cost efficiency of genomic 

22 research, genetic testing, genetic counseling, 

23 and genetic screening to minority populations. 

24 (D) Determine and recommend procedures 

25 and policies to address the need for cultural, 
340

•HR 3459 IH 

1 linguistic, and religious sensitivity training for 

2 genetic counselors and researchers who work 

3 with minority groups. 

4 (E) Evaluate whether minority persons are 

5 provided with informed consent that is cul6 turally and linguistically appropriate to allow a 

7 fully informed decision about their healthcare, 

8 availability of treatments or options, or partici9 pation in any clinical trial involving the collec10 tion of genetic material. 

11 (F) Recommend how population sampling 

12 studies of genetic information can be improved 

13 to aid in the elimination of health disparities 

14 and improve healthcare for minority commu15 nities. 

16 (G) Examine how genetic material or in17 formation derived from individual minorities is 

18 used the help minority groups with the use of 

19 highly specific drug therapies. 

20 (H) Identify the accessibility, effectiveness, 

21 availability, privacy, and benefit of genetic data22 bases and depositories to minority communities. 

23 (I) Identify the accessibility, effectiveness, 

24 and affordability of reproductive technologies to 

25 minority groups. 
341

•HR 3459 IH 

1 (J) Recommend an incentives program for 

2 genomic researchers that will encourage the 

3 study of disease and genetic ailments that dis4 proportionately affect minority communities. 

5 SEC. 513. REPORT. 

6 Not later than 2 years after the date of the enact7 ment of this Act, the Commission shall prepare and sub8 mit to the appropriate committees of Congress, the Presi9 dent, and the general public a report containing a detailed 

10 statement of the findings and conclusions of the Commis11 sion with respect to matters described in section 

12 512(b)(2), together with such recommendations as the 

13 Commission considers appropriate that may be specific to 

14 each minority group. 

15 SEC. 514. MEMBERSHIP. 

16 (a) NUMBER AND APPOINTMENT.—The Commission 

17 shall be composed of 17 members to be appointed as fol18 lows: 

19 (1) Four members shall be appointed by the 

20 Speaker of the House of Representatives. 

21 (2) Four members shall be appointed by the mi22 nority leader of the House of Representatives. 

23 (3) Four members shall be appointed by the 

24 majority leader of the Senate. 
342

•HR 3459 IH 

1 (4) Four members shall be appointed by the mi2 nority leader of the Senate. 

3 (5) One member shall be appointed by the 

4 President. 

5 (b) PERSONS ELIGIBLE.—

6 (1) IN GENERAL.—The members of the Com7 mission shall be individuals who have knowledge or 

8 expertise, whether by experience or training, in mat9 ters to be studied by the Commission. The members 

10 may be from the public or private sector, and may 

11 include employees of the Federal Government or of 

12 State, territory, tribal, or local governments, mem13 bers of academia, legal scholars and practitioners, 

14 tribal leaders, representatives of nonprofit organiza15 tions, or other interested individuals who dem16 onstrate a dedication to the use of genomics to im17 prove minority healthcare and the elimination of 

18 health disparities among minorities. 

19 (2) DIVERSITY.—It is the intent of Congress 

20 that individuals appointed to the Commission rep21 resent diverse interests, ethnicities, various profes22 sional backgrounds, and are from different regions 

23 of the United States. 

24 (c) CONSULTATION AND APPOINTMENT.—
343

•HR 3459 IH 

1 (1) IN GENERAL.—The President, Speaker of 

2 the House of Representatives, minority leader of the 

3 House of Representatives, majority leader of the 

4 Senate, and minority leader of the Senate shall con5 sult among themselves before appointing the mem6 bers of the Commission in order to achieve, to the 

7 maximum extent practicable, fair and equitable rep8 resentation of various points of view with respect to 

9 matters studied by the Commission. 

10 (2) DATE OF APPOINTMENT.—The appoint11 ments of the members of the Commission shall be 

12 made not later than 90 days after the date of enact13 ment of this Act. 

14 (d) TERMS.—

15 (1) IN GENERAL.—Each member of the Com16 mission shall be appointed for the life of the Com17 mission. 

18 (2) VACANCIES.—A vacancy in the Commission 

19 shall be filled in the manner in which the original 

20 appointment was made. 

21 (e) BASIC PAY.—Members of the Commission shall 

22 serve without pay. 

23 (f) TRAVEL EXPENSES.—Each member of the Com24 mission shall receive travel expenses, including per diem 

25 in lieu of subsistence, in accordance with applicable provi-
344

•HR 3459 IH 

1 sions under subchapter I of chapter 57 of title 5, United 

2 States Code. 

3 (g) CHAIRPERSON AND VICE CHAIRPERSON.—The 

4 members of the Commission shall elect a Chairperson and 

5 Vice Chairperson of the Commission from among the 

6 members. 

7 (h) MEETINGS.—

8 (1) IN GENERAL.—The Commission shall meet 

9 at the call of the Chairperson or a majority of its 

10 members. 

11 (2) INITIAL MEETING.—Not later than 30 days 

12 after the date on which all members of the Commis13 sion have been appointed, the Commission shall hold 

14 its first meeting. 

15 SEC. 515. POWERS OF COMMISSION. 

16 (a) HEARINGS AND SESSIONS.—The Commission 

17 may, for the purpose of carrying out this subtitle, hold 

18 hearings, sit and act at times and places, take testimony, 

19 and receive evidence as the Commission considers appro20 priate to carry out this subtitle. 

21 (b) POWERS OF MEMBERS AND AGENTS.—Any mem22 ber or agent of the Commission may, if authorized by the 

23 Commission, take any action that the Commission is au24 thorized to take by this section. 
345

•HR 3459 IH 

1 (c) OBTAINING OFFICIAL DATA.—Notwithstanding 

2 sections 552 and 552a of title 5, United States Code, the 

3 Commission may secure directly from any department or 

4 agency of the United States information necessary to en5 able it to carry out this subtitle. Upon request of the Com6 mission, the head of that department or agency shall fur7 nish that information to the Commission. 

8 (d) POSTAL SERVICES.—The Commission may use 

9 the United States mails in the same manner and under 

10 the same conditions as other departments and agencies of 

11 the United States. 

12 (e) WEBSITE.—For purposes of conducting the study 

13 under section 512(b)(1), the Commission shall establish 

14 and maintain a website to facilitate public comment and 

15 participation. 

16 (f) STAFF OF FEDERAL AGENCIES.—Upon request 

17 of the Commission, the head of any Federal department 

18 or agency may detail, on a nonreimbursable basis, any of 

19 the personnel of that department or agency to the Com20 mission to assist it in carrying out its duties under this 

21 subtitle. 

22 (g) ADMINISTRATIVE SUPPORT SERVICES.—Upon 

23 the request of the Commission, the Administrator of Gen24 eral Services may provide to the Commission, on a non25 reimbursable basis, the administrative support services 
346

•HR 3459 IH 

1 necessary for the Commission to carry out its responsibil2 ities under this subtitle. 

3 SEC. 516. TERMINATION. 

4 The Commission shall terminate 1 year after submit5 ting its final report pursuant to section 513. 

6 TITLE VI—ACCOUNTABILITY 

7 SEC. 601. REPORT ON WORKFORCE DIVERSITY. 

8 (a) IN GENERAL.—Not later than July 1, 2005, and 

9 annually thereafter, the Secretary, acting through the di10 rector of each entity within the Department of Health and 

11 Human Services, shall prepare and submit to the Com12 mittee on Health, Education, Labor, and Pensions of the 

13 Senate and the Committee on Energy and Commerce of 

14 the House of Representatives a report on healthcare work15 force diversity. 

16 (b) REQUIREMENT.—The report under subsection (a) 

17 shall contain the following information: 

18 (1) The response of the entity involved to the 

19 upcoming 2004 Institute of Medicine report on 

20 workforce diversity, the 2002 Institute of Medicine 

21 report entitled The Future of the Public Health in 

22 the 21st Century, and the Healthy People 2010 ini23 tiative. 
347

•HR 3459 IH 

1 (2) A description of the personnel in each such 

2 entity who are responsible for overseeing workforce 

3 diversity initiatives. 

4 (3) The level of workforce diversity achieved 

5 within each such entity, including absolute numbers 

6 and percentages of minority employees as well as the 

7 rank of such employees. 

8 (4) A description of any grant support that is 

9 provided by each entity for workforce diversity ini10 tiatives, including the amount of the grants and the 

11 percentage of grant funds as compared to overall en12 tity funding; 

13 (c) PUBLIC AVAILABILITY.—The report under sub14 section (a) shall be made available for public review and 

15 comment. 

16 SEC. 602. FEDERAL AGENCY PLAN TO ELIMINATE DISPARI17 TIES AND IMPROVE THE HEALTH OF MINOR18 ITY POPULATIONS. 

19 (a) IN GENERAL.—Not later than September 1, 

20 2005, each Federal health agency shall develop and imple21 ment a national strategic action plan to eliminate dispari22 ties on the basis of race, ethnicity, and primary language 

23 and improve the health and healthcare of minority popu24 lations, through programs relevant to the mission of the 

25 agency. 
348

•HR 3459 IH 

1 (b) PUBLICATION.—Each action plan described in 

2 paragraph (1) shall—

3 (1) be publicly reported in draft form for public 

4 review and comment; 

5 (2) include a response to the review and com6 ment described in paragraph (1) in the final plan; 

7 (3) include the agency response to the 2002 In8 stitute of Medicine report, Unequal Treatment—

9 Confronting Racial and Ethnic Disparities in 

10 Healthcare; 

11 (4) demonstrate progress in meeting the 

12 Healthy People 2010 objectives; and 

13 (5) be updated, including progress reports, for 

14 inclusion in an annual report to Congress. 

15 SEC. 603. ACCOUNTABILITY WITHIN THE DEPARTMENT OF 

16 HEALTH AND HUMAN SERVICES. 

17 Title XXIX of the Public Health Service Act, as 

18 amended by section 502(b), is further amended by adding 

19 at the end the following: 

20 ‘‘Subtitle F—Accountability 

21 ‘‘SEC. 2961. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

22 ‘‘(a) IN GENERAL.—The Secretary shall establish 

23 within the Office for Civil Rights an Office of Health Dis24 parities, which shall be headed by a director to be ap25 pointed by the Secretary.
349

•HR 3459 IH 

1 ‘‘(b) PURPOSE.—The Office of Health Disparities 

2 shall ensure that the health programs, activities, and oper3 ations of health entities which receive Federal financial as4 sistance are in compliance with title VI of the Civil Rights 

5 Act, which prohibits discrimination on the basis of race, 

6 color, or national origin. The activities of the Office shall 

7 include the following: 

8 ‘‘(1) The development and implementation of 

9 an action plan to address racial and ethnic 

10 healthcare disparities, which shall address concerns 

11 relating to the Office for Civil Rights as released by 

12 the United States Commission on Civil Rights in the 

13 report entitled ‘Health Care Challenge: Acknowl14 edging Disparity, Confronting Discrimination, and 

15 Ensuring Equity’ (September, 1999). This plan shall 

16 be publicly disclosed for review and comment and 

17 the final plan shall address any comments or con18 cerns that are received by the Office. 

19 ‘‘(2) Investigative and enforcement actions 

20 against intentional discrimination and policies and 

21 practices that have a disparate impact on minorities. 

22 ‘‘(3) The review of racial, ethnic, and primary 

23 language health data collected by Federal health 

24 agencies to assess healthcare disparities related to 
350

•HR 3459 IH 

1 intentional discrimination and policies and practices 

2 that have a disparate impact on minorities. 

3 ‘‘(4) Outreach and education activities relating 

4 to compliance with title VI of the Civil Rights Act. 

5 ‘‘(5) The provision of technical assistance for 

6 health entities to facilitate compliance with title VI 

7 of the Civil Rights Act. 

8 ‘‘(6) Coordination and oversight of activities of 

9 the civil rights compliance offices established under 

10 section 2962. 

11 ‘‘(7) Ensuring compliance with the 1997 Office 

12 of Management and Budget Standards for Maintain13 ing, Collecting, and Presenting Federal Data on 

14 Race, Ethnicity and the available language stand15 ards. 

16 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en17 sure the effectiveness of the Office of Health Disparities 

18 by ensuring that the Office is provided with—

19 ‘‘(1) adequate funding to enable the Office to 

20 carry out its duties under this section; and 

21 ‘‘(2) staff with expertise in—

22 ‘‘(A) epidemiology; 

23 ‘‘(B) statistics; 

24 ‘‘(C) health quality assurance; 
351

•HR 3459 IH 

1 ‘‘(D) minority health and health dispari2 ties; and 

3 ‘‘(E) civil rights. 

4 ‘‘(d) REPORT.—Not later than December 31, 2005, 

5 and annually thereafter, the Secretary, in collaboration 

6 with the Director of the Office for Civil Rights, shall sub7 mit a report to the Committee on Health, Education, 

8 Labor, and Pensions of the Senate and the Committee on 

9 Energy and Commerce of the House of Representatives 

10 that includes—

11 ‘‘(1) the number of cases filed, broken down by 

12 category; 

13 ‘‘(2) the number of cases investigated and 

14 closed by the office; 

15 ‘‘(3) the outcomes of cases investigated; and 

16 ‘‘(4) the staffing levels of the office including 

17 staff credentials. 

18 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section, 

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

21 2005 through 2010. 
352

•HR 3459 IH 

1 ‘‘SEC. 2962. ESTABLISHMENT OF HEALTH PROGRAM OF2 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

3 HEALTH AND HUMAN SERVICES AGENCIES. 

4 ‘‘(a) IN GENERAL.—The Secretary shall establish 

5 civil rights compliance offices in each agency within the 

6 Department of Health and Human Services that admin7 isters health programs. 

8 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

9 under subsection (a) shall ensure that recipients of Fed10 eral financial assistance under Federal health programs 

11 administer their programs, services, and activities in a 

12 manner that— 

13 ‘‘(1) does not discriminate, either intentionally 

14 or in effect, on the basis of race, national origin, lan15 guage, ethnicity, sex, age, or disability; and 

16 ‘‘(2) promotes the reduction and elimination of 

17 disparities in health and healthcare based on race, 

18 national origin, language, ethnicity, sex, age, and 

19 disability. 

20 ‘‘(c) POWERS AND DUTIES.—The offices established 

21 in subsection (a) shall have the following powers and du22 ties: 

23 ‘‘(1) The establishment of compliance and pro24 gram participation standards for recipients of Fed25 eral financial assistance under each program admin26 istered by an agency within the Department of 
353

•HR 3459 IH 

1 Health and Human Services including the establish2 ment of disparity reduction standards to encompass 

3 disparities in health and healthcare related to race, 

4 national origin, language, ethnicity, sex, age, and 

5 disability. 

6 ‘‘(2) The development and implementation of 

7 program-specific guidelines that interpret and apply 

8 Department of Health and Human Services guid9 ance under title VI of the Civil Rights Act of 1964 

10 to each Federal health program administered by the 

11 agency. 

12 ‘‘(3) The development of a disparity-reduction 

13 impact analysis methodology that shall be applied to 

14 every rule issued by the agency and published as 

15 part of the formal rulemaking process under sections 

16 555, 556, and 557 of title 5, United States Code. 

17 ‘‘(4) Oversight of data collection, analysis, and 

18 publication requirements for all recipients of Federal 

19 financial assistance under each Federal health pro20 gram administered by the agency, and compliance 

21 with the 1997 Office of Management and Budget 

22 Standards for Maintaining, Collecting, and Pre23 senting Federal Data on Race and Ethnicity and the 

24 available language standards. 
354

•HR 3459 IH 

1 ‘‘(5) The conduct of publicly available studies 

2 regarding discrimination within Federal health pro3 grams administered by the agency as well as dis4 parity reduction initiatives by recipients of Federal 

5 financial assistance under Federal health programs. 

6 ‘‘(6) Annual reports to the Committee on 

7 Health, Education, Labor, and Pensions and the 

8 Committee on Finance of the Senate and the Com9 mittee on Energy and Commerce and the Committee 

10 on Ways and Means of the House of Representatives 

11 on the progress in reducing disparities in health and 

12 healthcare through the Federal programs adminis13 tered by the agency. 

14 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

15 IN THE DEPARTMENT OF JUSTICE.—

16 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

17 SERVICES.—The Office for Civil Rights in the De18 partment of Health and Human Services shall pro19 vide standard-setting and compliance review inves20 tigation support services to the Civil Rights Compli21 ance Office for each agency. 

22 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

23 for Civil Rights in the Department of Justice shall 

24 continue to maintain the power to institute formal 

25 proceedings when an agency Office for Civil Rights
355

•HR 3459 IH 

1 determines that a recipient of Federal financial as2 sistance is not in compliance with the disparity re3 duction standards of the agency. 

4 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

5 health programs’ mean programs—

6 ‘‘(1) under the Social Security Act (42 U.S.C. 

7 301 et seq.) that pay for healthcare and services; 

8 and 

9 ‘‘(2) under this Act that provide Federal finan10 cial assistance for healthcare, biomedical research, 

11 health services research, and programs designed to 

12 improve the public’s health.’’. 

13 SEC. 604. OFFICE OF MINORITY HEALTH. 

14 Section 1707 of the Public Health Service Act (42 

15 U.S.C. 300u–6) is amended—

16 (1) by striking the section heading and insert17 ing the following: 

18 ‘‘OFFICE OF MINORITY HEALTH AND RACIAL, ETHNIC, 

19 AND PRIMARY LANGUAGE HEALTH DISPARITY ELIMI20 NATION’’; 

21 (2) by striking ‘‘Office of Minority Health’’ 

22 each place that such appears and inserting ‘‘Office 

23 of Minority Health and Racial, Ethnic, and Primary 

24 Language Health Disparities Elimination’’; 

25 (3) by striking subsection (b) and inserting the 

26 following: 
356

•HR 3459 IH 

1 ‘‘(b) DUTIES.—With respect to improving the health 

2 of racial and ethnic minority groups, the Secretary, acting 

3 through the Deputy Assistant Secretary for Minority 

4 Health and Racial, Ethnic, and Primary Language Health 

5 Disparities Elimination (in this section referred to as the 

6 ‘Deputy Assistant Secretary’), shall carry out the fol7 lowing: 

8 ‘‘(1) Establish, implement, monitor, and evalu9 ate short-range and long-range goals and objectives 

10 and oversee all other activities within the Public 

11 Health Service that relate to disease prevention, 

12 health promotion, service delivery, and research con13 cerning minority groups. The heads of each of the 

14 agencies of the Service shall consult with the Deputy 

15 Assistant Secretary to ensure the coordination of 

16 such activities. 

17 ‘‘(2) Oversee all activities within the Depart18 ment of Health and Human Services that relate to 

19 reducing or eliminating disparities in health and 

20 healthcare in racial and ethnic minority populations, 

21 including coordinating—

22 ‘‘(A) the design of programs, support for 

23 programs, and the evaluation of programs; 

24 ‘‘(B) the monitoring of trends in health 

25 and healthcare; 
357

•HR 3459 IH 

1 ‘‘(C) research efforts; 

2 ‘‘(D) the training of health providers; and 

3 ‘‘(E) information and education programs 

4 and campaigns. 

5 ‘‘(3) Enter into interagency and intra-agency 

6 agreements with other agencies of the Public Health 

7 Service. 

8 ‘‘(4) Ensure that the Federal health agencies 

9 and the National Center for Health Statistics collect 

10 data on the health status and healthcare of each mi11 nority group, using at a minimum the categories 

12 specified in the 1997 OMB Standards for Maintain13 ing, Collecting, and Presenting Federal Data on 

14 Race and Ethnicity as required under subtitle B and 

15 available language standards. 

16 ‘‘(5) Provide technical assistance to States, 

17 local agencies, territories, Indian tribes, and entities 

18 for activities relating to the elimination of racial and 

19 ethnic disparities in health and healthcare. 

20 ‘‘(6) Support a national minority health re21 source center to carry out the following: 

22 ‘‘(A) Facilitate the exchange of informa23 tion regarding matters relating to health infor24 mation, health promotion and wellness, preven-
358

•HR 3459 IH 

1 tive health services, and education in the appro2 priate use of health services. 

3 ‘‘(B) Facilitate timely access to culturally 

4 and linguistically appropriate information. 

5 ‘‘(C) Assist in the analysis of such infor6 mation. 

7 ‘‘(D) Provide technical assistance with re8 spect to the exchange of such information (in9 cluding facilitating the development of materials 

10 for such technical assistance). 

11 ‘‘(7) Carry out programs to improve access to 

12 healthcare services for individuals with limited 

13 English proficiency, including developing and car14 rying out programs to provide bilingual or interpre15 tive services through the development and support of 

16 a National Center for Cultural and Linguistic Com17 petence in Healthcare as provided for in section 

18 2903. 

19 ‘‘(8) Carry out programs to improve access to 

20 healthcare services and to improve the quality of 

21 healthcare services for individuals with low func22 tional health literacy. As used in the preceding sen23 tence, the term ‘functional health literacy’ means the 

24 ability to obtain, process, and understand basic 
359

•HR 3459 IH 

1 health information and services needed to make ap2 propriate health decisions. 

3 ‘‘(9) Advise in matters related to the develop4 ment, implementation, and evaluation of health pro5 fessions education on decreasing disparities in 

6 healthcare outcomes, with focus on cultural com7 petency as a method of eliminating disparities in 

8 health and healthcare in racial and ethnic minority 

9 populations. 

10 ‘‘(10) Assist healthcare professionals, commu11 nity and advocacy organizations, academic centers 

12 and public health departments in the design and im13 plementation of programs that will improve the qual14 ity of health outcomes by strengthening the pro15 vider-patient relationship.’’. 

16 (2) by redesignating subsections (c) through (f) 

17 and subsections (g) and (h) as subsections (d) 

18 through (g) and subsections (j) and (k), respectively; 

19 (3) by inserting after subsection (b), the fol20 lowing: 

21 ‘‘(c) NATIONAL PLAN TO ELIMINATE RACIAL AND

22 ETHNIC HEALTH AND HEALTHCARE DISPARITIES.—

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

24 through the Deputy Assistant Secretary, shall—
360

•HR 3459 IH 

1 ‘‘(A) not later than 1 year after the date 

2 of enactment of the Healthcare Equality and 

3 Accountability Act, establish and implement a 

4 comprehensive plan to achieve the goal of 

5 Healthy People 2010 to eliminate health dis6 parities in the United States; 

7 ‘‘(B) establish the plan referred to in sub8 paragraph (A) in consultation with—

9 ‘‘(i) the Director of the Centers for 

10 Disease Control and Prevention; 

11 ‘‘(ii) the Director of the National In12 stitutes of Health; 

13 ‘‘(iii) the Director of the National 

14 Center on Minority Health and Health 

15 Disparities; 

16 ‘‘(iv) the Director of the Agency for 

17 Healthcare Research and Quality; 

18 ‘‘(v) the Administrator of the Health 

19 Resources and Services Administration; 

20 ‘‘(vi) the Administrator of the Centers 

21 for Medicare and Medicaid Services; 

22 ‘‘(vii) the Director of the Office for 

23 Civil Rights;
361

•HR 3459 IH 

1 ‘‘(viii) the Administrator of the Sub2 stance Abuse and Mental Health Services 

3 Administration; 

4 ‘‘(ix) the Commissioner of the Food 

5 and Drug Administration; and 

6 ‘‘(x) the heads of other appropriate 

7 public and private entities; 

8 ‘‘(C) ensure that the plan includes measur9 able objectives, describes the means for achiev10 ing such objectives, and designates a date by 

11 which such objectives are expected to be 

12 achieved; 

13 ‘‘(D) ensure that all amounts appropriated 

14 for such activities are expended in accordance 

15 with the plan; 

16 ‘‘(E) review the plan on at least an annual 

17 basis and revise the plan as appropriate; 

18 ‘‘(F) ensure that the plan will serve as a 

19 binding statement of policy with respect to the 

20 agencies’ activities related to disparities in 

21 health and healthcare; and 

22 ‘‘(G) not later than March 1 of each year, 

23 submit the plan (or any revisions to the plan), 

24 to the Committee on Health, Education, Labor, 

25 and Pensions of the Senate and the Committee 
362

•HR 3459 IH 

1 on Energy and Commerce of the House of Rep2 resentatives. 

3 ‘‘(2) COMPONENTS OF THE PLAN.—The Deputy 

4 Assistant Secretary shall ensure that the comprehen5 sive plan established under paragraph (1) address6 es—

7 ‘‘(A) the recommendations of the 2002 In8 stitute of Medicine report (Unequal Treatment) 

9 with respect to racial and ethnic disparities in 

10 healthcare; 

11 ‘‘(B) health and disease prevention edu12 cation for racial, ethnic, and primary language 

13 health disparity populations; 

14 ‘‘(C) research to identify sources of health 

15 and healthcare disparities in minority groups; 

16 ‘‘(D) the implementation and assessment 

17 of promising intervention strategies; 

18 ‘‘(E) data collection and the monitoring of 

19 the healthcare and health status of health dis20 parity populations; 

21 ‘‘(F) care of individuals who lack pro22 ficiency with the English language; 

23 ‘‘(G) care of individuals with low func24 tional health literacy; 
363

•HR 3459 IH 

1 ‘‘(H) the training, recruitment, and reten2 tion of minority health professionals; 

3 ‘‘(I) programs to expand and facilitate ac4 cess to healthcare services, including the use of 

5 telemedicine, National Health Service Scholars, 

6 community health workers, and case managers; 

7 ‘‘(J) public and health provider awareness 

8 of racial and ethnic disparities in healthcare; 

9 ‘‘(K) methods to evaluate and measure 

10 progress toward the goal of eliminating dispari11 ties in health and healthcare in racial and eth12 nic minority populations; 

13 ‘‘(L) the promotion of interagency and 

14 intra-agency coordination and collaboration and 

15 public-private and community partnerships; and 

16 ‘‘(M) the preparedness of health profes17 sionals to care for racially, ethnically, and lin18 guistically diverse populations and low func19 tional health literacy populations including eval20 uations as required under section 606 of the 

21 Healthcare Equality and Accountability Act.’’; 

22 (4) in subsection (d) (as so redesignated)—

23 (A) in paragraph (1), by inserting ‘‘and 

24 Racial, Ethnic, and Primary Language Health 
364

•HR 3459 IH 

1 Disparities Elimination’’ after ‘‘Minority 

2 Health’’; and 

3 (B) in paragraph (2)—

4 (i) by striking ‘‘Deputy Assistant’’; 

5 and 

6 (ii) by striking ‘‘(10) of subsection 

7 (b)’’ and inserting ‘‘(9) of subsection (c)’’; 

8 (5) in subsection (e)(1) (as so redesignated)—

9 (A) in subparagraph (A), by striking ‘‘sub10 section (b)(9)’’ and inserting ‘‘subsection 

11 (b)(7)’’; and 

12 (B) in subparagraph (B), by striking ‘‘sub13 section (b)(10)’’ and inserting ‘‘subsection 

14 (b)(8)’’; 

15 (6) in subsection (f)(3) (as so redesignated), by 

16 striking ‘‘subsection (f)’’ and inserting ‘‘subsection 

17 (g)’’; 

18 (7) in subsection (g)(1) (as so redesignated)—

19 (A) by striking ‘‘1999 and each second’’ 

20 and inserting ‘‘2004 and each’’; 

21 (B) by striking ‘‘Labor and Human Re22 sources’’ and inserting ‘‘Health, Education, 

23 Labor, and Pensions’’; 

24 (C) by striking ‘‘2 fiscal years’’ and insert25 ing ‘‘fiscal year’’; and
365

•HR 3459 IH 

1 (D) by inserting after ‘‘improving the 

2 health of racial and ethnic minority groups’’ the 

3 following: ‘‘reducing and eliminating disparities 

4 in health and healthcare in racial and ethnic 

5 minority populations, in accordance with the 

6 national plan specified under subsection (c) and 

7 the goals of Healthy People 2010’’; 

8 (8) by inserting after subsection (g) (as so re9 designated) the following: 

10 ‘‘(h) FEDERAL PARTNERSHIP WITH ACCREDITATION

11 ENTITIES.— 

12 ‘‘(1) IN GENERAL.—Not later than 1 year after 

13 the date of enactment of the Healthcare Equality 

14 and Accountability Act, the Secretary, in collabora15 tion with the Director of the Agency for Healthcare 

16 Research and Quality, the Administrator of the Cen17 ters for Medicare and Medicaid Services, the Direc18 tor of the Office for Minority Health, and the heads 

19 of appropriate State agencies, shall convene a work20 ing group with members of accreditation organiza21 tions and other quality standard setting organiza22 tions to develop guidelines to evaluate and report on 

23 the health and healthcare of minority populations 

24 served by health centers, health plans, hospitals, and 

25 other federally funded health entities. 
366

•HR 3459 IH 

1 ‘‘(2) REPORT.—Not later than 6 months after 

2 the convening of the working group under paragraph 

3 (1), the working group shall submit a report to the 

4 Secretary at such time, in such manner, and con5 taining such information as the Secretary may re6 quire, including guidelines and recommendations on 

7 how each accreditation body will work with con8 stituent members to ensure the adoption of such 

9 guidelines. 

10 ‘‘(3) DEMONSTRATION PROJECTS.—The Sec11 retary, acting through the Administrator of the Cen12 ters for Medicare and Medicaid Services, shall award 

13 grants for the establishment of demonstration 

14 projects to assess the impact of providing financial 

15 incentives for the reporting and analysis of the qual16 ity of minority healthcare by hospitals, health plans, 

17 health centers, and other healthcare entities. 

18 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.—

19 There are authorized to be appropriated to carry out 

20 this subsection, such sums as may be necessary for 

21 each of fiscal years 2005 through 2010. 

22 ‘‘(i) PREPARATION OF HEALTH PROFESSIONALS TO

23 PROVIDE HEALTHCARE TO MINORITY POPULATIONS.—

24 The Secretary, in collaboration with the Director of the 

25 Bureau of Health Professions and the Director of the Of-
367

•HR 3459 IH 

1 fice of Minority Health, shall require that health profes2 sional schools that receive Federal funds train future 

3 health professionals to provide culturally and linguistically 

4 appropriate healthcare to diverse populations.’’; and 

5 (9) by striking subsection (k) (as so redesig6 nated) and inserting the following: 

7 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—For the 

8 purpose of carrying out this section (other than subsection 

9 (h)), there is authorized to be appropriated $100,000,000 

10 for fiscal year 2004, and such sums as may be necessary 

11 for each of fiscal years 2005 through 2010.’’. 

12 SEC. 605. ESTABLISHMENT OF THE INDIAN HEALTH SERV13 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

14 SERVICE. 

15 (a) ESTABLISHMENT.—

16 (1) IN GENERAL.—In order to more effectively 

17 and efficiently carry out the responsibilities, authori18 ties, and functions of the United States to provide 

19 healthcare services to Indians and Indian tribes, as 

20 are or may be hereafter provided by Federal statute 

21 or treaties, there is established within the Public 

22 Health Service of the Department of Health and 

23 Human Services the Indian Health Service. 

24 (2) ASSISTANT SECRETARY OF INDIAN

25 HEALTH.—The Service shall be administered by an 
368

•HR 3459 IH 

1 Assistant Secretary of Indian Health, who shall be 

2 appointed by the President, by and with the advice 

3 and consent of the Senate. The Assistant Secretary 

4 shall report to the Secretary. Effective with respect 

5 to an individual appointed by the President, by and 

6 with the advice and consent of the Senate the term 

7 of service of the Assistant Secretary shall be 4 years. 

8 An Assistant Secretary may serve more than 1 term. 

9 (b) AGENCY.—The Service shall be an agency within 

10 the Public Health Service of the Department, and shall 

11 not be an office, component, or unit of any other agency 

12 of the Department. 

13 (c) FUNCTIONS AND DUTIES.—The Secretary shall 

14 carry out through the Assistant Secretary of the Service—

15 (1) all functions which were, on the day before 

16 the date of enactment of the Indian Health Care 

17 Amendments of 1988, carried out by or under the 

18 direction of the individual serving as Director of the 

19 Service on such day; 

20 (2) all functions of the Secretary relating to the 

21 maintenance and operation of hospital and health fa22 cilities for Indians and the planning for, and provi23 sion and utilization of, health services for Indians; 

24 (3) all health programs under which healthcare 

25 is provided to Indians based upon their status as In-
369

•HR 3459 IH 

1 dians which are administered by the Secretary, in2 cluding programs under—

3 (A) the Indian Health Care Improvement 

4 Act; 

5 (B) the Act of November 2, 1921 (25 

6 U.S.C. 13); 

7 (C) the Act of August 5, 1954 (42 U.S.C. 

8 2001, et seq.); 

9 (D) the Act of August 16, 1957 (42 

10 U.S.C. 2005 et seq.); 

11 (E) the Indian Self-Determination Act (25 

12 U.S.C. 450f, et seq.); and 

13 (F) title XXIX of the Public Health Serv14 ice Act; and 

15 (4) all scholarship and loan functions carried 

16 out under title I of the Indian Health Care Improve17 ment Act. 

18 (d) AUTHORITY.—

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

20 through the Assistant Secretary, shall have the au21 thority—

22 (A) except to the extent provided for in 

23 paragraph (2), to appoint and compensate em24 ployees for the Service in accordance with title 

25 5, United States Code; 
370

•HR 3459 IH 

1 (B) to enter into contracts for the procure2 ment of goods and services to carry out the 

3 functions of the Service; and 

4 (C) to manage, expend, and obligate all 

5 funds appropriated for the Service. 

6 (2) PERSONNEL ACTIONS.—Notwithstanding 

7 any other provision of law, the provisions of section 

8 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

9 U.S.C. 472), shall apply to all personnel actions 

10 taken with respect to new positions created within 

11 the Service as a result of its establishment under 

12 subsection (a). 

13 (e) RATE OF PAY.—

14 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

15 title 5, United States Code, is amended by striking 

16 the following: ‘‘Assistant Secretaries of Health and 

17 Human Services (6).’’ and inserting ‘‘Assistant Sec18 retaries of Health and Human Services (7).’’. 

19 (2) POSITIONS AT LEVEL V.—Section 5316 of 

20 such title is amended by striking the following: ‘‘Di21 rector, Indian Health Service, Department of Health 

22 and Human Services.’’. 

23 (f) DUTIES OF ASSISTANT SECRETARY FOR INDIAN

24 HEALTH.—Section 601 of the Indian Health Care Im-
371

•HR 3459 IH 

1 provement Act (25 U.S.C. 1661) is amended in subsection 

2 (a)—

3 (1) by inserting ‘‘(1)’’ after ‘‘(a)’’; 

4 (2) in the second sentence of paragraph (1), as 

5 so designated, by striking ‘‘a Director,’’ and insert6 ing ‘‘the Assistant Secretary for Indian Health,’’; 

7 (3) by striking the third sentence of paragraph 

8 (1), as so designated, and all that follows through 

9 the end of the subsection (a) of such section and in10 serting the following: ‘‘The Assistant Secretary for 

11 Indian Health shall carry out the duties specified in 

12 paragraph (2).’’; and 

13 (4) by adding after paragraph (1) the following: 

14 ‘‘(2) The Assistant Secretary for Indian Health 

15 shall—

16 ‘‘(A) report directly to the secretary con17 cerning all policy and budget-related matters 

18 affecting Indian health; 

19 ‘‘(B) collaborate with the Assistant Sec20 retary for Health concerning appropriate mat21 ters of Indian health that affect the agencies of 

22 the Public Health Service; 

23 ‘‘(C) advise each Assistant Secretary of the 

24 Department of Health and Human Services 

25 concerning matters of Indian health with re-
372

•HR 3459 IH 

1 spect to which that Assistant Secretary has au2 thority and responsibility; 

3 ‘‘(D) advise the heads of other agencies 

4 and programs of the Department of Health and 

5 Human Services concerning matters of Indian 

6 health with respect to which those heads have 

7 authority and responsibility; and 

8 ‘‘(E) coordinate the activities of the De9 partment of Health and Human Services con10 cerning matters of Indian health.’’. 

11 (g) CONTINUED SERVICE BY INCUMBENT.—The indi12 vidual serving in the position of Director of the Indian 

13 Health Service on the date preceding the date of enact14 ment of this Act may serve as Assistant Secretary for In15 dian Health, at the pleasure of the President after the 

16 date of enactment of this Act. 

17 (h) CONFORMING AMENDMENTS.—

18 (1) AMENDMENTS TO INDIAN HEALTH CARE IM19 PROVEMENT ACT.—The Indian Health Care Im20 provement Act (25 U.S.C. 1601 et seq.) is amend21 ed—

22 (A) in section 601—

23 (i) in subsection (c), by striking ‘‘Di24 rector of the Indian Health Service’’ both 
373

•HR 3459 IH 

1 places it appears and inserting ‘‘Assistant 

2 Secretary for Indian Health’’; and 

3 (ii) in subsection (d), by striking ‘‘Di4 rector of the Indian Health Service’’ and 

5 inserting ‘‘Assistant Secretary for Indian 

6 Health’’; and 

7 (B) in section 816(c)(1), by striking ‘‘Di8 rector of the Indian Health Service’’ and insert9 ing ‘‘Assistant Secretary for Indian Health’’. 

10 (2) AMENDMENTS TO OTHER PROVISIONS OF

11 LAW.—The following provisions are each amended 

12 by striking ‘‘Director of the Indian Health Service’’ 

13 each place it appears and inserting ‘‘Assistant Sec14 retary for Indian Health’’: 

15 (A) Section 203(a)(1) of the Rehabilitation 

16 Act of 1973 (29 U.S.C. 761b(a)(1)). 

17 (B) Subsections (b) and (e) of section 518 

18 of the Federal Water Pollution Control Act (33 

19 U.S.C. 1377 (b) and (e)). 

20 (C) Section 803B(d)(1) of the Native 

21 American Programs Act of 1974 (42 U.S.C. 

22 2991b–2(d)(1)). 

23 (i) REFERENCES.—Reference in any other Federal 

24 law, Executive order, rule, regulation, or delegation of au25 thority, or any document of or relating to the Director 
374

•HR 3459 IH 

1 of the Indian Health Service shall be deemed to refer to 

2 the Assistant Secretary for Indian Health. 

3 (j) DEFINITIONS.—For purposes of this section, the 

4 definitions contained in section 4 of the Indian Health 

5 Care Improvement Act shall apply. 

6 SEC. 606. OFFICE OF MINORITY HEALTH AT THE CENTERS 

7 FOR MEDICARE AND MEDICAID SERVICES. 

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

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

10 Human Services shall establish within the Centers for 

11 Medicare and Medicaid Services an Office of Minority 

12 Health (referred to in this section as the ‘‘Office’’). 

13 (b) DUTIES.—The Office shall be responsible for the 

14 coordination and facilitation of activities of the Centers 

15 for Medicare and Medicaid Services to improve minority 

16 health and healthcare and to reduce racial and ethnic dis17 parities in health and healthcare, which shall include—

18 (1) creating a strategic plan, which shall be 

19 made available for public review, to improve the 

20 health and healthcare of Medicare, Medicaid, and 

21 SCHIP beneficiaries; 

22 (2) promoting agency-wide policies relating to 

23 healthcare delivery and financing that could have a 

24 beneficial impact on the health and healthcare of mi25 nority populations; 
375

•HR 3459 IH 

1 (3) assisting health plans, hospitals, and other 

2 health entities in providing culturally and linguis3 tically appropriate healthcare services; 

4 (4) increasing awareness and outreach activities 

5 for minority healthcare consumers and providers 

6 about the causes and remedies for health and 

7 healthcare disparities; 

8 (5) developing grant programs and demonstra9 tion projects to identify, implement and evaluate in10 novative approaches to improving the health and 

11 healthcare of minority beneficiaries in the Medicare, 

12 Medicaid, and SCHIP programs; 

13 (6) considering incentive programs relating to 

14 reimbursement that would reward health entities for 

15 providing quality healthcare for minority populations 

16 using established benchmarks for quality of care; 

17 (7) collaborating with the compliance office to 

18 ensure compliance with the anti-discrimination provi19 sions under title VI of the Civil Rights Act of 1964; 

20 (8) identifying barriers to enrollment in public 

21 programs under the jurisdiction of the Centers for 

22 Medicare and Medicaid Services; 

23 (9) monitoring and evaluating on a regular 

24 basis the success of minority health programs and 

25 initiatives; 
376

•HR 3459 IH 

1 (10) publishing an annual report about the ac2 tivities of the Centers for Medicare and Medicaid 

3 Services relating to minority health improvement; 

4 and 

5 (11) other activities determined appropriate by 

6 the Secretary of Health and Human Services. 

7 (c) STAFF.—The staff at the Office shall include—

8 (1) one or more individuals with expertise in 

9 minority health and racial and ethnic health dispari10 ties; and 

11 (2) one or more individuals with expertise in 

12 healthcare financing and delivery in underserved 

13 communities. 

14 (d) COORDINATION.—In carrying out its duties under 

15 this section, the Office shall coordinate with—

16 (1) the Office of Minority Health in the Office 

17 of the Secretary of Health and Human Services; 

18 (2) the National Centers for Minority Health 

19 and Health Disparities in the National Institutes of 

20 Health; and 

21 (3) the Office of Minority Health in the Centers 

22 for Disease Control and Prevention. 

23 (e) AUTHORIZATION OF APPROPRIATIONS.—For the 

24 purpose of carrying out this section, there are authorized 

25 to be appropriated $10,000,000 for fiscal year 2004, and
377

•HR 3459 IH 

1 such sums may be necessary for each of fiscal years 2005 

2 through 2010. 

3 SEC. 607. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND 

4 DRUG ADMINISTRATION. 

5 Chapter IX of the Federal Food, Drug, and Cosmetic 

6 Act (21 U.S.C. 391 et seq.) is amended by adding at the 

7 end the following: 

8 ‘‘SEC. 908. OFFICE OF MINORITY AFFAIRS. 

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

10 date of enactment of this section, the Secretary shall es11 tablish within the Office of the Commissioner of the Food 

12 and Drug Administration an Office of Minority Affairs 

13 (referred to in this section as the ‘Office’). 

14 ‘‘(b) DUTIES.—The Office shall be responsible for the 

15 coordination and facilitation of activities of the Food and 

16 Drug Administration to improve minority health and 

17 healthcare and to reduce racial and ethnic disparities in 

18 health and healthcare, which shall include—

19 ‘‘(1) promoting policies in the development and 

20 review of medical products that reduce racial and 

21 ethnic disparities in health and healthcare; 

22 ‘‘(2) encouraging appropriate data collection, 

23 analysis, and dissemination of racial and ethnic dif24 ferences using, at a minimum, the categories de25 scribed in the 1997 Office of Management and 
378

•HR 3459 IH 

1 Budget standards, in response to different therapies 

2 in both adult and pediatric populations; 

3 ‘‘(3) providing, in coordination with other ap4 propriate government agencies, education, training, 

5 and support to increase participation of minority pa6 tients and physicians in clinical trials; 

7 ‘‘(4) collecting and analyzing data using, at a 

8 minimum, the categories described in the 1997 Of9 fice of Management and Budget standards, on the 

10 number of participants from minority racial and eth11 nic backgrounds in clinical trials used to support 

12 medical product approvals; 

13 ‘‘(5) the identification of methods to reduce lan14 guage and literacy barriers; and 

15 ‘‘(6) publishing an annual report about the ac16 tivities of the Food and Drug Administration per17 taining to minority health. 

18 ‘‘(c) STAFF.—The staff of the Office shall include—

19 ‘‘(1) one or more individuals with expertise in 

20 the design and conduct of clinical trials of drugs, bi21 ological products, and medical devices; and 

22 ‘‘(2) one or more individuals with expertise in 

23 therapeutic classes or disease states for which med24 ical evidence suggests a difference based on race or 

25 ethnicity. 
379

•HR 3459 IH 

1 ‘‘(d) COORDINATION.—In carrying out its duties 

2 under this section, the Office shall coordinate with—

3 ‘‘(1) the Office of Minority Health in the Office 

4 of the Secretary of Health and Human Services; 

5 ‘‘(2) the National Center for Minority Health 

6 and Health Disparities in the National Institutes of 

7 Health; and 

8 ‘‘(3) the Office of Minority Health in the Cen9 ters for Disease Control and Prevention. 

10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 

11 purpose of carrying out this section, there are authorized 

12 to be appropriated such sums as may be necessary for 

13 each of the fiscal years 2005 through 2010.’’. 

14 SEC. 608. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

15 RESPECT TO RACIAL AND ETHNIC BACK16 GROUND. 

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

18 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend19 ed by adding after section 505B the following: 

20 ‘‘SEC. 505C. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

21 RESPECT TO RACIAL AND ETHNIC BACK22 GROUND. 

23 ‘‘(a) PRE-APPROVAL STUDIES.—If there is evidence 

24 that there may be a disparity on the basis of racial or 
380

•HR 3459 IH 

1 ethnic background as to the safety or effectiveness of a 

2 drug, then—

3 ‘‘(1)(A) the investigations required under sec4 tion 505(b)(1)(A) shall include adequate and well5 controlled investigations of the disparity; or 

6 ‘‘(B) the evidence required under section 351(a) 

7 of the Public Health Service Act for approval of a 

8 biologics license application for the drug shall in9 clude adequate and well-controlled investigations of 

10 the disparity; and 

11 ‘‘(2) if the investigations confirm that there is 

12 a disparity, the labeling of the drug shall include ap13 propriate information about the disparity. 

14 ‘‘(b) POST-MARKET STUDIES.—

15 ‘‘(1) IN GENERAL.—If there is evidence that 

16 there may be a disparity on the basis of racial or 

17 ethnic background as to the safety or effectiveness 

18 of a drug for which there is an approved application 

19 under section 505 or a license under section 351 of 

20 the Public Health Service Act, the Secretary may by 

21 order require the holder of the approved application 

22 or license to conduct, by a date specified by the Sec23 retary, post-marketing studies to investigate the dis24 parity. 
381

•HR 3459 IH 

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

2 that the post-market studies confirm that there is a 

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

4 the drug shall include appropriate information about 

5 the disparity. 

6 ‘‘(3) STUDY DESIGN.—The Secretary may 

7 specify all aspects of study design, including the 

8 number of studies and study participants, in the 

9 order requiring post-market studies of the drug. 

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

11 Secretary may by order modify any aspect of the 

12 study design as necessary after issuing an order 

13 under paragraph (1). 

14 ‘‘(5) STUDY RESULTS.—The results from stud15 ies required under paragraph (1) shall be submitted 

16 to the Secretary as supplements to the drug applica17 tion or biological license application. 

18 ‘‘(c) DISPARITY.—The term ‘evidence that there may 

19 be a disparity on the basis of racial or ethnic background 

20 for adult and pediatric populations as to the safety or ef21 fectiveness of a drug’ includes—

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

23 basis of racial or ethnic background as to safety or 

24 effectiveness of a drug in the same chemical class as 

25 the drug; 
382

•HR 3459 IH 

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

2 basis of racial or ethnic background in the way the 

3 drug is metabolized; and 

4 ‘‘(3) other evidence as the Secretary may deter5 mine. 

6 ‘‘(d) APPLICATIONS UNDER SECTION 505(b)(2) AND

7 505(j).—

8 ‘‘(1) IN GENERAL.—A drug for which an appli9 cation has been submitted or approved under section 

10 505(j) shall not be considered ineligible for approval 

11 under that section or misbranded under section 502 

12 on the basis that the labeling of the drug omits in13 formation relating to a disparity on the basis of ra14 cial or ethnic background as to the safety or effec15 tiveness of the drug, whether derived from investiga16 tions or studies required under this section or de17 rived from other sources, when the omitted informa18 tion is protected by patent or by exclusivity under 

19 clause (iii) or (iv) of section 505(j)(5)(D). 

20 ‘‘(2) LABELING.—Notwithstanding clauses (iii) 

21 and (iv) of section 505(j)(5)(D), the Secretary may 

22 require that the labeling of a drug approved under 

23 section 505(j) that omits information relating to a 

24 disparity on the basis of racial or ethnic background 

25 as to the safety or effectiveness of the drug include
383

•HR 3459 IH 

1 a statement of any appropriate contraindications, 

2 warnings, or precautions related to the disparity 

3 that the Secretary considers necessary.’’. 

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

5 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend6 ed by adding at the end the following: 

7 ‘‘(w)(1) If it is a drug and the holder of the approved 

8 application under section 505 or license under section 351 

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

10 to complete the investigations or studies, or comply with 

11 any other requirement, of section 505C.’’. 

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

13 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379h) 

14 is amended by adding after ‘‘required’’ the following: ‘‘, 

15 including supplements required under section 505C of the 

16 Act’’. 

17 SEC. 609. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

18 (a) COORDINATION WITHIN DEPARTMENT OF JUS19 TICE OF ACTIVITIES REGARDING HEALTH DISPARI20 TIES.—Section 3 of the Civil Rights Commission Act of 

21 1983 (42 U.S.C. 1975a) is amended—

22 (1) in paragraph (1)(B), by striking ‘‘and’’ at 

23 the end; 
384

•HR 3459 IH 

1 (2) in paragraph (2), in the matter after and 

2 below subparagraph (D), by striking the period and 

3 inserting ‘‘; and’’; and 

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

5 ‘‘(3) shall, with respect to activities carried out 

6 in healthcare and correctional facilities toward the 

7 goal of eliminating health disparities between the 

8 general population and members of racial or ethnic 

9 minority groups, coordinate such activities of—

10 ‘‘(A) the Office for Civil Rights within the 

11 Department of Justice; 

12 ‘‘(B) the Office of Justice Programs within 

13 the Department of Justice; 

14 ‘‘(C) the Office for Civil Rights within the 

15 Department of Health and Human Services; 

16 and 

17 ‘‘(D) the Office of Minority Health within 

18 the Department of Health and Human Services 

19 (headed by the Deputy Assistant Secretary for 

20 Minority Health).’’. 

21 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

22 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

23 1975c) is amended by striking the first sentence and in24 serting the following: ‘‘For the purpose of carrying out 

25 this Act, there are authorized to be appropriated 
385

•HR 3459 IH 

1 $30,000,000 for fiscal year 2005, and such sums as may 

2 be necessary for each of the fiscal years 2006 through 

3 2010.’’. 

4 SEC. 610. SENSE OF CONGRESS CONCERNING FULL FUND5 ING OF ACTIVITIES TO ELIMINATE RACIAL 

6 AND ETHNIC HEALTH DISPARITIES. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

9 (1) The health status of the American populace 

10 is declining and the United States currently ranks 

11 below most industrialized nations in health status 

12 measured by longevity, sickness, and mortality. 

13 (2) Within the spectrum of declining health, ra14 cial and ethnic minority populations tend to be in 

15 the poorest of health and face substantial cultural, 

16 social, and economic barriers to obtaining quality 

17 healthcare. 

18 (3) The problems affecting minority health have 

19 been exacerbated by the fact that adequate resources 

20 (funding, staffing, stewardship, and accountability) 

21 have not been devoted to initiatives designed to ex22 amine and eliminate racial and ethnic disparities in 

23 health. 

24 (b) SENSE OF CONGRESS.—It is the sense of Con25 gress that—
386

•HR 3459 IH 

1 (1) funding should be doubled by fiscal year 

2 2005 for the National Center for Minority Health 

3 Disparities, the Office of Civil Rights in the Depart4 ment of Health and Human Services, the National 

5 Institute of Nursing Research, and the Office of Mi6 nority Health; 

7 (2) adequate funding by fiscal year 2005, and 

8 subsequent funding increases, should be provided for 

9 health professions training programs, the Racial and 

10 Ethnic Approaches to Community Health (REACH) 

11 at the Center for Disease Control and Prevention, 

12 the Minority HIV/AIDS Initiative, and the Excel13 lence Centers to Eliminate Ethnic/Racial Disparities 

14 (EXCEED) Program at the Agency for Healthcare 

15 Research and Quality; 

16 (3) current and newly-created health disparity 

17 elimination incentives, programs, agencies, and de18 partments under this Act (and the amendments 

19 made by this Act) should receive adequate staffing 

20 and funding by fiscal year 2005; and 

21 (4) stewardship and accountability should be 

22 provided by Congress and the President for health 

23 disparity elimination. 
387

•HR 3459 IH 

1 TITLE VII—STRENGTHENING 

2 HEALTH INSTITUTIONS THAT 

3 PROVIDE HEALTHCARE TO 

4 MINORITY POPULATIONS 

5 SEC. 701. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

6 ACT. 

7 Title XXIX of the Public Health Service Act, as 

8 amended by section 602, is further amended by adding 

9 at the end the following: 

10 ‘‘Subtitle G—Strengthening Health 

11 Institutions That Provide 

12 Healthcare to Minority Popu13 lations 

14 ‘‘CHAPTER 1—GENERAL PROGRAMS 

15 ‘‘SEC. 2971. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

16 INITIATIVES. 

17 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

18 with the Administrator of the Health Resources and Serv19 ices Administration, the Director of the Agency for 

20 Healthcare Research and Quality, and the Administrator 

21 of the Centers for Medicare and Medicaid Services, shall 

22 award grants to eligible entities for the conduct of dem23 onstration projects to improve the quality of and access 

24 to healthcare. 
388

•HR 3459 IH 

1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a), an entity shall—

3 ‘‘(1) be a health center, hospital, health plan, 

4 health system, community clinic. or other health en5 tity determined appropriate by the Secretary—

6 ‘‘(A) that, by legal mandate or explicitly 

7 adopted mission, provides patients with access 

8 to services regardless of their ability to pay; 

9 ‘‘(B) that provides care or treatment for a 

10 substantial number of patients who are unin11 sured, are receiving assistance under a State 

12 program under title XIX of the Social Security 

13 Act, or are members of vulnerable populations, 

14 as determined by the Secretary; and 

15 ‘‘(C)(i) with respect to which, not less than 

16 50 percent of the entity’s patient population is 

17 made up of racial and ethnic minorities; or 

18 ‘‘(ii) that—

19 ‘‘(I) serves a disproportionate percent20 age of local, minority racial and ethnic pa21 tients, or that has a patient population, at 

22 least 50 percent of which is limited English 

23 proficient; and 

24 ‘‘(II) provides an assurance that 

25 amounts received under the grant will be
389

•HR 3459 IH 

1 used only to support quality improvement 

2 activities in the racial and ethnic popu3 lation served; and 

4 ‘‘(2) prepare and submit to the Secretary an 

5 application at such time, in such manner, and con6 taining such information as the Secretary may re7 quire. 

8 ‘‘(c) PRIORITY.—In awarding grants under sub9 section (a), the Secretary shall give priority to applicants 

10 under subsection (b)(2) that—

11 ‘‘(1) demonstrate an intent to operate as part 

12 of a healthcare partnership, network, collaborative, 

13 coalition, or alliance where each member entity con14 tributes to the design, implementation, and evalua15 tion of the proposed intervention; or 

16 ‘‘(2) intend to use funds to carry out system17 wide changes with respect to healthcare quality im18 provement, including—

19 ‘‘(A) improved systems for data collection 

20 and reporting; 

21 ‘‘(B) innovative collaborative or similar 

22 processes; 

23 ‘‘(C) group programs with behavioral or 

24 self-management interventions; 

25 ‘‘(D) case management services; 
390

•HR 3459 IH 

1 ‘‘(E) physician or patient reminder sys2 tems; 

3 ‘‘(F) educational interventions; or 

4 ‘‘(G) other activities determined appro5 priate by the Secretary. 

6 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

7 received under a grant under subsection (a) to support 

8 the implementation and evaluation of healthcare quality 

9 improvement activities or minority health and healthcare 

10 disparity reduction activities that include—

11 ‘‘(1) with respect to healthcare systems, activi12 ties relating to improving—

13 ‘‘(A) patient safety; 

14 ‘‘(B) timeliness of care; 

15 ‘‘(C) effectiveness of care; 

16 ‘‘(D) efficiency of care; and 

17 ‘‘(E) patient centeredness; and 

18 ‘‘(2) with respect to patients, activities relating 

19 to—

20 ‘‘(A) staying healthy; 

21 ‘‘(B) getting well; 

22 ‘‘(C) living with illness or disability; and 

23 ‘‘(D) coping with end of life issues. 

24 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

25 provide financial and other technical assistance to grant-
391

•HR 3459 IH 

1 ees under this section for the development of common data 

2 systems. 

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 2005 through 2010. 

7 ‘‘SEC. 2971A. CENTERS OF EXCELLENCE. 

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

9 the Administrator of the Health Resources and Services 

10 Administration, shall designate centers of excellence at 

11 public hospitals, and other health systems serving large 

12 numbers of minority patients, that—

13 ‘‘(1) meet the requirements of section 

14 2971(b)(1); 

15 ‘‘(2) demonstrate excellence in providing care to 

16 minority populations; and 

17 ‘‘(3) demonstrate excellence in reducing dispari18 ties in health and healthcare. 

19 ‘‘(b) REQUIREMENTS.—A hospital or health system 

20 that serves as a Center of Excellence under subsection (a) 

21 shall—

22 ‘‘(1) design, implement, and evaluate programs 

23 and policies relating to the delivery of care in ra24 cially, ethnically, and linguistically diverse popu25 lations; 
392

•HR 3459 IH 

1 ‘‘(2) provide training and technical assistance 

2 to other hospitals and health systems relating to the 

3 provision of quality healthcare to minority popu4 lations; and 

5 ‘‘(3) develop activities for graduate or con6 tinuing medical education that institutionalize a 

7 focus on cultural competence training for health care 

8 providers. 

9 ‘‘(c) 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 2005 through 2010. 

13 ‘‘SEC. 2971B. CONSULTATION, CONSTRUCTION AND REN14 OVATION OF AMERICAN INDIAN AND ALASKA 

15 NATIVE FACILITIES; REPORTS. 

16 ‘‘(a) CONSULTATION.—Prior to the expenditure of, or 

17 the making of any firm commitment to expend, any funds 

18 appropriated for the planning, design, construction, or 

19 renovation of facilities pursuant to the Act of November 

20 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder 

21 Act), the Secretary, acting through the Service, shall—

22 ‘‘(1) consult with any Indian tribe that would 

23 be significantly affected by such expenditure for the 

24 purpose of determining and, whenever practicable, 

25 honoring tribal preferences concerning size, location, 
393

•HR 3459 IH 

1 type, and other characteristics of any facility on 

2 which such expenditure is to be made; and 

3 ‘‘(2) ensure, whenever practicable, that such fa4 cility meets the construction standards of any na5 tionally recognized accrediting body by not later 

6 than 1 year after the date on which the construction 

7 or renovation of such facility is completed. 

8 ‘‘(b) CLOSURE OF FACILITIES.—

9 ‘‘(1) IN GENERAL.—Notwithstanding any provi10 sion of law other than this subsection, no Service 

11 hospital or outpatient healthcare facility or any inpa12 tient service or special care facility operated by the 

13 Service, may be closed if the Secretary has not sub14 mitted to the Congress at least 1 year prior to the 

15 date such proposed closure an evaluation of the im16 pact of such proposed closure which specifies, in ad17 dition to other considerations—

18 ‘‘(A) the accessibility of alternative 

19 healthcare resources for the population served 

20 by such hospital or facility; 

21 ‘‘(B) the cost effectiveness of such closure; 

22 ‘‘(C) the quality of healthcare to be pro23 vided to the population served by such hospital 

24 or facility after such closure; 
394

•HR 3459 IH 

1 ‘‘(D) the availability of contract healthcare 

2 funds to maintain existing levels of service; 

3 ‘‘(E) the views of the Indian tribes served 

4 by such hospital or facility concerning such clo5 sure; 

6 ‘‘(F) the level of utilization of such hos7 pital or facility by all eligible Indians; and 

8 ‘‘(G) the distance between such hospital or 

9 facility and the nearest operating Service hos10 pital. 

11 ‘‘(2) TEMPORARY CLOSURE.—Paragraph (1) 

12 shall not apply to any temporary closure of a facility 

13 or of any portion of a facility if such closure is nec14 essary for medical, environmental, or safety reasons. 

15 ‘‘(c) PRIORITY SYSTEM.—

16 ‘‘(1) ESTABLISHMENT.—The Secretary shall es17 tablish a healthcare facility priority system, that 

18 shall—

19 ‘‘(A) be developed with Indian tribes and 

20 tribal organizations through negotiated rule21 making; 

22 ‘‘(B) give the needs of Indian tribes the 

23 highest priority, with additional priority being 

24 given to those service areas where the health 

25 status of Indians within the area, as measured
395

•HR 3459 IH 

1 by life expectancy based upon the most recent 

2 data available, is significantly lower than the 

3 average health status for Indians in all service 

4 areas; and 

5 ‘‘(C) at a minimum, include the lists re6 quired in paragraph (2)(B) and the method7 ology required in paragraph (2)(E); 

8 except that the priority of any project established 

9 under the construction priority system in effect on 

10 the date of this Act shall not be affected by any 

11 change in the construction priority system taking 

12 place thereafter if the project was identified as one 

13 of the top 10 priority inpatient projects or one of the 

14 top 10 outpatient projects in the Indian Health 

15 Service budget justification for fiscal year 2004, or 

16 if the project had completed both Phase I and Phase 

17 II of the construction priority system in effect on 

18 the date of this title. 

19 ‘‘(2) REPORT.—The Secretary shall submit to 

20 the President and Congress a report that includes—

21 ‘‘(A) a description of the healthcare facility 

22 priority system of the Service, as established 

23 under paragraph (1); 

24 ‘‘(B) healthcare facility lists, including— 
396

•HR 3459 IH 

1 ‘‘(i) the total healthcare facility plan2 ning, design, construction and renovation 

3 needs for Indians; 

4 ‘‘(ii) the 10 top-priority inpatient care 

5 facilities; 

6 ‘‘(iii) the 10 top-priority outpatient 

7 care facilities; 

8 ‘‘(iv) the 10 top-priority specialized 

9 care facilities (such as long-term care and 

10 alcohol and drug abuse treatment); and 

11 ‘‘(v) any staff quarters associated 

12 with such prioritized facilities; 

13 ‘‘(C) the justification for the order of pri14 ority among facilities; 

15 ‘‘(D) the projected cost of the projects in16 volved; and 

17 ‘‘(E) the methodology adopted by the Serv18 ice in establishing priorities under its healthcare 

19 facility priority system. 

20 ‘‘(3) CONSULTATION.—In preparing each report 

21 required under paragraph (2) (other than the initial 

22 report) the Secretary shall annually—

23 ‘‘(A) consult with, and obtain information 

24 on all healthcare facilities needs from, Indian 

25 tribes and tribal organizations including those 
397

•HR 3459 IH 

1 tribes or tribal organizations operating health 

2 programs or facilities under any funding agree3 ment entered into with the Service under the 

4 Indian Self-Determination and Education As5 sistance Act; and 

6 ‘‘(B) review the total unmet needs of all 

7 tribes and tribal organizations for healthcare 

8 facilities (including staff quarters), including 

9 needs for renovation and expansion of existing 

10 facilities. 

11 ‘‘(4) CRITERIA.—For purposes of this sub12 section, the Secretary shall, in evaluating the needs 

13 of facilities operated under any funding agreement 

14 entered into with the Service under the Indian Self15 Determination and Education Assistance Act, use 

16 the same criteria that the Secretary uses in evalu17 ating the needs of facilities operated directly by the 

18 Service. 

19 ‘‘(5) EQUITABLE INTEGRATION.—The Secretary 

20 shall ensure that the planning, design, construction, 

21 and renovation needs of Service and non-Service fa22 cilities, operated under funding agreements in ac23 cordance with the Indian Self-Determination and 

24 Education Assistance Act are fully and equitably in25 tegrated into the healthcare facility priority system. 
398

•HR 3459 IH 

1 ‘‘(d) REVIEW OF NEED FOR FACILITIES.—

2 ‘‘(1) REPORT.—Beginning in 2005, the Sec3 retary shall annually submit to the President and 

4 Congress a report which sets forth the needs of the 

5 Service and all Indian tribes and tribal organiza6 tions, including urban Indian organizations, for in7 patient, outpatient and specialized care facilities, in8 cluding the needs for renovation and expansion of 

9 existing facilities. 

10 ‘‘(2) CONSULTATION.—In preparing each report 

11 required under paragraph (1) (other than the initial 

12 report), the Secretary shall consult with Indian 

13 tribes and tribal organizations including those tribes 

14 or tribal organizations operating health programs or 

15 facilities under any funding agreement entered into 

16 with the Service under the Indian Self-Determina17 tion and Education Assistance Act, and with urban 

18 Indian organizations. 

19 ‘‘(3) CRITERIA.—For purposes of this sub20 section, the Secretary shall, in evaluating the needs 

21 of facilities operated under any funding agreement 

22 entered into with the Service under the Indian Self23 Determination and Education Assistance Act, use 

24 the same criteria that the Secretary uses in evalu-
399

•HR 3459 IH 

1 ating the needs of facilities operated directly by the 

2 Service. 

3 ‘‘(4) EQUITABLE INTEGRATION.—The Secretary 

4 shall ensure that the planning, design, construction, 

5 and renovation needs of facilities operated under 

6 funding agreements, in accordance with the Indian 

7 Self-Determination and Education Assistance Act, 

8 are fully and equitably integrated into the develop9 ment of the health facility priority system. 

10 ‘‘(5) ANNUAL NOMINATIONS.—Each year the 

11 Secretary shall provide an opportunity for the nomi12 nation of planning, design, and construction projects 

13 by the Service and all Indian tribes and tribal orga14 nizations for consideration under the healthcare fa15 cility priority system. 

16 ‘‘(e) INCLUSION OF CERTAIN PROGRAMS.—All funds 

17 appropriated under the Act of November 2, 1921 (25 

18 U.S.C. 13), for the planning, design, construction, or ren19 ovation of health facilities for the benefit of an Indian 

20 tribe or tribes shall be subject to the provisions of section 

21 102 of the Indian Self-Determination and Education As22 sistance Act. 

23 ‘‘(f) INNOVATIVE APPROACHES.—The Secretary shall 

24 consult and cooperate with Indian tribes, tribal organiza25 tions and urban Indian organizations in developing inno-
400

•HR 3459 IH 

1 vative approaches to address all or part of the total unmet 

2 need for construction of health facilities, including those 

3 provided for in other sections of this title and other ap4 proaches. 

5 ‘‘(g) LOCATION OF FACILITIES.—

6 ‘‘(1) PRIORITY.—The Bureau of Indian Affairs 

7 and the Service shall, in all matters involving the re8 organization or development of Service facilities, or 

9 in the establishment of related employment projects 

10 to address unemployment conditions in economically 

11 depressed areas, give priority to locating such facili12 ties and projects on Indian lands if requested by the 

13 Indian owner and the Indian tribe with jurisdiction 

14 over such lands or other lands owned or leased by 

15 the Indian tribe or tribal organization so long as pri16 ority is given to Indian land owned by an Indian 

17 tribe or tribes. 

18 ‘‘(2) DEFINITION.—In this subsection, the term 

19 ‘Indian lands’ means— 

20 ‘‘(A) all lands within the exterior bound21 aries of any Indian reservation; 

22 ‘‘(B) any lands title to which is held in 

23 trust by the United States for the benefit of 

24 any Indian tribe or individual Indian, or held by 

25 any Indian tribe or individual Indian subject to
401

•HR 3459 IH 

1 restriction by the United States against alien2 ation and over which an Indian tribe exercises 

3 governmental power; and 

4 ‘‘(C) all lands in Alaska owned by any 

5 Alaska Native village, or any village or regional 

6 corporation under the Alaska Native Claims 

7 Settlement Act, or any land allotted to any 

8 Alaska Native. 

9 ‘‘(h) DEFINITIONS.—For purposes of this section, the 

10 definitions contained in section 4 of the Indian Health 

11 Care Improvement Act shall apply. 

12 ‘‘SEC. 2971C. RECONSTRUCTION AND IMPROVEMENT 

13 GRANTS FOR PUBLIC HEALTH CARE FACILI14 TIES SERVING PACIFIC ISLANDERS AND THE 

15 INSULAR AREAS. 

16 ‘‘(a) IN GENERAL.—The Secretary shall provide di17 rect financial assistance to designated healthcare providers 

18 and community health centers in American Samoa, Guam, 

19 the Commonwealth of the Northern Mariana Islands, the 

20 United States Virgin Islands, Puerto Rico, and Hawaii for 

21 the purposes of reconstructing and improving health care 

22 facilities and services. 

23 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi24 nancial assistance under subsection (a), an entity shall be 

25 a public health facility or community health center located 
402

•HR 3459 IH 

1 in American Samoa, Guam, or the Commonwealth of the 

2 Northern Mariana Islands, the United States Virgin Is3 lands, Puerto Rico, and Hawaii that—

4 ‘‘(1) is owned or operated by—

5 ‘‘(A) the government of American Samoa, 

6 Guam, or the Commonwealth of the Northern 

7 Mariana Islands, the United States Virgin Is8 lands, Puerto Rico, and Hawaii or a unit of 

9 local government; or 

10 ‘‘(B) a nonprofit organization; and 

11 ‘‘(2)(A) provides care or treatment for a sub12 stantial number of patients who are uninsured, re13 ceiving assistance under a State program under a 

14 title XVIII of the Social Security Act, or a State 

15 program under title XIX of such Act, or who are 

16 members of a vulnerable population, as determined 

17 by the Secretary; or 

18 ‘‘(B) serves a disproportionate percentage of 

19 local, minority racial and ethnic patients. 

20 ‘‘(c) REPORT.—Not later than 180 days after the 

21 date of enactment of this title and annually thereafter, the 

22 Secretary shall submit to the Congress and the President 

23 a report that includes an assessment of health resources 

24 and facilities serving populations in American Samoa, 

25 Guam, and the Commonwealth of the Northern Mariana 
403

•HR 3459 IH 

1 Islands, the United States Virgin Islands, Puerto Rico, 

2 and Hawaii. In preparing such report, the Secretary 

3 shall—

4 ‘‘(1) consult with and obtain information on all 

5 healthcare facilities needs from the entities described 

6 in subsection (b); and 

7 ‘‘(2) include all amounts of Federal assistance 

8 received by each entity in the preceding fiscal year; 

9 ‘‘(3) review the total unmet needs of each juris10 diction for healthcare facilities, including needs for 

11 renovation and expansion of existing facilities; and 

12 ‘‘(4) include a strategic plan for addressing the 

13 needs of each jurisdiction identified in the report. 

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

15 is authorized to be appropriated such sums as necessary 

16 to carry out this section. 

17 ‘‘CHAPTER 2—NATIONAL HEALTH SAFETY 

18 NET INFRASTRUCTURE. 

19 ‘‘Subchapter A—General Provisions 

20 ‘‘SEC. 2972. PAYMENTS TO HEALTHCARE FACILITIES. 

21 ‘‘(a) IN GENERAL.—The Secretary, with the approval 

22 of the Health Safety Net Infrastructure Trust Fund 

23 Board of Trustees described in section 2972C(d) (here24 after in this subtitle referred to as the ‘Trust Fund 

25 Board’), shall make payments, from amounts in the 
404

•HR 3459 IH 

1 Health Safety Net Infrastructure Trust Fund established 

2 under section 2972C(a) (hereafter in this subtitle referred 

3 to as the ‘Trust Fund’), for capital financing assistance 

4 to eligible healthcare facilities whose applications for as5 sistance have been approved under this subtitle. 

6 ‘‘(b) GENERAL ELIGIBILITY REQUIREMENTS FOR AS7 SISTANCE.—

8 ‘‘(1) ELIGIBLE HEALTHCARE FACILITIES DE9 SCRIBED.—

10 ‘‘(A) IN GENERAL.—A healthcare facility 

11 shall be generally eligible for capital financing 

12 assistance under this subtitle if the healthcare 

13 facility—

14 ‘‘(i) receives an additional payment 

15 under section 1886(d)(5)(F) of the Social 

16 Security Act and is described in clause 

17 (i)(II) or clause (vii)(I) of such section, or 

18 is deemed a disproportionate share hospital 

19 under a State plan for medical assistance 

20 under title XIX of the Social Security Act 

21 on the basis described in section 

22 1923(b)(1) of such Act; 

23 ‘‘(ii) is a hospital which meets the cri24 teria for designation by the Secretary as 

25 an essential access community hospital 
405

•HR 3459 IH 

1 under section 1820(i)(1) of such Act or a 

2 rural primary care hospital under section 

3 1820(i)(2) of such Act (whether or not 

4 such hospital is actually designated under 

5 such section);

6 ‘‘(iii) is a Federally qualified health 

7 center (as defined in section 1905(l)(2)(B) 

8 of such Act); 

9 ‘‘(iv) is a hospital which—

10 ‘‘(I) is a sole community pro11 vider; or 

12 ‘‘(II) has closed within the pre13 ceding 12 months; 

14 ‘‘(v) is a facility which—

15 ‘‘(I) provides service to ill or in16 jured individuals prior to the trans17 portation of such individuals to a hos18 pital or provides inpatient care to in19 dividuals needing such care for a pe20 riod not longer than 96 hours; 

21 ‘‘(II) is located in a county (or 

22 equivalent unit of local government) 

23 with fewer than 6 residents per 

24 square mile or is located more than 
406

•HR 3459 IH 

1 35 road miles from the nearest hos2 pital; 

3 ‘‘(III) permits a physician assist4 ant or nurse practitioner to admit and 

5 treat patients under the supervision of 

6 a physician not present in such facil7 ity; and 

8 ‘‘(IV) has obtained a waiver from 

9 the Secretary permitting the facility 

10 to participate in the medicare pro11 gram under title XVIII of the Social 

12 Security Act; or 

13 ‘‘(vi) is a hospital that the Secretary 

14 otherwise determines to be an appropriate 

15 recipient of assistance under this subtitle 

16 on the basis of the existence of a patient 

17 care operating deficit, a demonstrated in18 ability to secure or repay financing for a 

19 qualifying project on reasonable terms, or 

20 such other criteria as the Secretary con21 siders appropriate. 

22 ‘‘(B) DEVELOPMENT OF CRITERIA.—For 

23 purposes of subparagraph (A)(vi), with respect 

24 to rural hospitals which are at risk or critical 

25 to healthcare access, the Prospective Payment
407

•HR 3459 IH 

1 Review Commission, not later than January 1, 

2 1994, shall develop criteria to assist the Sec3 retary in deciding if such hospitals deserve as4 sistance, after considering, at a minimum, the 

5 following factors: 

6 ‘‘(i) AT-RISK RURAL HOSPITALS.—In 

7 the case of rural hospitals the closure of 

8 which within the next year is imminent or 

9 the continued operation of which over a 2- 

10 to 5-year period is questionable, such fac11 tors as the level of health resources avail12 able in a community as measured by physi13 cian supply, the population base of the 

14 area served by the hospital and utilization 

15 of services by such population as measured 

16 by service area population, and financial 

17 indicators predictive of closure. 

18 ‘‘(ii) RURAL HOSPITALS CRITICAL TO

19 HEALTHCARE ACCESS.—In the case of 

20 rural hospitals which provide access to es21 sential health services within a service area 

22 where no other provider of such essential 

23 services exists, such factors as the market 

24 share of the hospital for an area or popu25 lation, the number of outpatient visits, the 
408

•HR 3459 IH 

1 proximity of the next closest provider of 

2 such services, and the degree to which the 

3 area population is medically underserved. 

4 ‘‘(2) OWNERSHIP REQUIREMENTS.—In order to 

5 be eligible for assistance under this subtitle, a 

6 healthcare facility (other than a healthcare facility 

7 described in clauses (ii) and (v) of paragraph (1)) 

8 must—

9 ‘‘(A) be owned or operated by a unit of 

10 State or local government; 

11 ‘‘(B) be a quasi-public corporation, defined 

12 as a private, nonprofit corporation or public 

13 benefit corporation which is formally granted 

14 one or more governmental powers by legislative 

15 action through (or is otherwise partially funded 

16 by) the State legislature, city or county council; 

17 ‘‘(C) be a private nonprofit healthcare fa18 cility which has contracted with, or is otherwise 

19 funded by, a governmental agency to provide 

20 healthcare services to low income individuals 

21 not eligible for assistance under title XVIII or 

22 title XIX of the Social Security Act, where rev23 enue from such contracts constitute at least 10 

24 percent of the facility’s operating revenues over 

25 the prior 3 fiscal years; or 
409

•HR 3459 IH 

1 ‘‘(D) be a nonprofit small rural healthcare 

2 facility (as determined by the Secretary).

3 ‘‘(3) PRIORITY.—In making payments under 

4 this section, the Secretary shall give priority to eligi5 ble healthcare entities that are federally qualified 

6 health centers (as defined in section 1905(l)(2)(B) 

7 of the Social Security Act), or other similar entities 

8 at least 50 percent of the patients of which are mi9 nority or low-income individuals. 

10 ‘‘(c) MEETING ADDITIONAL SPECIFIC CRITERIA.—

11 Healthcare facilities that are generally eligible for assist12 ance under this subtitle under subsection (b) may apply 

13 for the specific programs described in this subtitle and 

14 must meet any additional criteria for participation in such 

15 programs. 

16 ‘‘(d) ASSISTANCE AVAILABLE.—Capital financing as17 sistance available under this subtitle shall include loan 

18 guarantees, interest rate subsidies, matching loans and di19 rect grants. Healthcare facilities determined to be gen20 erally eligible for assistance under this subtitle may apply 

21 for and receive more than one type of assistance under 

22 this subtitle. 
410

•HR 3459 IH 

1 ‘‘SEC. 2972A. APPLICATION FOR ASSISTANCE. 

2 ‘‘(a) IN GENERAL.—No healthcare facilities may re3 ceive assistance for a qualifying project under this subtitle 

4 unless the healthcare facility—

5 ‘‘(1) has filed with the Secretary, in a form and 

6 manner specified by the Secretary, with the advice 

7 and approval of the Trust Fund Board (as described 

8 in section 2972C(d)), an application for assistance 

9 under this subtitle; 

10 ‘‘(2) establishes in its application (for its most 

11 recent cost reporting period) that it meets the cri12 teria for general eligibility under this subtitle; 

13 ‘‘(3) includes a description of the project, in14 cluding the community in which it is located, and 

15 describes utilization and services characteristics of 

16 the project and the healthcare facility, and the pa17 tient population that is to be served; 

18 ‘‘(4) describes the extent to which the project 

19 will include the financial participation of State and 

20 local governments if assistance is granted under this 

21 subtitle, and all other sources of financing sought 

22 for the project; and 

23 ‘‘(5) establishes, to the satisfaction of the Sec24 retary and the Trust Fund Board, that the project 

25 meets the additional criteria for each type of capital 

26 financing assistance for which it is applying.
411

•HR 3459 IH 

1 ‘‘(b) CRITERIA FOR APPROVAL.—The Secretary, with 

2 the approval of the Trust Fund Board, shall determine 

3 for each application for assistance under this subtitle—

4 ‘‘(1) whether the healthcare facility meets the 

5 general eligibility criteria under section 2972(b); 

6 ‘‘(2) whether the healthcare facility meets the 

7 specific eligibility criteria of each type of assistance 

8 for which it has applied, including whether the 

9 healthcare facility meets any criteria for priority 

10 consideration for the type of assistance for which it 

11 has applied; 

12 ‘‘(3) whether the capital project for which as13 sistance is being requested is a qualifying project 

14 under this subtitle; and 

15 ‘‘(4) whether funds are available, pursuant to 

16 the limitations of each program, to fully fund the re17 quest for assistance. 

18 ‘‘(c) PRIORITY OF APPLICATIONS.—In addition to 

19 meeting the criteria otherwise described in this subtitle, 

20 at the discretion of the Trust Fund Board, the Secretary 

21 shall give preference to those applications for qualifying 

22 projects that—

23 ‘‘(1)(A) are necessary to bring existing safety 

24 net healthcare facilities into compliance with accredi25 tation standards of fire and life safety, seismic, or 
412

•HR 3459 IH 

1 other related Federal, State or local regulatory 

2 standards; 

3 ‘‘(B) improve the provision of essential services 

4 such as emergency medical and trauma services, 

5 AIDS and infectious disease, perinatal, burn, pri6 mary care, and other services which the Trust Fund 

7 Board may designate; or 

8 ‘‘(C) provide access to otherwise unavailable es9 sential health services to the indigent and other 

10 needy persons within the healthcare facility’s terri11 torial area; 

12 ‘‘(2) include specific State or local governmental 

13 or other non-Federal assurances of financial support 

14 if assistance for a qualifying project is granted 

15 under this subtitle; and 

16 ‘‘(3) are unlikely to be financed without assist17 ance granted under this subtitle. 

18 ‘‘(d) SUBMISSION OF APPLICATIONS.—Applications 

19 under this subtitle shall be submitted to the Secretary 

20 through the Trust Fund Board. If two or more healthcare 

21 facilities join in the project, the application shall be sub22 mitted by all participating healthcare facilities jointly. 

23 Such applications shall set forth all of the descriptions, 

24 plans, specifications, and assurances as required by this
413

•HR 3459 IH 

1 subtitle and contain other such information as the Trust 

2 Fund Board shall require. 

3 ‘‘(e) OPPORTUNITY FOR APPEAL.—The Trust Fund 

4 Board shall afford a healthcare facility applying for a loan 

5 guarantee under this section an opportunity for a hearing 

6 if the guarantee is denied. 

7 ‘‘(f) APPLICATIONS FOR AMENDMENTS.—Amend8 ment of an approved application shall be subject to ap9 proval in the same manner as an original application. 

10 ‘‘SEC. 2972B. PUBLIC SERVICE RESPONSIBILITIES. 

11 ‘‘(a) IN GENERAL.—Any healthcare facility accepting 

12 capital financing assistance under this subtitle shall 

13 agree—

14 ‘‘(1) to make the services of the facility or por15 tion thereof to be constructed, acquired, or modern16 ized available to all persons; and 

17 ‘‘(2) to provide a significant volume of services 

18 to persons unable to pay therefore, consistent with 

19 other provisions of this Act and the amount of as20 sistance received under this subtitle. 

21 ‘‘(b) ENFORCEMENT.—The Director of the Office for 

22 Civil Rights of the Department of Health and Human 

23 Services shall be given the power to enforce the public 

24 service responsibilities described in this section. 
414

•HR 3459 IH 

1 ‘‘SEC. 2972C. HEALTH SAFETY NET INFRASTRUCTURE 

2 TRUST FUND. 

3 ‘‘(a) CREATION OF TRUST FUND.—There is estab4 lished in the Treasury of the United States a trust fund 

5 to be known as the Health Safety Net Infrastructure 

6 Trust Fund, consisting of such amounts as may be trans7 ferred, appropriated, or credited to such Trust Fund as 

8 provided in this subtitle. 

9 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS TO

10 TRUST FUND.—There are authorized to be appropriated 

11 to the Trust Fund such sums as may be necessary to carry 

12 out the purposes of this subtitle. 

13 ‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts 

14 in the Trust Fund shall be available, pursuant to appro15 priations Acts, only for making expenditures to carry out 

16 the purposes of this subtitle. 

17 ‘‘(d) BOARD OF TRUSTEES; COMPOSITION; MEET18 INGS; DUTIES.—

19 ‘‘(1) IN GENERAL.—There shall be created a 

20 Health Safety Net Infrastructure Trust Fund Board 

21 of Trustees composed of the Secretary of Health and 

22 Human Services, the Secretary of the Treasury, the 

23 Assistant Secretary for Health, the Director of the 

24 Office of Minority Health, and the Administrator of 

25 the Centers for Medicare and Medicaid Services (all 

26 serving in their ex officio capacities), and 5 public 
415

•HR 3459 IH 

1 members who shall be appointed for 4 year terms by 

2 the President, from the following categories—

3 ‘‘(A) one chief health officer from a State;

4 ‘‘(B) one chief executive officer of a 

5 healthcare facility that meets the general eligi6 bility criteria of this subtitle; 

7 ‘‘(C) one representative of the financial 

8 community; and 

9 ‘‘(D) two additional public or consumer 

10 representatives.

11 ‘‘(2) DUTIES.—The Board of Trustees shall 

12 meet no less than quarterly and shall have the re13 sponsibility to approve implementing regulations, to 

14 establish criteria, and to recommend and approve ex15 penditures by the Secretary under the programs set 

16 forth in this subtitle. 

17 ‘‘(3) MANAGING TRUSTEE.—The Secretary of 

18 the Treasury shall serve as the Managing Trustee of 

19 the Trust Fund, and shall be responsible for the in20 vestment of funds. The provisions of subsections (b) 

21 through (e) of section 1817 of the Social Security 

22 Act shall apply to the Trust Fund and the Managing 

23 Trustee of the Trust Fund in the same manner as 

24 they apply to the Federal Hospital Insurance Trust 
416

•HR 3459 IH 

1 Fund and the Managing Trustee of that Trust 

2 Fund. 

3 ‘‘SEC. 2972D. ADMINISTRATION. 

4 ‘‘(a) IN GENERAL.—The Administrator of the Cen5 ters for Medicare and Medicaid Services shall serve as Sec6 retary of the Board of Trustees and shall administer the 

7 programs under this subtitle. 

8 ‘‘(b) LIMITATION ON ADMINISTRATIVE EXPENSES.—

9 Not more than 5 percent of the funds annually appro10 priated to the Trust Fund may be available for adminis11 tration of the Trust Fund or programs under this subtitle. 

12 ‘‘Subchapter B—Loan Guarantees 

13 ‘‘SEC. 2973. PROVISION OF LOAN GUARANTEES TO SAFETY 

14 NET HEALTHCARE FACILITIES. 

15 ‘‘(a) IN GENERAL.—The Safety Net Infrastructure 

16 Trust Fund will provide a Federal guarantee of loan re17 payment, including guarantees of repayment of refi18 nancing loans, to non-Federal lenders making loans to eli19 gible healthcare facilities for healthcare facility replace20 ment (either by construction or acquisition), moderniza21 tion and renovation projects, and capital equipment acqui22 sition. 

23 ‘‘(b) PURPOSES.—The loan guarantee program shall 

24 be designed by the Trust Fund Board with the goal of 

25 rebuilding and maintaining the essential health services of 
417

•HR 3459 IH 

1 healthcare facilities eligible for assistance under this sub2 title. 

3 ‘‘SEC. 2973A. ELIGIBLE LOANS. 

4 ‘‘(a) IN GENERAL.—Loan guarantees under this 

5 chapter are available for loans made to eligible healthcare 

6 facilities for replacement facilities (either newly con7 structed or acquired), modernization and renovation of ex8 isting facilities, and for capital equipment acquisition. 

9 ‘‘(b) LOAN GUARANTEE MUST BE ESSENTIAL TO

10 BOND FINANCING.—Eligible healthcare facilities must 

11 demonstrate that a Federal loan guarantee is essential to 

12 obtaining bond financing from non-Federal lenders at a 

13 reasonably affordable rate of interest. 

14 ‘‘(c) ADDITIONAL ELIGIBILITY CRITERIA FOR LOAN

15 GUARANTEES.—In order to be eligible for assistance 

16 under this chapter, a healthcare facility must demonstrate 

17 that the following criteria are met: 

18 ‘‘(1) The healthcare facility has evidence of an 

19 ability to meet debt service. 

20 ‘‘(2) The assistance, when considered with other 

21 resources available to the project, is necessary and 

22 will restore, improve, or maintain the financial or 

23 physical soundness of the healthcare facility. 

24 ‘‘(3) The applicant agrees to assume the public 

25 service responsibilities described in section 2972B. 
418

•HR 3459 IH 

1 ‘‘(4) The project is being, or will be, operated 

2 and managed in accordance with a management-im3 provement-and-operating plan which is designed to 

4 reduce the operating costs of the project, which has 

5 been approved by the Trust Fund Board, and which 

6 includes—

7 ‘‘(A) a detailed maintenance schedule; 

8 ‘‘(B) a schedule for correcting past defi9 ciencies in maintenance, repairs, and replace10 ments; 

11 ‘‘(C) a plan to upgrade the project to meet 

12 cost-effective energy efficiency standards pre13 scribed by the Trust Fund Board; 

14 ‘‘(D) a plan to improve financial and man15 agement control systems; 

16 ‘‘(E) a detailed annual operating budget 

17 taking into account such standards for oper18 ating costs in the area as may be determined by 

19 the Trust Fund Board; and 

20 ‘‘(F) such other requirements as the Trust 

21 Fund Board may determine. 

22 ‘‘(5) The application includes stringent provi23 sions for continued State or local support of the pro24 gram, both with respect to operating and financial 

25 capital.
419

•HR 3459 IH 

1 ‘‘(6) The terms, conditions, maturity, security 

2 (if any), and schedule and amount of repayments 

3 with respect to the loan are sufficient to protect the 

4 financial interests of the United States and are oth5 erwise reasonable and in accord with regulation, in6 cluding a determination that the rate of interest 

7 does not exceed such annual percentage on the prin8 cipal obligation outstanding as the Trust Fund 

9 Board determines to be reasonable, taking into ac10 count the range of interest rates prevailing in the 

11 private market for similar loans and the risks as12 sumed by the United States.

13 ‘‘(7) The healthcare facility must meet such 

14 other additional criteria as the Secretary may im15 pose. 

16 ‘‘(e) STATE OR LOCAL PARTICIPATION.—Projects in 

17 which State or local governmental entities participate in 

18 the form of first guarantees of part or all of the total loan 

19 value shall be given a preference for loan guarantees under 

20 this chapter. 

21 ‘‘SEC. 2973B. GUARANTEE ALLOTMENTS. 

22 ‘‘(a) IN GENERAL.—$150,000,000 shall be annually 

23 allocated within the Trust Fund to the loan guarantee pro24 gram established by this chapter in order to create a cu25 mulative reserve in support of loan guarantees. 
420

•HR 3459 IH 

1 ‘‘(b) LOAN GUARANTEES FOR RURAL HEALTHCARE

2 FACILITIES.—At least 20 percent of the dollar value of 

3 loan guarantees made under this program during any 

4 given year shall be allocated for eligible rural healthcare 

5 facilities, to the extent a sufficient number of applications 

6 are made by such healthcare facilities.

7 ‘‘(c) GUARANTEES FOR SMALL LOANS.—At least 

8 $200,000,000 of the annual dollar value of loan guaran9 tees made under the program shall be reserved for loans 

10 of under $50,000,000, if there are a sufficient number of 

11 applicants for loans of that size. 

12 ‘‘(d) SPECIAL RULE FOR REFINANCING LOANS.—

13 Not more than 20 percent of the amount allocated each 

14 year to the loan guarantee program established by this 

15 chapter may be allocated to guarantee refinancing loans 

16 during the year. 

17 ‘‘SEC. 2973C. TERMS AND CONDITIONS OF LOAN GUARAN18 TEES. 

19 ‘‘(a) IN GENERAL.—The principal amount of the 

20 guaranteed loan, when added to any Federal grant assist21 ance made under this subtitle, may not exceed 95 percent 

22 of the total value of the project, including land. 

23 ‘‘(b) GUARANTEES PROVIDED MAY NOT SUPPLANT

24 OTHER FUNDS.—Guarantees provided under this chapter 
421

•HR 3459 IH 

1 may not be used to supplant other forms of State or local 

2 support. 

3 ‘‘(c) RIGHT TO RECOVER FUNDS.—The United 

4 States shall be entitled to recover from any applicant 

5 healthcare facility the amount of payments made pursuant 

6 to any loan guarantee under this chapter, unless the Trust 

7 Fund Board for good cause waives its right of recovery, 

8 and the United States shall, upon making any such pay9 ment pursuant to any such loan guarantee be subrogated 

10 to all of the rights of the recipients of the payments. 

11 ‘‘(d) MODIFICATION OF TERMS.—Loan guarantees 

12 made under this chapter shall be subject to further terms 

13 and conditions as the Trust Fund Board determines to 

14 be necessary to assure that the purposes of this Act will 

15 be achieved, and any such terms and conditions may be 

16 modified by the Trust Fund Board to the extent that it 

17 determines such modifications to be consistent with the 

18 financial interest of the United States. 

19 ‘‘(e) TERMS ARE INCONTESTABLE ABSENT FRAUD

20 OR MISREPRESENTATION.—Any loan guarantee made by 

21 the Trust Fund Board pursuant to this chapter shall be 

22 incontestable in the hands of an applicant on whose behalf 

23 such guarantee is made, and as to any person who makes 

24 or contracts to make a loan to such applicant in reliance 
422

•HR 3459 IH 

1 thereon, except for fraud or misrepresentation on the part 

2 of such applicant or other person. 

3 ‘‘SEC. 2973D. PREMIUMS FOR LOAN GUARANTEES. 

4 ‘‘(a) IN GENERAL.—The Trust Fund Board shall de5 termine a reasonable loan insurance premium which shall 

6 be charged for loan guarantees under this chapter, taking 

7 into account the availability of the reserves created under 

8 section 2973B. Premium charges shall be payable in cash 

9 to the Trust Fund Board, either in full upon issuance, 

10 or annually in advance. In addition to the premium charge 

11 herein provided for, the Trust Fund Board is authorized 

12 to charge and collect such amount as it may deem reason13 able for the appraisal of a property or project offered for 

14 insurance and for the inspection of such property or 

15 project.

16 ‘‘(b) PAYMENT IN ADVANCE.—In the event that the 

17 principal obligation of any loan accepted for insurance 

18 under this chapter is paid in full prior to the maturity 

19 date, the Trust Fund Board is authorized in its discretion 

20 to require the payment by the borrower of an adjusted 

21 premium charge in such amount as the Board determines 

22 to be equitable, but not in excess of the aggregate amount 

23 of the premium charges that the healthcare facility would 

24 otherwise have been required to pay if the loan had contin25 ued to be insured until maturity date. 
423

•HR 3459 IH 

1 ‘‘(c) TRUST FUND BOARD MAY WAIVE PREMIUMS.—

2 The Trust Fund Board may in its discretion partially or 

3 totally waive premiums charged for loan insurance under 

4 this section for financially distressed healthcare facilities 

5 (as described by the Secretary). 

6 ‘‘SEC. 2973E. PROCEDURES IN THE EVENT OF LOAN DE7 FAULT. 

8 ‘‘(a) IN GENERAL.—Failure of the borrower to make 

9 payments due under or provided by the terms of a loan 

10 accepted for insurance under this chapter shall constitute 

11 a default. 

12 ‘‘(b) ASSIGNMENT OF DEFAULTED LOANS.—If a de13 fault continues for 30 days, then, upon the lender’s trans14 fer to the Trust Fund Board of all its rights and interests 

15 arising under the defaulted loan or in connection with the 

16 loan transaction, the lender shall be entitled to debentures 

17 which, together with a certificate of claim, are equal in 

18 value to the amount the lender would have received if, on 

19 the date of transfer, the borrower had repaid the loan in 

20 full, together with the amount of necessary expenses in21 curred by the lender in connection with the default.

22 ‘‘(c) FORECLOSURE BY LENDER.—Subject to the ap23 proval of the Trust Fund Board, or as provided in regula24 tions, the lender may foreclose on the property securing 

25 the defaulted loan. 
424

•HR 3459 IH 

1 ‘‘(d) FORECLOSURE BY TRUST FUND BOARD.—The 

2 Trust Fund Board is authorized to—

3 ‘‘(1) acquire possession of and title to any prop4 erty securing a defaulted loan by voluntary convey5 ance in extinguishment of the indebtedness, or 

6 ‘‘(2) institute proceedings for foreclosure on the 

7 property securing any such defaulted loan and pros8 ecute such proceedings to conclusion. 

9 ‘‘(e) HANDLING AND DISPOSAL OF PROPERTY; SET10 TLEMENT OF CLAIMS.—

11 ‘‘(1) PAYMENT FOR CERTAIN EXPENSES.—Not12 withstanding any other provision of law relating to 

13 the acquisition, handling, or disposal of real and 

14 other property by the United States, the Trust Fund 

15 Board shall also have power, for the protection of 

16 the interests of the Trust Fund, to pay out of the 

17 Trust Fund all expenses or charges in connection 

18 with, and to deal with, complete, reconstruct, rent, 

19 renovate, modernize, insure, make contracts for the 

20 management of, or establish suitable agencies for 

21 the management of, or sell for cash or credit or lease 

22 in its discretion, any property acquired by the Trust 

23 Fund under this section. 

24 ‘‘(2) SETTLEMENT OF CLAIMS.—Notwith25 standing any other provision of law, the Trust Fund
425

•HR 3459 IH 

1 Board shall also have the power to pursue to final 

2 collection by way of compromise or otherwise all 

3 claims assigned and transferred to the Trust Fund 

4 in connection with the assignment, transfer, and de5 livery provided for in this section, and at any time, 

6 upon default, to foreclose or refrain from foreclosing 

7 on any property secured by any defaulted loan as8 signed and transferred to or held by the Trust 

9 Fund.

10 ‘‘(3) LIMITATIONS ON AUTHORITY.—Sub11 sections (a) and (b) shall not be construed to apply 

12 to any contract for hazard insurance, or to any pur13 chase or contract for services or supplies on account 

14 of such property if the amount thereof does not ex15 ceed $1,000.

16 ‘‘(f) REGULATIONS.—The Trust Fund Board shall 

17 propose and the Secretary shall promulgate regulations 

18 governing procedures in the event of a default on a loan 

19 accepted for insurance under this chapter. 

20 ‘‘Subchapter C—Grants for Urgent Capital 

21 Needs 

22 ‘‘SEC. 2976. PROVISION OF GRANTS. 

23 ‘‘(a) IN GENERAL.—The Trust Fund Board shall 

24 make available $400,000,000 in direct grants annually. 

25 The Secretary, with the approval of the Trust Fund 
426

•HR 3459 IH 

1 Board, shall make direct grants to eligible healthcare fa2 cilities with urgent capital needs. 

3 ‘‘(b) PURPOSES.—Direct grants shall be available to 

4 eligible healthcare facilities for 3 types of projects: 

5 ‘‘(1) Emergency certification and licensure 

6 grants would be available to eligible healthcare facili7 ties that are threatened with closure or loss of ac8 creditation or certification of a facility or of essential 

9 services as a result of life or safety code violations 

10 or similar facility or equipment failures. Such grants 

11 would provide limited funding for repair and renova12 tion where failure to fund would disrupt the provi13 sion of essential public health services such as emer14 gency care. 

15 ‘‘(2) Emergency grants would be available for 

16 capital renovation, expansion, or replacement nec17 essary to the maintenance or expansion of essential 

18 safety and health services such as obstetrics, 

19 perinatal, emergency and trauma, primary care and 

20 preventive health services. 

21 ‘‘(3) Planning grants would be available to eli22 gible healthcare facilities who require pre-approval 

23 assistance to meet regulatory requirements related 

24 to management and finance in order to apply for 
427

•HR 3459 IH 

1 loans, loan guarantees, and interest subsidies under 

2 this subtitle. 

3 ‘‘(c) PRIORITY TO FINANCIALLY DISTRESSED

4 HEALTHCARE FACILITIES.—Priority for direct grants 

5 under this section would be given to financially distressed 

6 healthcare facilities (as described by the Secretary). 

7 ‘‘(d) APPLICATION PROCESS.—The Secretary, with 

8 the approval of the Trust Fund Board, shall create an 

9 expedited application process for direct grants. 

10 ‘‘SEC. 2976B. ELIGIBLE PROJECTS. 

11 ‘‘(a) MATCHING GRANTS.—

12 ‘‘(1) LIMITATION ON AMOUNT.—Grants for cap13 ital expenditures by eligible healthcare facilities will 

14 be limited to $25,000,000. 

15 ‘‘(2) MATCHING REQUIREMENT.—At least half 

16 of the projects funded in a year must receive at least 

17 50 percent of their funding from State or local 

18 sources. The remaining projects funded during the 

19 year could be financed up to 90 percent with a com20 bination of Federal grants and loans. 

21 ‘‘(3) RESERVATION FOR RURAL HEALTHCARE

22 FACILITIES.—No less than 20 percent of the grant 

23 funds in any given year would be reserved for rural 

24 healthcare facilities, provided that a sufficient num25 ber of applications are approved. 
428

•HR 3459 IH 

1 ‘‘(b) PLANNING GRANTS.—Applicants who can dem2 onstrate general qualification for the direct matching loan, 

3 loan guarantee, or interest subsidy programs under this 

4 subtitle or eligibility for mortgage insurance under section 

5 242 of the National Housing Act will be eligible for a 

6 grant of up to $500,000 to assist in implementation of 

7 key budgetary and financial systems as well as manage8 ment and governance restructuring.’’. 

9 TITLE VIII—MISCELLANEOUS 

10 PROVISIONS 

11 SEC. 801. DEFINITIONS. 

12 For purposes of this Act (including the amendments 

13 made by this Act other than the amendments made by 

14 subtitles A through G of title I): 

15 (1) APPROPRIATE HEALTHCARE SERVICES.—

16 The term ‘‘appropriate healthcare services’’ includes 

17 services or treatments to address physical, mental, 

18 and behavioral diseases, conditions, or syndromes. 

19 The definition contained in this paragraph shall not 

20 apply for purposes of sections 206 and 606. 

21 (2) HISPANIC.—The term ‘‘Hispanic’’ means 

22 individuals whose origin is Mexican, Puerto Rican, 

23 Cuban, Central or South American, or any other 

24 Spanish-speaking country. 
429

•HR 3459 IH 

1 (3) INDIAN.—The term ‘‘Indian’’, unless other2 wise designated, means any person who is a member 

3 of an Indian tribe 

4 (4) INDIAN TRIBE.—The term ‘‘Indian tribe’’ 

5 means any Indian tribe, band, nation, or other orga6 nized group or community, including any Alaska Na7 tive village or group or regional or village corpora8 tion as defined in or established pursuant to the 

9 Alaska Native Claims Settlement Act (85 Stat. 688) 

10 (43 U.S.C. 1601 et seq.), which is recognized as eli11 gible for the special programs and services provided 

12 by the United States to Indians because of their sta13 tus as Indians. 

14 (5) LIMITED ENGLISH PROFICIENT.—The term 

15 ‘‘limited English proficient’’ with respect to an indi16 vidual means an individual who cannot speak, read, 

17 write, or understand the English language at a level 

18 that permits them to interact effectively with clinical 

19 or nonclinical staff at a healthcare organization. 

20 (6) MINORITY.—

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

22 and ‘‘minorities’’ refer to individuals from a mi23 nority group. 
430

•HR 3459 IH 

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

2 with respect to populations, refers to racial and 

3 ethnic minority groups. 

4 (7) MINORITY GROUP.—The term ‘‘minority 

5 group’’ has the meaning given the term ‘‘racial and 

6 ethnic minority group’’. 

7 (8) RACIAL AND ETHNIC MINORITY GROUP.—

8 The term ‘‘racial and ethnic minority group’’ means 

9 American Indians and Alaska Natives, African 

10 Americans (including Blacks), Asian Americans, 

11 Hispanics (including Latinos), and Native Hawai12 ians and other Pacific Islanders. 

13 (9) SECRETARY.—The term ‘‘Secretary’’ means 

14 the Secretary of Health and Human Services. 

15 (10) STATE.—The term ‘‘State’’ means each of 

16 the several states, the District of Columbia, the 

17 Commonwealth of Puerto Rico, the Indian tribes, 

18 the Virgin Islands, Guam, American Samoa, and the 

19 Commonwealth of the Northern Mariana Islands. 

20 (11) TRIBAL ORGANIZATION.—The term ‘‘tribal 

21 organization’’ means the elected governing body of 

22 any Indian tribe or any legally established organiza23 tion of Indians which is controlled by one or more 

24 such bodies or by a board of directors elected or se25 lected by one or more such bodies (or elected by the
431

•HR 3459 IH 

1 Indian population to be served by such organization) 

2 and which includes the maximum participation of 

3 Indians in all phases of its activities. 

4 (12) UNDERREPRESENTED MINORITY.—The 

5 terms ‘‘underrepresented minority’’ and ‘‘underrep6 resented minorities’’ refer to individuals who are 

7 members of racial or ethnic minority groups that are 

8 underrepresented in the health professions relative 

9 to their numbers in the general population. 

10 (13) UNDERSERVED POPULATIONS.—The term 

11 ‘‘underserved population’’ means the population of 

12 an urban or rural area designated by the Secretary 

13 as an area with a shortage of personal health serv14 ices or a population group designated by the Sec15 retary as having a shortage of such services. 

16 SEC. 802. DAVIS-BACON ACT. 

17 All laborers and mechanics employed by contractors 

18 or subcontractors in the performance of construction work 

19 financed in whole or in part with assistance under this 

20 Act (or an amendment made by this Act), including cap21 ital financing assistance, or grants or loan guarantees 

22 from the Safety Net Infrastructure Trust Fund (estab23 lished under section 2972C of the Public Health Service 

24 Act), shall be paid wages at rates not less than those pre25 vailing on similar work in the locality involved as deter-
432

•HR 3459 IH 

1 mined by the Secretary of Labor in accordance with sub2 chapter IV of chapter 31 of title 40, United States Code 

3 (commonly referred to as the Davis-Bacon Act). The Sec4 retary of Labor shall have, with respect to such labor 

5 standards, the authority and functions set forth in Reor6 ganization Plan Numbered 14 of 1950 (15 F.R. 3176; 64 

7 Stat 1267) and section 3145 of title 40, United States 

8 Code.

Æ