II 

116TH CONGRESS 

2D SESSION S. 4262 

To direct the Secretary of Health and Human Services to develop an action 

plan, make targeted grants, and develop public awareness campaigns 

with respect to COVID–19 and the disproportionate impact of the 

COVID–19 pandemic on racial and ethnic minorities and other vulnerable 

populations. 

IN THE SENATE OF THE UNITED STATES 

JULY 22, 2020 

Mr. MENENDEZ (for himself, Mr. CARDIN, Ms. WARREN, Mr. VAN HOLLEN, 

Mr. MARKEY, Ms. SMITH, Mr. BOOKER, Ms. CORTEZ MASTO, Mr. 

MERKLEY, Ms. HIRONO, Mr. SANDERS, Mrs. SHAHEEN, Mr. 

BLUMENTHAL, Ms. ROSEN, Ms. HARRIS, Ms. HASSAN, Mr. WARNER, and 

Ms. KLOBUCHAR) introduced the following bill; which was read twice and 

referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To direct the Secretary of Health and Human Services to 

develop an action plan, make targeted grants, and develop public awareness campaigns with respect to 

COVID–19 and the disproportionate impact of the 

COVID–19 pandemic on racial and ethnic minorities and 

other vulnerable populations. 

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


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘COVID–19 Health Disparities Action Act of 2020’’. 

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

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Health disparity-informed contact tracing grants. 

Sec. 3. COVID–19 health disparities action plan. 

Sec. 4. Federal public awareness campaigns to address health disparities. 

Sec. 5. Grant program for public awareness campaigns to address health disparities. 

Sec. 6. Vaccine safety public awareness campaign. 

Sec. 7. Addendum to testing plans to address disparities. 

Sec. 8. Definitions. 

6 SEC. 2. HEALTH DISPARITY-INFORMED CONTACT TRACING 

7 GRANTS. 

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

9 Human Services (referred to in this section as the ‘‘Sec10 retary’’), acting through the Director of the Centers for 

11 Disease Control and Prevention and in coordination with 

12 the Office of Minority Health of the Department of Health 

13 and Human Services, and, as appropriate, in coordination 

14 with the relevant Offices of Minority Health of the Depart15 ment of Health and Human Services, the National Insti16 tute of Minority Health and Health Disparities, and the 

17 Indian Health Service, shall award grants to eligible enti18 ties to conduct contact tracing operations, using amounts 

19 appropriated under the heading ‘‘Public Health and Social 

20 Services Emergency Fund’’ under the heading ‘‘Office of 

21 the Secretary’’ under the heading ‘‘Department of Health 


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1 and Human Services’’ of title I of division B of the Pay2 check Protection Program and Health Care Enhancement 

3 Act (Public Law 116–139). 

4 (b) ELIGIBLE ENTITIES.— 

5 (1) IN GENERAL.—To be eligible for a grant 

6 under this section, an entity shall— 

7 (A) be a State, local, Tribal, or territorial 

8 health department, a nonprofit community9 based organization, a nonprofit faith-based or10 ganization, an urban Indian organization, a 

11 Tribal organization, or a health care provider, 

12 serving one or more of the grant regions de13 scribed in paragraph (2); and 

14 (B) submit an application to the Secretary 

15 at such time, in such manner, and containing 

16 such information as the Secretary may require, 

17 including demographic data on the entity’s em18 ployees or projected hires at the time of submis19 sion. 

20 (2) GRANT REGIONS.—The Secretary may 

21 award grants to eligible entities serving one or more 

22 of the following: 

23 (A) A State. 

24 (B) A territory. 

25 (C) An Indian Tribe. 


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1 (D) A Tribal organization. 

2 (E) An urban Indian organization. 

3 (F) A county. 

4 (G) A metropolitan statistical area. 

5 (H) Any other city, town, or other public 

6 body created by, or pursuant to, State law. 

7 (3) PROHIBITION ON DISCRIMINATION.—Pro8 grams funded under this section shall not discrimi9 nate on the basis of actual or perceived sex, race, 

10 color, ethnicity, national origin, disability, sexual ori11 entation, gender identity, or religion. Nothing in this 

12 section shall be construed to invalidate or limit 

13 rights, remedies, procedures, or legal standards 

14 available under any other Federal law or any law of 

15 a State or a political subdivision of a State, includ16 ing the Civil Rights Act of 1964 (42 U.S.C. 2000a 

17 et seq.), title IX of the Education Amendments of 

18 1972 (20 U.S.C. 1681 et seq.), section 504 of the 

19 Rehabilitation Act of 1973 (29 U.S.C. 794), the 

20 Americans with Disabilities Act of 1990 (42 U.S.C. 

21 12101 et seq.), and section 1557 of the Patient Pro22 tection and Affordable Care Act (42 U.S.C. 18116). 

23 (c) PRIORITIZATION.—In awarding grants under sub24 section (a), the Secretary shall give special consideration 

25 to eligible entities that have demonstrated a commitment 


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1 to recruiting and retaining employees who are racial and 

2 ethnic minorities representative of the demographic 

3 groups of a grant area served by the entity, which may 

4 include entities that employ, or plan to employ, community 

5 health workers, as defined in section 2113(f)(4) of the So6 cial Security Act (42 U.S.C. 1397mm(f)(4)). 

7 (d) REPORTING.— 

8 (1) BY ENTITIES.—An eligible entity receiving 

9 a grant under this section shall report to the Sec10 retary demographic information of employees di11 rectly involved in contact tracing operations sup12 ported by such grant not later than 60 days after 

13 receipt of such grant. 

14 (2) BY THE SECRETARY.—Beginning not later 

15 than 90 days after the date on which the first grant 

16 is awarded under this section, the Secretary, in co17 ordination with the Deputy Assistant Secretary for 

18 Minority Health, the Director of the Centers for 

19 Disease Control and Prevention, and the Director of 

20 the Office of Minority Health and Health Equity at 

21 the Centers for Disease Control and Prevention, 

22 shall make public the data reported under paragraph 

23 (1). 


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1 SEC. 3. COVID–19 HEALTH DISPARITIES ACTION PLAN. 

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

3 Director of the Office of Minority Health of the Depart4 ment of Health and Human Services, shall develop an evi5 dence-based action plan (referred to in this section as the 

6 ‘‘action plan’’) for addressing health disparities related to 

7 COVID–19 testing, infections, hospitalizations, ICU ad8 missions, and deaths among racial and ethnic minority, 

9 rural, and other vulnerable populations. 

10 (b) COORDINATION.—In developing the action plan 

11 described in subsection (a), the Director of the Office of 

12 Minority Health shall coordinate with— 

13 (1) the Director of the Office of Minority 

14 Health and Health Equity of the Centers for Dis15 ease Control and Prevention; 

16 (2) the Director of the Office of Extramural 

17 Research, Education, and Priority Populations of 

18 the Agency for Healthcare Research and Quality; 

19 (3) the Director of the Office of Minority 

20 Health of the Centers for Medicare & Medicaid Serv21 ices; 

22 (4) the Director of the Office of Minority 

23 Health and Health Equity of the Food and Drug 

24 Administration; 


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1 (5) the Director of the Office of Health Equity 

2 of the Health Resources and Services Administra3 tion; 

4 (6) the Director of the Office of Behavioral 

5 Health Equity of the Substance Abuse and Mental 

6 Health Services Administration; 

7 (7) the Director of the National Institute of Mi8 nority Health and Health Disparities; and 

9 (8) the Director of the Indian Health Service. 

10 (c) LITERATURE REVIEW AND CONSULTATION.—In 

11 developing the action plan described in subsection (a), the 

12 Secretary shall— 

13 (1) review peer-reviewed literature to identify 

14 evidence-informed and evidence-based best practices 

15 for addressing health disparities among racial and 

16 ethnic minority, rural, and other vulnerable popu17 lations; and 

18 (2) consult with— 

19 (A) community-based organizations with 

20 expertise in addressing health disparities that 

21 affect racial and ethnic minority, rural, and 

22 other vulnerable populations; and 

23 (B) State, local, Tribal, and territorial 

24 health officials that serve areas with high con25 centrations of racial and ethnic minority, rural, 


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1 and other vulnerable populations that have been 

2 disproportionately impacted by the COVID–19 

3 pandemic. 

4 (d) REQUIREMENTS.—The action plan shall in5 clude— 

6 (1) a quantitative and qualitative analysis of 

7 the current barriers to complete and accurate data 

8 collection on health disparities related to COVID–19 

9 testing, infections, hospitalizations, ICU admissions, 

10 and deaths among racial and ethnic minority, rural, 

11 and other vulnerable populations; 

12 (2) a description of the health disparities that 

13 have been identified with current data related to 

14 COVID–19 testing, infections, hospitalizations, ICU 

15 admissions, and deaths among racial and ethnic mi16 nority, rural, and other vulnerable populations, using 

17 existing metrics where possible; 

18 (3) a description of the actions that the Sec19 retary will take to address the barriers to complete 

20 and accurate data collection on health disparities re21 lated to COVID–19 testing, infections, hospitaliza22 tions, ICU admissions, and deaths among racial and 

23 ethnic minority, rural, and other vulnerable popu24 lations, including specific dates by when such actions 


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1 will be completed and the metrics that will be used 

2 to evaluate the impact of such actions; 

3 (4) the actions that the Secretary will take to 

4 address the health disparities that have been identi5 fied with current data related to COVID–19 testing, 

6 infections, hospitalizations, ICU admissions, and 

7 deaths among racial and ethnic minority, rural, and 

8 other vulnerable populations, including specific dates 

9 by when such actions will be taken and completed 

10 and the metrics that will be used to evaluate the im11 pact of such actions; and 

12 (5) a summary of any additional resources that 

13 the Secretary requires in order to fully identify and 

14 address health disparities related to COVID–19 test15 ing, infections, hospitalizations, ICU admissions, and 

16 deaths among racial and ethnic minority, rural, and 

17 other vulnerable populations. 

18 (e) SUBMISSION OF ACTION PLAN AND REPORTS ON

19 THE ACTION PLAN.— 

20 (1) INITIAL ACTION PLAN.—Not later than 30 

21 days after the date of enactment of this Act, the 

22 Secretary shall submit the action plan to the Com23 mittee on Health, Education, Labor, and Pensions 

24 and the Committee on Finance of the Senate and 

25 the Committee on Energy and Commerce and the 


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1 Committee on Ways and Means of the House of 

2 Representatives, and make such plan publicly avail3 able on the internet website of the Department of 

4 Health and Human Services. 

5 (2) UPDATES.—Not later than 30 days after 

6 the date of publication of the initial action plan 

7 under paragraph (1), and at least every 30 days 

8 thereafter until the date that is 6 months after the 

9 COVID–19 public health emergency has ended, the 

10 Secretary shall submit updates to the action plan to 

11 Congress. Each such update shall provide updates 

12 on the Secretary’s actions and the relevant evalua13 tion metrics, and shall include any actions that the 

14 Secretary has identified since issuance of the initial 

15 action plan under paragraph (1) and any previous 

16 updates under this paragraph, as necessary to ad17 dress health disparities related to COVID–19 test18 ing, infections, hospitalizations, ICU admissions, and 

19 deaths among racial and ethnic minority, rural, and 

20 other vulnerable populations. The Secretary shall 

21 make each update publicly available on the internet 

22 website of the Department of Health and Human 

23 Services. 

24 (3) FINAL REPORT ON ACTION PLANS.—Not 

25 later than 1 year after the end of the COVID–19 


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1 public health emergency, the Secretary shall submit 

2 to Congress a final report analyzing the health dis3 parities related to COVID–19 testing, infections, 

4 hospitalizations, ICU admissions, and deaths among 

5 racial and ethnic minority, rural, and other vulner6 able populations, including an analysis of the social 

7 determinants of health and the underlying causes of 

8 health disparities. The report shall include— 

9 (A) the Secretary’s long-term plan for ad10 dressing racial and ethnic health disparities, in11 cluding an assessment of any additional re12 sources that may be required for the Office of 

13 Minority Health of the Department of Health 

14 and Human Services, or such department in 

15 general, to sustain long-term initiatives to ad16 dress racial and ethnic health disparities; and 

17 (B) recommendations for Congress to ad18 dress the underlying causes and prevent health 

19 disparities among racial and ethnic minority, 

20 rural, and other vulnerable populations during 

21 future public health emergencies. 

22 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

23 authorized to be appropriated to carry out this section 

24 $1,000,000 for fiscal year 2020. 


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1 SEC. 4. FEDERAL PUBLIC AWARENESS CAMPAIGNS TO AD2 DRESS HEALTH DISPARITIES. 

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

4 Director of the Centers for Disease Control and Preven5 tion and in coordination with the Office of Minority 

6 Health and, as appropriate, in coordination with the rel7 evant Offices of Minority Health in the Department of 

8 Health and Human Services, the National Institute of Mi9 nority Health and Health Disparities, and the Indian 

10 Health Service, shall develop and implement accessible, 

11 multilingual and culturally competent public awareness 

12 campaigns about COVID–19 directed at racial and ethnic 

13 minority, rural, and other vulnerable populations that 

14 have experienced health disparities during the COVID–19 

15 public health emergency related to testing, infections, hos16 pitalizations, ICU admissions, and deaths. 

17 (b) REQUIREMENTS.—The public awareness cam18 paigns under this section shall— 

19 (1) prioritize communities where the greatest 

20 health disparities have been identified with respect 

21 to testing access and rates of infections, hospitaliza22 tions, and deaths related to COVID–19; 

23 (2)(A) provide information, based on scientific 

24 evidence, about the benefits of being tested for 

25 COVID–19, the availability of COVID–19 testing 

26 with no cost-sharing for most United States resiVerDate Sep 11 2014 04:39 Aug 04, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S4262.IS S4262

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1 dents, and the actions that individuals can take to 

2 protect themselves from COVID–19, including mask3 ing and social distancing; and 

4 (B) dispel misinformation about COVID–19 

5 symptoms, testing, or treatment; and 

6 (3) use print, radio, or internet media, or other 

7 forms of public communication, including local, inde8 pendent, or community-based written news and elec9 tronic publications. 

10 (c) COORDINATION.—The public awareness cam11 paigns under this section shall be complementary to, and 

12 coordinated with, any other Federal, State, and local ef13 forts, including the action plan described in section 3, as 

14 appropriate. 

15 (d) REPORT TO CONGRESS.—Not later than 45 days 

16 after the date on which appropriated funds are made avail17 able to the Secretary under this section, the Secretary 

18 shall submit to Congress a report on how such funds have 

19 been used during such 45-day period and a plan for using 

20 any remaining funds within the next 45 days. 

21 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated to carry out this section 

23 $10,000,000 for fiscal year 2020. 


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1 SEC. 5. GRANT PROGRAM FOR PUBLIC AWARENESS CAM2 PAIGNS TO ADDRESS HEALTH DISPARITIES. 

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

4 Director of the Centers for Disease Control and Preven5 tion and in coordination with the Office of Minority 

6 Health, and, as appropriate, in coordination with the rel7 evant Offices of Minority Health in the Department of 

8 Health and Human Services, the National Institute of Mi9 nority Health and Health Disparities, and the Indian 

10 Health Service, shall award competitive grants to eligible 

11 entities to support such entities in developing and imple12 menting accessible, multilingual, and culturally competent 

13 public awareness campaigns about COVID–19 directed at 

14 racial and ethnic minority, rural, and other vulnerable 

15 populations that have experienced health disparities dur16 ing the COVID–19 public health emergency related to 

17 testing, infections, hospitalizations, ICU admissions, and 

18 deaths. 

19 (b) ELIGIBLE ENTITIES.—To be eligible to receive a 

20 grant under this section, an entity shall be a State, local, 

21 Tribal, or territorial health department, a nonprofit com22 munity-based organization, a Tribal organization, an 

23 urban Indian organization, or a health care provider, or 

24 a nonprofit faith-based organization. 

25 (c) PRIORITIZATION.—When awarding grants under 

26 this section, the Secretary shall prioritize entities serving 


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1 communities where the greatest health disparities exist 

2 with respect to testing access, infections, hospitalizations, 

3 and deaths related to COVID–19, impacting racial and 

4 ethnic minority, rural, and other vulnerable populations. 

5 (d) REQUIREMENTS.—An entity awarded a grant 

6 under this section shall conduct a public awareness cam7 paign that— 

8 (1)(A) provides to the public information, based 

9 on scientific evidence, about the benefits of being 

10 tested for COVID–19, the availability of COVID–19 

11 testing with no cost-sharing for most United States 

12 residents, and the actions that individuals can take 

13 to protect themselves from COVID–19, including 

14 masking and social distancing; and 

15 (B) dispels misinformation about COVID–19 

16 symptoms, testing, or treatment; 

17 (2) uses print, radio, or internet media, or 

18 other forms of public communication; and 

19 (3) communicates in the language or languages 

20 necessary to reach racial and ethnic minority, rural, 

21 and other vulnerable populations in the applicable 

22 region that have experienced health disparities dur23 ing the COVID–19 public health emergency related 

24 to testing, infections, hospitalizations, ICU admis25 sions, and deaths. 


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1 (e) COORDINATION.—The public health campaigns 

2 supported by grants awarded under this section shall be 

3 complementary to, and coordinated with, any other Fed4 eral, State, or local efforts, including the action plan de5 scribed in section 3, as appropriate. 

6 (f) TIMING.—The Secretary shall award the grants 

7 under this section not later than 60 days after the date 

8 of enactment of this Act. 

9 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

10 authorized to be appropriated to carry out this section 

11 $10,000,000 for fiscal year 2020. 

12 SEC. 6. VACCINE SAFETY PUBLIC AWARENESS CAMPAIGN. 

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

14 Director of the Centers for Disease Control and Preven15 tion and in coordination with the Office of Minority 

16 Health, and, as appropriate, the relevant Offices of Minor17 ity Health in the Department of Health and Human Serv18 ices, the National Institute of Minority Health and Health 

19 Disparities, and the Indian Health Service, shall establish 

20 grant funding opportunities for eligible entities to dissemi21 nate COVID–19 vaccination information. 

22 (b) ELIGIBLE ENTITIES.—To be eligible to receive a 

23 grant under this section, an entity shall be a State, local, 

24 Tribal, or territorial health department, an urban Indian 


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1 organization, a nonprofit community-based organization, 

2 or a nonprofit faith-based organization. 

3 (c) USE OF FUNDS.— 

4 (1) IN GENERAL.—Entities receiving a grant 

5 under this section shall use such grant funds to— 

6 (A) increase awareness to the benefit of re7 ceiving a COVID–19 vaccine, and include infor8 mation on where the vaccine can be obtained; 

9 and 

10 (B) create and disseminate culturally and 

11 linguistically appropriate messaging. 

12 (2) ADDITIONAL GRANT FUNDS.—The Sec13 retary shall have discretion to award additional 

14 grant funding under this section to broaden the 

15 grant recipient’s vaccine public safety awareness 

16 campaign to include routine immunizations and gen17 eral influenza vaccine messaging. 

18 (d) PRIORITIZATION.—In awarding grants under this 

19 section, the Secretary shall give priority to eligible entities 

20 in either urban or rural communities (or a combination 

21 of urban and rural communities) that serve vulnerable 

22 populations, including ethnic minority populations, which 

23 may include low-income, uninsured, and medically under24 served individuals or populations with historically low 

25 rates of receiving vaccines. 


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1 (e) TIMING.—The Secretary shall awards the grants 

2 under this section not later than 60 days after the date 

3 on the earlier of the date on which the Food and Drug 

4 Administration licenses a COVID–19 vaccine under sec5 tion 351 of the Public Health Service Act (42 U.S.C. 262) 

6 or the date on which a manufacturer begins to distribute 

7 a COVID–19 vaccine to public or private entities pursuant 

8 to an emergency use authorization under section 564 of 

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

10 360bbb–3). 

11 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

12 authorized to be appropriated to carry out this section 

13 $5,000,000 for fiscal year 2020. 

14 SEC. 7. ADDENDUM TO TESTING PLANS TO ADDRESS DIS15 PARITIES. 

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

17 Director of the Centers for Disease Control and Preven18 tion, shall report to the Committee on Appropriations and 

19 the Committee on Health, Education, Labor, and Pen20 sions of the Senate, and the Committee on Appropriations 

21 and the Committee on Energy and Commerce of the 

22 House of Representatives, on State testing plans referred 

23 to under the heading ‘‘Public Health and Social Services 

24 Emergency Fund’’ under the heading ‘‘Office of the Sec25 retary’’ under the heading ‘‘Department of Health and 


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1 Human Services’’ of title I of division B of the Paycheck 

2 Protection Program and Health Care Enhancement Act 

3 (Public Law 116–139). 

4 (b) REQUIREMENT TO DEVELOP ADDENDUM.— 

5 (1) IN GENERAL.—The Secretary shall solicit 

6 States, territories, and Indian tribes to develop an 

7 addendum to testing plans described in subsection 

8 (a), to specifically address testing plans for racial 

9 and ethnic minority, rural, and other vulnerable pop10 ulations experiencing health disparities related to 

11 COVID–19 testing, infections, hospitalizations, ICU 

12 admissions, or deaths. The Secretary shall model 

13 questions for the addendum based on the original 

14 testing plans. 

15 (2) FUNDING.—To carry out this subsection, 

16 the Secretary shall use amounts appropriated under 

17 the heading ‘‘Public Health and Social Services 

18 Emergency Fund’’ under the heading ‘‘Office of the 

19 Secretary’’ under the heading ‘‘Department of 

20 Health and Human Services’’ of title I of division B 

21 of the Paycheck Protection Program and Health 

22 Care Enhancement Act (Public Law 116–139). 

23 SEC. 8. DEFINITIONS. 

24 In this Act— 


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1 (1) the term ‘‘COVID–19 public health emer2 gency’’ means the public health emergency first de3 clared by the Secretary of Health and Human Serv4 ices under section 319 of the Public Health Service 

5 Act (42 U.S.C. 247d) on January 31, 2020, with re6 spect to COVID–19; 

7 (2) the term ‘‘ICU’’ means intensive care unit; 

8 (3) the terms ‘‘racial and ethnic minority 

9 group’’ and ‘‘racial and ethnic minority’’ have the 

10 meaning given the term ‘‘racial and ethnic minority 

11 group’’ in section 1707(g) of the Public Health Serv12 ice Act (42 U.S.C. 300u–6(g)); 

13 (4) the term ‘‘relevant Offices of Minority 

14 Health in the Department of Health and Human 

15 Services’’ may include— 

16 (A) the Office of Extramural Research, 

17 Education, and Priority Populations of the 

18 Agency for Healthcare Research and Quality; 

19 (B) the Office of Minority Health and 

20 Health Equity of the Centers for Disease Con21 trol and Prevention; 

22 (C) the Office of Minority Health of the 

23 Centers for Medicare & Medicaid Services; 


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1 (D) the Office of Minority Health and 

2 Health Equity of the Food and Drug Adminis3 tration; 

4 (E) the Office of Health Equity of the 

5 Health Resources and Services Administration; 

6 and 

7 (F) the Office of Behavioral Health Equity 

8 of the Substance Abuse and Mental Health 

9 Services Administration; 

10 (5) the term ‘‘Secretary’’, unless indicated oth11 erwise, means the Secretary of Health and Human 

12 Services; 

13 (6) the terms ‘‘Indian Tribe’’ and ‘‘Tribal orga14 nization’’ have the meanings given the terms ‘‘In15 dian tribe’’ and ‘‘tribal organization’’ in section 4 of 

16 the Indian Self-Determination and Education Assist17 ance Act (25 U.S.C. 5304); and 

18 (7) the term ‘‘urban Indian organization’’ has 

19 the meaning given the term in section 4 of the In20 dian Health Care Improvement Act (25 U.S.C. 

21 1603). 

Æ 


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