II 

116TH CONGRESS 

2D SESSION S. 4819 

To improve the health of minority individuals, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 20 (legislative day, OCTOBER 19), 2020 

Ms. HIRONO (for herself, Mrs. GILLIBRAND, Mr. MERKLEY, Ms. DUCKWORTH, 

Mr. BLUMENTHAL, Mr. SANDERS, Mr. BOOKER, Mr. CARDIN, and Mr. 

KAINE) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To improve the health of minority individuals, and for other 

purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Equity and 

5 Accountability Act of 2020’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents of this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

TITLE I—DATA COLLECTION AND REPORTING 


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Sec. 101. Amendment to the Public Health Service Act. 

Sec. 102. Elimination of prerequisite of direct appropriations for data collection 

and analysis. 

Sec. 103. Collection of data for the Medicare program. 

Sec. 104. Revision of HIPAA claims standards. 

Sec. 105. National Center for Health Statistics. 

Sec. 106. Disparities data collected by the Federal Government. 

Sec. 107. Data collection and analysis grants to minority-serving institutions. 

Sec. 108. Standards for measuring sexual orientation, gender identity, and socioeconomic status in collection of health data. 

Sec. 109. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 110. Improving health data regarding Native Hawaiians and other Pacific 

Islanders. 

Sec. 111. Clarification of simplified administrative reporting requirement. 

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTH AND HEALTH CARE 

Sec. 201. Definitions; findings. 

Sec. 202. Improving access to services for individuals with limited English proficiency. 

Sec. 203. Ensuring standards for culturally and linguistically appropriate services in health care. 

Sec. 204. Culturally and linguistically appropriate health care in the Public 

Health Service Act. 

Sec. 205. Pilot program for improvement and development of State medical interpreting services. 

Sec. 206. Training tomorrow’s doctors for culturally and linguistically appropriate care: graduate medical education. 

Sec. 207. Federal reimbursement for culturally and linguistically appropriate 

services under the Medicare, Medicaid, and State Children’s 

Health Insurance Programs. 

Sec. 208. Increasing understanding of and improving health literacy. 

Sec. 209. Requirements for health programs or activities receiving Federal 

funds. 

Sec. 210. Report on Federal efforts to provide culturally and linguistically appropriate health care services. 

Sec. 211. English for speakers of other languages. 

Sec. 212. Implementation. 

Sec. 213. Language access services. 

Sec. 214. Medically underserved populations. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

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

Sec. 302. Hispanic-serving institutions, historically black colleges and universities, Asian American and Native American Pacific Islanderserving institutions, Tribal colleges, regional community-based 

organizations, and national minority medical associations. 

Sec. 303. Loan repayment program of Centers for Disease Control and Prevention. 

Sec. 304. Cooperative agreements for online degree programs at schools of public health and schools of allied health. 

Sec. 305. Sense of Congress on the mission of the National Health Care Workforce Commission. 


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Sec. 306. Scholarship and fellowship programs. 

Sec. 307. McNair Postbaccalaureate Achievement Program. 

Sec. 308. Rules for determination of full-time equivalent residents for cost-reporting periods. 

Sec. 309. Developing and implementing strategies for local health equity. 

Sec. 310. Loan forgiveness for mental and behavioral health social workers. 

Sec. 311. Health Professions Workforce Fund. 

Sec. 312. Findings; sense of Congress relating to graduate medical education. 

Sec. 313. Career support for skilled, internationally educated health professionals. 

Sec. 314. Study and report on strategies for increasing diversity. 

Sec. 315. Conrad State 30 program; physician retention. 

TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY 

Subtitle A—Improvement of Coverage 

Sec. 401. Repeal of requirement for documentation evidencing citizenship or 

nationality under the Medicaid program. 

Sec. 402. Removing citizenship and immigration barriers to access to affordable 

health care under ACA. 

Sec. 403. Study on the uninsured. 

Sec. 404. Medicaid in the territories. 

Sec. 405. Extension of Medicare secondary payer. 

Sec. 406. Indian defined in title I of the Patient Protection and Affordable 

Care Act. 

Sec. 407. Removing Medicare barrier to health care. 

Sec. 408. 100 percent FMAP for medical assistance provided by urban Indian 

health centers. 

Sec. 409. 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally qualified health center or a Native 

Hawaiian health care system under the Medicaid program. 

Sec. 410. Medicaid coverage for citizens of freely associated states. 

Subtitle B—Expansion of Access 

Sec. 412. Amendment to the Public Health Service Act. 

Sec. 413. Protecting sensitive locations. 

Sec. 414. Grants for racial and ethnic approaches to community health. 

Sec. 415. Border health grants. 

Sec. 416. Critical access hospital improvements. 

Sec. 417. Establishment of Rural Community Hospital (RCH) Program. 

Sec. 418. Medicare remote monitoring pilot projects. 

Sec. 419. Rural Health Quality Advisory Commission and demonstration 

projects. 

Sec. 420. Rural health care services. 

Sec. 421. Community health center collaborative access expansion. 

Sec. 422. Facilitating the provision of telehealth services across State lines. 

Sec. 423. Scoring of preventive health savings. 

Sec. 424. Sense of Congress on Maintenance of Effort Provisions Regarding 

Children’s Health. 

Sec. 425. Protection of the HHS Offices of Minority Health. 

Sec. 426. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs. 

Sec. 427. Study of DSH payments to ensure hospital access for low-income patients. 


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Sec. 428. Assistant Secretary of the Indian Health Service. 

Sec. 429. Reauthorization of the Native Hawaiian Health Care Improvement 

Act. 

Sec. 430. Availability of non-English language speaking providers. 

Sec. 431. Access to essential community providers. 

Sec. 432. Provider network adequacy in communities of color. 

Sec. 433. Improving access to dental care. 

Sec. 434. Providing for a special enrollment period for pregnant individuals. 

Sec. 435. Coverage of maternity care for dependent children. 

Sec. 436. Federal Employee Health Benefit Plans. 

Sec. 437. Continuation of Medicaid income eligibility standard for pregnant individuals and infants. 

Subtitle C—Advancing Health Equity Through Payment and Delivery Reform 

Sec. 441. Sense of Congress. 

Sec. 442. Centers for Medicare & Medicaid Services reporting and value based 

programs. 

Sec. 443. Development and testing of disparity reducing delivery and payment 

models. 

Sec. 444. Diversity in Centers for Medicare and Medicaid consultation. 

Sec. 445. Supporting safety net and community-based providers to compete in 

value-based payment systems. 

Subtitle D—Health Empowerment Zones 

Sec. 451. Short title. 

Sec. 452. Findings. 

Sec. 453. Designation of health empowerment zones. 

Sec. 454. Assistance to those seeking designation. 

Sec. 455. Benefits of designation. 

Sec. 456. Definition of Secretary. 

Sec. 457. Authorization of appropriations. 

TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 

CHILDREN, AND FAMILIES 

Subtitle A—In General 

Sec. 501. Grants to promote health for underserved communities. 

Sec. 502. Removing barriers to health care and nutrition assistance for children, pregnant persons, and lawfully present individuals. 

Sec. 503. Repeal of denial of SNAP benefits. 

Sec. 504. Birth defects prevention, risk reduction, and awareness. 

Sec. 505. MOMMA’s Act. 

Sec. 506. Rural maternal and obstetric modernization of services. 

Sec. 507. Decreasing the risk factors for sudden unexpected infant death and 

sudden unexplained death in childhood. 

Sec. 508. Reducing unintended teenage pregnancies. 

Sec. 509. Gestational diabetes. 

Sec. 510. Emergency contraception education and information programs. 

Sec. 511. Comprehensive sex education programs. 

Sec. 512. Compassionate assistance for rape emergencies. 

Sec. 513. Access to birth control duties of pharmacies to ensure provision of 

FDA-approved contraception. 

Sec. 514. Additional focus area for the Office on Women’s Health. 


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Sec. 515. Interagency Coordinating Committee on the Promotion of Optimal 

Maternity Outcomes. 

Sec. 516. Consumer education campaign. 

Sec. 517. Bibliographic database of systematic reviews for care of childbearing 

individuals and newborns. 

Sec. 518. Expansion of CDC Prevention Research Centers Program to include 

Centers on Optimal Maternity Outcomes. 

Sec. 519. Expanding models allowed to be tested by Center for Medicare & 

Medicaid Innovation to include maternity care models. 

Sec. 520. Development of interprofessional maternity care educational models 

and tools. 

Sec. 521. Including services furnished by certain students, interns, and residents supervised by certified nurse midwives within inpatient 

hospital services under Medicare. 

Sec. 522. Grants to professional organizations to increase diversity in maternal, 

reproductive, and sexual health professionals. 

Sec. 523. Interagency update to the quality family planning guidelines. 

Sec. 524. Dissemination of the quality family planning guidelines. 

Subtitle B—Pregnancy Screening 

Sec. 531. Pregnancy intention screening initiative demonstration program. 

TITLE VI—MENTAL HEALTH 

Sec. 601. Mental health findings. 

Sec. 602. Coverage of marriage and family therapist services, mental health 

counselor services, substance abuse counselor services, and peer 

support specialist services under part B of the Medicare program. 

Sec. 603. Integrated Health Care Demonstration Program. 

Sec. 604. Addressing racial and ethnic mental health disparities research gaps. 

Sec. 605. Health professions competencies to address racial and ethnic mental 

health disparities. 

Sec. 606. Geoaccess study. 

Sec. 607. Asian American, Native Hawaiian, Pacific Islander, and Hispanic and 

Latino behavioral and mental health outreach and education 

strategies. 

Sec. 608. Mental health in schools. 

Sec. 609. Building an effective workforce in mental health. 

Sec. 610. Mental health at the border. 

TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES 

Subtitle A—Cancer 

Sec. 701. Lung cancer mortality reduction. 

Sec. 702. Expanding prostate cancer research, outreach, screening, testing, access, and treatment effectiveness. 

Sec. 703. Prostate research, imaging, and men’s education (PRIME). 

Sec. 704. Prostate cancer detection research and education. 

Sec. 705. National Prostate Cancer Council. 

Sec. 706. Improved Medicaid coverage for certain breast and cervical cancer patients in the territories. 

Sec. 707. Cancer prevention and treatment demonstration for ethnic and racial 

minorities. 

Sec. 708. Reducing cancer disparities within Medicare. 


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Sec. 709. Cancer clinical trials. 

Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 

Sec. 711. Viral hepatitis and liver cancer control and prevention. 

Subtitle C—Acquired Bone Marrow Failure Diseases 

Sec. 721. Acquired bone marrow failure diseases. 

Subtitle D—Cardiovascular Disease, Chronic Disease, Obesity, and Other 

Disease Issues 

Sec. 731. Guidelines for disease screening for minority patients. 

Sec. 732. CDC Wisewoman Screening Program. 

Sec. 733. Report on cardiovascular care for women and minorities. 

Sec. 734. Coverage of comprehensive tobacco cessation services in Medicaid and 

private health insurance. 

Sec. 735. Clinical research funding for oral health. 

Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. 

Sec. 737. Guide on evidence-based strategies for public health department obesity prevention programs. 

Subtitle E—HIV/AIDS 

Sec. 741. Statement of policy. 

Sec. 742. Findings. 

Sec. 743. Additional funding for AIDS drug assistance program treatments. 

Sec. 744. Enhancing the national HIV surveillance system. 

Sec. 745. Evidence-based strategies for improving linkage to and retention in 

appropriate care. 

Sec. 746. Improving entry into and retention in care and antiretroviral adherence for persons with HIV. 

Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority communities. 

Sec. 748. Minority AIDS initiative. 

Sec. 749. Health care professionals treating individuals with HIV. 

Sec. 750. HIV/AIDS provider loan repayment program. 

Sec. 751. Dental education loan repayment program. 

Sec. 752. Reducing new HIV infections among injecting drug users. 

Sec. 753. Report on impact of HIV/AIDS in vulnerable populations. 

Sec. 754. National HIV/AIDS observance days. 

Sec. 755. Review of all Federal and State laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related offenses. 

Sec. 756. Expanding support for condoms in prisons. 

Sec. 757. Automatic reinstatement or enrollment in Medicaid for people who 

test positive for HIV before reentering communities. 

Sec. 758. Stop HIV in prison. 

Sec. 759. Support data system review and indicators for monitoring HIV care. 

Sec. 760. Transfer of funds for implementation of ending the HIV epidemic: a 

plan for America. 

Subtitle F—Diabetes 

Sec. 771. Research, treatment, and education. 

Sec. 772. Research, education, and other activities. 


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Sec. 773. Programs to educate health providers on the causes and effects of diabetes in minority populations. 

Sec. 774. Research, education, and other activities regarding diabetes in American Indian populations. 

Sec. 775. Updated report on health disparities. 

Subtitle G—Lung Disease 

Sec. 776. Expansion of the National Asthma Education and Prevention Program. 

Sec. 777. Asthma-related activities of the Centers for Disease Control and Prevention. 

Sec. 778. Influenza and pneumonia vaccination campaign. 

Sec. 779. Chronic obstructive pulmonary disease action plan. 

Subtitle H—Tuberculosis 

Sec. 781. Elimination of all forms of tuberculosis. 

Sec. 782. Additional funding for States in combating and eliminating tuberculosis. 

Sec. 783. Strengthening clinical research funding for tuberculosis. 

Subtitle I—Osteoarthritis and Musculoskeletal Diseases 

Sec. 785. Findings. 

Sec. 786. Osteoarthritis and other musculoskeletal health-related activities of 

the Centers for Disease Control and Prevention. 

Sec. 787. Grants for comprehensive osteoarthritis and musculoskeletal disease 

health education within health professions schools. 

Subtitle J—Sleep and Circadian Rhythm Disorders 

Sec. 791. Short title; findings. 

Sec. 792. Sleep and circadian rhythm disorders research activities of the National Institutes of Health. 

Sec. 793. Sleep and circadian rhythm health disparities-related activities of the 

Centers for Disease Control and Prevention. 

Sec. 794. Grants for comprehensive sleep and circadian health education within 

health professions schools. 

Sec. 795. Report on impact of sleep and circadian health disorders in vulnerable and racial/ethnic populations. 

Subtitle K—Kidney Disease Research, Surveillance, Prevention, and 

Treatment 

Sec. 797. Kidney disease, research, surveillance, prevention, and treatment. 

Sec. 798. Kidney disease research in minority populations. 

Sec. 799. Kidney disease action plan. 

Sec. 799A. Home dialysis and increasing end-stage renal disease treatment modalities in minority communities action plan. 

Sec. 799B. Increasing kidney transplants in minority populations. 

Sec. 799C. Environmental and occupational health programs. 

Sec. 799D. Understanding the treatment patterns associated with providing 

care and treatment of kidney failure in minority populations. 

Sec. 799E. Improving access in underserved areas. 

TITLE VIII—HEALTH INFORMATION TECHNOLOGY 


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Sec. 800. Definitions. 

Subtitle A—Reducing Health Disparities Through Health IT 

Sec. 801. HRSA assistance to health centers for promotion of Health IT. 

Sec. 802. Assessment of impact of Health IT on racial and ethnic minority 

communities; outreach and adoption of Health IT in such communities. 

Sec. 803. Nondiscrimination and health equity in health information technology. 

Sec. 804. Language access in health information technology. 

Subtitle B—Modifications To Achieve Parity in Existing Programs 

Sec. 811. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities. 

Sec. 812. Extending competitive grants for the development of loan programs 

to facilitate adoption of certified EHR technology by providers 

serving racial and ethnic minority groups. 

Sec. 813. Authorization of appropriations. 

Subtitle C—Additional Research and Studies 

Sec. 821. Data collection and assessments conducted in coordination with minority-serving institutions. 

Sec. 822. Study of health information technology in medically underserved communities. 

Sec. 823. Assessment of use and misuse of de-identified health data. 

Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 

Sec. 831. Extending Medicaid EHR incentive payments to rehabilitation facilities, long-term care facilities, and home health agencies. 

Sec. 832. Extending physician assistant eligibility for Medicaid electronic health 

record incentive payments. 

TITLE IX—ACCOUNTABILITY AND EVALUATION 

Sec. 901. Prohibition on discrimination in Federal assisted health care services 

and research programs on the basis of sex (including sex orientation, gender identity, and pregnancy, including termination 

of pregnancy), race, color, national origin, marital status, familial status, sexual orientation, gender identity, or disability 

status. 

Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights 

Act of 1964. 

Sec. 903. Accountability and transparency within the Department of Health 

and Human Services. 

Sec. 904. United States Commission on Civil Rights. 

Sec. 905. Sense of Congress concerning full funding of activities to eliminate 

racial and ethnic health disparities. 

Sec. 906. GAO and NIH reports. 

TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 

ENVIRONMENTAL JUSTICE 

Subtitle A—In General 


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Sec. 1001. Definitions. 

Sec. 1002. Findings. 

Sec. 1003. Health impact assessments. 

Sec. 1004. Implementation of recommendations by Environmental Protection 

Agency. 

Sec. 1005. Grant program to conduct environmental health improvement activities and to improve social determinants of health. 

Sec. 1006. Additional research on the relationship between the built environment and the health of community residents. 

Sec. 1007. Environment and public health restoration. 

Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig explosion 

in the Gulf Coast. 

Sec. 1009. Establish an interagency counsel and grant programs on social determinants of health. 

Sec. 1010. Correcting hurtful and alienating names in government expression 

(CHANGE). 

Subtitle B—Gun Violence 

Sec. 1011. Findings. 

Sec. 1012. Reaffirming research authority of the Centers for Disease Control 

and Prevention. 

Sec. 1013. National Violent Death Reporting System. 

Sec. 1014. Report on effects of gun violence on public health. 

Sec. 1015. Report on effects of gun violence on mental health in minority communities. 

1 SEC. 3. FINDINGS. 

2 The Congress finds as follows: 

3 (1) The population of racial and ethnic minori4 ties is expected to increase over the next few dec5 ades, yet racial and ethnic minorities have the poor6 est health status and face substantial cultural, so7 cial, and economic barriers to obtaining quality 

8 health care. 

9 (2) Health disparities are a function of not only 

10 access to health care, but also the social deter11 minants of health—including the environment, the 

12 physical structure of communities, nutrition and 

13 food options, educational attainment, employment, 


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1 race, ethnicity, sex, geography, language preference, 

2 immigrant or citizenship status, sexual orientation, 

3 gender identity, socioeconomic status, or disability 

4 status—that directly and indirectly affect the health, 

5 health care, and wellness of individuals and commu6 nities. 

7 (3) Over the next few decades, the United 

8 States will face a shortage of health care providers 

9 and allied health workers. 

10 (4) All efforts to reduce health disparities and 

11 barriers to quality health services require better and 

12 more consistent data and better and more consistent 

13 collection of and access to data. 

14 (5) A full range of culturally and linguistically 

15 appropriate health care and public health services 

16 must be available and accessible in every community. 

17 (6) Racial and ethnic minorities and under18 served populations must be included early and equi19 tably in health reform innovations. 

20 (7) Efforts to improve minority health have 

21 been limited by inadequate resources in funding, 

22 staffing, stewardship, and accountability. Targeted 

23 investments that are focused on disparities elimi24 nation must be made in providing care and services 


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1 that are community-based, including prevention and 

2 policies addressing social determinants of health. 

3 (8) In 2011, the Department of Health and 

4 Human Services developed the HHS Action Plan to 

5 Reduce Racial and Ethnic Health Disparities and 

6 the National Stakeholder Strategy for Achieving 

7 Health Equity, which are 2 strategic plans that rep8 resent the first coordinated roadmap in the United 

9 States to reducing health disparities. These com10 prehensive plans, along with the National Prevention 

11 Strategy issued by the National Prevention Council 

12 of the Department of Health and Human Services, 

13 Healthy People 2030, and the National Quality 

14 Strategy of the Agency for Healthcare Research and 

15 Quality, as well as critical resources such as the 

16 2012 National Healthcare Quality and Disparities 

17 Reports, will work to increase the number of people 

18 in the United States who are healthy at every stage 

19 of life. 

20 (9) The Secretary of Health and Human Serv21 ices has also reviewed and advanced updated clinical 

22 guidelines and developed other strategic planning 

23 documents to combat health disparities with a high 

24 impact on minority populations and to provide high25 quality family planning services. Such guidelines and 


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1 documents include the National HIV/AIDS Strategy, 

2 the Action Plan for the Prevention, Care, and Treat3 ment of Viral Hepatitis, and recommendations of the 

4 Centers for Disease Control and Prevention and the 

5 Office of Population Affairs. 

6 (10) The Patient Protection and Affordable 

7 Care Act (Public Law 111–148), as amended by the 

8 Health Care and Education Reconciliation Act (Pub9 lic Law 111–152), represents the biggest advance10 ment for minority health in the 40 years imme11 diately preceding the enactment of this Act. 

12 (11) The Health Information Technology for 

13 Economic and Clinical Health Act of 2009, part of 

14 the American Recovery and Reinvestment Act of 

15 2009 (Public Law 111–5), provides that the nation16 wide health information exchange infrastructure be 

17 developed and used to reduce health disparities, 

18 among other purposes. 

19 TITLE I—DATA COLLECTION 

20 AND REPORTING 

21 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

22 ACT. 

23 (a) PURPOSE.—It is the purpose of the amendment 

24 made by this section to promote data collection, analysis, 

25 and reporting by race, ethnicity, sex, primary language, 


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1 sexual orientation, disability status, gender identity, age, 

2 and socioeconomic status among federally supported 

3 health programs. 

4 (b) AMENDMENT.—Title XXXIV of the Public 

5 Health Service Act, as added by titles II and III of this 

6 Act, is further amended by inserting after subtitle B the 

7 following: 

8 ‘‘Subtitle C—Strengthening Data 

9 Collection, Improving Data 

10 Analysis, and Expanding Data 

11 Reporting 

12 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 

13 ‘‘(a) REQUIREMENTS.— 

14 ‘‘(1) IN GENERAL.—Each health-related pro15 gram shall— 

16 ‘‘(A) require the collection, by the agency 

17 or program involved, of data on the race, eth18 nicity, sex, primary language, sexual orienta19 tion, disability status, gender identity, age, and 

20 socioeconomic status of each applicant for and 

21 recipient of health-related assistance under such 

22 program, including— 

23 ‘‘(i) using, at a minimum, standards 

24 for data collection on race, ethnicity, sex, 

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1 der identity, age, socioeconomic status, and 

2 disability status as each are developed 

3 under section 3101; 

4 ‘‘(ii) collecting data for additional 

5 population groups if such groups can be 

6 aggregated into the race and ethnicity cat7 egories outlined by standards developed 

8 under section 3101; 

9 ‘‘(iii) using, where practicable, the 

10 standards developed by the Health and 

11 Medicine Division of the National Acad12 emies of Sciences, Engineering, and Medi13 cine (formerly known as the ‘Institute of 

14 Medicine’) in the 2009 publication, entitled 

15 ‘Race, Ethnicity, and Language Data: 

16 Standardization for Health Care Quality 

17 Improvement’; and 

18 ‘‘(iv) where practicable, collecting 

19 such data through self-reporting; 

20 ‘‘(B) with respect to the collection of the 

21 data described in subparagraph (A), for appli22 cants and recipients who are minors, require 

23 communication assistance in speech or writing, 

24 and for applicants and recipients who are other25 wise legally incapacitated, require that— 


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1 ‘‘(i) such data be collected from the 

2 parent or legal guardian of such an appli3 cant or recipient; and 

4 ‘‘(ii) the primary language of the par5 ent or legal guardian of such an applicant 

6 or recipient be collected; 

7 ‘‘(C) systematically analyze such data 

8 using the smallest appropriate units of analysis 

9 feasible to detect racial and ethnic disparities, 

10 as well as disparities along the lines of primary 

11 language, sex, disability status, sexual orienta12 tion, gender identity, age, and socioeconomic 

13 status in health and health care, and report the 

14 results of such analysis to the Secretary, the 

15 Director of the Office for Civil Rights, each 

16 agency listed in section 3101(c)(1), the Com17 mittee on Health, Education, Labor, and Pen18 sions and the Committee on Finance of the 

19 Senate, and the Committee on Energy and 

20 Commerce and the Committee on Ways and 

21 Means of the House of Representatives; 

22 ‘‘(D) provide such data to the Secretary on 

23 at least an annual basis; and 

24 ‘‘(E) ensure that the provision of assist25 ance to an applicant or recipient of assistance 


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1 is not denied or otherwise adversely affected be2 cause of the failure of the applicant or recipient 

3 to provide race, ethnicity, primary language, 

4 sex, sexual orientation, disability status, gender 

5 identity, age, and socioeconomic status data. 

6 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 

7 this subsection shall be construed to— 

8 ‘‘(A) permit the use of information col9 lected under this subsection in a manner that 

10 would adversely affect any individual providing 

11 any such information; or 

12 ‘‘(B) diminish any requirements, including 

13 such requirements in effect on or after the date 

14 of enactment of this section, on health care pro15 viders to collect data. 

16 ‘‘(3) NO COMPELLED DISCLOSURE OF DATA.— 

17 This title does not authorize any health care pro18 vider, Federal official, or other entity to compel the 

19 disclosure of any data collected under this title. The 

20 disclosure of any such data by an individual pursu21 ant to this title shall be strictly voluntary. 

22 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 

23 ensure (through the promulgation of regulations or other24 wise) that all data collected pursuant to subsection (a) are 

25 protected— 


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1 ‘‘(1) under the same privacy protections as the 

2 Secretary applies to other health data under the reg3 ulations promulgated under section 264(c) of the 

4 Health Insurance Portability and Accountability Act 

5 of 1996 relating to the privacy of individually identi6 fiable health information and other protections; and 

7 ‘‘(2) from all inappropriate internal use by any 

8 entity that collects, stores, or receives the data, in9 cluding use of such data in determinations of eligi10 bility (or continued eligibility) in health plans, and 

11 from other inappropriate uses, as defined by the 

12 Secretary. 

13 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 

14 Secretary shall develop and implement a national plan to 

15 ensure the collection of data in a culturally and linguis16 tically appropriate manner, to improve the collection, anal17 ysis, and reporting of racial, ethnic, sex, primary lan18 guage, sexual orientation, disability status, gender iden19 tity, age, and socioeconomic status data at the Federal, 

20 State, territorial, Tribal, and local levels, including data 

21 to be collected under subsection (a), and to ensure that 

22 data collection activities carried out under this section are 

23 in compliance with standards developed under section 

24 3101. The Data Council of the Department of Health and 

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1 mittee on Vital Health Statistics, the Office of Minority 

2 Health, Office on Women’s Health, and other appropriate 

3 public and private entities, shall make recommendations 

4 to the Secretary concerning the development, implementa5 tion, and revision of the national plan. Such plan shall 

6 include recommendations on how to— 

7 ‘‘(1) implement subsection (a) while minimizing 

8 the cost and administrative burdens of data collec9 tion and reporting; 

10 ‘‘(2) expand knowledge among Federal agen11 cies, States, territories, Indian Tribes, counties, mu12 nicipalities, health providers, health plans, and the 

13 general public that data collection, analysis, and re14 porting by race, ethnicity, sex, primary language, 

15 sexual orientation, gender identity, age, socio16 economic status, and disability status is legal and 

17 necessary to assure equity and nondiscrimination in 

18 the quality of health care services; 

19 ‘‘(3) ensure that future patient record systems 

20 follow Federal standards promulgated under the 

21 Health Information Technology for Economic and 

22 Clinical Health Act for the collection and meaningful 

23 use of electronic health data on race, ethnicity, sex, 

24 primary language, sexual orientation, gender iden25 tity, age, socioeconomic status, and disability status; 


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1 ‘‘(4) improve health and health care data collec2 tion and analysis for more population groups if such 

3 groups can be aggregated into the minimum race 

4 and ethnicity categories, including exploring the fea5 sibility of enhancing collection efforts in States, 

6 counties, and municipalities for racial and ethnic 

7 groups that comprise a significant proportion of the 

8 population of the State, county, or municipality; 

9 ‘‘(5) provide researchers with greater access to 

10 racial, ethnic, primary language, sex, sexual orienta11 tion, gender identity, age, socioeconomic status data, 

12 and disability status data, subject to all applicable 

13 privacy and confidentiality requirements, including 

14 HIPAA privacy and security law as defined in sec15 tion 3009; and 

16 ‘‘(6) safeguard and prevent the misuse of data 

17 collected under subsection (a). 

18 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col19 lected under subsection (a) shall be obtained, maintained, 

20 and presented (including for reporting purposes) in ac21 cordance with standards developed under section 3101. 

22 ‘‘(e) ANALYSIS OF HEALTH DISPARITY DATA.—The 

23 Secretary, acting through the Director of the Agency for 

24 Healthcare Research and Quality and in coordination with 

25 the Assistant Secretary for Planning and Evaluation, the 


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1 Administrator of the Centers for Medicare & Medicaid 

2 Services, the Director of the National Center for Health 

3 Statistics, and the Director of the National Institutes of 

4 Health, shall provide technical assistance to agencies of 

5 the Department of Health and Human Services in meeting 

6 Federal standards for health disparity data collection and 

7 for analysis of racial, ethnic, and other disparities in 

8 health and health care in programs conducted or sup9 ported by such agencies by— 

10 ‘‘(1) identifying appropriate quality assurance 

11 mechanisms to monitor for health disparities; 

12 ‘‘(2) specifying the clinical, diagnostic, or thera13 peutic measures which should be monitored; 

14 ‘‘(3) developing new quality measures relating 

15 to racial and ethnic disparities and their overlap 

16 with other disparity factors in health and health 

17 care; 

18 ‘‘(4) identifying the level at which data analysis 

19 should be conducted; and 

20 ‘‘(5) sharing data with external organizations 

21 for research and quality improvement purposes. 

22 ‘‘(f) DEFINITION OF HEALTH-RELATED PROGRAM.— 

23 In this section, the term ‘health-related program’ means 

24 a program that is operated by the Secretary, or that reVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ceives funding or reimbursement, in whole or in part, ei2 ther directly or indirectly from the Secretary— 

3 ‘‘(1) for activities under the Social Security Act 

4 for health care services; or 

5 ‘‘(2) for providing Federal financial assistance 

6 for health care, biomedical research, or health serv7 ices research or for otherwise improving the health 

8 of the public. 

9 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

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

12 2021 through 2025. 

13 ‘‘SEC. 3432. ESTABLISHING GRANTS FOR DATA COLLECTION 

14 IMPROVEMENT ACTIVITIES. 

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

16 the Director of the Agency for Healthcare Research and 

17 Quality and in consultation with the Deputy Assistant 

18 Secretary for Minority Health, the Director of the Na19 tional Institutes of Health, the Assistant Secretary for 

20 Planning and Evaluation, and the Director of the National 

21 Center for Health Statistics, shall establish a technical as22 sistance program under which the Secretary provides 

23 grants to eligible entities to assist such entities in com24 plying with section 3431. 


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1 ‘‘(b) TYPES OF ASSISTANCE.—A grant provided 

2 under this section may be used to— 

3 ‘‘(1) enhance or upgrade computer technology 

4 that will facilitate collection, analysis, and reporting 

5 of racial, ethnic, primary language, sexual orienta6 tion, sex, gender identity, socioeconomic status, and 

7 disability status data; 

8 ‘‘(2) improve methods for health data collection 

9 and analysis, including additional population groups 

10 if such groups can be aggregated into the race and 

11 ethnicity categories outlined by standards developed 

12 under section 3101; 

13 ‘‘(3) develop mechanisms for submitting col14 lected data subject to any applicable privacy and 

15 confidentiality regulations; and 

16 ‘‘(4) develop educational programs to inform 

17 health plans, health providers, health-related agen18 cies, and the general public that data collection and 

19 reporting by race, ethnicity, primary language, sex20 ual orientation, sex, gender identity, disability sta21 tus, and socioeconomic status are legal and essential 

22 for eliminating health and health care disparities. 

23 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 

24 under this section, an entity shall be a State, territory, 

25 Indian Tribe, municipality, county, health provider, health 


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1 care organization, or health plan making a demonstrated 

2 effort to bring data collections into compliance with sec3 tion 3431. 

4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

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

7 2021 through 2025. 

8 ‘‘SEC. 3433. OVERSAMPLING OF UNDERREPRESENTED 

9 GROUPS IN FEDERAL HEALTH SURVEYS. 

10 ‘‘(a) NATIONAL STRATEGY.— 

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

12 through the Director of the National Center for 

13 Health Statistics of the Centers for Disease Control 

14 and Prevention, and other agencies within the De15 partment of Health and Human Services as the Sec16 retary determines appropriate, shall develop and im17 plement an ongoing and sustainable national strat18 egy for oversampling underrepresented populations 

19 within the categories of race, ethnicity, sex, primary 

20 language, sexual orientation, disability status, gen21 der identity, and socioeconomic status as determined 

22 appropriate by the Secretary in Federal health sur23 veys and program data collections. Such national 

24 strategy shall include a strategy for oversampling of 


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1 Asian Americans, Native Hawaiians, and Pacific Is2 landers. 

3 ‘‘(2) CONSULTATION.—In developing and imple4 menting a national strategy, as described in para5 graph (1), not later than 180 days after the date of 

6 the enactment of this section, the Secretary shall— 

7 ‘‘(A) consult with representatives of com8 munity groups, nonprofit organizations, non9 governmental organizations, and government 

10 agencies working with underrepresented popu11 lations; 

12 ‘‘(B) solicit the participation of representa13 tives from other Federal departments and agen14 cies, including subagencies of the Department 

15 of Health and Human Services; and 

16 ‘‘(C) consult on, and use as models, the 

17 2014 National Health Interview Survey over18 sample of Native Hawaiian and Pacific Islander 

19 populations and the 2017 Behavioral Risk Fac20 tor Surveillance System oversample of American 

21 Indian and Alaska Native communities. 

22 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 

23 after the date of the enactment of this section, the Sec24 retary shall submit to the Congress a progress report, 


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1 which shall include the national strategy described in sub2 section (a)(1). 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this section, there are authorized to be appro5 priated such sums as may be necessary for fiscal years 

6 2021 through 2025.’’. 

7 SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP8 PROPRIATIONS FOR DATA COLLECTION AND 

9 ANALYSIS. 

10 Section 3101 of the Public Health Service Act (42 

11 U.S.C. 300kk) is amended— 

12 (1) by striking subsection (h); and 

13 (2) by redesignating subsection (i) as subsection 

14 (h). 

15 SEC. 103. COLLECTION OF DATA FOR THE MEDICARE PRO16 GRAM. 

17 Part A of title XI of the Social Security Act (42 

18 U.S.C. 1301 et seq.) is amended by adding at the end 

19 the following: 

20 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM

21 ‘‘SEC. 1150C. 

22 ‘‘(a) REQUIREMENT.— 

23 ‘‘(1) IN GENERAL.—The Commissioner of So24 cial Security, in consultation with the Administrator 

25 of the Centers for Medicare & Medicaid Services, 

26 shall collect data on the race, ethnicity, sex, primary 


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1 language, sexual orientation, gender identity, socio2 economic status, and disability status of all appli3 cants for Social Security benefits under title II or 

4 Medicare benefits under title XVIII. 

5 ‘‘(2) DATA COLLECTION STANDARDS.—In col6 lecting data under paragraph (1), the Commissioner 

7 of Social Security shall at least use the standards 

8 for data collection developed under section 3101 of 

9 the Public Health Service Act or the standards de10 veloped by the Office of Management and Budget, 

11 whichever is more disaggregated. In the event there 

12 are no standards for the demographic groups listed 

13 under paragraph (1), the Commissioner shall consult 

14 with stakeholder groups representing the various 

15 identities as well as with the Office of Minority 

16 Health within the Centers for Medicare & Medicaid 

17 Services to develop appropriate standards. 

18 ‘‘(3) DATA FOR ADDITIONAL POPULATION

19 GROUPS.—Where practicable, the information col20 lected by the Commissioner of Social Security under 

21 paragraph (1) shall include data for additional popu22 lation groups if such groups can be aggregated into 

23 the race and ethnicity categories outlined by the 

24 data collection standards described in paragraph (2). 


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1 ‘‘(4) COLLECTION OF DATA FOR MINORS AND

2 LEGALLY INCAPACITATED INDIVIDUALS.—With re3 spect to the collection of the data described in para4 graph (1) of applicants who are under 18 years of 

5 age or otherwise legally incapacitated, the Commis6 sioner of Social Security shall require that— 

7 ‘‘(A) such data be collected from the par8 ent or legal guardian of such an applicant; and 

9 ‘‘(B) the primary language of the parent 

10 or legal guardian of such an applicant or recipi11 ent be used in collecting the data. 

12 ‘‘(5) QUALITY OF DATA.—The Commissioner of 

13 Social Security shall periodically review the quality 

14 and completeness of the data collected under para15 graph (1) and make adjustments as necessary to im16 prove both. 

17 ‘‘(6) TRANSMISSION OF DATA.—Upon an indi18 vidual’s entitlement to, or enrollment for, benefits 

19 under title XVIII, the Commissioner of Social Secu20 rity shall transmit the demographic data of the indi21 vidual as collected under paragraph (1) to the Cen22 ters for Medicare & Medicaid Services. 

23 ‘‘(7) ANALYSIS AND REPORTING OF DATA.— 

24 With respect to data transmitted under paragraph 

25 (6), the Administrator of the Centers for Medicare 


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1 & Medicaid Services, in consultation with the Com2 missioner of Social Security shall— 

3 ‘‘(A) require that such data be uniformly 

4 analyzed and that such analysis be reported at 

5 least annually to Congress; 

6 ‘‘(B) incorporate such data in other anal7 ysis and reporting on health disparities as ap8 propriate; 

9 ‘‘(C) make such data available to research10 ers, under the protections outlined in paragraph 

11 (8); 

12 ‘‘(D) provide opportunities to individuals 

13 entitled to, or enrolled for, benefits under title 

14 XVIII to submit updated data; and 

15 ‘‘(E) ensure that the provision of assist16 ance or benefits to an applicant is not denied 

17 or otherwise adversely affected because of the 

18 failure of the applicant to provide any of the 

19 data collected under paragraph (1). 

20 ‘‘(8) PROTECTION OF DATA.—The Commis21 sioner of Social Security shall ensure (through the 

22 promulgation of regulations or otherwise) that all 

23 data collected pursuant to this subsection is pro24 tected— 


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1 ‘‘(A) under the same privacy protections as 

2 the Secretary applies to health data under the 

3 regulations promulgated under section 264(c) of 

4 the Health Insurance Portability and Account5 ability Act of 1996 (relating to the privacy of 

6 individually identifiable health information and 

7 other protections); and 

8 ‘‘(B) from all inappropriate internal use by 

9 any entity that collects, stores, or receives the 

10 data, including use of such data in determina11 tions of eligibility (or continued eligibility) in 

12 health plans, and from other inappropriate 

13 uses, as defined by the Secretary. 

14 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec15 tion shall be construed to permit the use of information 

16 collected under this section in a manner that would ad17 versely affect any individual providing any such informa18 tion. 

19 ‘‘(c) TECHNICAL ASSISTANCE.—The Secretary may, 

20 either directly or by grant or contract, provide technical 

21 assistance to enable any entity to comply with the require22 ments of this section or with regulations implementing this 

23 section. 

24 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section 


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1 $500,000,000 for fiscal year 2021 and $100,000,000 for 

2 each fiscal year thereafter.’’. 

3 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 

4 (a) IN GENERAL.—Not later than 1 year after the 

5 date of enactment of this Act, the Secretary of Health and 

6 Human Services shall revise the regulations promulgated 

7 under part C of title XI of the Social Security Act (42 

8 U.S.C. 1320d et seq.), relating to the collection of data 

9 on race, ethnicity, and primary language in a health-re10 lated transaction, to require— 

11 (1) the use, at a minimum, of standards for 

12 data collection on race, ethnicity, primary language, 

13 disability, sex, sexual orientation, gender identity, 

14 and socioeconomic status developed under section 

15 3101 of the Public Health Service Act (42 U.S.C. 

16 300kk); and 

17 (2) in consultation with the Office of the Na18 tional Coordinator for Health Information Tech19 nology, the designation of the appropriate racial, 

20 ethnic, primary language, disability, sex, and other 

21 code sets as required for claims and enrollment data. 

22 (b) DISSEMINATION.—The Secretary of Health and 

23 Human Services shall disseminate the new standards de24 veloped under subsection (a) to all entities that are subject 

25 to the regulations described in such subsection and provide 


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1 technical assistance with respect to the collection of the 

2 data involved. 

3 (c) COMPLIANCE.—The Secretary of Health and 

4 Human Services shall require that entities comply with the 

5 new standards developed under subsection (a) not later 

6 than 2 years after the final promulgation of such stand7 ards. 

8 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 

9 Section 306(n) of the Public Health Service Act (42 

10 U.S.C. 242k(n)) is amended— 

11 (1) in paragraph (1), by striking ‘‘2003’’ and 

12 inserting ‘‘2022’’; 

13 (2) in paragraph (2), in the first sentence, by 

14 striking ‘‘2003’’ and inserting ‘‘2022’’; and 

15 (3) in paragraph (3), by striking ‘‘2002’’ and 

16 inserting ‘‘2022’’. 

17 SEC. 106. DISPARITIES DATA COLLECTED BY THE FEDERAL 

18 GOVERNMENT. 

19 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec20 retary of Health and Human Services, in coordination 

21 with the departments, agencies, or offices described in 

22 subsection (b), shall establish a centralized electronic re23 pository of Government data on factors related to the 

24 health and well-being of the population of the United 

25 States. 


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1 (b) COLLECTION; SUBMISSION.—Not later than 180 

2 days after the date of the enactment of this Act, and Jan3 uary 31 of each year thereafter, each department, agency, 

4 and office of the Federal Government that has collected 

5 data on race, ethnicity, sex, primary language, sexual ori6 entation, disability status, gender identity, age, or socio7 economic status during the preceding calendar year shall 

8 submit such data to the repository of Government data 

9 established under subsection (a). 

10 (c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 

11 Not later than April 30, 2021, and April 30 of each year 

12 thereafter, the Secretary of Health and Human Services, 

13 acting through the Assistant Secretary for Planning and 

14 Evaluation, the Assistant Secretary for Health, the Direc15 tor of the Agency for Healthcare Research and Quality, 

16 the Director of the National Center for Health Statistics, 

17 the Administrator of the Centers for Medicare & Medicaid 

18 Services, the Director of the National Institute on Minor19 ity Health and Health Disparities, and the Deputy Assist20 ant Secretary for Minority Health, shall— 

21 (1) prepare and make available datasets for 

22 public use that relate to disparities in health status, 

23 health care access, health care quality, health out24 comes, public health, and other areas of health and 

25 well-being by factors that include race, ethnicity, 


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1 sex, primary language, sexual orientation, disability 

2 status, gender identity, and socioeconomic status; 

3 (2) ensure that these datasets are publicly iden4 tified on the repository established under subsection 

5 (a) as ‘‘disparities’’ data; and 

6 (3) submit a report to the Congress on the 

7 availability and use of such data by public stake8 holders. 

9 SEC. 107. DATA COLLECTION AND ANALYSIS GRANTS TO MI10 NORITY-SERVING INSTITUTIONS. 

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

12 Human Services, acting through the Director of the Na13 tional Institute on Minority Health and Health Disparities 

14 and the Deputy Assistant Secretary for Minority Health, 

15 shall award grants to eligible entities to access and analyze 

16 racial and ethnic data on disparities in health and health 

17 care, and where possible other data on disparities in health 

18 and health care, to monitor and report on progress to re19 duce and eliminate disparities in health and health care. 

20 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el21 igible entity’’ means an entity that has an accredited pub22 lic health, health policy, or health services research pro23 gram and is any of the following: 


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1 (1) A part B institution, as defined in section 

2 322 of the Higher Education Act of 1965 (20 

3 U.S.C. 1061). 

4 (2) A Hispanic-serving institution, as defined in 

5 section 502 of such Act (20 U.S.C. 1101a). 

6 (3) A Tribal College or University, as defined in 

7 section 316 of such Act (20 U.S.C. 1059c). 

8 (4) An Asian American and Native American 

9 Pacific Islander-serving institution, as defined in 

10 section 371(c) of such Act (20 U.S.C. 1067q(c)). 

11 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

12 out this section, there are authorized to be appropriated 

13 such sums as may be necessary for fiscal years 2021 

14 through 2025. 

15 SEC. 108. STANDARDS FOR MEASURING SEXUAL ORIENTA16 TION, GENDER IDENTITY, AND SOCIO17 ECONOMIC STATUS IN COLLECTION OF 

18 HEALTH DATA. 

19 Section 3101(a) of the Public Health Service Act (42 

20 U.S.C. 300kk(a)) is amended— 

21 (1) in paragraph (1)(A), by inserting ‘‘sexual 

22 orientation, gender identity, socioeconomic status,’’ 

23 before ‘‘and disability status’’; 


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1 (2) in paragraph (1)(C), by inserting ‘‘sexual 

2 orientation, gender identity, socioeconomic status,’’ 

3 before ‘‘and disability status’’; and 

4 (3) in paragraph (2)(B), by inserting ‘‘sexual 

5 orientation, gender identity, socioeconomic status,’’ 

6 before ‘‘and disability status’’. 

7 SEC. 109. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

8 RESPECT TO RACIAL AND ETHNIC BACK9 GROUND. 

10 (a) IN GENERAL.—Chapter V of the Federal Food, 

11 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend12 ed by adding after section 505G the following: 

13 ‘‘SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

14 RESPECT TO RACIAL AND ETHNIC BACK15 GROUND. 

16 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence 

17 that there may be a disparity on the basis of racial or 

18 ethnic background as to the safety or effectiveness of a 

19 drug or biological product, then— 

20 ‘‘(1)(A) in the case of a drug, the investigations 

21 required under section 505(b)(1)(A) shall include 

22 adequate and well-controlled investigations of the 

23 disparity; or 

24 ‘‘(B) in the case of a biological product, the evi25 dence required under section 351(a) of the Public 


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1 Health Service Act for approval of a biologics license 

2 application for the biological product shall include 

3 adequate and well-controlled investigations of the 

4 disparity; and 

5 ‘‘(2) if the investigations described in subpara6 graph (A) or (B) of paragraph (1) confirm that 

7 there is such a disparity, the labeling of the drug or 

8 biological product shall include appropriate informa9 tion about the disparity. 

10 ‘‘(b) POSTMARKET STUDIES.— 

11 ‘‘(1) IN GENERAL.—If there is evidence that 

12 there may be a disparity on the basis of racial or 

13 ethnic background as to the safety or effectiveness 

14 of a drug for which there is an approved application 

15 under section 505 of this Act or of a biological prod16 uct for which there is an approved license under sec17 tion 351 of the Public Health Service Act, the Sec18 retary may by order require the holder of the ap19 proved application or license to conduct, by a date 

20 specified by the Secretary, postmarket studies to in21 vestigate the disparity. 

22 ‘‘(2) LABELING.—If the Secretary determines 

23 that the postmarket studies confirm that there is a 

24 disparity described in paragraph (1), the labeling of 


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1 the drug or biological product shall include appro2 priate information about the disparity. 

3 ‘‘(3) STUDY DESIGN.—The Secretary may, in 

4 an order under paragraph (1), specify all aspects of 

5 the design of the postmarket studies required under 

6 such paragraph for a drug or biological product, in7 cluding the number of studies and study partici8 pants, and the other demographic characteristics of 

9 the study participants. 

10 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 

11 Secretary may, by order and as necessary, modify 

12 any aspect of the design of a postmarket study re13 quired in an order under paragraph (1) after issuing 

14 such order. 

15 ‘‘(5) STUDY RESULTS.—The results from a 

16 study required under paragraph (1) shall be sub17 mitted to the Secretary as a supplement to the drug 

18 application or biologics license application. 

19 ‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 

20 ‘‘(1) IN GENERAL.—A drug for which an appli21 cation has been submitted or approved under section 

22 505(j) shall not be considered ineligible for approval 

23 under that section or misbranded under section 502 

24 on the basis that the labeling of the drug omits in25 formation relating to a disparity on the basis of raVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 cial or ethnic background as to the safety or effec2 tiveness of the drug, whether derived from investiga3 tions or studies required under this section or de4 rived from other sources, when the omitted informa5 tion is protected by patent or by exclusivity under 

6 section 505(j)(5)(F). 

7 ‘‘(2) LABELING.—Notwithstanding paragraph 

8 (1), the Secretary may require that the labeling of 

9 a drug approved under section 505(j) that omits in10 formation relating to a disparity on the basis of ra11 cial or ethnic background as to the safety or effec12 tiveness of the drug include a statement of any ap13 propriate contraindications, warnings, or precautions 

14 related to the disparity that the Secretary considers 

15 necessary. 

16 ‘‘(d) DEFINITION.—The term ‘evidence that there 

17 may be a disparity on the basis of racial or ethnic back18 ground as to the safety or effectiveness’, with respect to 

19 a drug or biological product, includes— 

20 ‘‘(1) evidence that there is a disparity on the 

21 basis of racial or ethnic background as to safety or 

22 effectiveness of a drug or biological product in the 

23 same chemical class as the drug or biological prod24 uct; 


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1 ‘‘(2) evidence that there is a disparity on the 

2 basis of racial or ethnic background in the way the 

3 drug or biological product is metabolized; and 

4 ‘‘(3) other evidence as the Secretary may deter5 mine appropriate.’’. 

6 (b) ENFORCEMENT.—Section 502 of the Federal 

7 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend8 ed by adding at the end the following: 

9 ‘‘(gg) If it is a drug and the holder of the approved 

10 application under section 505 or license under section 351 

11 of the Public Health Service Act for the drug has failed 

12 to complete the investigations or studies, or comply with 

13 any other requirement, of section 505H.’’. 

14 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 

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

16 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 

17 required’’ the following: ‘‘, including postmarket studies 

18 required under section 505H’’. 

19 SEC. 110. IMPROVING HEALTH DATA REGARDING NATIVE 

20 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 

21 Part B of title III of the Public Health Service Act 

22 (42 U.S.C. 243 et seq.) is amended by inserting after sec23 tion 317U the following: 


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1 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS2 LANDER HEALTH DATA. 

3 ‘‘(a) DEFINITIONS.—In this section: 

4 ‘‘(1) COMMUNITY GROUP.—The term ‘commu5 nity group’ means a group of NHOPI who are orga6 nized at the community level, and may include a 

7 church group, social service group, national advocacy 

8 organization, or cultural group. 

9 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI10 ZATION.—The term ‘nonprofit, nongovernmental or11 ganization’ means a group of NHOPI with a dem12 onstrated history of addressing NHOPI issues, in13 cluding a NHOPI coalition. 

14 ‘‘(3) DESIGNATED ORGANIZATION.—The term 

15 ‘designated organization’ means an entity estab16 lished to represent NHOPI populations and which 

17 has statutory responsibilities to provide, or has com18 munity support for providing, health care. 

19 ‘‘(4) GOVERNMENT REPRESENTATIVES OF

20 NHOPI POPULATIONS.—The term ‘government rep21 resentatives of NHOPI populations’ means rep22 resentatives from Hawaii, American Samoa, the 

23 Commonwealth of the Northern Mariana Islands, 

24 the Federated States of Micronesia, Guam, the Re25 public of Palau, and the Republic of the Marshall Is26 lands. 


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1 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC

2 ISLANDERS (NHOPI).—The term ‘Native Hawaiians 

3 and Other Pacific Islanders’ or ‘NHOPI’ means peo4 ple having origins in any of the original peoples of 

5 American Samoa, the Commonwealth of the North6 ern Mariana Islands, the Federated States of Micro7 nesia, Guam, Hawaii, the Republic of the Marshall 

8 Islands, the Republic of Palau, or any other Pacific 

9 Island. 

10 ‘‘(6) INSULAR AREA.—The term ‘insular area’ 

11 means Guam, the Commonwealth of the Northern 

12 Mariana Islands, American Samoa, the United 

13 States Virgin Islands, the Federated States of Mi14 cronesia, the Republic of Palau, or the Republic of 

15 the Marshall Islands. 

16 ‘‘(b) NATIONAL STRATEGY.— 

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

18 through the Director of the National Center for 

19 Health Statistics (referred to in this section as 

20 ‘NCHS’) of the Centers for Disease Control and 

21 Prevention, and other agencies within the Depart22 ment of Health and Human Services as the Sec23 retary determines appropriate, shall develop and im24 plement an ongoing and sustainable national strat25 egy for identifying and evaluating the health status 


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1 and health care needs of NHOPI populations living 

2 in the continental United States, Hawaii, American 

3 Samoa, the Commonwealth of the Northern Mariana 

4 Islands, the Federated States of Micronesia, Guam, 

5 the Republic of Palau, and the Republic of the Mar6 shall Islands. 

7 ‘‘(2) CONSULTATION.—In developing and imple8 menting a national strategy, as described in para9 graph (1), not later than 180 days after the date of 

10 enactment of the Health Equity and Accountability 

11 Act of 2020, the Secretary— 

12 ‘‘(A) shall consult with representatives of 

13 community groups, designated organizations, 

14 and nonprofit, nongovernmental organizations 

15 and with government representatives of NHOPI 

16 populations; and 

17 ‘‘(B) may solicit the participation of rep18 resentatives from other Federal departments. 

19 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 

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

21 through the Director of NCHS, shall conduct a pre22 liminary health survey in order to identify the major 

23 areas and regions in the continental United States, 

24 Hawaii, American Samoa, the Commonwealth of the 

25 Northern Mariana Islands, the Federated States of 


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1 Micronesia, Guam, the Republic of Palau, and the 

2 Republic of the Marshall Islands in which NHOPI 

3 people reside. 

4 ‘‘(2) CONTENTS.—The health survey described 

5 in paragraph (1) shall include health data and any 

6 other data the Secretary determines to be— 

7 ‘‘(A) useful in determining health status 

8 and health care needs; or 

9 ‘‘(B) required for developing or imple10 menting a national strategy. 

11 ‘‘(3) METHODOLOGY.—Methodology for the 

12 health survey described in paragraph (1), including 

13 plans for designing questions, implementation, sam14 pling, and analysis, shall be developed in consulta15 tion with community groups, designated organiza16 tions, nonprofit, nongovernmental organizations, and 

17 government representatives of NHOPI populations, 

18 as determined by the Secretary. 

19 ‘‘(4) TIMEFRAME.—The survey required under 

20 this subsection shall be completed not later than 18 

21 months after the date of enactment of the Health 

22 Equity and Accountability Act of 2020. 

23 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 

24 after the date of enactment of the Health Equity and Ac25 countability Act of 2020, the Secretary shall submit to 


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1 Congress a progress report, which shall include the na2 tional strategy described in subsection (b)(1). 

3 ‘‘(e) STUDY AND REPORT BY THE HEALTH AND

4 MEDICINE DIVISION.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall seek to 

6 enter into an agreement with the Health and Medi7 cine Division of the National Academies of Sciences, 

8 Engineering, and Medicine to conduct a study, with 

9 input from stakeholders in insular areas, on each of 

10 the following: 

11 ‘‘(A) The standards and definitions of 

12 health care applied to health care systems in in13 sular areas and the appropriateness of such 

14 standards and definitions. 

15 ‘‘(B) The status and performance of health 

16 care systems in insular areas, evaluated based 

17 upon standards and definitions, as the Sec18 retary determines appropriate. 

19 ‘‘(C) The effectiveness of donor aid in ad20 dressing health care needs and priorities in in21 sular areas. 

22 ‘‘(D) The progress toward implementation 

23 of recommendations of the Committee on 

24 Health Care Services in the United States—As25 sociated Pacific Basin that are set forth in the 


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1 1998 report entitled ‘Pacific Partnerships for 

2 Health: Charting a New Course’. 

3 ‘‘(2) REPORT.—An agreement described in 

4 paragraph (1) shall require the Health and Medicine 

5 Division to submit to the Secretary and to Congress, 

6 not later than 2 years after the date of the enact7 ment of the Health Equity and Accountability Act of 

8 2020, a report containing a description of the results 

9 of the study conducted under paragraph (1), includ10 ing the conclusions and recommendations of the 

11 Health and Medicine Division for each of the items 

12 described in subparagraphs (A) through (D) of such 

13 paragraph. 

14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 

15 carry out this section, there are authorized to be appro16 priated such sums as may be necessary for fiscal years 

17 2021 through 2025.’’. 

18 SEC. 111. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 

19 REPORTING REQUIREMENT. 

20 Section 11(a) of the Food and Nutrition Act of 2008 

21 (7 U.S.C. 2020(a)) is amended by adding at the end the 

22 following: 

23 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING

24 REQUIREMENT.—With respect to any obligation of a 

25 State agency carrying out the supplemental nutrition 


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1 assistance program to comply with the notification 

2 requirement under paragraph (2) of section 421(e) 

3 of the Personal Responsibility and Work Oppor4 tunity Reconciliation Act of 1996 (8 U.S.C. 

5 1631(e)), notwithstanding the requirement to in6 clude in that notification the names of the sponsor 

7 and the sponsored alien involved, the State agency 

8 shall be considered to have complied with the notifi9 cation requirement if the State agency submits to 

10 the Attorney General a report that includes the ag11 gregate number of exceptions granted by the State 

12 agency under paragraph (1) of that section.’’. 

13 TITLE II—CULTURALLY AND LIN14 GUISTICALLY APPROPRIATE 

15 HEALTH AND HEALTH CARE 

16 SEC. 201. DEFINITIONS; FINDINGS. 

17 (a) DEFINITIONS.—In this title, the definitions in 

18 section 3400 of the Public Health Service Act, as added 

19 by section 204, shall apply. 

20 (b) FINDINGS.—Congress finds the following: 

21 (1) Effective communication is essential to 

22 meaningful access to quality physical and mental 

23 health care. 

24 (2) Research indicates that the lack of appro25 priate language services creates language barriers 


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1 that result in increased risk of misdiagnosis, ineffec2 tive treatment plans, and poor health outcomes for 

3 individuals with limited English proficiency and indi4 viduals with communication disabilities such as cog5 nitive, hearing, vision, or print impairments. 

6 (3) The number of limited English-speaking 

7 residents in the United States who speak English 

8 less than very well and, therefore, cannot effectively 

9 communicate with health and social service providers 

10 continues to increase significantly. 

11 (4) The responsibility to fund language services 

12 in the provision of health care and health-care-re13 lated services to individuals with limited English 

14 proficiency and individuals with communication dis15 abilities such as cognitive hearing, vision, or print 

16 impairments is a societal one that cannot fairly be 

17 placed solely upon the health care, public health, or 

18 social services community. 

19 (5) Title VI of the Civil Rights Act of 1964 (42 

20 U.S.C. 2000d et seq.) prohibits discrimination based 

21 on the grounds of race, color, or national origin by 

22 any entity receiving Federal financial assistance. In 

23 order to avoid discrimination on the grounds of na24 tional origin, all programs or activities administered 

25 by the Federal Government must take adequate 


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1 steps to ensure that their policies and procedures do 

2 not deny or have the effect of denying individuals 

3 with limited English proficiency with equal access to 

4 benefits and services for which such persons qualify. 

5 (6) Both the Americans with Disabilities Act of 

6 1990 (42 U.S.C. 12101 et seq.) and the Rehabilita7 tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 

8 discrimination on the basis of disability and require 

9 the provision of appropriate auxiliary aids and serv10 ices necessary to ensure effective communication 

11 with individuals with disabilities. The type of auxil12 iary aid or service necessary to ensure effective com13 munication will vary in accordance with the method 

14 of communication used by the individual; the nature, 

15 length, and complexity of the communication in16 volved; and the context in which the communication 

17 is taking place. A public accommodation should con18 sult with individuals with disabilities whenever pos19 sible to determine what type of auxiliary aid is need20 ed to ensure effective communication. The public ac21 commodation should use the individual’s preferred 

22 method of communication whenever possible, unless 

23 it would be an undue burden to the public accommo24 dation and an alternative would provide an equally 

25 effective means of communication. The ultimate deVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 cision as to what measures to take rests with the 

2 public accommodation, provided that the method 

3 chosen results in effective communication. 

4 (7) Section 1557 of the Patient Protection and 

5 Affordable Care Act (42 U.S.C. 18116) builds on 

6 title VI of the Civil Rights Act of 1964 (42 U.S.C. 

7 2000d et seq.) and section 504 of the Rehabilitation 

8 Act of 1973 (29 U.S.C. 794), prohibits discrimina9 tion on the basis of race, color, national origin, dis10 ability, sex, and age, requires the provision of lan11 guage services to ensure effective communication 

12 with individuals with limited English proficiency, 

13 and requires the provision of appropriate auxiliary 

14 aids and services necessary to ensure effective com15 munication with individuals with disabilities. 

16 (8) Linguistic diversity in the health care and 

17 health-care-related services workforce is important 

18 for providing all patients the environment most con19 ducive to positive health outcomes. 

20 (9) All members of the health care and health21 care-related services community should continue to 

22 educate their staff and constituents about limited 

23 English-proficient and disability communication 

24 issues and help them identify resources to improve 

25 access to quality care for individuals with limited 


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1 English proficiency and individuals with communica2 tion disabilities such as cognitive, hearing, vision, or 

3 print impairments. 

4 (10) Access to English as a second language, 

5 foreign language, and sign language interpreters, 

6 translated and alternative format documents, read7 ers, and other auxiliary aids and services, are essen8 tial to ensure effective communication and eliminate 

9 the language barriers that impede access to health 

10 care. 

11 (11) Competent language services in health care 

12 settings should be available as a matter of course. 

13 SEC. 202. IMPROVING ACCESS TO SERVICES FOR INDIVID14 UALS WITH LIMITED ENGLISH PROFICIENCY. 

15 (a) PURPOSE.—Consistent with the goals provided in 

16 Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 

17 to improving access to services for persons with limited 

18 English proficiency), it is the purpose of this section— 

19 (1) to improve Federal agency performance re20 garding access to federally conducted and federally 

21 assisted programs and activities for individuals with 

22 limited English proficiency; 

23 (2) to require each Federal agency to examine 

24 the services it provides and develop and implement 

25 a system by which individuals with limited English 


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1 proficiency can obtain culturally competence services 

2 and meaningful access to those services consistent 

3 with, and without substantially burdening, the fun4 damental mission of the agency; 

5 (3) to require each Federal agency to ensure 

6 that recipients of Federal financial assistance pro7 vide culturally competence services and meaningful 

8 access to applicants and beneficiaries that are indi9 viduals with limited English proficiency; 

10 (4) to ensure that recipients of Federal finan11 cial assistance take reasonable steps, consistent with 

12 the guidelines set forth in the ‘‘Guidance to Federal 

13 Financial Assistance Recipients Regarding Title VI 

14 Prohibition Against National Origin Discrimination 

15 Affecting Limited English Proficient Persons (67 

16 Fed. Reg. 41455 (June 18, 2002))’’, to ensure cul17 turally and linguistically appropriate access to their 

18 programs and activities by individuals with limited 

19 English proficiency; and 

20 (5) to ensure compliance with title VI of the 

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

22 and section 1557 of the Patient Protection and Af23 fordable Care Act (42 U.S.C. 18116) as published in 

24 the Federal Register on May 18, 2016, that health 


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1 care providers and organizations do not discriminate 

2 in the provision of services. 

3 (b) FEDERALLY CONDUCTED PROGRAMS AND AC4 TIVITIES.— 

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

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

7 agency providing financial assistance to, or admin8 istering, a health program or activity described in 

9 section 203(a) shall prepare a plan or update a plan 

10 to improve culturally and linguistically appropriate 

11 access to such program or activity with respect to 

12 individuals with limited English proficiency. Not 

13 later than 1 year after the date of enactment of this 

14 Act, each such Federal agency shall ensure that 

15 such plan is fully implemented. 

16 (2) PLAN REQUIREMENT.—Each plan under 

17 paragraph (1) shall include— 

18 (A) the steps the agency will take to en19 sure that individuals with limited English pro20 ficiency have access to each health program or 

21 activity supported or administered by the agen22 cy; 

23 (B) the policies and procedures for identi24 fying, assessing, and meeting the culturally and 

25 linguistically appropriate language needs of its 


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1 beneficiaries that are individuals with limited 

2 English proficiency served by such program or 

3 activity; 

4 (C) the steps the agency will take for such 

5 program or activity to be culturally and linguis6 tically appropriate by providing a range of lan7 guage assistance options, notice to individuals 

8 with limited English proficiency of the right to 

9 competent language services, periodic training 

10 of staff, monitoring and quality assessment of 

11 the language services and, in appropriate cir12 cumstances, the translation of written mate13 rials; 

14 (D) the steps the agency will take for such 

15 program or activity to provide reasonable ac16 commodations necessary for individuals with 

17 limited English proficiency, including those in18 dividuals with a communication disability, to 

19 understand communications from the agency; 

20 (E) the steps the agency will take to en21 sure that applications, forms, and other rel22 evant documents for such program or activity 

23 are competently translated into the primary 

24 language of a client that is an individual with 

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1 rials are needed to improve access of such client 

2 to such program or activity; 

3 (F) the resources the agency will provide 

4 to improve cultural and linguistic appropriate5 ness to assist recipients of Federal funds to im6 prove access to health care related programs 

7 and activities for individuals with limited 

8 English proficiency; 

9 (G) the resources the agency will provide 

10 to ensure that competent language assistance is 

11 provided to patients that are individuals with 

12 limited English proficiency by interpreters or 

13 trained bilingual staff; and 

14 (H) the resources the agency will provide 

15 to ensure that family, particularly minor chil16 dren, and friends are not used to provide inter17 pretation services, except as permitted under 

18 regulations implementing section 1557 of the 

19 Patient Protection and Affordable Care Act (42 

20 U.S.C. 18116) as published in the Federal Reg21 ister on May 18, 2016. 

22 (3) SUBMISSION OF PLAN TO DOJ.—Each agen23 cy that is required to prepare a plan under para24 graph (1) shall send a copy of such plan to the AtVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 torney General, which shall serve as the central re2 pository of all such plans. 

3 SEC. 203. ENSURING STANDARDS FOR CULTURALLY AND 

4 LINGUISTICALLY APPROPRIATE SERVICES IN 

5 HEALTH CARE. 

6 (a) APPLICABILITY.—This section shall apply to any 

7 health program or activity, any part of which is receiving 

8 Federal financial assistance, including credits, subsidies, 

9 or contracts of insurance, or any program or activity that 

10 is administered by an executive agency or any entity estab11 lished under title I of the Patient Protection and Afford12 able Care Act (42 U.S.C. 18001 et seq.) (or amendments 

13 made thereby). 

14 (b) STANDARDS.—Each program or activity de15 scribed in subsection (a)— 

16 (1) shall implement strategies to recruit, retain, 

17 and promote individuals at all levels to maintain a 

18 diverse staff and leadership that can provide cul19 turally and linguistically appropriate health care to 

20 patient populations of the service area of the pro21 gram or activity; 

22 (2) shall educate and train governance, leader23 ship, and workforce at all levels and across all dis24 ciplines of the program or activity in culturally and 


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1 linguistically appropriate policies and practices on an 

2 ongoing basis at least annually; 

3 (3) shall offer and provide language assistance, 

4 including trained and competent bilingual staff and 

5 interpreter services, to individuals with limited 

6 English proficiency or who have other communica7 tion needs, at no cost to the individual at all points 

8 of contact, and during all hours of operation, to fa9 cilitate timely access to health care services and 

10 health-care-related services; 

11 (4) shall for each language group consisting of 

12 individuals with limited English proficiency that con13 stitutes 5 percent or 500 individuals, whichever is 

14 less, of the population of persons eligible to be 

15 served or likely to be affected or encountered in the 

16 service area of the program or activity, make avail17 able at a fifth grade reading level— 

18 (A) easily understood patient-related mate19 rials, including print and multimedia materials, 

20 in the language of such language group; 

21 (B) information or notices about termi22 nation of benefits in such language; 

23 (C) signage; and 

24 (D) any other documents or types of docu25 ments designated by the Secretary; 


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1 (5) shall develop and implement clear goals, 

2 policies, operational plans, and management, ac3 countability, and oversight mechanisms to provide 

4 culturally and linguistically appropriate services and 

5 infuse them throughout the planning and operations 

6 of the program or activity; 

7 (6) shall conduct initial and ongoing, at least 

8 annually, organizational assessments of culturally 

9 and linguistically appropriate services-related activi10 ties and integrate valid linguistic, competence-related 

11 National Standards for Culturally and Linguistically 

12 Appropriate Services (CLAS) measures into the in13 ternal audits, performance improvement programs, 

14 patient satisfaction assessments, continuous quality 

15 improvement activities, and outcomes-based evalua16 tions of the program or activity and develop ways to 

17 standardize the assessments; 

18 (7) shall ensure that, consistent with the pri19 vacy protections provided for under the regulations 

20 promulgated under section 264(c) of the Health In21 surance Portability and Accountability Act of 1996 

22 (42 U.S.C. 1320–2 note), data on an individual re23 quired to be collected pursuant to section 3101, in24 cluding the individual’s alternative format pref25 erences and policy modification needs, are— 


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1 (A) collected in health records; 

2 (B) integrated into the management infor3 mation systems of the program or activity; and 

4 (C) periodically updated; 

5 (8) shall maintain a current demographic, cul6 tural, and epidemiological profile of the community, 

7 conduct regular assessments of community health 

8 assets and needs, and use the results of such assess9 ments to accurately plan for and implement services 

10 that respond to the cultural and linguistic character11 istics of the service area of the program or activity; 

12 (9) shall develop participatory, collaborative 

13 partnerships with communities and utilize a variety 

14 of formal and informal mechanisms to facilitate 

15 community and patient involvement in designing, 

16 implementing, and evaluating policies and practices 

17 to ensure culturally and linguistically appropriate 

18 service-related activities; 

19 (10) shall ensure that conflict and grievance 

20 resolution processes are culturally and linguistically 

21 appropriate and capable of identifying, preventing, 

22 and resolving cross-cultural conflicts or complaints 

23 by patients; 

24 (11) shall regularly make available to the public 

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1 novations in implementing the standards under this 

2 section and provide public notice in their commu3 nities about the availability of this information; and 

4 (12) shall, if requested, regularly make avail5 able to the head of each Federal entity from which 

6 Federal funds are provided, information about the 

7 progress and successful innovations of the program 

8 or activity in implementing the standards under this 

9 section as required by the head of such entity. 

10 (c) COMMENTS ACCEPTED THROUGH NOTICE AND

11 COMMENT RULEMAKING.—An agency carrying out a pro12 gram described in subsection (a)— 

13 (1) shall ensure that comments with respect to 

14 such program that are accepted through notice and 

15 comment rulemaking are accepted in all languages; 

16 (2) may not require such comments to be sub17 mitted only in English; and 

18 (3) shall ensure that any such comments that 

19 are not submitted in English are considered, during 

20 the agency’s review of such comments, equally as 

21 such comments that are submitted in English. 


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1 SEC. 204. CULTURALLY AND LINGUISTICALLY APPRO2 PRIATE HEALTH CARE IN THE PUBLIC 

3 HEALTH SERVICE ACT. 

4 The Public Health Service Act (42 U.S.C. 201 et 

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

6 ‘‘TITLE XXXIV—CULTURALLY 

7 AND LINGUISTICALLY APPRO8 PRIATE HEALTH CARE 

9 ‘‘SEC. 3400. DEFINITIONS. 

10 ‘‘(a) IN GENERAL.—In this title: 

11 ‘‘(1) BILINGUAL.—The term ‘bilingual’, with 

12 respect to an individual, means an individual who 

13 has sufficient degree of proficiency in 2 languages. 

14 ‘‘(2) CULTURAL.—The term ‘cultural’ means 

15 relating to integrated patterns of human behavior 

16 that include the language, thoughts, communica17 tions, actions, customs, beliefs, values, and institu18 tions of racial, ethnic, religious, or social groups, in19 cluding lesbian, gay, bisexual, transgender, queer, 

20 and questioning individuals, and individuals with 

21 physical and mental disabilities. 

22 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP23 PROPRIATE.—The term ‘culturally and linguistically 

24 appropriate’ means being respectful of and respon25 sive to the cultural and linguistic needs of all indi26 viduals. 


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1 ‘‘(4) EFFECTIVE COMMUNICATION.—The term 

2 ‘effective communication’ means an exchange of in3 formation between the provider of health care or 

4 health-care-related services and the recipient of such 

5 services who is limited in English proficiency, or has 

6 a communication impairment such as a hearing, vi7 sion, speaking, or learning impairment, that enables 

8 access to, understanding of, and benefit from health 

9 care or health-care-related services, and full partici10 pation in the development of their treatment plan. 

11 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 

12 term ‘grievance resolution process’ means all aspects 

13 of dispute resolution including filing complaints, 

14 grievance and appeal procedures, and court action. 

15 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 

16 care group’ means a group of physicians organized, 

17 at least in part, for the purposes of providing physi18 cian services under the Medicaid program under title 

19 XIX of the Social Security Act, the State Children’s 

20 Health Insurance Program under title XXI of such 

21 Act, or the Medicare program under title XVIII of 

22 such Act and may include a hospital and any other 

23 individual or entity furnishing services covered under 

24 any such program that is affiliated with the health 

25 care group. 


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1 ‘‘(7) HEALTH CARE SERVICES.—The term 

2 ‘health care services’ means services that address 

3 physical as well as mental health conditions in all 

4 care settings. 

5 ‘‘(8) HEALTH-CARE-RELATED SERVICES.—The 

6 term ‘health-care-related services’ means human or 

7 social services programs or activities that provide ac8 cess, referrals, or links to health care. 

9 ‘‘(9) HEALTH EDUCATOR.—The term ‘health 

10 educator’ includes a professional with a bacca11 laureate degree who is responsible for designing, im12 plementing, and evaluating individual and population 

13 health promotion and chronic disease prevention pro14 grams. 

15 ‘‘(10) INDIAN; INDIAN TRIBE.—The terms ‘In16 dian’ and ‘Indian Tribe’ have the meanings given 

17 such terms in section 4 of the Indian Self-Deter18 mination and Education Assistance Act. 

19 ‘‘(11) INDIVIDUAL WITH A DISABILITY.—The 

20 term ‘individual with a disability’ means any indi21 vidual who has a disability as defined for the pur22 pose of section 504 of the Rehabilitation Act of 

23 1973. 

24 ‘‘(12) INDIVIDUAL WITH LIMITED ENGLISH

25 PROFICIENCY.—The term ‘individual with limited 


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1 English proficiency’ means an individual whose pri2 mary language for communication is not English 

3 and who has a limited ability to read, write, speak, 

4 or understand English. 

5 ‘‘(13) INTEGRATED HEALTH CARE DELIVERY

6 SYSTEM.—The term ‘integrated health care delivery 

7 system’ means an interdisciplinary system that 

8 brings together providers from the primary health, 

9 mental health, substance use disorder, and related 

10 disciplines to improve the health outcomes of an in11 dividual. Such providers may include hospitals, 

12 health, mental health, or substance use disorder clin13 ics and providers, home health agencies, ambulatory 

14 surgery centers, skilled nursing facilities, rehabilita15 tion centers, and employed, independent, or con16 tracted physicians. 

17 ‘‘(14) INTERPRETING; INTERPRETATION.—The 

18 terms ‘interpreting’ and ‘interpretation’ mean the 

19 transmission of a spoken, written, or signed message 

20 from one language or format into another, faithfully, 

21 accurately, and objectively. 

22 ‘‘(15) LANGUAGE ACCESS.—The term ‘language 

23 access’ means the provision of language services to 

24 an individual with limited English proficiency or an 

25 individual with communication disabilities designed 


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1 to enhance that individual’s access to, understanding 

2 of, or benefit from health care services or health3 care-related services. 

4 ‘‘(16) LANGUAGE ASSISTANCE SERVICES.—The 

5 term ‘language assistance services’ includes— 

6 ‘‘(A) oral language assistance, including in7 terpretation in non-English languages provided 

8 in-person or remotely by a qualified interpreter 

9 for an individual with limited English pro10 ficiency, and the use of qualified bilingual or 

11 multilingual staff to communicate directly with 

12 individuals with limited English proficiency; 

13 ‘‘(B) written translation, performed by a 

14 qualified translator, of written content in paper 

15 or electronic form into languages other than 

16 English; and 

17 ‘‘(C) taglines. 

18 ‘‘(17) MINORITY.— 

19 ‘‘(A) IN GENERAL.—The terms ‘minority’ 

20 and ‘minorities’ refer to individuals from a mi21 nority group. 

22 ‘‘(B) POPULATIONS.—The term ‘minority’, 

23 with respect to populations, refers to racial and 

24 ethnic minority groups, members of sexual and 


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1 gender minority groups, and individuals with a 

2 disability. 

3 ‘‘(18) MINORITY GROUP.—The term ‘minority 

4 group’ has the meaning given the term ‘racial and 

5 ethnic minority group’. 

6 ‘‘(19) ONSITE INTERPRETATION.—The term 

7 ‘onsite interpretation’ means a method of inter8 preting or interpretation for which the interpreter is 

9 in the physical presence of the provider of health 

10 care services or health-care-related services and the 

11 recipient of such services who is limited in English 

12 proficiency or has a communication impairment such 

13 as an impairment in hearing, vision, or learning. 

14 ‘‘(20) QUALIFIED INDIVIDUAL WITH A DIS15 ABILITY.—The term ‘qualified individual with a dis16 ability’ means, with respect to a health program or 

17 activity, an individual with a disability who, with or 

18 without reasonable modifications to policies, prac19 tices, or procedures, the removal of architectural, 

20 communication, or transportation barriers, or the 

21 provision of auxiliary aids and services, meets the es22 sential eligibility requirements for the receipt of aids, 

23 benefits, or services offered or provided by the health 

24 program or activity. 


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1 ‘‘(21) QUALIFIED INTERPRETER FOR AN INDI2 VIDUAL WITH A DISABILITY.—The term ‘qualified 

3 interpreter for an individual with a disability’, with 

4 respect to an individual with a disability— 

5 ‘‘(A) means an interpreter for such indi6 vidual who by means of a remote interpreting 

7 service or an onsite appearance; 

8 ‘‘(i) adheres to generally accepted in9 terpreter ethics principles, including client 

10 confidentiality; and 

11 ‘‘(ii) is able to interpret effectively, ac12 curately, and impartially, both receptively 

13 and expressively, using any necessary spe14 cialized vocabulary, terminology, and phra15 seology; and 

16 ‘‘(B) may include— 

17 ‘‘(i) sign language interpreters; 

18 ‘‘(ii) oral transliterators, which are in19 dividuals who represent or spell in the 

20 characters of another alphabet; and 

21 ‘‘(iii) cued language transliterators, 

22 which are individuals who represent or 

23 spell by using a small number of 

24 handshapes. 


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1 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI2 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 

3 The term ‘qualified interpreter for an individual with 

4 limited English proficiency’ means an interpreter 

5 who by means of a remote interpreting service or an 

6 onsite appearance— 

7 ‘‘(A) adheres to generally accepted inter8 preter ethics principles, including client con9 fidentiality; 

10 ‘‘(B) has demonstrated proficiency in 

11 speaking and understanding both spoken 

12 English and one or more other spoken lan13 guages; and 

14 ‘‘(C) is able to interpret effectively, accu15 rately, and impartially, both receptively and ex16 pressly, to and from such languages and 

17 English, using any necessary specialized vocab18 ulary, terminology, and phraseology. 

19 ‘‘(23) QUALIFIED TRANSLATOR.—The term 

20 ‘qualified translator’ means a translator who— 

21 ‘‘(A) adheres to generally accepted trans22 lator ethics principles, including client confiden23 tiality; 

24 ‘‘(B) has demonstrated proficiency in writ25 ing and understanding both written English 


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1 and one or more other written non-English lan2 guages; and 

3 ‘‘(C) is able to translate effectively, accu4 rately, and impartially to and from such lan5 guages and English, using any necessary spe6 cialized vocabulary, terminology, and phrase7 ology. 

8 ‘‘(24) RACIAL AND ETHNIC MINORITY GROUP.— 

9 The term ‘racial and ethnic minority group’ means 

10 Indians and Alaska Natives, African Americans (in11 cluding Caribbean Blacks, Africans, and other 

12 Blacks), Asian Americans, Hispanics (including 

13 Latinos), and Native Hawaiians and other Pacific 

14 Islanders. 

15 ‘‘(25) SEXUAL AND GENDER MINORITY

16 GROUP.—The term ‘sexual and gender minority 

17 group’ encompasses lesbian, gay, bisexual, and 

18 transgender populations, as well as those whose sex19 ual orientation, gender identity and expression, or 

20 reproductive development varies from traditional, so21 cietal, cultural, or physiological norms. 

22 ‘‘(26) SIGHT TRANSLATION.—The term ‘sight 

23 translation’ means the transmission of a written 

24 message in one language into a spoken or signed 


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1 message in another language, or an alternative for2 mat in English or another language. 

3 ‘‘(27) STATE.—Notwithstanding section 2, the 

4 term ‘State’ means each of the several States, the 

5 District of Columbia, the Commonwealth of Puerto 

6 Rico, the United States Virgin Islands, Guam, 

7 American Samoa, and the Commonwealth of the 

8 Northern Mariana Islands. 

9 ‘‘(28) TELEPHONIC INTERPRETATION.—The 

10 term ‘telephonic interpretation’ (also known as ‘over 

11 the phone interpretation’ or ‘OPI’) means, with re12 spect to interpretation for an individual with limited 

13 English proficiency, a method of interpretation in 

14 which the interpreter is not in the physical presence 

15 of the provider of health care services or health-care16 related services and such individual receiving such 

17 services, but the interpreter is connected via tele18 phone. 

19 ‘‘(29) TRANSLATION.—The term ‘translation’ 

20 means the transmission of a written message in one 

21 language into a written or signed message in an22 other language, and includes translation into an23 other language or alternative format, such as large 

24 print font, Braille, audio recording, or CD. 


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1 ‘‘(30) VIDEO REMOTE INTERPRETING SERV2 ICES.—The term ‘video remote interpreting services’ 

3 means the provision, in health care services or 

4 health-care-related services, through a qualified in5 terpreter for an individual with limited English pro6 ficiency, of video remote interpreting services that 

7 are— 

8 ‘‘(A) in real-time, full-motion video, and 

9 audio over a dedicated high-speed, wide-band10 width video connection or wireless connection 

11 that delivers high quality video images that do 

12 not produce lags, choppy, blurry, or grainy im13 ages, or irregular pauses in communication; and 

14 ‘‘(B) in a sharply delineated image that is 

15 large enough to display. 

16 ‘‘(31) VITAL DOCUMENT.—The term ‘vital doc17 ument’ includes applications for government pro18 grams that provide health care services, medical or 

19 financial consent forms, financial assistance docu20 ments, letters containing important information re21 garding patient instructions (such as prescriptions, 

22 referrals to other providers, and discharge plans) 

23 and participation in a program (such as a Medicaid 

24 managed care program), notices pertaining to the 

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1 fits, notices of the right to appeal such actions, and 

2 notices advising individuals with limited English pro3 ficiency with communication disabilities of the avail4 ability of free language services, alternative formats, 

5 and other outreach materials. 

6 ‘‘(b) REFERENCE.—In any reference in this title to 

7 a regulatory provision applicable to a ‘handicapped indi8 vidual’, the term ‘handicapped individual’ in such provi9 sion shall have the same meaning as the term ‘individual 

10 with a disability’ as defined in subsection (a). 

11 ‘‘Subtitle A—Resources and Innova12 tion for Culturally and Linguis13 tically Appropriate Health Care 

14 ‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 

15 AND LINGUISTICALLY APPROPRIATE HEALTH 

16 CARE. 

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

18 through the Director of the Agency for Healthcare Re19 search and Quality, shall establish and support a center 

20 to be known as the ‘Robert T. Matsui Center for Cul21 turally and Linguistically Appropriate Health Care’ (re22 ferred to in this section as the ‘Center’) to carry out each 

23 of the following activities: 

24 ‘‘(1) INTERPRETATION SERVICES.—The Center 

25 shall provide resources via the internet to identify 


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1 and link health care providers to competent inter2 preter and translation services. 

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

4 ‘‘(A) VITAL DOCUMENTS.—The Center 

5 shall provide, directly or through contract, vital 

6 documents from competent translation services 

7 for providers of health care services and health8 care-related services at no cost to such pro9 viders. Such documents may be submitted by 

10 covered entities (as defined in section 92.4 of 

11 title 45, Code of Federal Regulations, as in ef12 fect on May 18, 2016) for translation into non13 English languages or alternative formats at a 

14 fifth-grade reading level. Such translation serv15 ices shall be provided in a timely and reason16 able manner. The quality of such translation 

17 services shall be monitored and reported pub18 licly. 

19 ‘‘(B) FORMS.—For each form developed or 

20 revised by the Secretary that will be used by in21 dividuals with limited English proficiency in 

22 health care or health-care-related settings, the 

23 Center shall translate the form, at a minimum, 

24 into the top 15 non-English languages in the 

25 United States according to the most recent data 


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1 from the American Community Survey or its re2 placement. The translation shall be completed 

3 within 45 calendar days of the Secretary receiv4 ing final approval of the form from the Office 

5 of Management and Budget. The Center shall 

6 post all translated forms on its website so that 

7 other entities may use the same translations. 

8 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE9 PHONE NUMBER.—The Center shall provide, 

10 through a toll-free number, a customer service line 

11 for individuals with limited English proficiency— 

12 ‘‘(A) to obtain information about federally 

13 conducted or funded health programs, including 

14 the Medicare program under title XVIII of the 

15 Social Security Act, the Medicaid program 

16 under title XIX of such Act, and the State Chil17 dren’s Health Insurance Program under title 

18 XXI of such Act, and coverage available 

19 through an Exchange established under title I 

20 of the Patient Protection and Affordable Care 

21 Act, and other sources of free or reduced care 

22 including through federally qualified health cen23 ters, entities receiving assistance under title X, 

24 and public health departments; 


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1 ‘‘(B) to obtain assistance with applying for 

2 or accessing these programs and understanding 

3 Federal notices written in English; and 

4 ‘‘(C) to learn how to access language serv5 ices. 

6 ‘‘(4) HEALTH INFORMATION CLEARING7 HOUSE.— 

8 ‘‘(A) IN GENERAL.—The Center shall de9 velop and maintain an information clearing10 house to facilitate the provision of language 

11 services by providers of health care services and 

12 health-care-related services to reduce medical 

13 errors, improve medical outcomes, improve cul14 tural competence, reduce health care costs 

15 caused by miscommunication with individuals 

16 with limited English proficiency, and reduce or 

17 eliminate the duplication of efforts to translate 

18 materials. The clearinghouse shall include the 

19 information described in subparagraphs (B) 

20 through (F) and make such information avail21 able on the internet and in print. 

22 ‘‘(B) DOCUMENT TEMPLATES.—The Cen23 ter shall collect and evaluate for accuracy, de24 velop, and make available templates for stand25 ard documents that are necessary for patients 


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1 and consumers to access and make educated de2 cisions about their health care, including tem3 plates for each of the following: 

4 ‘‘(i) Administrative and legal docu5 ments, including— 

6 ‘‘(I) intake forms; 

7 ‘‘(II) forms related to the Medi8 care program under title XVIII of the 

9 Social Security Act, the Medicaid pro10 gram under title XIX of such Act, 

11 and the State Children’s Health In12 surance Program under title XXI of 

13 such Act, including eligibility informa14 tion for such programs; 

15 ‘‘(III) forms informing patients 

16 of the compliance and consent re17 quirements pursuant to the regula18 tions under section 264(c) of the 

19 Health Insurance Portability and Ac20 countability Act of 1996 (42 U.S.C. 

21 1320–2 note); and 

22 ‘‘(IV) documents concerning in23 formed consent, advanced directives, 

24 and waivers of rights. 


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1 ‘‘(ii) Clinical information, such as how 

2 to take medications, how to prevent trans3 mission of a contagious disease, and other 

4 prevention and treatment instructions. 

5 ‘‘(iii) Public health, patient education, 

6 and outreach materials, such as immuniza7 tion notices, health warnings, or screening 

8 notices. 

9 ‘‘(iv) Additional health or health-care10 related materials as determined appro11 priate by the Director of the Center. 

12 ‘‘(C) STRUCTURE OF FORMS.—In oper13 ating the clearinghouse, the Center shall— 

14 ‘‘(i) ensure that the documents posted 

15 in English and non-English languages are 

16 culturally and linguistically appropriate; 

17 ‘‘(ii) allow public review of the docu18 ments before dissemination in order to en19 sure that the documents are understand20 able and culturally and linguistically ap21 propriate for the target populations; 

22 ‘‘(iii) allow health care providers to 

23 customize the documents for their use; 

24 ‘‘(iv) facilitate access to these docu25 ments; 


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1 ‘‘(v) provide technical assistance with 

2 respect to the access and use of such infor3 mation; and 

4 ‘‘(vi) carry out any other activities the 

5 Secretary determines to be useful to fulfill 

6 the purposes of the clearinghouse. 

7 ‘‘(D) LANGUAGE ASSISTANCE PRO8 GRAMS.—The Center shall provide for the col9 lection and dissemination of information on cur10 rent examples of language assistance programs 

11 and strategies to improve language services for 

12 individuals with limited English proficiency, in13 cluding case studies using de-identified patient 

14 information, program summaries, and program 

15 evaluations. 

16 ‘‘(E) CULTURALLY AND LINGUISTICALLY

17 APPROPRIATE MATERIALS.—The Center shall 

18 provide information relating to culturally and 

19 linguistically appropriate health care for minor20 ity populations residing in the United States to 

21 all health care providers and health-care-related 

22 services at no cost. Such information shall in23 clude— 

24 ‘‘(i) tenets of culturally and linguis25 tically appropriate care; 


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1 ‘‘(ii) culturally and linguistically ap2 propriate self-assessment tools; 

3 ‘‘(iii) culturally and linguistically ap4 propriate training tools; 

5 ‘‘(iv) strategic plans to increase cul6 tural and linguistic appropriateness in dif7 ferent types of providers of health care 

8 services and health-care-related services, 

9 including regional collaborations among 

10 health care organizations; and 

11 ‘‘(v) culturally and linguistically ap12 propriate information for educators, practi13 tioners, and researchers. 

14 ‘‘(F) TRANSLATION GLOSSARIES.—The 

15 Center shall— 

16 ‘‘(i) develop and publish on its website 

17 translation glossaries that provide stand18 ardized translations of commonly used 

19 terms and phrases utilized in documents 

20 translated by the Center; and 

21 ‘‘(ii) make these glossaries available— 

22 ‘‘(I) free of charge; 

23 ‘‘(II) in each language in which 

24 the Center translates forms under 

25 paragraph (2)(B); and 


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1 ‘‘(III) in alternative formats in 

2 accordance with the Americans with 

3 Disabilities Act of 1990 (42 U.S.C. 

4 12101 et seq.). 

5 ‘‘(G) INFORMATION ABOUT PROGRESS.— 

6 The Center shall regularly collect and make 

7 publicly available information about the 

8 progress of entities receiving grants under sec9 tion 3402 regarding successful innovations in 

10 implementing the obligations under this sub11 section and provide public notice in the entities’ 

12 communities about the availability of this infor13 mation. 

14 ‘‘(b) DIRECTOR.—The Center shall be headed by a 

15 Director who shall be appointed by, and who shall report 

16 to, the Director of the Agency for Healthcare Research 

17 and Quality. 

18 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di19 rector shall collaborate with the Deputy Assistant Sec20 retary for Minority Health, the Administrator of the Cen21 ters for Medicare & Medicaid Services, and the Adminis22 trator of the Health Resources and Services Administra23 tion to notify health care providers and health care organi24 zations about the availability of language access services 

25 by the Center. 


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1 ‘‘(d) EDUCATION.—The Secretary, directly or 

2 through contract, shall undertake a national education 

3 campaign to inform providers, individuals with limited 

4 English proficiency, individuals with hearing or vision im5 pairments, health professionals, graduate schools, and 

6 community health centers about— 

7 ‘‘(1) Federal and State laws and guidelines gov8 erning access to language services; 

9 ‘‘(2) the value of using trained and competent 

10 interpreters and the risks associated with using fam11 ily members, friends, minors, and untrained bilin12 gual staff; 

13 ‘‘(3) funding sources for developing and imple14 menting language services; and 

15 ‘‘(4) promising practices to effectively provide 

16 language services. 

17 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to carry out this section 

19 $5,000,000 for each of fiscal years 2021 through 2025. 

20 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS21 TICALLY APPROPRIATE HEALTH CARE 

22 GRANTS. 

23 ‘‘(a) IN GENERAL.— 

24 ‘‘(1) GRANTS.—The Secretary, acting through 

25 the Director of the Agency for Healthcare Research 


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1 and Quality, shall award grants to eligible entities to 

2 enable such entities to design, implement, and evalu3 ate innovative, cost-effective programs to improve 

4 culturally and linguistically appropriate access to 

5 health care services for individuals with limited 

6 English proficiency. 

7 ‘‘(2) COORDINATION.—The Director of the 

8 Agency for Healthcare Research and Quality shall 

9 coordinate with, and ensure the participation of, 

10 other agencies including the Health Resources and 

11 Services Administration, the National Institute on 

12 Minority Health and Health Disparities at the Na13 tional Institutes of Health, and the Office of Minor14 ity Health, regarding the design and evaluation of 

15 the grants program. 

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

17 under subsection (a), an entity shall— 

18 ‘‘(1) be— 

19 ‘‘(A) a city, county, Indian Tribe, State, or 

20 subdivision thereof; 

21 ‘‘(B) an organization described in section 

22 501(c)(3) of the Internal Revenue Code of 1986 

23 and exempt from tax under section 501(a) of 

24 such Code; 


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1 ‘‘(C) a community health, mental health, 

2 or substance use disorder center or clinic; 

3 ‘‘(D) a solo or group physician practice; 

4 ‘‘(E) an integrated health care delivery 

5 system; 

6 ‘‘(F) a public hospital; 

7 ‘‘(G) a health care group, university, or 

8 college; or 

9 ‘‘(H) any other entity designated by the 

10 Secretary; and 

11 ‘‘(2) prepare and submit to the Secretary an 

12 application, at such time, in such manner, and con13 taining such additional information as the Secretary 

14 may reasonably require. 

15 ‘‘(c) USE OF FUNDS.—An entity shall use funds re16 ceived through a grant under this section to— 

17 ‘‘(1) develop, implement, and evaluate models of 

18 providing competent interpretation services through 

19 onsite interpretation, telephonic interpretation, or 

20 video remote interpreting services; 

21 ‘‘(2) implement strategies to recruit, retain, and 

22 promote individuals at all levels of the organization 

23 to maintain a diverse staff and leadership that can 

24 promote and provide language services to patient 

25 populations of the service area of the entity; 


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1 ‘‘(3) develop and maintain a needs assessment 

2 that identifies the current demographic, cultural, 

3 and epidemiological profile of the community to ac4 curately plan for and implement language services 

5 needed in the service area of the entity; 

6 ‘‘(4) develop a strategic plan to implement lan7 guage services; 

8 ‘‘(5) develop participatory, collaborative part9 nerships with communities encompassing the patient 

10 populations of individuals with limited English pro11 ficiency served by the grant to gain input in design12 ing and implementing language services; 

13 ‘‘(6) develop and implement grievance resolu14 tion processes that are culturally and linguistically 

15 appropriate and capable of identifying, preventing, 

16 and resolving complaints by individuals with limited 

17 English proficiency; 

18 ‘‘(7) develop short-term medical and mental 

19 health interpretation training courses and incentives 

20 for bilingual health care staff who are asked to pro21 vide interpretation services in the workplace; 

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1 terpreters and culturally and linguistically appro2 priate providers; 

3 ‘‘(9) provide staff language training instruction, 

4 which shall include information on the practical limi5 tations of such instruction for nonnative speakers; 

6 ‘‘(10) develop policies that address compensa7 tion in salary for staff who receive training to be8 come either a staff interpreter or bilingual provider; 

9 ‘‘(11) develop other language assistance services 

10 as determined appropriate by the Secretary; 

11 ‘‘(12) develop, implement, and evaluate models 

12 of improving cultural competence, including cultural 

13 competence programs for community health workers; 

14 and 

15 ‘‘(13) ensure that, consistent with the privacy 

16 protections provided for under the regulations pro17 mulgated under section 264(c) of the Health Insur18 ance Portability and Accountability Act of 1996 and 

19 any applicable State privacy laws, data on the indi20 vidual patient or recipient’s race, ethnicity, and pri21 mary language are collected (and periodically up22 dated) in health records and integrated into the or23 ganization’s information management systems or 

24 any similar system used to store and retrieve data. 


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1 ‘‘(d) PRIORITY.—In awarding grants under this sec2 tion, the Secretary shall give priority to entities that pri3 marily engage in providing direct care and that have devel4 oped partnerships with community organizations or with 

5 agencies with experience in improving language access. 

6 ‘‘(e) EVALUATION.— 

7 ‘‘(1) BY GRANTEES.—An entity that receives a 

8 grant under this section shall submit to the Sec9 retary an evaluation that describes, in the manner 

10 and to the extent required by the Secretary, the ac11 tivities carried out with funds received under the 

12 grant, and how such activities improved access to 

13 health care services and health-care-related services 

14 and the quality of health care for individuals with 

15 limited English proficiency. Such evaluation shall be 

16 collected and disseminated through the Robert T. 

17 Matsui Center for Culturally and Linguistically Ap18 propriate Health Care established under section 

19 3401. The Director of the Agency for Healthcare 

20 Research and Quality shall notify grantees of the 

21 availability of technical assistance for the evaluation 

22 and provide such assistance upon request. 

23 ‘‘(2) BY SECRETARY.—The Director of the 

24 Agency for Healthcare Research and Quality shall 

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1 zations to evaluate projects funded under this sec2 tion. 

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

5 $5,000,000 for each of fiscal years 2021 through 2025. 

6 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM7 PETENCE. 

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

9 the Director of the Agency for Healthcare Research and 

10 Quality, shall expand research concerning language access 

11 in the provision of health care services. 

12 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 

13 Healthcare Research and Quality may conduct the re14 search described in subsection (a) or enter into contracts 

15 with other individuals or organizations to conduct such re16 search. 

17 ‘‘(c) USE OF FUNDS.—Research conducted under 

18 this section shall be designed to do one or more of the 

19 following: 

20 ‘‘(1) To identify the barriers to mental and be21 havioral services that are faced by individuals with 

22 limited English proficiency. 

23 ‘‘(2) To identify health care providers’ and 

24 health administrators’ attitudes, knowledge, and 

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1 ices that are faced by individuals with limited 

2 English proficiency. 

3 ‘‘(3) To identify optimal approaches for deliv4 ering language access. 

5 ‘‘(4) To identify best practices for data collec6 tion, including— 

7 ‘‘(A) the collection by providers of health 

8 care services and health-care-related services of 

9 data on the race, ethnicity, and primary lan10 guage of recipients of such services, taking into 

11 account existing research conducted by the Gov12 ernment or private sector; 

13 ‘‘(B) the development and implementation 

14 of data collection and reporting systems; and 

15 ‘‘(C) effective privacy safeguards for col16 lected data. 

17 ‘‘(5) To develop a minimum data collection set 

18 for primary language. 

19 ‘‘(6) To evaluate the most effective ways in 

20 which the Secretary can create or coordinate, and 

21 subsidize or otherwise fund, telephonic interpretation 

22 services for health care providers, taking into consid23 eration, among other factors, the flexibility necessary 

24 for such a system to accommodate variations in— 

25 ‘‘(A) provider type; 


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1 ‘‘(B) languages needed and their frequency 

2 of use; 

3 ‘‘(C) type of encounter; 

4 ‘‘(D) time of encounter, including regular 

5 business hours and after hours; and 

6 ‘‘(E) location of encounter. 

7 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated to carry out this section 

9 $5,000,000 for each of fiscal years 2021 through 2025.’’. 

10 SEC. 205. PILOT PROGRAM FOR IMPROVEMENT AND DE11 VELOPMENT OF STATE MEDICAL INTER12 PRETING SERVICES. 

13 (a) GRANTS AUTHORIZED.—The Secretary of Health 

14 and Human Services shall award 1 grant in accordance 

15 with this section to each of 3 States (to be selected by 

16 the Secretary) to assist each such State in designing, im17 plementing, and evaluating a statewide program to provide 

18 onsite interpreter services under the State Medicaid plan. 

19 (b) GRANT PERIOD.—A grant awarded under this 

20 section is authorized for the period of 3 fiscal years begin21 ning on October 1, 2021, and ending on September 30, 

22 2024. 

23 (c) PREFERENCE.—In awarding a grant under this 

24 section, the Secretary shall give preference to a State— 


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1 (1) that has a high proportion of qualified LEP 

2 enrollees, as determined by the Secretary; 

3 (2) that has a large number of qualified LEP 

4 enrollees, as determined by the Secretary; 

5 (3) that has a high growth rate of the popu6 lation of individuals with limited English proficiency, 

7 as determined by the Secretary; and 

8 (4) that has a population of qualified LEP en9 rollees that is linguistically diverse, requiring inter10 preter services in at least 200 non-English lan11 guages. 

12 (d) USE OF FUNDS.—A State receiving a grant under 

13 this section shall use the grant funds to— 

14 (1) ensure that all health care providers in the 

15 State participating in the State Medicaid plan have 

16 access to onsite interpreter services, for the purpose 

17 of enabling effective communication between such 

18 providers and qualified LEP enrollees during the 

19 furnishing of items and services and administrative 

20 interactions; 

21 (2) establish, expand, procure, or contract for— 

22 (A) a statewide health care information 

23 technology system that is designed to achieve 

24 efficiencies and economies of scale with respect 

25 to onsite interpreter services provided to health 


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1 care providers in the State participating in the 

2 State Medicaid plan; and 

3 (B) an entity to administer such system, 

4 the duties of which shall include— 

5 (i) procuring and scheduling inter6 preter services for qualified LEP enrollees; 

7 (ii) procuring and scheduling inter8 preter services for individuals with limited 

9 English proficiency seeking to enroll in the 

10 State Medicaid plan; 

11 (iii) ensuring that interpreters receive 

12 payment for interpreter services rendered 

13 under the system; and 

14 (iv) consulting regularly with organi15 zations representing consumers, inter16 preters, and health care providers; and 

17 (3) develop mechanisms to establish, improve, 

18 and strengthen the competency of the medical inter19 pretation workforce that serves qualified LEP enroll20 ees in the State, including a national certification 

21 process that is valid, credible, and vendor-neutral. 

22 (e) APPLICATION.—To receive a grant under this sec23 tion, a State shall submit an application at such time and 

24 containing such information as the Secretary may require, 

25 which shall include the following: 


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1 (1) A description of the language access needs 

2 of individuals in the State enrolled in the State Med3 icaid plan. 

4 (2) A description of the extent to which the 

5 program will— 

6 (A) use the grant funds for the purposes 

7 described in subsection (d); 

8 (B) meet the health care needs of rural 

9 populations of the State; and 

10 (C) collect information that accurately 

11 tracks the language services requested by con12 sumers as compared to the language services 

13 provided by health care providers in the State 

14 participating in the State Medicaid plan. 

15 (3) A description of how the program will be 

16 evaluated, including a proposal for collaboration with 

17 organizations representing interpreters, consumers, 

18 and individuals with limited English proficiency. 

19 (f) DEFINITIONS.—In this section: 

20 (1) QUALIFIED LEP ENROLLEE.—The term 

21 ‘‘qualified LEP enrollee’’ means an individual— 

22 (A) who is limited English proficient; and 

23 (B) who is enrolled in a State Medicaid 

24 plan. 


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1 (2) STATE.—The term ‘‘State’’ has the mean2 ing given the term in section 1101(a)(1) of the So3 cial Security Act (42 U.S.C. 1301(a)(1)), for pur4 poses of title XIX of such Act (42 U.S.C. 1396 et 

5 seq.). 

6 (3) STATE MEDICAID PLAN.—The term ‘‘State 

7 Medicaid plan’’ means a State plan under title XIX 

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

9 or a waiver of such a plan. 

10 (4) UNITED STATES.—The term ‘‘United 

11 States’’ has the meaning given the term in section 

12 1101(a)(2) of the Social Security Act (42 U.S.C. 

13 1301(a)(2)), for purposes of title XIX of such Act 

14 (42 U.S.C. 1396 et seq.). 

15 (g) CONTINUATION PAST DEMONSTRATION.—Any 

16 State receiving a grant under this section must agree to 

17 directly pay for language services in Medicaid for all Med18 icaid providers by the end of the grant period. 

19 (h) FUNDING.— 

20 (1) AUTHORIZATION OF APPROPRIATIONS.— 

21 There is authorized to be appropriated $5,000,000 

22 to carry out this section. 

23 (2) AVAILABILITY OF FUNDS.—Amounts appro24 priated pursuant to the authorization in paragraph 


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1 (1) are authorized to remain available without fiscal 

2 year limitation. 

3 (3) INCREASED FEDERAL FINANCIAL PARTICI4 PATION.—Section 1903(a)(2)(E) of the Social Secu5 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 

6 inserting ‘‘(or, in the case of a State that was 

7 awarded a grant under section 205 of the Health 

8 Equity and Accountability Act of 2020, 100 percent 

9 for each quarter occurring during the grant period 

10 specified in subsection (b) of such section)’’ after 

11 ‘‘75 percent’’. 

12 (i) LIMITATION.—No Federal funds awarded under 

13 this section may be used to provide interpreter services 

14 from a location outside the United States. 

15 SEC. 206. TRAINING TOMORROW’S DOCTORS FOR CUL16 TURALLY AND LINGUISTICALLY APPRO17 PRIATE CARE: GRADUATE MEDICAL EDU18 CATION. 

19 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec20 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 

21 1395ww(h)(4)) is amended by adding at the end the fol22 lowing new subparagraph: 

23 ‘‘(L) TREATMENT OF CULTURALLY AND

24 LINGUISTICALLY APPROPRIATE TRAINING.—In 

25 determining a hospital’s number of full-time 


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1 equivalent residents for purposes of this sub2 section, all the time that is spent by an intern 

3 or resident in an approved medical residency 

4 training program for education and training in 

5 culturally and linguistically appropriate service 

6 delivery, which shall include all diverse popu7 lations including people with disabilities and the 

8 Lesbian, gay, bisexual, transgender, queer, 

9 questioning, questioning and intersex 

10 (LGBTQIA) community, shall be counted to11 ward the determination of full-time equiva12 lency.’’. 

13 (b) INDIRECT MEDICAL EDUCATION.—Section 

14 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

15 1395ww(d)(5)(B)) is amended— 

16 (1) by redesignating the clause (x) added by 

17 section 5505(b) of the Patient Protection and Af18 fordable Care Act as clause (xi) and moving the left 

19 margin of such clause and each subclause and item 

20 therein 2 ems to the left; and 

21 (2) by adding at the end the following new 

22 clause: 

23 ‘‘(xii) The provisions of subparagraph (L) of 

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1 graph in the same manner as they apply under such 

2 subsection.’’. 

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

4 subsections (a) and (b) shall apply with respect to pay5 ments made to hospitals on or after the date that is one 

6 year after the date of the enactment of this Act. 

7 SEC. 207. FEDERAL REIMBURSEMENT FOR CULTURALLY 

8 AND LINGUISTICALLY APPROPRIATE SERV9 ICES UNDER THE MEDICARE, MEDICAID, AND 

10 STATE CHILDREN’S HEALTH INSURANCE 

11 PROGRAMS. 

12 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE

13 PROVIDERS.— 

14 (1) ESTABLISHMENT.— 

15 (A) IN GENERAL.—Not later than 6 

16 months after the date of the enactment of this 

17 Act, the Secretary of Health and Human Serv18 ices, acting through the Centers for Medicare & 

19 Medicaid Services and in consultation with the 

20 Center for Medicare and Medicaid Innovation 

21 (as referred to in section 1115A of the Social 

22 Security Act (42 U.S.C. 1315a)), shall establish 

23 a demonstration program under which the Sec24 retary shall award grants to eligible Medicare 

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1 tween such providers and Medicare beneficiaries 

2 who are limited English proficient, including 

3 beneficiaries who live in diverse and under4 served communities. 

5 (B) APPLICATION OF INNOVATION

6 RULES.—The demonstration project under sub7 paragraph (A) shall be conducted in a manner 

8 that is consistent with the applicable provisions 

9 of subsections (b), (c), and (d) of section 1115A 

10 of the Social Security Act (42 U.S.C. 1315a). 

11 (C) NUMBER OF GRANTS.—To the extent 

12 practicable, the Secretary shall award not less 

13 than 24 grants under this subsection. 

14 (D) GRANT PERIOD.—Except as provided 

15 under paragraph (2)(D), each grant awarded 

16 under this subsection shall be for a 3-year pe17 riod. 

18 (2) ELIGIBILITY REQUIREMENTS.—To be eligi19 ble for a grant under this subsection, an entity must 

20 meet the following requirements: 

21 (A) MEDICARE PROVIDER.—The entity 

22 must be— 

23 (i) a provider of services under part A 

24 of title XVIII of the Social Security Act 

25 (42 U.S.C. 1395c et seq.); 


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1 (ii) a provider of services under part 

2 B of such title (42 U.S.C. 1395j et seq.); 

3 (iii) a Medicare Advantage organiza4 tion offering a Medicare Advantage plan 

5 under part C of such title (42 U.S.C. 

6 1395w–21 et seq.); or 

7 (iv) a PDP sponsor offering a pre8 scription drug plan under part D of such 

9 title (42 U.S.C. 1395w–101 et seq.). 

10 (B) UNDERSERVED COMMUNITIES.—The 

11 entity must serve a community that, with re12 spect to necessary language services for improv13 ing access and utilization of health care among 

14 English learners, is disproportionally under15 served. 

16 (C) APPLICATION.—The entity must pre17 pare and submit to the Secretary an applica18 tion, at such time, in such manner, and accom19 panied by such additional information as the 

20 Secretary may require. 

21 (D) REPORTING.—In the case of a grantee 

22 that received a grant under this subsection in 

23 a previous year, such grantee is only eligible for 

24 continued payments under a grant under this 

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1 quirements under paragraph (9) for such year. 

2 If a grantee fails to meet the requirement of 

3 such paragraph for the first year of a grant, the 

4 Secretary may terminate the grant and solicit 

5 applications from new grantees to participate in 

6 the demonstration program. 

7 (3) DISTRIBUTION.—To the extent feasible, the 

8 Secretary shall award— 

9 (A) at least 6 grants to providers of serv10 ices described in paragraph (2)(A)(i); 

11 (B) at least 6 grants to service providers 

12 described in paragraph (2)(A)(ii); 

13 (C) at least 6 grants to organizations de14 scribed in paragraph (2)(A)(iii); and 

15 (D) at least 6 grants to sponsors described 

16 in paragraph (2)(A)(iv). 

17 (4) CONSIDERATIONS IN AWARDING GRANTS.— 

18 (A) VARIATION IN GRANTEES.—In award19 ing grants under this subsection, the Secretary 

20 shall select grantees to ensure the following: 

21 (i) The grantees provide many dif22 ferent types of language services. 

23 (ii) The grantees serve Medicare bene24 ficiaries who speak different languages, 


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1 and who, as a population, have differing 

2 needs for language services. 

3 (iii) The grantees serve Medicare 

4 beneficiaries in both urban and rural set5 tings. 

6 (iv) The grantees serve Medicare 

7 beneficiaries in at least two geographic re8 gions, as defined by the Secretary. 

9 (v) The grantees serve Medicare bene10 ficiaries in at least two large metropolitan 

11 statistical areas with racial, ethnic, sexual, 

12 gender, disability, and economically diverse 

13 populations. 

14 (B) PRIORITY FOR PARTNERSHIPS WITH

15 COMMUNITY ORGANIZATIONS AND AGENCIES.— 

16 In awarding grants under this subsection, the 

17 Secretary shall give priority to eligible entities 

18 that have a partnership with— 

19 (i) a community organization; or 

20 (ii) a consortia of community organi21 zations, State agencies, and local agencies, 

22 that has experience in providing language serv23 ices. 

24 (5) USE OF FUNDS FOR COMPETENT LANGUAGE

25 SERVICES.— 


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1 (A) IN GENERAL.—Subject to subpara2 graph (E), a grantee may only use grant funds 

3 received under this subsection to pay for the 

4 provision of competent language services to 

5 Medicare beneficiaries who are English learn6 ers. 

7 (B) COMPETENT LANGUAGE SERVICES DE8 FINED.—For purposes of this subsection, the 

9 term ‘‘competent language services’’ means— 

10 (i) interpreter and translation services 

11 that— 

12 (I) subject to the exceptions 

13 under subparagraph (C)— 

14 (aa) if the grantee operates 

15 in a State that has statewide 

16 health care interpreter standards, 

17 meet the State standards cur18 rently in effect; or 

19 (bb) if the grantee operates 

20 in a State that does not have 

21 statewide health care interpreter 

22 standards, utilizes competent in23 terpreters who follow the Na24 tional Council on Interpreting in 

25 Health Care’s Code of Ethics and 


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1 Standards of Practice and com2 ply with the requirements of sec3 tion 1557 of the Patient Protec4 tion and Affordable Care Act (42 

5 U.S.C. 18116) as published in 

6 the Federal Register on May 18, 

7 2016; and 

8 (II) that, in the case of inter9 preter services, are provided 

10 through— 

11 (aa) onsite interpretation; 

12 (bb) telephonic interpreta13 tion; or 

14 (cc) video interpretation; 

15 and 

16 (ii) the direct provision of health care 

17 or health-care-related services by a com18 petent bilingual health care provider. 

19 (C) EXCEPTIONS.—The requirements of 

20 subparagraph (B)(i)(I) do not apply, with re21 spect to interpreter and translation services and 

22 a grantee— 

23 (i) in the case of a Medicare bene24 ficiary who is an English learner if— 


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1 (I) such beneficiary has been in2 formed, in the beneficiary’s primary 

3 language, of the availability of free in4 terpreter and translation services and 

5 the beneficiary instead requests that a 

6 family member, friend, or other per7 son provide such services; and 

8 (II) the grantee documents such 

9 request in the beneficiary’s medical 

10 record; or 

11 (ii) in the case of a medical emergency 

12 where the delay directly associated with ob13 taining a competent interpreter or trans14 lation services would jeopardize the health 

15 of the patient. 

16 Clause (ii) shall not be construed to exempt 

17 emergency rooms or similar entities that regu18 larly provide health care services in medical 

19 emergencies to patients who are English learn20 ers from any applicable legal or regulatory re21 quirements related to providing competent in22 terpreter and translation services without undue 

23 delay. 

24 (D) MEDICARE ADVANTAGE ORGANIZA25 TIONS AND PDP SPONSORS.—If a grantee is a 


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1 Medicare Advantage organization offering a 

2 Medicare Advantage plan under part C of title 

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

4 1395w–21 et seq.) or a PDP sponsor offering 

5 a prescription drug plan under part D of such 

6 title (42 U.S.C. 1395w–101 et seq.), such entity 

7 must provide at least 50 percent of the grant 

8 funds that the entity receives under this sub9 section directly to the entity’s network providers 

10 (including all health providers and pharmacists) 

11 for the purpose of providing support for such 

12 providers to provide competent language serv13 ices to Medicare beneficiaries who are English 

14 learners. 

15 (E) ADMINISTRATIVE AND REPORTING

16 COSTS.—A grantee may use up to 10 percent of 

17 the grant funds to pay for administrative costs 

18 associated with the provision of competent lan19 guage services and for reporting required under 

20 paragraph (9). 

21 (6) DETERMINATION OF AMOUNT OF GRANT

22 PAYMENTS.— 

23 (A) IN GENERAL.—Payments to grantees 

24 under this subsection shall be calculated based 

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1 ficiaries who are English learners in a grantee’s 

2 service area utilizing— 

3 (i) data on the numbers of English 

4 learners who speak English less than ‘‘very 

5 well’’ from the most recently available data 

6 from the Bureau of the Census or other 

7 State-based study the Secretary determines 

8 likely to yield accurate data regarding the 

9 number of such individuals in such service 

10 area; or 

11 (ii) data provided by the grantee, if 

12 the grantee routinely collects data on the 

13 primary language of the Medicare bene14 ficiaries that the grantee serves and the 

15 Secretary determines that the data is accu16 rate and shows a greater number of 

17 English learners than would be estimated 

18 using the data under clause (i). 

19 (B) DISCRETION OF SECRETARY.—Subject 

20 to subparagraph (C), the amount of payment 

21 made to a grantee under this subsection may be 

22 modified annually at the discretion of the Sec23 retary, based on changes in the data under sub24 paragraph (A) with respect to the service area 

25 of a grantee for the year. 


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1 (C) LIMITATION ON AMOUNT.—The 

2 amount of a grant made under this subsection 

3 to a grantee may not exceed $500,000 for the 

4 period under paragraph (1)(D). 

5 (7) ASSURANCES.—Grantees under this sub6 section shall, as a condition of receiving a grant 

7 under this subsection— 

8 (A) ensure that clinical and support staff 

9 receive appropriate ongoing education and 

10 training in linguistically appropriate service de11 livery; 

12 (B) ensure the linguistic competence of bi13 lingual providers; 

14 (C) offer and provide appropriate language 

15 services at no additional charge to each patient 

16 who is an English learner for all points of con17 tact between the patient and the grantee, in a 

18 timely manner during all hours of operation; 

19 (D) notify Medicare beneficiaries of their 

20 right to receive language services in their pri21 mary language; 

22 (E) post signage in the primary languages 

23 commonly used by the patient population in the 

24 service area of the organization; and 

25 (F) ensure that— 


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1 (i) primary language data are col2 lected for recipients of language services 

3 and such data are consistent with stand4 ards developed under title XXXIV of the 

5 Public Health Service Act, as added by 

6 section 202 of this Act, to the extent such 

7 standards are available upon the initiation 

8 of the demonstration program; and 

9 (ii) consistent with the privacy protec10 tions provided under the regulations pro11 mulgated pursuant to section 264(c) of the 

12 Health Insurance Portability and Account13 ability Act of 1996 (42 U.S.C. 1320d–2 

14 note), if the recipient of language services 

15 is a minor or is incapacitated, primary lan16 guage data are collected on the parent or 

17 legal guardian of such recipient. 

18 (8) NO COST SHARING.—Medicare beneficiaries 

19 who are English learners shall not have to pay cost 

20 sharing or co-payments for competent language serv21 ices provided under this demonstration program. 

22 (9) REPORTING REQUIREMENTS FOR GRANT23 EES.—Not later than the end of each calendar year, 

24 a grantee that receives funds under this subsection 


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1 in such year shall submit to the Secretary a report 

2 that includes the following information: 

3 (A) The number of Medicare beneficiaries 

4 to whom competent language services are pro5 vided. 

6 (B) The primary languages of those Medi7 care beneficiaries. 

8 (C) The types of language services pro9 vided to such beneficiaries. 

10 (D) Whether such language services were 

11 provided by employees of the grantee or 

12 through a contract with external contractors or 

13 agencies. 

14 (E) The types of interpretation services 

15 provided to such beneficiaries, and the approxi16 mate length of time such service is provided to 

17 such beneficiaries. 

18 (F) The costs of providing competent lan19 guage services. 

20 (G) An account of the training or accredi21 tation of bilingual staff, interpreters, and trans22 lators providing services funded by the grant 

23 under this subsection. 

24 (10) EVALUATION AND REPORT TO CON25 GRESS.—Not later than 1 year after the completion 


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1 of a 3-year grant under this subsection, the Sec2 retary shall conduct an evaluation of the demonstra3 tion program under this subsection and shall submit 

4 to the Congress a report that includes the following: 

5 (A) An analysis of the patient outcomes 

6 and the costs of furnishing care to the Medicare 

7 beneficiaries who are English learners partici8 pating in the project as compared to such out9 comes and costs for such Medicare beneficiaries 

10 not participating, based on the data provided 

11 under paragraph (9) and any other information 

12 available to the Secretary. 

13 (B) The effect of delivering language serv14 ices on— 

15 (i) Medicare beneficiary access to care 

16 and utilization of services; 

17 (ii) the efficiency and cost effective18 ness of health care delivery; 

19 (iii) patient satisfaction; 

20 (iv) health outcomes; and 

21 (v) the provision of culturally appro22 priate services provided to such bene23 ficiaries. 

24 (C) The extent to which bilingual staff, in25 terpreters, and translators providing services 


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1 under such demonstration were trained or ac2 credited and the nature of accreditation or 

3 training needed by type of provider, service, or 

4 other category as determined by the Secretary 

5 to ensure the provision of high-quality interpre6 tation, translation, or other language services to 

7 Medicare beneficiaries if such services are ex8 panded pursuant to section 1115A(c) of the So9 cial Security Act (42 U.S.C. 1315a(c)). 

10 (D) Recommendations, if any, regarding 

11 the extension of such project to the entire Medi12 care Program, subject to the provisions of such 

13 section 1115A(c). 

14 (11) APPROPRIATIONS.—There is appropriated 

15 to carry out this subsection, in equal parts from the 

16 Federal Hospital Insurance Trust Fund under sec17 tion 1817 of the Social Security Act (42 U.S.C. 

18 1395i) and the Federal Supplementary Medical In19 surance Trust Fund under section 1841 of such Act 

20 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 

21 of the demonstration program. 

22 (12) ENGLISH LEARNER DEFINED.—In this 

23 subsection, the term ‘‘English learner’’ has the 

24 meaning given such term in section 8101(20) of the 

25 Elementary and Secondary Education Act of 1965, 


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1 except that subparagraphs (A), (B), and (D) of such 

2 section shall not apply. 

3 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE

4 MEDICARE PROGRAM.— 

5 (1) INCLUSION AS RURAL HEALTH CLINIC

6 SERVICES.—Section 1861 of the Social Security Act 

7 (42 U.S.C. 1395x) is amended— 

8 (A) in subsection (aa)(1)— 

9 (i) in subparagraph (B), by striking 

10 ‘‘and’’ at the end; 

11 (ii) by adding ‘‘and’’ at the end of 

12 subparagraph (C); and 

13 (iii) by inserting after subparagraph 

14 (C) the following new subparagraph: 

15 ‘‘(D) language assistance services as defined in 

16 subsection (kkk)(1),’’; and 

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

18 subsection: 

19 ‘‘Language Assistance Services and Related Terms 

20 ‘‘(kkk)(1) The term ‘language assistance services’ 

21 means ‘language access’ or ‘language assistance services’ 

22 (as those terms are defined in section 3400 of the Public 

23 Health Service Act) furnished by a ‘qualified interpreter 

24 for an individual with limited English proficiency’ or a 

25 ‘qualified translator’ (as those terms are defined in such 


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1 section 3400) to an ‘individual with limited English pro2 ficiency’ (as defined in such section 3400) or an ‘English 

3 learner’ (as defined in paragraph (2)). 

4 ‘‘(2) The term ‘English learner’ has the meaning 

5 given that term in section 8101(20) of the Elementary and 

6 Secondary Education Act of 1965, except that subpara7 graphs (A), (B), and (D) of such section shall not apply.’’. 

8 (2) COVERAGE.—Section 1832(a)(2) of the So9 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend10 ed— 

11 (A) by striking ‘‘and’’ at the end of sub12 paragraph (I); 

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

14 subparagraph (J) and inserting ‘‘; and’’; and 

15 (C) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(K) language assistance services (as de18 fined in section 1861(kkk)(1)).’’. 

19 (3) PAYMENT.—Section 1833(a) of the Social 

20 Security Act (42 U.S.C. 1395l(a)) is amended— 

21 (A) by striking ‘‘and’’ at the end of para22 graph (8); 

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

24 paragraph (9) and inserting ‘‘; and’’; and 


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1 (C) by inserting after paragraph (9) the 

2 following new paragraph: 

3 ‘‘(10) in the case of language assistance serv4 ices (as defined in section 1861(kkk)(1)), 100 per5 cent of the reasonable charges for such services, as 

6 determined in consultation with the Medicare Pay7 ment Advisory Commission.’’. 

8 (4) WAIVER OF BUDGET NEUTRALITY.—For 

9 the 3-year period beginning on the date of enact10 ment of this section, the budget neutrality provision 

11 of section 1848(c)(2)(B)(ii) of the Social Security 

12 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 

13 apply with respect to language assistance services 

14 (as defined in section 1861(kkk)(1) of such Act). 

15 (c) MEDICARE PARTS C AND D.— 

16 (1) IN GENERAL.—Medicare Advantage plans 

17 under part C of title XVIII of the Social Security 

18 Act (42 U.S.C. 1395w–21 et seq.) and prescription 

19 drug plans under part D of such title (42 U.S.C. 

20 1395q–101) shall comply with title VI of the Civil 

21 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 

22 section 1557 of the Patient Protection and Afford23 able Care Act (42 U.S.C. 18116) to provide effective 

24 language services to enrollees of such plans. 


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1 (2) MEDICARE ADVANTAGE PLANS AND PRE2 SCRIPTION DRUG PLANS REPORTING REQUIRE3 MENT.—Section 1857(e) of the Social Security Act 

4 (42 U.S.C. 1395w–27(e)) is amended by adding at 

5 the end the following new paragraph: 

6 ‘‘(6) REPORTING REQUIREMENTS RELATING TO

7 EFFECTIVE LANGUAGE SERVICES.—A contract under 

8 this part shall require a Medicare Advantage organi9 zation (and, through application of section 1860D– 

10 12(b)(3)(D), a contract under section 1860D–12 

11 shall require a PDP sponsor) to annually submit 

12 (for each year of the contract) a report that contains 

13 information on the internal policies and procedures 

14 of the organization (or sponsor) related to recruit15 ment and retention efforts directed to workforce di16 versity and linguistically and culturally appropriate 

17 provision of services in each of the following con18 texts: 

19 ‘‘(A) The collection of data in a manner 

20 that meets the requirements of title I of the 

21 Health Equity and Accountability Act of 2020, 

22 regarding the enrollee population. 

23 ‘‘(B) Education of staff and contractors 

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1 ing the various needs of the diverse enrollee 

2 population. 

3 ‘‘(C) Evaluation of the language services 

4 programs and services offered by the organiza5 tion (or sponsor) with respect to the enrollee 

6 population, such as through analysis of com7 plaints or satisfaction survey results. 

8 ‘‘(D) Methods by which the plan provides 

9 to the Secretary information regarding the eth10 nic diversity of the enrollee population. 

11 ‘‘(E) The periodic provision of educational 

12 information to plan enrollees on the language 

13 services and programs offered by the organiza14 tion (or sponsor).’’. 

15 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID

16 AND CHIP.— 

17 (1) PAYMENTS TO STATES.—Section 

18 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 

19 1396b(a)(2)(E)), as amended by section 205(h)(3), 

20 is further amended by— 

21 (A) striking ‘‘75’’ and inserting ‘‘95’’; 

22 (B) striking ‘‘translation or interpretation 

23 services’’ and inserting ‘‘language assistance 

24 services’’; and 


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1 (C) striking ‘‘children of families’’ and in2 serting ‘‘individuals’’. 

3 (2) STATE PLAN REQUIREMENTS.—Section 

4 1902(a)(10)(A) of the Social Security Act (42 

5 U.S.C. 1396a(a)(10)(A)) is amended by striking 

6 ‘‘and (29)’’ and inserting ‘‘(29), and (30)’’. 

7 (3) DEFINITION OF MEDICAL ASSISTANCE.— 

8 Section 1905(a) of the Social Security Act (42 

9 U.S.C. 1396d(a)) is amended— 

10 (A) in paragraph (29), by striking ‘‘and’’ 

11 at the end; 

12 (B) by redesignating paragraph (30) as 

13 paragraph (31); and 

14 (C) by inserting after paragraph (29) the 

15 following new paragraph: 

16 ‘‘(30) language assistance services, as such 

17 term is defined in section 1861(kkk)(1), provided in 

18 a timely manner to individuals with limited English 

19 proficiency as defined in section 3400 of the Public 

20 Health Service Act; and’’. 

21 (4) USE OF DEDUCTIONS AND COST SHAR22 ING.—Section 1916(a)(2) of the Social Security Act 

23 (42 U.S.C. 1396o(a)(2)) is amended— 

24 (A) by striking ‘‘or’’ at the end of subpara25 graph (F); 


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1 (B) by striking ‘‘; and’’ at the end of sub2 paragraph (G) and inserting ‘‘, or’’; and 

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

4 subparagraph: 

5 ‘‘(H) language assistance services de6 scribed in section 1905(a)(30); and’’. 

7 (5) CHIP COVERAGE REQUIREMENTS.—Section 

8 2103 of the Social Security Act (42 U.S.C. 1397cc) 

9 is amended— 

10 (A) in subsection (a), in the matter before 

11 paragraph (1), by striking ‘‘(7) and (8)’’ and 

12 inserting ‘‘(7), (10), and (11)’’; 

13 (B) in subsection (c), by adding at the end 

14 the following new paragraph: 

15 ‘‘(11) LANGUAGE ASSISTANCE SERVICES.—The 

16 child health assistance provided to a targeted low-in17 come child shall include coverage of language assist18 ance services, as such term is defined in section 

19 1861(kkk)(1), provided in a timely manner to indi20 viduals with limited English proficiency (as defined 

21 in section 3400 of the Public Health Service Act).’’; 

22 and 

23 (C) in subsection (e)(2)— 

24 (i) in the heading, by striking ‘‘PRE25 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 


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1 (ii) by inserting ‘‘language assistance 

2 services described in subsection (c)(11),’’ 

3 before ‘‘visits described in’’. 

4 (6) DEFINITION OF CHILD HEALTH ASSIST5 ANCE.—Section 2110(a)(27) of the Social Security 

6 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik7 ing ‘‘translation’’ and inserting ‘‘language assistance 

8 services as described in section 2103(c)(11)’’. 

9 (7) STATE DATA COLLECTION.—Pursuant to 

10 the reporting requirement described in section 

11 2107(b)(1) of the Social Security Act (42 U.S.C. 

12 1397gg(b)(1)), the Secretary of Health and Human 

13 Services shall require that States collect data on— 

14 (A) the primary language of individuals re15 ceiving child health assistance under title XXI 

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

17 seq.); and 

18 (B) in the case of such individuals who are 

19 minors or incapacitated, the primary language 

20 of the individual’s parent or guardian. 

21 (8) CHIP PAYMENTS TO STATES.—Section 

22 2105 of the Social Security Act (42 U.S.C. 1397ee) 

23 is amended— 

24 (A) in subsection (a)(1)— 


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1 (i) in the matter preceding subpara2 graph (A), by striking ‘‘75’’ and inserting 

3 ‘‘95’’; and 

4 (ii) in subparagraph (D)(iv), by strik5 ing ‘‘translation or interpretation services’’ 

6 and inserting ‘‘language assistance serv7 ices’’; and 

8 (B) in subsection (c)(2)(A), by inserting 

9 before the period at the end the following: ‘‘, 

10 except that expenditures pursuant to clause (iv) 

11 of subparagraph (D) of such paragraph shall 

12 not count towards this total’’. 

13 (e) FUNDING LANGUAGE ASSISTANCE SERVICES

14 FURNISHED BY PROVIDERS OF HEALTH CARE AND

15 HEALTH-CARE-RELATED SERVICES THAT SERVE HIGH

16 RATES OF UNINSURED LEP INDIVIDUALS.— 

17 (1) PAYMENT OF COSTS.— 

18 (A) IN GENERAL.—Subject to subpara19 graph (B), the Secretary of Health and Human 

20 Services (referred to in this subsection as the 

21 ‘‘Secretary’’) shall make payments (on a quar22 terly basis) directly to eligible entities to sup23 port the provision of language assistance serv24 ices to English learners in an amount equal to 


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1 an eligible entity’s eligible costs for providing 

2 such services for the quarter. 

3 (B) FUNDING.—Out of any funds in the 

4 Treasury not otherwise appropriated, there are 

5 appropriated to the Secretary of Health and 

6 Human Services such sums as may be nec7 essary for each of fiscal years 2021 through 

8 2025. 

9 (C) RELATION TO MEDICAID DSH.—Pay10 ments under this subsection shall not offset or 

11 reduce payments under section 1923 of the So12 cial Security Act (42 U.S.C. 1396r–4), nor 

13 shall payments under such section be consid14 ered when determining uncompensated costs as15 sociated with the provision of language assist16 ance services for the purposes of this section. 

17 (2) METHODOLOGY FOR PAYMENT OF

18 CLAIMS.— 

19 (A) IN GENERAL.—The Secretary shall es20 tablish a methodology to determine the average 

21 per person cost of language assistance services. 

22 (B) DIFFERENT ENTITIES.—In estab23 lishing such methodology, the Secretary may es24 tablish different methodologies for different 

25 types of eligible entities. 


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1 (C) NO INDIVIDUAL CLAIMS.—The Sec2 retary may not require eligible entities to sub3 mit individual claims for language assistance 

4 services for individual patients as a requirement 

5 for payment under this subsection. 

6 (3) DATA COLLECTION INSTRUMENT.—For pur7 poses of this subsection, the Secretary shall create a 

8 standard data collection instrument that is con9 sistent with any existing reporting requirements by 

10 the Secretary or relevant accrediting organizations 

11 regarding the number of individuals to whom lan12 guage access are provided. 

13 (4) GUIDELINES.—Not later than 6 months 

14 after the date of enactment of this Act, the Sec15 retary shall establish and distribute guidelines con16 cerning the implementation of this subsection. 

17 (5) REPORTING REQUIREMENTS.— 

18 (A) REPORT TO SECRETARY.—Entities re19 ceiving payment under this subsection shall pro20 vide the Secretary with a quarterly report on 

21 how the entity used such funds. Such report 

22 shall contain aggregate (and may not contain 

23 individualized) data collected using the instru24 ment under paragraph (3) and shall otherwise 


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1 be in a form and manner determined by the 

2 Secretary. 

3 (B) REPORT TO CONGRESS.—Not later 

4 than 2 years after the date of enactment of this 

5 Act, and every 2 years thereafter, the Secretary 

6 shall submit a report to Congress concerning 

7 the implementation of this subsection. 

8 (6) DEFINITIONS.—In this subsection: 

9 (A) ELIGIBLE COSTS.—The term ‘‘eligible 

10 costs’’ means, with respect to an eligible entity 

11 that provides language assistance services to 

12 English learners, the product of— 

13 (i) the average per person cost of lan14 guage assistance services, determined ac15 cording to the methodology devised under 

16 paragraph (2); and 

17 (ii) the number of English learners 

18 who are provided language assistance serv19 ices by the entity and for whom no reim20 bursement is available for such services 

21 under the amendments made by subsection 

22 (a), (b), (c), or (d) or by private health in23 surance. 

24 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

25 entity’’ means an entity that— 


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1 (i) is a Medicaid provider that is— 

2 (I) a physician; 

3 (II) a hospital with a low-income 

4 utilization rate (as defined in section 

5 1923(b)(3) of the Social Security Act 

6 (42 U.S.C. 1396r–4(b)(3))) of greater 

7 than 25 percent; or 

8 (III) a federally qualified health 

9 center (as defined in section 

10 1905(l)(2)(B) of the Social Security 

11 Act (42 U.S.C. 1396d(l)(2)(B))); 

12 (ii) not later than 6 months after the 

13 date of the enactment of this Act, provides 

14 language assistance services to not less 

15 than 8 percent of the entity’s total number 

16 of patients; and 

17 (iii) prepares and submits an applica18 tion to the Secretary, at such time, in such 

19 manner, and accompanied by such infor20 mation as the Secretary may require, to 

21 ascertain the entity’s eligibility for funding 

22 under this subsection. 

23 (C) ENGLISH LEARNER.—The term 

24 ‘‘English learner’’ has the meaning given such 

25 term in section 8101(20) of the Elementary 


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1 and Secondary Education Act of 1965 (20 

2 U.S.C. 7801(20)), except that subparagraphs 

3 (A), (B), and (D) of such section shall not 

4 apply. 

5 (D) LANGUAGE ASSISTANCE SERVICES.— 

6 The term ‘‘language assistance services’’ has 

7 the meaning given such term in section 

8 1861(kkk)(1) of the Social Security Act, as 

9 added by subsection (b). 

10 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 

11 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND

12 OTHER LAWS.—Nothing in this section shall be construed 

13 to limit otherwise existing obligations of recipients of Fed14 eral financial assistance under title VI of the Civil Rights 

15 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 

16 the Affordable Care Act, or other laws that protect the 

17 civil rights of individuals. 

18 (g) EFFECTIVE DATE.— 

19 (1) IN GENERAL.—Except as otherwise pro20 vided and subject to paragraph (2), the amendments 

21 made by this section shall take effect on January 1, 

22 2021. 

23 (2) EXCEPTION IF STATE LEGISLATION RE24 QUIRED.—In the case of a State plan for medical as25 sistance under title XIX of the Social Security Act 


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1 (42 U.S.C. 1396 et seq.) or a State plan for child 

2 health assistance under title XXI of such Act (42 

3 U.S.C. 1397aa et seq.) which the Secretary of 

4 Health and Human Services determines requires 

5 State legislation (other than legislation appro6 priating funds) in order for the plan to meet the ad7 ditional requirement imposed by the amendments 

8 made by this section, such State plan shall not be 

9 regarded as failing to comply with the requirements 

10 of such title solely on the basis of its failure to meet 

11 this additional requirement before the first day of 

12 the first calendar quarter beginning after the close 

13 of the first regular session of the State legislature 

14 that begins after the date of the enactment of this 

15 Act. For purposes of the previous sentence, in the 

16 case of a State that has a 2-year legislative session, 

17 each year of such session shall be deemed to be a 

18 separate regular session of the State legislature. 

19 SEC. 208. INCREASING UNDERSTANDING OF AND IMPROV20 ING HEALTH LITERACY. 

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

22 Human Services, acting through the Director of the Agen23 cy for Healthcare Research and Quality with respect to 

24 grants under subsection (c)(1) and through the Adminis25 trator of the Health Resources and Services AdministraVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 tion with respect to grants under subsection (c)(2), in con2 sultation with the Director of the National Institute on 

3 Minority Health and Health Disparities and the Deputy 

4 Assistant Secretary for Minority Health, shall award 

5 grants to eligible entities to improve health care for pa6 tient populations that have low functional health literacy. 

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

8 under subsection (a), an entity shall— 

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

10 plan, or other health entity (including a nonprofit 

11 minority health organization or association); and 

12 (2) prepare and submit to the Secretary an ap13 plication at such time, in such manner, and con14 taining such information as the Secretary may rea15 sonably require. 

16 (c) USE OF FUNDS.— 

17 (1) AGENCY FOR HEALTHCARE RESEARCH AND

18 QUALITY.—A grant awarded under subsection (a) 

19 through the Director of the Agency for Healthcare 

20 Research and Quality shall be used— 

21 (A) to define and increase the under22 standing of health literacy; 

23 (B) to investigate the correlation between 

24 low health literacy and health and health care; 


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1 (C) to clarify which aspects of health lit2 eracy have an effect on health outcomes; and 

3 (D) for any other activity determined ap4 propriate by the Director. 

5 (2) HEALTH RESOURCES AND SERVICES ADMIN6 ISTRATION.—A grant awarded under subsection (a) 

7 through the Administrator of the Health Resources 

8 and Services Administration shall be used to conduct 

9 demonstration projects for interventions for patients 

10 with low health literacy that may include— 

11 (A) the development of new disease man12 agement programs for patients with low health 

13 literacy; 

14 (B) the tailoring of disease management 

15 programs addressing mental, physical, oral, and 

16 behavioral health conditions for patients with 

17 low health literacy; 

18 (C) the translation of written health mate19 rials for patients with low health literacy; 

20 (D) the identification, implementation, and 

21 testing of low health literacy screening tools; 

22 (E) the conduct of educational campaigns 

23 for patients and providers about low health lit24 eracy; 


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1 (F) the conduct of educational campaigns 

2 concerning health directed specifically at pa3 tients with mental disabilities, including those 

4 with cognitive and intellectual disabilities, de5 signed to reduce the incidence of low health lit6 eracy among these populations, which shall 

7 have instructional materials in the plain lan8 guage standards promulgated under the Plain 

9 Writing Act of 2010 (5 U.S.C. 301 note) for 

10 Federal agencies; and 

11 (G) other activities determined appropriate 

12 by the Administrator. 

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

14 health literacy’’ means the inability of an individual to ob15 tain, process, and understand basic health information 

16 and services needed to make appropriate health decisions. 

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to carry out this section, 

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

20 2021 through 2025. 

21 SEC. 209. REQUIREMENTS FOR HEALTH PROGRAMS OR AC22 TIVITIES RECEIVING FEDERAL FUNDS. 

23 (a) COVERED ENTITY; COVERED PROGRAM OR AC24 TIVITY.—In this section— 


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1 (1) the term ‘‘covered entity’’ has the meaning 

2 given such term in section 92.4 of title 45, Code of 

3 Federal Regulations, as in effect on May 18, 2016 

4 (81 Fed. Reg. 31466 (May 18, 2016)); and 

5 (2) the term ‘‘health program or activity’’ has 

6 the meaning given such term in section 92.4 of title 

7 45, Code of Federal Regulations, as in effect on May 

8 18, 2016 (81 Fed. Reg. 31466 (May 18, 2016)). 

9 (b) REQUIREMENTS.—A covered entity, in order to 

10 ensure the right of individuals with limited English pro11 ficiency to receive access to high-quality health care 

12 through the covered program or activity, shall— 

13 (1) ensure that appropriate clinical and support 

14 staff receive ongoing education and training in cul15 turally and linguistically appropriate service delivery; 

16 (2) offer and provide appropriate language as17 sistance services at no additional charge to each pa18 tient that is an individual with limited English pro19 ficiency at all points of contact, in a timely manner 

20 during all hours of operation; 

21 (3) notify patients of their right to receive lan22 guage services in their primary language; and 

23 (4) utilize only qualified interpreters for an in24 dividual with limited English proficiency or qualified 

25 translators, except as provided in subsection (c). 


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1 (c) EXEMPTIONS.—The requirements of subsection 

2 (b)(4) shall not apply as follows: 

3 (1) When a patient requests the use of family, 

4 friends, or other persons untrained in interpretation 

5 or translation if each of the following conditions are 

6 met: 

7 (A) The interpreter requested by the pa8 tient is over the age of 18. 

9 (B) The covered entity informs the patient 

10 in the primary language of the patient that he 

11 or she has the option of having the entity pro12 vide to the patient an interpreter and trans13 lation services without charge. 

14 (C) The covered entity informs the patient 

15 that the entity may not require an individual 

16 with a limited English proficiency to use a fam17 ily member or friend as an interpreter. 

18 (D) The covered entity evaluates whether 

19 the person the patient wishes to use as an in20 terpreter is competent. If the covered entity has 

21 reason to believe that such person is not com22 petent as an interpreter, the entity provides its 

23 own interpreter to protect the covered entity 

24 from liability if the patient’s interpreter is later 

25 found not competent. 


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1 (E) If the covered entity has reason to be2 lieve that there is a conflict of interest between 

3 the interpreter and patient, the covered entity 

4 may not use the patient’s interpreter. 

5 (F) The covered entity has the patient sign 

6 a waiver, witnessed by at least 1 individual not 

7 related to the patient, that includes the infor8 mation stated in subparagraphs (A) through 

9 (E) and is translated into the patient’s primary 

10 language. 

11 (2) When a medical emergency exists and the 

12 delay directly associated with obtaining competent 

13 interpreter or translation services would jeopardize 

14 the health of the patient, but only until a competent 

15 interpreter or translation service is available. 

16 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 

17 shall not be construed to mean that emergency rooms or 

18 similar entities that regularly provide health care services 

19 in medical emergencies are exempt from legal or regu20 latory requirements related to competent interpreter serv21 ices. 


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1 SEC. 210. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL2 TURALLY AND LINGUISTICALLY APPRO3 PRIATE HEALTH CARE SERVICES. 

4 (a) REPORT.—Not later than 1 year after the date 

5 of enactment of this Act and annually thereafter, the Sec6 retary of Health and Human Services shall enter into a 

7 contract with the National Academy of Medicine for the 

8 preparation and publication of a report that describes 

9 Federal efforts to ensure that all individuals with limited 

10 English proficiency have meaningful access to health care 

11 services and health-care-related services that are culturally 

12 and linguistically appropriate. Such report shall include— 

13 (1) a description and evaluation of the activities 

14 carried out under this Act; 

15 (2) a description and analysis of best practices, 

16 model programs, guidelines, and other effective 

17 strategies for providing access to culturally and lin18 guistically appropriate health care services; 

19 (3) recommendations on the development and 

20 implementation of policies and practices by providers 

21 of health care services and health-care-related serv22 ices for individuals with limited English proficiency, 

23 including people with cognitive, hearing, vision, or 

24 print impairments; 

25 (4) recommend guidelines or standards for 

26 health literacy and plain language, informed consent, 


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1 discharge instructions, and written communications, 

2 and for improvement of health care access; 

3 (5) a description of the effect of providing lan4 guage services on quality of health care and access 

5 to care; and 

6 (6) a description of the costs associated with or 

7 savings related to the provision of language services. 

8 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to carry out this section 

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

11 2021 through 2025. 

12 SEC. 211. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 

13 (a) GRANTS AUTHORIZED.—The Secretary of Edu14 cation is authorized to provide grants to eligible entities 

15 for the provision of English as a second language (in this 

16 section referred to ‘‘ESL’’) instruction and shall deter17 mine, after consultation with appropriate stakeholders, the 

18 mechanism for administering and distributing such 

19 grants. 

20 (b) ELIGIBLE ENTITY DEFINED.—In this section, 

21 the term ‘‘eligible entity’’ means a State or community22 based organization that employs and serves minority popu23 lations. 

24 (c) APPLICATION.—An eligible entity may apply for 

25 a grant under this section by submitting such information 


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1 as the Secretary of Education may require and in such 

2 form and manner as the Secretary may require. 

3 (d) USE OF GRANT.—As a condition of receiving a 

4 grant under this section, an eligible entity shall— 

5 (1) develop and implement a plan for assuring 

6 the availability of ESL instruction that effectively 

7 integrates information about the nature of the 

8 United States health care system, how to access 

9 care, and any special language skills that may be re10 quired for individuals to access and regularly nego11 tiate the system effectively; 

12 (2) develop a plan, including, where appro13 priate, public-private partnerships, for making ESL 

14 instruction progressively available to all individuals 

15 seeking instruction; and 

16 (3) maintain current ESL instruction efforts by 

17 using funds available under this section to supple18 ment rather than supplant any funds expended for 

19 ESL instruction in the State as of January 1, 2020. 

20 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 

21 Secretary of Education shall— 

22 (1) collect and publicize annual data on how 

23 much Federal, State, and local governments spend 

24 on ESL instruction; 


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1 (2) collect data from State and local govern2 ments to identify the unmet needs of English lan3 guage learners for appropriate ESL instruction, in4 cluding— 

5 (A) the preferred written and spoken lan6 guage of such English language learners; 

7 (B) the extent of waiting lists for ESL in8 struction, including how many programs main9 tain waiting lists and, for programs that do not 

10 have waiting lists, the reasons why not; 

11 (C) the availability of programs to geo12 graphically isolated communities; 

13 (D) the impact of course enrollment poli14 cies, including open enrollment, on the avail15 ability of ESL instruction; 

16 (E) the number of individuals in the State 

17 and each participating locality; 

18 (F) the effectiveness of the instruction in 

19 meeting the needs of individuals receiving in20 struction and individuals needing instruction; 

21 (G) an assessment of the need for pro22 grams that integrate job training and ESL in23 struction, to assist individuals to obtain better 

24 jobs; and 


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1 (H) the availability of ESL slots by State 

2 and locality; 

3 (3) determine the cost and most appropriate 

4 methods of making ESL instruction available to all 

5 English language learners seeking instruction; and 

6 (4) not later than 1 year after the date of en7 actment of this Act, issue a report to Congress that 

8 assesses the information collected in paragraphs (1), 

9 (2), and (3) and makes recommendations on steps 

10 that should be taken to progressively realize the goal 

11 of making ESL instruction available to all English 

12 language learners seeking instruction. 

13 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to the Secretary of Edu15 cation $250,000,000 for each of fiscal years 2021 through 

16 2024 to carry out this section. 

17 SEC. 212. IMPLEMENTATION. 

18 (a) GENERAL PROVISIONS.— 

19 (1) IMMUNITY.—A State shall not be immune 

20 under the 11th Amendment to the Constitution of 

21 the United States from suit in Federal court for a 

22 violation of this title (including an amendment made 

23 by this title). 

24 (2) REMEDIES.—In a suit against a State for 

25 a violation of this title (including an amendment 


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1 made by this title), remedies (including remedies 

2 both at law and in equity) are available for such a 

3 violation to the same extent as such remedies are 

4 available for such a violation in a suit against any 

5 public or private entity other than a State. 

6 (b) RULE OF CONSTRUCTION.—Nothing in this title 

7 shall be construed to limit otherwise existing obligations 

8 of recipients of Federal financial assistance under title VI 

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

10 or any other Federal statute. 

11 SEC. 213. LANGUAGE ACCESS SERVICES. 

12 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 

13 the Patient Protection and Affordable Care Act (42 

14 U.S.C. 18022(b)(1)) is amended by adding at the end the 

15 following: 

16 ‘‘(K) Language access services, including 

17 oral interpretation and written translations.’’. 

18 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL

19 COVERAGE.— 

20 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 

21 Internal Revenue Code of 1986 is amended by redes22 ignating clauses (iii) and (iv) as clauses (iv) and (v), 

23 respectively, and by inserting after clause (ii) the fol24 lowing new clause: 


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1 ‘‘(iii) COVERAGE MUST INCLUDE LAN2 GUAGE ACCESS AND SERVICES.—Except as 

3 provided in clause (iv), an employee shall 

4 not be treated as eligible for minimum es5 sential coverage if such coverage consists 

6 of an eligible employer-sponsored plan (as 

7 defined in section 5000A(f)(2)) and the 

8 plan does not provide coverage for lan9 guage access services, including oral inter10 pretation and written translations.’’. 

11 (2) CONFORMING AMENDMENTS.— 

12 (A) Section 36B(c)(2)(C) of such Code is 

13 amended by striking ‘‘clause (iii)’’ each place it 

14 appears in clauses (i) and (ii) and inserting 

15 ‘‘clause (iv)’’. 

16 (B) Section 36B(c)(2)(C)(iv) of such Code, 

17 as redesignated by this subsection, is amended 

18 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 

19 and (iii)’’. 

20 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 

21 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 

22 amended— 

23 (1) by striking ‘‘and’’ at the end of subpara24 graph (C); 


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1 (2) by striking the period at the end of sub2 paragraph (D) and inserting ‘‘; and’’; and 

3 (3) by adding at the end the following new sub4 paragraph: 

5 ‘‘(E) reduce health disparities through the 

6 provision of language access services, including 

7 oral interpretation and written translations.’’. 

8 (d) REGULATIONS REGARDING INTERNAL CLAIMS

9 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR

10 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 

11 The Secretary of the Treasury, the Secretary of Labor, 

12 and the Secretary of Health and Human Services shall 

13 amend the regulations in section 54.9815–2719(e) of title 

14 26, Code of Federal Regulations, section 2590.715– 

15 2719(e) of title 29, Code of Federal Regulations, and sec16 tion 147.136(e) of title 45, Code of Federal Regulations 

17 (or a successor regulation), respectively, to require group 

18 health plans and health insurance issuers offering group 

19 or individual health insurance coverage to which such sec20 tions apply— 

21 (1) to provide oral interpretation services with22 out any threshold requirements; 

23 (2) to provide in the English versions of all no24 tices a statement prominently displayed in not less 

25 than 15 non-English languages clearly indicating 


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1 how to access the language services provided by the 

2 plan or issuer; and 

3 (3) with respect to the requirements for pro4 viding relevant notices in a culturally and linguis5 tically appropriate manner in the applicable non6 English languages, to apply a threshold that 5 per7 cent of the population, or not less than 500 individ8 uals, in the county is literate only in the same non9 English language in order for the language to be 

10 considered an applicable non-English language. 

11 (e) DATA COLLECTION AND REPORTING.—The Sec12 retary of Health and Human Services shall— 

13 (1) amend the single streamlined application 

14 form developed pursuant to section 1413 of the Pa15 tient Protection and Affordable Care Act (42 U.S.C. 

16 18083) to collect the preferred spoken and written 

17 language for each household member applying for 

18 coverage under a qualified health plan through an 

19 Exchange under title I of such Act (42 U.S.C. 

20 18001 et seq.); 

21 (2) require navigators, certified application 

22 counselors, and other individuals assisting with en23 rollment to collect and report requests for language 

24 assistance; and 


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1 (3) require the toll-free telephone hotlines es2 tablished pursuant to section 1311(d)(4)(B) of the 

3 Patient Protection and Affordable Care Act (42 

4 U.S.C. 18031(d)(4)(B)) to submit an annual report 

5 documenting the number of language assistance re6 quests, the types of languages requested, the range 

7 and average wait time for a consumer to speak with 

8 an interpreter, and any steps the hotline, and any 

9 entity contracting with the Secretary to provide lan10 guage services, have taken to actively address some 

11 of the consumer complaints. 

12 (f) EFFECTIVE DATE.—The amendments made by 

13 this section shall not apply to plans beginning prior to the 

14 date of the enactment of this Act. 

15 SEC. 214. MEDICALLY UNDERSERVED POPULATIONS. 

16 Section 330(b)(3)(A) of the Public Health Service 

17 Act (42 U.S.C. 254b(b)(3)(A)) is amended to read as fol18 lows: 

19 ‘‘(A) IN GENERAL.—The term ‘medically 

20 underserved’, with respect to a population, 

21 means— 

22 ‘‘(i) the population of an urban or 

23 rural area designated by the Secretary 

24 as— 


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1 ‘‘(I) an area with a shortage of 

2 personal health services; or 

3 ‘‘(II) a population group having a 

4 shortage of such services; or 

5 ‘‘(ii) a population of individuals, not 

6 confined to a particular urban or rural 

7 area, who are designated by the Secretary 

8 as having a shortage of personal health 

9 services due to a specific demographic 

10 trait.’’. 

11 TITLE III—HEALTH WORKFORCE 

12 DIVERSITY 

13 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

14 ACT. 

15 Title XXXIV of the Public Health Service Act, as 

16 added by section 204, is amended by adding at the end 

17 the following: 

18 ‘‘Subtitle B—Diversifying the 

19 Health Care Workplace 

20 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 

21 DIVERSITY. 

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

23 the Bureau of Health Workforce of the Health Resources 

24 and Services Administration, shall award a grant to an 

25 entity determined appropriate by the Secretary for the esVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 tablishment of a national working group on workforce di2 versity. 

3 ‘‘(b) REPRESENTATION.—In establishing the national 

4 working group under subsection (a): 

5 ‘‘(1) The grantee shall ensure that the group 

6 has representatives of each of the following: 

7 ‘‘(A) The Health Resources and Services 

8 Administration. 

9 ‘‘(B) The Department of Health and 

10 Human Services Data Council. 

11 ‘‘(C) The Office of Minority Health of the 

12 Department of Health and Human Services. 

13 ‘‘(D) The Substance Abuse and Mental 

14 Health Services Administration. 

15 ‘‘(E) The Bureau of Labor Statistics of 

16 the Department of Labor. 

17 ‘‘(F) The National Institute on Minority 

18 Health and Health Disparities. 

19 ‘‘(G) The Agency for Healthcare Research 

20 and Quality. 

21 ‘‘(H) The Institute of Medicine Study 

22 Committee for the 2004 workforce diversity re23 port. 

24 ‘‘(I) The Indian Health Service. 

25 ‘‘(J) The Department of Education. 


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1 ‘‘(K) Minority-serving academic institu2 tions. 

3 ‘‘(L) Consumer organizations. 

4 ‘‘(M) Health professional associations, in5 cluding those that represent underrepresented 

6 minority populations. 

7 ‘‘(N) Researchers in the area of health 

8 workforce. 

9 ‘‘(O) Health workforce accreditation enti10 ties. 

11 ‘‘(P) Private (including nonprofit) founda12 tions that have sponsored workforce diversity 

13 initiatives. 

14 ‘‘(Q) Local and State health departments. 

15 ‘‘(R) Representatives of community mem16 bers to be included on admissions committees 

17 for health profession schools pursuant to sub18 section (c)(9). 

19 ‘‘(S) National community-based organiza20 tions that serve as a national intermediary to 

21 their urban affiliate members and have dem22 onstrated capacity to train health care profes23 sionals. 

24 ‘‘(T) The Veterans Health Administration. 


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1 ‘‘(U) Other entities determined appropriate 

2 by the Secretary. 

3 ‘‘(2) The grantee shall ensure that, in addition 

4 to the representatives under paragraph (1), the 

5 working group has not less than 5 health professions 

6 students representing various health profession fields 

7 and levels of training. 

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

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

10 to complete the following activities: 

11 ‘‘(1) Review public and private health workforce 

12 diversity initiatives. 

13 ‘‘(2) Identify successful health workforce diver14 sity programs and practices. 

15 ‘‘(3) Examine challenges relating to the devel16 opment and implementation of health workforce di17 versity initiatives. 

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

19 health workforce diversity, including recommenda20 tions for public and private sector initiatives. 

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

22 evaluation of current and future health workforce di23 versity initiatives. 

24 ‘‘(6) Develop recommended standards for work25 force diversity that could be applicable to all health 


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1 professions programs and programs funded under 

2 this Act. 

3 ‘‘(7) Develop guidelines to train health profes4 sionals to care for a diverse population. 

5 ‘‘(8) Develop a workforce data collection or 

6 tracking system to identify where racial and ethnic 

7 minority health professionals practice. 

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

9 community members on admissions committees for 

10 health profession schools. 

11 ‘‘(10) Help with monitoring and implementation 

12 of standards for diversity, equity, and inclusion. 

13 ‘‘(11) Other activities determined appropriate 

14 by the Secretary. 

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

16 the establishment of the working group under subsection 

17 (a), and annually thereafter, the working group shall pre18 pare and make available to the general public for com19 ment, an annual report on the activities of the working 

20 group. Such report shall include the recommendations of 

21 the working group for improving health workforce diver22 sity. 

23 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

24 is authorized to be appropriated to carry out this section 


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

2 2021 through 2025. 

3 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 

4 WORKFORCE DIVERSITY. 

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

6 the Deputy Assistant Secretary for Minority Health, and 

7 in collaboration with the Bureau of Health Workforce 

8 within the Health Resources and Services Administration 

9 and the National Institute on Minority Health and Health 

10 Disparities, shall establish a technical clearinghouse on 

11 health workforce diversity within the Office of Minority 

12 Health and coordinate current and future clearinghouses 

13 related to health workforce diversity. 

14 ‘‘(b) INFORMATION AND SERVICES.—The clearing15 house established under subsection (a) shall offer the fol16 lowing information and services: 

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

18 workforce diversity. 

19 ‘‘(2) Statistical information relating to under20 represented minority representation in health and al21 lied health professions and occupations. 

22 ‘‘(3) Model health workforce diversity practices 

23 and programs, including integrated models of care. 


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1 ‘‘(4) Admissions policies that promote health 

2 workforce diversity and are in compliance with Fed3 eral and State laws. 

4 ‘‘(5) Retainment policies that promote comple5 tion of health profession degrees for underserved 

6 populations. 

7 ‘‘(6) Lists of scholarship, loan repayment, and 

8 loan cancellation grants as well as fellowship infor9 mation for underserved populations for health pro10 fessions schools. 

11 ‘‘(7) Foundation and other large organizational 

12 initiatives relating to health workforce diversity. 

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

14 the Secretary shall consult with non-Federal entities which 

15 may include minority health professional associations and 

16 minority sections of major health professional associations 

17 to ensure the adequacy and accuracy of information. 

18 ‘‘(d) 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 2021 through 2025. 


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1 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 

2 WORKFORCE DIVERSITY, EQUITY, AND IN3 CLUSION. 

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

5 the Administrator of the Health Resources and Services 

6 Administration and the Director of the Centers for Dis7 ease Control and Prevention, shall award grants to eligible 

8 entities that demonstrate a commitment to health work9 force diversity. 

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

11 under subsection (a), an entity shall— 

12 ‘‘(1) be an educational institution or entity that 

13 historically produces or trains meaningful numbers 

14 of underrepresented minority health professionals, 

15 including— 

16 ‘‘(A) part B institutions, as defined in sec17 tion 322 of the Higher Education Act of 1965; 

18 ‘‘(B) Hispanic-serving health professions 

19 schools; 

20 ‘‘(C) Hispanic-serving institutions, as de21 fined in section 502 of such Act; 

22 ‘‘(D) Tribal colleges or universities, as de23 fined in section 316 of such Act; 

24 ‘‘(E) Asian American and Native American 

25 Pacific Islander-serving institutions, as defined 

26 in section 371(c) of such Act; 


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1 ‘‘(F) institutions that have programs to re2 cruit and retain underrepresented minority 

3 health professionals, in which a significant 

4 number of the enrolled participants are under5 represented minorities; 

6 ‘‘(G) health professional associations, 

7 which may include underrepresented minority 

8 health professional associations; and 

9 ‘‘(H) institutions, including national and 

10 regional community-based organizations with 

11 demonstrated commitment to a diversified 

12 workforce— 

13 ‘‘(i) located in communities with pre14 dominantly underrepresented minority pop15 ulations; 

16 ‘‘(ii) with whom partnerships have 

17 been formed for the purpose of increasing 

18 workforce diversity; and 

19 ‘‘(iii) in which at least 20 percent of 

20 the enrolled participants are underrep21 resented minorities; and 

22 ‘‘(2) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 


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1 ‘‘(c) USE OF FUNDS.—Amounts received under a 

2 grant under subsection (a) shall be used to expand existing 

3 workforce diversity programs, implement new workforce 

4 diversity programs, or evaluate existing or new workforce 

5 diversity programs, including with respect to mental 

6 health care professions. Such programs shall enhance di7 versity by considering minority status as part of an indi8 vidualized consideration of qualifications. Possible activi9 ties may include— 

10 ‘‘(1) educational outreach programs relating to 

11 opportunities in the health professions; 

12 ‘‘(2) scholarship, fellowship, grant, loan repay13 ment, and loan cancellation programs; 

14 ‘‘(3) postbaccalaureate programs; 

15 ‘‘(4) academic enrichment programs, particu16 larly targeting those who would not be competitive 

17 for health professions schools; 

18 ‘‘(5) supporting workforce diversity in kinder19 garten through 12th grade and other health pipeline 

20 programs; 

21 ‘‘(6) mentoring programs; 

22 ‘‘(7) internship or rotation programs involving 

23 hospitals, health systems, health plans, and other 

24 health entities; 


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1 ‘‘(8) community partnership development for 

2 purposes relating to workforce diversity; or 

3 ‘‘(9) leadership training. 

4 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

5 a grant under this section, and annually for the term of 

6 the grant, a grantee shall submit to the Secretary a report 

7 that summarizes and evaluates all activities conducted 

8 under the grant. 

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 2021 through 2025. 

13 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 

14 RESEARCHERS. 

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

16 the Director of the National Institutes of Health, the Di17 rector of the Centers for Disease Control and Prevention, 

18 the Commissioner of Food and Drugs, the Director of the 

19 Agency for Healthcare Research and Quality, and the Ad20 ministrator of the Health Resources and Services Admin21 istration, shall award grants that expand existing opportu22 nities for scientists and researchers and promote the inclu23 sion of underrepresented minorities in the health profes24 sions. 


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1 ‘‘(b) RESEARCH FUNDING.—The head of each agency 

2 listed in subsection (a) shall establish or expand existing 

3 programs to provide research funding to scientists and re4 searchers in training. Under such programs, the head of 

5 each such entity shall give priority in allocating research 

6 funding to support health research in traditionally under7 served communities, including underrepresented minority 

8 communities, and research classified as community or 

9 participatory. 

10 ‘‘(c) DATA COLLECTION.—The head of each agency 

11 listed in subsection (a) shall collect data on the number 

12 (expressed as an absolute number and a percentage) of 

13 underrepresented minority and nonminority applicants 

14 who receive and are denied agency funding at every stage 

15 of review. Such data shall be reported annually to the Sec16 retary and the appropriate committees of Congress. 

17 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec18 retary shall establish a student loan reimbursement pro19 gram to provide student loan reimbursement assistance to 

20 researchers who focus on racial and ethnic disparities in 

21 health. The Secretary shall promulgate regulations to de22 fine the scope and procedures for the program under this 

23 subsection. 

24 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec25 retary shall establish a student loan cancellation program 


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1 to provide student loan cancellation assistance to research2 ers who focus on racial and ethnic disparities in health. 

3 Students participating in the program shall make a min4 imum 5-year commitment to work at an accredited health 

5 profession school. The Secretary shall promulgate addi6 tional regulations to define the scope and procedures for 

7 the program under this subsection. 

8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to carry out this section, 

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

11 2021 through 2025. 

12 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 

13 PROFESSIONALS. 

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

15 the Director of the Centers for Disease Control and Pre16 vention, the Assistant Secretary for Mental Health and 

17 Substance Use, the Administrator of the Health Resources 

18 and Services Administration, and the Administrator of the 

19 Centers for Medicare & Medicaid Services, shall establish 

20 a program to award grants to eligible individuals for ca21 reer support in nonresearch-related health and wellness 

22 professions. 

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

24 under subsection (a), an individual shall— 


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1 ‘‘(1) be a student in a health professions school, 

2 a graduate of such a school who is working in a 

3 health profession, an individual working in a health 

4 or wellness profession (including mental and behav5 ioral health), or a faculty member of such a school; 

6 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.—An individual shall use 

11 amounts received under a grant under this section to— 

12 ‘‘(1) support the individual’s health activities or 

13 projects that involve underserved communities, in14 cluding racial and ethnic minority communities; 

15 ‘‘(2) support health-related career advancement 

16 activities; 

17 ‘‘(3) pay, or as reimbursement for payments of, 

18 student loans or training or credentialing costs for 

19 individuals who are health professionals and are fo20 cused on health issues affecting underserved commu21 nities, including racial and ethnic minority commu22 nities; and 

23 ‘‘(4) establish and promote leadership training 

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1 crease cultural competence with the goal of increas2 ing diversity in leadership positions. 

3 ‘‘(d) DEFINITION.—In this section, the term ‘career 

4 in nonresearch-related health and wellness professions’ 

5 means employment or intended employment in the field 

6 of public health, health policy, health management, health 

7 administration, medicine, nursing, pharmacy, psychology, 

8 social work, psychiatry, other mental and behavioral 

9 health, allied health, community health, social work, or 

10 other fields determined appropriate by the Secretary, 

11 other than in a position that involves research. 

12 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated to carry out this section 

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

15 2021 through 2025. 

16 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI17 VERSITY ON QUALITY. 

18 ‘‘(a) IN GENERAL.—The Director of the Agency for 

19 Healthcare Research and Quality, in collaboration with 

20 the Deputy Assistant Secretary for Minority Health and 

21 the Director of the National Institute on Minority Health 

22 and Health Disparities, shall award grants to eligible enti23 ties to expand research on the link between health work24 force diversity and quality health care. 


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

2 under subsection (a), an entity shall— 

3 ‘‘(1) be a clinical, public health, or health serv4 ices research entity or other entity determined ap5 propriate by the Director; and 

6 ‘‘(2) 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 a 

10 grant awarded under subsection (a) shall be used to sup11 port research that investigates the effect of health work12 force diversity on— 

13 ‘‘(1) language access; 

14 ‘‘(2) cultural competence; 

15 ‘‘(3) patient satisfaction; 

16 ‘‘(4) timeliness of care; 

17 ‘‘(5) safety of care; 

18 ‘‘(6) effectiveness of care; 

19 ‘‘(7) efficiency of care; 

20 ‘‘(8) patient outcomes; 

21 ‘‘(9) community engagement; 

22 ‘‘(10) resource allocation; 

23 ‘‘(11) organizational structure; 

24 ‘‘(12) compliance of care; or 


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1 ‘‘(13) other topics determined appropriate by 

2 the Director. 

3 ‘‘(d) PRIORITY.—In awarding grants under sub4 section (a), the Director shall give individualized consider5 ation to all relevant aspects of the applicant’s background. 

6 Consideration of prior research experience involving the 

7 health of underserved communities shall be such a factor. 

8 ‘‘(e) 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 2021 through 2025. 

12 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 

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

14 through the Office of Minority Health, in collaboration 

15 with the National Institute on Minority Health and Health 

16 Disparities, the Office for Civil Rights, the Centers for 

17 Disease Control and Prevention, the Centers for Medicare 

18 & Medicaid Services, the Health Resources and Services 

19 Administration, and other appropriate public and private 

20 entities, shall establish and coordinate a health and health 

21 care disparities education program to support, develop, 

22 and implement educational initiatives and outreach strate23 gies that inform health care professionals and the public 

24 about the existence of and methods to reduce racial and 

25 ethnic disparities in health and health care. 


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1 ‘‘(b) ACTIVITIES.—The Secretary, through the edu2 cation program established under subsection (a), shall, 

3 through the use of public awareness and outreach cam4 paigns targeting the general public and the medical com5 munity at large— 

6 ‘‘(1) disseminate scientific evidence for the ex7 istence and extent of racial and ethnic disparities in 

8 health care, including disparities that are not other9 wise attributable to known factors such as access to 

10 care, patient preferences, or appropriateness of 

11 intervention, as described in the 2002 Institute of 

12 Medicine Report entitled ‘Unequal Treatment: Con13 fronting Racial and Ethnic Disparities in Health 

14 Care’, as well as the impact of disparities related to 

15 age, disability status, socioeconomic status, sex, gen16 der identity, and sexual orientation on racial and 

17 ethnic minorities; 

18 ‘‘(2) disseminate new research findings to 

19 health care providers and patients to assist them in 

20 understanding, reducing, and eliminating health and 

21 health care disparities; 

22 ‘‘(3) disseminate information about the impact 

23 of linguistic and cultural barriers on health care 

24 quality and the obligation of health providers who 

25 receive Federal financial assistance to ensure that 


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1 individuals with limited English proficiency have ac2 cess to language access services; 

3 ‘‘(4) disseminate information about the impor4 tance and legality of racial, ethnic, disability status, 

5 socioeconomic status, sex, gender identity, and sex6 ual orientation, and primary language data collec7 tion, analysis, and reporting; 

8 ‘‘(5) design and implement specific educational 

9 initiatives to health care providers relating to health 

10 and health care disparities; 

11 ‘‘(6) assess the impact of the programs estab12 lished under this section in raising awareness of 

13 health and health care disparities and providing in14 formation on available resources; and 

15 ‘‘(7) design and implement specific educational 

16 initiatives to educate the health care workforce relat17 ing to unconscious bias. 

18 ‘‘(c) 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 2021 through 2025.’’. 


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1 SEC. 302. HISPANIC-SERVING INSTITUTIONS, HISTORI2 CALLY BLACK COLLEGES AND UNIVERSITIES, 

3 ASIAN AMERICAN AND NATIVE AMERICAN PA4 CIFIC ISLANDER-SERVING INSTITUTIONS, 

5 TRIBAL COLLEGES, REGIONAL COMMUNITY6 BASED ORGANIZATIONS, AND NATIONAL MI7 NORITY MEDICAL ASSOCIATIONS. 

8 (a) IN GENERAL.—Part B of title VII of the Public 

9 Health Service Act (42 U.S.C. 293 et seq.) is amended 

10 by adding at the end the following: 

11 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI12 CALLY BLACK COLLEGES AND UNIVERSITIES, 

13 ASIAN AMERICAN AND NATIVE AMERICAN PA14 CIFIC ISLANDER-SERVING INSTITUTIONS, 

15 AND TRIBAL COLLEGES. 

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

17 the Administrator of the Health Resources and Services 

18 Administration and in consultation with the Secretary of 

19 Education, shall award grants to Hispanic-serving institu20 tions, historically black colleges and universities, Asian 

21 American and Native American Pacific Islander-serving 

22 institutions, Tribal Colleges or Universities, regional com23 munity-based organizations, and national minority med24 ical associations, for counseling, mentoring, and providing 

25 information on financial assistance to prepare underrep26 resented minority individuals to enroll in and graduate 


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1 from health professional schools and to increase services 

2 for underrepresented minority students including— 

3 ‘‘(1) mentoring with underrepresented health 

4 professionals; and 

5 ‘‘(2) providing financial assistance information 

6 for continued education and applications to health 

7 professional schools. 

8 ‘‘(b) DEFINITIONS.—In this section: 

9 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN

10 PACIFIC ISLANDER-SERVING INSTITUTION.—The 

11 term ‘Asian American and Native American Pacific 

12 Islander-serving institution’ has the meaning given 

13 such term in section 320(b) of the Higher Education 

14 Act of 1965. 

15 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 

16 term ‘Hispanic-serving institution’ means an entity 

17 that— 

18 ‘‘(A) is a school or program for which 

19 there is a definition under section 799B; 

20 ‘‘(B) has an enrollment of full-time equiva21 lent students that is made up of at least 9 per22 cent Hispanic students; 

23 ‘‘(C) has been effective in carrying out pro24 grams to recruit Hispanic individuals to enroll 

25 in and graduate from the school; 


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1 ‘‘(D) has been effective in recruiting and 

2 retaining Hispanic faculty members; 

3 ‘‘(E) has a significant number of graduates 

4 who are providing health services to medically 

5 underserved populations or to individuals in 

6 health professional shortage areas; and 

7 ‘‘(F) is a Hispanic Center of Excellence in 

8 Health Professions Education designated under 

9 section 736(d)(2) of the Public Health Service 

10 Act (42 U.S.C. 293(d)(2)). 

11 ‘‘(3) HISTORICALLY BLACK COLLEGES AND

12 UNIVERSITY.—The term ‘historically black college 

13 and university’ has the meaning given the term ‘part 

14 B institution’ as defined in section 322 of the High15 er Education Act of 1965. 

16 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 

17 term ‘Tribal College or University’ has the meaning 

18 given such term in section 316(b) of the Higher 

19 Education Act of 1965. 

20 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 

21 carrying out the National Health Service Corps Loan Re22 payment Program established under subpart III of part 

23 D of title III and the loan repayment program under sec24 tion 317F, the Secretary shall ensure, notwithstanding 

25 such subpart or section, that loan repayments of not less 


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1 than $50,000 per year per person are awarded for repay2 ment of loans incurred for enrollment or participation of 

3 underrepresented minority individuals in health profes4 sional schools and other health programs described in this 

5 section. 

6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

7 is authorized to be appropriated to carry out this section 

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

9 2021 through 2026.’’. 

10 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

11 DISEASE CONTROL AND PREVENTION. 

12 Section 317F(c)(1) of the Public Health Service Act 

13 (42 U.S.C. 247b–7(c)(1)) is amended— 

14 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 

15 (2) by inserting before the period at the end the 

16 following: ‘‘, $750,000 for fiscal year 2021, and such 

17 sums as may be necessary for each of the fiscal 

18 years 2022 through 2026’’. 

19 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE20 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

21 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

22 Part B of title VII of the Public Health Service Act 

23 (42 U.S.C. 293 et seq.), as amended by section 302, is 

24 further amended by adding at the end the following: 


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1 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE2 GREE PROGRAMS. 

3 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

4 acting through the Administrator of the Health Resources 

5 and Services Administration, in consultation with the Di6 rector of the Centers for Disease Control and Prevention, 

7 the Director of the Agency for Healthcare Research and 

8 Quality, and the Deputy Assistant Secretary for Minority 

9 Health, shall enter into cooperative agreements with 

10 schools of public health and schools of allied health to de11 sign and implement online degree programs. 

12 ‘‘(b) PRIORITY.—In entering into cooperative agree13 ments under this section, the Secretary shall give priority 

14 to any school of public health or school of allied health 

15 that has an established track record of serving medically 

16 underserved communities. 

17 ‘‘(c) REQUIREMENTS.—As a condition of entering 

18 into a cooperative agreement with the Secretary under this 

19 section, a school of public health or school of allied health 

20 shall agree to design and implement an online degree pro21 gram that meets the following restrictions: 

22 ‘‘(1) Enrollment of individuals who have ob23 tained a secondary school diploma or its recognized 

24 equivalent. 


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1 ‘‘(2) Maintaining a significant enrollment of 

2 underrepresented minority or disadvantaged stu3 dents. 

4 ‘‘(3) Achieving a high completion rate of en5 rolled underrepresented minority or disadvantaged 

6 students. 

7 ‘‘(d) PERIOD OF COOPERATIVE AGREEMENTS.—The 

8 period during which payments are made through a cooper9 ative agreement entered into under this section may not 

10 exceed 3 years. 

11 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to carry out this section 

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

14 2021 through 2025.’’. 

15 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 

16 NATIONAL HEALTH CARE WORKFORCE COM17 MISSION. 

18 It is the sense of Congress that the National Health 

19 Care Workforce Commission established by section 5101 

20 of the Patient Protection and Affordable Care Act (42 

21 U.S.C. 294q) should, in carrying out its assigned duties 

22 under that section, give attention to the needs of racial 

23 and ethnic minorities, individuals with lower socio24 economic status, individuals with mental, developmental, 

25 and physical disabilities, lesbian, gay, bisexual, 


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1 transgender, queer, and questioning populations, and indi2 viduals who are members of multiple minority or special 

3 population groups. 

4 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

5 Subtitle B of title XXXIV of the Public Health Serv6 ice Act, as added by section 301, is further amended by 

7 inserting after section 3417 the following: 

8 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 

9 SERVICES CORPS. 

10 ‘‘(a) IN GENERAL.—The Director of the Centers for 

11 Disease Control and Prevention, in collaboration with the 

12 Administrator of the Health Resources and Services Ad13 ministration and the Deputy Assistant Secretary for Mi14 nority Health, shall award grants to eligible entities to in15 crease awareness among secondary and postsecondary stu16 dents of career opportunities in the health professions. 

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

18 under subsection (a), an entity shall— 

19 ‘‘(1) be a clinical, public health, or health serv20 ices organization, community-based or nonprofit en21 tity, or other entity determined appropriate by the 

22 Director of the Centers for Disease Control and Pre23 vention; 

24 ‘‘(2) serve a health professional shortage area, 

25 as determined by the Secretary; 


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1 ‘‘(3) work with students, including those from 

2 racial and ethnic minority backgrounds, that have 

3 expressed an interest in the health professions; and 

4 ‘‘(4) submit to the Secretary an application at 

5 such time, in such manner, and containing such in6 formation as the Secretary may require. 

7 ‘‘(c) USE OF FUNDS.—Grant awards under sub8 section (a) shall be used to support internships that will 

9 increase awareness among students of non-research-based, 

10 career opportunities in the following health professions: 

11 ‘‘(1) Medicine. 

12 ‘‘(2) Nursing. 

13 ‘‘(3) Public health. 

14 ‘‘(4) Pharmacy. 

15 ‘‘(5) Health administration and management. 

16 ‘‘(6) Health policy. 

17 ‘‘(7) Psychology. 

18 ‘‘(8) Dentistry. 

19 ‘‘(9) International health. 

20 ‘‘(10) Social work. 

21 ‘‘(11) Allied health. 

22 ‘‘(12) Psychiatry. 

23 ‘‘(13) Hospice care. 

24 ‘‘(14) Community health, patient navigation, 

25 and peer support. 


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1 ‘‘(15) Other professions determined appropriate 

2 by the Director of the Centers for Disease Control 

3 and Prevention. 

4 ‘‘(d) PRIORITY.—In awarding grants under sub5 section (a), the Director of the Centers for Disease Con6 trol and Prevention shall give priority to those entities 

7 that— 

8 ‘‘(1) serve a high proportion of individuals from 

9 disadvantaged backgrounds; 

10 ‘‘(2) have experience in health disparity elimi11 nation programs; 

12 ‘‘(3) facilitate the entry of disadvantaged indi13 viduals into institutions of higher education; and 

14 ‘‘(4) provide counseling or other services de15 signed to assist disadvantaged individuals in success16 fully completing their education at the postsecondary 

17 level. 

18 ‘‘(e) STIPENDS.— 

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

20 an entity receiving a grant under this section may 

21 use the funds made available through such grant to 

22 award stipends for educational and living expenses 

23 to students participating in the internship supported 

24 by the grant. 


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1 ‘‘(2) LIMITATIONS.—A stipend awarded under 

2 paragraph (1) to an individual— 

3 ‘‘(A) may not be provided for a period that 

4 exceeds 6 months; and 

5 ‘‘(B) may not exceed $20 per day for an 

6 individual (notwithstanding any other provision 

7 of law regarding the amount of a stipend). 

8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

9 is authorized to be appropriated to carry out this section 

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

11 2021 through 2026. 

12 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

13 PROGRAM. 

14 ‘‘(a) IN GENERAL.—The Director of the Centers for 

15 Disease Control and Prevention, in collaboration with the 

16 Deputy Assistant Secretary for Minority Health, shall 

17 award scholarships to eligible individuals under subsection 

18 (b) who seek a career in public health. 

19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol20 arship under subsection (a), an individual shall— 

21 ‘‘(1) have interest, knowledge, or skill in public 

22 health research or public health practice, or other 

23 health professions as determined appropriate by the 

24 Director of the Centers for Disease Control and Pre25 vention; 


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1 ‘‘(2) reside in a health professional shortage 

2 area as determined by the Secretary; 

3 ‘‘(3) demonstrate promise for becoming a leader 

4 in public health; 

5 ‘‘(4) secure admission to a 4-year institution of 

6 higher education; and 

7 ‘‘(5) 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 an 

11 award under subsection (a) shall be used to support oppor12 tunities for students to become public health professionals. 

13 ‘‘(d) PRIORITY.—In awarding grants under sub14 section (a), the Director shall give priority to those stu15 dents that— 

16 ‘‘(1) are from disadvantaged backgrounds; 

17 ‘‘(2) have secured admissions to a minority18 serving institution; and 

19 ‘‘(3) have identified a health professional as a 

20 mentor at their school or institution and an aca21 demic advisor to assist in the completion of their 

22 baccalaureate degree. 

23 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

24 payment of scholarships under this section for such indi25 viduals for any period of education in student underVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 graduate tenure, except that such a scholarship may not 

2 be provided to an individual for more than 4 years, and 

3 such a scholarship may not exceed $10,000 per academic 

4 year for an individual (notwithstanding any other provi5 sion of law regarding the amount of a scholarship). 

6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

7 is authorized to be appropriated to carry out this section 

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

9 2021 through 2025. 

10 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 

11 FELLOWSHIP PROGRAM. 

12 ‘‘(a) IN GENERAL.—The Director of the Centers for 

13 Disease Control and Prevention, in collaboration with the 

14 Deputy Assistant Secretary for Minority Health, the As15 sistant Secretary for Mental Health and Substance Use, 

16 and the Director of the Indian Health Services, shall 

17 award research fellowships to eligible individuals under 

18 subsection (b) to conduct research that will examine gen19 der and health disparities and to pursue a career in the 

20 health professions. 

21 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow22 ship under subsection (a), an individual shall— 

23 ‘‘(1) have experience in health research or pub24 lic health practice; 


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1 ‘‘(2) reside in a health professional shortage 

2 area as designated by the Secretary under section 

3 332; 

4 ‘‘(3) have expressed an interest in the health 

5 professions; 

6 ‘‘(4) demonstrate promise for becoming a leader 

7 in the field of women’s health; 

8 ‘‘(5) secure admission to a health professions 

9 school or graduate program with an emphasis in 

10 gender studies; and 

11 ‘‘(6) 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.—A fellowship awarded under 

15 subsection (a) to an eligible individual shall be used to 

16 support an opportunity for the individual to become a re17 searcher and advance the research base on the intersection 

18 between gender and health. 

19 ‘‘(d) PRIORITY.—In awarding fellowships under sub20 section (a), the Director of the Centers for Disease Con21 trol and Prevention shall give priority to those applicants 

22 that— 

23 ‘‘(1) are from disadvantaged backgrounds; and 

24 ‘‘(2) have identified a mentor and academic ad25 visor who will assist in the completion of their gradVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 uate or professional degree and have secured a re2 search assistant position with a researcher working 

3 in the area of gender and health. 

4 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

5 Disease Control and Prevention may approve fellowships 

6 for individuals under this section for any period of edu7 cation in the student’s graduate or health profession ten8 ure, except that such a fellowship may not be provided 

9 to an individual for more than 3 years, and such a fellow10 ship may not exceed $18,000 per academic year for an 

11 individual (notwithstanding any other provision of law re12 garding the amount of a fellowship). 

13 ‘‘(f) 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 2021 through 2025. 

17 ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 

18 HEALTH FELLOWSHIP PROGRAM. 

19 ‘‘(a) IN GENERAL.—The Director of the Agency for 

20 Healthcare Research and Quality, in collaboration with 

21 the Deputy Assistant Secretary for Minority Health, shall 

22 award research fellowships to eligible individuals under 

23 subsection (b) to advance their understanding of inter24 national health. 


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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow2 ship under subsection (a), an individual shall— 

3 ‘‘(1) have educational experience in the field of 

4 international health; 

5 ‘‘(2) reside in a health professional shortage 

6 area as determined by the Secretary; 

7 ‘‘(3) demonstrate promise for becoming a leader 

8 in the field of international health; 

9 ‘‘(4) be a college senior or recent graduate of 

10 a 4-year institution of higher education; and 

11 ‘‘(5) 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.—A fellowship awarded under 

15 subsection (a) to an eligible individual shall be used to 

16 support an opportunity for the individual to become a 

17 health professional and to advance the knowledge of the 

18 individual about international issues relating to health 

19 care access and quality. 

20 ‘‘(d) PRIORITY.—In awarding fellowships under sub21 section (a), the Director shall give priority to eligible indi22 viduals that— 

23 ‘‘(1) are from a disadvantaged background; and 

24 ‘‘(2) have identified a mentor at a health pro25 fessions school or institution, an academic advisor to 


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1 assist in the completion of their graduate or profes2 sional degree, and an advisor from an international 

3 health non-governmental organization, private volun4 teer organization, or other international institution 

5 or program that focuses on increasing health care 

6 access and quality for residents in developing coun7 tries. 

8 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 

9 this section may not— 

10 ‘‘(1) be provided to an eligible individual for 

11 more than a period of 6 months; 

12 ‘‘(2) be awarded to a graduate of a 4-year insti13 tution of higher education that has not been enrolled 

14 in such institution for more than 1 year; and 

15 ‘‘(3) exceed $4,000 per academic year (notwith16 standing any other provision of law regarding the 

17 amount of a fellowship). 

18 ‘‘(f) 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 2021 through 2025. 

22 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO23 GRAM. 

24 ‘‘(a) IN GENERAL.—The Director of the Agency for 

25 Healthcare Research and Quality, the Director of the CenVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ters for Medicare & Medicaid Services, and the Adminis2 trator of the Health Resources and Services Administra3 tion, in collaboration with the Deputy Assistant Secretary 

4 for Minority Health, shall award grants to eligible entities 

5 to expose entering graduate students to the health profes6 sions. 

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

8 under subsection (a), an entity shall— 

9 ‘‘(1) be a clinical, public health, or health serv10 ices organization, community-based, academic, or 

11 nonprofit entity, or other entity determined appro12 priate by the Director of the Agency for Healthcare 

13 Research and Quality; 

14 ‘‘(2) serve in a health professional shortage 

15 area as designated by the Secretary under section 

16 332; 

17 ‘‘(3) work with students obtaining a degree in 

18 the health professions; and 

19 ‘‘(4) submit to the Secretary an application at 

20 such time, in such manner, and containing such in21 formation as the Secretary may require. 

22 ‘‘(c) USE OF FUNDS.—Amounts received under a 

23 grant awarded under subsection (a) shall be used to sup24 port opportunities that expose students to non-research25 based health professions, including— 


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1 ‘‘(1) public health policy; 

2 ‘‘(2) health care and pharmaceutical policy; 

3 ‘‘(3) health care administration and manage4 ment; 

5 ‘‘(4) health economics; and 

6 ‘‘(5) other professions determined appropriate 

7 by the Director of the Agency for Healthcare Re8 search and Quality, the Director of the Centers for 

9 Medicare & Medicaid Services, or the Administrator 

10 of the Health Resources and Services Administra11 tion. 

12 ‘‘(d) PRIORITY.—In awarding grants under sub13 section (a), the Director of the Agency for Healthcare Re14 search and Quality, the Director of the Centers for Medi15 care & Medicaid Services, and the Administrator of the 

16 Health Resources and Services Administration, in collabo17 ration with the Deputy Assistant for Secretary for Minor18 ity Health, shall give priority to those entities that— 

19 ‘‘(1) have experience with health disparity elimi20 nation programs; 

21 ‘‘(2) facilitate training in the fields described in 

22 subsection (c); and 

23 ‘‘(3) provide counseling or other services de24 signed to assist students in successfully completing 

25 their education at the postsecondary level. 


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1 ‘‘(e) STIPENDS.— 

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

3 an entity receiving a grant under this section may 

4 use the funds made available through such grant to 

5 award stipends for educational and living expenses 

6 to students participating in the opportunities sup7 ported by the grant. 

8 ‘‘(2) LIMITATIONS.—A stipend awarded under 

9 paragraph (1) to an individual— 

10 ‘‘(A) may not be provided for a period that 

11 exceeds 2 months; and 

12 ‘‘(B) may not exceed $100 per day (not13 withstanding any other provision of law regard14 ing the amount of a stipend). 

15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to carry out this section 

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

18 2021 through 2025. 

19 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 

20 ‘‘(a) IN GENERAL.—The Secretary shall award 

21 grants to national minority medical or health professional 

22 associations to develop leadership fellowship programs for 

23 underrepresented health professionals in order to— 


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1 ‘‘(1) assist such professionals in becoming fu2 ture leaders in public health and health care delivery 

3 institutions; and 

4 ‘‘(2) increase diversity in decision-making posi5 tions that can improve the health of underserved 

6 communities. 

7 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro8 gram supported under this section shall— 

9 ‘‘(1) focus on training mid-career physicians 

10 and health care executives who have documented 

11 leadership experience and a commitment to public 

12 health services in underserved communities; and 

13 ‘‘(2) support Federal public health policy and 

14 budget programs, and priorities that impact health 

15 equity, through activities such as didactic lectures 

16 and leader site visits. 

17 ‘‘(c) PERIOD OF GRANTS.—The period during which 

18 payments are made under a grant awarded under sub19 section (a) may not exceed 3 years. 

20 ‘‘(d) 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 2021 through 2026.’’. 


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1 SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 

2 PROGRAM. 

3 Section 402E of the Higher Education Act of 1965 

4 (20 U.S.C. 1070a–15) is amended by striking subsection 

5 (g) and inserting the following: 

6 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI7 VERSITY TRAINING PROGRAMS.—The Secretary shall co8 ordinate with the Secretary of Health and Human Serv9 ices to ensure that there is collaboration between the goals 

10 of the program under this section and programs of the 

11 Health Resources and Services Administration that pro12 mote health workforce diversity. The Secretary of Edu13 cation shall take such measures as may be necessary to 

14 encourage students participating in projects assisted 

15 under this section to consider health profession careers. 

16 ‘‘(h) FUNDING.—From amounts appropriated pursu17 ant to the authority of section 402A(g), the Secretary 

18 shall, to the extent practicable, allocate funds for projects 

19 authorized by this section in an amount that is not less 

20 than $31,000,000 for each of the fiscal years 2021 

21 through 2026.’’. 


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1 SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 

2 EQUIVALENT RESIDENTS FOR COST-REPORT3 ING PERIODS. 

4 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 

5 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 

6 amended by section 206(a), is amended— 

7 (1) in subparagraph (E), by striking ‘‘Subject 

8 to subparagraphs (J) and (K), such rules’’ and in9 serting ‘‘Subject to subparagraphs (J), (K), and 

10 (M), such rules’’; 

11 (2) in subparagraph (J), by striking ‘‘Such 

12 rules’’ and inserting ‘‘Subject to subparagraph (M), 

13 such rules’’; 

14 (3) in subparagraph (K), by striking ‘‘In deter15 mining’’ and inserting ‘‘Subject to subparagraph 

16 (M), in determining’’; and 

17 (4) by adding at the end the following new sub18 paragraph: 

19 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS

20 AND INTERNS.—For purposes of cost-reporting 

21 periods beginning on or after October 1, 2021, 

22 in determining the hospital’s number of full23 time equivalent residents for purposes of this 

24 paragraph, all the time spent by an intern or 

25 resident in an approved medical residency train26 ing program shall be counted toward the deterVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 mination of full-time equivalency if the hos2 pital— 

3 ‘‘(i) is recognized as a subsection (d) 

4 hospital; 

5 ‘‘(ii) is recognized as a subsection (d) 

6 Puerto Rico hospital; 

7 ‘‘(iii) is reimbursed under a reim8 bursement system authorized under section 

9 1814(b)(3); or 

10 ‘‘(iv) is a provider-based hospital out11 patient department.’’. 

12 (b) IME DETERMINATIONS.—Section 

13 1886(d)(5)(B)(xi) of the Social Security Act (42 U.S.C. 

14 1395ww(d)(5)(B)(xi)), as redesignated by section 206(b), 

15 is amended— 

16 (1) in subclause (II), by striking ‘‘In deter17 mining’’ and inserting ‘‘Subject to subclause (IV), in 

18 determining’’; 

19 (2) in subclause (III), by striking ‘‘In deter20 mining’’ and inserting ‘‘Subject to subclause (IV), in 

21 determining’’; and 

22 (3) by inserting after subclause (III) the fol23 lowing new subclause: 

24 ‘‘(IV) For purposes of cost-reporting peri25 ods beginning on or after October 1, 2021, the 


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1 provisions of subparagraph (M) of subsection 

2 (h)(4) shall apply under this subparagraph in 

3 the same manner as they apply under such sub4 section.’’. 

5 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 

6 FOR LOCAL HEALTH EQUITY. 

7 (a) GRANTS.—The Secretary of Health and Human 

8 Services, acting jointly with the Secretary of Education 

9 and the Secretary of Labor, shall make grants to institu10 tions of higher education for the purposes of— 

11 (1) in accordance with subsection (b), devel12 oping capacity— 

13 (A) to build an evidence base for successful 

14 strategies for increasing local health equity; and 

15 (B) to serve as national models of driving 

16 local health equity; 

17 (2) in accordance with subsection (c), devel18 oping a strategic partnership with the community in 

19 which the institution is located; and 

20 (3) collecting data on, and periodically evalu21 ating, the effectiveness of the institution’s programs 

22 funded through this section to enable the institution 

23 to adapt accordingly for maximum efficiency and 

24 success. 


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1 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL

2 HEALTH EQUITY.—As a condition on receipt of a grant 

3 under subsection (a), an institution of higher education 

4 shall agree to use the grant to build an evidence base for 

5 successful strategies for increasing local health equity, and 

6 to serve as a national model of driving local health equity, 

7 by supporting— 

8 (1) resources to strengthen institutional metrics 

9 and capacity to execute institution-wide health work10 force goals that can serve as models for increasing 

11 health equity in communities across the United 

12 States; 

13 (2) collaborations among a cohort of institu14 tions in implementing systemic change, partnership 

15 development, and programmatic efforts supportive of 

16 health equity goals across disciplines and popu17 lations; and 

18 (3) enhanced or newly developed data systems 

19 and research infrastructure capable of informing 

20 current and future workforce efforts and building a 

21 foundation for a broader research agenda targeting 

22 urban health disparities. 

23 (c) STRATEGIC PARTNERSHIPS.—As a condition on 

24 receipt of a grant under subsection (a), an institution of 

25 higher education shall agree to use the grant to develop 


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1 a strategic partnership with the community in which the 

2 institution is located for the purposes of— 

3 (1) strengthening connections between the insti4 tution and the community— 

5 (A) to improve evaluation of and address 

6 the community’s health and health workforce 

7 needs; and 

8 (B) to engage the community in health 

9 workforce development; 

10 (2) developing, enhancing, or accelerating inno11 vative undergraduate and graduate programs in the 

12 biomedical sciences and health professions; and 

13 (3) strengthening pipeline programs in the bio14 medical sciences and health professions, including by 

15 developing partnerships between institutions of high16 er education and elementary schools and secondary 

17 schools to recruit the next generation of health pro18 fessionals earlier in the pipeline to a health care ca19 reer. 

20 (d) 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 2021 through 2026. 


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1 SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV2 IORAL HEALTH SOCIAL WORKERS. 

3 Section 455 of the Higher Education Act of 1965 (20 

4 U.S.C. 1087e) is amended by adding at the end the fol5 lowing: 

6 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV7 IORAL HEALTH SOCIAL WORKERS.— 

8 ‘‘(1) IN GENERAL.—The Secretary shall cancel 

9 the balance of interest and principal due, in accord10 ance with paragraph (2), on any eligible Federal Di11 rect Loan not in default for a borrower who— 

12 ‘‘(A) has made 120 monthly payments on 

13 the eligible Federal Direct Loan after October 

14 1, 2020, pursuant to any one or a combination 

15 of the following— 

16 ‘‘(i) payments under an income-based 

17 repayment plan under section 493C; 

18 ‘‘(ii) payments under a standard re19 payment plan under subsection (d)(1)(A), 

20 based on a 10-year repayment period; 

21 ‘‘(iii) monthly payments under a re22 payment plan under subsection (d)(1) or 

23 (g) of not less than the monthly amount 

24 calculated under subsection (d)(1)(A), 

25 based on a 10-year repayment period; or 


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1 ‘‘(iv) payments under an income con2 tingent repayment plan under subsection 

3 (d)(1)(D); and 

4 ‘‘(B)(i) is employed as a mental health or 

5 behavioral health social worker, as defined by 

6 the Secretary by regulation, at the time of such 

7 forgiveness; and 

8 ‘‘(ii) has been employed as such a mental 

9 health or behavioral health social worker during 

10 the period in which the borrower makes each of 

11 the 120 payments as described in subparagraph 

12 (A). 

13 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 

14 conclusion of the employment period described in 

15 paragraph (1), the Secretary shall cancel the obliga16 tion to repay the balance of principal and interest 

17 due as of the time of such cancellation, on the eligi18 ble Federal Direct Loans made to the borrower 

19 under this part. 

20 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 

21 No borrower may, for the same employment as a 

22 mental health or behavioral health social worker, re23 ceive a reduction of loan obligations under both this 

24 subsection and subsection (m), 428J, 428K, 428L, 

25 or 460. 


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1 ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI2 RECT LOAN.—In this subsection, the term ‘eligible 

3 Federal Direct Loan’ means a Federal Direct Staf4 ford Loan, Federal Direct PLUS Loan, Federal Di5 rect Unsubsidized Stafford Loan, or a Federal Di6 rect Consolidation Loan.’’. 

7 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 

8 (a) ESTABLISHMENT.—There is established in the 

9 Health Resources and Services Administration of the De10 partment of Health and Human Services a Health Profes11 sions Workforce Fund to provide for expanded and sus12 tained national investment in the health professions and 

13 nursing workforce development programs under title VII 

14 and title VIII of the Public Health Service Act (42 U.S.C. 

15 292 et seq.; 42 U.S.C. 296 et seq.). 

16 (b) FUNDING.— 

17 (1) IN GENERAL.—There is authorized to be 

18 appropriated, and there is appropriated, out of any 

19 monies in the Treasury not otherwise appropriated, 

20 to the Health Professions Workforce Fund— 

21 (A) $355,000,000 for fiscal year 2021; 

22 (B) $375,000,000 for fiscal year 2022; 

23 (C) $392,000,000 for fiscal year 2023; 

24 (D) $412,000,000 for fiscal year 2024; 

25 (E) $432,000,000 for fiscal year 2025; 


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1 (F) $454,000,000 for fiscal year 2026; 

2 (G) $476,000,000 for fiscal year 2027; 

3 (H) $500,000,000 for fiscal year 2028; 

4 (I) $525,000,000 for fiscal year 2029; and 

5 (J) $552,000,000 for fiscal year 2030. 

6 (2) HEALTH PROFESSIONS EDUCATION PRO7 GRAMS.—For the purpose of carrying out health 

8 professions education programs authorized under 

9 title VII of the Public Health Service Act, in addi10 tion to any other amounts authorized to be appro11 priated for such purpose, there is authorized to be 

12 appropriated out of any monies in the Health Pro13 fessions Workforce Fund, the following: 

14 (A) $240,000,000 for fiscal year 2021. 

15 (B) $253,000,000 for fiscal year 2022. 

16 (C) $265,000,000 for fiscal year 2023. 

17 (D) $278,000,000 for fiscal year 2024. 

18 (E) $292,000,000 for fiscal year 2025. 

19 (F) $307,000,000 for fiscal year 2026. 

20 (G) $322,000,000 for fiscal year 2027. 

21 (H) $338,000,000 for fiscal year 2028. 

22 (I) $355,000,000 for fiscal year 2029. 

23 (J) $373,000,000 for fiscal year 2030. 

24 (3) NURSING WORKFORCE DEVELOPMENT PRO25 GRAMS.—For the purpose of carrying out nursing 


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1 workforce development programs authorized under 

2 title VIII of the Public Health Service Act, in addi3 tion to any other amounts authorized to be appro4 priated for such purpose, there is authorized to be 

5 appropriated out of any monies in the Health Pro6 fessions Workforce Fund, the following: 

7 (A) $115,000,000 for fiscal year 2021. 

8 (B) $122,000,000 for fiscal year 2022. 

9 (C) $127,000,000 for fiscal year 2023. 

10 (D) $134,000,000 for fiscal year 2024. 

11 (E) $140,000,000 for fiscal year 2025. 

12 (F) $147,000,000 for fiscal year 2026. 

13 (G) $154,000,000 for fiscal year 2027. 

14 (H) $162,000,000 for fiscal year 2028. 

15 (I) $170,000,000 for fiscal year 2029. 

16 (J) $179,000,000 for fiscal year 2030. 

17 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 

18 GRADUATE MEDICAL EDUCATION. 

19 (a) FINDINGS.—Congress finds the following: 

20 (1) Projections by the Association of American 

21 Medical Colleges and other expert entities, such as 

22 the Health Resources and Services Administration, 

23 have indicated a nationwide shortage of up to 

24 121,900 physicians, split evenly between primary 

25 care and specialists, by 2032. 


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1 (2) Primarily due to the growing and aging 

2 population, over the next decade, physician demand 

3 is expected to grow up to 17 percent. 

4 (3) The United States Census Bureau estimates 

5 that the United States population will grow from 

6 321,000,000 in 2015 to 347,000,000 in 2025. Fur7 ther, the number of Medicare beneficiaries is esti8 mated to increase from 47,800,000 in 2015 to ap9 proximately 66,000,000 in 2025. 

10 (4) Approximately 36 percent of practicing phy11 sicians are over the age of 55 and are likely to retire 

12 within the next decade. 

13 (5) A nationwide physician shortage will result 

14 in many people in the United States waiting longer 

15 and traveling farther for health care; seeking non16 emergent care in emergency departments; and delay17 ing treatment until their health care needs become 

18 more serious, complex, and costly. 

19 (6) Changing demographics (such as an aging 

20 population), new health care delivery models (such 

21 as medical homes), and other factors (such as dis22 aster preparedness) are contributing to a shortage of 

23 both generalist and specialist physicians. 

24 (7) These shortages will have the most severe 

25 impact on vulnerable and underserved populations, 


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1 including racial and ethnic minorities and the ap2 proximately 20 percent of people in the United 

3 States who live in rural or inner-city locations des4 ignated as health professional shortage areas. 

5 (8) The health care utilization equity model of 

6 the Association of American Medical Colleges esti7 mates that if racial and ethnic minorities and indi8 viduals from rural areas utilized health care in a 

9 similar way to their Caucasian counterparts living in 

10 metropolitan areas, the physician shortage would re11 quire an additional 96,000 physicians. 

12 (9) To address the physician shortage in rural 

13 and medically underserved areas, medical education 

14 and training need to be accessible to underrep15 resented minorities (including individuals who are 

16 African American, Hispanic, Native American, or 

17 Native Hawaiian), and need to increase pathway 

18 programs for such underrepresented minorities who 

19 make up less than 12 percent of individuals enrolled 

20 in graduate medical education and for international 

21 students who make up 25 percent of individuals en22 rolled in graduate medical education. Immigration 

23 pathways like student, exchange-visitor, and employ24 ment visas, and programs like the National Interest 


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1 Waiver and Conrad 30 J–1 Visa Waiver, help im2 prove health access across the United States. 

3 (10) United States medical school enrollment 

4 was expected to grow by 30 percent from 2018 to 

5 2019 to help reduce the shortage of quality physi6 cians in the United States. 

7 (11) An increase in United States medical 

8 school graduates must be accompanied by an in9 crease of 4,000 graduate medical education training 

10 positions each year. 

11 (12) Graduate medical education programs and 

12 teaching hospitals provide venues in which the next 

13 generation of physicians learns to work collabo14 ratively with other physicians and health profes15 sionals, adopt more efficient care delivery models 

16 (such as care coordination and medical homes), in17 corporate health information technology and elec18 tronic health records in every aspect of their work, 

19 apply new methods of assuring quality and safety, 

20 and participate in groundbreaking clinical and public 

21 health research. 

22 (13) The Medicare program under title XVIII 

23 of the Social Security Act (42 U.S.C. 1395 et seq.) 

24 (having more beneficiaries than any other health 


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1 care program) supports its ‘‘fair share’’ of the costs 

2 associated with graduate medical education. 

3 (14) In general, the level of support of graduate 

4 medical education by the Medicare program has 

5 been capped since 1997 and has not been increased 

6 to support the expansion of graduate medical edu7 cation programs needed to avert the projected physi8 cian shortage or to accommodate the increase in 

9 United States medical school graduates. 

10 (b) SENSE OF CONGRESS.—It is the sense of Con11 gress that eliminating the limit of the number of residency 

12 positions that receive some level of Medicare support 

13 under section 1886(h) of the Social Security Act (42 

14 U.S.C. 1395ww(h)), also referred to as the Medical grad15 uate medical education cap, is critical to— 

16 (1) ensuring an appropriate supply of physi17 cians to meet the health care needs in the United 

18 States; 

19 (2) facilitating equitable access for all who seek 

20 health care; and 

21 (3) mitigating disparities in health and health 

22 care. 

23 SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATION24 ALLY EDUCATED HEALTH PROFESSIONALS. 

25 (a) FINDINGS.—Congress finds the following: 


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1 (1) According to a 2018 study, the State and 

2 local public health workforce has shrunk by more 

3 than 50,000 individuals since the beginning of the 

4 2008 Great Recession and almost one quarter of in5 dividuals comprising the governmental public health 

6 workforce plan to leave or retire in the coming years. 

7 (2) Shortages are projected for other health 

8 professions, including within the fields of nursing 

9 (500,000 by 2025), dentistry (15,000 by 2025), 

10 pharmacy (38,000 by 2030), mental and behavioral 

11 health, primary care (46,000 by 2025), and commu12 nity and allied health. 

13 (3) A nationwide health workforce shortage will 

14 result in serious health threats and more severe and 

15 costly health care needs, due to, in part, a delayed 

16 response to food-borne outbreaks, emerging infec17 tious diseases, natural disasters, fewer cancer 

18 screenings, and delayed treatment. 

19 (4) Vulnerable and underserved populations and 

20 health professional shortage areas will be most se21 verely impacted by the health workforce shortage. 

22 (5) According to the Migration Policy Institute, 

23 more than 2,000,000 college-educated immigrants in 

24 the United States today are unemployed or underVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 employed in low- or semi-skilled jobs that fail to 

2 draw on their education and expertise. 

3 (6) Approximately 2 out of every 5 internation4 ally educated immigrants are unemployed or under5 employed. 

6 (7) According to the Drexel University Center 

7 for Labor Markets and Policy, underemployment for 

8 internationally educated immigrant women is 28 per9 cent higher than for their male counterparts. 

10 (8) According to the Drexel University Center 

11 for Labor Markets and Policy, the mean annual 

12 earnings of underemployed immigrants were 

13 $32,000, or 43 percent less than United States born 

14 college graduates employed in the college labor mar15 ket. 

16 (9) According to Upwardly Global and the Wel17 come Back Initiative, with proper guidance and sup18 port, underemployed skilled immigrants typically in19 crease their income by 215 percent to 900 percent. 

20 (10) According to the Brookings Institution and 

21 the Partnership for a New American Economy, im22 migrants working in the health workforce are, on av23 erage, better educated than United States-born 

24 workers in the health workforce. 

25 (b) GRANTS TO ELIGIBLE ENTITIES.— 


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1 (1) AUTHORITY TO PROVIDE GRANTS.—The 

2 Secretary of Health and Human Services, acting 

3 through the Bureau of Health Workforce within the 

4 Health Resources and Services Administration, the 

5 National Institute on Minority Health and Health 

6 Disparities, or the Office of Minority Health (in this 

7 section referred to as the ‘‘Secretary’’), may award 

8 grants to eligible entities to carry out activities de9 scribed in subsection (c). 

10 (2) ELIGIBILITY.—To be eligible to receive a 

11 grant under this section, an entity shall— 

12 (A) be a clinical, public health, or health 

13 services organization, a community-based or 

14 nonprofit entity, an academic institution, a 

15 faith-based organization, a State, county, or 

16 local government, an area health education cen17 ter, or another entity determined appropriate by 

18 the Secretary; and 

19 (B) submit to the Secretary an application 

20 at such time, in such manner, and containing 

21 such information as the Secretary may require. 

22 (c) AUTHORIZED ACTIVITIES.—A grant awarded 

23 under this section shall be used— 

24 (1) to provide services to assist unemployed and 

25 underemployed skilled immigrants, residing in the 


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1 United States, who have legal, permanent work au2 thorization and who are internationally educated 

3 health professionals, enter into the health workforce 

4 of the United States with employment matching 

5 their health professional skills and education, and 

6 advance in employment to positions that better 

7 match their health professional education and exper8 tise; 

9 (2) to provide training opportunities to reduce 

10 barriers to entry and advancement in the health 

11 workforce for skilled, internationally educated immi12 grants; 

13 (3) to educate employers regarding the abilities 

14 and capacities of internationally educated health 

15 professionals; 

16 (4) to assist in the evaluation of foreign creden17 tials; 

18 (5) to support preceptorships for international 

19 medical graduates in hospital primary care training; 

20 and 

21 (6) to facilitate access to contextualized and ac22 celerated courses on English as a second language. 


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1 SEC. 314. STUDY AND REPORT ON STRATEGIES FOR IN2 CREASING DIVERSITY. 

3 (a) STUDY.—The Comptroller General of the United 

4 States shall conduct a study on strategies for increasing 

5 the diversity of the health professional workforce. Such 

6 study shall include an analysis of strategies for increasing 

7 the number of health professionals from rural, lower in8 come, and underrepresented minority communities, includ9 ing which strategies are most effective for achieving such 

10 goal. 

11 (b) REPORT.—Not later than 2 years after the date 

12 of enactment of this Act, the Comptroller General shall 

13 submit to Congress a report on the study conducted under 

14 subsection (a), together with recommendations for such 

15 legislation and administrative action as the Comptroller 

16 General determines appropriate. 

17 SEC. 315. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN18 TION. 

19 (a) CONRAD STATE 30 PROGRAM EXTENSION.—Sec20 tion 220(c) of the Immigration and Nationality Technical 

21 Corrections Act of 1994 (Public Law 103–416; 8 U.S.C. 

22 1182 note) is amended by striking ‘‘September 30, 2015’’ 

23 and inserting ‘‘September 30, 2021’’. 

24 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED

25 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 

26 201(b)(1) of the Immigration and Nationality Act (8 


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1 U.S.C. 1151(b)(1)) is amended by adding at the end the 

2 following: 

3 ‘‘(F)(i) Alien physicians who have completed 

4 service requirements for a national interest waiver 

5 requested under section 203(b)(2)(B)(ii), includ6 ing— 

7 ‘‘(I) alien physicians who completed such 

8 service before the date of the enactment of the 

9 Health Equity and Accountability Act of 2020; 

10 and 

11 ‘‘(II) the spouse or children of an alien 

12 physician described in subclause (I). 

13 ‘‘(ii) Nothing in this subparagraph may be con14 strued— 

15 ‘‘(I) to prevent the filing of a petition with 

16 the Secretary of Homeland Security for classi17 fication under section 204(a) or the filing of an 

18 application for adjustment of status under sec19 tion 245 by an alien physician described in 

20 clause (i) before the date on which such alien 

21 physician completes the service described in sec22 tion 214(l) or worked full-time as a physician 

23 for an aggregate of 5 years at the location iden24 tified in the waiver of the 2-year foreign resi25 dence requirement under section 214(l) or in an 


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1 area or areas designated by the Secretary of 

2 Health and Human Services as having a short3 age of health care professionals; or 

4 ‘‘(II) to permit the Secretary of Homeland 

5 Security to grant a petition or application de6 scribed in subclause (I) until the alien has sat7 isfied all of the requirements of the waiver re8 ceived under section 214(l).’’. 

9 (c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 

10 (1) EXCEPTIONS TO 2-YEAR FOREIGN RESI11 DENCY REQUIREMENT.—Section 214(l)(1) of the 

12 Immigration and Nationality Act (8 U.S.C. 

13 1184(l)(1)) is amended— 

14 (A) in the matter preceding subparagraph 

15 (A), by striking ‘‘Attorney General shall not’’ 

16 and inserting ‘‘Secretary of Homeland Security 

17 may not’’; 

18 (B) in subparagraph (A), by striking ‘‘Di19 rector of the United States Information Agen20 cy’’ and inserting ‘‘Secretary of State’’; 

21 (C) in subparagraph (B), by inserting ‘‘, 

22 except as provided in paragraphs (7) and (8)’’ 

23 before the semicolon at the end; 

24 (D) in subparagraph (C), by amending 

25 clauses (i) and (ii) to read as follows: 


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1 ‘‘(i) the alien demonstrates a bona fide 

2 offer of full-time employment at a health facil3 ity or health care organization, which employ4 ment has been determined by the Secretary of 

5 Homeland Security to be in the public interest; 

6 and 

7 ‘‘(ii) the alien— 

8 ‘‘(I) has accepted employment with 

9 the health facility or health care organiza10 tion in a geographic area or areas which 

11 are designated by the Secretary of Health 

12 and Human Services as having a shortage 

13 of health care professionals; 

14 ‘‘(II) begins employment by the later 

15 of the date that is— 

16 ‘‘(aa) 120 days after receiving 

17 such waiver; 

18 ‘‘(bb) 120 days after completing 

19 graduate medical education or train20 ing under a program approved pursu21 ant to section 212(j)(1); or 

22 ‘‘(cc) 120 days after receiving 

23 nonimmigrant status or employment 

24 authorization, if the alien or the 

25 alien’s employer petitions for such 


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1 nonimmigrant status or employment 

2 authorization not later than 120 days 

3 after the date on which the alien com4 pletes his or her graduate medical 

5 education or training under a pro6 gram approved pursuant to section 

7 212(j)(1); and 

8 ‘‘(III) agrees to continue to work for 

9 a total of not less than 3 years in the sta10 tus authorized for such employment under 

11 this subsection, except as provided in para12 graph (8).’’; and 

13 (E) in subparagraph (D), in the matter 

14 preceding clause (i), by inserting ‘‘subject to 

15 paragraph (8),’’ before ‘‘in the case’’. 

16 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS

17 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY

18 UNDERSERVED AREAS.—Section 214(l)(2)(A) of 

19 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 

20 read as follows: 

21 ‘‘(A) Upon the request of an interested Federal 

22 agency or an interested State agency for rec23 ommendation of a waiver under this section by a 

24 physician who is maintaining valid nonimmigrant 

25 status under section 101(a)(15)(J) and received a 


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1 favorable recommendation by the Secretary of State, 

2 the Secretary of Homeland Security may change the 

3 status of such physician to any status authorized for 

4 employment under this Act. The numerical limita5 tions set forth in subsection (g)(1)(A) shall not 

6 apply to any alien whose status is changed under 

7 this subparagraph.’’. 

8 (3) VIOLATION OF AGREEMENTS.—Section 

9 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

10 amended by inserting ‘‘substantial requirement of 

11 an’’ before ‘‘agreement entered into’’. 

12 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED

13 AREAS.—Section 214(l) of such Act (8 U.S.C. 

14 1184(l)), as amended by this section, is further 

15 amended by adding at the end the following: 

16 ‘‘(4)(A) If an interested State agency denies the ap17 plication for a waiver under paragraph (1)(B) from a phy18 sician pursuing graduate medical education or training 

19 pursuant to section 101(a)(15)(J) because the State has 

20 requested the maximum number of waivers permitted for 

21 that fiscal year, the physician’s nonimmigrant status shall 

22 be extended for up to 6 months if the physician agrees 

23 to seek a waiver under this subsection (except for para24 graph (1)(D)(ii)) to work for an employer described in 


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1 paragraph (1)(C) in a State that has not yet requested 

2 the maximum number of waivers. 

3 ‘‘(B) A physician described in subparagraph (A) may 

4 only work for the employer referred to in subparagraph 

5 (A) during the period beginning on the date on which a 

6 new waiver application is filed with such State and ending 

7 on the earlier of— 

8 ‘‘(i) the date on which the Secretary of Home9 land Security denies such waiver; or 

10 ‘‘(ii) the date on which the Secretary approves 

11 an application for change of status under paragraph 

12 (2)(A) pursuant to the approval of such waiver.’’. 

13 (5) CONTRACT REQUIREMENTS.—Section 214(l) 

14 of such Act, as amended by this section, is further 

15 amended by adding at the end the following: 

16 ‘‘(5) An alien granted a waiver under paragraph 

17 (1)(C) shall enter into an employment agreement with the 

18 contracting health facility or health care organization 

19 that— 

20 ‘‘(A) specifies the maximum number of on-call 

21 hours per week (which may be a monthly average) 

22 that the alien will be expected to be available and 

23 the compensation the alien will receive for on-call 

24 time; 

25 ‘‘(B) specifies— 


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1 ‘‘(i) whether the contracting facility or or2 ganization will pay the alien’s malpractice in3 surance premiums; 

4 ‘‘(ii) whether the employer will provide 

5 malpractice insurance; and 

6 ‘‘(iii) the amount of such insurance that 

7 will be provided; 

8 ‘‘(C) describes all of the work locations that the 

9 alien will work, including a statement that the con10 tracting facility or organization will not add addi11 tional work locations without the approval of the 

12 Federal agency or State agency that requested the 

13 waiver; and 

14 ‘‘(D) does not include a non-compete provision. 

15 ‘‘(6) An alien granted a waiver under this subsection 

16 whose employment relationship with a health facility or 

17 health care organization terminates under paragraph 

18 (1)(C)(ii) during the 3-year service period required under 

19 paragraph (1) shall be considered to be maintaining lawful 

20 status in an authorized period of stay during the 120-day 

21 period referred to in items (aa) and (bb) of subclause (III) 

22 of paragraph (1)(C)(ii) or the 45-day period referred to 

23 in subclause (III)(cc) of such paragraph.’’. 

24 (6) RECAPTURING WAIVER SLOTS LOST TO

25 OTHER STATES.—Section 214(l) of such Act, as 


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1 amended by this section, is further amended by add2 ing at the end the following: 

3 ‘‘(7) If a recipient of a waiver under this subsection 

4 terminates the recipient’s employment with a health facil5 ity or health care organization pursuant to paragraph 

6 (1)(C)(ii), including termination of employment because of 

7 circumstances described in paragraph (1)(C)(ii)(III), and 

8 accepts new employment with such a facility or organiza9 tion in a different State, the State from which the alien 

10 is departing may be accorded an additional waiver by the 

11 Secretary of State for use in the fiscal year in which the 

12 alien’s employment was terminated.’’. 

13 (7) EXCEPTION TO 3-YEAR WORK REQUIRE14 MENT.—Section 214(l) of such Act, as amended by 

15 this section, is further amended by adding at the 

16 end the following: 

17 ‘‘(8) The 3-year work requirement set forth in sub18 paragraphs (C) and (D) of paragraph (1) shall not apply 

19 if— 

20 ‘‘(A)(i) the Secretary of Homeland Security de21 termines that extenuating circumstances, including 

22 violations by the employer of the employment agree23 ment with the alien or of labor and employment 

24 laws, exist that justify a lesser period of employment 

25 at such facility or organization; and 


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1 ‘‘(ii) not later than 120 days after the employ2 ment termination date (unless the Secretary deter3 mines that extenuating circumstances would justify 

4 an extension), the alien demonstrates another bona 

5 fide offer of employment at a health facility or 

6 health care organization in a geographic area or 

7 areas which are designated by the Secretary of 

8 Health and Human Services as having a shortage of 

9 health care professionals, for the remainder of such 

10 3-year period; 

11 ‘‘(B)(i) the interested State agency that re12 quested the waiver attests that extenuating cir13 cumstances, including violations by the employer of 

14 the employment agreement with the alien or of labor 

15 and employment laws, exist that justify a lesser pe16 riod of employment at such facility or organization; 

17 and 

18 ‘‘(ii) not later than 120 days after the employ19 ment termination date (unless the Secretary deter20 mines that extenuating circumstances would justify 

21 an extension), the alien demonstrates another bona 

22 fide offer of employment at a health facility or 

23 health care organization in a geographic area or 

24 areas which are designated by the Secretary of 

25 Health and Human Services as having a shortage of 


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1 health care professionals, for the remainder of such 

2 3-year period; or 

3 ‘‘(C) the alien— 

4 ‘‘(i) elects not to pursue a determination of 

5 extenuating circumstances pursuant to sub6 clause (A) or (B); 

7 ‘‘(ii) terminates the alien’s employment re8 lationship with the health facility or health care 

9 organization at which the alien was employed; 

10 ‘‘(iii) not later than 45 days after the em11 ployment termination date, demonstrates an12 other bona fide offer of employment at a health 

13 facility or health care organization in a geo14 graphic area or areas, in the State that re15 quested the alien’s waiver, which are designated 

16 by the Secretary of Health and Human Services 

17 as having a shortage of health care profes18 sionals; and 

19 ‘‘(iv) agrees to be employed for the remain20 der of such 3-year period, and 1 additional year 

21 for each termination under clause (ii).’’. 

22 (d) ALLOTMENT OF CONRAD 30 WAIVERS.— 

23 (1) IN GENERAL.—Section 214(l) of the Immi24 gration and Nationality Act (8 U.S.C. 1184(l)), as 


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1 amended by subsection (c), is further amended by 

2 adding at the end the following: 

3 ‘‘(9)(A)(i) All States shall be allotted 35 waivers 

4 under paragraph (1)(B) for each fiscal year if 90 percent 

5 of the waivers available to the States receiving at least 

6 5 waivers were used in the previous fiscal year. 

7 ‘‘(ii) When an allotment occurs under clause (i), all 

8 States shall be allotted an additional 5 waivers under 

9 paragraph (1)(B) for each subsequent fiscal year if 90 

10 percent of the waivers available to the States receiving at 

11 least 5 waivers were used in the previous fiscal year. If 

12 the States are allotted 45 or more waivers for a fiscal year, 

13 the States will only receive an additional increase of 5 

14 waivers the following fiscal year if 95 percent of the waiv15 ers available to the States receiving at least 1 waiver were 

16 used in the previous fiscal year. 

17 ‘‘(B) Any increase in allotments under subparagraph 

18 (A) shall be maintained indefinitely, unless in a fiscal year, 

19 the total number of such waivers granted is 5 percent 

20 lower than in the last year in which there was an increase 

21 in the number of waivers allotted pursuant to this para22 graph. In such case— 

23 ‘‘(i) the number of waivers allotted beginning in 

24 the next fiscal year shall be decreased by 5 for all 

25 States; and 


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1 ‘‘(ii) each additional 5 percent decrease in such 

2 waivers granted from the last year in which there 

3 was an increase in the allotment, shall result in an 

4 additional decrease of 5 waivers allotted for all 

5 States, provided that the number of waivers allotted 

6 for all States shall not drop below 30.’’. 

7 (2) ACADEMIC MEDICAL CENTERS.—Section 

8 214(l)(1)(D) of such Act, as amended by subsection 

9 (c)(1)(E), is further amended— 

10 (A) in clause (ii), by striking ‘‘and’’ at the 

11 end; 

12 (B) in clause (iii), by striking the period at 

13 the end and inserting ‘‘; and’’; and 

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

15 ‘‘(iv) in the case of a request by an inter16 ested State agency— 

17 ‘‘(I) the head of such agency deter18 mines that the alien is to practice medicine 

19 in, or be on the faculty of a residency pro20 gram at, an academic medical center (as 

21 defined in section 411.355(e)(2) of title 42, 

22 Code of Federal Regulations), without re23 gard to whether such facility is located 

24 within an area designated by the Secretary 


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1 of Health and Human Services as having 

2 a shortage of health care professionals; and 

3 ‘‘(II) the head of such agency deter4 mines that— 

5 ‘‘(aa) the alien physician’s work 

6 is in the public interest; and 

7 ‘‘(bb) subject to paragraph (6), 

8 the grant of such waiver would not 

9 cause the number of the waivers 

10 granted on behalf of aliens for such 

11 State for a fiscal year to exceed 3, 

12 within the limitation under subpara13 graph (B).’’. 

14 (e) AMENDMENTS TO THE PROCEDURES, DEFINI15 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN

16 IMMIGRATION.— 

17 (1) DUAL INTENT FOR PHYSICIANS SEEKING

18 GRADUATE MEDICAL TRAINING.—Section 214(b) of 

19 the Immigration and Nationality Act (8 U.S.C. 

20 1184(b)) is amended by striking ‘‘and other than a 

21 nonimmigrant described in any provision of section 

22 101(a)(15)(H)(i) except subclause (b1) of such sec23 tion)’’ and inserting ‘‘a nonimmigrant described in 

24 any provision of section 101(a)(15)(H)(i) (except 

25 subclause (b1) of such section), and an alien coming 


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1 to the United States to receive graduate medical 

2 education or training as described in section 212(j) 

3 or to take examinations required to receive graduate 

4 medical education or training as described in section 

5 212(j))’’. 

6 (2) PHYSICIAN NATIONAL INTEREST WAIVER

7 CLARIFICATIONS.— 

8 (A) PRACTICE AND GEOGRAPHIC AREA.— 

9 Section 203(b)(2)(B)(ii)(I) of the Immigration 

10 and Nationality Act (8 U.S.C. 

11 1153(b)(2)(B)(ii)(I)) is amended by striking 

12 items (aa) and (bb) and inserting the following: 

13 ‘‘(aa) the alien physician agrees to 

14 work on a full-time basis practicing pri15 mary care, specialty medicine, or a com16 bination thereof, in an area or areas des17 ignated by the Secretary of Health and 

18 Human Services as having a shortage of 

19 health care professionals, or at a health 

20 care facility under the jurisdiction of the 

21 Secretary of Veterans Affairs; or 

22 ‘‘(bb) the alien physician is pursuing 

23 such waiver based upon service at a facility 

24 or facilities that serve patients who reside 

25 in a geographic area or areas designated 


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1 by the Secretary of Health and Human 

2 Services as having a shortage of health 

3 care professionals (without regard to 

4 whether such facility or facilities are lo5 cated within such an area) and a Federal 

6 agency, or a local, county, regional, or 

7 State department of public health deter8 mines the alien physician’s work was or 

9 will be in the public interest.’’. 

10 (B) FIVE-YEAR SERVICE REQUIREMENT.— 

11 Section 203(b)(2)(B)(ii) of such Act is amend12 ed— 

13 (i) by moving subclauses (II), (III), 

14 and (IV) 4 ems to the left; and 

15 (ii) in subclause (II)— 

16 (I) by inserting ‘‘(aa)’’ after 

17 ‘‘(II)’’; and 

18 (II) by adding at the end the fol19 lowing: 

20 ‘‘(bb) The 5-year service requirement 

21 described in item (aa) shall begin on the 

22 date on which the alien physician begins 

23 work in the shortage area in any legal sta24 tus and not on the date on which an immi25 grant visa petition is filed or approved. 


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1 Such service shall be aggregated without 

2 regard to when such service began and 

3 without regard to whether such service 

4 began during or in conjunction with a 

5 course of graduate medical education. 

6 ‘‘(cc) An alien physician shall not be 

7 required to submit an employment contract 

8 with a term exceeding the balance of the 5- 

9 year commitment yet to be served or an 

10 employment contract dated within a min11 imum time period before filing a visa peti12 tion under this subsection. 

13 ‘‘(dd) An alien physician shall not be 

14 required to file additional immigrant visa 

15 petitions upon a change of work location 

16 from the location approved in the original 

17 national interest immigrant petition.’’. 

18 (3) TECHNICAL CLARIFICATION REGARDING AD19 VANCED DEGREE FOR PHYSICIANS.—Section 

20 203(b)(2)(A) of such Act (8 U.S.C. 1153(b)(2)(A)) 

21 is amended by adding at the end the following: ‘‘An 

22 alien physician holding a foreign medical degree that 

23 has been deemed sufficient for acceptance by an ac24 credited United States medical residency or fellow25 ship program shall be considered a member of the 


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1 professions holding an advanced degree or its equiv2 alent for purposes of this paragraph.’’. 

3 (4) SHORT-TERM WORK AUTHORIZATION FOR

4 PHYSICIANS COMPLETING THEIR RESIDENCIES.— 

5 (A) IN GENERAL.—A physician completing 

6 graduate medical education or training de7 scribed in section 212(j) of the Immigration 

8 and Nationality Act (8 U.S.C. 1182(j)) as a 

9 nonimmigrant described in section 

10 101(a)(15)(H)(i) of such Act (8 U.S.C. 

11 1101(a)(15)(H)(i))— 

12 (i) shall have such nonimmigrant sta13 tus automatically extended until October 1 

14 of the fiscal year for which a petition for 

15 a continuation of such nonimmigrant sta16 tus has been submitted in a timely manner 

17 and the employment start date for the ben18 eficiary of such petition is October 1 of 

19 that fiscal year; and 

20 (ii) shall be authorized to be employed 

21 incident to status during the period be22 tween the filing of such petition and Octo23 ber 1 of such fiscal year. 

24 (B) TERMINATION.—The status and em25 ployment authorization of a physician described 


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1 in subparagraph (A) shall terminate on the date 

2 that is 30 days after the date on which a peti3 tion described in clause (i)(I) is rejected, denied 

4 or revoked. 

5 (C) AUTOMATIC EXTENSION.—The status 

6 and employment authorization of a physician 

7 described in subparagraph (A) will automati8 cally extend to October 1 of the next fiscal year 

9 if all of the visas described in section 

10 101(a)(15)(H)(i) of the Immigration and Na11 tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 

12 were authorized to be issued for the fiscal year 

13 have been issued. 

14 (5) APPLICABILITY OF SECTION 212(e) TO

15 SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI16 TORS.—A spouse or child of an exchange visitor de17 scribed in section 101(a)(15)(J) of the Immigration 

18 and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 

19 not be subject to the requirements under section 

20 212(e) of such Act (8 U.S.C. 1182(e)). 


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1 TITLE IV—IMPROVING HEALTH 

2 CARE ACCESS AND QUALITY 

3 Subtitle A—Improvement of 

4 Coverage 

5 SEC. 401. REPEAL OF REQUIREMENT FOR DOCUMENTA6 TION EVIDENCING CITIZENSHIP OR NATION7 ALITY UNDER THE MEDICAID PROGRAM. 

8 (a) REPEAL.—Subsections (i)(22) and (x) of section 

9 1903 of the Social Security Act (42 U.S.C. 1396b) are 

10 each repealed. 

11 (b) CONFORMING AMENDMENTS.— 

12 (1) STATE PAYMENTS FOR MEDICAL ASSIST13 ANCE.—Section 1902 of the Social Security Act (42 

14 U.S.C. 1396a) is amended— 

15 (A) by amending paragraph (46) of sub16 section (a) to read as follows: 

17 ‘‘(46) provide that information is requested and 

18 exchanged for purposes of income and eligibility 

19 verification in accordance with a State system which 

20 meets the requirements of section 1137 of this 

21 Act;’’; 

22 (B) in subsection (e)(13)(A)(i)— 

23 (i) in the matter preceding subclause 

24 (I), by striking ‘‘sections 1902(a)(46)(B) 


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1 and 1137(d)’’ and inserting ‘‘section 

2 1137(d)’’; and 

3 (ii) in subclause (IV), by striking 

4 ‘‘1902(a)(46)(B) or’’; and 

5 (C) by striking subsection (ee). 

6 (2) PAYMENT TO STATES.—Section 1903 of the 

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

8 (A) in subsection (i), by redesignating 

9 paragraphs (23) through (27) as paragraphs 

10 (22) through (26), respectively; and 

11 (B) by redesignating subsections (y), (z), 

12 and (aa) as subsections (x), (y), and (z), respec13 tively. 

14 (3) REPEAL.—Subsection (c) of section 6036 of 

15 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 

16 note) is repealed. 

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

18 this section shall take effect on the date of enactment of 

19 this Act. 

20 SEC. 402. REMOVING CITIZENSHIP AND IMMIGRATION BAR21 RIERS TO ACCESS TO AFFORDABLE HEALTH 

22 CARE UNDER ACA. 

23 (a) IN GENERAL.— 

24 (1) PREMIUM TAX CREDITS.—Section 36B of 

25 the Internal Revenue Code of 1986 is amended— 


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1 (A) in subsection (c)(1)(B)— 

2 (i) by amending the heading to read 

3 as follows: ‘‘SPECIAL RULE FOR CERTAIN

4 INDIVIDUALS INELIGIBLE FOR MEDICAID

5 DUE TO STATUS’’; and 

6 (ii) in clause (ii), by striking ‘‘lawfully 

7 present in the United States, but’’ and in8 serting ‘‘who’’; and 

9 (B) by striking subsection (e). 

10 (2) COST-SHARING REDUCTIONS.—Section 1402 

11 of the Patient Protection and Affordable Care Act 

12 (42 U.S.C. 18071) is amended by striking sub13 section (e). 

14 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

15 Section 1331(e)(1)(B) of the Patient Protection and 

16 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

17 amended by striking ‘‘lawfully present in the United 

18 States’’. 

19 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

20 Section 1412 of the Patient Protection and Afford21 able Care Act (42 U.S.C. 18082) is amended by 

22 striking subsection (d). 

23 (5) REQUIREMENT TO MAINTAIN MINIMUM ES24 SENTIAL COVERAGE.—Section 5000A(d) of the In25 ternal Revenue Code of 1986 is amended by striking 


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1 paragraph (3) and by redesignating paragraph (4) 

2 as paragraph (3). 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) Section 1411(a) of the Patient Protection 

5 and Affordable Care Act (42 U.S.C. 18081(a)) is 

6 amended by striking paragraph (1) and redesig7 nating paragraphs (2), (3), and (4) as paragraphs 

8 (1), (2), and (3), respectively. 

9 (2) Section 1312(f) of the Patient Protection 

10 and Affordable Care Act (42 U.S.C. 18032(f)) is 

11 amended— 

12 (A) in the heading, by striking ‘‘; ACCESS

13 LIMITED TO CITIZENS AND LAWFUL RESI14 DENTS’’; and 

15 (B) by striking paragraph (3). 

16 SEC. 403. STUDY ON THE UNINSURED. 

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

18 Human Services (in this section referred to as the ‘‘Sec19 retary’’) shall— 

20 (1) conduct a study, in accordance with the 

21 standards under section 3101 of the Public Health 

22 Service Act (42 U.S.C. 300kk), on the demographic 

23 characteristics of the population of individuals who 

24 do not have health insurance coverage or oral health 

25 coverage; and 


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1 (2) predict, based on such study, the demo2 graphic characteristics of the population of individ3 uals who would remain without health insurance cov4 erage after the end of any annual open enrollment 

5 or any special enrollment period or upon enactment 

6 and implementation of any legislative changes to the 

7 Patient Protection and Affordable Care Act (Public 

8 Law 111–148) that affect the number of persons eli9 gible for coverage. 

10 (b) REPORTING REQUIREMENTS.— 

11 (1) IN GENERAL.—Not later than 12 months 

12 after the date of the enactment of this Act, the Sec13 retary shall submit to the Congress the results of 

14 the study under subsection (a)(1) and the prediction 

15 made under subsection (a)(2). 

16 (2) REPORTING OF DEMOGRAPHIC CHARACTER17 ISTICS.—The Secretary shall— 

18 (A) report the demographic characteristics 

19 under paragraphs (1) and (2) of subsection (a) 

20 on the basis of racial and ethnic group, and 

21 shall stratify the reporting on each racial and 

22 ethnic group by other demographic characteris23 tics that can impact access to health insurance 

24 coverage, such as sexual orientation, gender 

25 identity, primary language, disability status, 


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1 sex, socioeconomic status, age group, and citi2 zenship and immigration status, in a manner 

3 consistent with title I of this Act, including the 

4 amendments made by such title; and 

5 (B) not use such report to engage in or an6 ticipate any deportation or immigration related 

7 enforcement action by any entity, including the 

8 Department of Homeland Security. 

9 SEC. 404. MEDICAID IN THE TERRITORIES. 

10 (a) ELIMINATION OF GENERAL MEDICAID FUNDING

11 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 

12 (1) REPEAL OF PROVISIONS RELATED TO CAP

13 AFTER 2019.—Subsections (a), (b), and (d) of section 

14 202 of subtitle B of title I of division N of the Fur15 ther Consolidated Appropriations Act, 2020 (Public 

16 Law 116–94) and section 6009 of the Families First 

17 Coronavirus Response Act (Public Law 116–127) 

18 are repealed and the provisions of law amended by 

19 such subsections and section are restored as if such 

20 subsections and section had not been enacted. 

21 (2) SUNSET OF MEDICAID FUNDING LIMITA22 TIONS FOR TERRITORIES.—Section 1108 of the So23 cial Security Act (42 U.S.C. 1308) (as restored by 

24 paragraph (1)) is amended— 


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1 (A) in subsection (f), in the matter pre2 ceding paragraph (1), by striking ‘‘subsection 

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

4 (B) in subsection (g)(2), in the matter pre5 ceding subparagraph (A), by inserting ‘‘and 

6 subsection (h)’’ after ‘‘paragraphs (3) and (5)’’; 

7 and 

8 (C) by adding at the end the following new 

9 subsection: 

10 ‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS

11 FOR PUERTO RICO, THE VIRGIN ISLANDS OF THE

12 UNITED STATES, GUAM, THE NORTHERN MARIANA IS13 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 

14 shall not apply to Puerto Rico, the Virgin Islands of the 

15 United States, Guam, the Northern Mariana Islands, and 

16 American Samoa beginning with fiscal year 2020.’’. 

17 (3) CONFORMING AMENDMENTS.— 

18 (A) Section 1902(j) of the Social Security 

19 Act (42 U.S.C. 1396a(j)) is amended by strik20 ing ‘‘, the limitation in section 1108(f),’’. 

21 (B) Section 1903(u) of the Social Security 

22 Act (42 U.S.C. 1396b(u)) is amended by strik23 ing paragraph (4). 


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1 (4) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply beginning with fiscal 

3 year 2020. 

4 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL

5 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR

6 TERRITORIES.—Section 1905 of the Social Security Act 

7 (42 U.S.C. 1396d) is amended— 

8 (1) in clause (2) of subsection (b), by inserting 

9 ‘‘for fiscal years before fiscal year 2020’’ after 

10 ‘‘American Samoa’’; and 

11 (2) in subsection (ff)— 

12 (A) by striking ‘‘(z)(2)—’’ and all that fol13 lows through ‘‘beginning October 1, 2019’’ and 

14 inserting ‘‘(z)(2), for the period beginning Octo15 ber 1, 2019’’; 

16 (B) by striking ‘‘100 percent;’’ and insert17 ing ‘‘100 percent.’’; and 

18 (C) by striking paragraphs (2) and (3). 

19 (c) APPLICATION OF MEDICAID WAIVER AUTHORITY

20 TO ALL OF THE TERRITORIES.— 

21 (1) IN GENERAL.—Section 1902(j) of the Social 

22 Security Act (42 U.S.C. 1396a(j)), as amended by 

23 subsection (a)(3)(A), is amended— 

24 (A) by striking ‘‘American Samoa and the 

25 Northern Mariana Islands’’ and inserting 


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1 ‘‘Puerto Rico, the Virgin Islands of the United 

2 States, Guam, the Northern Mariana Islands, 

3 and American Samoa’’; 

4 (B) by striking ‘‘American Samoa or the 

5 Northern Mariana Islands’’ and inserting 

6 ‘‘Puerto Rico, the Virgin Islands of the United 

7 States, Guam, the Northern Mariana Islands, 

8 or American Samoa’’; 

9 (C) by inserting ‘‘(1)’’ after ‘‘(j)’’; 

10 (D) by inserting ‘‘except as otherwise pro11 vided in this subsection,’’ after ‘‘Notwith12 standing any other requirement of this title’’; 

13 and 

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

15 ‘‘(2) The Secretary may not waive under this 

16 subsection the requirement of subsection 

17 (a)(10)(A)(i)(IX) (relating to coverage of adults for18 merly under foster care) with respect to any terri19 tory.’’. 

20 (2) EFFECTIVE DATE.—The amendments made 

21 by this subsection shall apply beginning October 1, 

22 2021. 

23 (d) PERMITTING MEDICAID DSH ALLOTMENTS FOR

24 TERRITORIES.—Section 1923(f) of the Social Security Act 

25 (42 U.S.C. 1396r–4) is amended— 


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1 (1) in paragraph (6), by adding at the end the 

2 following new subparagraph: 

3 ‘‘(C) TERRITORIES.— 

4 ‘‘(i) FISCAL YEAR 2020.—For fiscal 

5 year 2020, the DSH allotment for Puerto 

6 Rico, the Virgin Islands of the United 

7 States, Guam, the Northern Mariana Is8 lands, and American Samoa shall bear the 

9 same ratio to $300,000,000 as the ratio of 

10 the number of individuals who are low-in11 come or uninsured and residing in such re12 spective territory (as estimated from time 

13 to time by the Secretary) bears to the 

14 sums of the number of such individuals re15 siding in all of the territories. 

16 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 

17 For each subsequent fiscal year, the DSH 

18 allotment for each such territory is subject 

19 to an increase in accordance with para20 graph (2).’’; and 

21 (2) in paragraph (9), by inserting before the pe22 riod at the end the following: ‘‘, and includes, begin23 ning with fiscal year 2020, Puerto Rico, the Virgin 

24 Islands of the United States, Guam, the Northern 

25 Mariana Islands, and American Samoa’’. 


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1 SEC. 405. EXTENSION OF MEDICARE SECONDARY PAYER. 

2 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So3 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend4 ed— 

5 (1) in the last sentence, by inserting ‘‘, and be6 fore January 1, 2021’’ after ‘‘prior to such date)’’; 

7 and 

8 (2) by adding at the end the following new sen9 tence: ‘‘Effective for items and services furnished on 

10 or after January 1, 2021 (with respect to periods 

11 beginning on or after the date that is 42 months 

12 prior to such date), clauses (i) and (ii) shall be ap13 plied by substituting ‘42-month’ for ‘12-month’ each 

14 place it appears.’’. 

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

16 this section shall take effect on the date of enactment of 

17 this Act. For purposes of determining an individual’s sta18 tus under section 1862(b)(1)(C) of the Social Security Act 

19 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 

20 (a), an individual who is within the coordinating period 

21 as of the date of enactment of this Act shall have that 

22 period extended to the full 42 months described in the last 

23 sentence of such section, as added by the amendment 

24 made by subsection (a)(2). 


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1 SEC. 406. INDIAN DEFINED IN TITLE I OF THE PATIENT 

2 PROTECTION AND AFFORDABLE CARE ACT. 

3 (a) DEFINITION OF INDIAN.—Section 1304 of the 

4 Patient Protection and Affordable Care Act (42 U.S.C. 

5 18024) is amended by adding at the end the following: 

6 ‘‘(f) INDIAN.— 

7 ‘‘(1) IN GENERAL.—In this title, the term ‘In8 dian’ means any individual— 

9 ‘‘(A) described in paragraph (13) or (28) 

10 of section 4 of the Indian Health Care Improve11 ment Act (25 U.S.C. 1603); 

12 ‘‘(B) who is eligible for health services pro13 vided by the Indian Health Service under sec14 tion 809 of the Indian Health Care Improve15 ment Act (25 U.S.C. 1679); 

16 ‘‘(C) who is of Indian descent and belongs 

17 to an Indian community served by a local facil18 ity or program of the Indian Health Service; or 

19 ‘‘(D) who is otherwise described in para20 graph (2). 

21 ‘‘(2) INCLUSIONS.—An individual is described 

22 in this paragraph if the individual is any of the fol23 lowing: 

24 ‘‘(A) A member of a federally recognized 

25 Indian Tribe. 


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1 ‘‘(B) A resident of an urban center who 

2 meets any of the following criteria: 

3 ‘‘(i) Membership in a Tribe, band, or 

4 other organized group of Indians, including 

5 those Tribes, bands, or groups terminated 

6 since 1940 and those recognized as of the 

7 date of enactment of the Health Equity 

8 and Accountability Act of 2018 or later by 

9 the State in which they reside, or being a 

10 descendant, in the first or second degree, 

11 of any such member. 

12 ‘‘(ii) Is an Eskimo or Aleut or other 

13 Alaska Native. 

14 ‘‘(iii) Is considered by the Secretary of 

15 the Interior to be an Indian for any pur16 pose. 

17 ‘‘(iv) Is determined to be an Indian 

18 under regulations promulgated by the Sec19 retary. 

20 ‘‘(C) An individual who is considered by 

21 the Secretary of the Interior to be an Indian for 

22 any purpose. 

23 ‘‘(D) An individual who is considered by 

24 the Secretary to be an Indian for purposes of 

25 eligibility for Indian health care services, includVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ing as a California Indian, Eskimo, Aleut, or 

2 other Alaska Native.’’. 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) AFFORDABLE CHOICES HEALTH BENEFIT

5 PLANS.—Section 1311(c)(6)(D) of the Patient Pro6 tection and Affordable Care Act (42 U.S.C. 

7 18031(c)(6)(D)) is amended by striking ‘‘(as defined 

8 in section 4 of the Indian Health Care Improvement 

9 Act)’’. 

10 (2) REDUCED COST-SHARING FOR INDIVIDUALS

11 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 

12 1402(d) of the Patient Protection and Affordable 

13 Care Act (42 U.S.C. 18071(d)) is amended— 

14 (A) in paragraph (1), in the matter pre15 ceding subparagraph (A), by striking ‘‘(as de16 fined in section 4(d) of the Indian Self-Deter17 mination and Education Assistance Act (25 

18 U.S.C. 450b(d))’’; and 

19 (B) in paragraph (2), in the matter pre20 ceding subparagraph (A), by striking ‘‘(as so 

21 defined)’’. 

22 (3) EXEMPTION FROM PENALTY FOR NOT

23 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 

24 Section 5000A(e) of the Internal Revenue Code of 


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1 1986 is amended by striking paragraph (3) and in2 serting the following: 

3 ‘‘(3) INDIANS.—Any applicable individual who 

4 is an Indian (as defined in section 1304(f) of the 

5 Patient Protection and Affordable Care Act).’’. 

6 SEC. 407. REMOVING MEDICARE BARRIER TO HEALTH 

7 CARE. 

8 (a) PART A.—Section 1818(a)(3) of the Social Secu9 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 

10 ‘‘an alien’’ and all that follows through ‘‘under this sec11 tion’’ and inserting ‘‘an individual who is lawfully present 

12 in the United States’’. 

13 (b) PART B.—Section 1836(2) of the Social Security 

14 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 

15 alien’’ and all that follows through ‘‘under this part’’ and 

16 inserting ‘‘an individual who is lawfully present in the 

17 United States’’. 

18 SEC. 408. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

19 PROVIDED BY URBAN INDIAN HEALTH CEN20 TERS. 

21 (a) IN GENERAL.—The third sentence of section 

22 1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 

23 is amended by inserting ‘‘or are received through a pro24 gram operated by an urban Indian organization through 

25 a grant or contract under title V of the Indian Health 


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1 Care Improvement Act’’ after ‘‘(as defined in section 4 

2 of the Indian Health Care Improvement Act)’’. 

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

4 this section shall apply to medical assistance provided on 

5 or after the date of enactment of this Act. 

6 SEC. 409. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

7 PROVIDED TO A NATIVE HAWAIIAN THROUGH 

8 A FEDERALLY QUALIFIED HEALTH CENTER 

9 OR A NATIVE HAWAIIAN HEALTH CARE SYS10 TEM UNDER THE MEDICAID PROGRAM. 

11 (a) IN GENERAL.—The third sentence of section 

12 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 

13 as amended by section 408(a), is amended by inserting 

14 before the period the following: ‘‘, and with respect to 

15 medical assistance provided to a Native Hawaiian (as de16 fined in section 12(2) of the Native Hawaiian Health Care 

17 Improvement Act) through a federally qualified health 

18 center or a Native Hawaiian health care system (as de19 fined in section 12(6) of such Act), whether directly, by 

20 referral, or under contract or other arrangement between 

21 such federally qualified health center or Native Hawaiian 

22 health care system and another health care provider’’. 

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

24 this section shall apply to medical assistance provided on 

25 or after the date of enactment of this Act. 


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1 SEC. 410. MEDICAID COVERAGE FOR CITIZENS OF FREELY 

2 ASSOCIATED STATES. 

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

4 Responsibility and Work Opportunity Reconciliation Act 

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

6 the end the following new subparagraph: 

7 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS

8 OF FREELY ASSOCIATED STATES.—With respect 

9 to eligibility for benefits for the designated Fed10 eral program described in paragraph (3)(C), 

11 section 401(a) and paragraph (1) shall not 

12 apply to any individual who lawfully resides in 

13 1 of the 50 States or the District of Columbia 

14 in accordance with the Compacts of Free Asso15 ciation between the Government of the United 

16 States and the Governments of the Federated 

17 States of Micronesia, the Republic of the Mar18 shall Islands, and the Republic of Palau and 

19 shall not apply, at the option of the Governors 

20 of Puerto Rico, the Virgin Islands, Guam, the 

21 Northern Mariana Islands, or American Samoa, 

22 respectively, as communicated to the Secretary 

23 of Health and Human Services in writing, to 

24 any individual who lawfully resides in the re25 spective territory in accordance with such Com26 pacts.’’. 


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1 (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 

2 Section 403(d) of the Personal Responsibility and Work 

3 Opportunity Reconciliation Act of 1996 (8 U.S.C. 

4 1613(d)) is amended— 

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

6 end; 

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

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

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

10 paragraph: 

11 ‘‘(3) an individual described in section 

12 402(b)(2)(G), but only with respect to the des13 ignated Federal program described in section 

14 402(b)(3)(C).’’. 

15 (c) DEFINITION OF QUALIFIED ALIEN.—Section 

16 431(b) of the Personal Responsibility and Work Oppor17 tunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)) is 

18 amended— 

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

20 end and inserting a comma; 

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

22 the end and inserting ‘‘, or’’; and 

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

24 paragraph: 


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

2 United States in accordance with a Compact of Free 

3 Association referred to in section 402(b)(2)(G), but 

4 only with respect to the designated Federal program 

5 described in section 402(b)(3)(C) (relating to the 

6 Medicaid program).’’. 

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

8 this section take effect on October 1, 2021. 

9 Subtitle B—Expansion of Access 

10 SEC. 412. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

11 ACT. 

12 Title XXXIV of the Public Health Service Act, as 

13 amended by titles I, II, III, and IX of this Act, is further 

14 amended by inserting after subtitle D the following: 

15 ‘‘Subtitle E—Reconstruction and 

16 Improvement Grants for Public 

17 Health Care Facilities Serving 

18 Pacific Islanders and the Insu19 lar Areas 

20 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

21 INITIATIVES. 

22 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

23 with the Administrator of the Health Resources and Serv24 ices Administration, the Director of the Agency for 

25 Healthcare Research and Quality, and the Administrator 


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1 of the Centers for Medicare & Medicaid Services, shall 

2 award grants to eligible entities for the conduct of dem3 onstration projects to improve the quality of and access 

4 to health care. 

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

6 under subsection (a), an entity shall— 

7 ‘‘(1) be a health center, hospital, health plan, 

8 health system, community clinic, or other health en9 tity determined appropriate by the Secretary— 

10 ‘‘(A) that, by legal mandate or explicitly 

11 adopted mission, provides patients with access 

12 to services regardless of their ability to pay; 

13 ‘‘(B) that provides care or treatment for a 

14 substantial number of patients who are unin15 sured, are receiving assistance under a State 

16 plan under title XIX of the Social Security Act 

17 (or under a waiver of such plan), or are mem18 bers of vulnerable populations, as determined 

19 by the Secretary; and 

20 ‘‘(C)(i) with respect to which, not less than 

21 50 percent of the entity’s patient population is 

22 made up of racial and ethnic minority groups; 

23 or 

24 ‘‘(ii) that— 


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1 ‘‘(I) serves a disproportionate percent2 age of local patients that are from a racial 

3 and ethnic minority group, or that has a 

4 patient population, at least 50 percent of 

5 which is composed of individuals with lim6 ited English proficiency; and 

7 ‘‘(II) provides an assurance that 

8 amounts received under the grant will be 

9 used only to support quality improvement 

10 activities in the racial and ethnic minority 

11 population served; and 

12 ‘‘(2) prepare and submit to the Secretary an 

13 application at such time, in such manner, and con14 taining such information as the Secretary may re15 quire. 

16 ‘‘(c) PRIORITY.—In awarding grants under sub17 section (a), the Secretary shall give priority to applicants 

18 meeting the criteria under subsection (b) that— 

19 ‘‘(1) demonstrate an intent to operate as part 

20 of a health care partnership, network, collaborative, 

21 coalition, or alliance where each member entity con22 tributes to the design, implementation, and evalua23 tion of the proposed intervention; or 


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1 ‘‘(2) intend to use funds to carry out system2 wide changes with respect to health care quality im3 provement, including— 

4 ‘‘(A) improved systems for data collection 

5 and reporting; 

6 ‘‘(B) innovative collaborative or similar 

7 processes; 

8 ‘‘(C) group programs with behavioral or 

9 self-management interventions; 

10 ‘‘(D) case management services; 

11 ‘‘(E) physician or patient reminder sys12 tems; 

13 ‘‘(F) educational interventions; or 

14 ‘‘(G) other activities determined appro15 priate by the Secretary. 

16 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

17 received under a grant under subsection (a) to support 

18 the implementation and evaluation of health care quality 

19 improvement activities or minority health and health care 

20 disparity reduction activities that include— 

21 ‘‘(1) with respect to health care systems, activi22 ties relating to improving— 

23 ‘‘(A) patient safety; 

24 ‘‘(B) timeliness of care; 

25 ‘‘(C) effectiveness of care; 


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1 ‘‘(D) efficiency of care; 

2 ‘‘(E) patient centeredness; and 

3 ‘‘(F) health information technology; and 

4 ‘‘(2) with respect to patients, activities relating 

5 to— 

6 ‘‘(A) staying healthy; 

7 ‘‘(B) getting well, mentally and physically; 

8 ‘‘(C) living effectively with illness or dis9 ability; 

10 ‘‘(D) coping with end-of-life issues; and 

11 ‘‘(E) shared decision making. 

12 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

13 provide financial and other technical assistance to grant14 ees under this section for the development of common data 

15 systems. 

16 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

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

19 2021 through 2026. 

20 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 

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

22 the Administrator of the Health Resources and Services 

23 Administration, shall designate centers of excellence at 

24 public hospitals, and other health systems serving large 

25 numbers of minority patients, that— 


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1 ‘‘(1) meet the requirements of section 

2 3451(b)(1); 

3 ‘‘(2) demonstrate excellence in providing care to 

4 minority populations; and 

5 ‘‘(3) demonstrate excellence in reducing dispari6 ties in health and health care. 

7 ‘‘(b) REQUIREMENTS.—A hospital or health system 

8 that serves as a center of excellence under subsection (a) 

9 shall— 

10 ‘‘(1) design, implement, and evaluate programs 

11 and policies relating to the delivery of care in ra12 cially, ethnically, and linguistically diverse popu13 lations; 

14 ‘‘(2) provide training and technical assistance 

15 to other hospitals and health systems relating to the 

16 provision of quality health care to minority popu17 lations; and 

18 ‘‘(3) develop activities for graduate or con19 tinuing medical education that institutionalize a 

20 focus on cultural competence training for health care 

21 providers. 

22 ‘‘(c) 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 2021 through 2026. 


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1 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 

2 FOR PUBLIC HEALTH CARE FACILITIES SERV3 ING PACIFIC ISLANDERS AND THE INSULAR 

4 AREAS. 

5 ‘‘(a) IN GENERAL.—The Secretary shall provide di6 rect financial assistance to designated health care pro7 viders and community health centers in American Samoa, 

8 Guam, the Commonwealth of the Northern Mariana Is9 lands, the United States Virgin Islands, Puerto Rico, and 

10 Hawaii for the purposes of reconstructing and improving 

11 health care facilities and services in a culturally competent 

12 and sustainable manner. 

13 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi14 nancial assistance under subsection (a), an entity shall be 

15 a public health facility or community health center located 

16 in American Samoa, Guam, the Commonwealth of the 

17 Northern Mariana Islands, the United States Virgin Is18 lands, Puerto Rico, or Hawaii that— 

19 ‘‘(1) is owned or operated by— 

20 ‘‘(A) the Government of American Samoa, 

21 Guam, the Commonwealth of the Northern 

22 Mariana Islands, the United States Virgin Is23 lands, Puerto Rico, or Hawaii or a unit of local 

24 government; or 

25 ‘‘(B) a nonprofit organization; and 


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1 ‘‘(2)(A) provides care or treatment for a sub2 stantial number of patients who are uninsured, re3 ceiving assistance under title XVIII of the Social Se4 curity Act, or a State plan under title XIX of such 

5 Act (or under a waiver of such plan), or who are 

6 members of a vulnerable population, as determined 

7 by the Secretary; or 

8 ‘‘(B) serves a disproportionate percentage of 

9 local patients that are from a racial and ethnic mi10 nority group. 

11 ‘‘(c) REPORT.—Not later than 180 days after the 

12 date of enactment of this title and annually thereafter, the 

13 Secretary shall submit to the Congress and the President 

14 a report that includes an assessment of health resources 

15 and facilities serving populations in American Samoa, 

16 Guam, the Commonwealth of the Northern Mariana Is17 lands, the United States Virgin Islands, Puerto Rico, and 

18 Hawaii. In preparing such report, the Secretary shall— 

19 ‘‘(1) consult with and obtain information on all 

20 health care facilities needs from the entities receiv21 ing direct financial assistance under subsection (a); 

22 ‘‘(2) include all amounts of Federal assistance 

23 received by each such entity in the preceding fiscal 

24 year; 


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1 ‘‘(3) review the total unmet needs of health care 

2 facilities serving American Samoa, Guam, the Com3 monwealth of the Northern Mariana Islands, the 

4 United States Virgin Islands, Puerto Rico, and Ha5 waii, including needs for renovation and expansion 

6 of existing facilities; 

7 ‘‘(4) include a strategic plan for addressing the 

8 needs of each such population identified in the re9 port; and 

10 ‘‘(5) evaluate the effectiveness of the care pro11 vided by measuring patient outcomes and cost meas12 ures. 

13 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated such sums as necessary 

15 to carry out this section.’’. 

16 SEC. 413. PROTECTING SENSITIVE LOCATIONS. 

17 Section 287 of the Immigration and Nationality Act 

18 (8 U.S.C. 1357) is amended— 

19 (1) by striking ‘‘Service’’ each place such term 

20 appears and inserting ‘‘Department of Homeland 

21 Security’’; 

22 (2) by striking ‘‘Attorney General’’ each place 

23 such term appears and inserting ‘‘Secretary of 

24 Homeland Security’’; 


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1 (3) in subsection (f)(1), by striking ‘‘Commis2 sioner’’ and inserting ‘‘Director of U.S. Citizenship 

3 and Immigration Services’’; 

4 (4) in subsection (h)— 

5 (A) by striking ‘‘of the Immigration and 

6 Nationality Act’’; and 

7 (B) by striking ‘‘of such Act’’; and 

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

9 ‘‘(i)(1) In this subsection: 

10 ‘‘(A) The term ‘appropriate congressional com11 mittees’ means— 

12 ‘‘(i) the Committee on Homeland Security 

13 and Governmental Affairs of the Senate; 

14 ‘‘(ii) the Committee on the Judiciary of the 

15 Senate; 

16 ‘‘(iii) the Committee on Homeland Security 

17 of the House of Representatives; and 

18 ‘‘(iv) the Committee on the Judiciary of 

19 the House of Representatives. 

20 ‘‘(B) The term ‘enforcement action’— 

21 ‘‘(i) means an apprehension, arrest, inter22 view, request for identification, search, or sur23 veillance for the purposes of immigration en24 forcement; and 


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1 ‘‘(ii) includes an enforcement action at, or 

2 focused on, a sensitive location that is part of 

3 a joint case led by another law enforcement 

4 agency. 

5 ‘‘(C) The term ‘exigent circumstances’ means a 

6 situation involving— 

7 ‘‘(i) the imminent risk of death, violence, 

8 or physical harm to any person or property, in9 cluding a situation implicating terrorism or the 

10 national security of the United States; 

11 ‘‘(ii) the immediate arrest or pursuit of a 

12 dangerous felon, terrorist suspect, or other indi13 vidual presenting an imminent danger; or 

14 ‘‘(iii) the imminent risk of destruction of 

15 evidence that is material to an ongoing criminal 

16 case. 

17 ‘‘(D) The term ‘prior approval’ means— 

18 ‘‘(i) in the case of officers and agents of 

19 U.S. Immigration and Customs Enforcement, 

20 prior written approval to carry out an enforce21 ment action involving a specific individual or in22 dividuals authorized by— 

23 ‘‘(I) the Assistant Director of Oper24 ations, Homeland Security Investigations; 


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1 ‘‘(II) the Executive Associate Direc2 tor, Homeland Security Investigations; 

3 ‘‘(III) the Assistant Director for Field 

4 Operations, Enforcement and Removal Op5 erations; or 

6 ‘‘(IV) the Executive Associate Direc7 tor for Field Operations, Enforcement and 

8 Removal Operations; 

9 ‘‘(ii) in the case of officers and agents of 

10 U.S. Customs and Border Protection, prior 

11 written approval to carry out an enforcement 

12 action involving a specific individual or individ13 uals authorized by— 

14 ‘‘(I) a Chief Patrol Agent; 

15 ‘‘(II) the Director of Field Operations; 

16 ‘‘(III) the Director of Air and Marine 

17 Operations; or 

18 ‘‘(IV) the Internal Affairs Special 

19 Agent in Charge; and 

20 ‘‘(iii) in the case of other Federal, State, 

21 or local law enforcement officers, to carry out 

22 an enforcement action involving a specific indi23 vidual or individuals authorized by— 

24 ‘‘(I) the head of the Federal agency 

25 carrying out the enforcement action; or 


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1 ‘‘(II) the head of the State or local 

2 law enforcement agency carrying out the 

3 enforcement action. 

4 ‘‘(E) The term ‘sensitive location’ includes all of 

5 the physical space located within 1,000 feet of— 

6 ‘‘(i) any medical treatment or health care 

7 facility, including any hospital, doctor’s office, 

8 accredited health clinic, alcohol or drug treat9 ment center, or emergent or urgent care facil10 ity; 

11 ‘‘(ii) any public or private school, including 

12 any known and licensed day care facility, pre13 school, other early learning program facility, 

14 primary school, secondary school, postsecondary 

15 school (including colleges and universities), or 

16 other institution of learning (including voca17 tional or trade schools); 

18 ‘‘(iii) any scholastic or education-related 

19 activity or event, including field trips and inter20 scholastic events; 

21 ‘‘(iv) any school bus or school bus stop 

22 during periods when school children are present 

23 on the bus or at the stop; 

24 ‘‘(v) any organization or subdivision of 

25 government that— 


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1 ‘‘(I) assists children, pregnant women, 

2 victims of crime or abuse, or individuals 

3 with significant mental or physical disabil4 ities; or 

5 ‘‘(II) provides social services and as6 sistance, including emergency and disaster 

7 services or assistance with food and nutri8 tion, housing affordability and income or 

9 other services funded by State or local gov10 ernment, charitable giving, the Special 

11 Supplemental Nutrition Program for 

12 Women, Infants, and Children (WIC), 

13 Supplemental Nutrition Assistance Pro14 gram (SNAP), Temporary Assistance for 

15 Needy Families (TANF), or the United 

16 States Housing Act; 

17 ‘‘(vi) any church, synagogue, mosque, or 

18 other place of worship, including buildings 

19 rented for the purpose of religious services, re20 treats, counseling, workshops, instruction, and 

21 education; 

22 ‘‘(vii) any Federal, State, or local court23 house, including the office of an individual’s 

24 legal counsel or representative, and a probation, 

25 parole, or supervised release office; 


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1 ‘‘(viii) the site of a funeral, wedding, or 

2 other religious ceremony or observance; 

3 ‘‘(ix) any public demonstration, such as a 

4 march, rally, or parade; 

5 ‘‘(x) any domestic violence shelter, rape 

6 crisis center, supervised visitation center, family 

7 justice center, or victim services provider; or 

8 ‘‘(xi) any other location specified by the 

9 Secretary of Homeland Security for purposes of 

10 this subsection. 

11 ‘‘(2)(A) An enforcement action may not take place 

12 at, or be focused on, a sensitive location unless— 

13 ‘‘(i) the action involves exigent circumstances; 

14 and 

15 ‘‘(ii) prior approval for the enforcement action 

16 was obtained from the appropriate official. 

17 ‘‘(B) If an enforcement action is initiated pursuant 

18 to subparagraph (A) and the exigent circumstances per19 mitting the enforcement action cease, the enforcement ac20 tion shall be discontinued until such exigent circumstances 

21 reemerge. 

22 ‘‘(C) If an enforcement action is carried out in viola23 tion of this subsection— 

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1 ceived into evidence in a removal proceeding result2 ing from the enforcement action; and 

3 ‘‘(ii) the alien who is the subject of such re4 moval proceeding may file a motion for the imme5 diate termination of the removal proceeding. 

6 ‘‘(3)(A) This subsection shall apply to any enforce7 ment action by officers or agents of the Department of 

8 Homeland Security, including— 

9 ‘‘(i) officers or agents of U.S. Immigration and 

10 Customs Enforcement; 

11 ‘‘(ii) officers or agents of U.S. Customs and 

12 Border Protection; and 

13 ‘‘(iii) any individual designated to perform im14 migration enforcement functions pursuant to sub15 section (g). 

16 ‘‘(B) While carrying out an enforcement action at a 

17 sensitive location, officers and agents referred to in sub18 paragraph (A) shall make every effort— 

19 ‘‘(i) to limit the time spent at the sensitive loca20 tion; 

21 ‘‘(ii) to limit the enforcement action at the sen22 sitive location to the person or persons for whom 

23 prior approval was obtained; and 

24 ‘‘(iii) to conduct themselves discreetly. 


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1 ‘‘(C) If, while carrying out an enforcement action 

2 that is not initiated at or focused on a sensitive location, 

3 officers or agents are led to a sensitive location, and no 

4 exigent circumstance and prior approval with respect to 

5 the sensitive location exists, such officers or agents shall— 

6 ‘‘(i) cease before taking any further enforce7 ment action; 

8 ‘‘(ii) conduct themselves in a discreet manner; 

9 ‘‘(iii) maintain surveillance; and 

10 ‘‘(iv) immediately consult their supervisor in 

11 order to determine whether such enforcement action 

12 should be discontinued. 

13 ‘‘(D) The limitations under this paragraph shall not 

14 apply to the transportation of an individual apprehended 

15 at or near a land or sea border to a hospital or health 

16 care provider for the purpose of providing medical care 

17 to such individual. 

18 ‘‘(4)(A) Each official specified in subparagraph (B) 

19 shall ensure that the employees under his or her super20 vision receive annual training on compliance with— 

21 ‘‘(i) the requirements under this subsection in 

22 enforcement actions at or focused on sensitive loca23 tions and enforcement actions that lead officers or 

24 agents to a sensitive location; and 


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1 ‘‘(ii) the requirements under section 239 of this 

2 Act and section 384 of the Illegal Immigration Re3 form and Immigrant Responsibility Act of 1996 (8 

4 U.S.C. 1367). 

5 ‘‘(B) The officials specified in this subparagraph 

6 are— 

7 ‘‘(i) the Chief Counsel of U.S. Immigration and 

8 Customs Enforcement; 

9 ‘‘(ii) the Field Office Directors of U.S. Immi10 gration and Customs Enforcement; 

11 ‘‘(iii) each Special Agent in Charge of U.S. Im12 migration and Customs Enforcement; 

13 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 

14 and Border Protection; 

15 ‘‘(v) the Director of Field Operations of U.S. 

16 Customs and Border Protection; 

17 ‘‘(vi) the Director of Air and Marine Operations 

18 of U.S. Customs and Border Protection; 

19 ‘‘(vii) the Internal Affairs Special Agent in 

20 Charge of U.S. Customs and Border Protection; and 

21 ‘‘(viii) the chief law enforcement officer of each 

22 State or local law enforcement agency that enters 

23 into a written agreement with the Department of 

24 Homeland Security pursuant to subsection (g). 


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1 ‘‘(5) The Secretary of Homeland Security shall mod2 ify the Notice to Appear form (I–862)— 

3 ‘‘(A) to provide the subjects of an enforcement 

4 action with information, written in plain language, 

5 summarizing the restrictions against enforcement 

6 actions at sensitive locations set forth in this sub7 section and the remedies available to the alien if 

8 such action violates such restrictions; 

9 ‘‘(B) to ensure that the information described 

10 in subparagraph (A) is accessible to individuals with 

11 limited English proficiency; and 

12 ‘‘(C) to ensure that subjects of an enforcement 

13 action are not permitted to verify that the officers 

14 or agents that carried out such action complied with 

15 the restrictions set forth in this subsection. 

16 ‘‘(6)(A) The Director of U.S. Immigration and Cus17 toms Enforcement and the Commissioner of U.S. Customs 

18 and Border Protection shall each submit an annual report 

19 to the appropriate congressional committees that includes 

20 the information set forth in subparagraph (B) with respect 

21 to the respective agency. 

22 ‘‘(B) Each report submitted under subparagraph (A) 

23 shall include, with respect to the submitting agency during 

24 the reporting period— 


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1 ‘‘(i) the number of enforcement actions that 

2 were carried out at, or focused on, a sensitive loca3 tion; 

4 ‘‘(ii) the number of enforcement actions in 

5 which officers or agents were subsequently led to a 

6 sensitive location; and 

7 ‘‘(iii) for each enforcement action described in 

8 clause (i) or (ii)— 

9 ‘‘(I) the date on which it occurred; 

10 ‘‘(II) the specific site, city, county, and 

11 State in which it occurred; 

12 ‘‘(III) the components of the agency in13 volved in the enforcement action; 

14 ‘‘(IV) a description of the enforcement ac15 tion, including the nature of the criminal activ16 ity of its intended target; 

17 ‘‘(V) the number of individuals, if any, ar18 rested or taken into custody; 

19 ‘‘(VI) the number of collateral arrests, if 

20 any, and the reasons for each such arrest; 

21 ‘‘(VII) a certification whether the location 

22 administrator was contacted before, during, or 

23 after the enforcement action; and 

24 ‘‘(VIII) the percentage of all of the staff 

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1 cials listed in paragraph (4)(B) who completed 

2 the training required under paragraph (4)(A). 

3 ‘‘(7) Nothing in the subsection may be construed— 

4 ‘‘(A) to affect the authority of Federal, State, 

5 or local law enforcement agencies— 

6 ‘‘(i) to enforce generally applicable Federal 

7 or State criminal laws unrelated to immigra8 tion; or 

9 ‘‘(ii) to protect residents from imminent 

10 threats to public safety; or 

11 ‘‘(B) to limit or override the protections pro12 vided in— 

13 ‘‘(i) section 239; or 

14 ‘‘(ii) section 384 of the Illegal Immigration 

15 Reform and Immigrant Responsibility Act of 

16 1996 (8 U.S.C. 1367).’’. 

17 SEC. 414. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

18 TO COMMUNITY HEALTH. 

19 (a) PURPOSE.—It is the purpose of this section to 

20 award grants to assist communities in mobilizing and or21 ganizing resources in support of effective and sustainable 

22 programs that will reduce or eliminate disparities in health 

23 and health care experienced by racial and ethnic minority 

24 individuals. 


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1 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 

2 of Health and Human Services, acting through the Ad3 ministrator of the Health Resources and Services Admin4 istration (referred to in this section as the ‘‘Secretary’’), 

5 shall award grants to eligible entities to assist in design6 ing, implementing, and evaluating culturally and linguis7 tically appropriate, science-based, and community-driven 

8 sustainable strategies to eliminate racial and ethnic health 

9 and health care disparities. 

10 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

11 grant under this section, an entity shall— 

12 (1) represent a coalition— 

13 (A) whose principal purpose is to develop 

14 and implement interventions to reduce or elimi15 nate a health or health care disparity in a tar16 geted racial or ethnic minority group in the 

17 community served by the coalition; and 

18 (B) that includes— 

19 (i) members selected from among— 

20 (I) public health departments; 

21 (II) community-based organiza22 tions; 

23 (III) university and research or24 ganizations; 


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1 (IV) Indian tribes or tribal orga2 nizations (as such terms are defined 

3 in section 4 of the Indian Self-Deter4 mination and Education Assistance 

5 Act (25 U.S.C. 5304)), the Indian 

6 Health Service, or any other organiza7 tion that serves Alaska Natives; and 

8 (V) interested public or private 

9 health care providers or organizations 

10 as determined appropriate by the Sec11 retary; and 

12 (ii) at least 1 member from a commu13 nity-based organization that represents the 

14 targeted racial or ethnic minority group; 

15 and 

16 (2) submit to the Secretary an application at 

17 such time, in such manner, and containing such in18 formation as the Secretary may require, which shall 

19 include— 

20 (A) a description of the targeted racial or 

21 ethnic populations in the community to be 

22 served under the grant; 

23 (B) a description of at least 1 health dis24 parity that exists in the racial or ethnic tar25 geted populations, including health issues such 


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1 as infant mortality, breast and cervical cancer 

2 screening and management, musculoskeletal 

3 diseases and obesity, prostate cancer screening 

4 and management, cardiovascular disease, diabe5 tes, child and adult immunization levels, oral 

6 disease, or other health priority areas as des7 ignated by the Secretary; and 

8 (C) a demonstration of a proven record of 

9 accomplishment of the coalition members in 

10 serving and working with the targeted commu11 nity. 

12 (d) SUSTAINABILITY.—The Secretary shall give pri13 ority to an eligible entity under this section if the entity 

14 agrees that, with respect to the costs to be incurred by 

15 the entity in carrying out the activities for which the grant 

16 was awarded, the entity (and each of the participating 

17 partners in the coalition represented by the entity) will 

18 maintain its expenditures of non-Federal funds for such 

19 activities at a level that is not less than the level of such 

20 expenditures during the fiscal year immediately preceding 

21 the first fiscal year for which the grant is awarded. 

22 (e) NONDUPLICATION.—Any funds provided to an eli23 gible entity through a grant under this section shall— 


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1 (1) supplement, not supplant, any other Federal 

2 funds made available to the entity for the purposes 

3 of this section; and 

4 (2) not be used to duplicate the activities of any 

5 other health disparity grant program under this Act, 

6 including an amendment made by this Act. 

7 (f) TECHNICAL ASSISTANCE.—The Secretary may, 

8 either directly or by grant or contract, provide any entity 

9 that receives a grant under this section with technical and 

10 other nonfinancial assistance necessary to meet the re11 quirements of this section. 

12 (g) DISSEMINATION.—The Secretary shall encourage 

13 and enable eligible entities receiving grants under this sec14 tion to share best practices, evaluation results, and reports 

15 with communities not affiliated with such entities, by 

16 using the internet, conferences, and other pertinent infor17 mation regarding the projects funded by this section, in18 cluding through using outreach efforts of the Office of Mi19 nority Health and the Centers for Disease Control and 

20 Prevention. 

21 (h) ADMINISTRATIVE BURDENS.—The Secretary 

22 shall make every effort to minimize duplicative or unneces23 sary administrative burdens on eligible entities receiving 

24 grants under this section. 


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1 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary to carry out this section. 

4 SEC. 415. BORDER HEALTH GRANTS. 

5 (a) DEFINITIONS.—In this section: 

6 (1) BORDER AREA.—The term ‘‘border area’’ 

7 means the United States-Mexico Border Area, as de8 fined in section 8 of the United States-Mexico Bor9 der Health Commission Act (22 U.S.C. 290n–6). 

10 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti11 ty’’ means an entity that is located in the border 

12 area and is any of the following: 

13 (A) A State, local government, or Tribal 

14 government. 

15 (B) A public institution of higher edu16 cation. 

17 (C) A nonprofit health organization. 

18 (D) A community health center. 

19 (E) A community clinic that is a health 

20 center receiving assistance under section 330 of 

21 the Public Health Service Act (42 U.S.C. 

22 254b). 

23 (b) AUTHORIZATION.—From funds appropriated 

24 under subsection (f), the Secretary of Health and Human 

25 Services (in this section referred to as the ‘‘Secretary’’), 


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1 acting through the United States members of the United 

2 States-Mexico Border Health Commission, shall award 

3 grants to eligible entities to address priorities and rec4 ommendations to improve the health of border area resi5 dents that are established by— 

6 (1) the United States members of the United 

7 States-Mexico Border Health Commission; 

8 (2) the State border health offices; and 

9 (3) the Secretary. 

10 (c) APPLICATION.—An eligible entity that desires a 

11 grant under subsection (b) shall submit an application to 

12 the Secretary at such time, in such manner, and con13 taining such information as the Secretary may require. 

14 (d) USE OF FUNDS.—An eligible entity that receives 

15 a grant under subsection (b) shall use the grant funds 

16 for— 

17 (1) programs relating to— 

18 (A) maternal and child health; 

19 (B) primary care and preventative health; 

20 (C) public health and public health infra21 structure; 

22 (D) musculoskeletal health and obesity; 

23 (E) health education and promotion; 

24 (F) oral health; 

25 (G) mental and behavioral health; 


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1 (H) substance use disorders; 

2 (I) health conditions that have a high prev3 alence in the border area; 

4 (J) medical and health services research; 

5 (K) workforce training and development; 

6 (L) community health workers, patient 

7 navigators, and promotores; 

8 (M) health care infrastructure problems in 

9 the border area (including planning and con10 struction grants); 

11 (N) health disparities in the border area; 

12 (O) environmental health; and 

13 (P) outreach and enrollment services with 

14 respect to Federal programs (including pro15 grams authorized under titles XIX and XXI of 

16 the Social Security Act (42 U.S.C. 1396 et seq.; 

17 42 U.S.C. 1397aa et seq.)); and 

18 (2) other programs determined appropriate by 

19 the Secretary. 

20 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro21 vided to an eligible entity awarded a grant under sub22 section (b) shall be used to supplement and not supplant 

23 other funds available to the eligible entity to carry out the 

24 activities described in subsection (d). 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section, 

3 $200,000,000 for fiscal year 2021, and such sums as may 

4 be necessary for each succeeding fiscal year. 

5 SEC. 416. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

6 (a) ELIMINATION OF ISOLATION TEST FOR COST7 BASED AMBULANCE REIMBURSEMENT.— 

8 (1) IN GENERAL.—Section 1834(l)(8) of the 

9 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

10 amended— 

11 (A) in subparagraph (B)— 

12 (i) by striking ‘‘owned and’’; and 

13 (ii) by inserting ‘‘(including when 

14 such services are provided by the entity 

15 under an arrangement with the hospital)’’ 

16 after ‘‘hospital’’; and 

17 (B) by striking the comma at the end of 

18 subparagraph (B) and all that follows and in19 serting a period. 

20 (2) EFFECTIVE DATE.—The amendments made 

21 by this subsection shall apply to services furnished 

22 on or after January 1, 2021. 

23 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE

24 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT

25 REQUIREMENT.— 


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1 (1) IN GENERAL.—Section 1820(c)(2) of the 

2 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 

3 amended— 

4 (A) in subparagraph (B)(iii), by striking 

5 ‘‘provides not more than’’ and inserting ‘‘sub6 ject to subparagraph (F), provides not more 

7 than’’; and 

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

9 subparagraph: 

10 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED

11 LIMIT REQUIREMENT.— 

12 ‘‘(i) IN GENERAL.—A State may elect 

13 to treat a facility, with respect to the des14 ignation of the facility for a cost-reporting 

15 period, as satisfying the requirement of 

16 subparagraph (B)(iii) relating to a max17 imum number of acute care inpatient beds 

18 if the facility elects, in accordance with a 

19 method specified by the Secretary and be20 fore the beginning of the cost reporting pe21 riod, to meet the requirement under clause 

22 (ii). 

23 ‘‘(ii) ALTERNATE REQUIREMENT.— 

24 The requirement under this clause, with 

25 respect to a facility and a cost-reporting 


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1 period, is that the total number of inpa2 tient bed days described in subparagraph 

3 (B)(iii) during such period will not exceed 

4 7,300. For purposes of this subparagraph, 

5 an individual who is an inpatient in a bed 

6 in the facility for a single day shall be 

7 counted as one inpatient bed day. 

8 ‘‘(iii) WITHDRAWAL OF ELECTION.— 

9 The option described in clause (i) shall not 

10 apply to a facility for a cost-reporting pe11 riod if the facility (for any two consecutive 

12 cost-reporting periods during the previous 

13 5 cost-reporting periods) was treated under 

14 such option and had a total number of in15 patient bed days for each of such two cost16 reporting periods that exceeded the num17 ber specified in such clause.’’. 

18 (2) EFFECTIVE DATE.—The amendments made 

19 by paragraph (1) shall apply to cost-reporting peri20 ods beginning on or after the date of the enactment 

21 of this Act. 

22 SEC. 417. ESTABLISHMENT OF RURAL COMMUNITY HOS23 PITAL (RCH) PROGRAM. 

24 (a) IN GENERAL.—Section 1861 of the Social Secu25 rity Act (42 U.S.C. 1395x), as amended by section 


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1 207(b)(1), is amended by adding at the end of the fol2 lowing new subsection: 

3 ‘‘Rural Community Hospital; Rural Community Hospital 

4 Services 

5 ‘‘(lll)(1) The term ‘rural community hospital’ means 

6 a hospital (as defined in subsection (e)) that— 

7 ‘‘(A) is located in a rural area (as defined in 

8 section 1886(d)(2)(D)) or treated as being so lo9 cated pursuant to section 1886(d)(8)(E); 

10 ‘‘(B) subject to paragraph (2), has less than 51 

11 acute care inpatient beds, as reported in its most re12 cent cost report; 

13 ‘‘(C) makes available 24-hour emergency care 

14 services; 

15 ‘‘(D) subject to paragraph (3), has a provider 

16 agreement in effect with the Secretary and is open 

17 to the public as of January 1, 2010; and 

18 ‘‘(E) applies to the Secretary for such designa19 tion. 

20 ‘‘(2) For purposes of paragraph (1)(B), beds in a 

21 psychiatric or rehabilitation unit of the hospital which is 

22 a distinct part of the hospital shall not be counted. 

23 ‘‘(3) Paragraph (1)(D) shall not be construed to pro24 hibit any of the following from qualifying as a rural com25 munity hospital: 


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1 ‘‘(A) A replacement facility (as defined by the 

2 Secretary in regulations in effect on January 1, 

3 2012) with the same service area (as defined by the 

4 Secretary in regulations in effect on such date). 

5 ‘‘(B) A facility obtaining a new provider num6 ber pursuant to a change of ownership. 

7 ‘‘(C) A facility which has a binding written 

8 agreement with an outside, unrelated party for the 

9 construction, reconstruction, lease, rental, or financ10 ing of a building as of January 1, 2012. 

11 ‘‘(4) Nothing in this subsection shall be construed as 

12 prohibiting a critical access hospital from qualifying as a 

13 rural community hospital if the critical access hospital 

14 meets the conditions otherwise applicable to hospitals 

15 under subsection (e) and section 1866. 

16 ‘‘(5) Nothing in this subsection shall be construed as 

17 prohibiting a rural community hospital participating in 

18 the demonstration program under section 410A of the 

19 Medicare Prescription Drug, Improvement, and Mod20 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

21 2313) from qualifying as a rural community hospital if 

22 the rural community hospital meets the conditions other23 wise applicable to hospitals under subsection (e) and sec24 tion 1866.’’. 

25 (b) PAYMENT.— 


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1 (1) INPATIENT HOSPITAL SERVICES.—Section 

2 1814 of the Social Security Act (42 U.S.C. 1395f) 

3 is amended by adding at the end the following new 

4 subsection: 

5 ‘‘Payment for Inpatient Services Furnished in Rural 

6 Community Hospitals 

7 ‘‘(m) The amount of payment under this part for in8 patient hospital services furnished in a rural community 

9 hospital, other than such services furnished in a psy10 chiatric or rehabilitation unit of the hospital which is a 

11 distinct part, is, at the election of the hospital in the appli12 cation referred to in section 1861(lll)(1)(E)— 

13 ‘‘(1) 101 percent of the reasonable costs of pro14 viding such services, without regard to the amount 

15 of the customary or other charge, or 

16 ‘‘(2) the amount of payment provided for under 

17 the prospective payment system for inpatient hos18 pital services under section 1886(d).’’. 

19 (2) OUTPATIENT SERVICES.—Section 1834 of 

20 such Act (42 U.S.C. 1395m) is amended by adding 

21 at the end the following new subsection: 

22 ‘‘(x) PAYMENT FOR OUTPATIENT SERVICES FUR23 NISHED IN RURAL COMMUNITY HOSPITALS.—The 

24 amount of payment under this part for outpatient services 

25 furnished in a rural community hospital is, at the election 


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1 of the hospital in the application referred to in section 

2 1861(lll)(1)(E)— 

3 ‘‘(1) 101 percent of the reasonable costs of pro4 viding such services, without regard to the amount 

5 of the customary or other charge and any limitation 

6 under section 1861(v)(1)(U), or 

7 ‘‘(2) the amount of payment provided for under 

8 the prospective payment system for covered OPD 

9 services under section 1833(t).’’. 

10 (3) EXEMPTION FROM 30-PERCENT REDUCTION

11 IN REIMBURSEMENT FOR BAD DEBT.—Section 

12 1861(v)(1)(T) of such Act (42 U.S.C. 

13 1395x(v)(1)(T)) is amended by inserting ‘‘(other 

14 than for a rural community hospital)’’ after ‘‘In de15 termining such reasonable costs for hospitals’’. 

16 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT

17 SERVICES.—Section 1834(x) of such Act (as added by 

18 subsection (b)(2)) is amended— 

19 (1) by redesignating paragraphs (1) and (2) as 

20 subparagraphs (A) and (B), respectively; 

21 (2) by inserting ‘‘(1)’’ after ‘‘(x)’’; and 

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

23 ‘‘(2) The amounts of beneficiary cost-sharing for out24 patient services furnished in a rural community hospital 

25 under this part shall be as follows: 


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1 ‘‘(A) For items and services that would have 

2 been paid under section 1833(t) if furnished by a 

3 hospital, the amount of cost-sharing determined 

4 under paragraph (8) of such section. 

5 ‘‘(B) For items and services that would have 

6 been paid under section 1833(h) if furnished by a 

7 provider of services or supplier, no cost-sharing shall 

8 apply. 

9 ‘‘(C) For all other items and services, the 

10 amount of cost-sharing that would apply to the item 

11 or service under the methodology that would be used 

12 to determine payment for such item or service if pro13 vided by a physician, provider of services, or sup14 plier, as the case may be.’’. 

15 (d) CONFORMING AMENDMENTS.— 

16 (1) PART A PAYMENT.—Section 1814(b) of 

17 such Act (42 U.S.C. 1395f(b)) is amended in the 

18 matter preceding paragraph (1) by inserting ‘‘other 

19 than inpatient hospital services furnished by a rural 

20 community hospital,’’ after ‘‘critical access hospital 

21 services,’’. 

22 (2) PART B PAYMENT.—Section 1833(a) of 

23 such Act (42 U.S.C. 1395l(a)), as amended by sec24 tion 207(b)(3), is amended— 


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1 (A) by striking ‘‘and’’ at the end of para2 graph (9); 

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

4 paragraph (10) and inserting ‘‘; and’’; and 

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

6 ‘‘(11) in the case of outpatient services fur7 nished by a rural community hospital, the amounts 

8 described in section 1834(x).’’. 

9 (3) TECHNICAL AMENDMENTS.— 

10 (A) CONSULTATION WITH STATE AGEN11 CIES.—Section 1863 of such Act (42 U.S.C. 

12 1395z) is amended by striking ‘‘and (dd)(2)’’ 

13 and inserting ‘‘(dd)(2), and (lll)(1)’’. 

14 (B) PROVIDER AGREEMENTS.—Section 

15 1866(a)(2)(A) of such Act (42 U.S.C. 

16 1395cc(a)(2)(A)) is amended by inserting ‘‘sec17 tion 1834(x)(2),’’ after ‘‘section 1833(b),’’. 

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

19 this section shall apply to items and services furnished on 

20 or after October 1, 2021. 

21 SEC. 418. MEDICARE REMOTE MONITORING PILOT 

22 PROJECTS. 

23 (a) PILOT PROJECTS.— 

24 (1) IN GENERAL.—Not later than 9 months 

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1 retary of Health and Human Services (in this sec2 tion referred to as the ‘‘Secretary’’) shall conduct 

3 pilot projects under title XVIII of the Social Secu4 rity Act (42 U.S.C. 1395 et seq.) for the purpose of 

5 providing incentives to home health agencies to uti6 lize home monitoring and communications tech7 nologies that— 

8 (A) enhance health outcomes for Medicare 

9 beneficiaries; and 

10 (B) reduce expenditures under such title. 

11 (2) SITE REQUIREMENTS.— 

12 (A) URBAN AND RURAL.—The Secretary 

13 shall conduct the pilot projects under this sec14 tion in both urban and rural areas. 

15 (B) SITE IN A SMALL STATE.—The Sec16 retary shall conduct at least 3 of the pilot 

17 projects in a State with a population of less 

18 than 1,000,000. 

19 (3) DEFINITION OF HOME HEALTH AGENCY.— 

20 In this section, the term ‘‘home health agency’’ has 

21 the meaning given that term in section 1861(o) of 

22 the Social Security Act (42 U.S.C. 1395x(o)). 

23 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

24 OF PROJECTS.—The Secretary shall specify the criteria 

25 for identifying those Medicare beneficiaries who shall be 


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1 considered within the scope of the pilot projects under this 

2 section for purposes of the application of subsection (c) 

3 and for the assessment of the effectiveness of the home 

4 health agency in achieving the objectives of this section. 

5 Such criteria may provide for the inclusion in the projects 

6 of Medicare beneficiaries who begin receiving home health 

7 services under title XVIII of the Social Security Act (42 

8 U.S.C. 1395 et seq.) after the date of the implementation 

9 of the projects. 

10 (c) INCENTIVES.— 

11 (1) PERFORMANCE TARGETS.—The Secretary 

12 shall establish for each home health agency partici13 pating in a pilot project under this section a per14 formance target using one of the following meth15 odologies, as determined appropriate by the Sec16 retary: 

17 (A) ADJUSTED HISTORICAL PERFORMANCE

18 TARGET.—The Secretary shall establish for the 

19 agency— 

20 (i) a base expenditure amount equal 

21 to the average total payments made to the 

22 agency under parts A and B of title XVIII 

23 of the Social Security Act (42 U.S.C. 1395 

24 et seq.) for Medicare beneficiaries deter25 mined to be within the scope of the pilot 


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1 project in a base period determined by the 

2 Secretary; and 

3 (ii) an annual per capita expenditure 

4 target for such beneficiaries, reflecting the 

5 base expenditure amount adjusted for risk 

6 and adjusted growth rates. 

7 (B) COMPARATIVE PERFORMANCE TAR8 GET.—The Secretary shall establish for the 

9 agency a comparative performance target equal 

10 to the average total payments under such parts 

11 A and B during the pilot project for comparable 

12 individuals in the same geographic area that 

13 are not determined to be within the scope of the 

14 pilot project. 

15 (2) INCENTIVE.—Subject to paragraph (3), the 

16 Secretary shall pay to each participating home care 

17 agency an incentive payment for each year under the 

18 pilot project equal to a portion of the Medicare sav19 ings realized for such year relative to the perform20 ance target under paragraph (1). 

21 (3) LIMITATION ON EXPENDITURES.—The Sec22 retary shall limit incentive payments under this sec23 tion in order to ensure that the aggregate expendi24 tures under title XVIII of the Social Security Act 

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1 ments under this subsection) do not exceed the 

2 amount that the Secretary estimates would have 

3 been expended if the pilot projects under this section 

4 had not been implemented. 

5 (d) WAIVER AUTHORITY.—The Secretary may waive 

6 such provisions of titles XI and XVIII of the Social Secu7 rity Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) 

8 as the Secretary determines to be appropriate for the con9 duct of the pilot projects under this section. 

10 (e) REPORT TO CONGRESS.—Not later than 5 years 

11 after the date that the first pilot project under this section 

12 is implemented, the Secretary shall submit to Congress a 

13 report on the pilot projects. Such report shall contain a 

14 detailed description of issues related to the expansion of 

15 the projects under subsection (f) and recommendations for 

16 such legislation and administrative actions as the Sec17 retary considers appropriate. 

18 (f) EXPANSION.—If the Secretary determines that 

19 any of the pilot projects under this section enhance health 

20 outcomes for Medicare beneficiaries and reduce expendi21 tures under title XVIII of the Social Security Act (42 

22 U.S.C. 1395 et seq.), the Secretary may initiate com23 parable projects in additional areas. 


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1 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

2 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen3 tive payment under this section— 

4 (1) shall be in addition to the payments that a 

5 home health agency would otherwise receive under 

6 title XVIII of the Social Security Act for the provi7 sion of home health services; and 

8 (2) shall have no effect on the amount of such 

9 payments. 

10 SEC. 419. RURAL HEALTH QUALITY ADVISORY COMMISSION 

11 AND DEMONSTRATION PROJECTS. 

12 (a) RURAL HEALTH QUALITY ADVISORY COMMIS13 SION.— 

14 (1) ESTABLISHMENT.—Not later than 6 

15 months after the date of the enactment of this sec16 tion, the Secretary of Health and Human Services 

17 (in this section referred to as the ‘‘Secretary’’) shall 

18 establish a commission to be known as the Rural 

19 Health Quality Advisory Commission (in this section 

20 referred to as the ‘‘Commission’’). 

21 (2) DUTIES OF COMMISSION.— 

22 (A) NATIONAL PLAN.—The Commission 

23 shall develop, coordinate, and facilitate imple24 mentation of a national plan for rural health 

25 quality improvement. The national plan shall— 


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1 (i) identify objectives for rural health 

2 quality improvement; 

3 (ii) identify strategies to eliminate 

4 known gaps in rural health system capacity 

5 and improve rural health quality; and 

6 (iii) provide recommendations for 

7 Federal programs to identify opportunities 

8 for strengthening and aligning policies and 

9 programs to improve rural health quality. 

10 (B) DEMONSTRATION PROJECTS.—The 

11 Commission shall design demonstration projects 

12 to recommend to the Secretary to test alter13 native models for rural health quality improve14 ment, including with respect to both personal 

15 and population health. 

16 (C) MONITORING.—The Commission shall 

17 monitor progress toward the objectives identi18 fied pursuant to subparagraph (A)(i). 

19 (3) MEMBERSHIP.— 

20 (A) NUMBER.—The Commission shall be 

21 composed of 11 members appointed by the Sec22 retary. 

23 (B) SELECTION.—The Secretary shall se24 lect the members of the Commission from 

25 among individuals with significant rural health 


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1 care and health care quality expertise, including 

2 expertise in clinical health care, health care 

3 quality research, population or public health, or 

4 purchaser organizations. 

5 (4) CONTRACTING AUTHORITY.—Subject to the 

6 availability of funds, the Commission may enter into 

7 contracts and make other arrangements, as may be 

8 necessary to carry out the duties described in para9 graph (2). 

10 (5) STAFF.—Upon the request of the Commis11 sion, the Secretary may detail, on a reimbursable 

12 basis, any of the personnel of the Office of Rural 

13 Health Policy of the Health Resources and Services 

14 Administration, the Agency for Healthcare Research 

15 and Quality, or the Centers for Medicare & Medicaid 

16 Services to the Commission to assist in carrying out 

17 this subsection. 

18 (6) REPORTS TO CONGRESS.—Not later than 1 

19 year after the establishment of the Commission, and 

20 annually thereafter, the Commission shall submit a 

21 report to the Congress on rural health quality. Each 

22 such report shall include the following: 

23 (A) An inventory of relevant programs and 

24 recommendations for improved coordination and 

25 integration of policy and programs. 


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1 (B) An assessment of achievement of the 

2 objectives identified in the national plan devel3 oped under paragraph (2) and recommenda4 tions for realizing such objectives. 

5 (C) Recommendations on Federal legisla6 tion, regulations, or administrative policies to 

7 enhance rural health quality and outcomes. 

8 (b) RURAL HEALTH QUALITY DEMONSTRATION

9 PROJECTS.— 

10 (1) IN GENERAL.—Not later than 270 days 

11 after the date of the enactment of this section, the 

12 Secretary, in consultation with the Rural Health 

13 Quality Advisory Commission, the Office of Rural 

14 Health Policy of the Health Resources and Services 

15 Administration, the Agency for Healthcare Research 

16 and Quality, and the Centers for Medicare & Med17 icaid Services, shall make grants to eligible entities 

18 for a total of 5 demonstration projects to implement 

19 and evaluate methods for improving the quality of 

20 health care in rural communities. Each such dem21 onstration project shall include— 

22 (A) alternative community models that— 

23 (i) will achieve greater integration of 

24 personal and population health services; 

25 and 


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1 (ii) address safety, effectiveness, 

2 patient- or community-centeredness, timeli3 ness, efficiency, and equity (the 6 aims 

4 identified by the National Academy of 

5 Medicine (formerly known as the ‘‘Institute 

6 of Medicine’’) in its report entitled ‘‘Cross7 ing the Quality Chasm: A New Health Sys8 tem for the 21st Century’’ released on 

9 March 1, 2001); 

10 (B) innovative approaches to the financing 

11 and delivery of health services to achieve rural 

12 health quality goals; and 

13 (C) development of quality improvement 

14 support structures to assist rural health sys15 tems and professionals (such as workforce sup16 port structures, quality monitoring and report17 ing, clinical care protocols, and information 

18 technology applications). 

19 (2) ELIGIBLE ENTITIES.—In this subsection, 

20 the term ‘‘eligible entity’’ means a consortium 

21 that— 

22 (A) shall include— 

23 (i) at least one health care provider or 

24 health care delivery system located in a 

25 rural area; and 


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1 (ii) at least one organization rep2 resenting multiple community stakeholders; 

3 and 

4 (B) may include other partners such as 

5 rural research centers. 

6 (3) CONSULTATION.—In developing the pro7 gram for awarding grants under this subsection, the 

8 Secretary shall consult with the Administrator of the 

9 Agency for Healthcare Research and Quality, rural 

10 health care providers, rural health care researchers, 

11 and private and nonprofit groups (including national 

12 associations) which are undertaking similar efforts. 

13 (4) EXPEDITED WAIVERS.—The Secretary shall 

14 expedite the processing of any waiver that— 

15 (A) is authorized under title XVIII or XIX 

16 of the Social Security Act (42 U.S.C. 1395 et 

17 seq.; 42 U.S.C. 1396 et seq.); and 

18 (B) is necessary to carry out a demonstra19 tion project under this subsection. 

20 (5) DEMONSTRATION PROJECT SITES.—The 

21 Secretary shall ensure that the 5 demonstration 

22 projects funded under this subsection are conducted 

23 at a variety of sites representing the diversity of 

24 rural communities in the United States. 


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1 (6) DURATION.—Each demonstration project 

2 under this subsection shall be for a period of 4 

3 years. 

4 (7) INDEPENDENT EVALUATION.—The Sec5 retary shall enter into an arrangement with an enti6 ty that has experience working directly with rural 

7 health systems for the conduct of an independent 

8 evaluation of the program carried out under this 

9 subsection. 

10 (8) REPORT.—Not later than 1 year after the 

11 conclusion of all of the demonstration projects fund12 ed under this subsection, the Secretary shall submit 

13 a report to the Congress on the results of such 

14 projects. The report shall include— 

15 (A) an evaluation of patient access to care, 

16 patient outcomes, and an analysis of the cost 

17 effectiveness of each such project; and 

18 (B) recommendations on Federal legisla19 tion, regulations, or administrative policies to 

20 enhance rural health quality and outcomes. 

21 (c) APPROPRIATION.— 

22 (1) IN GENERAL.—Out of funds in the Treas23 ury not otherwise appropriated, there are appro24 priated to the Secretary to carry out this section 


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1 $30,000,000 for the period of fiscal years 2021 

2 through 2025. 

3 (2) AVAILABILITY.— 

4 (A) IN GENERAL.—Funds appropriated 

5 under paragraph (1) shall remain available for 

6 expenditure through fiscal year 2025. 

7 (B) REPORT.—For purposes of carrying 

8 out subsection (b)(8), funds appropriated under 

9 paragraph (1) shall remain available for ex10 penditure through fiscal year 2026. 

11 (3) RESERVATION.—Of the amount appro12 priated under paragraph (1), the Secretary shall re13 serve— 

14 (A) $5,000,000 to carry out subsection (a); 

15 and 

16 (B) $25,000,000 to carry out subsection 

17 (b), of which— 

18 (i) 2 percent shall be for the provision 

19 of technical assistance to grant recipients; 

20 and 

21 (ii) 5 percent shall be for independent 

22 evaluation under subsection (b)(7). 

23 SEC. 420. RURAL HEALTH CARE SERVICES. 

24 Section 330A of the Public Health Service Act (42 

25 U.S.C. 254c) is amended to read as follows: 


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1 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 

2 RURAL HEALTH NETWORK DEVELOPMENT, 

3 DELTA RURAL DISPARITIES AND HEALTH 

4 SYSTEMS DEVELOPMENT, AND SMALL RURAL 

5 HEALTH CARE PROVIDER QUALITY IMPROVE6 MENT GRANT PROGRAMS. 

7 ‘‘(a) PURPOSE.—The purpose of this section is to 

8 provide for grants— 

9 ‘‘(1) under subsection (b), to promote rural 

10 health care services outreach; 

11 ‘‘(2) under subsection (c), to provide for the 

12 planning and implementation of integrated health 

13 care networks in rural areas; 

14 ‘‘(3) under subsection (d), to assist rural com15 munities in the Delta Region to reduce health dis16 parities and to promote and enhance health system 

17 development; and 

18 ‘‘(4) under subsection (e), to provide for the 

19 planning and implementation of small rural health 

20 care provider quality improvement activities. 

21 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH

22 GRANTS.— 

23 ‘‘(1) GRANTS.—The Director of the Office of 

24 Rural Health Policy of the Health Resources and 

25 Services Administration (referred to in this section 

26 as the ‘Director’) may award grants to eligible entiVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ties to promote rural health care services outreach 

2 by expanding the delivery of health care services to 

3 include new and enhanced services in rural areas. 

4 The Director may award the grants for periods of 

5 not more than 3 years. 

6 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

7 grant under this subsection for a project, an enti8 ty— 

9 ‘‘(A) shall be a rural public or rural non10 profit private entity, a facility that qualifies as 

11 a rural health clinic under title XVIII of the 

12 Social Security Act, a public or nonprofit entity 

13 existing exclusively to provide services to mi14 grant and seasonal farm workers in rural areas, 

15 or a Tribal government whose grant-funded ac16 tivities will be conducted within federally recog17 nized Tribal areas; 

18 ‘‘(B) shall represent a consortium com19 posed of members— 

20 ‘‘(i) that include 3 or more independ21 ently owned health care entities; and 

22 ‘‘(ii) that may be nonprofit or for23 profit entities; and 

24 ‘‘(C) shall not previously have received a 

25 grant under this subsection for the same or a 


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1 similar project, unless the entity is proposing to 

2 expand the scope of the project or the area that 

3 will be served through the project. 

4 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

5 grant under this subsection, an eligible entity shall 

6 prepare and submit to the Director an application at 

7 such time, in such manner, and containing such in8 formation as the Director may require, including— 

9 ‘‘(A) a description of the project that the 

10 eligible entity will carry out using the funds 

11 provided under the grant; 

12 ‘‘(B) a description of the manner in which 

13 the project funded under the grant will meet 

14 the health care needs of rural populations in 

15 the local community or region to be served; 

16 ‘‘(C) a plan for quantifying how health 

17 care needs will be met through identification of 

18 the target population and benchmarks of service 

19 delivery or health status, such as— 

20 ‘‘(i) quantifiable measurements of 

21 health status improvement for projects fo22 cusing on health promotion; or 

23 ‘‘(ii) benchmarks of increased access 

24 to primary care, including tracking factors 

25 such as the number and type of primary 


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1 care visits, identification of a medical 

2 home, or other general measures of such 

3 access; 

4 ‘‘(D) a description of how the local com5 munity or region to be served will be involved 

6 in the development and ongoing operations of 

7 the project; 

8 ‘‘(E) a plan for sustaining the project after 

9 Federal support for the project has ended; 

10 ‘‘(F) a description of how the project will 

11 be evaluated; 

12 ‘‘(G) the administrative capacity to submit 

13 annual performance data electronically as speci14 fied by the Director; and 

15 ‘‘(H) other such information as the Direc16 tor determines to be appropriate. 

17 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT

18 GRANTS.— 

19 ‘‘(1) GRANTS.— 

20 ‘‘(A) IN GENERAL.—The Director may 

21 award rural health network development grants 

22 to eligible entities to promote, through planning 

23 and implementation, the development of inte24 grated health care networks that have combined 


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1 the functions of the entities participating in the 

2 networks in order to— 

3 ‘‘(i) achieve efficiencies and economies 

4 of scale; 

5 ‘‘(ii) expand access to, coordinate, and 

6 improve the quality of the health care de7 livery system through development of orga8 nizational efficiencies; 

9 ‘‘(iii) implement health information 

10 technology to achieve efficiencies, reduce 

11 medical errors, and improve quality; 

12 ‘‘(iv) coordinate care and manage 

13 chronic illness; and 

14 ‘‘(v) strengthen the rural health care 

15 system as a whole in such a manner as to 

16 show a quantifiable return on investment 

17 to the participants in the network. 

18 ‘‘(B) GRANT PERIODS.—The Director may 

19 award such a rural health network development 

20 grant— 

21 ‘‘(i) for a period of 3 years for imple22 mentation activities; or 

23 ‘‘(ii) for a period of 1 year for plan24 ning activities to assist in the initial devel25 opment of an integrated health care netVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 work, if the proposed participants in the 

2 network do not have a history of collabo3 rative efforts and a 3-year grant would be 

4 inappropriate. 

5 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

6 grant under this subsection, an entity— 

7 ‘‘(A) shall be a rural public or rural non8 profit private entity, a facility that qualifies as 

9 a rural health clinic under title XVIII of the 

10 Social Security Act, a public or nonprofit entity 

11 existing exclusively to provide services to mi12 grant and seasonal farm workers in rural areas, 

13 or a Tribal government whose grant-funded ac14 tivities will be conducted within federally recog15 nized Tribal areas; 

16 ‘‘(B) shall represent a network composed 

17 of participants— 

18 ‘‘(i) that include 3 or more independ19 ently owned health care entities; and 

20 ‘‘(ii) that may be nonprofit or for21 profit entities; and 

22 ‘‘(C) shall not previously have received a 

23 grant under this subsection (other than a 1- 

24 year grant for planning activities) for the same 

25 or a similar project. 


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1 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

2 grant under this subsection, an eligible entity, in 

3 consultation with the appropriate State office of 

4 rural health or another appropriate State entity, 

5 shall prepare and submit to the Director an applica6 tion at such time, in such manner, and containing 

7 such information as the Director may require, in8 cluding— 

9 ‘‘(A) a description of the project that the 

10 eligible entity will carry out using the funds 

11 provided under the grant; 

12 ‘‘(B) an explanation of the reasons why 

13 Federal assistance is required to carry out the 

14 project; 

15 ‘‘(C) a description of— 

16 ‘‘(i) the history of collaborative activi17 ties carried out by the participants in the 

18 network; 

19 ‘‘(ii) the degree to which the partici20 pants are ready to integrate their func21 tions; and 

22 ‘‘(iii) how the local community or re23 gion to be served will benefit from and be 

24 involved in the activities carried out by the 

25 network; 


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1 ‘‘(D) a description of how the local com2 munity or region to be served will experience in3 creased access to quality health care services 

4 across the continuum of care as a result of the 

5 integration activities carried out by the net6 work, including a description of— 

7 ‘‘(i) return on investment for the com8 munity and the network members; and 

9 ‘‘(ii) other quantifiable performance 

10 measures that show the benefit of the net11 work activities; 

12 ‘‘(E) a plan for sustaining the project after 

13 Federal support for the project has ended; 

14 ‘‘(F) a description of how the project will 

15 be evaluated; 

16 ‘‘(G) the administrative capacity to submit 

17 annual performance data electronically as speci18 fied by the Director; and 

19 ‘‘(H) other such information as the Direc20 tor determines to be appropriate. 

21 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS22 TEMS DEVELOPMENT GRANTS.— 

23 ‘‘(1) GRANTS.—The Director may award grants 

24 to eligible entities to support reduction of health dis25 parities, improve access to health care, and enhance 


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1 rural health system development in the Delta Re2 gion. 

3 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

4 grant under this subsection, an entity shall be a 

5 rural public or rural nonprofit private entity, a facil6 ity that qualifies as a rural health clinic under title 

7 XVIII of the Social Security Act, a public or non8 profit entity existing exclusively to provide services 

9 to migrant and seasonal farm workers in rural 

10 areas, or a Tribal government whose grant-funded 

11 activities will be conducted within federally recog12 nized Tribal areas. 

13 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

14 grant under this subsection, an eligible entity shall 

15 prepare and submit to the Director an application at 

16 such time, in such manner, and containing such in17 formation as the Director may require, including— 

18 ‘‘(A) a description of the project that the 

19 eligible entity will carry out using the funds 

20 provided under the grant; 

21 ‘‘(B) an explanation of the reasons why 

22 Federal assistance is required to carry out the 

23 project; 


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1 ‘‘(C) a description of the manner in which 

2 the project funded under the grant will meet 

3 the health care needs of the Delta Region; 

4 ‘‘(D) a description of how the local com5 munity or region to be served will experience in6 creased access to quality health care services as 

7 a result of the activities carried out by the enti8 ty; 

9 ‘‘(E) a description of how health dispari10 ties will be reduced or the health system will be 

11 improved; 

12 ‘‘(F) a plan for sustaining the project after 

13 Federal support for the project has ended; 

14 ‘‘(G) a description of how the project will 

15 be evaluated including process and outcome 

16 measures related to the quality of care provided 

17 or how the health care system improves its per18 formance; 

19 ‘‘(H) a description of how the grantee will 

20 develop an advisory group made up of rep21 resentatives of the communities to be served to 

22 provide guidance to the grantee to best meet 

23 community need; and 

24 ‘‘(I) other such information as the Director 

25 determines to be appropriate. 


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1 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL2 ITY IMPROVEMENT GRANTS.— 

3 ‘‘(1) GRANTS.—The Director may award grants 

4 to provide for the planning and implementation of 

5 small rural health care provider quality improvement 

6 activities. The Director may award the grants for 

7 periods of 1 to 3 years. 

8 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

9 under this subsection, an entity— 

10 ‘‘(A) shall be— 

11 ‘‘(i) a rural public or rural nonprofit 

12 private health care provider or provider of 

13 health care services, such as a rural health 

14 clinic; or 

15 ‘‘(ii) another rural provider or net16 work of small rural providers identified by 

17 the Director as a key source of local care; 

18 and 

19 ‘‘(B) shall not previously have received a 

20 grant under this subsection for the same or a 

21 similar project. 

22 ‘‘(3) PREFERENCE.—In awarding grants under 

23 this subsection, the Director shall give preference to 

24 facilities that qualify as rural health clinics under 

25 title XVIII of the Social Security Act. 


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1 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

2 grant under this subsection, an eligible entity shall 

3 prepare and submit to the Director an application at 

4 such time, in such manner, and containing such in5 formation as the Director may require, including— 

6 ‘‘(A) a description of the project that the 

7 eligible entity will carry out using the funds 

8 provided under the grant; 

9 ‘‘(B) an explanation of the reasons why 

10 Federal assistance is required to carry out the 

11 project; 

12 ‘‘(C) a description of the manner in which 

13 the project funded under the grant will assure 

14 continuous quality improvement in the provision 

15 of services by the entity; 

16 ‘‘(D) a description of how the local com17 munity or region to be served will experience in18 creased access to quality health care services as 

19 a result of the activities carried out by the enti20 ty; 

21 ‘‘(E) a plan for sustaining the project after 

22 Federal support for the project has ended; 

23 ‘‘(F) a description of how the project will 

24 be evaluated including process and outcome 


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1 measures related to the quality of care pro2 vided; and 

3 ‘‘(G) other such information as the Direc4 tor determines to be appropriate. 

5 ‘‘(f) GENERAL REQUIREMENTS.— 

6 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 

7 that receives a grant under this section may not use 

8 funds provided through the grant— 

9 ‘‘(A) to build or acquire real property; or 

10 ‘‘(B) for construction. 

11 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 

12 The Director shall coordinate activities carried out 

13 under grant programs described in this section, to 

14 the extent practicable, with Federal and State agen15 cies and nonprofit organizations that are operating 

16 similar grant programs, to maximize the effect of 

17 public dollars in funding meritorious proposals. 

18 ‘‘(g) REPORT.—Not later than September 30, 2022, 

19 the Secretary shall prepare and submit to the appropriate 

20 committees of Congress a report on the progress and ac21 complishments of the grant programs described in sub22 sections (b), (c), (d), and (e). 

23 ‘‘(h) DEFINITION OF DELTA REGION.—In this sec24 tion, the term ‘Delta Region’ has the meaning given to 


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1 the term ‘region’ in section 382A of the Consolidated 

2 Farm and Rural Development Act (7 U.S.C. 2009aa). 

3 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

5 $40,000,000 for fiscal year 2021, and such sums as may 

6 be necessary for each of fiscal years 2022 through 2025.’’. 

7 SEC. 421. COMMUNITY HEALTH CENTER COLLABORATIVE 

8 ACCESS EXPANSION. 

9 Section 330(r)(4) of the Public Health Service Act 

10 (42 U.S.C. 254b(r)(4)) is amended— 

11 (1) in subparagraph (A), by striking ‘‘primary 

12 health care services’’ each place it appears and in13 serting ‘‘primary health care and other mental, den14 tal, and physical health services’’; and 

15 (2) in subparagraph (B)— 

16 (A) in clause (i), by striking ‘‘and’’ at the 

17 end; 

18 (B) in clause (ii), by striking the period at 

19 the end and inserting ‘‘; and’’; and 

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

21 ‘‘(iii) in the case of a rural health 

22 clinic described in such subparagraph— 

23 ‘‘(I) that such clinic provides, to 

24 the extent possible, enabling services, 

25 such as transportation and language 


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1 assistance (including translation and 

2 interpretation); and 

3 ‘‘(II) that the primary health 

4 care and other services described in 

5 such subparagraph are subject to full 

6 reimbursement according to the pro7 spective payment system for Federally 

8 qualified health center services under 

9 section 1834(o) of the Social Security 

10 Act.’’. 

11 SEC. 422. FACILITATING THE PROVISION OF TELEHEALTH 

12 SERVICES ACROSS STATE LINES. 

13 (a) IN GENERAL.—For purposes of expediting the 

14 provision of telehealth services, for which payment is made 

15 under the Medicare Program, across State lines, the Sec16 retary of Health and Human Services shall, in consulta17 tion with representatives of States, physicians, health care 

18 practitioners, and patient advocates, encourage and facili19 tate the adoption of provisions allowing for multistate 

20 practitioner practice across State lines. 

21 (b) DEFINITIONS.—In subsection (a): 

22 (1) TELEHEALTH SERVICE.—The term ‘‘tele23 health service’’ has the meaning given that term in 

24 subparagraph (F) of section 1834(m)(4) of the So25 cial Security Act (42 U.S.C. 1395m(m)(4)). 


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1 (2) PHYSICIAN, PRACTITIONER.—The terms 

2 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

3 given those terms in subparagraphs (D) and (E), re4 spectively, of such section. 

5 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

6 Program’’ means the program of health insurance 

7 administered by the Secretary of Health and Human 

8 Services under title XVIII of the Social Security Act 

9 (42 U.S.C. 1395 et seq.). 

10 SEC. 423. SCORING OF PREVENTIVE HEALTH SAVINGS. 

11 Section 202 of the Congressional Budget and Im12 poundment Control Act of 1974 (2 U.S.C. 602) is amend13 ed by adding at the end the following: 

14 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 

15 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 

16 Upon a request by the chairman or ranking minority 

17 member of the Committee on the Budget of the Sen18 ate, or by the chairman or ranking minority member 

19 of the Committee on the Budget of the House of 

20 Representatives, the Director shall determine if a 

21 proposed measure would result in reductions in 

22 budget outlays in budgetary outyears through the 

23 use of preventive health and preventive health serv24 ices. 


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1 ‘‘(2) PROJECTIONS.—If the Director determines 

2 that a measure would result in substantial reduc3 tions in budget outlays as described in paragraph 

4 (1), the Director— 

5 ‘‘(A) shall include, in any projection pre6 pared by the Director, a description and esti7 mate of the reductions in budget outlays in the 

8 budgetary outyears and a description of the 

9 basis for such conclusions; and 

10 ‘‘(B) may prepare a budget projection that 

11 includes some or all of the budgetary outyears, 

12 notwithstanding the time periods for projections 

13 described in subsection (e) and sections 308, 

14 402, and 424. 

15 ‘‘(3) DEFINITIONS.—As used in this sub16 section— 

17 ‘‘(A) the term ‘budgetary outyears’ means 

18 the 2 consecutive 10-year periods beginning 

19 with the first fiscal year that is 10 years after 

20 the budget year provided for in the most re21 cently agreed to concurrent resolution on the 

22 budget; and 

23 ‘‘(B) the term ‘preventive health’ means an 

24 action that focuses on the health of the public, 

25 individuals, and defined populations in order to 


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1 protect, promote, and maintain health, wellness, 

2 and functional ability, and prevent disease, dis3 ability, and premature death that is dem4 onstrated by credible and publicly available epi5 demiological projection models, incorporating 

6 clinical trials or observational studies in hu7 mans, to avoid future health care costs.’’. 

8 SEC. 424. SENSE OF CONGRESS ON MAINTENANCE OF EF9 FORT PROVISIONS REGARDING CHILDREN’S 

10 HEALTH. 

11 It is the sense of the Congress that— 

12 (1) the maintenance of effort provisions added 

13 to sections 1902 and 2105(d) of the Social Security 

14 Act (42 U.S.C. 1396a; 42 U.S.C. 1397ee(d)) by sec15 tions 2001(b) and 2101(b) of the Patient Protection 

16 and Affordable Care Act were intended to maintain 

17 the eligibility standards for the Medicaid program 

18 under title XIX of the Social Security Act (42 

19 U.S.C. 1396 et seq.) and Children’s Health Insur20 ance Program under title XXI of such Act (42 

21 U.S.C. 1397aa et seq.) until the American Health 

22 Benefit Exchanges in the States are fully oper23 ational; 

24 (2) it is imperative that the maintenance of ef25 fort provisions are enforced to the strict standard inVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 tended by the Congress through September 30, 

2 2027; 

3 (3) waiving the maintenance of effort provisions 

4 should not be permitted; 

5 (4) the maintenance of effort provisions ensure 

6 the continued success of the Medicaid program and 

7 Children’s Health Insurance Program and were in8 tended to specifically protect vulnerable and disabled 

9 adults, children, and senior citizens, many of whom 

10 are also members of communities of color; and 

11 (5) the maintenance of effort provisions must 

12 be strictly enforced and proposals to weaken the 

13 maintenance of effort provisions must not be consid14 ered. 

15 SEC. 425. PROTECTION OF THE HHS OFFICES OF MINORITY 

16 HEALTH. 

17 (a) IN GENERAL.—Pursuant to section 1707A of the 

18 Public Health Service Act (42 U.S.C. 300u–6a), the Of19 fices of Minority Health established within the Centers for 

20 Disease Control and Prevention, the Health Resources 

21 and Services Administration, the Substance Abuse and 

22 Mental Health Services Administration, the Agency for 

23 Healthcare Research and Quality, the Food and Drug Ad24 ministration, and the Centers for Medicare & Medicaid 

25 Services, are offices that, regardless of change in the 


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1 structure of the Department of Health and Human Serv2 ices, shall report to the Secretary of Health and Human 

3 Services. 

4 (b) SENSE OF CONGRESS.—It is the sense of the 

5 Congress that any effort to eliminate or consolidate such 

6 Offices of Minority Health undermines the progress 

7 achieved so far. 

8 SEC. 426. OFFICE OF MINORITY HEALTH IN VETERANS 

9 HEALTH ADMINISTRATION OF DEPARTMENT 

10 OF VETERANS AFFAIRS. 

11 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 

12 I of chapter 73 of title 38, United States Code, is amended 

13 by inserting after section 7308 the following new section: 

14 ‘‘§ 7308A. Office of Minority Health 

15 ‘‘(a) ESTABLISHMENT.—There is established in the 

16 Department within the Office of the Under Secretary for 

17 Health an office to be known as the ‘Office of Minority 

18 Health’ (in this section referred to as the ‘Office’). 

19 ‘‘(b) HEAD.—The Director of the Office of Minority 

20 Health shall be the head of the Office. The Director of 

21 the Office of Minority Health shall be appointed by the 

22 Under Secretary for Health from among individuals quali23 fied to perform the duties of the position. 

24 ‘‘(c) FUNCTIONS.—The functions of the Office are as 

25 follows: 


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1 ‘‘(1) To establish short-range and long-range 

2 goals and objectives and coordinate all other activi3 ties within the Veterans Health Administration that 

4 relate to disease prevention, health promotion, health 

5 care services delivery, and health care research con6 cerning veterans who are members of a racial or eth7 nic minority group. 

8 ‘‘(2) To support research, demonstrations, and 

9 evaluations to test new and innovative models for 

10 the discharge of activities described in paragraph 

11 (1). 

12 ‘‘(3) To increase knowledge and understanding 

13 of health risk factors for veterans who are members 

14 of a racial or ethnic minority group. 

15 ‘‘(4) To develop mechanisms that support bet16 ter health care information dissemination, education, 

17 prevention, and services delivery to veterans from 

18 disadvantaged backgrounds, including veterans who 

19 are members of a racial or ethnic minority group. 

20 ‘‘(5) To enter into contracts or agreements with 

21 appropriate public and nonprofit private entities to 

22 develop and carry out programs to provide bilingual 

23 or interpretive services to assist veterans who are 

24 members of a racial or ethnic minority group and 

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1 guage in accessing and receiving health care services 

2 through the Veterans Health Administration. 

3 ‘‘(6) To carry out programs to improve access 

4 to health care services through the Veterans Health 

5 Administration for veterans with limited proficiency 

6 in speaking the English language, including the de7 velopment and evaluation of demonstration and pilot 

8 projects for that purpose. 

9 ‘‘(7) To advise the Under Secretary for Health 

10 on matters relating to the development, implementa11 tion, and evaluation of health professions education 

12 in decreasing disparities in health care outcomes be13 tween veterans who are members of a racial or eth14 nic minority group and other veterans, including cul15 tural competency as a method of eliminating such 

16 health disparities. 

17 ‘‘(8) To perform such other functions and du18 ties as the Secretary or the Under Secretary for 

19 Health considers appropriate. 

20 ‘‘(d) DEFINITIONS.—In this section: 

21 ‘‘(1) The term ‘racial or ethnic minority group’ 

22 means any of the following: 

23 ‘‘(A) American Indians (including Alaska 

24 Natives, Eskimos, and Aleuts). 

25 ‘‘(B) Asian Americans. 


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1 ‘‘(C) Native Hawaiians and other Pacific 

2 Islanders. 

3 ‘‘(D) Blacks. 

4 ‘‘(E) Hispanics. 

5 ‘‘(2) The term ‘Hispanic’ means individuals 

6 whose origin is Mexican, Puerto Rican, Cuban, Cen7 tral or South American, or any other Spanish-speak8 ing country.’’. 

9 (b) CLERICAL AMENDMENT.—The table of sections 

10 at the beginning of such subchapter is amended by insert11 ing after the item relating to section 7308 the following 

12 new item: 

‘‘7308A. Office of Minority Health.’’. 

13 SEC. 427. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 

14 ACCESS FOR LOW-INCOME PATIENTS. 

15 (a) IN GENERAL.—Not later than January 1, 2021, 

16 the Comptroller General of the United States shall con17 duct a study on how amendments made by the Patient 

18 Protection and Affordable Care Act (Public Law 111– 

19 148) and the Health Care and Education Reconciliation 

20 Act of 2010 (Public Law 111–152) to titles XVIII and 

21 XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 

22 42 U.S.C. 1396 et seq.) relating to disproportionate share 

23 hospital adjustment payments under Medicare and Med24 icaid (and subsequent amendments made with respect to 


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1 such payments) affect the timely access to health care 

2 services for low-income patients. Such study shall— 

3 (1) evaluate and examine whether States elect4 ing to make medical assistance available under sec5 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 

6 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 

7 States making such an election through a waiver of 

8 the State plan) to individuals described in such sec9 tion mitigate the need for payments to dispropor10 tionate share hospitals under section 1886(d)(5)(F) 

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

12 1395ww(d)(5)(F)) and section 1923 of such Act (42 

13 U.S.C. 1396r–4), including the impact of such 

14 States electing to make medical assistance available 

15 to such individuals on— 

16 (A) the number of individuals in the 

17 United States who are without health insurance 

18 and the distribution of such individuals in rela19 tion to areas primarily served by dispropor20 tionate share hospitals; and 

21 (B) the low-income utilization rate of such 

22 hospitals and the resulting fiscal sustainability 

23 of such hospitals; 


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1 (2) evaluate the appropriate level and distribu2 tion of such payments among such disproportionate 

3 share hospitals for purposes of— 

4 (A) sufficiently accounting for the level of 

5 uncompensated care provided by such hospitals 

6 to low-income patients; and 

7 (B) providing timely access to health serv8 ices for individuals in medically underserved 

9 areas; and 

10 (3) assess, with respect to such disproportionate 

11 share hospitals— 

12 (A) the role played by such hospitals in 

13 providing critical access to emergency, inpa14 tient, and outpatient health services, as well as 

15 the location of such hospitals in relation to 

16 medically underserved areas; and 

17 (B) the extent to which such hospitals sat18 isfy the requirements established for charitable 

19 hospital organizations under section 501(r) of 

20 the Internal Revenue Code of 1986 with respect 

21 to community health needs assessments, finan22 cial assistance policy requirements, limitations 

23 on charges, and billing and collection require24 ments. 

25 (b) REPORTS.— 


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1 (1) REPORT TO CONGRESS.—Not later than 

2 180 days after the date on which the study under 

3 subsection (a) is completed, the Comptroller General 

4 of the United States shall submit to the Committee 

5 on Energy and Commerce of the House of Rep6 resentatives and the Committee on Finance of the 

7 Senate a report that contains— 

8 (A) the results of the study; 

9 (B) recommendations to Congress for any 

10 legislative changes to the payments to dis11 proportionate share hospitals under section 

12 1886(d)(5)(F) of the Social Security Act (42 

13 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 

14 such Act (42 U.S.C. 1396r–4) that are needed 

15 to ensure access to health services for low-in16 come patients that— 

17 (i) are based on the number of indi18 viduals without health insurance, the 

19 amount of uncompensated care provided by 

20 such hospitals, and the impact of reduced 

21 payment levels on low-income communities; 

22 and 

23 (ii) takes into account any reports 

24 submitted by the Secretary of the Treas25 ury, in consultation with the Secretary of 


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1 Health and Human Services, to congres2 sional committees regarding the costs in3 curred by charitable hospital organizations 

4 for charity care, bad debt, nonreimbursed 

5 expenses for services provided to individ6 uals under the Medicare program under 

7 title XVIII of the Social Security Act and 

8 the Medicaid program under title XIX of 

9 such Act, and any community benefit ac10 tivities provided by such organizations. 

11 (2) REPORT TO THE SECRETARY OF HEALTH

12 AND HUMAN SERVICES.—Not later than 180 days 

13 after the date on which the study under subsection 

14 (a) is completed, the Comptroller General of the 

15 United States shall submit to the Secretary of 

16 Health and Human Services a report that con17 tains— 

18 (A) the results of the study; and 

19 (B) any recommendations for purposes of 

20 assisting in the development of the methodology 

21 for the adjustment of payments to dispropor22 tionate share hospitals, as required under sec23 tion 1886(r) of the Social Security Act (42 

24 U.S.C. 1395ww(r)) and the reduction of such 

25 payments under section 1923(f)(7) of such Act 


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1 (42 U.S.C. 1396r–4(f)(7)), taking into account 

2 the reports referred to in paragraph (1)(B)(ii). 

3 SEC. 428. ASSISTANT SECRETARY OF THE INDIAN HEALTH 

4 SERVICE. 

5 (a) REFERENCES.—Any reference in a law, regula6 tion, document, paper, or other record of the United 

7 States to the Director of the Indian Health Service shall 

8 be deemed to be a reference to the Assistant Secretary 

9 of the Indian Health Service. 

10 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 

11 United States Code, is amended in the matter relating to 

12 the Assistant Secretaries of Health and Human Services 

13 by striking ‘‘(6)’’ and inserting ‘‘(7), one of whom shall 

14 be the Assistant Secretary of the Indian Health Service’’. 

15 (c) CONFORMING AMENDMENT.—Section 5316 of 

16 title 5, United States Code, is amended by striking ‘‘Direc17 tor, Indian Health Service, Department of Health and 

18 Human Services.’’. 

19 SEC. 429. REAUTHORIZATION OF THE NATIVE HAWAIIAN 

20 HEALTH CARE IMPROVEMENT ACT. 

21 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 

22 Section 6(h)(1) of the Native Hawaiian Health Care Im23 provement Act (42 U.S.C. 11705(h)(1)) is amended by 

24 striking ‘‘may be necessary for fiscal years 1993 through 

25 2019’’ and inserting ‘‘are necessary’’. 


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1 (b) ADMINISTRATIVE GRANT FOR PAPA OLA

2 LOKAHI.—Section 7(b) of the Native Hawaiian Health 

3 Care Improvement Act (42 U.S.C. 11706(b)) is amended 

4 by striking ‘‘may be necessary for fiscal years 1993 

5 through 2019’’ and inserting ‘‘are necessary’’. 

6 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 

7 Section 10(c) of the Native Hawaiian Health Care Im8 provement Act (42 U.S.C. 11709(c)) is amended by strik9 ing ‘‘may be necessary for fiscal years 1993 through 

10 2019’’ and inserting ‘‘are necessary’’. 

11 SEC. 430. AVAILABILITY OF NON-ENGLISH LANGUAGE 

12 SPEAKING PROVIDERS. 

13 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa14 tient Protection and Affordable Care Act (42 U.S.C. 

15 18031(c)(1)(B)) is amended by inserting before the semi16 colon the following: ‘‘and the ability of such provider to 

17 provide care in a language other than English either 

18 through the provider speaking such language or by the 

19 provider having a qualified interpreter for an individual 

20 with limited English proficiency (as defined in section 

21 3400 of such Act) who speaks such language available 

22 during office hours’’. 

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

24 subsection (a) shall not apply to any plan beginning on 


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1 or prior to the date that is 1 year after the date of the 

2 enactment of this Act. 

3 SEC. 431. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 

4 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 

5 1311(c)(1)(C) of the Patient Protection and Affordable 

6 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 

7 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 

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

9 clauses: 

10 ‘‘(ii) not later than January 1, 2021, in11 crease the percentage of essential community 

12 providers as described in clause (i) included in 

13 its network by 10 percent annually (based on 

14 the level in the plan for 2016) until 90 percent 

15 of all federally qualified health centers and 75 

16 percent of all other such essential community 

17 providers in the contract service area are in-net18 work; and 

19 ‘‘(iii) include at least one essential commu20 nity provider in each of the essential community 

21 provider categories described in section 

22 156.235(a)(2)(ii)(B) of title 45, Code of Fed23 eral Regulations (as in effect on the date of en24 actment of the Health Equity and AccountVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ability Act of 2020), in each county in the serv2 ice area, where available;’’. 

3 (b) REPORTING REQUIREMENTS.—Section 

4 1311(e)(3) of the Patient Protection and Affordable Care 

5 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 

6 end the following new subparagraph: 

7 ‘‘(E) DATA ON ESSENTIAL COMMUNITY

8 PROVIDERS.—The Secretary shall require quali9 fied health plans to submit annually to the Sec10 retary data on the percentage of essential com11 munity providers as described in clause (ii) of 

12 subsection (c)(1)(C), by county, that contract 

13 with each qualified health plan offered in that 

14 county and the percentage of such essential 

15 community providers, by category as described 

16 in clause (iii) of such subsection, that contract 

17 with each qualified health plan offered in that 

18 county. Such data shall be made available to 

19 the general public.’’. 

20 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS

21 APPLIED UNDER MEDICARE AND MEDICAID.— 

22 (1) MEDICARE.—Section 1852(d)(1) of the So23 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 

24 amended— 


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1 (A) by striking ‘‘and’’ at the end of sub2 paragraph (D); 

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

4 subparagraph (E) and inserting ‘‘; and’’; and 

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

6 subparagraph: 

7 ‘‘(F) the plan meets the requirements of 

8 clauses (ii) and (iii) of section 1311(c)(1)(C) of 

9 the Patient Protection and Affordable Care Act 

10 (relating to inclusion in networks of essential 

11 community providers).’’. 

12 (2) MEDICAID.—Section 1932(b)(5) of the So13 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 

14 amended— 

15 (A) by striking ‘‘and’’ at the end of sub16 paragraph (A); 

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

18 subparagraph (B) and inserting ‘‘; and’’; and 

19 (C) by adding at the end the following new 

20 subparagraph: 

21 ‘‘(C) meets the requirements of clauses (ii) 

22 and (iii) of section 1311(c)(1)(C) of the Patient 

23 Protection and Affordable Care Act (relating to 

24 inclusion in networks of essential community 


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1 providers) with respect to services offered in the 

2 service area involved.’’. 

3 SEC. 432. PROVIDER NETWORK ADEQUACY IN COMMU4 NITIES OF COLOR. 

5 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa6 tient Protection and Affordable Care Act (42 U.S.C. 

7 18031(c)(1)(B)), as amended by section 430(a), is further 

8 amended— 

9 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 

10 (2) by adding at the end the following new 

11 clauses: 

12 ‘‘(ii) meet such network adequacy 

13 standards as the Secretary may establish 

14 with regard to— 

15 ‘‘(I) appointment wait time; 

16 ‘‘(II) travel time and distance to 

17 health care provider facilities and pro18 viders by public and private transit; 

19 ‘‘(III) hours of operation to ac20 commodate individuals who cannot 

21 come to provider appointments during 

22 standard business hours; and 

23 ‘‘(IV) other network adequacy 

24 standards to ensure that care through 

25 these plans is accessible to diverse 


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1 communities, including individuals 

2 with limited English proficiency as de3 fined in section 3400 of such Act; and 

4 ‘‘(iii) provide coverage for services for 

5 enrollees through out-of-network providers 

6 at no additional cost to the enrollees in 

7 cases where in-network providers are un8 able to comply with the standards estab9 lished under subclause (III) or (IV) of 

10 clause (ii) for such services and the out-of11 network providers can deliver such services 

12 in compliance with such standards. 

13 ‘‘(b) EFFECTIVE DATE.—The amendments made by 

14 subsection (a) shall not apply to plans beginning on or 

15 prior to the date that is 1 year after the date of the enact16 ment of the Health Equity and Accountability Act of 

17 2020.’’. 

18 SEC. 433. IMPROVING ACCESS TO DENTAL CARE. 

19 (a) REPORTS TO CONGRESS.— 

20 (1) GAO REPORTS.—Not later than 1 year 

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

22 Comptroller General of the United States shall sub23 mit to Congress— 

24 (A) a report on the Alaska Dental Health 

25 Aide Therapists program and the Dental TherVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 apist and Advanced Dental Therapist programs 

2 in Minnesota, to assess the effectiveness of den3 tal therapists in— 

4 (i) improving access to timely dental 

5 care among communities of color; 

6 (ii) providing high-quality care; 

7 (iii) providing culturally competent 

8 care; and 

9 (iv) providing accessible care to people 

10 with disabilities; 

11 (B) a report on State variations in the use 

12 of dental hygienists and the effectiveness of ex13 panding the scope of practice for dental hygien14 ists in— 

15 (i) improving access to timely dental 

16 care among communities of color; 

17 (ii) providing high-quality care; 

18 (iii) providing culturally competent 

19 care; and 

20 (iv) providing accessible care to people 

21 with disabilities; and 

22 (C) a report on the use of telehealth serv23 ices to enhance services provided by dental hy24 gienists and therapists, including recommenda25 tions for any modifications to the Medicare proVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 gram under title XVIII of the Social Security 

2 Act and the Medicaid program under title XIX 

3 of such Act to better provide for telehealth con4 sultations in conjunction with therapists’ and 

5 hygienists’ care. 

6 (2) HRSA REPORT ON DENTAL SHORTAGE

7 AREAS.—Not later than 1 year after the date of the 

8 enactment of this Act, the Secretary of Health and 

9 Human Services, acting through the Administrator 

10 of the Health Resources and Services Administra11 tion, shall submit to Congress a report which details 

12 geographic dental access shortages and the pre13 paredness of dental providers to offer culturally and 

14 linguistically appropriate, affordable, accessible, and 

15 timely services. 

16 (b) EXPANSION OF DENTAL HEALTH AID THERA17 PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 

18 Indian Health Care Improvement Act (25 U.S.C. 

19 1616l(d)) is amended— 

20 (1) in paragraph (2), by striking ‘‘Subject to’’ 

21 and all that follows and inserting ‘‘Subject to para22 graph (3), in establishing a national program under 

23 paragraph (1), the Secretary shall not reduce the 

24 amounts provided for the Community Health Aide 

25 Program described in subsections (a) and (b).’’; 


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1 (2) by striking paragraph (3); and 

2 (3) by redesignating paragraph (4) as para3 graph (3). 

4 (c) COVERAGE OF DENTAL SERVICES UNDER THE

5 MEDICARE PROGRAM.— 

6 (1) COVERAGE.—Section 1861(s)(2) of the So7 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend8 ed— 

9 (A) in subparagraph (GG), by striking 

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (HH), by striking the 

12 period and inserting ‘‘; and’’; and 

13 (C) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(II) oral health services (as defined in sub16 section (mmm));’’. 

17 (2) ORAL HEALTH SERVICES DEFINED.—Sec18 tion 1861 of the Social Security Act (42 U.S.C. 

19 1395x), as amended by sections 207(b)(1) and 

20 417(a), is amended by adding at the end the fol21 lowing new subsection: 

22 ‘‘Oral Health Services 

23 ‘‘(mmm)(1) The term ‘oral health services’ means 

24 services (as defined by the Secretary) that are necessary 

25 to prevent disease and promote oral health, restore oral 


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1 structures to health and function, and treat emergency 

2 conditions. 

3 ‘‘(2) For purposes of paragraph (1), such term shall 

4 include mobile and portable oral health services (as de5 fined by the Secretary) that— 

6 ‘‘(A) are provided for the purpose of over7 coming mobility, transportation, and access barriers 

8 for individuals; and 

9 ‘‘(B) satisfy the standards and certification re10 quirements established under section 1902(a)(82)(B) 

11 for the State in which the services are provided.’’. 

12 (3) PAYMENT AND COINSURANCE.—Section 

13 1833(a)(1) of the Social Security Act (42 U.S.C. 

14 1395l(a)(1)) is amended— 

15 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 

16 (B) by inserting before the semicolon at 

17 the end the following: ‘‘, and (EE) with respect 

18 to oral health services (as defined in section 

19 1861(mmm)), the amount paid shall be (i) in 

20 the case of such services that are preventive, 

21 100 percent of the lesser of the actual charge 

22 for the services or the amount determined 

23 under the payment basis determined under sec24 tion 1848, and (ii) in the case of all other such 

25 services, 80 percent of the lesser of the actual 


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1 charge for the services or the amount deter2 mined under the payment basis determined 

3 under section 1848’’. 

4 (4) PAYMENT UNDER PHYSICIAN FEE SCHED5 ULE.—Section 1848(j)(3) of the Social Security Act 

6 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

7 ‘‘(2)(II),’’ after ‘‘risk assessment),’’. 

8 (5) DENTURES.—Section 1861(s)(8) of the So9 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend10 ed— 

11 (A) by striking ‘‘(other than dental)’’ and 

12 inserting ‘‘(including dentures)’’; and 

13 (B) by striking ‘‘internal body’’. 

14 (6) REPEAL OF GROUND FOR EXCLUSION.— 

15 Section 1862(a) of the Social Security Act (42 

16 U.S.C. 1395y) is amended by striking paragraph 

17 (12). 

18 (7) EFFECTIVE DATE.—The amendments made 

19 by this section shall apply to services furnished on 

20 or after January 1, 2021. 

21 (d) COVERAGE OF DENTAL SERVICES UNDER THE

22 MEDICAID PROGRAM.— 

23 (1) IN GENERAL.—Section 1905 of the Social 

24 Security Act (42 U.S.C. 1396d) is amended— 


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1 (A) in subsection (a)(10), by striking ‘‘den2 tal services’’ and inserting ‘‘oral health services 

3 (as defined in subsection (gg)(1))’’; and 

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

5 subsection: 

6 ‘‘(gg)(1) Subject to paragraphs (2) and (3), for pur7 poses of this title, the term ‘oral health services’ means 

8 services (as defined by the Secretary) that are necessary 

9 to prevent disease and promote oral health, restore oral 

10 structures to health and function, and treat emergency 

11 conditions. 

12 ‘‘(2) For purposes of paragraph (1), such term shall 

13 include— 

14 ‘‘(A) dentures; and 

15 ‘‘(B) mobile and portable oral health services 

16 (as defined by the Secretary) that— 

17 ‘‘(i) are provided for the purpose of over18 coming mobility, transportation, and access bar19 riers for individuals; and 

20 ‘‘(ii) satisfy the standards and certification 

21 requirements established under section 

22 1902(a)(87)(C) for the State in which the serv23 ices are provided. 


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1 ‘‘(3) For purposes of paragraph (1), such term shall 

2 not include dental care or services provided to individuals 

3 under the age of 21 under subsection (r)(3).’’. 

4 (2) CONFORMING AMENDMENTS.— 

5 (A) STATE PLAN REQUIREMENTS.—Section 

6 1902(a) of the Social Security Act (42 U.S.C. 

7 1396a(a)) is amended— 

8 (i) in paragraph (10)(A), in the mat9 ter preceding clause (i), by inserting 

10 ‘‘(10),’’ after ‘‘(5),’’; 

11 (ii) in paragraph (85), by striking 

12 ‘‘and’’ at the end; 

13 (iii) in paragraph (86), by striking the 

14 period at the end and inserting ‘‘; and’’; 

15 and 

16 (iv) by inserting after paragraph (86) 

17 the following: 

18 ‘‘(87) provide for— 

19 ‘‘(A) informing, in writing, all individuals 

20 who have been determined to be eligible for 

21 medical assistance of the availability of oral 

22 health services (as defined in section 1905(gg)); 

23 ‘‘(B) conducting targeted outreach to preg24 nant women who have been determined to be el25 igible for medical assistance about the availVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ability of medical assistance for such dental 

2 services and the importance of receiving dental 

3 care while pregnant; and 

4 ‘‘(C) establishing and maintaining stand5 ards for and certification of mobile and portable 

6 oral health services (as described in subsections 

7 (r)(3)(C) and (gg)(2)(B) of section 1905).’’. 

8 (B) DEFINITION OF MEDICAL ASSIST9 ANCE.—Section 1905(a)(12) of the Social Secu10 rity Act (42 U.S.C. 1396d(a)(12)) is amended 

11 by striking ‘‘, dentures,’’. 

12 (3) MOBILE AND PORTABLE ORAL HEALTH

13 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 

14 Social Security Act (42 U.S.C. 1396d(r)(3)) is 

15 amended— 

16 (A) in subparagraph (A)(ii), by striking ‘‘; 

17 and’’ and inserting a semicolon; 

18 (B) in subparagraph (B), by striking the 

19 period at the end and inserting ‘‘; and’’; and 

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(C) which shall include mobile and port23 able oral health services (as defined by the Sec24 retary) that— 


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1 ‘‘(i) are provided for the purpose of 

2 overcoming mobility, transportation, or ac3 cess barriers for children; and 

4 ‘‘(ii) satisfy the standards and certifi5 cation requirements established under sec6 tion 1902(a)(87)(C) for the State in which 

7 the services are provided.’’. 

8 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL

9 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro10 tection and Affordable Care Act (42 U.S.C. 18022(b)) is 

11 amended— 

12 (1) in paragraph (1)— 

13 (A) in subparagraph (J), by striking ‘‘oral 

14 and’’; and 

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

16 ‘‘(K) Oral health services for children and 

17 adults.’’; and 

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

19 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 

20 of paragraph (1)(K), the term ‘oral health services’ 

21 means services (as defined by the Secretary) that 

22 are necessary to prevent any oral disease and pro23 mote oral health, restore oral structures to health 

24 and function, and treat emergency oral conditions.’’. 


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1 (f) DEMONSTRATION PROGRAM ON TRAINING AND

2 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

3 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

4 VETERANS IN RURAL AND OTHER UNDERSERVED COM5 MUNITIES.— 

6 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

7 The Secretary of Veterans Affairs may carry out a 

8 demonstration program to establish programs to 

9 train and employ alternative dental health care pro10 viders in order to increase access to dental health 

11 care services for veterans who are entitled to such 

12 services from the Department of Veterans Affairs 

13 and reside in rural and other underserved commu14 nities. 

15 (2) TELEHEALTH.—For purposes of alternative 

16 dental health care providers and other dental care 

17 providers who are licensed to provide clinical care, 

18 dental services provided under the demonstration 

19 program under this subsection may be administered 

20 by such providers through telehealth-enabled collabo21 ration and supervision when appropriate and fea22 sible. 

23 (3) ALTERNATIVE DENTAL HEALTH CARE PRO24 VIDERS DEFINED.—In this subsection, the term ‘‘al25 ternative dental health care providers’’ has the 


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1 meaning given that term in section 340G–1(a)(2) of 

2 the Public Health Service Act (42 U.S.C. 256g– 

3 1(a)(2)). 

4 (4) AUTHORIZATION OF APPROPRIATIONS.— 

5 There are authorized to be appropriated such sums 

6 as are necessary to carry out the demonstration pro7 gram under this subsection. 

8 (g) DEMONSTRATION PROGRAM ON TRAINING AND

9 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

10 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

11 MEMBERS OF THE ARMED FORCES AND DEPENDENTS

12 LACKING READY ACCESS TO SUCH SERVICES.— 

13 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

14 The Secretary of Defense may carry out a dem15 onstration program to establish programs to train 

16 and employ alternative dental health care providers 

17 in order to increase access to dental health care 

18 services for members of the Armed Forces and their 

19 dependents who lack ready access to such services, 

20 including the following: 

21 (A) Members and dependents who reside in 

22 rural areas or areas otherwise underserved by 

23 dental health care providers. 


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1 (B) Members of a reserve component of 

2 the Armed Forces in active status who are po3 tentially deployable. 

4 (2) TELEHEALTH.—For purposes of alternative 

5 dental health care providers and other dental care 

6 providers who are licensed to provide clinical care, 

7 dental services provided under the demonstration 

8 program under this subsection may be administered 

9 by such providers through telehealth-enabled collabo10 ration and supervision when appropriate and fea11 sible. 

12 (3) DEFINITIONS.—In this subsection: 

13 (A) ACTIVE STATUS.—The term ‘‘active 

14 status’’ has the meaning given that term in sec15 tion 101(d) of title 10, United States Code. 

16 (B) ALTERNATIVE DENTAL HEALTH CARE

17 PROVIDERS.—The term ‘‘alternative dental 

18 health care providers’’ has the meaning given 

19 that term in section 340G–1(a)(2) of the Public 

20 Health Service Act (42 U.S.C. 256g–1(a)(2)). 

21 (4) AUTHORIZATION OF APPROPRIATIONS.— 

22 There are authorized to be appropriated such sums 

23 as are necessary to carry out the demonstration pro24 gram under this subsection. 


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1 (h) DEMONSTRATION PROGRAM ON TRAINING AND

2 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

3 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

4 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF

5 PRISONS.— 

6 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

7 The Attorney General, acting through the Director 

8 of the Bureau of Prisons, may carry out a dem9 onstration program to establish programs to train 

10 and employ alternative dental health care providers 

11 in order to increase access to dental health services 

12 for prisoners within the custody of the Bureau of 

13 Prisons. 

14 (2) TELEHEALTH.—For purposes of alternative 

15 dental health care providers and other dental care 

16 providers who are licensed to provide clinical care, 

17 dental services provided under the demonstration 

18 program under this subsection may be administered 

19 by such providers through telehealth-enabled collabo20 ration and supervision when appropriate and fea21 sible. 

22 (3) ALTERNATIVE DENTAL HEALTH CARE PRO23 VIDERS DEFINED.—In this subsection and sub24 section (i), the term ‘‘alternative dental health care 

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1 tion 340G–1(a)(2) of the Public Health Service Act 

2 (42 U.S.C. 256g–1(a)(2)). 

3 (4) AUTHORIZATION OF APPROPRIATIONS.— 

4 There are authorized to be appropriated such sums 

5 as are necessary to carry out the demonstration pro6 gram under this subsection. 

7 (i) DEMONSTRATION PROGRAM ON TRAINING AND

8 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

9 PROVIDERS FOR DENTAL HEALTH CARE SERVICES

10 UNDER THE INDIAN HEALTH SERVICE.— 

11 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

12 The Secretary of Health and Human Services, act13 ing through the Indian Health Service, may carry 

14 out a demonstration program to establish programs 

15 to train and employ alternative dental health care 

16 providers in order to help eliminate oral health dis17 parities and increase access to dental services 

18 through health programs operated by the Indian 

19 Health Service, Indian tribes, tribal organizations, 

20 and urban Indian organizations (as the preceding 3 

21 terms are defined in section 4 of the Indian Health 

22 Care Improvement Act (25 U.S.C. 1603)). 

23 (2) TELEHEALTH.—For purposes of alternative 

24 dental health care providers and other dental care 

25 providers who are licensed to provide clinical care, 


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1 dental services provided under the demonstration 

2 program under this subsection may be administered 

3 by such providers through telehealth-enabled collabo4 ration and supervision when appropriate and fea5 sible. 

6 (3) AUTHORIZATION OF APPROPRIATIONS.— 

7 There are authorized to be appropriated such sums 

8 as are necessary to carry out the demonstration pro9 gram under this subsection. 

10 SEC. 434. PROVIDING FOR A SPECIAL ENROLLMENT PE11 RIOD FOR PREGNANT INDIVIDUALS. 

12 (a) PUBLIC HEALTH SERVICE ACT.—Section 

13 2702(b)(2) of the Public Health Service Act (42 U.S.C. 

14 300gg–1(b)(2)) is amended by inserting ‘‘including a spe15 cial enrollment period for pregnant individuals, beginning 

16 on the date on which the pregnancy is reported to the 

17 health insurance issuer’’ before the period at the end. 

18 (b) PATIENT PROTECTION AND AFFORDABLE CARE

19 ACT.—Section 1311(c)(6) of the Patient Protection and 

20 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend21 ed— 

22 (1) in subparagraph (C), by striking ‘‘and’’ at 

23 the end; 

24 (2) by redesignating subparagraph (D) as sub25 paragraph (E); and 


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1 (3) by inserting after subparagraph (C) the fol2 lowing new subparagraph: 

3 ‘‘(D) a special enrollment period for preg4 nant individuals, beginning on the date on 

5 which the pregnancy is reported to the Ex6 change; and’’. 

7 (c) SPECIAL ENROLLMENT PERIODS.— 

8 (1) INTERNAL REVENUE CODE.—Section 

9 9801(f) of the Internal Revenue Code of 1986 (26 

10 U.S.C. 9801(f)) is amended by adding at the end 

11 the following new paragraph: 

12 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

13 ‘‘(A) A group health plan shall permit an 

14 employee who is eligible, but not enrolled, for 

15 coverage under the terms of the plan (or a de16 pendent of such an employee if the dependent 

17 is eligible, but not enrolled, for coverage under 

18 such terms) to enroll for coverage under the 

19 terms of the plan upon pregnancy, with the spe20 cial enrollment period beginning on the date on 

21 which the pregnancy is reported to the group 

22 health plan or the pregnancy is confirmed by a 

23 health care provider. 

24 ‘‘(B) The Secretary shall promulgate regu25 lations with respect to the special enrollment 


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1 period under subparagraph (A), including es2 tablishing a time period for pregnant individ3 uals to enroll in coverage and effective date of 

4 such coverage.’’. 

5 (2) ERISA.—Section 701(f) of the Employee 

6 Retirement Income Security Act of 1974 (29 U.S.C. 

7 1181(f)) is amended by adding at the end the fol8 lowing: 

9 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

10 ‘‘(A) A group health plan, and a health in11 surance issuer offering group health insurance 

12 coverage in connection with a group health 

13 plan, shall permit an employee who is eligible, 

14 but not enrolled, for coverage under the terms 

15 of the plan (or a dependent of such an employee 

16 if the dependent is eligible, but not enrolled, for 

17 coverage under such terms) to enroll for cov18 erage under the terms of the plan upon preg19 nancy, with the special enrollment period begin20 ning on the date on which the pregnancy is re21 ported to the group health plan or health insur22 ance issuer or the pregnancy is confirmed by a 

23 health care provider. 

24 ‘‘(B) The Secretary shall promulgate regu25 lations with respect to the special enrollment 


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1 period under subparagraph (A), including es2 tablishing a time period for pregnant individ3 uals to enroll in coverage and effective date of 

4 such coverage.’’. 

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

6 this section shall apply with respect to plan years begin7 ning on or after January 1, 2022. 

8 SEC. 435. COVERAGE OF MATERNITY CARE FOR DEPEND9 ENT CHILDREN. 

10 Section 2719A of the Public Health Service Act (42 

11 U.S.C. 300gg–19a) is amended by adding at the end the 

12 following: 

13 ‘‘(e) COVERAGE OF MATERNITY CARE.—A group 

14 health plan, or health insurance issuer offering group or 

15 individual health insurance coverage, that provides cov16 erage for dependants shall ensure that such plan or cov17 erage includes coverage for maternity care associated with 

18 pregnancy, childbirth, and postpartum care for all partici19 pants, beneficiaries, or enrollees, including dependants, in20 cluding coverage of labor and delivery. Such coverage shall 

21 be provided to all pregnant dependents regardless of age.’’. 

22 SEC. 436. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

23 (a) COVERAGE OF PREGNANCY.— 

24 (1) IN GENERAL.—The Director of the Office of 

25 Personnel Management shall issue such regulations 


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1 as are necessary to ensure that pregnancy is consid2 ered a change in family status and a qualifying life 

3 event for an individual who is eligible to enroll, but 

4 is not enrolled, in a health benefit plan under chap5 ter 89 of title 5, United States Code. 

6 (2) EFFECTIVE DATE.—The requirement in 

7 paragraph (1) shall apply with respect to any con8 tract entered into under section 8902 of such title 

9 beginning 12 months after the date of enactment of 

10 this Act. 

11 (b) DESIGNATING CERTAIN FEHBP-RELATED

12 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI13 DEFICIENCY ACT.— 

14 (1) IN GENERAL.—Section 8905 of title 5, 

15 United States Code, is amended by adding at the 

16 end the following: 

17 ‘‘(i) Any services by an officer or em18 ployee under this chapter relating to en19 rolling individuals in a health benefits plan 

20 under this chapter, or changing the enroll21 ment of an individual already so enrolled 

22 due to an event described in section 

23 436(a)(1) of the Health Equity and Ac24 countability Act of 2020, shall be deemed, 

25 for purposes of section 1342 of title 31, 


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1 services for emergencies involving the safe2 ty of human life or the protection of prop3 erty.’’. 

4 (2) APPLICATION.—The amendment made by 

5 paragraph (1) shall apply to any lapse in appropria6 tions beginning on or after the date of enactment of 

7 this Act. 

8 SEC. 437. CONTINUATION OF MEDICAID INCOME ELIGI9 BILITY STANDARD FOR PREGNANT INDIVID10 UALS AND INFANTS. 

11 Section 1902(l)(2)(A) of the Social Security Act (42 

12 U.S.C. 1396a(l)(2)(A)) is amended— 

13 (1) in clause (i), by striking ‘‘and not more 

14 than 185 percent’’; 

15 (2) in clause (ii)— 

16 (A) in subclause (I), by striking ‘‘and’’ 

17 after the comma; 

18 (B) in subclause (II), by striking the pe19 riod at the end and inserting ‘‘, and’’; and 

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

21 ‘‘(III) January 1, 2021, is the 

22 percentage provided under clause 

23 (v).’’; and 

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

25 clause: 


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1 ‘‘(v) The percentage provided under 

2 clause (ii) for medical assistance provided 

3 on or after January 1, 2021, with respect 

4 to individuals described in subparagraph 

5 (A) or (B) of paragraph (1) shall not be 

6 less than— 

7 ‘‘(I) the percentage specified for 

8 such individuals by the State in an 

9 amendment to its State plan (whether 

10 approved or not) as of January 1, 

11 2014; or 

12 ‘‘(II) if no such percentage is 

13 specified as of January 1, 2014, the 

14 percentage established for such indi15 viduals under the State’s authorizing 

16 legislation or provided for under the 

17 State’s appropriations as of that 

18 date.’’. 

19 Subtitle C—Advancing Health Eq20 uity Through Payment and De21 livery Reform 

22 SEC. 441. SENSE OF CONGRESS. 

23 It is the sense of Congress that— 

24 (1) the sustainability of the health care system 

25 in the United States hinges on restructuring how 


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1 health care is paid for, shifting away from paying 

2 for the volume of services provided to the value the 

3 services provide; 

4 (2) high value care is care that provides higher 

5 quality care more efficiently, achieving greater 

6 health improvement and better health outcomes at 

7 lower cost (per patient and overall); 

8 (3) a high value health care system must deliver 

9 timely, accessible, well-coordinated, high-quality, cul10 turally centered, and language-appropriate care to 

11 everyone; 

12 (4) eliminating health disparities and achieving 

13 health equity must be central to efforts to achieve a 

14 high value health care system; 

15 (5) eliminating such disparities and achieving 

16 such equity will require tailored interventions and 

17 targeted investments to address inequities in health 

18 and health care to make sure that health care deliv19 ery and payment efforts are responsive to and inclu20 sive of the needs of communities of color and other 

21 communities experiencing disparities; and 

22 (6) new models of value-based payment and 

23 care delivery should consider the holistic needs of 

24 and other factors with respect to the patient popu25 lation, including with respect to behavioral health, 


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1 oral health, history of adverse childhood experiences 

2 and adverse community environments, social deter3 minants of health, social risk factors, unmet social 

4 needs, and the burden of intergenerational racial 

5 and other inequities. 

6 SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES 

7 REPORTING AND VALUE BASED PROGRAMS. 

8 (a) ADVANCING HEALTH EQUITY IN REPORTING AND

9 VALUE BASED PAYMENT PROGRAMS.— 

10 (1) IN GENERAL.—The Administrator of the 

11 Centers for Medicare & Medicaid Services (in this 

12 section referred to as the ‘‘Administrator’’) shall re13 quire that a clinician or other professional partici14 pating in any pay-for-reporting or value based pay15 ment program stratify clinical quality measures by 

16 disparity variables, including race, ethnicity, sex, pri17 mary language, disability status, sexual orientation, 

18 gender identity, and socioeconomic status. A clini19 cian or other professional may use existing demo20 graphic data collection fields in certified electronic 

21 health record technology (as defined in section 

22 1848(o)(4) of the Social Security Act (42 U.S.C. 

23 1395w–4(o)(4))) to carry out such data stratifica24 tion under the preceding sentence. Such stratified 

25 data will assist clinicians and other professionals in 


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1 the identification of disparities obscured in aggre2 gated data and assist with the provision of interven3 tions that target reducing those disparities. 

4 (2) CLINICIAN.—In assessing performance in 

5 any value-based payment program, the Adminis6 trator shall incorporate a clinician or other profes7 sional’s performance in reducing disparities across 

8 race, ethnicity, sex, primary language, disability sta9 tus, sexual orientation, gender identity, and socio10 economic status. Linking performance payments to 

11 the reduction of health care disparities across such 

12 variables will assist in holding clinicians and other 

13 professionals accountable for providing quality care 

14 that can lead to decreased health inequities. 

15 (3) REQUIREMENT OF ADOPTION OF CERT.—All 

16 entities, clinicians, or other professionals partici17 pating in the Quality Payment Program of the Cen18 ters for Medicare & Medicaid Services shall be re19 quired to adopt 2015 certified electronic health 

20 record technology (as so defined) as a condition of 

21 participating in such program. 

22 (b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad23 ministrator, upon yearly review of the Quality Payment 

24 Program, shall add quality improvement activities that im25 plement the Culturally and Linguistically Accessible 


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1 Standards (CLAS) as Improvement Activities under the 

2 Quality Payment Program. 

3 SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY RE4 DUCING DELIVERY AND PAYMENT MODELS. 

5 (a) IN GENERAL.—The Center for Medicare and 

6 Medicaid Innovation established under section 1115A of 

7 the Social Security Act (42 U.S.C. 1315a) (in this section 

8 referred to as the ‘‘CMI’’) shall establish a dedicated fund 

9 to identify, test, evaluate, and scale delivery and payment 

10 models under the applicable titles (as defined in subsection 

11 (a)(4)(B) of such section) that target health disparities 

12 among racial and ethnic minorities, including models that 

13 support high-value non-medical services that address so14 cially determined barriers to health, including English pro15 ficiency status, low health literacy, case management, 

16 transportation, enrollment assistance needs, stable and af17 fordable housing, utility assistance, employment and ca18 reer development, and nutrition and food security which 

19 will help to reduce disparities and impact the overall cost 

20 of care. 

21 (b) AMENDMENT TO SOCIAL SECURITY ACT.—The 

22 second sentence of section 1115A(a)(1) of the Social Secu23 rity Act (42 U.S.C. 1315a(a)(1)) is amended by inserting 

24 ‘‘and improve health equity’’ after ‘‘expenditures’’. 


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1 (c) PILOT PROGRAMS.—The CMI shall prioritize the 

2 testing of models under such section 1115A that include 

3 partnerships with entities, including community based or4 ganizations or other nonprofit entities, to help address so5 cially determined barriers to health and health care. 

6 (d) ALTERNATIVES.—Any model tested by the CMI 

7 under such 1115A shall include measures to assess and 

8 track the impact of the model on health disparities, using 

9 existing measures such as the Healthcare Disparities and 

10 Cultural Competency Measures endorsed by the entity 

11 with a contract under section 1890(a) of the Social Secu12 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 

13 ethnicity, English proficiency, gender identity, sexual ori14 entation, and disability status. 

15 SEC. 444. DIVERSITY IN CENTERS FOR MEDICARE AND 

16 MEDICAID CONSULTATION. 

17 (a) IN GENERAL.—In carrying out the duties under 

18 this section, the CMI shall consult representatives of rel19 evant Federal agencies, and clinical and analytical experts 

20 with expertise in medicine and health care management, 

21 specifically such experts with expertise in— 

22 (1) the health care needs of minority, rural, and 

23 underserved populations; and 


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1 (2) the financial needs of safety net, community 

2 based, rural, and critical access providers, including 

3 federally qualified health centers. 

4 (b) OPEN DOOR FORUMS.—The CMI shall use open 

5 door forums or other mechanisms to seek external feed6 back from interested parties and incorporate that feedback 

7 into the development of models. 

8 SEC. 445. SUPPORTING SAFETY NET AND COMMUNITY9 BASED PROVIDERS TO COMPETE IN VALUE10 BASED PAYMENT SYSTEMS. 

11 (a) IN GENERAL.—Any pay-for-performance or alter12 native payment model that is developed and tested by the 

13 Center for Medicare and Medicaid Innovation established 

14 under section 1115A of the Social Security Act (42 U.S.C. 

15 1315a), or any other agency of the Department of Health 

16 and Human Services with respect to the programs under 

17 titles XVIII, XIX, or XXI of such Act, shall be assessed 

18 for potential impact on safety net, community based, and 

19 critical access providers, including Federally qualified 

20 health centers. 

21 (b) NEW MODELS.—The rollout of any such models 

22 shall include training and additional up front resources for 

23 community based and safety net providers to enable those 

24 providers to participate in the model. 


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1 Subtitle D—Health Empowerment 

2 Zones 

3 SEC. 451. SHORT TITLE. 

4 This subtitle may be cited as the ‘‘Health Empower5 ment Zone Act of 2020’’. 

6 SEC. 452. FINDINGS. 

7 Congress finds the following: 

8 (1) Numerous studies and reports, including 

9 the 2015 National Healthcare Quality and Dispari10 ties Report of the Agency for Healthcare Research 

11 and Quality and the 2002 report of the Institute of 

12 Medicine entitled ‘‘Unequal Treatment: Confronting 

13 Racial and Ethnic Disparities in Health Care’’, doc14 ument the extensiveness to which health disparities 

15 exist across the country. 

16 (2) These studies have found that, on average, 

17 racial and ethnic minorities are disproportionately 

18 afflicted with chronic and acute conditions—such as 

19 cancer, diabetes, musculoskeletal disease, obesity, 

20 and hypertension—and suffer worse health out21 comes, worse health status, and higher mortality 

22 rates than their White counterparts. 

23 (3) Several recent studies also show that health 

24 disparities are a function of not only access to health 

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1 cluding the environment, the physical structure of 

2 communities, nutrition and food options, educational 

3 attainment and health literacy, employment, race, 

4 ethnicity, immigration status, geography, and lan5 guage preference—that directly and indirectly affect 

6 the health, health care, and wellness of individuals 

7 and communities. 

8 (4) Integrally involving and fully supporting the 

9 communities most affected by health inequities in 

10 the assessment, planning, launch, and evaluation of 

11 health disparity elimination efforts are among the 

12 leading recommendations made to adequately ad13 dress and ultimately reduce health disparities. 

14 (5) Recommendations also include supporting 

15 the efforts of community stakeholders from a broad 

16 cross section—including local businesses, local de17 partments of commerce, education, labor, urban 

18 planning, and transportation, and community-based 

19 and other nonprofit organizations, including national 

20 and regional intermediaries with demonstrated ca21 pacity to serve low-income urban communities—to 

22 find areas of common ground around health dis23 parity elimination and collaborate to improve the 

24 overall health and wellness of a community and its 

25 residents. 


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1 SEC. 453. DESIGNATION OF HEALTH EMPOWERMENT 

2 ZONES. 

3 (a) IN GENERAL.—The Secretary may, at the request 

4 of an eligible community partnership described in sub5 section (b)(1), designate an eligible area described in sub6 section (b)(2) as a health empowerment zone for the pur7 pose of eligibility for a grant under section 455. 

8 (b) ELIGIBILITY CRITERIA.— 

9 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 

10 community partnership is eligible to submit a re11 quest under this section if the partnership— 

12 (A) demonstrates widespread public sup13 port from key individuals and entities in the eli14 gible area, including members of the target 

15 community, State and local governments, non16 profit organizations including national and re17 gional intermediaries with demonstrated capac18 ity to serve low-income urban communities, and 

19 community and industry leaders, for designa20 tion of the eligible area as a health empower21 ment zone; and 

22 (B) includes representatives of— 

23 (i) a broad cross section of stake24 holders and residents from communities in 

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1 tionate disparities in health status and 

2 health care; and 

3 (ii) organizations, facilities, and insti4 tutions that have a history of working 

5 within and serving such communities. 

6 (2) ELIGIBLE AREA.—An area is eligible to be 

7 designated as a health empowerment zone under this 

8 section if one or more communities in the area expe9 rience disproportionate disparities in health status 

10 and health care. In determining whether a commu11 nity experiences such disparities, the Secretary shall 

12 consider data collected by the Department of Health 

13 and Human Services focusing on the following areas: 

14 (A) Access to affordable, high-quality 

15 health services. 

16 (B) The prevalence of disproportionate 

17 rates of certain illnesses or diseases including 

18 the following: 

19 (i) Arthritis, osteoporosis, chronic 

20 back conditions, and other musculoskeletal 

21 diseases. 

22 (ii) Cancer. 

23 (iii) Chronic kidney disease. 

24 (iv) Diabetes. 


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1 (v) Injury (intentional and uninten2 tional). 

3 (vi) Violence (intimate and non4 intimate). 

5 (vii) Maternal and paternal illnesses 

6 and diseases. 

7 (viii) Infant mortality. 

8 (ix) Mental illness and other disabil9 ities. 

10 (x) Substance use disorder treatment 

11 and prevention, including underage drink12 ing. 

13 (xi) Nutrition, obesity, and overweight 

14 conditions. 

15 (xii) Heart disease. 

16 (xiii) Hypertension. 

17 (xiv) Cerebrovascular disease or 

18 stroke. 

19 (xv) Tuberculosis. 

20 (xvi) HIV/AIDS and other sexually 

21 transmitted infections. 

22 (xvii) Viral hepatitis. 

23 (xviii) Asthma. 

24 (xix) Tooth decay and other oral 

25 health issues. 


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1 (C) Within the community, the historical 

2 and persistent presence of conditions that have 

3 been found to contribute to health disparities 

4 including any such conditions respecting any of 

5 the following: 

6 (i) Poverty. 

7 (ii) Educational status and the quality 

8 of community schools. 

9 (iii) Income. 

10 (iv) Access to high-quality affordable 

11 health care. 

12 (v) Work and work environment. 

13 (vi) Environmental conditions in the 

14 community, including with respect to clean 

15 water, clean air, and the presence or ab16 sence of pollutants. 

17 (vii) Language and English pro18 ficiency. 

19 (viii) Access to affordable healthy 

20 food. 

21 (ix) Access to ethnically and culturally 

22 diverse health and human service providers 

23 and practitioners. 

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1 ices and health and human service pro2 viders. 

3 (xi) Health-supporting infrastructure. 

4 (xii) Health insurance that is ade5 quate and affordable. 

6 (xiii) Race, racism, and bigotry (con7 scious and unconscious). 

8 (xiv) Sexual orientation. 

9 (xv) Health literacy. 

10 (xvi) Place of residence (such as 

11 urban areas, rural areas, and reservations 

12 of Indian tribes). 

13 (xvii) Stress. 

14 (c) PROCEDURE.— 

15 (1) REQUEST.—A request under subsection (a) 

16 shall— 

17 (A) describe the bounds of the area to be 

18 designated as a health empowerment zone and 

19 the process used to select those bounds; 

20 (B) demonstrate that the partnership sub21 mitting the request is an eligible community 

22 partnership described in subsection (b)(1); 

23 (C) demonstrate that the area is an eligible 

24 area described in subsection (b)(2); 


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1 (D) include a comprehensive assessment of 

2 disparities in health status and health care ex3 perience by one or more communities in the 

4 area; 

5 (E) set forth— 

6 (i) a vision and a set of values for the 

7 area; and 

8 (ii) a comprehensive and holistic set of 

9 goals to be achieved in the area through 

10 designation as a health empowerment zone; 

11 and 

12 (F) include a strategic plan and an action 

13 plan for achieving the goals described in sub14 paragraph (E)(ii). 

15 (2) APPROVAL.—Not later than 60 days after 

16 the receipt of a request for designation of an area 

17 as a health empowerment zone under this section, 

18 the Secretary shall approve or disapprove the re19 quest. 

20 (d) MINIMUM NUMBER.—The Secretary— 

21 (1) shall designate not more than 110 health 

22 empowerment zones under this section; and 

23 (2) of such zones designated under paragraph 

24 (1), shall designate at least one health empowerment 

25 zone in each of the several States, the District of 


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1 Columbia, and each territory or possession of the 

2 United States. 

3 SEC. 454. ASSISTANCE TO THOSE SEEKING DESIGNATION. 

4 At the request of any organization or entity seeking 

5 to submit a request under section 453(a), the Secretary 

6 shall provide technical assistance, and may award a grant, 

7 to assist such organization or entity— 

8 (1) to form an eligible community partnership 

9 described in section 453(b)(1); 

10 (2) to complete a health assessment, including 

11 an assessment of health disparities under section 

12 453(c)(1)(D); or 

13 (3) to prepare and submit a request, including 

14 a strategic plan, in accordance with section 453. 

15 SEC. 455. BENEFITS OF DESIGNATION. 

16 (a) PRIORITY.—In awarding a grant under sub17 section (b), a Federal official shall give priority to any ap18 plicant that— 

19 (1) meets the eligibility criteria for the grant; 

20 (2) proposes to use the grant for activities in a 

21 health empowerment zone; and 

22 (3) demonstrates that such activities will di23 rectly and significantly further the goals of the stra24 tegic plan approved for such zone under section 453. 


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1 (b) GRANTS FOR INITIAL IMPLEMENTATION OF

2 STRATEGIC PLAN.— 

3 (1) IN GENERAL.—Upon designating an eligible 

4 area as a health empowerment zone at the request 

5 of an eligible community partnership, the Secretary 

6 shall, subject to the availability of appropriations, 

7 make a grant to the community partnership for im8 plementation of the strategic plan for such zone. 

9 (2) GRANT PERIOD.—A grant under paragraph 

10 (1) for a health empowerment zone shall be for a pe11 riod of 2 years and may be renewed, except that the 

12 total period of grants under paragraph (1) for such 

13 zone may not exceed 10 years. 

14 (3) LIMITATION.—In awarding grants under 

15 this subsection, the Secretary shall not give less pri16 ority to an applicant or reduce the amount of a 

17 grant because the Secretary rendered technical as18 sistance or made a grant to the same applicant 

19 under section 454. 

20 (4) REPORTING.—The Secretary shall establish 

21 metrics for measuring the progress of grantees 

22 under this subsection and, based on such metrics, 

23 require each such grantee to report to the Secretary 

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1 plementing the strategic plan for the health em2 powerment zone. 

3 SEC. 456. DEFINITION OF SECRETARY. 

4 In this subtitle, the term ‘‘Secretary’’ means the Sec5 retary of Health and Human Services, acting through the 

6 Administrator of the Health Resources and Services Ad7 ministration and the Deputy Assistant Secretary for Mi8 nority Health, and in cooperation with the Director of the 

9 Office of Community Services and the Director of the Na10 tional Institute on Minority Health and Health Dispari11 ties. 

12 SEC. 457. AUTHORIZATION OF APPROPRIATIONS. 

13 To carry out this subtitle, there is authorized to be 

14 appropriated $100,000,000 for fiscal year 2021. 

15 TITLE V—IMPROVING HEALTH 

16 OUTCOMES FOR WOMEN, 

17 CHILDREN, AND FAMILIES 

18 Subtitle A—In General 

19 SEC. 501. GRANTS TO PROMOTE HEALTH FOR UNDER20 SERVED COMMUNITIES. 

21 Part Q of title III of the Public Health Service Act 

22 (42 U.S.C. 280h et seq.) is amended by adding at the end 

23 the following: 


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1 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER2 SERVED COMMUNITIES. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col4 laboration with the Administrator of the Health Resources 

5 and Services Administration and other Federal officials 

6 determined appropriate by the Secretary, is authorized to 

7 award grants to eligible entities— 

8 ‘‘(1) to promote health for underserved commu9 nities, with preference given to projects that benefit 

10 racial and ethnic minority women, racial and ethnic 

11 minority children, adolescents, and lesbian, gay, bi12 sexual, transgender, queer, or questioning commu13 nities; and 

14 ‘‘(2) to strengthen health outreach initiatives in 

15 medically underserved communities, including lin16 guistically isolated populations. 

17 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

18 subsection (a) may be used to support the activities of 

19 community health workers, including such activities— 

20 ‘‘(1) to educate and provide outreach regarding 

21 enrollment in health insurance including the State 

22 Children’s Health Insurance Program under title 

23 XXI of the Social Security Act, Medicare under title 

24 XVIII of such Act, and Medicaid under title XIX of 

25 such Act; 


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1 ‘‘(2) to educate and provide outreach in a com2 munity setting regarding health problems prevalent 

3 among underserved communities, and especially 

4 among racial and ethnic minority women, racial and 

5 ethnic minority children, adolescents, and lesbian, 

6 gay, bisexual, transgender, queer, or questioning 

7 communities; 

8 ‘‘(3) to educate and provide experiential learn9 ing opportunities and target risk factors and healthy 

10 behaviors that impede or contribute to achieving 

11 positive health outcomes, including— 

12 ‘‘(A) healthy nutrition; 

13 ‘‘(B) physical activity; 

14 ‘‘(C) overweight or obesity; 

15 ‘‘(D) tobacco use, including the use of e16 cigarettes and vaping; 

17 ‘‘(E) alcohol and substance use; 

18 ‘‘(F) injury and violence; 

19 ‘‘(G) sexual health; 

20 ‘‘(H) mental health; 

21 ‘‘(I) musculoskeletal health and arthritis; 

22 ‘‘(J) prenatal and postnatal care; 

23 ‘‘(K) dental and oral health; 

24 ‘‘(L) understanding informed consent; 

25 ‘‘(M) stigma; and 


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1 ‘‘(N) environmental hazards; 

2 ‘‘(4) to promote community wellness and aware3 ness; and 

4 ‘‘(5) to educate and refer target populations to 

5 appropriate health care agencies and community6 based programs and organizations in order to in7 crease access to quality health care services, includ8 ing preventive health services. 

9 ‘‘(c) APPLICATION.— 

10 ‘‘(1) IN GENERAL.—Each eligible entity that 

11 desires to receive a grant under subsection (a) shall 

12 submit an application to the Secretary, at such time, 

13 in such manner, and accompanied by such additional 

14 information as the Secretary may require. 

15 ‘‘(2) CONTENTS.—Each application submitted 

16 pursuant to paragraph (1) shall— 

17 ‘‘(A) describe the activities for which as18 sistance under this section is sought; 

19 ‘‘(B) contain an assurance that, with re20 spect to each community health worker pro21 gram receiving funds under the grant awarded, 

22 such program provides in-language training and 

23 supervision to community health workers to en24 able such workers to provide authorized pro25 gram activities in (at least) the most commonly 


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1 used languages within a particular geographic 

2 region; 

3 ‘‘(C) contain an assurance that the appli4 cant will evaluate the effectiveness of commu5 nity health worker programs receiving funds 

6 under the grant; 

7 ‘‘(D) contain an assurance that each com8 munity health worker program receiving funds 

9 under the grant will provide culturally com10 petent services in the linguistic context most 

11 appropriate for the individuals served by the 

12 program; 

13 ‘‘(E) contain a plan to document and dis14 seminate project descriptions 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 


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1 ‘‘(ii) providing other services, as the 

2 Secretary determines to be appropriate, 

3 which may include transportation and 

4 translation 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 that— 

10 ‘‘(A)(i) have a high percentage of residents 

11 who are uninsured or underinsured (if the tar12 geted geographic area is located in a State that 

13 has elected to make medical assistance available 

14 under section 1902(a)(10)(A)(i)(VIII) of the 

15 Social Security Act to individuals described in 

16 such section); 

17 ‘‘(ii) have a high percentage of under18 insured residents in a particular geographic 

19 area (if the targeted geographic area is located 

20 in a State that has not so elected); or 

21 ‘‘(iii) have a high number of households ex22 periencing extreme poverty; and 

23 ‘‘(B) have a high percentage of families for 

24 whom English is not their primary language or 

25 including smaller limited English-proficient 


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1 communities within the region that are not oth2 erwise reached by linguistically appropriate 

3 health services; 

4 ‘‘(2) with experience in providing health or 

5 health-related social services to individuals who are 

6 underserved with respect to such services; and 

7 ‘‘(3) with documented community activity and 

8 experience with community health workers. 

9 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU10 TIONS.—The Secretary shall encourage community health 

11 worker programs receiving funds under this section to col12 laborate with academic institutions, including minority13 serving institutions. Nothing in this section shall be con14 strued to require such collaboration. 

15 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE16 NESS.—The Secretary shall establish guidelines for ensur17 ing the quality of the training and supervision of commu18 nity health workers under the programs funded under this 

19 section and for ensuring the cost effectiveness of such pro20 grams. 

21 ‘‘(g) MONITORING.—The Secretary shall monitor 

22 community health worker programs identified in approved 

23 applications and shall determine whether such programs 

24 are in compliance with the guidelines established under 

25 subsection (f). 


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1 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

2 provide technical assistance to community health worker 

3 programs identified in approved applications with respect 

4 to planning, developing, and operating programs under the 

5 grant. 

6 ‘‘(i) REPORT TO CONGRESS.— 

7 ‘‘(1) IN GENERAL.—Not later than 4 years 

8 after the date on which the Secretary first awards 

9 grants under subsection (a), the Secretary shall sub10 mit to Congress a report regarding the grant 

11 project. 

12 ‘‘(2) CONTENTS.—The report required under 

13 paragraph (1) shall include the following: 

14 ‘‘(A) A description of the programs for 

15 which grant funds were used. 

16 ‘‘(B) The number of individuals served. 

17 ‘‘(C) An evaluation of— 

18 ‘‘(i) the effectiveness of these pro19 grams; 

20 ‘‘(ii) the cost of these programs; and 

21 ‘‘(iii) the impact of these programs on 

22 the health outcomes of the community resi23 dents. 


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1 ‘‘(D) Recommendations for sustaining the 

2 community health worker programs developed 

3 or assisted under this section. 

4 ‘‘(E) Recommendations regarding training 

5 to enhance career opportunities for community 

6 health workers. 

7 ‘‘(j) DEFINITIONS.—In this section: 

8 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

9 ‘community health worker’ means an individual who 

10 promotes health or nutrition within the community 

11 in which the individual resides— 

12 ‘‘(A) by serving as a liaison between com13 munities and health care agencies; 

14 ‘‘(B) by providing guidance and social as15 sistance to community residents; 

16 ‘‘(C) by enhancing community residents’ 

17 ability to effectively communicate with health 

18 care providers; 

19 ‘‘(D) by providing culturally and linguis20 tically appropriate health or nutrition edu21 cation; 

22 ‘‘(E) by advocating for individual and com23 munity health, including dental, oral, mental, 

24 and environmental health, or nutrition needs; 


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1 ‘‘(F) by taking into consideration the 

2 needs of the communities served, including the 

3 prevalence rates of risk factors that impede 

4 achieving positive healthy outcomes among 

5 women and children, especially among racial 

6 and ethnic minority women and children; and 

7 ‘‘(G) by providing referral and followup 

8 services. 

9 ‘‘(2) COMMUNITY SETTING.—The term ‘commu10 nity setting’ means a home or a community organi11 zation that serves a population. 

12 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en13 tity’ means— 

14 ‘‘(A) a unit of State, territorial, local, or 

15 Tribal government (including a federally recog16 nized Tribe or Alaska Native village); or 

17 ‘‘(B) a community-based organization. 

18 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

19 The term ‘medically underserved community’ means 

20 a community— 

21 ‘‘(A) that has a substantial number of in22 dividuals who are members of a medically un23 derserved population, as defined by section 

24 330(b)(3); 


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1 ‘‘(B) a significant portion of which is a 

2 health professional shortage area as designated 

3 under section 332; and 

4 ‘‘(C) that includes populations that are lin5 guistically isolated, such as geographic areas 

6 with a shortage of health professionals able to 

7 provide linguistically appropriate services. 

8 ‘‘(5) SUPPORT.—The term ‘support’ means the 

9 provision of training, supervision, and materials 

10 needed to effectively deliver the services described in 

11 subsection (b), reimbursement for services, and 

12 other benefits. 

13 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

15 $15,000,000 for each of fiscal years 2021 through 2025.’’. 

16 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU17 TRITION ASSISTANCE FOR CHILDREN, PREG18 NANT PERSONS, AND LAWFULLY PRESENT IN19 DIVIDUALS. 

20 (a) MEDICAID.—Section 1903(v) of the Social Secu21 rity Act (42 U.S.C. 1396b(v)) is amended by striking 

22 paragraph (4) and inserting the following new paragraph: 

23 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 

24 403, and 421 of the Personal Responsibility and Work Op25 portunity Reconciliation Act of 1996 and paragraph (1), 


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1 payment shall be made to a State under this section for 

2 medical assistance furnished to an alien under this title 

3 (including an alien described in such paragraph) who 

4 meets any of the following conditions: 

5 ‘‘(i) The alien is otherwise eligible for such as6 sistance under the State plan approved under this 

7 title (other than the requirement of the receipt of 

8 aid or assistance under title IV, supplemental secu9 rity income benefits under title XVI, or a State sup10 plementary payment) within either or both of the 

11 following eligibility categories: 

12 ‘‘(I) Children under 21 years of age, in13 cluding any optional targeted low-income child 

14 (as such term is defined in section 

15 1905(u)(2)(B)). 

16 ‘‘(II) Pregnant persons during pregnancy 

17 and during the 12-month period beginning on 

18 the last day of the pregnancy. 

19 ‘‘(ii) The alien is lawfully present in the United 

20 States. 

21 ‘‘(B) No debt shall accrue under an affidavit of sup22 port against any sponsor of an alien who meets the condi23 tions specified in subparagraph (A) on the basis of the 

24 provision of medical assistance to such alien under this 


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1 paragraph and the cost of such assistance shall not be con2 sidered as an unreimbursed cost.’’. 

3 (b) CHIP.—Subparagraph (N) of section 2107(e)(1) 

4 of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

5 amended to read as follows: 

6 ‘‘(N) Paragraph (4) of section 1903(v) (re7 lating to coverage of categories of children, 

8 pregnant persons, and other lawfully present in9 dividuals).’’. 

10 (c) SUPPLEMENTAL NUTRITION ASSISTANCE FOR

11 LAWFULLY PRESENT INDIVIDUALS.— 

12 (1) IN GENERAL.—Section 402(a)(2)(J) of the 

13 Personal Responsibility and Work Opportunity Rec14 onciliation Act of 1996 (8 U.S.C. 1612(a)(2)(J)) is 

15 amended— 

16 (A) in the subparagraph heading, by strik17 ing ‘‘CERTAIN CHILDREN’’ inserting ‘‘CHILDREN

18 AND LAWFULLY PRESENT INDIVIDUALS’’; and 

19 (B) by striking ‘‘who is under 18 years of 

20 age.’’ and inserting ‘‘who is— 

21 ‘‘(i) under 21 years of age; or 

22 ‘‘(ii) lawfully present in the United 

23 States.’’. 

24 (2) CONFORMING AMENDMENTS.— 


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1 (A) Section 402(a)(3) of such Act (8 

2 U.S.C. 1612(a)(3)) is amended by striking sub3 paragraph (B) and inserting the following: 

4 ‘‘(B) SNAP (FOOD STAMP PROGRAM).— 

5 The supplemental nutrition assistance program 

6 established under the Food and Nutrition Act 

7 of 2008 (7 U.S.C. 2011 et seq.) (referred to in 

8 this title as ‘SNAP’ or the ‘food stamp pro9 gram’).’’. 

10 (B) Section 403(c)(2)(L) of such Act (42 

11 U.S.C. 1613(c)(2)(L)) is amended by striking 

12 ‘‘18’’ and all that follows through the period 

13 and inserting ‘‘21, or to individuals who are 

14 lawfully present in the United States, under the 

15 supplemental nutrition assistance program es16 tablished under the Food and Nutrition Act of 

17 2008 (7 U.S.C. 2011 et seq.).’’. 

18 (C) Section 5(i)(2)(E) of the Food and 

19 Nutrition Act of 2008 (7 U.S.C. 2014(i)(2)(E)) 

20 is amended by striking ‘‘18 years of age.’’ and 

21 inserting ‘‘21 years of age, or who is lawfully 

22 present in the United States.’’. 

23 (d) NONAPPLICATION OF SPONSOR DEEMING; AS24 SURING ELIGIBILITY FOR FAMILIES.—Section 421(d) of 

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1 onciliation Act of 1996 (8 U.S.C. 1631(d)) is amended 

2 by striking paragraph (3) and inserting the following: 

3 ‘‘(3) This section shall not apply to assistance 

4 or benefits under the supplemental nutrition assist5 ance program established under the Food and Nutri6 tion Act of 2008 (7 U.S.C. 2011 et seq.) for a quali7 fied alien who is eligible under section 402(a)(2)(J) 

8 and for any member of the household of such quali9 fied alien.’’. 

10 (e) ENSURING PROPER SCREENING.—Section 

11 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 

12 U.S.C. 2020(e)(2)(B)) is amended— 

13 (1) by redesignating clauses (vi) and (vii) as 

14 clauses (vii) and (viii), respectively; and 

15 (2) by inserting after clause (v) the following: 

16 ‘‘(vi) shall provide a method for imple17 menting section 421 of the Personal Re18 sponsibility and Work Opportunity Rec19 onciliation Act of 1996 (8 U.S.C. 1631) 

20 that does not require any unnecessary in21 formation from applicants who may be ex22 empt from that provision;’’. 


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1 SEC. 503. REPEAL OF DENIAL OF SNAP BENEFITS. 

2 Section 115 of the Personal Responsibility and Work 

3 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 

4 is amended— 

5 (1) in subsection (a), by striking ‘‘for—’’ and 

6 all that follows and inserting ‘‘for assistance under 

7 any State program funded under part A of title IV 

8 of the Social Security Act (42 U.S.C. 601 et seq.).’’; 

9 (2) in subsection (b)— 

10 (A) by striking ‘‘(1) PROGRAM OF TEM11 PORARY ASSISTANCE FOR NEEDY FAMILIES.—’’; 

12 and 

13 (B) by striking paragraph (2); and 

14 (3) in subsection (e), by striking ‘‘it—’’ and all 

15 that follows and inserting ‘‘the term in section 

16 419(5) of the Social Security Act (42 U.S.C. 

17 619(5)) when referring to assistance provided under 

18 a State program funded under paragraph A of title 

19 IV of the Social Security Act (42 U.S.C. 601 et 

20 seq.).’’. 

21 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 

22 AND AWARENESS. 

23 (a) IN GENERAL.—The Secretary shall establish and 

24 implement a birth defects prevention and public awareness 

25 program, consisting of the activities described in sub26 sections (c) and (d). 


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1 (b) DEFINITIONS.—In this section: 

2 (1) MATERNAL.—The term ‘‘maternal’’ refers 

3 to persons who are pregnant or breastfeeding of all 

4 gender identities. 

5 (2) PREGNANCY AND BREASTFEEDING INFOR6 MATION SERVICES.—The term ‘‘pregnancy and 

7 breastfeeding information services’’ includes only— 

8 (A) information services to provide accu9 rate, evidence-based, clinical information re10 garding maternal exposures during pregnancy 

11 that may be associated with birth defects or 

12 other health risks, such as exposures to medica13 tions, chemicals, infections, foodborne patho14 gens, illnesses, nutrition, or lifestyle factors; 

15 (B) information services to provide accu16 rate, evidence-based, clinical information re17 garding maternal exposures during breast18 feeding that may be associated with health risks 

19 to a breast-fed infant, such as exposures to 

20 medications, chemicals, infections, foodborne 

21 pathogens, illnesses, nutrition, lifestyle, or 

22 climate- and weather-related factors; 

23 (C) the provision of accurate, evidence24 based information weighing risks of exposures 


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1 during breastfeeding against the benefits of 

2 breastfeeding; and 

3 (D) the provision of information described 

4 in subparagraph (A), (B), or (C) through coun5 selors, websites, fact sheets, telephonic or elec6 tronic communication, community outreach ef7 forts, or other appropriate means. 

8 (3) SECRETARY.—The term ‘‘Secretary’’ means 

9 the Secretary of Health and Human Services, acting 

10 through the Director of the Centers for Disease 

11 Control and Prevention. 

12 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 

13 subsection (a), the Secretary shall conduct or support a 

14 nationwide media campaign to increase awareness among 

15 health care providers and at-risk populations about preg16 nancy and breastfeeding information services. 

17 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING

18 INFORMATION SERVICES.— 

19 (1) IN GENERAL.—In carrying out subsection 

20 (a), the Secretary shall award grants to State or re21 gional agencies or organizations for any of the fol22 lowing: 

23 (A) INFORMATION SERVICES.—The provi24 sion of, or campaigns to increase awareness 


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1 about, pregnancy and breastfeeding information 

2 services. 

3 (B) SURVEILLANCE AND RESEARCH.—The 

4 conduct or support of— 

5 (i) surveillance of or research on— 

6 (I) maternal exposures and ma7 ternal health conditions that may in8 fluence the risk of birth defects, pre9 maturity, or other adverse pregnancy 

10 outcomes; and 

11 (II) maternal exposures that may 

12 influence health risks to a breastfed 

13 infant; or 

14 (ii) networking to facilitate surveil15 lance or research described in this sub16 paragraph. 

17 (2) PREFERENCE FOR CERTAIN STATES.—The 

18 Secretary, in making any grant under this sub19 section, shall give preference to States, otherwise 

20 equally qualified, that have a pregnancy and 

21 breastfeeding information service in place. 

22 (3) MATCHING FUNDS.—The Secretary may 

23 only award a grant under this subsection to a State 

24 or regional agency or organization that agrees, with 

25 respect to the costs to be incurred in carrying out 


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1 the grant activities, to make available (directly or 

2 through donations from public or private entities) 

3 non-Federal funds toward such costs in an amount 

4 equal to not less than 25 percent of the amount of 

5 the grant. 

6 (4) COORDINATION.—The Secretary shall en7 sure that activities funded through a grant under 

8 this subsection are coordinated, to the maximum ex9 tent practicable, with other birth defects prevention 

10 and environmental health activities of the Federal 

11 Government, including with respect to pediatric envi12 ronmental health specialty units and children’s envi13 ronmental health centers. 

14 (e) EVALUATION.—In furtherance of the program 

15 under subsection (a), the Secretary shall provide for an 

16 evaluation of pregnancy and breastfeeding information 

17 services to identify efficient and effective models of— 

18 (1) providing information; 

19 (2) raising awareness and increasing knowledge 

20 about birth defects prevention measures and tar21 geting education to at-risk groups; 

22 (3) modifying risk behaviors; or 

23 (4) other outcome measures as determined ap24 propriate by the Secretary. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there are authorized to be appropriated 

3 $5,000,000 for fiscal year 2021, $6,000,000 for fiscal year 

4 2022, $7,000,000 for fiscal year 2023, $8,000,000 for fis5 cal year 2024, and $9,000,000 for fiscal year 2025. 

6 SEC. 505. MOMMA’S ACT. 

7 (a) SHORT TITLE.—This section may be cited as the 

8 ‘‘Mothers and Offspring Mortality and Morbidity Aware9 ness Act’’ or the ‘‘MOMMA’s Act’’. 

10 (b) FINDINGS.—Congress finds the following: 

11 (1) Every year, across the United States, 

12 4,000,000 women give birth, about 700 women suf13 fer fatal complications during pregnancy, while giv14 ing birth or during the postpartum period, and 

15 70,000 women suffer near-fatal, partum-related 

16 complications. 

17 (2) The maternal mortality rate is often used as 

18 a proxy to measure the overall health of a popu19 lation. While the infant mortality rate in the United 

20 States has reached its lowest point, the risk of death 

21 for women in the United States during pregnancy, 

22 childbirth, or the postpartum period is higher than 

23 such risk in many other developed nations. The esti24 mated maternal mortality rate (per 100,000 live 

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1 ington, DC, increased from 18.8 percent in 2000, to 

2 23.8 percent in 2014, to 26.6 percent in 2018. This 

3 estimated rate is on par with such rate for under4 developed nations such as Iraq and Afghanistan. 

5 (3) It is estimated that more than 60 percent 

6 of maternal deaths in the United States are prevent7 able. 

8 (4) According to the Centers for Disease Con9 trol and Prevention, the maternal mortality rate var10 ies drastically for women by race and ethnicity. 

11 There are 12.7 deaths per 100,000 live births for 

12 White women, 43.5 deaths per 100,000 live births 

13 for African-American women, and 14.4 deaths per 

14 100,000 live births for women of other ethnicities. 

15 While maternal mortality disparately impacts Afri16 can-American women, this urgent public health crisis 

17 traverses race, ethnicity, socioeconomic status, edu18 cational background, and geography. 

19 (5) African-American women are 3 to 4 times 

20 more likely to die from causes related to pregnancy 

21 and childbirth compared to non-Hispanic White 

22 women. 

23 (6) The findings described in paragraphs (1) 

24 through (6) are of major concern to researchers, 

25 academics, members of the business community, and 


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1 providers across the obstetrical continuum rep2 resented by organizations such as March of Dimes; 

3 the Preeclampsia Foundation; the American College 

4 of Obstetricians and Gynecologists; the Society for 

5 Maternal-Fetal Medicine; the Association of Wom6 en’s Health, Obstetric, and Neonatal Nurses; the 

7 California Maternal Quality Care Collaborative; 

8 Black Women’s Health Imperative; the National 

9 Birth Equity Collaborative; Black Mamas Matter Al10 liance; EverThrive Illinois; the National Association 

11 of Certified Professional Midwives; PCOS Challenge: 

12 The National Polycystic Ovary Syndrome Associa13 tion; and the American College of Nurse Midwives. 

14 (7) Hemorrhage, cardiovascular and coronary 

15 conditions, cardiomyopathy, infection, embolism, 

16 mental health conditions, preeclampsia and eclamp17 sia, polycystic ovary syndrome, infection and sepsis, 

18 and anesthesia complications are the predominant 

19 medical causes of maternal-related deaths and com20 plications. Most of these conditions are largely pre21 ventable or manageable. 

22 (8) Oral health is an important part of 

23 perinatal health. Reducing bacteria in a woman’s 

24 mouth during pregnancy can significantly reduce her 

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1 causing bacteria to her baby. Moreover, some evi2 dence suggests that women with periodontal disease 

3 during pregnancy could be at greater risk for poor 

4 birth outcomes, such as preeclampsia, pre-term 

5 birth, and low-birth weight. Furthermore, a woman’s 

6 oral health during pregnancy is a good predictor of 

7 her newborn’s oral health, and since mothers can 

8 unintentionally spread oral bacteria to their babies, 

9 putting their children at higher risk for tooth decay, 

10 prevention efforts should happen even before chil11 dren are born, as a matter of pre-pregnancy health 

12 and prenatal care during pregnancy. 

13 (9) The United States has not been able to sub14 mit a formal maternal mortality rate to international 

15 data repositories since 2007. Thus, no official ma16 ternal mortality rate exists for the United States. 

17 There can be no maternal mortality rate without 

18 streamlining maternal mortality-related data from 

19 the State level and extrapolating such data to the 

20 Federal level. 

21 (10) In the United States, death reporting and 

22 analysis is a State function rather than a Federal 

23 process. States report all deaths—including mater24 nal deaths—on a semi-voluntary basis, without 

25 standardization across States. While the Centers for 


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1 Disease Control and Prevention has the capacity and 

2 system for collecting death-related data based on 

3 death certificates, these data are not sufficiently re4 ported by States in an organized and standard for5 mat across States such that the Centers for Disease 

6 Control and Prevention is able to identify causes of 

7 maternal death and best practices for the prevention 

8 of such death. 

9 (11) Vital statistics systems often underesti10 mate maternal mortality and are insufficient data 

11 sources from which to derive a full scope of medical 

12 and social determinant factors contributing to ma13 ternal deaths. While the addition of pregnancy 

14 checkboxes on death certificates since 2003 have 

15 likely improved States’ abilities to identify preg16 nancy-related deaths, they are not generally com17 pleted by obstetrical providers or persons trained to 

18 recognize pregnancy-related mortality. Thus, these 

19 vital forms may be missing information or may cap20 ture inconsistent data. Due to varying maternal 

21 mortality-related analyses, lack of reliability, and 

22 granularity in data, current maternal mortality 

23 informatics do not fully encapsulate the myriad med24 ical and socially determinant factors that contribute 

25 to such high maternal mortality rates within the 


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1 United States compared to other developed nations. 

2 Lack of standardization of data and data sharing 

3 across States and between Federal entities, health 

4 networks, and research institutions keep the Nation 

5 in the dark about ways to prevent maternal deaths. 

6 (12) Having reliable and valid State data ag7 gregated at the Federal level are critical to the Na8 tion’s ability to quell surges in maternal death and 

9 imperative for researchers to identify long-lasting 

10 interventions. 

11 (13) Leaders in maternal wellness highly rec12 ommend that maternal deaths be investigated at the 

13 State level first, and that standardized, streamlined, 

14 de-identified data regarding maternal deaths be sent 

15 annually to the Centers for Disease Control and Pre16 vention. Such data standardization and collection 

17 would be similar in operation and effect to the Na18 tional Program of Cancer Registries of the Centers 

19 for Disease Control and Prevention and akin to the 

20 Confidential Enquiry in Maternal Deaths Pro21 gramme in the United Kingdom. Such a maternal 

22 mortalities and morbidities registry and surveillance 

23 system would help providers, academicians, law24 makers, and the public to address questions con25 cerning the types of, causes of, and best practices to 


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1 thwart, pregnancy-related or pregnancy-associated 

2 mortality and morbidity. 

3 (14) The United Nations Millennium Develop4 ment Goal 5a aimed to reduce by 75 percent, be5 tween 1990 and 2015, the maternal mortality rate, 

6 yet this metric has not been achieved. In fact, the 

7 maternal mortality rate in the United States has 

8 been estimated to have more than doubled between 

9 2000 and 2014. Yet, because national data are not 

10 fully available, the United States does not have an 

11 official maternal mortality rate. 

12 (15) Many States have struggled to establish or 

13 maintain Maternal Mortality Review Committees 

14 (referred to in this section as ‘‘MMRC’’). On the 

15 State level, MMRCs have lagged because States have 

16 not had the resources to mount local reviews. State17 level reviews are necessary as only the State depart18 ments of health have the authority to request med19 ical records, autopsy reports, and police reports crit20 ical to the function of the MMRC. 

21 (16) The United Kingdom regards maternal 

22 deaths as a health systems failure and a national 

23 committee of obstetrics experts review each maternal 

24 death or near-fatal childbirth complication. Such 

25 committee also establishes the predominant course of 


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1 maternal-related deaths from conditions such as 

2 preeclampsia. Consequently, the United Kingdom 

3 has been able to reduce its incidence of preeclampsia 

4 to less than one in 10,000 women—its lowest rate 

5 since 1952. 

6 (17) The United States has no comparable, co7 ordinated Federal process by which to review cases 

8 of maternal mortality, systems failures, or best prac9 tices. Many States have active MMRCs and leverage 

10 their work to impact maternal wellness. For exam11 ple, the State of California has worked extensively 

12 with their State health departments, health and hos13 pital systems, and research collaborative organiza14 tions, including the California Maternal Quality Care 

15 Collaborative and the Alliance for Innovation on Ma16 ternal Health, to establish MMRCs, wherein such 

17 State has determined the most prevalent causes of 

18 maternal mortality and recorded and shared data 

19 with providers and researchers, who have developed 

20 and implemented safety bundles and care protocols 

21 related to preeclampsia, maternal hemorrhage, and 

22 the like. In this way, the State of California has 

23 been able to leverage its maternal mortality review 

24 board system, generate data, and apply those data 

25 to effect changes in maternal care-related protocol. 


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1 To date, the State of California has reduced its ma2 ternal mortality rate, which is now comparable to 

3 the low rates of the United Kingdom. 

4 (18) Hospitals and health systems across the 

5 United States lack standardization of emergency ob6 stetrical protocols before, during, and after delivery. 

7 Consequently, many providers are delayed in recog8 nizing critical signs indicating maternal distress that 

9 quickly escalate into fatal or near-fatal incidences. 

10 Moreover, any attempt to address an obstetrical 

11 emergency that does not consider both clinical and 

12 public health approaches falls woefully under the 

13 mark of excellent care delivery. State-based maternal 

14 quality collaborative organizations, such as the Cali15 fornia Maternal Quality Care Collaborative or enti16 ties participating in the Alliance for Innovation on 

17 Maternal Health (AIM), have formed obstetrical pro18 tocols, tool kits, and other resources to improve sys19 tem care and response as they relate to maternal 

20 complications and warning signs for such conditions 

21 as maternal hemorrhage, hypertension, and 

22 preeclampsia. 

23 (19) The Centers for Disease Control and Pre24 vention reports that nearly half of all maternal 

25 deaths occur in the immediate postpartum period— 


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1 the 42 days following a pregnancy—whereas more 

2 than one-third of pregnancy-related or pregnancy-as3 sociated deaths occur while a person is still preg4 nant. Yet, for women eligible for the Medicaid pro5 gram on the basis of pregnancy, such Medicaid cov6 erage lapses at the end of the month on which the 

7 60th postpartum day lands. 

8 (20) The experience of serious traumatic 

9 events, such as being exposed to domestic violence, 

10 substance use disorder, or pervasive racism, can 

11 over-activate the body’s stress-response system. 

12 Known as toxic stress, the repetition of high doses 

13 of cortisol to the brain, can harm healthy neuro14 logical development, which can have cascading phys15 ical and mental health consequences, as documented 

16 in the Adverse Childhood Experiences study of the 

17 Centers for Disease Control and Prevention. 

18 (21) A growing body of evidence-based research 

19 has shown the correlation between the stress associ20 ated with one’s race—the stress of racism—and 

21 one’s birthing outcomes. The stress of sex and race 

22 discrimination and institutional racism has been 

23 demonstrated to contribute to a higher risk of ma24 ternal mortality, irrespective of one’s gestational 

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1 vidual-level health risk factors, including poverty, 

2 limited access to prenatal care, and poor physical 

3 and mental health (although these are not nominal 

4 factors). African-American women remain the most 

5 at risk for pregnancy-associated or pregnancy-re6 lated causes of death. When it comes to 

7 preeclampsia, for example, which is related to obe8 sity, African-American women of normal weight re9 main the most at risk of dying during the perinatal 

10 period compared to non-African-American obese 

11 women. 

12 (22) The rising maternal mortality rate in the 

13 United States is driven predominantly by the dis14 proportionately high rates of African-American ma15 ternal mortality. 

16 (23) Compared to women from other racial and 

17 ethnic demographics, African-American women 

18 across the socioeconomic spectrum experience pro19 longed, unrelenting stress related to racial and gen20 der discrimination, contributing to higher rates of 

21 maternal mortality, giving birth to low-weight ba22 bies, and experiencing pre-term birth. Racism is a 

23 risk factor for these aforementioned experiences. 

24 This cumulative stress often extends across the life 

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1 can-American women establish livelihood. Structural 

2 barriers, lack of access to care, and genetic pre3 dispositions to health vulnerabilities exacerbate Afri4 can-American women’s likelihood to experience poor 

5 or fatal birthing outcomes, but do not fully account 

6 for the great disparity. 

7 (24) African-American women are twice as like8 ly to experience postpartum depression, and dis9 proportionately higher rates of preeclampsia com10 pared to White women. 

11 (25) Racism is deeply ingrained in United 

12 States systems, including in health care delivery sys13 tems between patients and providers, often resulting 

14 in disparate treatment for pain, irreverence for cul15 tural norms with respect to health, and 

16 dismissiveness. Research has demonstrated that pa17 tients respond more warmly and adhere to medical 

18 treatment plans at a higher degree with providers of 

19 the same race or ethnicity or with providers with 

20 great ability to exercise empathy. However, the pro21 vider pool is not primed with many people of color, 

22 nor are providers (whether student-doctors in train23 ing or licensed practitioners) consistently required to 

24 undergo implicit bias, cultural competency, or empa25 thy training on a consistent, ongoing basis. 


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1 (c) IMPROVING FEDERAL EFFORTS WITH RESPECT

2 TO PREVENTION OF MATERNAL MORTALITY.— 

3 (1) TECHNICAL ASSISTANCE FOR STATES WITH

4 RESPECT TO REPORTING MATERNAL MORTALITY.— 

5 Not later than one year after the date of enactment 

6 of this Act, the Director of the Centers for Disease 

7 Control and Prevention (referred to in this sub8 section as the ‘‘Director’’), in consultation with the 

9 Administrator of the Health Resources and Services 

10 Administration, shall provide technical assistance to 

11 States that elect to report comprehensive data on 

12 maternal mortality, including oral, mental, and 

13 breastfeeding health information, for the purpose of 

14 encouraging uniformity in the reporting of such data 

15 and to encourage the sharing of such data among 

16 the respective States. 

17 (2) BEST PRACTICES RELATING TO PREVEN18 TION OF MATERNAL MORTALITY.— 

19 (A) IN GENERAL.—Not later than one year 

20 after the date of enactment of this Act— 

21 (i) the Director, in consultation with 

22 relevant patient and provider groups, shall 

23 issue best practices to State maternal mor24 tality review committees on how best to 

25 identify and review maternal mortality 


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1 cases, taking into account any data made 

2 available by States relating to maternal 

3 mortality, including data on oral, mental, 

4 and breastfeeding health, and utilization of 

5 any emergency services; and 

6 (ii) the Director, working in collabora7 tion with the Health Resources and Serv8 ices Administration, shall issue best prac9 tices to hospitals, State professional society 

10 groups, and perinatal quality collaboratives 

11 on how best to prevent maternal mortality. 

12 (B) AUTHORIZATION OF APPROPRIA13 TIONS.—For purposes of carrying out this 

14 paragraph, there is authorized to be appro15 priated $5,000,000 for each of fiscal years 

16 2021 through 2025. 

17 (3) ALLIANCE FOR INNOVATION ON MATERNAL

18 HEALTH GRANT PROGRAM.— 

19 (A) IN GENERAL.—Not later than one year 

20 after the date of enactment of this Act, the Sec21 retary of Health and Human Services (referred 

22 to in this paragraph as the ‘‘Secretary’’), acting 

23 through the Associate Administrator of the Ma24 ternal and Child Health Bureau of the Health 

25 Resources and Services Administration, shall 


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1 establish a grant program to be known as the 

2 Alliance for Innovation on Maternal Health 

3 Grant Program (referred to in this subsection 

4 as ‘‘AIM’’) under which the Secretary shall 

5 award grants to eligible entities for the purpose 

6 of— 

7 (i) directing widespread adoption and 

8 implementation of maternal safety bundles 

9 through collaborative State-based teams; 

10 and 

11 (ii) collecting and analyzing process, 

12 structure, and outcome data to drive con13 tinuous improvement in the implementa14 tion of such safety bundles by such State15 based teams with the ultimate goal of 

16 eliminating preventable maternal mortality 

17 and severe maternal morbidity in the 

18 United States. 

19 (B) ELIGIBLE ENTITIES.—In order to be 

20 eligible for a grant under subparagraph (A), an 

21 entity shall— 

22 (i) submit to the Secretary an applica23 tion at such time, in such manner, and 

24 containing such information as the Sec25 retary may require; and 


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1 (ii) demonstrate in such application 

2 that the entity is an interdisciplinary, 

3 multi-stakeholder, national organization 

4 with a national data-driven maternal safety 

5 and quality improvement initiative based 

6 on implementation approaches that have 

7 been proven to improve maternal safety 

8 and outcomes in the United States. 

9 (C) USE OF FUNDS.—An eligible entity 

10 that receives a grant under subparagraph (A) 

11 shall use such grant funds— 

12 (i) to develop and implement, through 

13 a robust, multi-stakeholder process, mater14 nal safety bundles to assist States and 

15 health care systems in aligning national, 

16 State, and hospital-level quality improve17 ment efforts to improve maternal health 

18 outcomes, specifically the reduction of ma19 ternal mortality and severe maternal mor20 bidity; 

21 (ii) to ensure, in developing and im22 plementing maternal safety bundles under 

23 clause (i), that such maternal safety bun24 dles— 


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1 (I) satisfy the quality improve2 ment needs of a State or health care 

3 system by factoring in the results and 

4 findings of relevant data reviews, such 

5 as reviews conducted by a State ma6 ternal mortality review committee; 

7 and 

8 (II) address topics such as— 

9 (aa) obstetric hemorrhage; 

10 (bb) maternal mental health; 

11 (cc) the maternal venous 

12 system; 

13 (dd) obstetric care for 

14 women with substance use dis15 orders, including opioid use dis16 order; 

17 (ee) postpartum care basics 

18 for maternal safety; 

19 (ff) reduction of peripartum 

20 racial and ethnic disparities; 

21 (gg) reduction of primary 

22 caesarean birth; 

23 (hh) severe hypertension in 

24 pregnancy; 


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1 (ii) severe maternal mor2 bidity reviews; 

3 (jj) support after a severe 

4 maternal morbidity event; 

5 (kk) thromboembolism; 

6 (ll) optimization of support 

7 for breastfeeding; and 

8 (mm) maternal oral health; 

9 and 

10 (iii) to provide ongoing technical as11 sistance at the national and State levels to 

12 support implementation of maternal safety 

13 bundles under clause (i). 

14 (D) MATERNAL SAFETY BUNDLE DE15 FINED.—For purposes of this paragraph, the 

16 term ‘‘maternal safety bundle’’ means standard17 ized, evidence-informed processes for maternal 

18 health care. 

19 (E) AUTHORIZATION OF APPROPRIA20 TIONS.—For purposes of carrying out this 

21 paragraph, there is authorized to be appro22 priated $10,000,000 for each of fiscal years 

23 2021 through 2025. 


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1 (4) FUNDING FOR STATE-BASED PERINATAL

2 QUALITY COLLABORATIVES DEVELOPMENT AND SUS3 TAINABILITY.— 

4 (A) IN GENERAL.—Not later than one year 

5 after the date of enactment of this Act, the Sec6 retary of Health and Human Services (referred 

7 to in this paragraph as the ‘‘Secretary’’), acting 

8 through the Division of Reproductive Health of 

9 the Centers for Disease Control and Prevention, 

10 shall establish a grant program to be known as 

11 the State-Based Perinatal Quality Collaborative 

12 grant program under which the Secretary 

13 awards grants to eligible entities for the pur14 pose of development and sustainability of 

15 perinatal quality collaboratives in every State, 

16 the District of Columbia, and eligible terri17 tories, in order to measurably improve perinatal 

18 care and perinatal health outcomes for preg19 nant and postpartum women and their infants. 

20 (B) GRANT AMOUNTS.—Grants awarded 

21 under this paragraph shall be in amounts not to 

22 exceed $250,000 per year, for the duration of 

23 the grant period. 

24 (C) STATE-BASED PERINATAL QUALITY

25 COLLABORATIVE DEFINED.—For purposes of 


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1 this paragraph, the term ‘‘State-based perinatal 

2 quality collaborative’’ means a network of mul3 tidisciplinary teams that— 

4 (i) work to improve measurable out5 comes for maternal and infant health by 

6 advancing evidence-informed clinical prac7 tices using quality improvement principles; 

8 (ii) work with hospital-based or out9 patient facility-based clinical teams, ex10 perts, and stakeholders, including patients 

11 and families, to spread best practices and 

12 optimize resources to improve perinatal 

13 care and outcomes; 

14 (iii) employ strategies that include the 

15 use of the collaborative learning model to 

16 provide opportunities for hospitals and 

17 clinical teams to collaborate on improve18 ment strategies, rapid-response data to 

19 provide timely feedback to hospital and 

20 other clinical teams to track progress, and 

21 quality improvement science to provide 

22 support and coaching to hospital and clin23 ical teams; and 


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1 (iv) have the goal of improving popu2 lation-level outcomes in maternal and in3 fant health. 

4 (D) AUTHORIZATION OF APPROPRIA5 TIONS.—For purposes of carrying out this 

6 paragraph, there is authorized to be appro7 priated $14,000,000 per year for each of fiscal 

8 years 2021 through 2025. 

9 (5) EXPANSION OF MEDICAID AND CHIP COV10 ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 

11 (A) REQUIRING COVERAGE OF CERTAIN

12 ORAL HEALTH SERVICES FOR PREGNANT AND

13 POSTPARTUM WOMEN.— 

14 (i) MEDICAID.—Subsection (gg) of 

15 section 1905 of the Social Security Act (42 

16 U.S.C. 1396d), as added by section 

17 433(d), is amended— 

18 (I) in paragraph (1), by striking 

19 ‘‘paragraphs (2) and (3)’’ and insert20 ing ‘‘paragraphs (2), (3), and (4)’’; 

21 and 

22 (II) by adding at the end the fol23 lowing new paragraph: 

24 ‘‘(4) Such term shall include, in the case of a 

25 woman who is pregnant (or during the 1-year period 


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1 beginning on the last day of her pregnancy) preven2 tive, diagnostic, periodontal, and restorative services 

3 recommended for perinatal oral health care and den4 tal care during pregnancy by the American Academy 

5 of Pediatric Dentistry and the American College of 

6 Obstetricians and Gynecologists.’’. 

7 (ii) CHIP.—Section 2103(c)(5)(A) of 

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

9 1397cc(c)(5)(A)) is amended by inserting 

10 ‘‘or a targeted low-income pregnant 

11 woman’’ after ‘‘targeted low-income child’’. 

12 (B) EXTENDING MEDICAID COVERAGE FOR

13 PREGNANT AND POSTPARTUM WOMEN.—Section 

14 1902 of the Social Security Act (42 U.S.C. 

15 1396a) is amended— 

16 (i) in subsection (e)— 

17 (I) in paragraph (5)— 

18 (aa) by inserting ‘‘(including 

19 oral health services (as defined in 

20 section 1905(gg) and including 

21 services for pregnant and 

22 postpartum women described in 

23 paragraph (4) of such section)’’ 

24 after ‘‘postpartum medical assist25 ance under the plan’’; and 


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1 (bb) by striking ‘‘60-day’’ 

2 and inserting ‘‘1-year’’; and 

3 (II) in paragraph (6), by striking 

4 ‘‘60-day’’ and inserting ‘‘1-year’’; and 

5 (ii) in subsection (l)(1)(A), by striking 

6 ‘‘60-day’’ and inserting ‘‘1-year’’. 

7 (C) EXTENDING MEDICAID COVERAGE FOR

8 LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of 

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

10 1396b(v)(4)(A)) is amended by striking ‘‘60- 

11 day’’ and inserting ‘‘1-year’’. 

12 (D) EXTENDING CHIP COVERAGE FOR

13 PREGNANT AND POSTPARTUM WOMEN.—Section 

14 2112(d)(2)(A) of the Social Security Act (42 

15 U.S.C. 1397ll(d)(2)(A)) is amended by striking 

16 ‘‘60-day’’ and inserting ‘‘1-year’’. 

17 (E) MAINTENANCE OF EFFORT.— 

18 (i) MEDICAID.—Section 1902(l) of the 

19 Social Security Act (42 U.S.C. 1396a(l)) is 

20 amended by adding at the end the fol21 lowing new paragraph: 

22 ‘‘(5) During the period that begins on the date of 

23 enactment of this paragraph and ends on the date that 

24 is 5 years after such date of enactment, as a condition 

25 for receiving any Federal payments under section 1903(a) 


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1 for calendar quarters occurring during such period, a 

2 State shall not have in effect, with respect to women who 

3 are eligible for medical assistance under the State plan 

4 or under a waiver of such plan on the basis of being preg5 nant or having been pregnant, eligibility standards, meth6 odologies, or procedures under the State plan or waiver 

7 that are more restrictive than the eligibility standards, 

8 methodologies, or procedures, respectively, under such 

9 plan or waiver that are in effect on the date of enactment 

10 of this paragraph.’’. 

11 (ii) CHIP.—Section 2105(d) of the 

12 Social Security Act (42 U.S.C. 1397ee(d)) 

13 is amended by adding at the end the fol14 lowing new paragraph: 

15 ‘‘(4) INELIGIBILITY STANDARDS FOR TARGETED

16 LOW-INCOME PREGNANT WOMEN.—During the pe17 riod that begins on the date of enactment of this 

18 paragraph and ends on the date that is 5 years after 

19 such date of enactment, as a condition of receiving 

20 payments under subsection (a) and section 1903(a), 

21 a State that elects to provide assistance to women 

22 on the basis of being pregnant (including pregnancy23 related assistance provided to targeted low-income 

24 pregnant women (as defined in section 2112(d)), 

25 pregnancy-related assistance provided to women who 


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1 are eligible for such assistance through application 

2 of section 1902(v)(4)(A)(i) under section 2107(e)(1), 

3 or any other assistance under the State child health 

4 plan (or a waiver of such plan) which is provided to 

5 women on the basis of being pregnant) shall not 

6 have in effect, with respect to such women, eligibility 

7 standards, methodologies, or procedures under such 

8 plan (or waiver) that are more restrictive than the 

9 eligibility standards, methodologies, or procedures, 

10 respectively, under such plan (or waiver) that are in 

11 effect on the date of enactment of this paragraph.’’. 

12 (F) INFORMATION ON BENEFITS.—The 

13 Secretary of Health and Human Services shall 

14 make publicly available on the internet website 

15 of the Department of Health and Human Serv16 ices, information regarding benefits available to 

17 pregnant and postpartum women and under the 

18 Medicaid program and the Children’s Health 

19 Insurance Program, including information on— 

20 (i) benefits that States are required to 

21 provide to pregnant and postpartum 

22 women under such programs; 

23 (ii) optional benefits that States may 

24 provide to pregnant and postpartum 

25 women under such programs; and 


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1 (iii) the availability of different kinds 

2 of benefits for pregnant and postpartum 

3 women, including oral health and mental 

4 health benefits, under such programs. 

5 (G) FEDERAL FUNDING FOR COST OF EX6 TENDED MEDICAID AND CHIP COVERAGE FOR

7 POSTPARTUM WOMEN.— 

8 (i) MEDICAID.—Section 1905 of the 

9 Social Security Act (42 U.S.C. 1396d), as 

10 amended by section 433(d), is further 

11 amended— 

12 (I) in subsection (b), by striking 

13 ‘‘and (ff)’’ and inserting ‘‘(ff), and 

14 (hh)’’; and 

15 (II) by adding at the end the fol16 lowing: 

17 ‘‘(hh) INCREASED FMAP FOR EXTENDED MEDICAL

18 ASSISTANCE FOR POSTPARTUM WOMEN.—Notwith19 standing subsection (b), the Federal medical assistance 

20 percentage for a State, with respect to amounts expended 

21 by such State for medical assistance for a woman who is 

22 eligible for such assistance on the basis of being pregnant 

23 or having been pregnant that is provided during the 305- 

24 day period that begins on the 60th day after the last day 

25 of her pregnancy (including any such assistance provided 


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1 during the month in which such period ends), shall be 

2 equal to— 

3 ‘‘(1) 100 percent for the first 20 calendar quar4 ters during which this subsection is in effect; and 

5 ‘‘(2) 90 percent for calendar quarters there6 after.’’. 

7 (ii) CHIP.—Section 2105(c) of the 

8 Social Security Act (42 U.S.C. 1397ee(c)) 

9 is amended by adding at the end the fol10 lowing new paragraph: 

11 ‘‘(12) ENHANCED PAYMENT FOR EXTENDED

12 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 

13 Notwithstanding subsection (b), the enhanced 

14 FMAP, with respect to payments under subsection 

15 (a) for expenditures under the State child health 

16 plan (or a waiver of such plan) for assistance pro17 vided under the plan (or waiver) to a woman who is 

18 eligible for such assistance on the basis of being 

19 pregnant (including pregnancy-related assistance 

20 provided to a targeted low-income pregnant woman 

21 (as defined in section 2112(d)), pregnancy-related 

22 assistance provided to a woman who is eligible for 

23 such assistance through application of section 

24 1902(v)(4)(A)(i) under section 2107(e)(1), or any 

25 other assistance under the plan (or waiver) provided 


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1 to a woman who is eligible for such assistance on the 

2 basis of being pregnant) during the 305-day period 

3 that begins on the 60th day after the last day of her 

4 pregnancy (including any such assistance provided 

5 during the month in which such period ends), shall 

6 be equal to— 

7 ‘‘(A) 100 percent for the first 20 calendar 

8 quarters during which this paragraph is in ef9 fect; and 

10 ‘‘(B) 90 percent for calendar quarters 

11 thereafter.’’. 

12 (H) EFFECTIVE DATE.— 

13 (i) IN GENERAL.—Subject to subpara14 graph (B), the amendments made by this 

15 subsection shall take effect on the first day 

16 of the first calendar quarter that begins on 

17 or after the date that is one year after the 

18 date of enactment of this Act. 

19 (ii) EXCEPTION FOR STATE LEGISLA20 TION.—In the case of a State plan under 

21 title XIX of the Social Security Act or a 

22 State child health plan under title XXI of 

23 such Act that the Secretary of Health and 

24 Human Services determines requires State 

25 legislation in order for the respective plan 


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1 to meet any requirement imposed by 

2 amendments made by this subsection, the 

3 respective plan shall not be regarded as 

4 failing to comply with the requirements of 

5 such title solely on the basis of its failure 

6 to meet such an additional requirement be7 fore the first day of the first calendar 

8 quarter beginning after the close of the 

9 first regular session of the State legislature 

10 that begins after the date of enactment of 

11 this Act. For purposes of the previous sen12 tence, in the case of a State that has a 2- 

13 year legislative session, each year of the 

14 session shall be considered to be a separate 

15 regular session of the State legislature. 

16 (6) REGIONAL CENTERS OF EXCELLENCE.— 

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

18 (42 U.S.C. 280g et seq.) is amended by adding at 

19 the end the following new section: 

20 ‘‘SEC. 399V–7. REGIONAL CENTERS OF EXCELLENCE AD21 DRESSING IMPLICIT BIAS AND CULTURAL 

22 COMPETENCY IN PATIENT-PROVIDER INTER23 ACTIONS EDUCATION. 

24 ‘‘(a) IN GENERAL.—Not later than one year after the 

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1 sultation with such other agency heads as the Secretary 

2 determines appropriate, shall award cooperative agree3 ments for the establishment or support of regional centers 

4 of excellence addressing implicit bias and cultural com5 petency in patient-provider interactions education for the 

6 purpose of enhancing and improving how health care pro7 fessionals are educated in implicit bias and delivering cul8 turally competent health care. 

9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper10 ative agreement under subsection (a), an entity shall— 

11 ‘‘(1) be a public or other nonprofit entity speci12 fied by the Secretary that provides educational and 

13 training opportunities for students and health care 

14 professionals, which may be a health system, teach15 ing hospital, community health center, medical 

16 school, school of public health, dental school, social 

17 work school, school of professional psychology, or 

18 any other health professional school or program at 

19 an institution of higher education (as defined in sec20 tion 101 of the Higher Education Act of 1965) fo21 cused on the prevention, treatment, or recovery of 

22 health conditions that contribute to maternal mor23 tality and the prevention of maternal mortality and 

24 severe maternal morbidity; 


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1 ‘‘(2) demonstrate community engagement and 

2 participation, such as through partnerships with 

3 home visiting and case management programs; and 

4 ‘‘(3) provide to the Secretary such information, 

5 at such time and in such manner, as the Secretary 

6 may require. 

7 ‘‘(c) DIVERSITY.—In awarding a cooperative agree8 ment under subsection (a), the Secretary shall take into 

9 account any regional differences among eligible entities 

10 and make an effort to ensure geographic diversity among 

11 award recipients. 

12 ‘‘(d) DISSEMINATION OF INFORMATION.— 

13 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 

14 shall make publicly available on the internet website 

15 of the Department of Health and Human Services 

16 information submitted to the Secretary under sub17 section (b)(3). 

18 ‘‘(2) EVALUATION.—The Secretary shall evalu19 ate each regional center of excellence established or 

20 supported pursuant to subsection (a) and dissemi21 nate the findings resulting from each such evalua22 tion to the appropriate public and private entities. 

23 ‘‘(3) DISTRIBUTION.—The Secretary shall share 

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1 ments of health and other relevant State level offices 

2 to inform State and local best practices. 

3 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec4 tion, the term ‘maternal mortality’ means death of a 

5 woman that occurs during pregnancy or within the one6 year period following the end of such pregnancy. 

7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 

8 purposes of carrying out this section, there is authorized 

9 to be appropriated $5,000,000 for each of fiscal years 

10 2021 through 2025.’’. 

11 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO12 GRAM FOR WOMEN, INFANTS, AND CHILDREN.— 

13 (A) DEFINITION OF BREASTFEEDING

14 WOMAN.—Section 17(b) of the Child Nutrition 

15 Act of 1966 (42 U.S.C. 1786(b)) is amended by 

16 striking paragraph (1) and inserting the fol17 lowing: 

18 ‘‘(1) BREASTFEEDING WOMAN.—The term 

19 ‘breastfeeding woman’ means a woman who is not 

20 more than 2 years postpartum and is breastfeeding 

21 the infant of the woman.’’. 

22 (B) CERTIFICATION.—Section 

23 17(d)(3)(A)(ii) of the Child Nutrition Act of 

24 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amend25 ed— 


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1 (i) by striking the clause designation 

2 and heading and all that follows through 

3 ‘‘A State’’ and inserting the following: 

4 ‘‘(ii) WOMEN.— 

5 ‘‘(I) BREASTFEEDING WOMEN.— 

6 A State’’; 

7 (ii) in subclause (I) (as so des8 ignated), by striking ‘‘1 year’’ and all that 

9 follows through ‘‘earlier’’ and inserting ‘‘2 

10 years postpartum’’; and 

11 (iii) by adding at the end the fol12 lowing: 

13 ‘‘(II) POSTPARTUM WOMEN.—A 

14 State may elect to certify a 

15 postpartum woman for a period of 2 

16 years.’’. 

17 (8) DEFINITIONS.—In this section: 

18 (A) MATERNAL MORTALITY.—The term 

19 ‘‘maternal mortality’’ means death of a woman 

20 that occurs during pregnancy or within the one21 year period following the end of such preg22 nancy. 

23 (B) SEVERE MATERNAL MORBIDITY.—The 

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1 sult in significant short-term or long-term con2 sequences to a woman’s health. 

3 (d) INCREASING EXCISE TAXES ON CIGARETTES AND

4 ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO5 BACCO PRODUCT TAX RATES.— 

6 (1) TAX PARITY FOR ROLL-YOUR-OWN TO7 BACCO.—Section 5701(g) of the Internal Revenue 

8 Code of 1986 is amended by striking ‘‘$24.78’’ and 

9 inserting ‘‘$49.56’’. 

10 (2) TAX PARITY FOR PIPE TOBACCO.—Section 

11 5701(f) of the Internal Revenue Code of 1986 is 

12 amended by striking ‘‘$2.8311 cents’’ and inserting 

13 ‘‘$49.56’’. 

14 (3) TAX PARITY FOR SMOKELESS TOBACCO.— 

15 (A) Section 5701(e) of the Internal Rev16 enue Code of 1986 is amended— 

17 (i) in paragraph (1), by striking 

18 ‘‘$1.51’’ and inserting ‘‘$26.84’’; 

19 (ii) in paragraph (2), by striking 

20 ‘‘50.33 cents’’ and inserting ‘‘$10.74’’; and 

21 (iii) by adding at the end the fol22 lowing: 

23 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE

24 SINGLE-USE UNITS.—On discrete single-use units, 

25 $100.66 per thousand.’’. 


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1 (B) Section 5702(m) of such Code is 

2 amended— 

3 (i) in paragraph (1), by striking ‘‘or 

4 chewing tobacco’’ and inserting ‘‘, chewing 

5 tobacco, or discrete single-use unit’’; 

6 (ii) in paragraphs (2) and (3), by in7 serting ‘‘that is not a discrete single-use 

8 unit’’ before the period in each such para9 graph; and 

10 (iii) by adding at the end the fol11 lowing: 

12 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 

13 ‘discrete single-use unit’ means any product con14 taining tobacco that— 

15 ‘‘(A) is not intended to be smoked; and 

16 ‘‘(B) is in the form of a lozenge, tablet, 

17 pill, pouch, dissolvable strip, or other discrete 

18 single-use or single-dose unit.’’. 

19 (4) TAX PARITY FOR SMALL CIGARS.—Para20 graph (1) of section 5701(a) of the Internal Revenue 

21 Code of 1986 is amended by striking ‘‘$50.33’’ and 

22 inserting ‘‘$100.66’’. 

23 (5) TAX PARITY FOR LARGE CIGARS.— 

24 (A) IN GENERAL.—Paragraph (2) of sec25 tion 5701(a) of the Internal Revenue Code of 


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1 1986 is amended by striking ‘‘52.75 percent’’ 

2 and all that follows through the period and in3 serting the following: ‘‘$49.56 per pound and a 

4 proportionate tax at the like rate on all frac5 tional parts of a pound but not less than 

6 10.066 cents per cigar.’’. 

7 (B) GUIDANCE.—The Secretary of the 

8 Treasury, or the Secretary’s delegate, may issue 

9 guidance regarding the appropriate method for 

10 determining the weight of large cigars for pur11 poses of calculating the applicable tax under 

12 section 5701(a)(2) of the Internal Revenue 

13 Code of 1986. 

14 (6) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO

15 AND CERTAIN PROCESSED TOBACCO.—Subsection (o) 

16 of section 5702 of the Internal Revenue Code of 

17 1986 is amended by inserting ‘‘, and includes proc18 essed tobacco that is removed for delivery or deliv19 ered to a person other than a person with a permit 

20 provided under section 5713, but does not include 

21 removals of processed tobacco for exportation’’ after 

22 ‘‘wrappers thereof’’. 

23 (7) CLARIFYING TAX RATE FOR OTHER TO24 BACCO PRODUCTS.— 


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1 (A) IN GENERAL.—Section 5701 of the In2 ternal Revenue Code of 1986 is amended by 

3 adding at the end the following new subsection: 

4 ‘‘(i) OTHER TOBACCO PRODUCTS.—Any product not 

5 otherwise described under this section that has been deter6 mined to be a tobacco product by the Food and Drug Ad7 ministration through its authorities under the Family 

8 Smoking Prevention and Tobacco Control Act shall be 

9 taxed at a level of tax equivalent to the tax rate for ciga10 rettes on an estimated per use basis as determined by the 

11 Secretary.’’. 

12 (B) ESTABLISHING PER USE BASIS.—For 

13 purposes of section 5701(i) of the Internal Rev14 enue Code of 1986, not later than 12 months 

15 after the later of the date of the enactment of 

16 this Act or the date that a product has been de17 termined to be a tobacco product by the Food 

18 and Drug Administration, the Secretary of the 

19 Treasury (or the Secretary of the Treasury’s 

20 delegate) shall issue final regulations estab21 lishing the level of tax for such product that is 

22 equivalent to the tax rate for cigarettes on an 

23 estimated per use basis. 

24 (8) CLARIFYING DEFINITION OF TOBACCO

25 PRODUCTS.— 


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1 (A) IN GENERAL.—Subsection (c) of sec2 tion 5702 of the Internal Revenue Code of 1986 

3 is amended to read as follows: 

4 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod5 ucts’ means— 

6 ‘‘(1) cigars, cigarettes, smokeless tobacco, pipe 

7 tobacco, and roll-your-own tobacco, and 

8 ‘‘(2) any other product subject to tax pursuant 

9 to section 5701(i).’’. 

10 (B) CONFORMING AMENDMENTS.—Sub11 section (d) of section 5702 of such Code is 

12 amended by striking ‘‘cigars, cigarettes, smoke13 less tobacco, pipe tobacco, or roll-your-own to14 bacco’’ each place it appears and inserting ‘‘to15 bacco products’’. 

16 (9) INCREASING TAX ON CIGARETTES.— 

17 (A) SMALL CIGARETTES.—Section 

18 5701(b)(1) of such Code is amended by striking 

19 ‘‘$50.33’’ and inserting ‘‘$100.66’’. 

20 (B) LARGE CIGARETTES.—Section 

21 5701(b)(2) of such Code is amended by striking 

22 ‘‘$105.69’’ and inserting ‘‘$211.38’’. 

23 (10) TAX RATES ADJUSTED FOR INFLATION.— 

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1 section (g), is amended by adding at the end the fol2 lowing new subsection: 

3 ‘‘(j) INFLATION ADJUSTMENT.— 

4 ‘‘(1) IN GENERAL.—In the case of any calendar 

5 year beginning after 2018, the dollar amounts pro6 vided under this chapter shall each be increased by 

7 an amount equal to— 

8 ‘‘(A) such dollar amount, multiplied by 

9 ‘‘(B) the cost-of-living adjustment deter10 mined under section 1(f)(3) for the calendar 

11 year, determined by substituting ‘calendar year 

12 2017’ for ‘calendar year 2016’ in subparagraph 

13 (A)(ii) thereof. 

14 ‘‘(2) ROUNDING.—If any amount as adjusted 

15 under paragraph (1) is not a multiple of $0.01, such 

16 amount shall be rounded to the next highest multiple 

17 of $0.01.’’. 

18 (11) FLOOR STOCKS TAXES.— 

19 (A) IMPOSITION OF TAX.—On tobacco 

20 products manufactured in or imported into the 

21 United States which are removed before any tax 

22 increase date and held on such date for sale by 

23 any person, there is hereby imposed a tax in an 

24 amount equal to the excess of— 


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1 (i) the tax which would be imposed 

2 under section 5701 of the Internal Rev3 enue Code of 1986 on the article if the ar4 ticle had been removed on such date, over 

5 (ii) the prior tax (if any) imposed 

6 under section 5701 of such Code on such 

7 article. 

8 (B) CREDIT AGAINST TAX.—Each person 

9 shall be allowed as a credit against the taxes 

10 imposed by paragraph (1) an amount equal to 

11 $500. Such credit shall not exceed the amount 

12 of taxes imposed by paragraph (1) on such date 

13 for which such person is liable. 

14 (C) LIABILITY FOR TAX AND METHOD OF

15 PAYMENT.— 

16 (i) LIABILITY FOR TAX.—A person 

17 holding tobacco products on any tax in18 crease date to which any tax imposed by 

19 paragraph (1) applies shall be liable for 

20 such tax. 

21 (ii) METHOD OF PAYMENT.—The tax 

22 imposed by paragraph (1) shall be paid in 

23 such manner as the Secretary shall pre24 scribe by regulations. 


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1 (iii) TIME FOR PAYMENT.—The tax 

2 imposed by paragraph (1) shall be paid on 

3 or before the date that is 120 days after 

4 the effective date of the tax rate increase. 

5 (D) ARTICLES IN FOREIGN TRADE

6 ZONES.—Notwithstanding the Act of June 18, 

7 1934 (commonly known as the Foreign Trade 

8 Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), 

9 or any other provision of law, any article which 

10 is located in a foreign trade zone on any tax in11 crease date shall be subject to the tax imposed 

12 by paragraph (1) if— 

13 (i) internal revenue taxes have been 

14 determined, or customs duties liquidated, 

15 with respect to such article before such 

16 date pursuant to a request made under the 

17 1st proviso of section 3(a) of such Act; or 

18 (ii) such article is held on such date 

19 under the supervision of an officer of the 

20 United States Customs and Border Protec21 tion of the Department of Homeland Secu22 rity pursuant to the 2d proviso of such sec23 tion 3(a). 

24 (E) DEFINITIONS.—For purposes of this 

25 subsection— 


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1 (i) IN GENERAL.—Any term used in 

2 this subsection which is also used in sec3 tion 5702 of such Code shall have the 

4 same meaning as such term has in such 

5 section. 

6 (ii) TAX INCREASE DATE.—The term 

7 ‘‘tax increase date’’ means the effective 

8 date of any increase in any tobacco prod9 uct excise tax rate pursuant to the amend10 ments made by this section (other than 

11 subsection (j) thereof). 

12 (iii) SECRETARY.—The term ‘‘Sec13 retary’’ means the Secretary of the Treas14 ury or the Secretary’s delegate. 

15 (F) CONTROLLED GROUPS.—Rules similar 

16 to the rules of section 5061(e)(3) of such Code 

17 shall apply for purposes of this subsection. 

18 (G) OTHER LAWS APPLICABLE.—All provi19 sions of law, including penalties, applicable with 

20 respect to the taxes imposed by section 5701 of 

21 such Code shall, insofar as applicable and not 

22 inconsistent with the provisions of this sub23 section, apply to the floor stocks taxes imposed 

24 by paragraph (1), to the same extent as if such 

25 taxes were imposed by such section 5701. The 


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1 Secretary may treat any person who bore the 

2 ultimate burden of the tax imposed by para3 graph (1) as the person to whom a credit or re4 fund under such provisions may be allowed or 

5 made. 

6 (12) EFFECTIVE DATES.— 

7 (A) IN GENERAL.—Except as provided in 

8 paragraphs (2) through (4), the amendments 

9 made by this section shall apply to articles re10 moved (as defined in section 5702(j) of the In11 ternal Revenue Code of 1986) after the last day 

12 of the month which includes the date of the en13 actment of this Act. 

14 (B) DISCRETE SINGLE-USE UNITS AND

15 PROCESSED TOBACCO.—The amendments made 

16 by subsections (c)(1)(C), (c)(2), and (f) shall 

17 apply to articles removed (as defined in section 

18 5702(j) of the Internal Revenue Code of 1986) 

19 after the date that is 6 months after the date 

20 of the enactment of this Act. 

21 (C) LARGE CIGARS.—The amendments 

22 made by subsection (e) shall apply to articles 

23 removed after December 31, 2021. 

24 (D) OTHER TOBACCO PRODUCTS.—The 

25 amendments made by subsection (g)(1) shall 


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1 apply to products removed after the last day of 

2 the month which includes the date that the Sec3 retary of the Treasury (or the Secretary of the 

4 Treasury’s delegate) issues final regulations es5 tablishing the level of tax for such product. 

6 SEC. 506. RURAL MATERNAL AND OBSTETRIC MODERNIZA7 TION OF SERVICES. 

8 (a) SHORT TITLE.—This section may be cited as the 

9 ‘‘Rural Maternal and Obstetric Modernization of Services 

10 Act’’ or the ‘‘Rural MOMS Act’’. 

11 (b) IMPROVING RURAL MATERNAL AND OBSTETRIC

12 CARE DATA.— 

13 (1) MATERNAL MORTALITY AND MORBIDITY AC14 TIVITIES.—Section 301 of the Public Health Service 

15 Act (42 U.S.C. 241) is amended— 

16 (A) by redesignating subsections (e) 

17 through (h) as subsections (f) through (i), re18 spectively; and 

19 (B) by inserting after subsection (d), the 

20 following: 

21 ‘‘(e) The Secretary, acting through the Director of 

22 the Centers for Disease Control and Prevention, shall ex23 pand, intensify, and coordinate the activities of the Cen24 ters for Disease Control and Prevention with respect to 

25 maternal mortality and morbidity.’’. 


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1 (2) OFFICE OF WOMEN’S HEALTH.—Section 

2 310A(b)(1) of the Public Health Service Act (42 

3 U.S.C. 242s(b)(1)) is amended by striking ‘‘and 

4 sociocultural contexts’’ and inserting ‘‘sociocultural 

5 (including race, ethnicity, language, class, and in6 come) contexts, including among Indians (as defined 

7 in section 4 of the Indian Health Care Improvement 

8 Act), and geographic contexts,’’ after ‘‘biological,’’. 

9 (3) SAFE MOTHERHOOD.—Section 317K(b)(2) 

10 of the Public Health Service Act (42 U.S.C. 247b– 

11 12(b)(2)) is amended— 

12 (A) in subparagraph (L), by striking 

13 ‘‘and’’ at the end; 

14 (B) by redesignating subparagraph (M) as 

15 subparagraph (N); and 

16 (C) by inserting after subparagraph (L), 

17 the following: 

18 ‘‘(M) an examination of the relationship 

19 between maternal health services in rural areas 

20 and outcomes in delivery and postpartum care; 

21 and’’. 

22 (4) OFFICE OF RESEARCH ON WOMEN’S

23 HEALTH.—Section 486 of the Public Health Service 

24 Act (42 U.S.C. 287d) is amended— 

25 (A) in subsection (b)— 


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1 (i) by redesignating paragraphs (4) 

2 through (9) as paragraphs (5) through 

3 (10), respectively; 

4 (ii) by inserting after paragraph (3) 

5 the following: 

6 ‘‘(4) carry out paragraphs (1) and (2) with re7 spect to pregnancy, with priority given to deaths re8 lated to pregnancy;’’; and 

9 (iii) in paragraph (5) (as so redesig10 nated), by striking ‘‘through (3)’’ and in11 serting ‘‘through (4)’’; and 

12 (B) in subsection (d)(4)(A)(iv), by insert13 ing ‘‘, including maternal mortality and other 

14 maternal morbidity outcomes’’ before the semi15 colon. 

16 (c) RURAL OBSTETRIC NETWORK GRANTS.—The 

17 Public Health Service Act is amended by inserting after 

18 section 317L–1 (42 U.S.C. 247b–13a) the following: 

19 ‘‘SEC. 317L–2. RURAL OBSTETRIC NETWORK GRANTS. 

20 ‘‘(a) IN GENERAL.—For the purpose of enabling the 

21 Secretary (through grants, contracts, or otherwise), acting 

22 through the Administrator of the Health Resources and 

23 Services Administration, to establish collaborative im24 provement and innovation networks (referred to in this 

25 section as ‘rural obstetric networks’) to improve outcomes 


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1 in birth and maternal morbidity and mortality, there is 

2 appropriated to the Secretary, out of any money in the 

3 Treasury not otherwise appropriated, $3,000,000 for each 

4 of fiscal years 2021 through 2025. Such amounts shall 

5 remain available until expended. 

6 ‘‘(b) USE OF FUNDS.—Amounts appropriated under 

7 subsection (a) shall be used for the establishment of col8 laborative improvement and innovation networks to im9 prove maternal health in rural areas by improving out10 comes in birth and maternal morbidity and mortality. 

11 Rural obstetric networks established in accordance with 

12 this section shall— 

13 ‘‘(1) assist pregnant women and other individ14 uals in rural areas in connecting with prenatal, labor 

15 and birth, and postpartum care to improve outcomes 

16 in birth and maternal mortality and morbidity; 

17 ‘‘(2) identify successful prenatal, labor and 

18 birth, and postpartum health delivery models for in19 dividuals in rural areas, including evidence-based 

20 home visiting programs and successful, culturally 

21 competent models with positive maternal health out22 comes that advance health equity; 

23 ‘‘(3) develop a model for collaboration between 

24 health facilities that have an obstetric health unit 


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1 and health facilities that do not have an obstetric 

2 health unit; 

3 ‘‘(4) provide training and guidance for health 

4 facilities that do not have obstetric health units; 

5 ‘‘(5) collaborate with academic institutions that 

6 can provide regional expertise and research on ac7 cess, outcomes, needs assessments, and other identi8 fied data; and 

9 ‘‘(6) measure and address inequities in birth 

10 outcomes among rural residents, with an emphasis 

11 on Black residents and residents who are Indians 

12 (as defined in section 4 of the Indian Health Care 

13 Improvement Act). 

14 ‘‘(c) REQUIREMENTS FOR ESTABLISHMENT.—Not 

15 later than 6 months after the date of enactment of this 

16 section, the Secretary shall establish rural obstetric health 

17 networks in at least 5 regions. 

18 ‘‘(d) DEFINITIONS.—In this section: 

19 ‘‘(1) FRONTIER AREA.—The term ‘frontier 

20 area’ means a frontier county, as defined in section 

21 1886(d)(3)(E)(iii)(III) of the Social Security Act. 

22 ‘‘(2) INDIAN; INDIAN TRIBE.—The terms ‘In23 dian’ and ‘Indian tribe’ have the meanings given 

24 such terms in section 4 of the Indian Health Care 

25 Improvement Act. 


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1 ‘‘(3) REGION.—The term ‘region’ means a 

2 State, Indian tribe, rural area, or frontier area. 

3 ‘‘(4) RURAL AREA.—The term ‘rural area’ has 

4 the meaning given that term in section 

5 1886(d)(2)(D) of the Social Security Act. 

6 ‘‘(5) STATE.—The term ‘State’ has the mean7 ing given that term for purposes of title V of the So8 cial Security Act.’’. 

9 (d) TELEHEALTH NETWORK AND TELEHEALTH RE10 SOURCE CENTERS GRANT PROGRAMS.—Section 330I of 

11 the Public Health Service Act (42 U.S.C. 254c–14) is 

12 amended— 

13 (1) in subsection (f)(3), by adding at the end 

14 the following: 

15 ‘‘(M) Providers of maternal care services, 

16 including prenatal, labor and birth, and 

17 postpartum care services, and entities operating 

18 obstetric care units.’’; 

19 (2) in subsection (h)(1)(B), by striking ‘‘or pre20 natal’’ and inserting ‘‘or prenatal, labor and birth, 

21 or postpartum’’; and 

22 (3) in subsection (j)(1)(B), by inserting ‘‘equip23 ment useful for caring for pregnant individuals, in24 cluding ultrasound machines and fetal monitoring 

25 equipment, and other’’ before ‘‘equipment’’. 


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1 (e) RURAL MATERNAL AND OBSTETRIC CARE TRAIN2 ING DEMONSTRATION.—Part D of title VII of the Public 

3 Health Service Act is amended by inserting after section 

4 760 (42 U.S.C. 294k) the following: 

5 ‘‘SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE 

6 TRAINING DEMONSTRATION. 

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

8 training demonstration program to award to eligible enti9 ties— 

10 ‘‘(1) grants to support training for physicians, 

11 medical residents, and fellows (including physicians, 

12 residents, and fellows in family medicine and obstet13 rics and gynecology) to practice maternal and ob14 stetric medicine in rural community-based settings; 

15 ‘‘(2) grants to support training for licensed and 

16 accredited nurse practitioners, physician assistants, 

17 certified nurse midwives, certified midwives, certified 

18 professional midwives, home visiting nurses, or non19 clinical professionals such as doulas and community 

20 health workers, to provide maternal care services in 

21 rural community-based settings; and 

22 ‘‘(3) grants to— 

23 ‘‘(A) support establishing, maintaining, or 

24 improving academic units or programs that pro25 vide training for students or faculty, including 


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1 through clinical experiences and research, to 

2 improve maternal care in rural areas; or 

3 ‘‘(B) develop evidence-based practices or 

4 recommendations for the design of the units or 

5 programs described in subparagraph (A), in6 cluding curriculum content standards. 

7 ‘‘(b) ACTIVITIES.— 

8 ‘‘(1) TRAINING FOR PHYSICIANS, MEDICAL

9 RESIDENTS, AND FELLOWS.—A recipient of a grant 

10 under subsection (a)(1)— 

11 ‘‘(A) shall use the grant funds to plan, de12 velop, and operate a training program for the 

13 physicians, medical residents, and fellows de14 scribed in subsection (a)(1) to provide maternal 

15 and obstetric health care services in rural com16 munity-based settings; and 

17 ‘‘(B) may use the grant funds to provide 

18 additional support for the administration of the 

19 program or to meet the costs of projects to es20 tablish, maintain, or improve faculty develop21 ment, or departments, divisions, or other units 

22 necessary to implement such training. 

23 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re24 cipient of a grant under subsection (a)(2)— 


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1 ‘‘(A) shall use the grant funds to plan, de2 velop, or operate a training program for the in3 dividuals described in subsection (a)(2) to pro4 vide maternal health care services in rural, com5 munity-based settings; and 

6 ‘‘(B) may use the grant funds to provide 

7 additional support for the administration of the 

8 program or to meet the costs of projects to es9 tablish, maintain, or improve faculty develop10 ment, or departments, divisions, or other units 

11 necessary to implement such program. 

12 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—A re13 cipient of a grant under subsection (a)(3) shall enter 

14 into a partnership with organizations such as an 

15 education accrediting organization (such as the Liai16 son Committee on Medical Education, the Accredita17 tion Council for Graduate Medical Education, the 

18 Commission on Osteopathic College Accreditation, 

19 the Accreditation Commission for Education in 

20 Nursing, the Commission on Collegiate Nursing 

21 Education, the Accreditation Commission for Mid22 wifery Education, or the Accreditation Review Com23 mission on Education for the Physician Assistant) to 

24 carry out activities under subsection (a)(3). 


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1 ‘‘(4) TRAINING PROGRAM REQUIREMENTS.— 

2 The recipient of a grant under subsection (a)(1) or 

3 (a)(2) shall ensure that training programs carried 

4 out under the grant include instruction on— 

5 ‘‘(A) maternal mental health, including 

6 perinatal depression and anxiety and 

7 postpartum depression; 

8 ‘‘(B) maternal substance use disorder; 

9 ‘‘(C) social determinants of health that im10 pact individuals living in rural communities, in11 cluding poverty, social isolation, access to nutri12 tion, education, transportation, and housing; 

13 and 

14 ‘‘(D) implicit bias. 

15 ‘‘(c) ELIGIBLE ENTITIES.— 

16 ‘‘(1) TRAINING FOR PHYSICIANS, MEDICAL

17 RESIDENTS, AND FELLOWS.—To be eligible to re18 ceive a grant under subsection (a)(1), an entity 

19 shall— 

20 ‘‘(A) be a consortium consisting of— 

21 ‘‘(i) at least one teaching health cen22 ter (as defined in section 749A(f)); or 

23 ‘‘(ii) the sponsoring institution (or 

24 parent institution of the sponsoring insti25 tution) of— 


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1 ‘‘(I) an obstetrics and gynecology 

2 or family medicine residency program 

3 that is accredited by the Accreditation 

4 Council for Graduate Medical Edu5 cation (or the parent institution of 

6 such a program); or 

7 ‘‘(II) a fellowship in maternal or 

8 obstetric medicine, as determined ap9 propriate by the Secretary; or 

10 ‘‘(B) be an entity described in subpara11 graph (A)(ii) that provides opportunities for 

12 medical residents or fellows to train in rural 

13 community-based settings. 

14 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—To be 

15 eligible to receive a grant under subsection (a)(2), 

16 an entity shall be— 

17 ‘‘(A) a teaching health center (as defined 

18 in section 749A(f)); 

19 ‘‘(B) a federally qualified health center (as 

20 defined in section 1905(l)(2)(B) of the Social 

21 Security Act); 

22 ‘‘(C) a community mental health center (as 

23 defined in section 1861(ff)(3)(B) of the Social 

24 Security Act); 


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1 ‘‘(D) a rural health clinic (as defined in 

2 section 1861(aa) of the Social Security Act); 

3 ‘‘(E) a freestanding birth center (as de4 fined in section 1905(l)(3) of the Social Secu5 rity Act); 

6 ‘‘(F) a health center operated by— 

7 ‘‘(i) the Indian Health Service, an In8 dian tribe, or a tribal organization (as such 

9 terms are defined in section 4 of the In10 dian Health Care Improvement Act); or 

11 ‘‘(ii) a Native Hawaiian Health Care 

12 System (as defined in section 12 of the 

13 Native Hawaiian Health Care Improve14 ment Act); or 

15 ‘‘(G) an entity with a demonstrated record 

16 of success in providing academic training for 

17 nurse practitioners, physician assistants, cer18 tified nurse-midwives, certified midwives, cer19 tified professional midwives, home visiting 

20 nurses, or non-clinical professionals, such as 

21 doulas and community health workers. 

22 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be 

23 eligible to receive a grant under subsection (a)(3), 

24 an entity shall be a school of medicine or osteopathic 

25 medicine, a nursing school, a physician assistant 


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1 training program, an accredited public or nonprofit 

2 private hospital, an accredited medical residency pro3 gram, a school accredited by the Midwifery Edu4 cation and Accreditation Council, or a public or pri5 vate nonprofit entity which the Secretary has deter6 mined is capable of carrying out activities supported 

7 by such grant. 

8 ‘‘(4) APPLICATION.—To be eligible to receive a 

9 grant under subsection (a), an entity shall submit to 

10 the Secretary an application at such time, in such 

11 manner, and containing such information as the Sec12 retary may require, including an estimate of the 

13 amount to be expended to conduct training activities 

14 under the grant (including ancillary and administra15 tive costs). 

16 ‘‘(d) DURATION.—Grants awarded under this section 

17 shall be for a minimum of 5 years. 

18 ‘‘(e) STUDY AND REPORT.— 

19 ‘‘(1) STUDY.— 

20 ‘‘(A) IN GENERAL.—The Secretary, acting 

21 through the Administrator of the Health Re22 sources and Services Administration, shall con23 duct a study on the results of the demonstra24 tion program under this section. 


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1 ‘‘(B) DATA SUBMISSION.—Not later than 

2 90 days after the completion of the first year 

3 of the training program, and each subsequent 

4 year for the duration of the grant, that the pro5 gram is in effect, each recipient of a grant 

6 under subsection (a) shall submit to the Sec7 retary such data as the Secretary may require 

8 for analysis for the report described in para9 graph (2). 

10 ‘‘(2) REPORT TO CONGRESS.—Not later than 1 

11 year after receipt of the data described in paragraph 

12 (1)(B), the Secretary shall submit to Congress a re13 port that includes— 

14 ‘‘(A) an analysis of the effect of the dem15 onstration program under this section on the 

16 quality, quantity, and distribution of maternal, 

17 including prenatal, labor and birth, and 

18 postpartum care services and the demographics 

19 of the recipients of those services; 

20 ‘‘(B) an analysis of maternal and infant 

21 health outcomes (including quality of care, mor22 bidity, and mortality) before and after imple23 mentation of the program in the communities 

24 served by entities participating in the dem25 onstration; and 


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1 ‘‘(C) recommendations on whether the 

2 demonstration program under this section 

3 should be expanded. 

4 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section, 

6 $5,000,000 for each of fiscal years 2021 through 2025.’’. 

7 (f) GAO REPORT.—Not later than 1 year after the 

8 date of enactment of this Act, the Comptroller General 

9 of the United States shall submit to the appropriate com10 mittees of Congress a report on the maternal, including 

11 prenatal, labor and birth, and postpartum, care in rural 

12 areas. Such report shall include the following: 

13 (1) The location of gaps in maternal and ob14 stetric clinicians and health professionals, including 

15 non-clinical professionals such as doulas and com16 munity health workers. 

17 (2) The location of gaps in facilities able to pro18 vide maternal, including prenatal, labor and birth, 

19 and postpartum, care in rural areas, including care 

20 for high-risk pregnancies. 

21 (3) The gaps in data on maternal mortality and 

22 recommendations to standardize the format on col23 lecting data related to maternal mortality and mor24 bidity. 


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1 (4) The gaps in maternal health by race and 

2 ethnicity in rural communities, with a focus on ra3 cial inequities for Black residents and among Indian 

4 Tribes and residents who are Indian (as such terms 

5 are defined in section 4 of the Indian Health Care 

6 Improvement Act). 

7 (5) A list of specific activities that the Sec8 retary of Health and Human Services plans to con9 duct on maternal, including prenatal, labor and 

10 birth, and postpartum, care. 

11 (6) A plan for completing such activities. 

12 (7) An explanation of Federal agency involve13 ment and coordination needed to conduct such ac14 tivities. 

15 (8) A budget for conducting such activities. 

16 (9) Other information that the Comptroller 

17 General determines appropriate. 

18 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 

19 UNEXPECTED INFANT DEATH AND SUDDEN 

20 UNEXPLAINED DEATH IN CHILDHOOD. 

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

22 Human Services, acting through the Administrator of the 

23 Health Resources and Services Administration and in con24 sultation with the Director of the Centers for Disease Con25 trol and Prevention and the Director of the National InstiVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 tutes of Health (in this section referred to as the ‘‘Sec2 retary’’), shall establish and implement a culturally and 

3 linguistically competent public health awareness and edu4 cation campaign to provide information that is focused on 

5 decreasing the risk factors for sudden unexpected infant 

6 death and sudden unexplained death in childhood, includ7 ing educating individuals about safe sleep environments, 

8 sleep positions, and reducing exposure to smoking during 

9 pregnancy and after birth. 

10 (b) TARGETED POPULATIONS.—The campaign under 

11 subsection (a) shall be designed to reduce health dispari12 ties through the targeting of populations with high rates 

13 of sudden unexpected infant death and sudden unex14 plained death in childhood. 

15 (c) CONSULTATION.—In establishing and imple16 menting the campaign under subsection (a), the Secretary 

17 shall consult with national organizations representing 

18 health care providers, including nurses and physicians, 

19 parents, child care providers, children’s advocacy and safe20 ty organizations, maternal and child health programs, nu21 trition professionals focusing on women, infants, and chil22 dren, and other individuals and groups determined nec23 essary by the Secretary for such establishment and imple24 mentation. 

25 (d) GRANTS.— 


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1 (1) IN GENERAL.—In carrying out the cam2 paign under subsection (a), the Secretary shall 

3 award grants to national organizations, State and 

4 local health departments, and community-based or5 ganizations for the conduct of education and out6 reach programs for nurses, parents, child care pro7 viders, public health agencies, and community orga8 nizations. 

9 (2) APPLICATION.—To be eligible to receive a 

10 grant under paragraph (1), an entity shall submit to 

11 the Secretary an application at such time, in such 

12 manner, and containing such information as the Sec13 retary may require. 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section 

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

17 2021 through 2025. 

18 SEC. 508. REDUCING UNINTENDED TEENAGE PREG19 NANCIES. 

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

21 241 et seq.) is amended by adding at the end the fol22 lowing: 


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1 ‘‘PART W—YOUTH ACCESS TO SEXUAL HEALTH 

2 SERVICES 

3 ‘‘SEC. 399OO. AUTHORIZATION OF GRANTS TO SUPPORT 

4 THE ACCESS OF MARGINALIZED YOUTH TO 

5 SEXUAL HEALTH SERVICES. 

6 ‘‘(a) GRANTS.—The Secretary may award grants on 

7 a competitive basis to eligible entities to support the access 

8 of marginalized youth to sexual health services. 

9 ‘‘(b) USE OF FUNDS.—An eligible entity that is 

10 awarded a grant under subsection (a) may use the funds 

11 to— 

12 ‘‘(1) provide medically accurate and complete 

13 and age-, developmentally, and culturally appro14 priate sexual health information to marginalized 

15 youth, including information on how to access sexual 

16 health services; 

17 ‘‘(2) promote effective communication regarding 

18 sexual health among marginalized youth; 

19 ‘‘(3) promote and support better health, edu20 cation, and economic opportunities for school-age 

21 parents; and 

22 ‘‘(4) train individuals who work with 

23 marginalized youth to promote— 

24 ‘‘(A) the prevention of unintended preg25 nancy; 


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1 ‘‘(B) the prevention of sexually transmitted 

2 infections, including the human immuno3 deficiency virus (HIV); 

4 ‘‘(C) healthy relationships; and 

5 ‘‘(D) the development of safe and sup6 portive environments. 

7 ‘‘(c) APPLICATION.—To be awarded a grant under 

8 subsection (a), an eligible entity shall submit an applica9 tion to the Secretary at such time, in such manner, and 

10 containing such information as the Secretary may require. 

11 ‘‘(d) PRIORITY.—In awarding grants under sub12 section (a), the Secretary shall give priority to eligible enti13 ties— 

14 ‘‘(1) with a history of supporting the access of 

15 marginalized youth to sexuality education or sexual 

16 health services; and 

17 ‘‘(2) that plan to serve marginalized youth that 

18 are not served by Federal adolescent programs for 

19 the prevention of pregnancy, HIV, and other sexu20 ally transmitted infections. 

21 ‘‘(e) REQUIREMENTS.—The Secretary may not award 

22 a grant under subsection (a) to an eligible entity unless— 

23 ‘‘(1) such eligible entity has formed a partner24 ship with a community organization; and 

25 ‘‘(2) such eligible entity agrees— 


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1 ‘‘(A) to employ a scientifically effective 

2 strategy; 

3 ‘‘(B) that all information provided to 

4 marginalized youth will be— 

5 ‘‘(i) age- and developmentally appro6 priate; 

7 ‘‘(ii) medically accurate and complete; 

8 ‘‘(iii) scientifically based; and 

9 ‘‘(iv) provided in the language and 

10 cultural context that is most appropriate 

11 for the individuals served by the eligible 

12 entity; and 

13 ‘‘(C) that for each year the eligible entity 

14 receives grant funds under subsection (a), the 

15 eligible entity will submit to the Secretary an 

16 annual report that includes— 

17 ‘‘(i) the use of grant funds by the eli18 gible entity; 

19 ‘‘(ii) how the use of grant funds has 

20 increased the access of marginalized youth 

21 to sexual health services; and 

22 ‘‘(iii) such other information as the 

23 Secretary may require. 

24 ‘‘(f) PUBLICATION AND EVALUATIONS.— 


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1 ‘‘(1) EVALUATIONS.—Not less than once every 

2 two years after the date of the enactment of this 

3 part, the Secretary shall evaluate the effectiveness of 

4 whichever of the following is greater: 

5 ‘‘(A) Eight grants awarded under sub6 section (a). 

7 ‘‘(B) Ten percent of the grants awarded 

8 under subsection (a). 

9 ‘‘(2) PUBLICATION.—The Secretary shall make 

10 available to the public— 

11 ‘‘(A) the evaluations required under para12 graph (1); and 

13 ‘‘(B) the reports required under subsection 

14 (e)(2)(C). 

15 ‘‘(g) LIMITATIONS.—No funds made available to an 

16 eligible entity under this section may be used by such enti17 ty to provide access to sexual health services that— 

18 ‘‘(1) withhold sexual health-promoting or life19 saving information; 

20 ‘‘(2) are medically inaccurate or have been sci21 entifically shown to be ineffective; 

22 ‘‘(3) promote gender stereotypes; 

23 ‘‘(4) are insensitive or unresponsive to the 

24 needs of young people, including— 


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1 ‘‘(A) youth with varying gender identities, 

2 gender expressions, and sexual orientations; 

3 ‘‘(B) sexually active youth; 

4 ‘‘(C) pregnant or parenting youth; 

5 ‘‘(D) survivors of sexual abuse or assault; 

6 and 

7 ‘‘(E) youth of all physical, developmental, 

8 and mental abilities; or 

9 ‘‘(5) are inconsistent with the ethical impera10 tives of medicine and public health. 

11 ‘‘(h) TRANSFER OF FUNDS.—Any unobligated bal12 ance of funds made available under section 510(f) of the 

13 Social Security Act (as in effect on the day before the date 

14 of the enactment of this part) are hereby transferred and 

15 made available to the Secretary to carry out this section. 

16 The amounts transferred and made available to carry out 

17 this section shall remain available until expended. 

18 ‘‘(i) DEFINITIONS.—In this section: 

19 ‘‘(1) COMMUNITY ORGANIZATION.—The term 

20 ‘community organization’ includes a State or local 

21 health or education agency, public school, youth-fo22 cused organization that is faith-based and commu23 nity-based, juvenile justice entity, or other organiza24 tion that provides confidential and appropriate sexuVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ality education or sexual health services to 

2 marginalized youth. 

3 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en4 tity’ includes a State or local health or education 

5 agency, public school, nonprofit organization, hos6 pital, or an Indian Tribe or Tribal organization (as 

7 such terms are defined in section 4 of the Indian 

8 Self-Determination and Education Assistance Act 

9 (25 U.S.C. 5304)). 

10 ‘‘(3) MARGINALIZED YOUTH.—The term 

11 ‘marginalized youth’ means a person under the age 

12 of 26 that is disadvantaged by underlying structural 

13 barriers and social inequity. 

14 ‘‘(4) MEDICALLY ACCURATE AND COMPLETE.— 

15 The term ‘medically accurate and complete’, when 

16 used with respect to information, means information 

17 that— 

18 ‘‘(A) is supported by research and recog19 nized as accurate, objective, and complete by 

20 leading medical, psychological, psychiatric, or 

21 public health organizations and agencies; and 

22 ‘‘(B) does not withhold any information re23 lating to the effectiveness and benefits of cor24 rect and consistent use of condoms or other 


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1 contraceptives and pregnancy prevention meth2 ods. 

3 ‘‘(5) SCIENTIFICALLY EFFECTIVE STRATEGY.— 

4 The term ‘scientifically effective strategy’ means a 

5 strategy that— 

6 ‘‘(A) is widely recognized by leading med7 ical and public health agencies as effective in 

8 promoting sexual health awareness and healthy 

9 behavior; and 

10 ‘‘(B) either— 

11 ‘‘(i) has been demonstrated to be ef12 fective on the basis of rigorous scientific 

13 research; or 

14 ‘‘(ii) incorporates characteristics of ef15 fective programs. 

16 ‘‘(6) SEXUAL HEALTH SERVICES.—The term 

17 ‘sexual health services’ includes— 

18 ‘‘(A) sexual health information, education, 

19 and counseling; 

20 ‘‘(B) contraception; 

21 ‘‘(C) emergency contraception; 

22 ‘‘(D) condoms and other barrier methods 

23 to prevent pregnancy or sexually transmitted in24 fections; 


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1 ‘‘(E) routine gynecological care, including 

2 human papillomavirus (HPV) vaccines and can3 cer screenings; 

4 ‘‘(F) pre-exposure prophylaxis or post-ex5 posure prophylaxis; 

6 ‘‘(G) mental health services; 

7 ‘‘(H) sexual assault survivor services; and 

8 ‘‘(I) other prevention, care, or treatment.’’. 

9 SEC. 509. GESTATIONAL DIABETES. 

10 Part B of title III of the Public Health Service Act 

11 (42 U.S.C. 243 et seq.) is amended by adding after section 

12 317H the following: 

13 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 

14 ‘‘(a) UNDERSTANDING AND MONITORING GESTA15 TIONAL DIABETES.— 

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

17 through the Director of the Centers for Disease 

18 Control and Prevention, in consultation with the Di19 abetes Mellitus Interagency Coordinating Committee 

20 established under section 429 and representatives of 

21 appropriate national health organizations, shall de22 velop a multisite gestational diabetes research 

23 project within the diabetes program of the Centers 

24 for Disease Control and Prevention to expand and 


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1 enhance surveillance data and public health research 

2 on gestational diabetes. 

3 ‘‘(2) AREAS TO BE ADDRESSED.—The research 

4 project developed under paragraph (1) shall ad5 dress— 

6 ‘‘(A) procedures to establish accurate and 

7 efficient systems for the collection of gestational 

8 diabetes data within each State and common9 wealth, territory, or possession of the United 

10 States; 

11 ‘‘(B) the progress of collaborative activities 

12 with the National Vital Statistics System, the 

13 National Center for Health Statistics, and 

14 State health departments with respect to the 

15 standard birth certificate, in order to improve 

16 surveillance of gestational diabetes; 

17 ‘‘(C) postpartum methods of tracking indi18 viduals with gestational diabetes after delivery 

19 as well as targeted interventions proven to 

20 lower the incidence of type 2 diabetes in that 

21 population; 

22 ‘‘(D) variations in the distribution of diag23 nosed and undiagnosed gestational diabetes, 

24 and of impaired fasting glucose tolerance and 


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1 impaired fasting glucose, within and among 

2 groups of pregnant individuals; and 

3 ‘‘(E) factors and culturally sensitive inter4 ventions that influence risks and reduce the in5 cidence of gestational diabetes and related com6 plications during childbirth, including cultural, 

7 behavioral, racial, ethnic, geographic, demo8 graphic, socioeconomic, and genetic factors. 

9 ‘‘(3) REPORT.—Not later than 2 years after the 

10 date of the enactment of this section, and annually 

11 thereafter, the Secretary shall generate a report on 

12 the findings and recommendations of the research 

13 project including prevalence of gestational diabetes 

14 in the multisite area and disseminate the report to 

15 the appropriate Federal and non-Federal agencies. 

16 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE17 SEARCH.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall expand 

19 and intensify public health research regarding gesta20 tional diabetes. Such research may include— 

21 ‘‘(A) developing and testing novel ap22 proaches for improving postpartum diabetes 

23 testing or screening and for preventing type 2 

24 diabetes in individuals who can become preg25 nant with a history of gestational diabetes; and 


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1 ‘‘(B) conducting public health research to 

2 further understanding of the epidemiologic, 

3 socioenvironmental, behavioral, translation, and 

4 biomedical factors and health systems that in5 fluence the risk of gestational diabetes and the 

6 development of type 2 diabetes in individuals 

7 who can become pregnant with a history of ges8 tational diabetes. 

9 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

11 this subsection $5,000,000 for each of fiscal years 

12 2021 through 2025. 

13 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE

14 RATE OF GESTATIONAL DIABETES.— 

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

16 through the Director of the Centers for Disease 

17 Control and Prevention, shall award grants, on a 

18 competitive basis, to eligible entities for demonstra19 tion projects that implement evidence-based inter20 ventions to reduce the incidence of gestational diabe21 tes, the recurrence of gestational diabetes in subse22 quent pregnancies, and the development of type 2 di23 abetes in individuals who can become pregnant with 

24 a history of gestational diabetes. 


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1 ‘‘(2) PRIORITY.—In making grants under this 

2 subsection, the Secretary shall give priority to 

3 projects focusing on— 

4 ‘‘(A) helping individuals who can become 

5 pregnant who have 1 or more risk factors for 

6 developing gestational diabetes; 

7 ‘‘(B) working with individuals who can be8 come pregnant with a history of gestational dia9 betes during a previous pregnancy; 

10 ‘‘(C) providing postpartum care for indi11 viduals who can become pregnant with gesta12 tional diabetes; 

13 ‘‘(D) tracking cases where individuals who 

14 can become pregnant with a history of gesta15 tional diabetes developed type 2 diabetes; 

16 ‘‘(E) educating mothers with a history of 

17 gestational diabetes about the increased risk of 

18 their child developing diabetes; 

19 ‘‘(F) working to prevent gestational diabe20 tes and prevent or delay the development of 

21 type 2 diabetes in individuals who can become 

22 pregnant with a history of gestational diabetes; 

23 and 

24 ‘‘(G) achieving outcomes designed to assess 

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1 tions that can inform decisions on long-term 

2 sustainability, including third-party reimburse3 ment. 

4 ‘‘(3) APPLICATION.—An eligible entity desiring 

5 to receive a grant under this subsection shall submit 

6 to the Secretary— 

7 ‘‘(A) an application at such time, in such 

8 manner, and containing such information as the 

9 Secretary may require; and 

10 ‘‘(B) a plan to— 

11 ‘‘(i) lower the rate of gestational dia12 betes during pregnancy; or 

13 ‘‘(ii) develop methods of tracking indi14 viduals who can become pregnant with a 

15 history of gestational diabetes and develop 

16 effective interventions to lower the inci17 dence of the recurrence of gestational dia18 betes in subsequent pregnancies and the 

19 development of type 2 diabetes. 

20 ‘‘(4) USES OF FUNDS.—An eligible entity re21 ceiving a grant under this subsection shall use the 

22 grant funds to carry out demonstration projects de23 scribed in paragraph (1), including— 

24 ‘‘(A) expanding community-based health 

25 promotion education, activities, and incentives 


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1 focused on the prevention of gestational diabe2 tes and development of type 2 diabetes in indi3 viduals who can become pregnant with a history 

4 of gestational diabetes; 

5 ‘‘(B) aiding State- and Tribal-based diabe6 tes prevention and control programs to collect, 

7 analyze, disseminate, and report surveillance 

8 data on individuals who can become pregnant 

9 with, and at risk for, gestational diabetes, the 

10 recurrence of gestational diabetes in subsequent 

11 pregnancies, and, for individuals who can be12 come pregnant with a history of gestational dia13 betes, the development of type 2 diabetes; and 

14 ‘‘(C) training and encouraging health care 

15 providers— 

16 ‘‘(i) to promote risk assessment, high17 quality care, and self-management for ges18 tational diabetes and the recurrence of ges19 tational diabetes in subsequent preg20 nancies; and 

21 ‘‘(ii) to prevent the development of 

22 type 2 diabetes in individuals who can be23 come pregnant with a history of gesta24 tional diabetes, and its complications in the 


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1 practice settings of the health care pro2 viders. 

3 ‘‘(5) REPORT.—Not later than 4 years after the 

4 date of the enactment of this section, the Secretary 

5 shall prepare and submit to the Congress a report 

6 concerning the results of the demonstration projects 

7 conducted through the grants awarded under this 

8 subsection. 

9 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 

10 this subsection, the term ‘eligible entity’ means a 

11 nonprofit organization (such as a nonprofit academic 

12 center or community health center) or a State, Trib13 al, or local health agency. 

14 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

15 There is authorized to be appropriated to carry out 

16 this subsection $5,000,000 for each of fiscal years 

17 2021 through 2025. 

18 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA19 TIONAL DIABETES.—The Secretary, acting through the 

20 Director of the Centers for Disease Control and Preven21 tion, shall work with the State- and Tribal-based diabetes 

22 prevention and control programs assisted by the Centers 

23 to encourage postpartum followup after gestational diabe24 tes, as medically appropriate, for the purpose of reducing 

25 the incidence of gestational diabetes, the recurrence of 


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1 gestational diabetes in subsequent pregnancies, the devel2 opment of type 2 diabetes in individuals with a history 

3 of gestational diabetes, and related complications.’’. 

4 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 

5 INFORMATION PROGRAMS. 

6 (a) EMERGENCY CONTRACEPTION PUBLIC EDU7 CATION PROGRAM.— 

8 (1) IN GENERAL.—The Secretary, acting 

9 through the Director of the Centers for Disease 

10 Control and Prevention, shall develop and dissemi11 nate to the public medically accurate and complete 

12 information on emergency contraceptives. 

13 (2) DISSEMINATION.—The Secretary may dis14 seminate medically accurate and complete informa15 tion under paragraph (1) directly or through ar16 rangements with nonprofit organizations, community 

17 health workers including promotores, consumer 

18 groups, institutions of higher education, clinics, the 

19 media, and Federal, State, and local agencies. 

20 (3) INFORMATION.—The information dissemi21 nated under paragraph (1) shall— 

22 (A) include, at a minimum, a description 

23 of emergency contraceptives and an explanation 

24 of the use, safety, efficacy, affordability, and 

25 availability, including over-the-counter access, 


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1 of such contraceptives and options for access 

2 without cost-sharing through insurance and 

3 other programs; and 

4 (B) be pilot tested for consumer com5 prehension, cultural and linguistic appropriate6 ness, and acceptance of the messages across 

7 geographically, racially, ethnically, and linguis8 tically diverse populations. 

9 (b) EMERGENCY CONTRACEPTION INFORMATION

10 PROGRAM FOR HEALTH CARE PROVIDERS.— 

11 (1) IN GENERAL.—The Secretary, acting 

12 through the Administrator of the Health Resources 

13 and Services Administration and in consultation 

14 with major medical and public health organizations, 

15 shall develop and disseminate to health care pro16 viders, including pharmacists, information on emer17 gency contraceptives. 

18 (2) INFORMATION.—The information dissemi19 nated under paragraph (1) shall include, at a min20 imum— 

21 (A) information describing the use, safety, 

22 efficacy, and availability of emergency contra23 ceptives, and options for access without cost24 sharing through insurance and other programs; 


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1 (B) a recommendation regarding the use of 

2 such contraceptives; and 

3 (C) information explaining how to obtain 

4 copies of the information developed under sub5 section (a) for distribution to the patients of 

6 the providers. 

7 (c) DEFINITIONS.—In this section: 

8 (1) HEALTH CARE PROVIDER.—The term 

9 ‘‘health care provider’’ means an individual who is li10 censed or certified under State law to provide health 

11 care services and who is operating within the scope 

12 of such license. Such term shall include a phar13 macist. 

14 (2) INSTITUTION OF HIGHER EDUCATION.—The 

15 term ‘‘institution of higher education’’ has the same 

16 meaning given such term in section 101(a) of the 

17 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 

18 (3) SECRETARY.—The term ‘‘Secretary’’ means 

19 the Secretary of Health and Human Services. 

20 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section 

22 such sums as may be necessary for each of the fiscal years 

23 2021 through 2025. 

24 SEC. 511. COMPREHENSIVE SEX EDUCATION PROGRAMS. 

25 (a) PURPOSES; FINDING; SENSE OF CONGRESS.— 


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1 (1) PURPOSES.—The purposes of this section 

2 are to provide young people with comprehensive sex 

3 education programs that— 

4 (A) promote and uphold the rights of 

5 young people to information in order to make 

6 healthy decisions about their sexual health; 

7 (B) provide the information and skills all 

8 young people need to make informed, respon9 sible, and healthy decisions in order to become 

10 sexually healthy adults and have healthy rela11 tionships; 

12 (C) provide information about the preven13 tion of unintended pregnancy, sexually trans14 mitted infections, including HIV, dating vio15 lence, sexual assault, bullying, and harassment; 

16 and 

17 (D) provide resources and information on 

18 topics ranging from gender stereotyping and 

19 gender roles and stigma and socio-cultural in20 fluences surrounding sex and sexuality. 

21 (2) FINDING ON REQUIRED RESOURCES.—In 

22 order to provide the comprehensive sex education de23 scribed in paragraph (1), Congress finds that in24 creased resources are required for sex education pro25 grams that— 


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1 (A) substantially incorporate elements of 

2 evidence-based programs or characteristics of 

3 effective programs; 

4 (B) cover a broad range of topics, includ5 ing medically accurate and complete informa6 tion that is age and developmentally appro7 priate about all the aspects of sex, sexual 

8 health, and sexuality; 

9 (C) are gender and gender identity-sen10 sitive, emphasizing the importance of equality 

11 and the social environment for achieving sexual 

12 and reproductive health and overall well-being; 

13 (D) promote educational achievement, crit14 ical thinking, decision making, self-esteem, and 

15 self-efficacy; 

16 (E) help develop healthy attitudes and in17 sights necessary for understanding relationships 

18 between oneself and others and society; 

19 (F) foster leadership skills and community 

20 engagement by— 

21 (i) promoting principles of fairness, 

22 human dignity, and respect; and 

23 (ii) engaging young people as partners 

24 in their communities; and 


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1 (G) are culturally and linguistically appro2 priate, reflecting the diverse circumstances and 

3 realities of young people. 

4 (3) SENSE OF CONGRESS.—It is the sense of 

5 Congress that— 

6 (A) federally funded sex education pro7 grams should aim to— 

8 (i) provide information about a range 

9 of human sexuality topics, including— 

10 (I) human development, healthy 

11 relationships, personal skills; 

12 (II) sexual behavior including ab13 stinence; 

14 (III) sexual health including pre15 venting unintended pregnancy; 

16 (IV) sexually transmitted infec17 tions including HIV; and 

18 (V) society and culture; 

19 (ii) promote safe and healthy relation20 ships; 

21 (iii) promote gender equity; 

22 (iv) use, and be informed by, the best 

23 scientific information available; 

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1 ties, gender expressions, and sexual ori2 entations; 

3 (vi) be built on characteristics of ef4 fective programs; 

5 (vii) expand the existing body of re6 search on comprehensive sex education 

7 programs through program evaluation; 

8 (viii) expand training programs for 

9 teachers of comprehensive sex education; 

10 (ix) build on programs funded under 

11 section 513 of the Social Security Act (42 

12 U.S.C. 713) and the Office of Adolescent 

13 Health’s Teen Pregnancy Prevention Pro14 gram, funded under title II of the Consoli15 dated Appropriations Act, 2010 (Public 

16 Law 111–117; 123 Stat. 3253), and on 

17 programs supported through the Centers 

18 for Disease Control and Prevention (CDC); 

19 and 

20 (x) promote and uphold the rights of 

21 young people to information in order to 

22 make healthy and autonomous decisions 

23 about their sexual health; and 

24 (B) no Federal funds should be used for 

25 health education programs that— 


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1 (i) withhold health-promoting or life2 saving information about sexuality-related 

3 topics, including HIV; 

4 (ii) are medically inaccurate or have 

5 been scientifically shown to be ineffective; 

6 (iii) promote gender or racial stereo7 types; 

8 (iv) are insensitive and unresponsive 

9 to the needs of sexually active young peo10 ple; 

11 (v) are insensitive and unresponsive to 

12 the needs of survivors of sexual violence; 

13 (vi) are insensitive and unresponsive 

14 to the needs of youth of all physical, devel15 opmental, and mental abilities; 

16 (vii) are insensitive and unresponsive 

17 to the needs of youth with varying gender 

18 identities, gender expressions, and sexual 

19 orientations; or 

20 (viii) are inconsistent with the ethical 

21 imperatives of medicine and public health. 

22 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION

23 FOR ADOLESCENTS.— 

24 (1) PROGRAM AUTHORIZED.—The Secretary of 

25 Health and Human Services, in coordination with 


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1 the Associate Commissioner of the Family and 

2 Youth Services Bureau of the Administration on 

3 Children, Youth, and Families of the Department of 

4 Health and Human Services, the Director of the Of5 fice of Adolescent Health, the Director of the Divi6 sion of Adolescent and School Health within the 

7 Centers for Disease Control and Prevention and the 

8 Secretary of Education, shall award grants, on a 

9 competitive basis, to eligible entities to enable such 

10 eligible entities to carry out programs that provide 

11 adolescents with comprehensive sex education, as de12 scribed in paragraph (6). 

13 (2) DURATION.—Grants awarded under this 

14 section shall be for a period of 5 years. 

15 (3) ELIGIBLE ENTITY.—In this section, the 

16 term ‘‘eligible entity’’ means a public or private enti17 ty that focuses on adolescent health and education 

18 or has experience working with adolescents. 

19 (4) APPLICATIONS.—An eligible entity desiring 

20 a grant under this subsection shall submit an appli21 cation to the Secretary at such time, in such man22 ner, and containing such information as the Sec23 retary may require, including an assurance to par24 ticipate in the evaluation described in subsection (e). 


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1 (5) PRIORITY.—In awarding grants under this 

2 section, the Secretary shall give priority to eligible 

3 entities that— 

4 (A) are State or local public entities; 

5 (B) are entities not currently receiving 

6 funds under— 

7 (i) section 513 of the Social Security 

8 Act (42 U.S.C. 713); 

9 (ii) the Office of Adolescent Health’s 

10 Teen Pregnancy Prevention Program, 

11 funded under title II of the Consolidated 

12 Appropriations Act, 2010 (Public Law 

13 111–117; 123 Stat. 3253), or any substan14 tially similar successive program; or 

15 (iii) the Centers for Disease Control 

16 and Prevention’s Division of Adolescent 

17 and School Health; and 

18 (C) address health inequities among young 

19 people that face systemic barriers resulting in 

20 disproportionate rates of not less than one of 

21 the following: 

22 (i) Unintended pregnancies. 

23 (ii) Sexually transmitted infections, 

24 including HIV. 


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1 (iii) Dating violence and sexual vio2 lence. 

3 (6) USE OF FUNDS.— 

4 (A) IN GENERAL.—Each eligible entity 

5 that receives a grant under this section shall 

6 use the grant funds to carry out an education 

7 program that provides adolescents with com8 prehensive sex education that— 

9 (i) is age and developmentally appro10 priate; 

11 (ii) is medically accurate and com12 plete; 

13 (iii) substantially incorporates ele14 ments of evidence-based sex education in15 struction; or 

16 (iv) creates a demonstration project 

17 based on characteristics of effective pro18 grams. 

19 (B) CONTENTS OF COMPREHENSIVE SEX

20 EDUCATION PROGRAMS.—The comprehensive 

21 sex education programs funded under this sec22 tion shall include instruction and materials that 

23 address— 

24 (i) the physical, social, and emotional 

25 changes of human development including, 


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1 human anatomy, reproduction, and sexual 

2 development; 

3 (ii) healthy relationships, including 

4 friendships, within families, and society, 

5 that are based on mutual respect, and the 

6 ability to distinguish between healthy and 

7 unhealthy relationships, including— 

8 (I) effective communication, ne9 gotiation and refusal skills, including 

10 the skills to recognize and report in11 appropriate or abusive sexual ad12 vances; 

13 (II) bodily autonomy, setting and 

14 respecting personal boundaries, prac15 ticing personal safety, and consent; 

16 and 

17 (III) the limitations and harm of 

18 gender- role stereotypes, violence, co19 ercion, bullying, harassment, and in20 timidation in relationships; 

21 (iii) healthy decision-making skills 

22 about sexuality and relationships that in23 clude— 


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1 (I) critical thinking, problem 

2 solving, self-efficacy, stress-manage3 ment, self-care, and decision making; 

4 (II) individual values and atti5 tudes; 

6 (III) the promotion of positive 

7 body images; 

8 (IV) developing an understanding 

9 that there are a range of body types 

10 and encouraging positive feeling about 

11 students’ own body types; 

12 (V) information on how to re13 spect others and ensure safety on the 

14 internet and when using other forms 

15 of digital communication; 

16 (VI) information on local services 

17 and resources where students can ob18 tain additional information related to 

19 bullying, harassment, dating violence 

20 and sexual assault, suicide prevention, 

21 and other related care; 

22 (VII) encouragement for youth to 

23 communicate with their parents or 

24 guardians, health and social service 

25 professionals, and other trusted adults 


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1 about sexuality and intimate relation2 ships; 

3 (VIII) information on how to cre4 ate a safe environment for all stu5 dents and others in society; 

6 (IX) examples of varying types of 

7 relationships, couples, and family 

8 structures; and 

9 (X) affirmative representation of 

10 varying gender identities, gender ex11 pressions, and sexual orientations, in12 cluding individuals and relationships 

13 between same sex couples and their 

14 families; 

15 (iv) abstinence, delaying age of first 

16 sexual activity, the use of condoms, preven17 tive medication, vaccination, birth control, 

18 and other sexually transmitted infection 

19 prevention measures, and the options for 

20 pregnancy, including parenting, adoption, 

21 and abortion, including— 

22 (I) the importance of effectively 

23 using condoms, preventive medication, 

24 and applicable vaccinations to protect 


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1 against sexually transmitted infec2 tions, including HIV; 

3 (II) the benefits of effective con4 traceptive and condom use in avoiding 

5 unintended pregnancy; 

6 (III) the relationship between 

7 substance use and sexual health and 

8 behaviors; and 

9 (IV) information about local 

10 health services where students can ob11 tain additional information and serv12 ices related to sexual and reproductive 

13 health and other related care; 

14 (v) through affirmative recognition, 

15 the roles that traditions, values, religion, 

16 norms, gender roles, acculturation, family 

17 structure, health beliefs, and political 

18 power play in how students make decisions 

19 that affect their sexual health, using exam20 ples of various types of races, ethnicities, 

21 cultures, and families, including single-par22 ent households and young families; 

23 (vi) information about gender identity, 

24 gender expression, and sexual orientation 

25 for all students, including— 


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1 (I) affirmative recognition that 

2 people have different gender identi3 ties, gender expressions, and sexual 

4 orientations; and 

5 (II) community resources that 

6 can provide additional support for in7 dividuals with varying gender identi8 ties, gender expressions, and sexual 

9 orientations; and 

10 (vii) opportunities to explore the roles 

11 that race, ethnicity, immigration status, 

12 disability status, economic status, home13 lessness, foster care status, and language 

14 within different communities affect sexual 

15 attitudes in society and culture and how 

16 this may impact student sexual health. 

17 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION

18 AT INSTITUTIONS OF HIGHER EDUCATION.— 

19 (1) PROGRAM AUTHORIZED.—The Secretary, in 

20 coordination with the Secretary of Education, shall 

21 award grants, on a competitive basis, to institutions 

22 of higher education or consortia of such institutions 

23 to enable such institutions to provide young people 

24 with comprehensive sex education, as described in 

25 paragraph (5)(B). 


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1 (2) DURATION.—Grants awarded under this 

2 subsection shall be for a period of 5 years. 

3 (3) APPLICATIONS.—An institution of higher 

4 education or consortium of such institutions desiring 

5 a grant under this subsection shall submit an appli6 cation to the Secretary at such time, in such man7 ner, and containing such information as the Sec8 retary may require, including an assurance to par9 ticipate in the evaluation described in subsection (e). 

10 (4) PRIORITY.—In awarding grants under this 

11 subsection, the Secretary shall give priority to an in12 stitution of higher education that— 

13 (A) has an enrollment of needy students, 

14 as defined in section 318(b) of the Higher Edu15 cation Act of 1965 (20 U.S.C. 1059e(b)); 

16 (B) is a Hispanic-serving institution, as 

17 defined in section 502(a) of such Act (20 

18 U.S.C. 1101a(a)); 

19 (C) is a Tribal College or University, as 

20 defined in section 316(b) of such Act (20 

21 U.S.C. 1059c(b)); 

22 (D) is an Alaska Native-serving institution, 

23 as defined in section 317(b) of such Act (20 

24 U.S.C. 1059d(b)); 


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1 (E) is a Native Hawaiian-serving institu2 tion, as defined in section 317(b) of such Act 

3 (20 U.S.C. 1059d(b)); 

4 (F) is a Predominately Black Institution, 

5 as defined in section 318(b) of such Act (20 

6 U.S.C. 1059e(b)); 

7 (G) is a Native American-serving, non8 tribal institution, as defined in section 319(b) 

9 of such Act (20 U.S.C. 1059f(b)); 

10 (H) is an Asian American and Native 

11 American Pacific Islander-serving institution, as 

12 defined in section 320(b) of such Act (20 

13 U.S.C. 1059g(b)); or 

14 (I) is a minority institution, as defined in 

15 section 365 of such Act (20 U.S.C. 1067k), 

16 with an enrollment of needy students, as de17 fined in section 312 of such Act (20 U.S.C. 

18 1058). 

19 (5) USES OF FUNDS.— 

20 (A) IN GENERAL.—An institution of higher 

21 education, or a consortium, receiving a grant 

22 under this subsection shall use grant funds to 

23 integrate issues relating to comprehensive sex 

24 education into the institution of higher edu25 cation, or consortium, in order to reach a large 


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1 number of students, by carrying out 1 or more 

2 of the following activities: 

3 (i) Developing or adopting educational 

4 content for issues relating to comprehen5 sive sex education that will be incorporated 

6 into student orientation, general education, 

7 or core courses. 

8 (ii) Developing or adopting, and im9 plementing schoolwide educational pro10 gramming outside of class that delivers ele11 ments of comprehensive sex education pro12 grams to students, faculty, and staff. 

13 (iii) Developing or adopting innovative 

14 technology-based approaches to deliver sex 

15 education to students, faculty, and staff. 

16 (iv) Developing or adopting, and im17 plementing peer-outreach and education 

18 programs to generate discussion, educate, 

19 and raise awareness among students about 

20 issues relating to comprehensive sex edu21 cation. 

22 (B) CONTENTS OF SEX EDUCATION PRO23 GRAMS.—Each institution of higher education’s 

24 program of comprehensive sex education funded 

25 under this section shall include instruction and 


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1 materials that address the contents required 

2 under subsection (b)(6). 

3 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE

4 TEACHER TRAINING.— 

5 (1) PROGRAM AUTHORIZED.—The Secretary, in 

6 coordination with the Director of the Centers for 

7 Disease Control and Prevention and the Secretary of 

8 Education, shall award grants, on a competitive 

9 basis, to eligible entities to enable such eligible enti10 ties to carry out the activities described in para11 graph (5). 

12 (2) DURATION.—Grants awarded under this 

13 section shall be for a period of 5 years. 

14 (3) ELIGIBLE ENTITY.—In this section, the 

15 term ‘‘eligible entity’’ means— 

16 (A) a State educational agency, as defined 

17 in section 8101 of the Elementary and Sec18 ondary Education of 1965 (20 U.S.C. 7801); 

19 (B) a local educational agency, as defined 

20 in section 8101 of the Elementary and Sec21 ondary Education of 1965 (20 U.S.C. 7801); 

22 (C) an Indian Tribe or Tribal organization, 

23 as defined in section 4 of the Indian Self-Deter24 mination and Education Assistance Act (25 

25 U.S.C. 5304); 


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1 (D) a State or local department of health; 

2 (E) a State or local department of edu3 cation; 

4 (F) an educational service agency, as de5 fined in section 8101 of the Elementary and 

6 Secondary Education of 1965 (20 U.S.C. 

7 7801); 

8 (G) a nonprofit institution of higher edu9 cation, as defined in section 101 of the Higher 

10 Education Act of 1965 (20 U.S.C. 1001); 

11 (H) a national or statewide nonprofit orga12 nization that has as its primary purpose the im13 provement of provision of comprehensive sex 

14 education through training and effective teach15 ing of comprehensive sex education; or 

16 (I) a consortium of nonprofit organizations 

17 that has as its primary purpose the improve18 ment of provision of comprehensive sex edu19 cation through training and effective teaching 

20 of comprehensive sex education. 

21 (4) APPLICATION.—An eligible entity desiring a 

22 grant under this subsection shall submit an applica23 tion to the Secretary at such time, in such manner, 

24 and containing such information as the Secretary 


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1 may require, including an assurance to participate in 

2 the evaluation described in subsection (e). 

3 (5) AUTHORIZED ACTIVITIES.— 

4 (A) REQUIRED ACTIVITY.—Each eligible 

5 entity receiving a grant under this section shall 

6 use grant funds for professional development 

7 and training of relevant faculty, school adminis8 trators, teachers, and staff, in order to increase 

9 effective teaching of comprehensive sex edu10 cation students. 

11 (B) PERMISSIBLE ACTIVITIES.—Each eligi12 ble entity receiving a grant under this section 

13 may use grant funds to— 

14 (i) provide research-based training of 

15 teachers for comprehensive sex education 

16 for adolescents as a means of broadening 

17 student knowledge about issues related to 

18 human development, healthy relationships, 

19 personal skills, and sexual behavior, includ20 ing abstinence, sexual health, and society 

21 and culture; 

22 (ii) support the dissemination of infor23 mation on effective practices and research 

24 findings concerning the teaching of com25 prehensive sex education; 


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1 (iii) support research on— 

2 (I) effective comprehensive sex 

3 education teaching practices; and 

4 (II) the development of assess5 ment instruments and strategies to 

6 document— 

7 (aa) student understanding 

8 of comprehensive sex education; 

9 and 

10 (bb) the effects of com11 prehensive sex education; 

12 (iv) convene national conferences on 

13 comprehensive sex education, in order to 

14 effectively train teachers in the provision of 

15 comprehensive sex education; and 

16 (v) develop and disseminate appro17 priate research-based materials to foster 

18 comprehensive sex education. 

19 (C) SUBGRANTS.—Each eligible entity re20 ceiving a grant under this subsection may 

21 award subgrants to nonprofit organizations that 

22 possess a demonstrated record of providing 

23 training to faculty, school administrators, 

24 teachers, and staff on comprehensive sex edu25 cation to— 


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1 (i) train teachers in comprehensive 

2 sex education; 

3 (ii) support internet or distance learn4 ing related to comprehensive sex education; 

5 (iii) promote rigorous academic stand6 ards and assessment techniques to guide 

7 and measure student performance in com8 prehensive sex education; 

9 (iv) encourage replication of best 

10 practices and model programs to promote 

11 comprehensive sex education; 

12 (v) develop and disseminate effective, 

13 research-based comprehensive sex edu14 cation learning materials; 

15 (vi) develop academic courses on the 

16 pedagogy of sex education at institutions 

17 of higher education; or 

18 (vii) convene State-based conferences 

19 to train teachers in comprehensive sex edu20 cation and to identify strategies for im21 provement. 

22 (e) IMPACT EVALUATION AND REPORTING.— 

23 (1) MULTI-YEAR EVALUATION.— 

24 (A) IN GENERAL.—Not later than 6 

25 months after the date of the enactment of this 


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1 Act, the Secretary shall enter into a contract 

2 with a nonprofit organization with experience in 

3 conducting impact evaluations, to conduct a 

4 multi-year evaluation on the impact of the 

5 grants under subsections (b), (c), and (d), and 

6 to report to Congress and the Secretary on the 

7 findings of such evaluation. 

8 (B) EVALUATION.—The evaluation con9 ducted under this subsection shall— 

10 (i) be conducted in a manner con11 sistent with relevant, nationally recognized 

12 professional and technical evaluation 

13 standards; 

14 (ii) use sound statistical methods and 

15 techniques relating to the behavioral 

16 sciences, including quasi-experimental de17 signs, inferential statistics, and other 

18 methodologies and techniques that allow 

19 for conclusions to be reached; 

20 (iii) be carried out by an independent 

21 organization that has not received a grant 

22 under subsection (b), (c), or (d); and 

23 (iv) be designed to provide informa24 tion on— 


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1 (I) output measures, such as the 

2 number of individuals served under 

3 the grant and the number of hours of 

4 instruction; 

5 (II) outcome measures, including 

6 measures relating to— 

7 (aa) the knowledge that in8 dividuals participating in the 

9 grant program have gained in 

10 each of the following age and de11 velopmentally appropriate 

12 areas— 

13 (AA) growth and devel14 opment; 

15 (BB) relationship dy16 namics; 

17 (CC) ways to prevent 

18 unintended pregnancy and 

19 sexually transmitted infec20 tions, including HIV; and 

21 (DD) sexual health; 

22 (bb) the age and develop23 mentally appropriate skills that 

24 individuals participating in the 


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1 grant program have gained re2 garding— 

3 (AA) negotiation and 

4 communication; 

5 (BB) decision making 

6 and goal setting; 

7 (CC) interpersonal 

8 skills and healthy relation9 ships; and 

10 (DD) condom use; and 

11 (cc) the behaviors of adoles12 cents participating in the grant 

13 program, including data about— 

14 (AA) age of first inter15 course; 

16 (BB) condom and con17 traceptive use at first inter18 course; 

19 (CC) recent condom 

20 and contraceptive use; 

21 (DD) substance use; 

22 (EE) dating abuse and 

23 lifetime history of sexual as24 sault, dating violence, bulVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 lying, harassment, stalking; 

2 and 

3 (FF) academic per4 formance; and 

5 (III) other measures necessary to 

6 evaluate the impact of the grant pro7 gram. 

8 (C) REPORT.—Not later than 6 years after 

9 the date of enactment of this Act, the organiza10 tion conducting the evaluation under this sub11 section shall prepare and submit to the appro12 priate committees of Congress and the Sec13 retary an evaluation report. Such report shall 

14 be made publicly available, including on the 

15 website of the Department of Health and 

16 Human Services. 

17 (2) SECRETARY’S REPORT TO CONGRESS.—Not 

18 later than 1 year after the date of the enactment of 

19 this Act, and annually thereafter for a period of 5 

20 years, the Secretary shall prepare and submit to the 

21 appropriate committees of Congress a report on the 

22 activities to provide adolescents and young people 

23 with comprehensive sex education and pre-service 

24 and in-service teacher training funded under this 


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1 section. The Secretary’s report to Congress shall in2 clude— 

3 (A) a statement of how grants awarded by 

4 the Secretary meet the purposes described in 

5 subsection (a)(1); and 

6 (B) information about— 

7 (i) the number of eligible entities and 

8 institutions of higher education that are 

9 receiving grant funds under subsections 

10 (b), (c), and (d); 

11 (ii) the specific activities supported by 

12 grant funds awarded under subsections 

13 (b), (c), and (d); 

14 (iii) the number of adolescents served 

15 by grant programs funded under sub16 section (b); 

17 (iv) the number of young people 

18 served by grant programs funded under 

19 subsection (c); 

20 (v) the number of faculty, school ad21 ministrators, teachers, and staff trained 

22 under subsection (d); and 

23 (vi) the status of the evaluation re24 quired under paragraph (1). 


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1 (f) NONDISCRIMINATION.—Programs funded under 

2 this section shall not discriminate on the basis of actual 

3 or perceived sex, race, color, ethnicity, national origin, dis4 ability, sexual orientation, gender identity, or religion. 

5 Nothing in this section shall be construed to invalidate or 

6 limit rights, remedies, procedures, or legal standards avail7 able under any other Federal law or any law of a State 

8 or a political subdivision of a State, including the Civil 

9 Rights Act of 1964 (42 U.S.C. 2000a et seq.), title IX 

10 of the Education Amendments of 1972 (20 U.S.C. 1681 

11 et seq.), section 504 of the Rehabilitation Act of 1973 (29 

12 U.S.C. 794), the Americans with Disabilities Act of 1990 

13 (42 U.S.C. 12101 et seq.), and section 1557 of the Patient 

14 Protection and Affordable Care Act (42 U.S.C. 18116). 

15 (g) LIMITATION.—No Federal funds provided under 

16 this section may be used for health education programs 

17 that— 

18 (1) withhold health-promoting or life-saving in19 formation about sexuality-related topics, including 

20 HIV; 

21 (2) are medically inaccurate or have been sci22 entifically shown to be ineffective; 

23 (3) promote gender or racial stereotypes; 

24 (4) are insensitive and unresponsive to the 

25 needs of sexually active young people; 


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1 (5) are insensitive and unresponsive to the 

2 needs of pregnant or parenting young people; 

3 (6) are insensitive and unresponsive to the 

4 needs of survivors of sexual abuse or assault; 

5 (7) are insensitive and unresponsive to the 

6 needs of youth of all physical, developmental, or 

7 mental abilities; 

8 (8) are insensitive and unresponsive to individ9 uals with varying gender identities, gender expres10 sions, and sexual orientations; or 

11 (9) are inconsistent with the ethical imperatives 

12 of medicine and public health. 

13 (h) AMENDMENTS TO OTHER LAWS.— 

14 (1) AMENDMENT TO THE PUBLIC HEALTH

15 SERVICE ACT.—Section 2500 of the Public Health 

16 Service Act (42 U.S.C. 300ee) is amended by strik17 ing subsections (b) through (d) and inserting the fol18 lowing: 

19 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 

20 education and information receiving funds under this title 

21 shall include information about the potential effects of in22 travenous substance abuse.’’. 

23 (2) AMENDMENTS TO THE ELEMENTARY AND

24 SECONDARY EDUCATION ACT OF 1965.—Section 8526 


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1 of the Elementary and Secondary Education Act of 

2 1965 (20 U.S.C. 7906) is amended— 

3 (A) by striking paragraph (3); 

4 (B) by redesignating paragraphs (4) and 

5 (5) as paragraphs (3) and (4), respectively; 

6 (C) in paragraph (3), as redesignated by 

7 subparagraph (B), by inserting ‘‘or’’ after the 

8 semicolon; 

9 (D) in paragraph (4), as redesignated by 

10 subparagraph (B), by striking ‘‘; or’’ and in11 serting a period; and 

12 (E) by striking paragraph (6). 

13 (i) DEFINITIONS.—In this section: 

14 (1) ADOLESCENTS.—The term ‘‘adolescents’’ 

15 means individuals who are ages 10 through 19 at 

16 the time of commencement of participation in a pro17 gram supported under this section. 

18 (2) AGE AND DEVELOPMENTALLY APPRO19 PRIATE.—The term ‘‘age and developmentally appro20 priate’’ means topics, messages, and teaching meth21 ods suitable to particular age, age group of children 

22 and adolescents, or developmental levels, based on 

23 cognitive, emotional, social, and behavioral capacity 

24 of most students at that age level. 


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1 (3) APPROPRIATE COMMITTEES OF CON2 GRESS.—The term ‘‘appropriate committees of Con3 gress’’ means the Committee on Health, Education, 

4 Labor, and Pensions of the Senate, the Committee 

5 on Appropriations of the Senate, the Committee on 

6 Energy and Commerce of the House of Representa7 tives, the Committee on Education and Labor of the 

8 House of Representatives, and the Committee on 

9 Appropriations of the House of Representatives. 

10 (4) CHARACTERISTICS OF EFFECTIVE PRO11 GRAMS.—The term ‘‘characteristics of effective pro12 grams’’ means the aspects of evidence-based pro13 grams, including development, content, and imple14 mentation of such programs, that— 

15 (A) have been shown to be effective in 

16 terms of increasing knowledge, clarifying values 

17 and attitudes, increasing skills, and impacting 

18 upon behavior; and 

19 (B) are widely recognized by leading med20 ical and public health agencies to be effective in 

21 changing sexual behaviors that lead to sexually 

22 transmitted infections, including HIV, unin23 tended pregnancy, and dating violence and sex24 ual assault among young people. 


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1 (5) COMPREHENSIVE SEX EDUCATION.—The 

2 term ‘‘comprehensive sex education’’ means instruc3 tional part of a comprehensive school health edu4 cation approach which addresses the physical, men5 tal, emotional, and social dimensions of human sexu6 ality; designed to motivate and assist students to 

7 maintain and improve their sexual health, prevent 

8 disease and reduce sexual health-related risk behav9 iors; and enable and empower students to develop 

10 and demonstrate age and developmentally appro11 priate sexuality and sexual health-related knowledge, 

12 attitudes, skills, and practices. 

13 (6) CONSENT.—The term ‘‘consent’’ means af14 firmative, conscious, and voluntary agreement to en15 gage in interpersonal, physical, or sexual activity. 

16 (7) CULTURALLY APPROPRIATE.—The term 

17 ‘‘culturally appropriate’’ means materials and in18 struction that respond to culturally diverse individ19 uals, families and communities in an inclusive, re20 spectful and effective manner; including materials 

21 and instruction that are inclusive of race, ethnicity, 

22 languages, cultural background, religion, sex, gender 

23 identity, sexual orientation, and different abilities. 

24 (8) EVIDENCE-BASED.—The term ‘‘evidence25 based’’, when used with respect to sex education inVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 struction, means a sex education program that has 

2 been proven through rigorous evaluation to be effec3 tive in changing sexual behavior or incorporates ele4 ments of other programs that have been proven to 

5 be effective in changing sexual behavior. 

6 (9) GENDER EXPRESSION.—The term ‘‘gender 

7 expression’’, when used with respect to a sex edu8 cation program, means the expression of one’s gen9 der, such as through behavior, clothing, haircut, or 

10 voice, and which may or may not conform to socially 

11 defined behaviors and characteristics typically asso12 ciated with being either masculine or feminine. 

13 (10) GENDER IDENTITY.—Except with respect 

14 to subsection (f), the term ‘‘gender identity’’, when 

15 used with respect to a sex education program, means 

16 the gender-related identity, appearance, mannerisms, 

17 or other gender-related characteristics of an indi18 vidual, regardless of the individual’s designated sex 

19 at birth including a person’s deeply held sense or 

20 knowledge of their own gender; such as male, fe21 male, both or neither. 

22 (11) INCLUSIVE.—The term ‘‘inclusive’’, when 

23 used with respect to a sex education program, means 

24 curriculum that ensures that students from historiVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 cally marginalized communities are reflected in 

2 classroom materials and lessons. 

3 (12) INSTITUTION OF HIGHER EDUCATION.— 

4 The term ‘‘institution of higher education’’ has the 

5 meaning given the term in section 101 of the Higher 

6 Education Act of 1965 (20 U.S.C. 1001). 

7 (13) MEDICALLY ACCURATE AND COMPLETE.— 

8 The term ‘‘medically accurate and complete’’, when 

9 used with respect to a sex education program, means 

10 that— 

11 (A) the information provided through the 

12 program is verified or supported by the weight 

13 of research conducted in compliance with ac14 cepted scientific methods and is published in 

15 peer-reviewed journals, where applicable; or 

16 (B)(i) the program contains information 

17 that leading professional organizations and 

18 agencies with relevant expertise in the field rec19 ognize as accurate, objective, and complete; and 

20 (ii) the program does not withhold infor21 mation about the effectiveness and benefits of 

22 correct and consistent use of condoms and 

23 other contraceptives. 

24 (14) SECRETARY.—The term ‘‘Secretary’’ 

25 means the Secretary of Health and Human Services. 


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1 (15) SEXUAL DEVELOPMENT.—The term ‘‘sex2 ual development’’ means the lifelong process of phys3 ical, behavioral, cognitive, and emotional growth and 

4 change as it relates to an individual’s sexuality and 

5 sexual maturation, including puberty, identity devel6 opment, socio-cultural influences, and sexual behav7 iors. 

8 (16) SEXUAL ORIENTATION.—Except with re9 spect to subsection (f), the term ‘‘sexual orienta10 tion’’, when used with respect to a sex education 

11 program, means an individual’s attraction, including 

12 physical or emotional, to the same or different gen13 der. 

14 (17) YOUNG PEOPLE.—The term ‘‘young peo15 ple’’ means individuals who are ages 10 through 24 

16 at the time of commencement of participation in a 

17 program supported under this section. 

18 (j) FUNDING.— 

19 (1) APPROPRIATION.—For the purpose of car20 rying out this section, there is appropriated 

21 $75,000,000 for each of fiscal years 2021 through 

22 2026. Amounts appropriated under this subsection 

23 shall remain available until expended. 

24 (2) RESERVATIONS OF FUNDS.— 


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1 (A) The Secretary shall reserve 50 percent 

2 of the amount appropriated under paragraph 

3 (1) for the purposes of awarding grants for 

4 comprehensive sex education for adolescents 

5 under subsection (c). 

6 (B) The Secretary shall reserve 25 percent 

7 of the amount appropriated under paragraph 

8 (1) for the purposes of awarding grants for 

9 comprehensive sex education at institutes of 

10 higher education under subsection (d). 

11 (C) The Secretary shall reserve 20 percent 

12 of the amount appropriated under paragraph 

13 (1) for the purposes of awarding grants for pre14 service and in-service teacher training under 

15 subsection (e). 

16 (D) The Secretary shall reserve 2 percent 

17 of the amount appropriated under paragraph 

18 (1) for the purpose of carrying out the impact 

19 evaluation and reporting required under sub20 section (a). 

21 (3) SECRETARIAL RESPONSIBILITIES.—The 

22 Secretary shall reserve 3 percent of the amount ap23 propriated under paragraph (1) for each fiscal year 

24 for expenditures by the Secretary to provide, directly 

25 or through a competitive grant process, research, 


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1 training, and technical assistance, including dissemi2 nation of research and information regarding effec3 tive and promising practices, providing consultation 

4 and resources, and developing resources and mate5 rials to support the activities of recipients of grants. 

6 In carrying out such functions, the Secretary shall 

7 collaborate with a variety of entities that have exper8 tise in adolescent sexual health development, edu9 cation, and promotion. 

10 (4) REPROGRAMMING OF ABSTINENCE ONLY

11 UNTIL MARRIAGE PROGRAM FUNDING.—The unobli12 gated balance of funds made available to carry out 

13 section 510 of the Social Security Act (42 U.S.C. 

14 710) (as in effect on the day before the date of en15 actment of this Act) are hereby transferred and shall 

16 be used by the Secretary to carry out this section. 

17 The amounts transferred and made available to 

18 carry out this section shall remain available until ex19 pended. 

20 (5) REPEAL OF ABSTINENCE ONLY UNTIL MAR21 RIAGE PROGRAM.—Section 510 of the Social Secu22 rity Act (42 U.S.C. 710) is repealed. 

23 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER24 GENCIES. 

25 (a) MEDICARE.— 


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1 (1) LIMITATION ON PAYMENT.—Section 

2 1866(a)(1) of the Social Security Act (42 U.S.C. 

3 1395cc(a)(1)) is amended— 

4 (A) by moving the indentation of subpara5 graph (W) 2 ems to the left; 

6 (B) in subparagraph (X)— 

7 (i) by moving the indentation 2 ems 

8 to the left; and 

9 (ii) by striking ‘‘and’’ at the end; 

10 (C) in subparagraph (Y), by striking the 

11 period at the end and inserting ‘‘; and’’; and 

12 (D) by inserting after subparagraph (Y) 

13 the following new subparagraph: 

14 ‘‘(Z) in the case of a hospital or critical access 

15 hospital, to adopt and enforce a policy to ensure 

16 compliance with the requirements of subsection (l) 

17 and to meet the requirements of such subsection.’’. 

18 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 

19 the Social Security Act (42 U.S.C. 1395cc) is 

20 amended by adding at the end the following new 

21 subsection: 

22 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER23 GENCIES.— 

24 ‘‘(1) IN GENERAL.—For purposes of section 

25 1866(a)(1)(Z), a hospital meets the requirements of 


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1 this subsection if the hospital provides each of the 

2 services described in paragraph (2) to each indi3 vidual, whether or not eligible for benefits under this 

4 title or under any other form of health insurance, 

5 who comes to the hospital on or after January 1, 

6 2021, and— 

7 ‘‘(A) who states to hospital personnel that 

8 they are victims of sexual assault; 

9 ‘‘(B) who is accompanied by an individual 

10 who states to hospital personnel that the indi11 vidual is a victim of sexual assault; or 

12 ‘‘(C) whom hospital personnel, during the 

13 course of treatment and care for the individual, 

14 have reason to believe is a victim of sexual as15 sault. 

16 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 

17 purposes of paragraph (1), the services described in 

18 this subparagraph are the following: 

19 ‘‘(A) Provision of medically and factually 

20 accurate and unbiased written and oral infor21 mation about emergency contraception that— 

22 ‘‘(i) is written in clear and concise 

23 language; 

24 ‘‘(ii) is readily comprehensible; 


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1 ‘‘(iii) includes an explanation that 

2 emergency contraceptives— 

3 ‘‘(I) has been approved by the 

4 Food and Drug Administration for in5 dividuals and is a safe and effective 

6 way to prevent pregnancy after unpro7 tected intercourse or contraceptive 

8 failure if taken in a timely manner; 

9 ‘‘(II) is more effective the sooner 

10 it is taken; and 

11 ‘‘(III) does not cause an abortion 

12 and cannot interrupt an established 

13 pregnancy; 

14 ‘‘(iv) meets such conditions regarding 

15 the provision of such information in lan16 guages other than English as the Secretary 

17 may establish; and 

18 ‘‘(v) is provided without regard to the 

19 ability of the individual or their family to 

20 pay costs associated with the provision of 

21 such information to the individual. 

22 ‘‘(B) Immediate offer to provide emergency 

23 contraception to the individual at the hospital 

24 and, in the case that the individual accepts such 

25 offer, immediate provision to the individual of 


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1 such contraception on the same day it is re2 quested without regard to the inability of the 

3 individual or their family to pay costs associ4 ated with the offer and provision of such con5 traception. 

6 ‘‘(C) Development and implementation of a 

7 written policy to ensure that an individual is 

8 present at the hospital, or on-call, who— 

9 ‘‘(i) has authority to dispense or pre10 scribe emergency contraception, independ11 ently, or under a protocol prepared by a 

12 physician for the administration of emer13 gency contraception at the hospital to a 

14 victim of sexual assault; and 

15 ‘‘(ii) is trained to comply with the re16 quirements of this section. 

17 ‘‘(D) Provision of medically and factually 

18 accurate and unbiased written and oral infor19 mation and counseling about post-exposure pro20 phylaxis (PEP) protocol for the prevention of 

21 HIV. 

22 ‘‘(E) Immediately offer to begin PEP to 

23 the individual at the hospital except in cases 

24 where the medical professional’s best judgement 

25 is that further evaluation is required or that 


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1 such a regimen will be substantially detrimental 

2 to the individual’s health. Such provision shall 

3 be offered regardless of the individual’s ability 

4 to pay. Hospitals shall be responsible for ensur5 ing adequate supply of PEP medications to pro6 vide to patients. 

7 ‘‘(3) HOSPITAL DEFINED.—For purposes of 

8 this paragraph, the term ‘hospital’ includes a critical 

9 access hospital, as defined in section 

10 1861(mm)(1).’’. 

11 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 

12 Section 1903(i) of the Social Security Act (42 U.S.C. 

13 1396b(i)) is amended by inserting after paragraph (8) the 

14 following new paragraph: 

15 ‘‘(9) with respect to any amount expended for 

16 care or services furnished under the plan by a hos17 pital on or after January 1, 2021, unless such hos18 pital meets the requirements specified in section 

19 1866(l) for purposes of title XVIII;’’. 

20 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR21 MACIES TO ENSURE PROVISION OF FDA-AP22 PROVED CONTRACEPTION. 

23 Part B of title II of the Public Health Service Act 

24 (42 U.S.C. 238 et seq.) is amended by adding at the end 

25 the following: 


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1 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 

2 OF FDA-APPROVED CONTRACEPTION. 

3 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 

4 pharmacy that receives Food and Drug Administration5 approved drugs or devices in interstate commerce shall 

6 maintain compliance with the following: 

7 ‘‘(1) If a customer requests a contraceptive or 

8 a medication related to a contraceptive, including 

9 emergency contraception, that is in stock, the phar10 macy shall ensure that the contraceptive is provided 

11 to the customer without delay. 

12 ‘‘(2) If a customer requests a contraceptive or 

13 a medication related to a contraceptive that is not 

14 in stock and the pharmacy in the normal course of 

15 business stocks contraception, the pharmacy shall 

16 immediately inform the customer that the contracep17 tive is not in stock and without delay offer the cus18 tomer the following options: 

19 ‘‘(A) If the customer prefers to obtain the 

20 contraceptive or a medication related to a con21 traceptive through a referral or transfer, the 

22 pharmacy shall— 

23 ‘‘(i) locate a pharmacy of the cus24 tomer’s choice or the closest pharmacy 

25 confirmed to have the contraceptive or a 


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1 medication related to a contraceptive in 

2 stock; and 

3 ‘‘(ii) refer the customer or transfer 

4 the prescription to that pharmacy. 

5 ‘‘(B) If the customer prefers for the phar6 macy to order the contraceptive or a medication 

7 related to a contraceptive, the pharmacy shall 

8 obtain the contraceptive or medication under 

9 the pharmacy’s standard procedure for expe10 dited ordering of medication and notify the cus11 tomer when the contraceptive or medication ar12 rives. 

13 ‘‘(3) The pharmacy shall ensure that— 

14 ‘‘(A) the pharmacy does not operate an en15 vironment in which customers are intimidated, 

16 threatened, or harassed in the delivery of serv17 ices relating to a request for contraception or a 

18 medication related to a contraceptive; 

19 ‘‘(B) the pharmacy’s employees do not 

20 interfere with or obstruct the delivery of serv21 ices relating to a request for contraception or a 

22 medication related to a contraceptive; 

23 ‘‘(C) the pharmacy’s employees do not in24 tentionally misrepresent or deceive customers 

25 about the availability of a contraceptive or a 


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1 medication related to a contraceptive, or the 

2 mechanism of action of such contraceptive or 

3 medication; 

4 ‘‘(D) the pharmacy’s employees do not 

5 breach medical confidentiality with respect to a 

6 request for a contraceptive or a medication re7 lated to a contraceptive or threaten to breach 

8 such confidentiality; or 

9 ‘‘(E) the pharmacy’s employees do not 

10 refuse to return a valid, lawful prescription for 

11 a contraceptive or a medication related to a 

12 contraceptive upon customer request. 

13 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY

14 STOCKED.—Nothing in subsection (a)(2) shall be con15 strued to require any pharmacy to comply with such sub16 section if the pharmacy does not ordinarily stock contra17 ceptives or a medication related to a contraceptive in the 

18 normal course of business. 

19 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR20 MACY PRACTICE.—This section does not prohibit a phar21 macy from refusing to provide a contraceptive or a medi22 cation related to a contraceptive to a customer in accord23 ance with any of the following: 

24 ‘‘(1) If it is unlawful to dispense the contracep25 tive or a medication related to a contraceptive to the 


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1 customer without a valid, lawful prescription and no 

2 such prescription is presented. 

3 ‘‘(2) If the customer is unable to pay for the 

4 contraceptive or the medication related to a contra5 ceptive. 

6 ‘‘(3) If the employee of the pharmacy refuses to 

7 provide the contraceptive or a medication related to 

8 a contraceptive on the basis of a professional clinical 

9 judgment. 

10 ‘‘(d) RELATION TO OTHER LAW.— 

11 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 

12 this section shall be construed to invalidate or limit 

13 rights, remedies, procedures, or legal standards 

14 under title VII of the Civil Rights Act of 1964. 

15 ‘‘(2) CERTAIN CLAIMS.—The Religious Free16 dom Restoration Act of 1993 shall not provide a 

17 basis for a claim concerning, or a defense to a claim 

18 under, this section, or provide a basis for challenging 

19 the application or enforcement of this section. 

20 ‘‘(e) PREEMPTION.—This section does not preempt 

21 any provision of State law or any professional obligation 

22 made applicable by a State board or other entity respon23 sible for licensing or discipline of pharmacies or phar24 macists, to the extent that such State law or professional 


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1 obligation provides protections for customers that are 

2 greater than the protections provided by this section. 

3 ‘‘(f) ENFORCEMENT.— 

4 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio5 lates a requirement of subsection (a) is liable to the 

6 United States for a civil penalty in an amount not 

7 exceeding $1,000 per day of violation, not to exceed 

8 $100,000 for all violations adjudicated in a single 

9 proceeding. 

10 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 

11 aggrieved as a result of a violation of a requirement 

12 of subsection (a) may, in any court of competent ju13 risdiction, commence a civil action against the phar14 macy involved to obtain appropriate relief, including 

15 actual and punitive damages, injunctive relief, and a 

16 reasonable attorney’s fee and cost. 

17 ‘‘(3) LIMITATIONS.—A civil action under para18 graph (1) or (2) may not be commenced against a 

19 pharmacy after the expiration of the 5-year period 

20 beginning on the date on which the pharmacy alleg21 edly engaged in the violation involved. 

22 ‘‘(g) DEFINITIONS.—In this section: 

23 ‘‘(1) CONTRACEPTION.—The term ‘contracep24 tion’ or ‘contraceptive’ means any drug or device apVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 proved by the Food and Drug Administration to pre2 vent pregnancy. 

3 ‘‘(2) EMPLOYEE.—The term ‘employee’ means 

4 a person hired, by contract or any other form of an 

5 agreement, by a pharmacy. 

6 ‘‘(3) MEDICATION RELATED TO A CONTRACEP7 TIVE.—The term ‘medication related to a contracep8 tive’ means any drug or device approved by the Food 

9 and Drug Administration that a medical professional 

10 determines necessary to use before or in conjunction 

11 with a contraceptive. 

12 ‘‘(4) PHARMACY.—The term ‘pharmacy’ means 

13 an entity that— 

14 ‘‘(A) is authorized by a State to engage in 

15 the business of selling prescription drugs at re16 tail; and 

17 ‘‘(B) employs one or more employees. 

18 ‘‘(5) PRODUCT.—The term ‘product’ means a 

19 Food and Drug Administration-approved drug or de20 vice. 

21 ‘‘(6) PROFESSIONAL CLINICAL JUDGMENT.— 

22 The term ‘professional clinical judgment’ means the 

23 use of professional knowledge and skills to form a 

24 clinical judgment, in accordance with prevailing 

25 medical standards. 


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1 ‘‘(7) WITHOUT DELAY.—The term ‘without 

2 delay’, with respect to a pharmacy providing, pro3 viding a referral for, or ordering contraception, or 

4 transferring the prescription for contraception, 

5 means within the usual and customary timeframe at 

6 the pharmacy for providing, providing a referral for, 

7 or ordering other products, or transferring the pre8 scription for other products, respectively. 

9 ‘‘(h) EFFECTIVE DATE.—This section shall take ef10 fect on the 31st day after the date of the enactment of 

11 this section, without regard to whether the Secretary has 

12 issued any guidance or final rule regarding this section.’’. 

13 SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 

14 WOMEN’S HEALTH. 

15 Section 229(b) of the Public Health Service Act (42 

16 U.S.C. 237a(b)) is amended— 

17 (1) in paragraph (6), at the end, by striking 

18 ‘‘and’’; 

19 (2) in paragraph (7), at the end, by striking the 

20 period and inserting a semicolon; and 

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

22 paragraph: 

23 ‘‘(8) facilitate policymakers, health system lead24 ers and providers, consumers, and other stake25 holders in understanding optimal maternity care and 


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1 support for the provision of such care, including the 

2 priorities of— 

3 ‘‘(A) protecting, promoting, and supporting 

4 the innate capacities of childbearing individuals 

5 and their newborns for childbirth, breastfeed6 ing, and attachment; 

7 ‘‘(B) using obstetric interventions only 

8 when such interventions are supported by 

9 strong, high-quality evidence, and minimizing 

10 overuse of maternity practices that have been 

11 shown to have benefit in limited situations and 

12 that can expose women, infants, or both to risk 

13 of harm if used routinely and indiscriminately, 

14 including continuous electronic fetal monitoring, 

15 labor induction, epidural analgesia, primary ce16 sarean section, and routine repeat cesarean 

17 birth; 

18 ‘‘(C) reliably incorporating noninvasive, 

19 evidence-based practices that have documented 

20 correlation with considerable improvement in 

21 outcomes with no detrimental side effects, such 

22 as smoking cessation programs in pregnancy 

23 and proven models of group prenatal care that 

24 integrate health assessment, education, and 

25 support into a unified program and supporting 


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1 evidence-based breastfeeding promotion efforts 

2 with respect for a breastfeeding individual’s 

3 personal decision making; 

4 ‘‘(D) a shared understanding of the quali5 fications of licensed providers of maternity care 

6 and the best evidence about the safety, satisfac7 tion, outcomes, and costs of their care, and ap8 propriate deployment of such caregivers within 

9 the maternity care workforce to address the 

10 needs of childbearing individuals and newborns 

11 and the growing shortage of maternity care12 givers; 

13 ‘‘(E) a shared understanding of the results 

14 of the best available research comparing hos15 pital, birth center, and planned home births, in16 cluding information about each setting’s safety, 

17 satisfaction, outcomes, and costs; 

18 ‘‘(F) high-quality, evidence-based child19 birth education that promotes a natural, 

20 healthy, and safe approach to pregnancy, child21 birth, and early parenting; is taught by certified 

22 educators, peer counselors, and health profes23 sionals; and promotes informed decision making 

24 by childbearing individuals; and 


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1 ‘‘(G) developing measures that enable a 

2 more robust, balanced set of standardized ma3 ternity care measures, including performance 

4 and quality measures;’’. 

5 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 

6 THE PROMOTION OF OPTIMAL MATERNITY 

7 OUTCOMES. 

8 (a) IN GENERAL.—Part A of title II of the Public 

9 Health Service Act (42 U.S.C. 202 et seq.) is amended 

10 by adding at the end the following: 

11 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 

12 THE PROMOTION OF OPTIMAL MATERNITY 

13 OUTCOMES. 

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

15 the Deputy Assistant Secretary for Women’s Health under 

16 section 229 and in collaboration with the Federal officials 

17 specified in subsection (b), shall establish the Interagency 

18 Coordinating Committee on the Promotion of Optimal Ma19 ternity Outcomes (referred to in this section as the 

20 ‘ICCPOM’). 

21 ‘‘(b) OTHER AGENCIES.—The officials specified in 

22 this subsection are the Secretary of Labor, the Secretary 

23 of Defense, the Secretary of Veterans Affairs, the Surgeon 

24 General, the Director of the Centers for Disease Control 

25 and Prevention, the Administrator of the Health ReVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 sources and Services Administration, the Administrator of 

2 the Centers for Medicare & Medicaid Services, the Direc3 tor of the Indian Health Service, the Administrator of the 

4 Substance Abuse and Mental Health Services Administra5 tion, the Director of the National Institute of Child Health 

6 and Human Development, the Director of the Agency for 

7 Healthcare Research and Quality, the Assistant Secretary 

8 for Children and Families, the Deputy Assistant Secretary 

9 for Minority Health, the Director of the Office of Per10 sonnel Management, and such other Federal officials as 

11 the Secretary of Health and Human Services determines 

12 to be appropriate. 

13 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 

14 Women’s Health shall serve as the chair of the ICCPOM. 

15 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 

16 program development across the Federal Government with 

17 respect to promotion of optimal maternity care, provided, 

18 however, that nothing in this section shall be construed 

19 as transferring regulatory or program authority from an 

20 agency to the ICCPOM. 

21 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 

22 seek the input of, and shall consult with, all appropriate 

23 and interested stakeholders, including State health depart24 ments, public health research and interest groups, founda25 tions, childbearing individuals and their advocates, and 


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1 maternity care professional associations and organiza2 tions, reflecting racially, ethnically, demographically, and 

3 geographically diverse communities. 

4 ‘‘(f) ANNUAL REPORT.— 

5 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 

6 the ICCPOM, shall annually submit to Congress a 

7 report that summarizes— 

8 ‘‘(A) all programs and policies of Federal 

9 agencies (including the Medicare Program 

10 under title XVIII of the Social Security Act and 

11 the Medicaid program under title XIX of such 

12 Act) designed to promote optimal maternity 

13 care, focusing particularly on programs and 

14 policies that support the adoption of evidence 

15 based maternity care, as defined by timely, sci16 entifically sound systematic reviews; 

17 ‘‘(B) all programs and policies of Federal 

18 agencies (including the Medicare Program 

19 under title XVIII of the Social Security Act and 

20 the Medicaid program under title XIX of such 

21 Act) designed to address the problems of mater22 nal mortality and morbidity, infant mortality, 

23 prematurity, and low birth weight, including 

24 such programs and policies designed to address 


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1 racial and ethnic disparities with respect to 

2 each of such problems; 

3 ‘‘(C) the extent of progress in reducing 

4 maternal mortality and infant mortality, low 

5 birth weight, and prematurity at State and na6 tional levels; and 

7 ‘‘(D) such other information regarding op8 timal maternity care (such as quality and per9 formance measures) as the Secretary deter10 mines to be appropriate. 

11 The information specified in subparagraph (C) shall 

12 be included in each such report in a manner that 

13 disaggregates such information by race, ethnicity, 

14 and indigenous status in order to determine the ex15 tent of progress in reducing racial and ethnic dis16 parities and disparities related to indigenous status. 

17 ‘‘(2) CERTAIN INFORMATION.—Each report 

18 under paragraph (1) shall include information 

19 (disaggregated by race, ethnicity, and indigenous 

20 status, as applicable) on the following rates and 

21 costs by State: 

22 ‘‘(A) The rate of primary cesarean deliv23 eries and repeat cesarean deliveries. 

24 ‘‘(B) The rate of vaginal births after cesar25 ean. 


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1 ‘‘(C) The rate of vaginal breech births. 

2 ‘‘(D) The rate of induction of labor. 

3 ‘‘(E) The rate of freestanding birth center 

4 births. 

5 ‘‘(F) The rate of planned and unplanned 

6 home birth. 

7 ‘‘(G) The rate of attended births by pro8 vider, including by an obstetrician-gynecologist, 

9 family practice physician, obstetrician-gyne10 cologist physician assistant, certified nurse-mid11 wife, certified midwife, and certified profes12 sional midwife. 

13 ‘‘(H) The cost of maternity care 

14 disaggregated by place of birth and provider of 

15 care, including— 

16 ‘‘(i) uncomplicated vaginal birth; 

17 ‘‘(ii) complicated vaginal birth; 

18 ‘‘(iii) uncomplicated cesarean birth; 

19 and 

20 ‘‘(iv) complicated cesarean birth. 

21 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated, in addition to amounts 

23 authorized to be appropriated under section 229(e), to 

24 carry out this section $1,000,000 for each of the fiscal 

25 years 2021 through 2025.’’. 


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1 (b) CONFORMING AMENDMENTS.— 

2 (1) INCLUSION AS DUTY OF HHS OFFICE ON

3 WOMEN’S HEALTH.—Section 229(b) of such Act (42 

4 U.S.C. 237a(b)), as amended by section 514, is fur5 ther amended by adding at the end the following 

6 new paragraph: 

7 ‘‘(9) establish the Interagency Coordinating 

8 Committee on the Promotion of Optimal Maternity 

9 Outcomes in accordance with section 229A; and’’. 

10 (2) TREATMENT OF BIENNIAL REPORTS.—Sec11 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 

12 amended by inserting ‘‘(other than under subsection 

13 (b)(9))’’ after ‘‘under this section’’. 

14 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 

15 Section 229(b) of the Public Health Service Act (42 

16 U.S.C. 237a(b)), as amended by sections 514 and 515, 

17 is further amended by adding at the end the following: 

18 ‘‘(10) not later than one year after the date of 

19 the enactment of the Health Equity and Account20 ability Act of 2020, develop and implement a 4-year 

21 culturally and linguistically appropriate multimedia 

22 consumer education campaign that is designed to 

23 promote understanding and acceptance of evidence24 based maternity practices and models of care for op25 timal maternity outcomes among individuals of 


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1 childbearing ages and families of such individuals 

2 and that— 

3 ‘‘(A) highlights the importance of pro4 tecting, promoting, and supporting the innate 

5 capacities of childbearing individuals and their 

6 newborns for childbirth, breastfeeding, and at7 tachment; 

8 ‘‘(B) promotes understanding of the impor9 tance of using obstetric interventions when 

10 medically necessary and when supported by 

11 strong, high-quality evidence; 

12 ‘‘(C) highlights the widespread overuse of 

13 maternity practices that have been shown to 

14 have benefit when used appropriately in situa15 tions of medical necessity, but which can expose 

16 pregnant individuals, infants, or both to risk of 

17 harm if used routinely and indiscriminately, in18 cluding continuous fetal monitoring, labor in19 duction, epidural anesthesia, elective primary 

20 cesarean section, and repeat cesarean delivery; 

21 ‘‘(D) emphasizes the noninvasive maternity 

22 practices that have strong proven correlation or 

23 may be associated with considerable improve24 ment in outcomes with no detrimental side ef25 fects, and are significantly underused in the 


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1 United States, including smoking cessation pro2 grams in pregnancy, group model prenatal care, 

3 continuous labor support, nonsupine positions 

4 for birth, and external version to turn breech 

5 babies at term; 

6 ‘‘(E) educates consumers about the quali7 fications of licensed providers of maternity care 

8 and the best evidence about their safety, satis9 faction, outcomes, and costs; 

10 ‘‘(F) informs consumers about the best 

11 available research comparing birth center 

12 births, planned home births, and hospital 

13 births, including information about each set14 ting’s safety, satisfaction, outcomes, and costs; 

15 ‘‘(G) fosters participation in high-quality, 

16 evidence-based childbirth education that pro17 motes a natural, healthy, and safe approach to 

18 pregnancy, childbirth, and early parenting; is 

19 taught by certified educators, peer counselors, 

20 and health professionals; and promotes in21 formed decision making by childbearing individ22 uals; and 

23 ‘‘(H) is pilot tested for consumer com24 prehension, cultural sensitivity, and acceptance 

25 of the messages across geographically, racially, 


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1 ethnically, and linguistically diverse popu2 lations.’’. 

3 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE4 VIEWS FOR CARE OF CHILDBEARING INDI5 VIDUALS AND NEWBORNS. 

6 (a) IN GENERAL.—Not later than one year after the 

7 date of the enactment of this Act, the Secretary of Health 

8 and Human Services, through the Agency for Healthcare 

9 Research and Quality, shall— 

10 (1) make publicly available an online biblio11 graphic database identifying systematic reviews, in12 cluding an explanation of the level and quality of 

13 evidence, for care of childbearing individuals and 

14 newborns; and 

15 (2) initiate regular updates that incorporate 

16 newly issued and updated systematic reviews. 

17 (b) SOURCES.—To aim for a comprehensive inventory 

18 of systematic reviews relevant to maternal and newborn 

19 care, the database shall identify reviews from diverse 

20 sources, including— 

21 (1) scientific peer-reviewed journals; 

22 (2) databases, including Cochrane Database of 

23 Systematic Reviews, Clinical Evidence, and Data24 base of Abstracts of Reviews of Effects; and 


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1 (3) internet websites of agencies and organiza2 tions throughout the world that produce such sys3 tematic reviews. 

4 (c) FEATURES.—The database shall— 

5 (1) provide bibliographic citations for each 

6 record within the database, and for each such cita7 tion include an explanation of the level and quality 

8 of evidence; 

9 (2) include abstracts, as available; 

10 (3) provide reference to companion documents 

11 as may exist for each review, such as evidence tables 

12 and guidelines or consumer educational materials de13 veloped from the review; 

14 (4) provide links to the source of the full review 

15 and to any companion documents; 

16 (5) provide links to the source of a previous 

17 version or update of the review; 

18 (6) be searchable by intervention or other topic 

19 of the review, reported outcomes, author, title, and 

20 source; and 

21 (7) offer to users periodic electronic notification 

22 of database updates relating to users’ topics of inter23 est. 

24 (d) OUTREACH.—Not later than the first date the 

25 database is made publicly available and periodically thereVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 after, the Secretary of Health and Human Services shall 

2 publicize the availability, features, and uses of the data3 base under this section to the stakeholders described in 

4 subsection (e). 

5 (e) CONSULTATION.—For purposes of developing the 

6 database under this section and maintaining and updating 

7 such database, the Secretary of Health and Human Serv8 ices shall convene and consult with an advisory committee 

9 composed of relevant stakeholders, including— 

10 (1) Federal Medicaid administrators and State 

11 agencies administrating State plans under title XIX 

12 of the Social Security Act pursuant to section 

13 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 

14 (2) providers of maternity and newborn care 

15 from both academic and community-based settings, 

16 including obstetrician-gynecologists, family physi17 cians, certified nurse midwives, certified midwives, 

18 certified professional midwives, physician assistants, 

19 perinatal nurses, pediatricians, and nurse practi20 tioners; 

21 (3) maternal-fetal medicine specialists; 

22 (4) neonatologists; 

23 (5) childbearing individuals and advocates for 

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1 resenting communities that are diverse in terms of 

2 race, ethnicity, indigenous status, and geographic 

3 area; 

4 (6) employers and purchasers; 

5 (7) health facility and system leaders, including 

6 both hospital and birth center facilities; 

7 (8) journalists; and 

8 (9) bibliographic informatics specialists. 

9 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

10 authorized to be appropriated $2,500,000 for each of the 

11 fiscal years 2021 through 2023 for the purpose of devel12 oping the database and such sums as may be necessary 

13 for each subsequent fiscal year for updating the database 

14 and providing outreach and notification to users, as de15 scribed in this section. 

16 SEC. 518. EXPANSION OF CDC PREVENTION RESEARCH 

17 CENTERS PROGRAM TO INCLUDE CENTERS 

18 ON OPTIMAL MATERNITY OUTCOMES. 

19 (a) IN GENERAL.—Not later than one year after the 

20 date of the enactment of this Act, the Secretary of Health 

21 and Human Services, shall support the establishment of 

22 additional Prevention Research Centers under the Preven23 tion Research Center Program administered by the Cen24 ters for Disease Control and Prevention. Such additional 


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1 centers shall each be known as a Center for Excellence 

2 on Optimal Maternity Outcomes. 

3 (b) RESEARCH.—Each Center for Excellence on Opti4 mal Maternity Outcomes shall— 

5 (1) conduct at least one focused program of re6 search to improve maternity outcomes, including the 

7 reduction of cesarean birth rates, elective inductions, 

8 prematurity rates, and low birth weight rates within 

9 an underserved population that has a disproportion10 ately large burden of suboptimal maternity out11 comes, including maternal mortality and morbidity, 

12 infant mortality, prematurity, or low birth weight, 

13 which such program shall include developing per14 formance and quality measures for accountability; 

15 (2) work with partners on special interest 

16 projects, as specified by the Centers for Disease 

17 Control and Prevention and other relevant agencies 

18 within the Department of Health and Human Serv19 ices, and on projects funded by other sources; and 

20 (3) involve a minimum of two distinct birth set21 ting models, such as— 

22 (A) a hospital labor and delivery model 

23 and freestanding birth center model; or 

24 (B) a hospital labor and delivery model 

25 and planned home birth model. 


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1 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 

2 for Excellence on Optimal Maternity Outcomes shall in3 clude the following interdisciplinary providers of maternity 

4 care: 

5 (1) Obstetrician-gynecologists. 

6 (2) At least two of the following providers: 

7 (A) Family practice physicians. 

8 (B) Nurse practitioners. 

9 (C) Physician assistants. 

10 (D) Certified professional midwives. 

11 (d) SERVICES.—Research conducted by each Center 

12 for Excellence on Optimal Maternity Outcomes shall in13 clude at least 2 (and preferably more) of the following sup14 portive provider services: 

15 (1) Mental health. 

16 (2) Doula labor support. 

17 (3) Nutrition education. 

18 (4) Childbirth education. 

19 (5) Social work. 

20 (6) Physical therapy or occupation therapy. 

21 (7) Substance abuse services. 

22 (8) Home visiting. 

23 (e) COORDINATION.—The programs of research at 

24 each of the Centers of Excellence on Optimal Maternity 


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1 Outcomes shall complement and not replicate the work of 

2 the other. 

3 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section 

5 $2,000,000 for each of the fiscal years 2021 through 

6 2025. 

7 SEC. 519. EXPANDING MODELS ALLOWED TO BE TESTED BY 

8 CENTER FOR MEDICARE & MEDICAID INNO9 VATION TO INCLUDE MATERNITY CARE MOD10 ELS. 

11 Section 1115A(b)(2)(B) of the Social Security Act 

12 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 

13 end the following new clause: 

14 ‘‘(xxviii) Promoting evidence-based 

15 models of care that have been associated 

16 with reductions in maternal and infant 

17 health disparities, including incorporating 

18 the use of doula and promotoras support 

19 for pregnant and childbearing individuals 

20 into evidence-based models of prenatal 

21 care, labor and delivery, and postpartum 

22 care, and supporting the appropriate use of 

23 out-of-hospital birth models, including 

24 births at home and in freestanding birth 

25 centers.’’. 


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1 SEC. 520. DEVELOPMENT OF INTERPROFESSIONAL MATER2 NITY CARE EDUCATIONAL MODELS AND 

3 TOOLS. 

4 (a) IN GENERAL.—Not later than 6 months after the 

5 date of the enactment of this Act, the Secretary of Health 

6 and Human Services, acting in conjunction with the Ad7 ministrator of Health Resources and Services Administra8 tion, shall convene, for a 1-year period, an Interprofes9 sional Maternity Provider Education Commission to dis10 cuss and make recommendations for— 

11 (1) a consensus standard physiologic maternity 

12 care curriculum that takes into account the core 

13 competencies for basic midwifery practice such as 

14 those developed by the American College of Nurse 

15 Midwives and the North American Registry of Mid16 wives, and the educational objectives for physicians 

17 practicing in obstetrics and gynecology as deter18 mined by the Council on Resident Education in Ob19 stetrics and Gynecology; 

20 (2) suggestions for multidisciplinary use of the 

21 consensus physiologic curriculum; 

22 (3) strategies to integrate and coordinate edu23 cation across maternity care disciplines, including 

24 recommendations to increase medical and midwifery 

25 student exposure to out-of-hospital birth; and 


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1 (4) pilot demonstrations of interprofessional 

2 educational models. 

3 (b) PARTICIPANTS.—The Commission shall include 

4 maternity care educators, curriculum developers, service 

5 leaders, certification leaders, and accreditation leaders 

6 from the various professions that provide maternity care 

7 in the United States. Such professions shall include obste8 trician gynecologists, certified nurse midwives or certified 

9 midwives, family practice physicians, nurse practitioners, 

10 physician assistants, certified professional midwives, and 

11 perinatal nurses. Additionally, the Commission shall in12 clude representation from maternity care consumer advo13 cates. 

14 (c) CURRICULUM.—The consensus standard physio15 logic maternity care curriculum described in subsection 

16 (a)(1) shall— 

17 (1) have a public health focus with a foundation 

18 in health promotion and disease prevention; 

19 (2) foster physiologic childbearing and woman 

20 and family centered care; 

21 (3) integrate strategies to reduce maternal and 

22 infant morbidity and mortality; 

23 (4) incorporate recommendations to ensure re24 spectful, safe, and seamless consultation, referral, 

25 transport, and transfer of care when necessary; 


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1 (5) include cultural sensitivity and strategies to 

2 decrease disparities in maternity outcomes; and 

3 (6) include implicit bias training. 

4 (d) REPORT.—Not later than 6 months after the final 

5 meeting of the Commission, the Secretary of Health and 

6 Human Services shall— 

7 (1) submit to Congress a report containing the 

8 recommendations made by the Commission under 

9 this section; and 

10 (2) make such report publicly available. 

11 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

12 authorized to be appropriated to carry out this section 

13 $1,000,000 for each of the fiscal years 2021 and 2022, 

14 and such sums as are necessary for each of the fiscal years 

15 2023 through 2025. 

16 SEC. 521. INCLUDING SERVICES FURNISHED BY CERTAIN 

17 STUDENTS, INTERNS, AND RESIDENTS SU18 PERVISED BY CERTIFIED NURSE MIDWIVES 

19 WITHIN INPATIENT HOSPITAL SERVICES 

20 UNDER MEDICARE. 

21 (a) IN GENERAL.—Section 1861(b) of the Social Se22 curity Act (42 U.S.C. 1395x(b)) is amended— 

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

24 end and inserting ‘‘, or in the case of services in a 

25 hospital or osteopathic hospital by a student midwife 


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1 or an intern or resident-in-training under a teaching 

2 program previously described in this paragraph who 

3 is in the field of obstetrics and gynecology, if such 

4 student midwife, intern, or resident-in-training is su5 pervised by a certified nurse-midwife to the extent 

6 permitted under applicable State law and as may be 

7 authorized by the hospital;’’; 

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

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

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

11 paragraph: 

12 ‘‘(8) a certified nurse-midwife where the hos13 pital has a teaching program approved as specified 

14 in paragraph (6), if— 

15 ‘‘(A) the hospital elects to receive any pay16 ment due under this title for reasonable costs of 

17 such services; and 

18 ‘‘(B) all certified nurse-midwives in such 

19 hospital agree not to bill charges for profes20 sional services rendered in such hospital to indi21 viduals covered under the insurance program 

22 established by this title.’’. 

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

24 subsection (a) shall apply to services furnished on or after 

25 the date of the enactment of this Act. 


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1 SEC. 522. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 

2 INCREASE DIVERSITY IN MATERNAL, REPRO3 DUCTIVE, AND SEXUAL HEALTH PROFES4 SIONALS. 

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

6 Human Services, through the Administrator of the Health 

7 Resources and Services Administration, shall carry out a 

8 grant program under which the Secretary may make to 

9 eligible organizations— 

10 (1) for fiscal year 2021, planning grants de11 scribed in subsection (b); and 

12 (2) for the subsequent 4-year period, implemen13 tation grants described in subsection (c). 

14 (b) PLANNING GRANTS.— 

15 (1) IN GENERAL.—Planning grants described in 

16 this subsection are grants for the following purposes: 

17 (A) To collect data and identify any work18 force disparities, with respect to a health pro19 fession, at each of the following areas along the 

20 health professional continuum: 

21 (i) Pipeline availability with respect to 

22 students at the high school and college or 

23 university levels considering and working 

24 toward entrance in the profession, includ25 ing barriers triggered by criminal records. 


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1 (ii) Entrance into the training pro2 gram for the profession. 

3 (iii) Graduation from such training 

4 program. 

5 (iv) Entrance into practice, including 

6 barriers triggered by criminal records. 

7 (v) Retention in practice for more 

8 than a 5-year period. 

9 (B) To develop one or more strategies to 

10 address the workforce disparities within the 

11 health profession, as identified under (and in 

12 response to the findings pursuant to) subpara13 graph (A). 

14 (2) APPLICATION.—To be eligible to receive a 

15 grant under this subsection, an eligible health pro16 fessional organization shall submit to the Secretary 

17 of Health and Human Services an application in 

18 such form and manner and containing such informa19 tion as specified by the Secretary. 

20 (3) AMOUNT.—Each grant awarded under this 

21 subsection shall be for an amount not to exceed 

22 $300,000. 

23 (4) REPORT.—Each recipient of a grant under 

24 this subsection shall submit to the Secretary of 

25 Health and Human Services a report containing— 


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1 (A) information on the extent and distribu2 tion of workforce disparities identified through 

3 the grant; and 

4 (B) reasonable objectives and strategies 

5 developed to address such disparities within a 

6 5-, 10-, and 25-year period. 

7 (c) IMPLEMENTATION GRANTS.— 

8 (1) IN GENERAL.—Implementation grants de9 scribed in this subsection are grants to implement 

10 one or more of the strategies developed pursuant to 

11 a planning grant awarded under subsection (b). 

12 (2) APPLICATION.—To be eligible to receive a 

13 grant under this subsection, an eligible health pro14 fessional organization shall submit to the Secretary 

15 of Health and Human Services an application in 

16 such form and manner as specified by the Secretary. 

17 Each such application shall contain information on 

18 the capability of the organization to carry out a 

19 strategy described in paragraph (1), involvement of 

20 partners or coalitions, plans for developing sustain21 ability of the efforts after the culmination of the 

22 grant cycle, and any other information specified by 

23 the Secretary. 

24 (3) AMOUNT.—Each grant awarded under this 

25 subsection shall be for an amount not to exceed 


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1 $500,000 each year during the 4-year period of the 

2 grant. 

3 (4) REPORTS.—For each of the first 3 years for 

4 which an eligible health professional organization is 

5 awarded a grant under this subsection, the organiza6 tion shall submit to the Secretary of Health and 

7 Human Services a report on the activities carried 

8 out by such organization through the grant during 

9 such year and objectives for the subsequent year. 

10 For the fourth year for which an eligible health pro11 fessional organization is awarded a grant under this 

12 subsection, the organization shall submit to the Sec13 retary a report that includes an analysis of all the 

14 activities carried out by the organization through the 

15 grant and a detailed plan for continuation of out16 reach efforts. 

17 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA18 TION DEFINED.—For purposes of this section, the term 

19 ‘‘eligible health professional organization’’ means a profes20 sional organization representing obstetrician-gyne21 cologists, certified nurse midwives, certified midwives, 

22 family practice physicians, nurse practitioners whose scope 

23 of practice includes maternity or sexual and reproductive 

24 health care, physician assistants whose scope of practice 

25 includes obstetrical or sexual and reproductive health care, 


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1 or certified professional midwives, adolescent medicine 

2 specialists, and pediatricians who provide sexual and re3 productive health care. 

4 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

5 authorized to be appropriated to carry out this section 

6 $2,000,000 for fiscal year 2021 and $3,000,000 for each 

7 of the fiscal years 2022 through 2025. 

8 SEC. 523. INTERAGENCY UPDATE TO THE QUALITY FAMILY 

9 PLANNING GUIDELINES. 

10 (a) IN GENERAL.—Not later than six months after 

11 the date of enactment of this Act, the Director of the Cen12 ters for Disease Control and Prevention and the Office 

13 of Population Affairs shall review and expand the 2014 

14 Quality Family Planning Guidelines to address— 

15 (1) health disparities; and 

16 (2) the importance of patient-directed contra17 ceptive decision making. 

18 (b) CONSULTATION.—In carrying out subsection (a), 

19 the Director of the Centers for Disease Control and Pre20 vention and the Office of Population Affairs shall convene 

21 a meeting, and solicit the views of, stakeholders including 

22 experts on health disparities, experts on reproductive coer23 cion, representatives of provider organizations, patient ad24 vocates, reproductive justice organizations, organizations 

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1 ganizations that represent people with disabilities, organi2 zations that represent LGBTQ persons, and organizations 

3 that represent people with limited English proficiency. 

4 SEC. 524. DISSEMINATION OF THE QUALITY FAMILY PLAN5 NING GUIDELINES. 

6 (a) IN GENERAL.—Not later than six months after 

7 the date of enactment of this Act, the Secretary of Health 

8 and Human Services and the Director of the Centers for 

9 Disease Control and Prevention shall— 

10 (1) develop a plan for outreach to publicly fund11 ed health care providers, including federally qualified 

12 health centers and branches of the Indian Health 

13 Service, about the quality family planning guidelines 

14 referred to in section 523; and 

15 (2) award grants to eligible entities to imple16 ment these guidelines for all patients seeking family 

17 planning services. 

18 (b) DEFINITION.—In this section, the term ‘‘eligible 

19 entity’’ means a publicly funded health care provider that 

20 serves persons of reproductive age. 

21 Subtitle B—Pregnancy Screening 

22 SEC. 531. PREGNANCY INTENTION SCREENING INITIATIVE 

23 DEMONSTRATION PROGRAM. 

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

25 (42 U.S.C. 280g et seq.), as amended by section 


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1 505(c)(6), is further amended by adding at the end the 

2 following: 

3 ‘‘SEC. 399V–8. PREGNANCY INTENTION SCREENING INITIA4 TIVE DEMONSTRATION PROGRAM. 

5 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 

6 acting through the Director of the Centers for Disease 

7 Control and Prevention, shall establish a demonstration 

8 program to facilitate the clinical adoption of pregnancy in9 tention screening initiatives by health care and social serv10 ices providers. 

11 ‘‘(b) GRANTS.—The Secretary may carry out the 

12 demonstration program through awarding grants to eligi13 ble entities to implement pregnancy intention screening 

14 initiatives, collect data, and evaluate such initiatives. 

15 ‘‘(c) ELIGIBLE ENTITIES.— 

16 ‘‘(1) IN GENERAL.—An eligible entity under 

17 this section is an entity described in paragraph (2) 

18 that provides non-directive, comprehensive, medically 

19 accurate information. 

20 ‘‘(2) ENTITIES DESCRIBED.—For purposes of 

21 paragraph (1), an entity described in this paragraph 

22 is a community-based organization, voluntary health 

23 organization, public health department, community 

24 health center, or other interested public or private 


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1 primary, behavioral, or other health care or social 

2 service provider or organization. 

3 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA4 TIVE.—For purposes of this section, the term ‘pregnancy 

5 intention screening initiative’ means any initiative by an 

6 eligible entity to routinely screen women with respect to 

7 their pregnancy intentions and goals to either prevent un8 intended pregnancies or improve the likelihood of healthy 

9 pregnancies, in order to better provide health care that 

10 meets the contraceptive or pre-pregnancy needs and goals 

11 of such women. 

12 ‘‘(e) EVALUATION.— 

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

14 through the Director of the Centers for Disease 

15 Control and Prevention, shall, by grant or contract, 

16 and after consultation as described in paragraph (2), 

17 conduct an evaluation of the demonstration pro18 gram, with respect to pregnancy intention screening 

19 initiatives, conducted under this section. Such eval20 uation shall include: 

21 ‘‘(A) Assessment of the implementation of 

22 pregnancy intention screening protocols among 

23 a diverse group of patients and providers, in24 cluding collecting data on the experiences and 


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1 outcomes for diverse patient populations in a 

2 variety of clinical settings. 

3 ‘‘(B) Analysis of outcome measures that 

4 will facilitate effective and widespread adoption 

5 of such protocols by health care providers for 

6 inquiring about and responding to pregnancy 

7 goals of women with both contraceptive and 

8 pre-pregnancy care. 

9 ‘‘(C) Consideration of health disparities 

10 among the population served. 

11 ‘‘(D) Assessment of the equitable and vol12 untary application of such initiatives to minor13 ity and medically underserved communities. 

14 ‘‘(E) Assessment of the training, capacity, 

15 and ongoing technical assistance needed for 

16 providers to effectively implement such preg17 nancy intention screening protocols. 

18 ‘‘(F) Assessment of whether referral sys19 tems for selected protocols follow evidence-based 

20 standards that ensure access to comprehensive 

21 health services and appropriate follow-up care. 

22 ‘‘(G) Measuring through rigorous methods 

23 the effect of such initiatives on key health out24 comes. 


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1 ‘‘(2) CONSULTATION WITH INDEPENDENT, EX2 PERT ADVISORY PANEL.—In conducting the evalua3 tion under paragraph (1), the Director of the Cen4 ters for Disease Control and Prevention shall consult 

5 with physicians, physician assistants, advanced prac6 tice registered nurses, nurse midwives, and other 

7 health care providers who specialize in women’s 

8 health, and other experts in public health, clinical 

9 practice, program evaluation, and research. 

10 ‘‘(3) REPORT.—Not later than one year after 

11 the last day of the demonstration program under 

12 this section, the Director of the Centers for Disease 

13 Control and Prevention shall submit to Congress a 

14 report on the results of the evaluation conducted 

15 under paragraph (1) and shall make the report pub16 licly available. 

17 ‘‘(f) FUNDING.— 

18 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

19 To carry out this section, there is authorized to be 

20 appropriated $10,000,000 for each of fiscal years 

21 2021 through 2025. 

22 ‘‘(2) LIMITATION.—Not more than 20 percent 

23 of funds appropriated to carry out this section pur24 suant to paragraph (1) for a fiscal year may be used 


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1 for purposes of the evaluation under subsection 

2 (e).’’. 

3 TITLE VI—MENTAL HEALTH 

4 SEC. 601. MENTAL HEALTH FINDINGS. 

5 Congress finds the following: 

6 (1) Despite the existence of effective treat7 ments, inequities lie in the availability, accessibility, 

8 and quality of mental health services for racial and 

9 ethnic minorities and people with disabilities. 

10 (2) These inequities have powerful significance 

11 for minority groups and for society as a whole. 

12 (3) Racial and ethnic minorities and people 

13 with disabilities bear a greater burden from unmet 

14 mental health needs and thus suffer a greater loss 

15 to their overall health and productivity. 

16 (4) Improving community conditions and one’s 

17 home environment, paired with high-quality, acces18 sible, and culturally tailored mental health services, 

19 can reduce the likelihood, frequency, and intensity of 

20 challenges to one’s mental health. 

21 (5) The presence of strong social connections 

22 and trust, opportunities to experience and share cul23 tural identity, safe gathering places, and economic 

24 opportunity are community factors that benefit men25 tal health. 


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1 (6) The social, physical, and economic condi2 tions in communities can have tremendous influence 

3 on daily stressors that shape mental health out4 comes. 

5 (7) The foremost barriers include the cost of 

6 care, societal stigma, and the fragmented organiza7 tion of services. 

8 (8) People with disabilities who are racial or 

9 ethnic minorities may have co-occurring mental 

10 health conditions which, without proper accommoda11 tions and support, further stigmatize them and limit 

12 their participation in society. 

13 (9) African-American, Latinx, Asian American, 

14 Pacific Islander, Native, and other people of color 

15 have attitudes toward mental health challenges that 

16 are another barrier to seeking mental health care. 

17 (10) Mental illness retains considerable stigma 

18 in many communities of color, including those of 

19 Asian Americans and Pacific Islanders, and seeking 

20 treatment is not always encouraged. 

21 (11) Addressing mental health stigma and in22 creasing culturally appropriate treatment modalities 

23 in communities will help to increase utilization of 

24 mental health services for people who have trouble 

25 functioning because of mental health challenges. 


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1 (12) There is a link between mental health di2 agnosis and the likelihood of an individual commit3 ting suicide. 

4 (13) A comprehensive public health approach to 

5 behavioral health fosters protective factors in racial 

6 and ethnic communities that support mental health. 

7 (14) Approaches to mental health and address8 ing trauma must keep in mind the historical and 

9 cultural trauma that has impacted many commu10 nities of color. 

11 (15) Treatment modalities must keep ap12 proaches of individual communities to mental health 

13 in mind, including by considering— 

14 (A) approaches to cultural healing prac15 tices; and 

16 (B) the mental health professionals needed 

17 for such practices, such as peer support special18 ists. 

19 (16) Approaches to mental health and address20 ing trauma must keep in mind the concept of 

21 intersectionality of individuals; that individuals may 

22 have many inequities that shape the way they proc23 ess and experience everyday life. 


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1 SEC. 602. COVERAGE OF MARRIAGE AND FAMILY THERA2 PIST SERVICES, MENTAL HEALTH COUN3 SELOR SERVICES, SUBSTANCE ABUSE COUN4 SELOR SERVICES, AND PEER SUPPORT SPE5 CIALIST SERVICES UNDER PART B OF THE 

6 MEDICARE PROGRAM. 

7 (a) COVERAGE OF SERVICES.— 

8 (1) IN GENERAL.—Section 1861(s)(2) of the 

9 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

10 amended by section 431(c), is amended— 

11 (A) in subparagraph (HH), by striking 

12 ‘‘and’’ at the end; 

13 (B) in subparagraph (II), by adding ‘‘and’’ 

14 after the semicolon at the end; and 

15 (C) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(JJ) marriage and family therapist services 

18 (as defined in subsection (nnn)(1)), mental health 

19 counselor services (as defined in subsection 

20 (nnn)(3)), substance abuse counselor services (as de21 fined in subsection (nnn)(5)), and peer support spe22 cialist services (as defined in subsection (nnn)(7));’’. 

23 (2) DEFINITIONS.—Section 1861 of the Social 

24 Security Act (42 U.S.C. 1395x), as amended by sec25 tions 207(b)(1), 417(a), and 433(c), is amended by 

26 adding at the end the following new subsection: 


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1 ‘‘Marriage and Family Therapist Services; Marriage and 

2 Family Therapist; Mental Health Counselor Serv3 ices; Mental Health Counselor; Substance Abuse 

4 Counselor Services; Substance Abuse Counselor; 

5 Peer Support Specialist Services; Peer Support Spe6 cialist 

7 ‘‘(nnn)(1) The term ‘marriage and family therapist 

8 services’ means services performed by a marriage and 

9 family therapist (as defined in paragraph (2)) for the diag10 nosis and treatment of mental illnesses, which the mar11 riage and family therapist is legally authorized to perform 

12 under State law (or the State regulatory mechanism pro13 vided by State law) of the State in which such services 

14 are performed, as would otherwise be covered if furnished 

15 by a physician or as an incident to a physician’s profes16 sional service, but only if no facility or other provider 

17 charges or is paid any amounts with respect to the fur18 nishing of such services. 

19 ‘‘(2) The term ‘marriage and family therapist’ means 

20 an individual who— 

21 ‘‘(A) possesses a master’s or doctoral degree 

22 that qualifies for licensure or certification as a mar23 riage and family therapist pursuant to State law, in24 cluding but not limited to, clinical social workers and 

25 occupational therapists; 


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1 ‘‘(B) after obtaining such degree has performed 

2 at least 2 years of clinical supervised experience in 

3 marriage and family therapy; and 

4 ‘‘(C) in the case of an individual performing 

5 services in a State that provides for licensure or cer6 tification of marriage and family therapists, is li7 censed or certified as a marriage and family thera8 pist in such State. 

9 ‘‘(3) The term ‘mental health counselor services’ 

10 means services performed by a mental health counselor (as 

11 defined in paragraph (4)) for the diagnosis and treatment 

12 of mental illnesses that the mental health counselor is le13 gally authorized to perform under State law (or the State 

14 regulatory mechanism provided by the State law) of the 

15 State in which such services are performed, as would oth16 erwise be covered if furnished by a physician or as incident 

17 to a physician’s professional service, but only if no facility 

18 or other provider charges or is paid any amounts with re19 spect to the furnishing of such services. 

20 ‘‘(4) The term ‘mental health counselor’ means an 

21 individual who— 

22 ‘‘(A) possesses a master’s or doctor’s degree in 

23 mental health counseling or a related field, including 

24 clinical social workers and occupational therapists; 


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1 ‘‘(B) after obtaining such a degree has per2 formed at least 2 years of supervised mental health 

3 counselor practice; and 

4 ‘‘(C) in the case of an individual performing 

5 services in a State that provides for licensure or cer6 tification of mental health counselors or professional 

7 counselors, is licensed or certified as a mental health 

8 counselor or professional counselor in such State. 

9 ‘‘(5) The term ‘substance abuse counselor services’ 

10 means services performed by a substance abuse counselor 

11 (as defined in paragraph (6)) for the diagnosis and treat12 ment of substance abuse and addiction that the substance 

13 abuse counselor is legally authorized to perform under 

14 State law (or the State regulatory mechanism provided by 

15 the State law) of the State in which such services are per16 formed, as would otherwise be covered if furnished by a 

17 physician or as incident to a physician’s professional serv18 ice, but only if no facility or other provider charges or is 

19 paid any amounts with respect to the furnishing of such 

20 services. 

21 ‘‘(6) The term ‘substance abuse counselor’ means an 

22 individual who— 

23 ‘‘(A) has performed at least 2 years of super24 vised substance abuse counselor practice; 


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1 ‘‘(B) in the case of an individual performing 

2 services in a State that provides for licensure or cer3 tification of substance abuse counselors or profes4 sional counselors, is licensed or certified as a sub5 stance abuse counselor or professional counselor in 

6 such State; or 

7 ‘‘(C) is a drug and alcohol counselor as defined 

8 in section 40.281 of title 49, Code of Federal Regu9 lations. 

10 ‘‘(7) The term ‘peer support specialist services’ 

11 means services performed by a peer support specialist (as 

12 defined in paragraph (8)) for the well-being of individuals 

13 needing mental health support that the peer support spe14 cialist is legally authorized to perform under State law (or 

15 the State regulatory mechanism provided by the State 

16 law) of the State in which such services are performed, 

17 as would otherwise be covered if furnished by a physician 

18 or as incident to a physician’s professional service, but 

19 only if no facility or other provider charges or is paid any 

20 amounts with respect to the furnishing of such services. 

21 ‘‘(8) The term ‘peer support specialist’ means an in22 dividual who— 

23 ‘‘(A) is an individual living in recovery with 

24 mental illness, addiction, or systems involvement; 

25 ‘‘(B) has skills learned in formal training; 


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1 ‘‘(C) uses assets-based framing in speaking 

2 about mental health, recovery, and well-being; and 

3 ‘‘(D) delivers services in behavioral health set4 tings to promote mind-body recovery and resil5 iency.’’. 

6 (3) PROVISION FOR PAYMENT UNDER PART

7 B.—Section 1832(a)(2)(B) of the Social Security 

8 Act (42 U.S.C. 1395k(a)(2)(B)) is amended— 

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

10 (iv); and 

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

12 clause: 

13 ‘‘(v) marriage and family therapist 

14 services, mental health counselor services, 

15 substance abuse counselor services, and 

16 peer support specialist services; and’’. 

17 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

18 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 

19 as amended by section 431(c)(3), is amended— 

20 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 

21 (B) by inserting before the semicolon at 

22 the end the following: ‘‘, and (EE) with respect 

23 to marriage and family therapist services, men24 tal health counselor services, substance abuse 

25 counselor services, and peer support specialist 


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1 services under section 1861(s)(2)(JJ), the 

2 amounts paid shall be 80 percent of the lesser 

3 of the actual charge for the services or 75 per4 cent of the amount determined for payment of 

5 a psychologist under subparagraph (L)’’. 

6 (5) EXCLUSION OF MARRIAGE AND FAMILY

7 THERAPIST SERVICES, MENTAL HEALTH COUNSELOR

8 SERVICES, AND PEER SUPPORT SPECIALIST SERV9 ICES FROM SKILLED NURSING FACILITY PROSPEC10 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 

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

12 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar13 riage and family therapist services (as defined in 

14 section 1861(nnn)(1)), mental health counselor serv15 ices (as defined in section 1861(nnn)(3)), and peer 

16 support specialist services (as defined in section 

17 1861(nnn)(7))’’ after ‘‘qualified psychologist serv18 ices,’’. 

19 (6) INCLUSION OF MARRIAGE AND FAMILY

20 THERAPISTS, MENTAL HEALTH COUNSELORS, AND

21 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS

22 FOR ASSIGNMENT OF CLAIMS.—Section 

23 1842(b)(18)(C) of the Social Security Act (42 

24 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

25 the end the following new clauses: 


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1 ‘‘(vii) A marriage and family therapist (as de2 fined in section 1861(nnn)(2)). 

3 ‘‘(viii) A mental health counselor (as defined in 

4 section 1861(nnn)(4)). 

5 ‘‘(ix) A substance abuse counselor (as defined 

6 in section 1861(nnn)(6)). 

7 ‘‘(x) A peer support specialist (as defined in 

8 section 1861(nnn)(8)).’’. 

9 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV10 ICES PROVIDED IN CERTAIN SETTINGS.— 

11 (1) RURAL HEALTH CLINICS AND FEDERALLY

12 QUALIFIED HEALTH CENTERS.—Section 

13 1861(aa)(1)(B) of the Social Security Act (42 

14 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

15 by a clinical social worker (as defined in subsection 

16 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 

17 (as defined in subsection (hh)(1)), by a marriage 

18 and family therapist (as defined in subsection 

19 (nnn)(2)), or by a mental health counselor (as de20 fined in subsection (nnn)(4)), or by a substance 

21 abuse counselor (as defined in section 1861 

22 (nnn)(6)), or by a peer support specialist (as defined 

23 in section 1861(nnn)(8)).’’. 

24 (2) HOSPICE PROGRAMS.—Section 

25 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 


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1 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in2 serting ‘‘or one marriage and family therapist (as 

3 defined in subsection (nnn)(2))’’ after ‘‘social work4 er’’. 

5 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

6 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR

7 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 

8 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 

9 amended by inserting ‘‘marriage and family therapist (as 

10 defined in subsection (nnn)(2)),’’ after ‘‘social worker,’’. 

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

12 this section shall apply with respect to services furnished 

13 on or after January 1, 2021. 

14 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 

15 PROGRAM. 

16 Part D of title V of the Public Health Service Act 

17 (42 U.S.C. 290dd et seq.) is amended by adding at the 

18 end the following: 

19 ‘‘SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

20 PROVISION OF BEHAVIORAL HEALTH CARE 

21 IN PRIMARY CARE SETTINGS. 

22 ‘‘(a) GRANTS.—The Secretary, acting through the 

23 Assistant Secretary for Mental Health and Substance Use, 

24 shall award grants to eligible entities for the purpose of 


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1 establishing interprofessional health care teams that pro2 vide behavioral health care. 

3 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

4 a grant under this section, an entity shall be a Federally 

5 qualified health center (as defined in section 1861(aa) of 

6 the Social Security Act), rural health clinic, women’s 

7 health clinic, or behavioral health program (including any 

8 such program operated by a community-based organiza9 tion) serving a high proportion of individuals from racial 

10 and ethnic minority groups (as defined in section 

11 1707(g)). 

12 ‘‘(c) LOAN FORGIVENESS.—To encourage qualified 

13 allied health professionals to enter the mental health field, 

14 an eligible entity receiving a grant under this section shall 

15 agree to use not less than $10,000 of the grant funds on 

16 a loan forgiveness program for practitioners who commit 

17 to working in the mental health field for a period of 2 

18 years. 

19 ‘‘(d) SCIENTIFICALLY AND CULTURALLY BASED.— 

20 Integrated health care funded through this section shall 

21 be scientifically and culturally based, taking into consider22 ation the results of the most recent peer-reviewed research 

23 available. 

24 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

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1 priated $20,000,000 for each of fiscal years 2021 through 

2 2025.’’. 

3 SEC. 604. ADDRESSING RACIAL AND ETHNIC MENTAL 

4 HEALTH DISPARITIES RESEARCH GAPS. 

5 (a) IN GENERAL.—Not later than 6 months after the 

6 date of the enactment of this Act, the Director of the Na7 tional Institute on Minority Health and Health Disparities 

8 shall enter into an arrangement with the National Acad9 emy of Sciences to carry out the activities under sub10 section (b), or, if the National Academy of Sciences de11 clines to enter into such an arrangement, the Director of 

12 the National Institute on Minority Health and Health Dis13 parities, in cooperation with the Agency for Healthcare 

14 Research and Quality, shall carry out the activities under 

15 subsection (b). 

16 (b) ACTIVITIES.—The applicable entity under sub17 section (a) shall— 

18 (1) conduct a study with respect to mental 

19 health disparities in racial and ethnic minority 

20 groups (as defined in section 1707(g) of the Public 

21 Health Service Act (42 U.S.C. 300u–6(g))); and 

22 (2) submit to Congress a report on the results 

23 of such study, including— 


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1 (A) a compilation of information on the dy2 namics of mental health outcomes in such racial 

3 and ethnic minority groups; 

4 (B) the degree of the co-occurrence of 

5 mental conditions with other disabilities in such 

6 racial and ethnic groups, including physical dis7 abilities, mental disabilities, and mental dis8 orders or mental health conditions which co9 occur with one another; 

10 (C) a compilation of information on the 

11 impact of exposure to community violence, com12 munity trauma, adverse childhood experiences, 

13 weather extremes worsened by climate change 

14 (such as heat waves, hurricanes, and wildfires), 

15 substance use, and other psychological traumas, 

16 on mental disorders in such racial and minority 

17 groups, stratified by household income level; 

18 (D) a compilation of information on the 

19 impact of the intersectionality of transgender 

20 individuals in racial and ethnic minority groups; 

21 and 

22 (E) a description of how protective factors 

23 contrast and compare among different commu24 nities of color, identifying cultural strengths. 


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1 SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD2 DRESS RACIAL AND ETHNIC MENTAL HEALTH 

3 DISPARITIES. 

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

5 Human Services, acting through the Assistant Secretary 

6 for Mental Health and Substance Use, shall award grants 

7 to qualified national organizations for the purposes of— 

8 (1) developing, and disseminating to health pro9 fessional educational programs curricula or core 

10 competencies addressing mental health inequities 

11 among racial and ethnic minority groups for use in 

12 the training of students in the professions of social 

13 work, psychology, psychiatry, marriage and family 

14 therapy, mental health counseling, peer support, and 

15 substance abuse counseling; and 

16 (2) certifying community health workers and 

17 peer wellness specialists with respect to such cur18 ricula and core competencies and integrating and ex19 panding the use of such workers and specialists into 

20 health care and community-based settings to address 

21 mental health disparities among racial and ethnic 

22 minority groups. 

23 (b) CURRICULA; CORE COMPETENCIES.—Organiza24 tions receiving funds under subsection (a) may use the 

25 funds to engage in the following activities related to the 


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1 development and dissemination of curricula or core com2 petencies described in subsection (a)(1): 

3 (1) Formation of committees or working groups 

4 comprised of experts from accredited health profes5 sions schools to identify core competencies relating 

6 to mental health disparities among racial and ethnic 

7 minority groups. 

8 (2) Planning of workshops in national fora to 

9 allow for public input, including input from commu10 nities of color with lived experience, into the edu11 cational needs associated with mental health dispari12 ties among racial and ethnic minority groups. 

13 (3) Dissemination and promotion of the use of 

14 curricula or core competencies in undergraduate and 

15 graduate health professions training programs na16 tionwide. 

17 (4) Establishing external stakeholder advisory 

18 boards to provide meaningful input into policy and 

19 program development and best practices to reduce 

20 mental health inequities among racial and ethnic 

21 groups, including participation from communities of 

22 color with lived experience of the impacts of mental 

23 health disparities. 

24 (c) DEFINITIONS.—In this section: 


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1 (1) QUALIFIED NATIONAL ORGANIZATION.—The 

2 term ‘‘qualified national organization’’ means a na3 tional organization that focuses on the education of 

4 students in programs of social work, occupational 

5 therapy, psychology, psychiatry, and marriage and 

6 family therapy. 

7 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

8 The term ‘‘racial and ethnic minority group’’ has the 

9 meaning given to such term in section 1707(g) of 

10 the Public Health Service Act (42 U.S.C. 300u– 

11 6(g)). 

12 (d) 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 2021 through 2025. 

16 SEC. 606. GEOACCESS STUDY. 

17 The Assistant Secretary for Mental Health and Sub18 stance Use shall— 

19 (1) conduct a study to— 

20 (A) determine which geographic areas of 

21 the United States have shortages of specialty 

22 mental health providers; and 

23 (B) assess the preparedness of speciality 

24 mental health providers to deliver culturally and 


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1 linguistically appropriate, affordable, and acces2 sible services; and 

3 (2) submit a report to Congress on the results 

4 of such study. 

5 SEC. 607. ASIAN AMERICAN, NATIVE HAWAIIAN, PACIFIC IS6 LANDER, AND HISPANIC AND LATINO BEHAV7 IORAL AND MENTAL HEALTH OUTREACH AND 

8 EDUCATION STRATEGIES. 

9 Part D of title V of the Public Health Service Act 

10 (42 U.S.C. 290dd et seq.), as amended by section 603, 

11 is further amended by adding at the end the following new 

12 section: 

13 ‘‘SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH 

14 AND EDUCATION STRATEGIES. 

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

16 the Assistant Secretary for Mental Health and Substance 

17 Use, shall, in coordination with advocacy and behavioral 

18 and mental health organizations serving populations of 

19 Asian American, Native Hawaiian, Pacific Islander, and 

20 Hispanic and Latino individuals or communities, develop 

21 and implement an outreach and education strategy to pro22 mote behavioral and mental health, clarify that behavioral 

23 and mental health conditions are treatable and that rea24 sonable accommodations are required under section 504 

25 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and 


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1 titles II and III of the Americans with Disabilities Act 

2 of 1990 (42 U.S.C. 12131 et seq.), and reduce stigma as3 sociated with mental health conditions and substance 

4 abuse among the Asian American, Native Hawaiian, Pa5 cific Islander, and Hispanic and Latino populations. Such 

6 strategy shall— 

7 ‘‘(1) be designed to— 

8 ‘‘(A) meet the diverse cultural and lan9 guage needs of the various Asian American, 

10 Native Hawaiian, Pacific Islander, and His11 panic and Latino populations; and 

12 ‘‘(B) ensure such strategies are develop13 mentally (with respect to the beneficiary’s rel14 ative age and experience) and age appropriate, 

15 as well as cognitively accessible to persons with 

16 cognitive disabilities; 

17 ‘‘(2) increase awareness of symptoms of mental 

18 illnesses common among such populations, taking 

19 into account differences within subgroups (such as 

20 gender, gender identity, age, sexual orientation, dis21 ability, and ethnicity) of such populations; 

22 ‘‘(3) provide information on evidence-based, cul23 turally and linguistically appropriate and adapted 

24 interventions and treatments; 


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1 ‘‘(4) ensure full participation of, and engage, 

2 both consumers and community members in the de3 velopment and implementation of materials; and 

4 ‘‘(5) seek to broaden the perspective among 

5 both individuals in such communities and stake6 holders serving such communities to use a com7 prehensive public health approach to promoting be8 havioral health that addresses a holistic view of 

9 health by focusing on the intersection between be10 havioral and physical health. 

11 ‘‘(b) REPORTS.—Beginning not later than 1 year 

12 after the date of the enactment of this section and annu13 ally thereafter, the Secretary, acting through the Assistant 

14 Secretary, shall submit to Congress, and make publicly 

15 available, a report on the extent to which the strategy de16 veloped and implemented under subsection (a) increased 

17 behavioral and mental health outcomes associated with 

18 mental health conditions and substance abuse among 

19 Asian American, Native Hawaiian, Pacific Islander, and 

20 Hispanic and Latino populations. 

21 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to carry out this section 

23 $300,000 for fiscal year 2021.’’. 

24 SEC. 608. MENTAL HEALTH IN SCHOOLS. 

25 (a) PURPOSE.—It is the purpose of this section to— 


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1 (1) revise, increase funding for, and expand the 

2 scope of the Project AWARE State Educational 

3 Agency Grant Program carried out by the Secretary 

4 of Health and Human Services, in order to provide 

5 access to more comprehensive school-based mental 

6 health services and supports; 

7 (2) provide for comprehensive staff development 

8 for school and community service personnel working 

9 in the school; 

10 (3) provide for comprehensive training to im11 prove health and academic outcomes for children 

12 with, or at risk for, mental health conditions, for 

13 parents or guardians, siblings, and other family 

14 members of such children, and for concerned mem15 bers of the community; 

16 (4) provide for comprehensive, universal, evi17 dence-based screening to identify children and ado18 lescents with potential mental health conditions or 

19 unmet emotional health needs; 

20 (5) recognize best practices for the delivery of 

21 mental health care in school-based settings, includ22 ing school-based health centers; 

23 (6) provide for comprehensive training for par24 ents or guardians, siblings, other family members, 

25 and concerned members of the community on behalf 


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1 of children and adolescents experiencing mental 

2 health trauma, disorder, or disability; and 

3 (7) establish formal working relationships be4 tween health, human service, and educational enti5 ties that support the mental and emotional health of 

6 children and adolescents in the school setting. 

7 (b) TECHNICAL AMENDMENTS.—The second part G 

8 (relating to services provided through religious organiza9 tions) of title V of the Public Health Service Act (42 

10 U.S.C. 290kk et seq.) is amended— 

11 (1) by redesignating such part as part J; and 

12 (2) by redesignating sections 581 through 584 

13 as sections 596 through 596C, respectively. 

14 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL15 DREN AND VIOLENCE.—Section 581 of the Public Health 

16 Service Act (42 U.S.C. 290hh) (relating to children and 

17 violence) is amended to read as follows: 

18 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 

19 AND ADOLESCENTS. 

20 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

21 with the Secretary of Education, shall, through grants, 

22 contracts, or cooperative agreements awarded to eligible 

23 entities described in subsection (c), provide comprehensive 

24 school-based mental health services and supports to assist 

25 children in local communities and schools (including 


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1 schools funded by the Bureau of Indian Education) deal2 ing with traumatic experiences, grief, bereavement, risk of 

3 suicide, and violence. Such services and supports shall 

4 be— 

5 ‘‘(1) developmentally, linguistically, and cul6 turally appropriate; 

7 ‘‘(2) trauma-informed; and 

8 ‘‘(3) incorporate positive behavioral interven9 tions and supports. 

10 ‘‘(b) ACTIVITIES.—Grants, contracts, or cooperative 

11 agreements awarded under subsection (a), shall, as appro12 priate, be used for— 

13 ‘‘(1) implementation of school and community14 based mental health programs that— 

15 ‘‘(A) build awareness of individual trauma 

16 and the intergenerational, continuum of impacts 

17 of trauma on populations; 

18 ‘‘(B) train appropriate staff to identify, 

19 and screen for, signs of trauma exposure, men20 tal health disorders, or risk of suicide; and 

21 ‘‘(C) incorporate positive behavioral inter22 ventions, family engagement, student treatment, 

23 and multigenerational supports to foster the 

24 health and development of children, prevent 


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1 mental health disorders, and ameliorate the im2 pact of trauma; 

3 ‘‘(2) technical assistance to local communities 

4 with respect to the development of programs de5 scribed in paragraph (1); 

6 ‘‘(3) facilitating community partnerships among 

7 families, students, law enforcement agencies, edu8 cation agencies, mental health and substance use 

9 disorder service systems, family-based mental health 

10 service systems, child welfare agencies, health care 

11 providers (including primary care physicians, mental 

12 health professionals, and other professionals who 

13 specialize in children’s mental health such as child 

14 and adolescent psychiatrists), institutions of higher 

15 education, faith-based programs, trauma networks, 

16 and other community-based systems to address child 

17 and adolescent trauma, mental health issues, and vi18 olence; and 

19 ‘‘(4) establishing and promoting best practices 

20 that are either evidence- or culturally-based for chil21 dren and adolescents to share their experiences of 

22 individual and community trauma, including their 

23 exposure to violence, with trusted adults. 

24 ‘‘(c) REQUIREMENTS.— 


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

2 contract, or cooperative agreement under subsection 

3 (a), an entity shall be a partnership that includes— 

4 ‘‘(A) a State educational agency, as de5 fined in section 8101 of the Elementary and 

6 Secondary Education Act of 1965, in coordina7 tion with one or more local educational agen8 cies, as defined in section 8101 of the Elemen9 tary and Secondary Education Act of 1965, or 

10 a consortium of any entities described in sub11 paragraph (B), (C), (D), or (E) of section 

12 8101(30) of such Act; and 

13 ‘‘(B) at least 1 community-based mental 

14 health provider, including a public or private 

15 mental health entity, health care entity, family16 based mental health entity, trauma network, or 

17 other community-based entity, as determined by 

18 the Secretary (and which may include addi19 tional entities such as a human services agency, 

20 law enforcement or juvenile justice entity, child 

21 welfare agency, an institution of higher edu22 cation, or another entity, as determined by the 

23 Secretary). 

24 ‘‘(2) COMPLIANCE WITH HIPAA.—Any patient 

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1 ties under the grant shall meet the regulations pro2 mulgated under section 264(c) of the Health Insur3 ance Portability and Accountability Act of 1996. 

4 ‘‘(3) COMPLIANCE WITH FERPA.—Section 444 

5 of the General Education Provisions Act (commonly 

6 known as the ‘Family Educational Rights and Pri7 vacy Act of 1974’) shall apply to any entity that is 

8 a member of the partnership in the same manner 

9 that such section applies to an educational agency or 

10 institution (as that term is defined in such section). 

11 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 

12 shall ensure that grants, contracts, or cooperative agree13 ments under subsection (a) will be distributed equitably 

14 among the regions of the country and among urban and 

15 rural areas. 

16 ‘‘(e) DURATION OF AWARDS.—With respect to a 

17 grant, contract, or cooperative agreement under sub18 section (a), the period during which payments under such 

19 an award will be made to the recipient shall be 5 years, 

20 with options for renewal. 

21 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 

22 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist23 ant Secretary shall develop a fiscally appropriate 

24 process for evaluating activities carried out under 

25 this section. Such process shall include— 


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1 ‘‘(A) the development of guidelines for the 

2 submission of program data by grant, contract, 

3 or cooperative agreement recipients; 

4 ‘‘(B) the development of measures of out5 comes (in accordance with paragraph (2)) to be 

6 applied by such recipients in evaluating pro7 grams carried out under this section; and 

8 ‘‘(C) the submission of annual reports by 

9 such recipients concerning the effectiveness of 

10 programs carried out under this section. 

11 ‘‘(2) MEASURES OF OUTCOMES.—The Assistant 

12 Secretary shall develop measures of outcomes to be 

13 applied by recipients of assistance under this section 

14 to evaluate the effectiveness of programs carried out 

15 under this section, including outcomes related to the 

16 student, family, and local educational systems sup17 ported by this Act. 

18 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi19 ble entity described in subsection (c) that receives a 

20 grant, contract, or cooperative agreement under this 

21 section shall annually submit to the Assistant Sec22 retary a report that includes data to evaluate the 

23 success of the program carried out by the entity 

24 based on whether such program is achieving the pur25 poses of the program. Such reports shall utilize the 


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1 measures of outcomes under paragraph (2) in a rea2 sonable manner to demonstrate the progress of the 

3 program in achieving such purposes. 

4 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 

5 Based on the data submitted under paragraph (3), 

6 the Assistant Secretary shall annually submit to 

7 Congress a report concerning the results and effec8 tiveness of the programs carried out with assistance 

9 received under this section. 

10 ‘‘(5) LIMITATION.—An eligible entity shall use 

11 not more than 20 percent of amounts received under 

12 a grant under this section to carry out evaluation 

13 activities under this subsection. 

14 ‘‘(g) INFORMATION AND EDUCATION.—The Sec15 retary shall disseminate best practices based on the find16 ings of the knowledge development and application under 

17 this section. 

18 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF

19 APPROPRIATIONS.— 

20 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 

21 section shall be in an amount that is not more than 

22 $2,000,000 for each of the first 5 fiscal years fol23 lowing the date of enactment of this section. The 

24 Secretary shall determine the amount of each such 


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1 grant based on the population of children up to age 

2 21 of the area to be served under the grant. 

3 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

4 There is authorized to be appropriated to carry out 

5 this section, $130,000,000 for each of fiscal years 

6 2021 through 2024.’’. 

7 (d) CONFORMING AMENDMENT.—Part G of title V 

8 of the Public Health Service Act (42 U.S.C. 290hh et 

9 seq.), as amended by this section, is further amended by 

10 striking the part heading and inserting the following: 

11 ‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 

12 SEC. 609. BUILDING AN EFFECTIVE WORKFORCE IN MEN13 TAL HEALTH. 

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

15 Human Services, in coordination with the Assistant Sec16 retary for Mental Health and Substance Use, the Adminis17 trator of the Health Resources and Services Administra18 tion, and the Secretary of Labor, shall, in coordination 

19 with advocacy and behavioral and mental health organiza20 tions serving people of color— 

21 (1) develop, strengthen, and implement strate22 gies to bolster career pathways for mental health 

23 professionals; and 

24 (2) identify the breadth of settings where men25 tal and behavioral health care can take place. 


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1 (b) CONTENTS.—Strategies under subsection (a) 

2 shall include— 

3 (1) the variety of settings where mental health 

4 professionals are needed, including community-based 

5 organizations, women’s centers, shelters, organiza6 tions focused on youth development, workforce agen7 cies, job placement and development centers, emer8 gency rooms, the special supplemental nutrition pro9 gram for women, infants, and children under section 

10 17 of the Child Nutrition Act of 1966 (42 U.S.C. 

11 1786), food banks, legal aid, and benefit issuers as 

12 defined in section 3 of the Food and Nutrition Act 

13 of 2008 (7 U.S.C. 2012); 

14 (2) defining career pathways in mental and be15 havioral health, to help communities understand the 

16 variety of careers in mental and behavioral health 

17 that are available; 

18 (3) building career pathways in mental and be19 havioral health as part of the curriculum at the 

20 postsecondary education level; 

21 (4) providing accessible training and certifi22 cation pathways for lay health workers such as com23 munity health workers and other peer support indi24 viduals to ensure that careers pay a living wage; 


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1 (5) creating incentives for students in the fields 

2 of occupational therapy, social work, medicine, and 

3 nursing to learn more about mental health, and to 

4 include a mental health rotation as a part of the 

5 health professional curricula; 

6 (6) including training and education for teach7 ers about the basics of section 504 of the Rehabilita8 tion Act of 1973 (29 U.S.C. 794) and individualized 

9 education programs (as defined in section 614(d) of 

10 the Individuals with Disabilities Education Act (20 

11 U.S.C. 1414(d))); 

12 (7) researching, developing, and implementing 

13 programs for mental and behavioral health profes14 sionals to prevent burnout; and 

15 (8) finding better and increased avenues to en16 sure equity by providing better loan forgiveness pro17 grams, including a focus area within the National 

18 Health Service Corps focused on community trauma. 

19 SEC. 610. MENTAL HEALTH AT THE BORDER. 

20 (a) SHORT TITLE.—This section may be cited as the 

21 ‘‘Immigrants’ Mental Health Act of 2020’’. 

22 (b) DEFINITIONS.—In this section: 

23 (1) FORWARD OPERATING BASE.—The term 

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1 tion in forward or remote locations, and designated 

2 as such by U.S. Customs and Border Protection. 

3 (2) U.S. CUSTOMS AND BORDER PROTECTION

4 FACILITY.—The term ‘‘U.S. Customs and Border 

5 Protection facility’’ means any of the following facili6 ties at which migrants are typically detained on be7 half of U.S. Customs and Border Protection: 

8 (A) U.S. Border Patrol stations. 

9 (B) Ports of entry. 

10 (C) Checkpoints. 

11 (D) Forward operating bases. 

12 (E) Secondary inspection areas. 

13 (F) Short-term custody facilities. 

14 (c) TRAINING FOR CERTAIN CBP PERSONNEL IN

15 MENTAL HEALTH ISSUES.— 

16 (1) TRAINING TO IDENTIFY RISK FACTORS AND

17 WARNING SIGNS IN IMMIGRANTS AND REFUGEES.— 

18 (A) IN GENERAL.—The Commissioner of 

19 U.S. Customs and Border Protection, in con20 sultation with the Assistant Secretary for Men21 tal Health and Substance Use, the Adminis22 trator of the Health Resources and Services Ad23 ministration, and nongovernmental experts in 

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1 dren, shall develop and implement a training 

2 curriculum for U.S. Customs and Border Pro3 tection agents and officers assigned to U.S. 

4 Customs and Border Protection facilities to en5 able such agents and officers to identify the 

6 risk factors and warning signs in immigrants 

7 and refugees of mental health issues relating to 

8 trauma. 

9 (B) REQUIREMENTS.—The training cur10 riculum described in subparagraph (A) shall— 

11 (i) apply to all U.S. Customs and 

12 Border Protection agents and officers 

13 working at U.S. Customs and Border Pro14 tection facilities; 

15 (ii) provide for crisis intervention 

16 using a trauma-informed approach; and 

17 (iii) provide for mental health 

18 screenings for immigrants and refugees ar19 riving at the border in their preferred lan20 guage or with appropriate language assist21 ance. 

22 (2) TRAINING TO ADDRESS MENTAL HEALTH

23 AND WELLNESS OF CBP AGENTS AND OFFICERS.— 

24 (A) IN GENERAL.—The Commissioner of 

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1 sultation with the Assistant Secretary for Men2 tal Health and Substance Use, the Adminis3 trator of the Health Resources and Services Ad4 ministration, and nongovernmental experts in 

5 the delivery of mental health care, shall develop 

6 and implement a training curriculum for U.S. 

7 Customs and Border Protection agents and offi8 cers assigned to U.S. Customs and Border Pro9 tection facilities to address the mental health 

10 and wellness of individuals working at such fa11 cilities. 

12 (B) REQUIREMENTS.—The training cur13 riculum described in subparagraph (A) shall be 

14 designed to help U.S. Customs and Border Pro15 tection agents and officers working at U.S. 

16 Customs and Border Protection facilities— 

17 (i) to better manage their own stress 

18 and the stress of their coworkers; and 

19 (ii) to be more aware of the psycho20 logical pressures experienced during their 

21 jobs. 

22 (3) ANNUAL REVIEW OF TRAINING.—Beginning 

23 with respect to fiscal year 2022, the Assistant Sec24 retary for Mental Health and Substance Use shall— 


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1 (A) conduct an annual review of the train2 ing implemented pursuant to paragraphs (1) 

3 and (2); and 

4 (B) submit the results of each such review, 

5 including any recommendations for improve6 ment of such training, to— 

7 (i) the Commissioner of U.S. Customs 

8 and Border Protection; 

9 (ii) the Committee on Appropriations 

10 of the Senate; 

11 (iii) the Committee on Health, Edu12 cation, Labor, and Pensions of the Senate; 

13 (iv) the Committee on Homeland Se14 curity and Governmental Affairs of the 

15 Senate; 

16 (v) the Committee on Appropriations 

17 of the House of Representatives; 

18 (vi) the Committee on Energy and 

19 Commerce of the House of Representa20 tives; 

21 (vii) the Committee on Homeland Se22 curity of the House of Representatives; 

23 and 

24 (viii) the Committee on the Judiciary 

25 of the House of Representatives. 


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1 (4) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated, to carry out 

3 this subsection— 

4 (A) for fiscal year 2021, $50,000 to de5 velop the training required under paragraphs 

6 (1) and (2); and 

7 (B) for each of the fiscal years 2022 

8 through 2026— 

9 (i) $20,000 to implement the training 

10 required under paragraphs (1) and (2); 

11 and 

12 (ii) such sums as may be necessary to 

13 review and make recommendations for 

14 such training pursuant to paragraph (3). 

15 (d) STAFFING BORDER FACILITIES AND DETENTION

16 CENTERS.— 

17 (1) IN GENERAL.—The Commissioner of U.S. 

18 Customs and Border Protection shall adequately 

19 evaluate the mental health needs of immigrants, ref20 ugees, border patrol agents, and staff by assigning 

21 not fewer than 1 qualified mental or behavioral 

22 health expert to each U.S. Customs and Border Pro23 tection facility. 


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1 (2) QUALIFICATIONS.—A mental or behavioral 

2 health expert is qualified for an assignment de3 scribed in paragraph (1) if the expert— 

4 (A) is bilingual; 

5 (B) is well-versed in culturally appropriate 

6 and trauma-informed interventions; and 

7 (C) has particular expertise in child or ad8 olescent mental health or family mental health. 

9 (3) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated $3,000,000 

11 for each of the fiscal years 2021 through 2025 to 

12 carry out this subsection. 

13 (e) PROHIBITION AGAINST SHARING DEPARTMENT

14 OF HEALTH AND HUMAN SERVICES MENTAL HEALTH IN15 FORMATION FOR ASYLUM DETERMINATIONS, IMMIGRA16 TION HEARINGS, OR DEPORTATION PROCEEDINGS.—The 

17 officers, employees, and agents of the Department of 

18 Health and Human Services, including the Office of Ref19 ugee Resettlement, may not share with the Department 

20 of Homeland Security, and the officers, employees, and 

21 agents of the Department of Homeland Security may not 

22 request or receive from the Department of Health and 

23 Human Services, for the purposes of an asylum deter24 mination, immigration hearing, or deportation proceeding, 

25 any information or record that— 


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1 (1) concerns the mental health of an alien; and 

2 (2) was obtained or produced by a mental or 

3 behavioral health professional while the alien was in 

4 a shelter or otherwise in the custody of the Federal 

5 Government. 

6 TITLE VII—ADDRESSING HIGH 

7 IMPACT MINORITY DISEASES 

8 Subtitle A—Cancer 

9 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 

10 (a) SHORT TITLE.—This section may be cited as the 

11 ‘‘Lung Cancer Mortality Reduction Act of 2020’’. 

12 (b) FINDINGS.—Congress makes the following find13 ings: 

14 (1) Lung cancer is the leading cause of cancer 

15 death for both men and women, accounting for 25 

16 percent of all cancer deaths. 

17 (2) Lung cancer kills more people annually 

18 than breast cancer, prostate cancer, colon cancer, 

19 liver cancer, melanoma, and kidney cancer combined. 

20 (3) Since the National Cancer Act of 1971 

21 (Public Law 92–218; 85 Stat. 778), coordinated and 

22 comprehensive research has raised the 5-year sur23 vival rates for breast cancer to 90 percent, for pros24 tate cancer to 99 percent, and for colon cancer to 

25 64 percent. 


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1 (4) The 5-year survival rate for lung cancer is 

2 still only 18 percent, and a similar coordinated and 

3 comprehensive research effort is required to achieve 

4 increases in lung cancer survivability rates. 

5 (5) Sixty percent of lung cancer cases are now 

6 diagnosed in nonsmokers or former smokers. 

7 (6) Two-thirds of nonsmokers diagnosed with 

8 lung cancer are women. 

9 (7) Certain minority populations, such as Afri10 can-American males, have disproportionately high 

11 rates of lung cancer incidence and mortality, despite 

12 their smoking rate being similar to other racial 

13 groups. 

14 (8) Members of the Baby Boomer Generation 

15 are entering their 60s, the most common age at 

16 which people develop lung cancer. 

17 (9) Tobacco addiction and exposure to other 

18 lung cancer carcinogens such as Agent Orange and 

19 other herbicides and battlefield emissions are serious 

20 problems among military personnel and war vet21 erans. 

22 (10) Significant and rapid improvements in 

23 lung cancer mortality can be expected through great24 er use and access to lung cancer screening tests for 

25 at-risk individuals. 


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1 (11) Recent research has shown that screening 

2 with low-dose computed tomography scan reduced 

3 lung cancer death mortality by 20 percent for those 

4 with a high risk of lung cancer through early detec5 tion. The Centers for Medicare & Medicaid Services 

6 supports annual lung cancer screening for high-risk 

7 patients with low-dose computed tomography. 

8 (12) Additional strategies are necessary to fur9 ther enhance the existing tests and therapies avail10 able to diagnose and treat lung cancer in the future. 

11 (13) The August 2001 Report of the Lung 

12 Cancer Progress Review Group of the National Can13 cer Institute stated that funding for lung cancer re14 search was ‘‘far below the levels characterized for 

15 other common malignancies and far out of propor16 tion to its massive health impact’’. 

17 (14) The Report of the Lung Cancer Progress 

18 Review Group identified as its ‘‘highest priority’’ the 

19 creation of integrated, multidisciplinary, multi-insti20 tutional research consortia organized around the 

21 problem of lung cancer rather than around specific 

22 research disciplines. 

23 (15) The United States must enhance its re24 sponse to the issues raised in the Report of the 

25 Lung Cancer Progress Review Group, and this can 


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1 be accomplished through the establishment of a co2 ordinated effort designed to reduce the lung cancer 

3 mortality rate by 50 percent by 2020 and targeted 

4 funding to support this coordinated effort. 

5 (c) SENSE OF CONGRESS CONCERNING INVESTMENT

6 IN LUNG CANCER RESEARCH.—It is the sense of the Con7 gress that— 

8 (1) lung cancer mortality reduction should be 

9 made a national public health priority; and 

10 (2) a comprehensive mortality reduction pro11 gram coordinated by the Secretary of Health and 

12 Human Services is justified and necessary to ade13 quately address and reduce lung cancer mortality. 

14 (d) LUNG CANCER MORTALITY REDUCTION PRO15 GRAM.— 

16 (1) IN GENERAL.—Subpart 1 of part C of title 

17 IV of the Public Health Service Act (42 U.S.C. 285 

18 et seq.) is amended by adding at the end the fol19 lowing: 

20 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO21 GRAM. 

22 ‘‘(a) IN GENERAL.—Not later than 6 months after 

23 the date of the enactment of the Health Equity and Ac24 countability Act of 2020, the Secretary, in consultation 

25 with the Secretary of Defense, the Secretary of Veterans 


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1 Affairs, the Director of the National Institutes of Health, 

2 the Director of the Centers for Disease Control and Pre3 vention, the Commissioner of Food and Drugs, the Admin4 istrator of the Centers for Medicare & Medicaid Services, 

5 the Director of the National Institute on Minority Health 

6 and Health Disparities, and other members of the Lung 

7 Cancer Advisory Board established under section 701 of 

8 the Health Equity and Accountability Act of 2020, shall 

9 implement a comprehensive program, to be known as the 

10 Lung Cancer Mortality Reduction Program, to achieve a 

11 reduction of at least 25 percent in the mortality rate of 

12 lung cancer by 2020. 

13 ‘‘(b) REQUIREMENTS.—The Program shall include at 

14 least the following: 

15 ‘‘(1) With respect to the National Institutes of 

16 Health— 

17 ‘‘(A) a strategic review and prioritization 

18 by the National Cancer Institute of research 

19 grants to achieve the goal of the Lung Cancer 

20 Mortality Reduction Program in reducing lung 

21 cancer mortality; 

22 ‘‘(B) the provision of funds to enable the 

23 Airway Biology and Disease Branch of the Na24 tional Heart, Lung, and Blood Institute to ex25 pand its research programs to include preVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 dispositions to lung cancer, the interrelationship 

2 between lung cancer and other pulmonary and 

3 cardiac disease, and the diagnosis and treat4 ment of those interrelationships; 

5 ‘‘(C) the provision of funds to enable the 

6 National Institute of Biomedical Imaging and 

7 Bioengineering to expedite the development of 

8 computer-assisted diagnostic, surgical, treat9 ment, and drug-testing innovations to reduce 

10 lung cancer mortality, such as through expan11 sion of the Institute’s Quantum Grant Program 

12 and Image-Guided Interventions programs; and 

13 ‘‘(D) the provision of funds to enable the 

14 National Institute of Environmental Health 

15 Sciences to implement research programs rel16 ative to the lung cancer incidence. 

17 ‘‘(2) With respect to the Food and Drug Ad18 ministration— 

19 ‘‘(A) activities under section 529B of the 

20 Federal Food, Drug, and Cosmetic Act; and 

21 ‘‘(B) activities under section 561 of the 

22 Federal Food, Drug, and Cosmetic Act to ex23 pand access to investigational drugs and devices 

24 for the diagnosis, monitoring, or treatment of 

25 lung cancer. 


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1 ‘‘(3) With respect to the Centers for Disease 

2 Control and Prevention, the establishment of an 

3 early disease research and management program 

4 under section 1511. 

5 ‘‘(4) With respect to the Agency for Healthcare 

6 Research and Quality, the conduct of a biannual re7 view of lung cancer screening, diagnostic, and treat8 ment protocols, and the issuance of updated guide9 lines. 

10 ‘‘(5) The promotion (including education) of 

11 lung cancer screening within minority and rural pop12 ulations and the study of the effectiveness of efforts 

13 to increase such screening. 

14 ‘‘(6) The cooperation and coordination of all 

15 minority and health disparity programs within the 

16 Department of Health and Human Services to en17 sure that all aspects of the Lung Cancer Mortality 

18 Reduction Program under this section adequately 

19 address the burden of lung cancer on minority and 

20 rural populations. 

21 ‘‘(7) The cooperation and coordination of all to22 bacco control and cessation programs within agen23 cies of the Department of Health and Human Serv24 ices to achieve the goals of the Lung Cancer Mor25 tality Reduction Program under this section with 


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1 particular emphasis on the coordination of drug and 

2 other cessation treatments with early detection pro3 tocols.’’. 

4 (2) FEDERAL FOOD, DRUG, AND COSMETIC

5 ACT.—Subchapter B of chapter V of the Federal 

6 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 

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

8 ‘‘SEC. 529B. DRUGS RELATING TO LUNG CANCER. 

9 ‘‘(a) IN GENERAL.—The provisions of this sub10 chapter shall apply to a drug described in subsection (b) 

11 to the same extent and in the same manner as such provi12 sions apply to a drug for a rare disease or condition. 

13 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 

14 subsection is— 

15 ‘‘(1) a chemoprevention drug for precancerous 

16 conditions of the lung; 

17 ‘‘(2) a drug for targeted therapeutic treat18 ments, including any vaccine, for lung cancer; or 

19 ‘‘(3) a drug to curtail or prevent nicotine addic20 tion. 

21 ‘‘(c) BOARD.—The Board established under section 

22 701 of the Health Equity and Accountability Act of 2020 

23 shall monitor the program implemented under this sec24 tion.’’. 


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1 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec2 tion 561(e) of the Federal Food, Drug, and Cos3 metic Act (21 U.S.C. 360bbb(e)) is amended by in4 serting before the period the following: ‘‘and shall 

5 include expanding access to drugs under section 

6 529B, with substantial consideration being given to 

7 whether the totality of information available to the 

8 Secretary regarding the safety and effectiveness of 

9 an investigational drug, as compared to the risk of 

10 morbidity and death from the disease, indicates that 

11 a patient may obtain more benefit than risk if treat12 ed with the drug’’. 

13 (4) CDC.—Title XV of the Public Health Serv14 ice Act (42 U.S.C. 300k et seq.) is amended by add15 ing at the end the following: 

16 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 

17 PROGRAM. 

18 ‘‘The Secretary shall establish and implement an 

19 early disease research and management program targeted 

20 at the high incidence and mortality rates of lung cancer 

21 among minority and low-income populations.’’. 

22 (e) DEPARTMENT OF DEFENSE AND THE DEPART23 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 

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1 tion with the Secretary of Health and Human Services, 

2 shall engage— 

3 (1) in the implementation within the Depart4 ment of Defense and the Department of Veterans 

5 Affairs of an early detection and disease manage6 ment research program for military personnel and 

7 veterans whose smoking history and exposure to car8 cinogens during active duty service has increased 

9 their risk for lung cancer; and 

10 (2) in the implementation of coordinated care 

11 programs for military personnel and veterans diag12 nosed with lung cancer. 

13 (f) LUNG CANCER ADVISORY BOARD.— 

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

15 Human Services shall convene a Lung Cancer Advi16 sory Board (referred to in this section as the 

17 ‘‘Board’’)— 

18 (A) to monitor the programs established 

19 under this section (and the amendments made 

20 by this section); and 

21 (B) to provide annual reports to the Con22 gress concerning benchmarks, expenditures, 

23 lung cancer statistics, and the public health im24 pact of such programs. 


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1 (2) COMPOSITION.—The Board shall be com2 prised of— 

3 (A) the Secretary of Health and Human 

4 Services; 

5 (B) the Secretary of Defense; 

6 (C) the Secretary of Veterans Affairs; and 

7 (D) 2 representatives each from the fields 

8 of clinical medicine focused on lung cancer, 

9 lung cancer research, imaging, drug develop10 ment, and lung cancer advocacy, to be ap11 pointed by the Secretary of Health and Human 

12 Services. 

13 (g) AUTHORIZATION OF APPROPRIATIONS.— 

14 (1) IN GENERAL.—To carry out this section 

15 (and the amendments made by this section), there 

16 are authorized to be appropriated $75,000,000 for 

17 fiscal year 2021 and such sums as may be necessary 

18 for each of fiscal years 2022 through 2025. 

19 (2) LUNG CANCER MORTALITY REDUCTION PRO20 GRAM.—The amounts appropriated under paragraph 

21 (1) shall be allocated as follows: 

22 (A) $25,000,000 for fiscal year 2021, and 

23 such sums as may be necessary for each of fis24 cal years 2022 through 2025, for the activities 

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1 lic Health Service Act, as added by subsection 

2 (d); 

3 (B) $25,000,000 for fiscal year 2021, and 

4 such sums as may be necessary for each of fis5 cal years 2022 through 2025, for the activities 

6 described in section 417H(b)(1)(C) of the Pub7 lic Health Service Act; 

8 (C) $10,000,000 for fiscal year 2021, and 

9 such sums as may be necessary for each of fis10 cal years 2022 through 2025, for the activities 

11 described in section 417H(b)(1)(D) of the Pub12 lic Health Service Act; and 

13 (D) $15,000,000 for fiscal year 2021, and 

14 such sums as may be necessary for each of fis15 cal years 2022 through 2025, for the activities 

16 described in section 417H(b)(3) of the Public 

17 Health Service Act. 

18 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT19 REACH, SCREENING, TESTING, ACCESS, AND 

20 TREATMENT EFFECTIVENESS. 

21 (a) SHORT TITLE.—This section may be cited as the 

22 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 

23 and Treatment Effectiveness Act of 2020’’ or the ‘‘PROS24 TATE Act’’. 


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1 (b) FINDINGS.—Congress makes the following find2 ings: 

3 (1) Prostate cancer is the second leading cause 

4 of cancer death among men. 

5 (2) In 2020, an estimated 191,930 individuals 

6 in the United States will be diagnosed with prostate 

7 cancer and approximately 33,330 will die from the 

8 disease. 

9 (3) Roughly 2,000,000 to 3,000,000 people in 

10 the United States are living with a diagnosis of pros11 tate cancer and its consequences. 

12 (4) Although prostate cancer generally affects 

13 older individuals, younger men are also at risk for 

14 the disease, and when prostate cancer appears in 

15 early middle age, it frequently takes on a more ag16 gressive form. 

17 (5) There are significant racial and ethnic dis18 parities that demand attention, for example, African 

19 Americans have prostate cancer mortality rates that 

20 are more than double those in the White population. 

21 (6) Underserved rural populations have higher 

22 rates of mortality compared to their urban counter23 parts, and innovative and cost-efficient methods to 

24 improve rural access to high-quality care should take 


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1 advantage of advances in telehealth to diagnose and 

2 treat prostate cancer when appropriate. 

3 (7) Certain populations of veterans may have 

4 nearly twice the incidence of prostate cancer as the 

5 general population of the United States. 

6 (8) Urologists may constitute the specialists 

7 who diagnose and treat the vast majority of prostate 

8 cancer patients. 

9 (9) Although much basic and translational re10 search has been completed and much is currently 

11 known, there are still many unanswered questions, 

12 such as the extent to which known disparities are at13 tributable to disease etiology, access to care, or edu14 cation and awareness in the community. 

15 (10) Causes of prostate cancer are not known. 

16 There is not good information regarding how to dif17 ferentiate accurately, early on, between aggressive 

18 and indolent forms of the disease. As a result, there 

19 is significant overtreatment in prostate cancer. 

20 There are no treatments that can durably arrest 

21 growth or cure prostate cancer once it has metasta22 sized. 

23 (11) A significant proportion of cases may be 

24 clinically indolent and ‘‘overdiagnosed’’, resulting in 

25 significant overtreatment. More accurate tests will 


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1 allow men and their families to face less physical, 

2 psychological, financial, and emotional trauma, and 

3 billions of dollars could be saved in private and pub4 lic health care systems. 

5 (12) Prostate cancer research and health care 

6 programs across Federal agencies should be coordi7 nated to improve accountability and actively encour8 age the translation of research into practice and to 

9 identify and implement best practices in order to 

10 foster an integrated and consistent focus on effective 

11 prevention, diagnosis, and treatment of the disease. 

12 (c) PROSTATE CANCER COORDINATION AND EDU13 CATION.— 

14 (1) INTERAGENCY PROSTATE CANCER COORDI15 NATION AND EDUCATION TASK FORCE.—Not later 

16 than 180 days after the date of the enactment of 

17 this Act, the Secretary of Veterans Affairs, in co18 operation with the Secretary of Defense and the Sec19 retary of Health and Human Services, shall estab20 lish an Interagency Prostate Cancer Coordination 

21 and Education Task Force (in this section referred 

22 to as the ‘‘Prostate Cancer Task Force’’). 

23 (2) DUTIES.—The Prostate Cancer Task Force 

24 shall— 


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1 (A) develop a summary of advances in 

2 prostate cancer research supported or con3 ducted by Federal agencies relevant to the diag4 nosis, prevention, and treatment of prostate 

5 cancer, including psychosocial impairments re6 lated to prostate cancer treatment, and compile 

7 a list of best practices that warrant broader 

8 adoption in health care programs; 

9 (B) consider establishing, and advocating 

10 for, a guidance to enable physicians to allow 

11 screening of men who are age 74 or older, on 

12 a case-by-case basis, taking into account quality 

13 of life and family history of prostate cancer; 

14 (C) share and coordinate information on 

15 research and health care program activities by 

16 the Federal Government, including activities re17 lated to— 

18 (i) determining how to improve re19 search and health care programs, including 

20 psychosocial impairments related to pros21 tate cancer treatment; 

22 (ii) identifying any gaps in the overall 

23 research inventory and in health care pro24 grams; 


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1 (iii) identifying opportunities to pro2 mote translation of research into practice; 

3 and 

4 (iv) maximizing the effects of Federal 

5 Government efforts by identifying opportu6 nities for collaboration and leveraging of 

7 resources in research and health care pro8 grams that serve individuals who are sus9 ceptible to or diagnosed with prostate can10 cer; 

11 (D) develop a comprehensive interagency 

12 strategy and advise relevant Federal agencies in 

13 the solicitation of proposals for collaborative, 

14 multidisciplinary research and health care pro15 grams, including proposals to evaluate factors 

16 that may be related to the etiology of prostate 

17 cancer, that would— 

18 (i) result in innovative approaches to 

19 study emerging scientific opportunities or 

20 eliminate knowledge gaps in research to 

21 improve the prostate cancer research port22 folio of the Federal Government; and 

23 (ii) outline key research questions, 

24 methodologies, and knowledge gaps; 


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1 (E) develop a coordinated message related 

2 to screening and treatment for prostate cancer 

3 to be reflected in educational and beneficiary 

4 materials for Federal health programs as such 

5 documents are updated; and 

6 (F) not later than 2 years after the date 

7 of the establishment of the Prostate Cancer 

8 Task Force, submit to the expert advisory pan9 els appointed under paragraph (4) to be re10 viewed and returned within 30 days, and then 

11 within 90 days submitted to Congress, rec12 ommendations— 

13 (i) regarding any appropriate changes 

14 to research and health care programs, in15 cluding recommendations to improve the 

16 research portfolio of the Department of 

17 Veterans Affairs, the Department of De18 fense, the National Institutes of Health, 

19 and other Federal agencies to ensure that 

20 scientifically based strategic planning is 

21 implemented in support of research and 

22 health care program priorities; 

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1 fairs, the Department of Defense, the De2 partment of Health and Human Services, 

3 and other Federal agencies are free of un4 necessary duplication; 

5 (iii) regarding public participation in 

6 decisions relating to prostate cancer re7 search and health care programs to in8 crease the involvement of patient advo9 cates, community organizations, and med10 ical associations representing a broad geo11 graphical area; 

12 (iv) on how to best disseminate infor13 mation on prostate cancer research and 

14 progress achieved by health care programs; 

15 (v) about how to expand partnerships 

16 between public entities, including Federal 

17 agencies, and private entities to encourage 

18 collaborative, cross-cutting research and 

19 health care delivery; 

20 (vi) assessing any cost savings and ef21 ficiencies realized through the efforts iden22 tified and supported in this subsection and 

23 recommending expansion of those efforts 

24 that have proved most promising while also 


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1 ensuring against any conflicts in directives 

2 in law; 

3 (vii) identifying key priority action 

4 items from among the recommendations; 

5 and 

6 (viii) with respect to the level of fund7 ing needed by each agency to implement 

8 the recommendations contained in the re9 port. 

10 (3) MEMBERS OF THE PROSTATE CANCER TASK

11 FORCE.—The Prostate Cancer Task Force shall be 

12 comprised of representatives from such Federal 

13 agencies, as the head of each such applicable agency 

14 determines necessary, so as to coordinate a uniform 

15 message relating to prostate cancer screening and 

16 treatment where appropriate, including representa17 tives of the following: 

18 (A) The Department of Veterans Affairs, 

19 including representatives of each relevant pro20 gram area of the Department of Veterans Af21 fairs. 

22 (B) The Prostate Cancer Research Pro23 gram of the Congressionally Directed Medical 

24 Research Program of the Department of De25 fense. 


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1 (C) The Department of Health and 

2 Human Services, including, at a minimum, rep3 resentatives of each of the following: 

4 (i) The National Institutes of Health. 

5 (ii) National research institutes and 

6 centers, including the National Cancer In7 stitute, the National Institute of Allergy 

8 and Infectious Diseases, and the Office of 

9 Minority Health. 

10 (iii) The Centers for Medicare & Med11 icaid Services. 

12 (iv) The Food and Drug Administra13 tion. 

14 (v) The Centers for Disease Control 

15 and Prevention. 

16 (vi) The Agency for Healthcare Re17 search and Quality. 

18 (vii) The Health Resources and Serv19 ices Administration. 

20 (4) APPOINTING EXPERT ADVISORY PANELS.— 

21 The Prostate Cancer Task Force shall appoint ex22 pert advisory panels, as the task force determines 

23 appropriate, to provide input and concurrence from 

24 individuals and organizations from the medical, 

25 prostate cancer patient and advocate, research, and 


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1 delivery communities with expertise in prostate can2 cer diagnosis, treatment, and research, including 

3 practicing urologists, primary care providers, and 

4 others, and individuals with expertise in education 

5 and outreach to underserved populations affected by 

6 prostate cancer. 

7 (5) MEETINGS.—The Prostate Cancer Task 

8 Force shall convene not less frequently than twice 

9 each year, or more frequently as the Secretary of 

10 Veterans Affairs determines to be appropriate. 

11 (6) FEDERAL ADVISORY COMMITTEE ACT.—The 

12 Federal Advisory Committee Act (5 U.S.C. App.) 

13 shall apply to the Prostate Cancer Task Force. 

14 (7) SUNSET DATE.—The Prostate Cancer Task 

15 Force shall terminate on September 30, 2025. 

16 (d) PROSTATE CANCER RESEARCH.— 

17 (1) RESEARCH COORDINATION PROGRAM.— 

18 (A) IN GENERAL.—The Secretary of Vet19 erans Affairs, in coordination with the Sec20 retary of Defense and the Secretary of Health 

21 and Human Services, shall establish and carry 

22 out a program to coordinate and intensify pros23 tate cancer research. 

24 (B) ELEMENTS.—The program established 

25 under subparagraph (A) shall— 


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1 (i) develop advances in diagnostic and 

2 prognostic methods and tests, including 

3 biomarkers and an improved prostate can4 cer screening blood test, including improve5 ments or alternatives to the prostate spe6 cific antigen test and additional tests to 

7 distinguish indolent from aggressive dis8 ease; 

9 (ii) develop better understanding of 

10 the etiology of the disease (including an 

11 analysis of lifestyle factors proven to be in12 volved in higher rates of prostate cancer, 

13 such as obesity and diet, and in different 

14 ethnic, racial, and socioeconomic groups, 

15 such as the African-American, Latino or 

16 Hispanic, and American Indian popu17 lations and men with a family history of 

18 prostate cancer) to improve prevention ef19 forts; 

20 (iii) expand basic research into pros21 tate cancer, including studies of funda22 mental molecular and cellular mechanisms; 

23 (iv) identify and provide clinical test24 ing of novel agents for the prevention and 

25 treatment of prostate cancer; 


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1 (v) establish clinical registries for 

2 prostate cancer; 

3 (vi) use the National Institute of Bio4 medical Imaging and Bioengineering and 

5 the National Cancer Institute for assess6 ment of appropriate imaging modalities; 

7 and 

8 (vii) address such other matters relat9 ing to prostate cancer research as may be 

10 identified by the Federal agencies partici11 pating in the program under this sub12 section. 

13 (C) UNDERSERVED MINORITY GRANT PRO14 GRAM.—In carrying out the program estab15 lished under subparagraph (A), the Secretary 

16 shall— 

17 (i) award grants to eligible entities to 

18 carry out components of the research out19 lined in subparagraph (B); 

20 (ii) integrate and build upon existing 

21 knowledge gained from comparative effec22 tiveness research; and 

23 (iii) recognize and address— 

24 (I) the racial and ethnic dispari25 ties in the incidence and mortality 


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1 rates of prostate cancer and men with 

2 a family history of prostate cancer; 

3 (II) any barriers in access to care 

4 and participation in clinical trials that 

5 are specific to racial, ethnic, and other 

6 underserved minorities and men with 

7 a family history of prostate cancer; 

8 (III) outreach and educational ef9 forts to raise awareness among the 

10 populations described in subclause 

11 (II); and 

12 (IV) appropriate access and utili13 zation of imaging modalities. 

14 (2) PROSTATE CANCER ADVISORY BOARD.— 

15 (A) IN GENERAL.—There is established in 

16 the Office of the Chief Scientist of the Food 

17 and Drug Administration a Prostate Cancer 

18 Scientific Advisory Board. 

19 (B) DUTIES.—The board established under 

20 subparagraph (A) shall be responsible for accel21 erating real-time sharing of the latest research 

22 data and accelerating movement of new medi23 cines to patients. 

24 (e) TELEHEALTH AND RURAL ACCESS PILOT

25 PROJECTS.— 


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1 (1) ESTABLISHMENT OF PILOT PROJECTS.— 

2 (A) IN GENERAL.—The Secretary of Vet3 erans Affairs, in cooperation with the Secretary 

4 of Defense and the Secretary of Health and 

5 Human Services (referred to in this subsection 

6 collectively as the ‘‘Secretaries’’) shall establish 

7 4-year telehealth pilot projects for the purpose 

8 of analyzing the clinical outcomes and cost-ef9 fectiveness associated with telehealth services in 

10 a variety of geographic areas that contain high 

11 proportions of medically underserved popu12 lations, including African Americans, Latinos or 

13 Hispanics, American Indians or Alaska Natives, 

14 and those in rural areas. 

15 (B) EFFICIENT AND EFFECTIVE CARE.— 

16 Pilot projects established under subparagraph 

17 (A) shall promote efficient use of specialist care 

18 through better coordination of primary care and 

19 physician extender teams in underserved areas 

20 and more effectively employ tumor boards to 

21 better counsel patients. 

22 (2) ELIGIBLE ENTITIES.— 

23 (A) IN GENERAL.—The Secretaries shall 

24 select eligible entities to participate in the pilot 

25 projects established under this subsection. 


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1 (B) PRIORITY.—In selecting eligible enti2 ties to participate in the pilot projects under 

3 this subsection, the Secretaries shall give pri4 ority to entities located in medically under5 served areas, particularly those that include Af6 rican Americans, Latinos and Hispanics, and 

7 facilities of the Indian Health Service, including 

8 facilities operated by the Indian Health Service, 

9 tribally operated facilities, and Urban Indian 

10 Clinics, and those in rural areas. 

11 (3) EVALUATION.—The Secretaries shall, 

12 through the pilot projects, evaluate— 

13 (A) the effective and economic delivery of 

14 care in diagnosing and treating prostate cancer 

15 with the use of telehealth services in medically 

16 underserved and Tribal areas including collabo17 rative uses of health professionals and integra18 tion of the range of telehealth and other tech19 nologies; 

20 (B) the effectiveness of improving the ca21 pacity of nonmedical providers and nonspecial22 ized medical providers to provide health services 

23 for prostate cancer in medically underserved 

24 and Tribal areas, including the exploration of 

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1 tion between urologists, other relevant medical 

2 specialists, including oncologists, radiologists, 

3 and primary care teams, and coordination of 

4 care through the efficient use of primary care 

5 teams and physician extenders; and 

6 (C) the effectiveness of using telehealth 

7 services to provide prostate cancer treatment in 

8 medically underserved areas, including the use 

9 of tumor boards to facilitate better patient 

10 counseling. 

11 (4) REPORT.—Not later than 1 year after the 

12 completion of the pilot projects under this sub13 section, the Secretaries shall submit to Congress a 

14 report describing the outcomes of such pilot projects, 

15 including any cost savings and efficiencies realized, 

16 and providing recommendations, if any, for expand17 ing the use of telehealth services. 

18 (f) EDUCATION AND AWARENESS.— 

19 (1) CAMPAIGN.— 

20 (A) IN GENERAL.—The Secretary of Vet21 erans Affairs shall develop a national education 

22 campaign for prostate cancer. 

23 (B) ELEMENTS.—The campaign developed 

24 under subparagraph (A) shall involve the use of 

25 written educational materials and public service 


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1 announcements consistent with the findings of 

2 the Prostate Cancer Task Force under sub3 section (c) that are intended to encourage men 

4 to seek prostate cancer screening when appro5 priate. 

6 (2) RACIAL DISPARITIES AND THE POPULATION

7 OF MEN WITH A FAMILY HISTORY OF PROSTATE

8 CANCER.—In developing the campaign under para9 graph (1), the Secretary shall ensure that edu10 cational materials and public service announcements 

11 used in the campaign are more readily available in 

12 communities experiencing racial disparities in the in13 cidence and mortality rates of prostate cancer and to 

14 men of any race classification with a family history 

15 of prostate cancer. 

16 (3) GRANTS.—In carrying out the campaign 

17 under this subsection, the Secretary shall award 

18 grants to nonprofit private entities to enable such 

19 entities to test alternative outreach and education 

20 strategies. 

21 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated to carry out this section for 

23 the period of fiscal years 2021 through 2025 an amount 

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1 ment projected to be achieved over such period by imple2 mentation of this section. 

3 SEC. 703. PROSTATE RESEARCH, IMAGING, AND MEN’S EDU4 CATION (PRIME). 

5 (a) SHORT TITLE.—This section may be cited as the 

6 ‘‘Prostate Research, Imaging, and Men’s Education Act 

7 of 2020’’ or the ‘‘PRIME Act of 2020’’. 

8 (b) FINDINGS.—Congress makes the following find9 ings: 

10 (1) Prostate cancer has reached epidemic pro11 portions, particularly among African-American men, 

12 and strikes and kills men in numbers comparable to 

13 the number of women who lose their lives from 

14 breast cancer. 

15 (2) Life-saving breakthroughs in screening, di16 agnosis, and treatment of breast cancer resulted 

17 from the development of advanced imaging tech18 nologies led by the Federal Government. 

19 (3) Men should have accurate and affordable 

20 prostate cancer screening exams and minimally 

21 invasive treatment tools, similar to what women have 

22 for breast cancer. 

23 (4) While it is important for men to take ad24 vantage of current prostate cancer screening tech25 niques, a recent NCI-funded study demonstrated 


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1 that the most common available methods of detect2 ing prostate cancer (PSA blood test and physical 

3 exams) are not foolproof, causing numerous false 

4 alarms and false reassurances. 

5 (5) The absence of advanced imaging tech6 nologies for prostate cancer causes the lack of accu7 rate information critical for clinical decisions, result8 ing in missed cancers and lost lives, as well as un9 necessary and costly medical procedures, with re10 lated complications. 

11 (6) With prostate imaging tools, men and their 

12 families would face less physical, psychological, fi13 nancial, and emotional trauma and billions of dollars 

14 could be saved in private and public health care sys15 tems. 

16 (c) RESEARCH AND DEVELOPMENT OF PROSTATE

17 CANCER IMAGING TECHNOLOGIES.— 

18 (1) EXPANSION OF RESEARCH.—The Secretary 

19 of Health and Human Services (referred to in this 

20 section as the ‘‘Secretary’’), acting through the Di21 rector of the National Institutes of Health and the 

22 Administrator of the Health Resources and Services 

23 Administration, and in consultation with the Sec24 retary of Defense, shall carry out a program to ex25 pand and intensify research to develop innovative 


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1 advanced imaging technologies for prostate cancer 

2 detection, diagnosis, and treatment comparable to 

3 state-of-the-art mammography technologies. 

4 (2) EARLY STAGE RESEARCH.—In imple5 menting the program under paragraph (1), the Sec6 retary, acting through the Administrator of the 

7 Health Resources and Services Administration, shall 

8 carry out a grant program to encourage the early 

9 stages of research in prostate imaging to develop 

10 and implement new ideas, proof of concepts, and 

11 pilot studies for high-risk technologic innovation in 

12 prostate cancer imaging that would have a high po13 tential impact for improving patient care, including 

14 individualized care, quality of life, and cost-effective15 ness. 

16 (3) LARGE SCALE LATER STAGE RESEARCH.— 

17 In implementing the program under paragraph (1), 

18 the Secretary, acting through the Director of the 

19 National Institutes of Health, shall utilize the Na20 tional Institute of Biomedical Imaging and Bio21 engineering and the National Cancer Institute for 

22 advanced stages of research in prostate imaging, in23 cluding technology development and clinical trials for 

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1 onstrated promising preliminary results and proof of 

2 concept. 

3 (4) INTERDISCIPLINARY PRIVATE-PUBLIC PART4 NERSHIPS.—In developing the program under para5 graph (1), the Secretary, acting through the Admin6 istrator of the Health Resources and Services Ad7 ministration, shall establish interdisciplinary private8 public partnerships to develop and implement re9 search strategies for expedited innovation in imaging 

10 and image-guided treatment and to conduct such re11 search. 

12 (5) RACIAL DISPARITIES.—In developing the 

13 program under paragraph (1), the Secretary shall 

14 recognize and address— 

15 (A) the racial disparities in the incidences 

16 of prostate cancer and mortality rates with re17 spect to such disease; and 

18 (B) any barriers in access to care and par19 ticipation in clinical trials that are specific to 

20 racial minorities. 

21 (6) AUTHORIZATION OF APPROPRIATIONS.— 

22 (A) IN GENERAL.—Subject to subpara23 graph (B), there is authorized to be appro24 priated to carry out this section, $100,000,000 

25 for each of the fiscal years 2021 through 2025. 


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1 (B) SPECIFIC ALLOCATIONS.—Of the 

2 amount authorized to be appropriated under 

3 subparagraph (A) for each of the fiscal years 

4 described in such subparagraph— 

5 (i) no less than 10 percent may be ap6 propriated to carry out the grant program 

7 under paragraph (2); and 

8 (ii) no more than 1 percent may be 

9 appropriated to carry out paragraph (4). 

10 (d) PUBLIC AWARENESS AND EDUCATION CAM11 PAIGN.— 

12 (1) NATIONAL CAMPAIGN.—The Secretary shall 

13 carry out a national campaign to increase the aware14 ness and knowledge of individuals in the United 

15 States with respect to the need for prostate cancer 

16 screening and for improved detection technologies. 

17 (2) REQUIREMENTS.—The national campaign 

18 conducted under this subsection shall include— 

19 (A) roles for the Health Resources Services 

20 Administration, the Office of Minority Health 

21 of the Department of Health and Human Serv22 ices, the Centers for Disease Control and Pre23 vention, and the Office of Minority Health and 

24 Health Equity of the Centers for Disease Con25 trol and Prevention; and 


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1 (B) the development and distribution of 

2 written educational materials, and the develop3 ment and placing of public service announce4 ments, that are intended to encourage men to 

5 seek prostate cancer screening and to create 

6 awareness of the need for improved imaging 

7 technologies for prostate cancer screening and 

8 diagnosis, including in vitro blood testing and 

9 imaging technologies. 

10 (3) RACIAL DISPARITIES.—In developing the 

11 national campaign under paragraph (1), the Sec12 retary shall recognize and address— 

13 (A) the racial disparities in the incidences 

14 of prostate cancer and mortality rates with re15 spect to such disease; and 

16 (B) any barriers in access to care and par17 ticipation in clinical trials that are specific to 

18 racial minorities. 

19 (4) GRANTS.—The Secretary shall establish a 

20 program to award grants to nonprofit private enti21 ties to enable such entities to test alternative out22 reach and education strategies to increase the 

23 awareness and knowledge of individuals in the 

24 United States with respect to the need for prostate 

25 cancer screening and improved imaging technologies. 


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1 (5) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated to carry out 

3 this section, $10,000,000 for each of fiscal years 

4 2021 through 2025. 

5 (e) IMPROVING PROSTATE CANCER SCREENING

6 BLOOD TESTS.— 

7 (1) IN GENERAL.—The Secretary, in coordina8 tion with the Secretary of Defense, shall carry out 

9 research to develop an improved prostate cancer 

10 screening blood test using in-vitro detection. 

11 (2) AUTHORIZATION OF APPROPRIATIONS.— 

12 There is authorized to be appropriated to carry out 

13 this section, $20,000,000 for each of fiscal years 

14 2021 through 2025. 

15 (f) REPORTING AND COMPLIANCE.— 

16 (1) REPORT AND STRATEGY.—Not later than 

17 12 months after the date of the enactment of this 

18 Act, the Secretary shall submit to Congress a report 

19 that details the strategy of the Secretary for imple20 menting the requirements of this section and the 

21 status of such efforts. 

22 (2) FULL COMPLIANCE.—Not later than 36 

23 months after the date of the enactment of this Act, 

24 and annually thereafter, the Secretary shall submit 

25 to Congress a report that— 


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1 (A) describes the research and development 

2 and public awareness and education campaigns 

3 funded under this section; 

4 (B) provides evidence that projects involv5 ing high-risk, high impact technologic innova6 tion, proof of concept, and pilot studies are 

7 prioritized; 

8 (C) provides evidence that the Secretary 

9 recognizes and addresses any barriers in access 

10 to care and participation in clinical trials that 

11 are specific to racial minorities in the imple12 mentation of this section; 

13 (D) contains assurances that all the other 

14 provisions of this section are fully implemented; 

15 and 

16 (E) certifies compliance with the provisions 

17 of this section, or in the case of a Federal agen18 cy that has not complied with any of such pro19 visions, an explanation as to such failure to 

20 comply. 

21 SEC. 704. PROSTATE CANCER DETECTION RESEARCH AND 

22 EDUCATION. 

23 (a) SHORT TITLE.—This section may be cited as the 

24 ‘‘Prostate Cancer Detection Research and Education 

25 Act’’. 


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1 (b) PLAN TO DEVELOP AND VALIDATE A TEST OR

2 TESTS FOR PROSTATE CANCER.— 

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

4 Human Services (referred to in this section as the 

5 ‘‘Secretary’’), acting through the Director of the Na6 tional Institutes of Health, shall establish an advi7 sory council on prostate cancer (referred to in this 

8 section as the ‘‘advisory council’’) to draft a plan for 

9 the development and validation of an accurate test 

10 or tests, such as biomarkers or imaging, to detect 

11 and diagnose prostate cancer. 

12 (2) ADVISORY COUNCIL.— 

13 (A) MEMBERSHIP.— 

14 (i) FEDERAL MEMBERS.—The advi15 sory council shall be comprised of the fol16 lowing experts: 

17 (I) A designee of the Centers for 

18 Disease Control and Prevention. 

19 (II) A designee of the Centers for 

20 Medicare & Medicaid Services. 

21 (III) A designee of the Office of 

22 the Director of the National Cancer 

23 Institute. 

24 (IV) A designee of the Director 

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1 gressionally Directed Medical Re2 search Programs. 

3 (V) A designee of the Director of 

4 the National Institute of Biomedical 

5 Imaging and Bioengineering. 

6 (VI) A designee of the Director 

7 of the National Institute of General 

8 Medical Sciences. 

9 (VII) A designee of the Director 

10 of the National Institute on Minority 

11 Health and Health Disparities. 

12 (VIII) A designee of the Office of 

13 the Director of the National Institutes 

14 of Health. 

15 (IX) A designee of the Food and 

16 Drug Administration. 

17 (X) A designee of the Agency for 

18 Healthcare Research and Quality. 

19 (XI) A designee of the Director 

20 of the Telemedicine and Advanced 

21 Technology Research Center of the 

22 Department of Defense. 

23 (ii) NON-FEDERAL MEMBERS.—In ad24 dition to the members described in clause 

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1 pert members from outside the Federal 

2 Government to be appointed by the Sec3 retary, which shall include— 

4 (I) 2 prostate cancer patient ad5 vocates; 

6 (II) 2 health care providers with 

7 a range of expertise and experience in 

8 prostate cancer; and 

9 (III) 4 leading researchers with 

10 prostate cancer-related expertise in a 

11 range of clinical disciplines. 

12 (B) MEETINGS.—The advisory council 

13 shall meet quarterly and such meetings shall be 

14 open to the public. 

15 (C) ADVICE.—The advisory council shall 

16 advise the Secretary, or the Secretary’s des17 ignee. 

18 (D) ANNUAL REPORT.—Not later than 1 

19 year after the date of enactment of this Act, the 

20 advisory council shall provide to the Secretary, 

21 or the Secretary’s designee, and Congress— 

22 (i) an initial evaluation of all federally 

23 funded efforts in prostate cancer research 

24 relating to the development and validation 


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1 of an accurate test or tests to detect and 

2 diagnose prostate cancer; 

3 (ii) a plan for the development and 

4 validation of a reliable test or tests for the 

5 detection and accurate diagnosis of pros6 tate cancer; and 

7 (iii) a set of standards for prostate 

8 cancer screening, developed in coordination 

9 with the United States Preventive Services 

10 Task Force, to ensure that any tools for 

11 screening, detection, and diagnosis devel12 oped in accordance with the plan under 

13 clause (ii) will meet the requirements of 

14 the Task Force for recommendation as a 

15 proven preventive or diagnostic service. 

16 (E) TERMINATION.—The advisory council 

17 shall terminate on December 31, 2024. 

18 (3) FUNDING.—Notwithstanding any other pro19 vision of law, the Secretary may make available 

20 $1,000,000, from any unobligated amounts appro21 priated to the National Institutes of Health, for each 

22 of fiscal years 2021 through 2025 to carry out this 

23 subsection. 

24 (c) COORDINATION AND INTENSIFICATION OF PROS25 TATE CANCER RESEARCH.— 


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1 (1) IN GENERAL.—The Director of the National 

2 Institutes of Health, in consultation with the Sec3 retary of Defense, shall coordinate and intensify re4 search in accordance with the plan provided under 

5 subsection (b)(2)(D)(ii), with particular attention 

6 provided to leveraging existing research to develop 

7 and validate a test or tests, such as biomarkers or 

8 imaging, to detect and accurately diagnose prostate 

9 cancer in order to improve quality of life for millions 

10 of individuals in the United States, and decrease 

11 health care system costs. 

12 (2) FUNDING.—Notwithstanding any other pro13 vision of law, the Secretary may make available 

14 $30,000,000, from any unobligated amounts appro15 priated to the National Institutes of Health, for each 

16 of fiscal years 2022 through 2026 to carry out this 

17 subsection. 

18 (d) PUBLIC AWARENESS AND EDUCATION CAM19 PAIGN.— 

20 (1) NATIONAL CAMPAIGN.—The Secretary, in 

21 coordination with the Director of the National Insti22 tutes of Health and the Director of the Centers for 

23 Disease Control and Prevention, shall carry out a 

24 national campaign to increase the awareness and 

25 knowledge of prostate cancer. 


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1 (2) REQUIREMENTS.—The national campaign 

2 conducted under paragraph (1) shall include— 

3 (A) roles for the National Cancer Institute, 

4 the National Institute on Minority Health and 

5 Health Disparities, the Office of Minority 

6 Health of the Department of Health and 

7 Human Services, and the Office of Minority 

8 Health and Health Equity of the Centers for 

9 Disease Control and Prevention; and 

10 (B) the development and distribution of 

11 written educational materials, and the develop12 ment and placing of public service announce13 ments, that are intended to encourage men to 

14 seek prostate cancer screening when symptoms 

15 are present, when they have a family history of 

16 prostate cancer, or if they belong to a high-risk 

17 population. 

18 (3) RACIAL DISPARITIES.—In developing the 

19 national campaign under paragraph (1), the Sec20 retary shall recognize and address— 

21 (A) the racial disparities in the incidences 

22 of prostate cancer and mortality rates with re23 spect to such disease; and 


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1 (B) any barriers in access to patient care 

2 and participation in clinical trials that are spe3 cific to racial minorities. 

4 (4) GRANTS.—The Secretary shall establish a 

5 program to award grants to nonprofit private enti6 ties to enable such entities to test alternative out7 reach and education strategies to increase the 

8 awareness and knowledge of individuals in the 

9 United States with respect to prostate cancer. 

10 (5) AUTHORIZATION OF APPROPRIATIONS.— 

11 There is authorized to be appropriated to carry out 

12 this subsection, $5,000,000 for each of fiscal years 

13 2021 through 2025. 

14 SEC. 705. NATIONAL PROSTATE CANCER COUNCIL. 

15 (a) SHORT TITLE.—This section may be cited as the 

16 ‘‘National Prostate Cancer Plan Act’’. 

17 (b) NATIONAL PROSTATE CANCER COUNCIL.— 

18 (1) ESTABLISHMENT.—There is established in 

19 the Office of the Secretary of Health and Human 

20 Services (referred to in this section as the ‘‘Sec21 retary’’) the National Prostate Cancer Council on 

22 Screening, Early Detection, Assessment, and Moni23 toring of Prostate Cancer (referred to in this section 

24 as the ‘‘Council’’). 


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1 (2) PURPOSE OF THE COUNCIL.—The Council 

2 shall— 

3 (A) develop and implement a national stra4 tegic plan for the accelerated creation, advance5 ment, and testing of diagnostic tools to improve 

6 screening, early detection, assessment, and 

7 monitoring of prostate cancer, including— 

8 (i) early detection of aggressive pros9 tate cancer to save lives; 

10 (ii) monitoring of tumor response to 

11 treatment, including recurrence and pro12 gression; and 

13 (iii) accurate assessment and surveil14 lance of indolent disease to reduce unnec15 essary biopsies and treatment; 

16 (B) provide information and coordination 

17 of prostate cancer research and services across 

18 all Federal agencies; 

19 (C) review diagnostic tools and their over20 all effectiveness at screening, detecting, assess21 ing, and monitoring of prostate cancer; 

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1 quests and approvals and public-private part2 nerships; 

3 (E) submit an annual report to the Sec4 retary and Congress on the creation and imple5 mentation of the national strategic plan under 

6 subparagraph (A); and 

7 (F) ensure the inclusion of men at high8 risk for prostate cancer, including men from 

9 minority ethnic and racial populations and men 

10 who are least likely to receive care, in clinical, 

11 research, and service efforts, with the purpose 

12 of decreasing health disparities. 

13 (3) MEMBERSHIP.— 

14 (A) FEDERAL MEMBERS.—The Council 

15 shall be led by the Secretary or designee and 

16 comprised of the following experts: 

17 (i) Two representatives of the Na18 tional Institutes of Health, including 1 rep19 resentative of the National Institute of 

20 Biomedical Imaging and Bioengineering 

21 and 1 representative of the National Can22 cer Institute. 

23 (ii) A representative of the Centers 

24 for Disease Control and Prevention. 


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1 (iii) A representative of the Centers 

2 for Medicare & Medicaid Services. 

3 (iv) A designee of the Director of the 

4 Department of Defense Congressionally 

5 Directed Medical Research Programs. 

6 (v) A designee of the Director of the 

7 Office of Minority Health. 

8 (vi) A representative of the Food and 

9 Drug Administration. 

10 (vii) A representative of the Agency 

11 for Healthcare Research and Quality. 

12 (B) NON-FEDERAL MEMBERS.—In addi13 tion to the members described in subparagraph 

14 (A), the Council shall include 14 expert mem15 bers from outside the Federal Government, 

16 which shall include— 

17 (i) 6 prostate cancer patient advo18 cates, including— 

19 (I) 2 patient-survivors; 

20 (II) 2 caregivers of prostate can21 cer patients; and 

22 (III) 2 representatives from na23 tional prostate cancer disease organi24 zations that fund research or have 

25 demonstrated experience in providing 


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1 assistance to patients, families, and 

2 medical professionals, including infor3 mation on health care options, edu4 cation, and referral; and 

5 (ii) 8 health care stakeholders with 

6 specific expertise in prostate cancer re7 search in the critical areas of clinical ex8 pertise, including medical oncology, radi9 ology, radiation oncology, urology, and pa10 thology. 

11 (4) MEETINGS.—The Council shall meet quar12 terly and meetings shall be open to the public. 

13 (5) ADVICE.—The Council shall advise the Sec14 retary, or the Secretary’s designee. 

15 (6) ANNUAL REPORT.—The Council shall sub16 mit annual reports, beginning not later than 1 year 

17 after the date of enactment of this Act, to the Sec18 retary or the Secretary’s designee and to Congress. 

19 The annual report shall include— 

20 (A) in the first year— 

21 (i) an evaluation of all federally fund22 ed efforts in prostate cancer research and 

23 gaps relating to the development and vali24 dation of diagnostic tools for prostate can25 cer; and 


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1 (ii) recommendations for priority ac2 tions to expand, eliminate, coordinate, or 

3 condense programs based on the perform4 ance, mission, and purpose of the pro5 grams; and 

6 (B) annually thereafter for 5 years— 

7 (i) an outline for the development and 

8 implementation of a national research plan 

9 for creation and validation of accurate di10 agnostic tools to improve prostate cancer 

11 care in accordance with paragraph (1); 

12 (ii) roles for the National Cancer In13 stitute, National Institute on Minority 

14 Health and Health Disparities, and the Of15 fice of Minority Health of the Department 

16 of Health and Human Services; 

17 (iii) an analysis of the disparities in 

18 the incidence and mortality rates of pros19 tate cancer in men at high risk of the dis20 ease, including individuals with family his21 tory, increasing age, or African-American 

22 heritage; and 

23 (iv) a review of the progress towards 

24 the realization of the proposed strategic 

25 plan. 


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1 (7) TERMINATION.—The Council shall termi2 nate on December 31, 2025. 

3 SEC. 706. IMPROVED MEDICAID COVERAGE FOR CERTAIN 

4 BREAST AND CERVICAL CANCER PATIENTS 

5 IN THE TERRITORIES. 

6 (a) ELIMINATION OF FUNDING LIMITATIONS.—Sec7 tion 1108(g)(4) of the Social Security Act (42 U.S.C. 

8 1308(g)(4)) is amended— 

9 (1) by striking ‘‘paragraphs (1), (2), (3), and 

10 (4) of’’; and 

11 (2) by adding at the end the following: ‘‘With 

12 respect to fiscal years beginning with fiscal year 

13 2021, payment for medical assistance for individuals 

14 who are eligible for such assistance only on the basis 

15 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 

16 taken into account in applying subsection (f) (as in17 creased in accordance with this subsection) to Puer18 to Rico, the Virgin Islands, Guam, the Northern 

19 Mariana Islands, or American Samoa for such fiscal 

20 year.’’. 

21 (b) APPLICATION OF ENHANCED FMAP FOR HIGH22 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 

23 1396d(b)) is amended by adding at the end the following: 

24 ‘‘Notwithstanding the first sentence of this subsection, 

25 with respect to medical assistance described in clause (4) 


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1 of such sentence that is furnished in Puerto Rico, the Vir2 gin Islands, Guam, the Northern Mariana Islands, or 

3 American Samoa in a fiscal year, the Federal medical as4 sistance percentage is equal to the highest such percentage 

5 applied under such clause for such fiscal year for any of 

6 the 50 States or the District of Columbia that provides 

7 such medical assistance for any portion of such fiscal 

8 year.’’. 

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

10 this section shall apply to payment for medical assistance 

11 for items and services furnished on or after October 1, 

12 2021. 

13 SEC. 707. CANCER PREVENTION AND TREATMENT DEM14 ONSTRATION FOR ETHNIC AND RACIAL MI15 NORITIES. 

16 (a) DEMONSTRATION.— 

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

18 Human Services (referred to in this section as the 

19 ‘‘Secretary’’) shall conduct demonstration projects 

20 for the purpose of developing models and evaluating 

21 methods that— 

22 (A) improve the quality of items and serv23 ices provided to target individuals in order to 

24 facilitate reduced disparities in early detection 

25 and treatment of cancer; 


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1 (B) improve clinical outcomes, satisfaction, 

2 quality of life, appropriate use of items and 

3 services covered under the Medicare program 

4 under title XVIII of the Social Security Act (42 

5 U.S.C. 1395 et seq.), and referral patterns with 

6 respect to target individuals with cancer; 

7 (C) eliminate disparities in the rate of pre8 ventive cancer screening measures, such as Pap 

9 smears, prostate cancer screenings, colon cancer 

10 screenings, breast cancer screenings, and com11 puted tomography scans, for lung cancer among 

12 target individuals; 

13 (D) promote collaboration with community14 based organizations to ensure cultural com15 petency of health care professionals and lin16 guistic access for target individuals who are 

17 persons with limited English proficiency; and 

18 (E) encourage the incorporation of commu19 nity health workers to increase the efficiency 

20 and appropriateness of cancer screening pro21 grams. 

22 (2) COMMUNITY HEALTH WORKER DEFINED.— 

23 In this section, the term ‘‘community health worker’’ 

24 includes a community health advocate, a lay health 

25 worker, a community health representative, a peer 


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1 health promoter, a community health outreach work2 er, and a promotore de salud, who promotes health 

3 or nutrition within the community in which the indi4 vidual resides. 

5 (3) TARGET INDIVIDUAL DEFINED.—In this 

6 section, the term ‘‘target individual’’ means an indi7 vidual of a racial and ethnic minority group, as de8 fined in section 1707(g)(1) of the Public Health 

9 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti10 tled to benefits under part A, and enrolled under 

11 part B, of title XVIII of the Social Security Act. 

12 (b) PROGRAM DESIGN.— 

13 (1) INITIAL DESIGN.—Not later than 1 year 

14 after the date of the enactment of this Act, the Sec15 retary shall evaluate best practices in the private 

16 sector, community programs, and academic research 

17 of methods that reduce disparities among individuals 

18 of racial and ethnic minority groups in the preven19 tion and treatment of cancer and shall design the 

20 demonstration projects based on such evaluation. 

21 (2) NUMBER AND PROJECT AREAS.—Not later 

22 than 2 years after the date of the enactment of this 

23 Act, the Secretary shall implement at least 9 dem24 onstration projects, including the following: 


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1 (A) Two projects, each of which shall tar2 get different ethnic subpopulations, for each of 

3 the 4 following major racial and ethnic minority 

4 groups: 

5 (i) American Indians and Alaska Na6 tives, Eskimos, and Aleuts. 

7 (ii) Asian Americans. 

8 (iii) Blacks and African Americans. 

9 (iv) Latinos and Hispanics. 

10 (v) Native Hawaiians and other Pa11 cific Islanders. 

12 (B) One project within the Pacific Islands 

13 or United States insular areas. 

14 (C) At least one project in a rural area. 

15 (D) At least one project in an inner-city 

16 area. 

17 (3) EXPANSION OF PROJECTS; IMPLEMENTA18 TION OF DEMONSTRATION PROJECT RESULTS.—The 

19 Secretary shall continue the existing demonstration 

20 projects and may expand the number of demonstra21 tion projects if the initial report under subsection (c) 

22 contains an evaluation that demonstration 

23 projects— 


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1 (A) reduce expenditures under the Medi2 care program under title XVIII of the Social 

3 Security Act (42 U.S.C. 1395 et seq.); or 

4 (B) do not increase expenditures under 

5 such Medicare program and reduce racial and 

6 ethnic health disparities in the quality of health 

7 care services provided to target individuals and 

8 increase satisfaction of Medicare beneficiaries 

9 and health care providers. 

10 (c) REPORT TO CONGRESS.— 

11 (1) IN GENERAL.—Not later than 2 years after 

12 the date the Secretary implements the initial dem13 onstration projects, and biannually thereafter, the 

14 Secretary shall submit to Congress a report regard15 ing the demonstration projects. 

16 (2) CONTENT OF REPORT.—Each report under 

17 paragraph (1) shall include the following: 

18 (A) A description of the demonstration 

19 projects. 

20 (B) An evaluation of— 

21 (i) the cost-effectiveness of the dem22 onstration projects; 

23 (ii) the quality of the health care serv24 ices provided to target individuals under 

25 the demonstration projects; and 


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1 (iii) beneficiary and health care pro2 vider satisfaction under the demonstration 

3 projects. 

4 (C) Any other information regarding the 

5 demonstration projects that the Secretary de6 termines to be appropriate. 

7 (d) WAIVER AUTHORITY.—The Secretary shall waive 

8 compliance with the requirements of title XVIII of the So9 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

10 and for such period as the Secretary determines is nec11 essary to conduct demonstration projects. 

12 SEC. 708. REDUCING CANCER DISPARITIES WITHIN MEDI13 CARE. 

14 (a) DEVELOPMENT OF MEASURES OF DISPARITIES

15 IN QUALITY OF CANCER CARE.— 

16 (1) DEVELOPMENT OF MEASURES.—The Sec17 retary of Health and Human Services (in this sec18 tion referred to as the ‘‘Secretary’’) shall enter into 

19 an agreement with an entity that specializes in de20 veloping quality measures for cancer care under 

21 which the entity shall develop a uniform set of meas22 ures to evaluate disparities in the quality of cancer 

23 care and annually update such set of measures. 

24 (2) MEASURES TO BE INCLUDED.—Such set of 

25 measures shall include, with respect to the treatment 


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1 of cancer, measures of patient outcomes, the process 

2 for delivering medical care related to such treat3 ment, patient counseling and engagement in deci4 sion-making, patient experience of care, resource 

5 use, and practice capabilities, such as care coordina6 tion. 

7 (b) ESTABLISHMENT OF REPORTING PROCESS.— 

8 (1) IN GENERAL.—The Secretary shall establish 

9 a reporting process that requires and provides for a 

10 method for health care providers specified under 

11 paragraph (2) to submit to the Secretary and make 

12 public data on the performance of such providers 

13 during each reporting period through use of the 

14 measures developed pursuant to subsection (a). Such 

15 data shall be submitted in a form and manner and 

16 at a time specified by the Secretary. 

17 (2) SPECIFICATION OF PROVIDERS TO REPORT

18 ON MEASURES.—The Secretary shall specify the 

19 classes of Medicare providers of services and sup20 pliers, including hospitals, cancer centers, physi21 cians, primary care providers, and specialty pro22 viders, that will be required under such process to 

23 publicly report on the measures specified under sub24 section (a). 


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1 (3) ASSESSMENT OF CHANGES.—Under such 

2 reporting process, the Secretary shall establish a for3 mat that assesses changes in both the absolute and 

4 relative disparities in cancer care over time. These 

5 measures shall be presented in an easily comprehen6 sible format, such as those presented in the final 

7 publications relating to Healthy People 2010 or the 

8 National Healthcare Disparities Report. 

9 (4) INITIAL IMPLEMENTATION.—The Secretary 

10 shall implement the reporting process under this 

11 subsection for reporting periods beginning not later 

12 than 6 months after the date that measures are first 

13 established under subsection (a). 

14 SEC. 709. CANCER CLINICAL TRIALS. 

15 (a) SHORT TITLE.—This section may be cited as the 

16 ‘‘Henrietta Lacks Enhancing Cancer Research Act of 

17 2020’’. 

18 (b) FINDINGS.—Congress finds as follows: 

19 (1) Only a small percent of patients participate 

20 in cancer clinical trials, even though most express an 

21 interest in clinical research. There are several obsta22 cles that restrict individuals from participating in23 cluding lack of available local trials, restrictive eligi24 bility criteria, transportation to trial sites, taking 

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1 ical and nonmedical costs. Ultimately, about 1 in 5 

2 cancer clinical trials fail because of lack of patient 

3 enrollment. 

4 (2) Groups that are generally underrepresented 

5 in clinical trials include racial and ethnic minorities 

6 and older, rural, and lower-income individuals. 

7 (3) Henrietta Lacks, an African-American 

8 woman, was diagnosed with cervical cancer at the 

9 age of 31, and despite receiving painful radium 

10 treatments, passed away on October 4, 1951. 

11 (4) Medical researchers took samples of Hen12 rietta Lacks’ tumor during her treatment and the 

13 HeLa cell line from her tumor proved remarkably 

14 resilient. 

15 (5) HeLa cells were the first immortal line of 

16 human cells. Henrietta Lacks’ cells were unique, 

17 growing by the millions, commercialized and distrib18 uted worldwide to researchers, resulting in advances 

19 in medicine. 

20 (6) Henrietta Lacks’ prolific cells continue to 

21 grow and contribute to remarkable advances in med22 icine, including the development of the polio vaccine, 

23 as well as drugs for treating the effects of cancer, 

24 HIV/AIDS, hemophilia, leukemia, and Parkinson’s 

25 disease. These cells have been used in research that 


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1 has contributed to our understanding of the effects 

2 of radiation and zero gravity on human cells. These 

3 immortal cells have informed research on chromo4 somal conditions, cancer, gene mapping, and preci5 sion medicine. 

6 (7) Henrietta Lacks and her immortal cells 

7 have made a significant contribution to global 

8 health, scientific research, quality of life, and patient 

9 rights. 

10 (8) For more than 20 years, the advances made 

11 possible by Henrietta Lacks’ cells were without her 

12 or her family’s consent, and the revenues they gen13 erated were not known to or shared with her family. 

14 (9) Henrietta Lacks and her family’s experience 

15 is fundamental to modern and future bioethics poli16 cies and informed consent laws that benefit patients 

17 nationwide by building patient trust; promoting eth18 ical research that benefits all individuals, including 

19 traditionally underrepresented populations; and pro20 tecting research participants. 

21 (c) GAO STUDY ON BARRIERS TO PARTICIPATION IN

22 FEDERALLY FUNDED CANCER CLINICAL TRIALS BY POP23 ULATIONS THAT HAVE BEEN TRADITIONALLY UNDER24 REPRESENTED IN SUCH TRIALS.— 


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1 (1) IN GENERAL.—Not later than 2 years after 

2 the date of enactment of this Act, the Comptroller 

3 General of the United States shall— 

4 (A) complete a study that— 

5 (i) reviews what actions Federal agen6 cies have taken to help to address barriers 

7 to participation in federally funded cancer 

8 clinical trials by populations that have 

9 been traditionally underrepresented in such 

10 trials, and identifies challenges, if any, in 

11 implementing such actions; and 

12 (ii) identifies additional actions that 

13 can be taken by Federal agencies to ad14 dress barriers to participation in federally 

15 funded cancer clinical trials by populations 

16 that have been traditionally underrep17 resented in such trials; and 

18 (B) submit a report to the Congress on the 

19 results of such study, including recommenda20 tions on potential changes in practices and poli21 cies to improve participation in such trials by 

22 such populations. 

23 (2) INCLUSION OF CLINICAL TRIALS.—The 

24 study under paragraph (1)(A) shall include review of 

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1 eral agencies, including the National Institutes of 

2 Health, the Department of Defense, the Department 

3 of Veterans Affairs, the Agency for Healthcare Re4 search and Quality, the Food and Drug Administra5 tion, and such other Federal agencies as the Comp6 troller General of the United States may identify. 

7 Subtitle B—Viral Hepatitis and 

8 Liver Cancer Control and Pre9 vention 

10 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 

11 AND PREVENTION. 

12 (a) SHORT TITLE.—This subtitle may be cited as the 

13 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 

14 Act of 2020’’. 

15 (b) FINDINGS.—Congress finds the following: 

16 (1) In the United States, nearly 5,000,000 per17 sons are living with the hepatitis B virus (referred 

18 to in this section as ‘‘HBV’’) or the hepatitis C virus 

19 (referred to in this section as ‘‘HCV’’). 

20 (2) In the United States, chronic HBV and 

21 HCV are the most common causes of liver cancer, 

22 the second deadliest and fastest growing cancer in 

23 this country. Such viruses are the most common 

24 cause of chronic liver disease, liver cirrhosis, and the 

25 most common indications for liver transplantation. 


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1 At least 21,000 deaths per year in the United States 

2 can be attributed to chronic HBV and HCV. Chron3 ic HCV is also a leading cause of death in Ameri4 cans living with HIV/AIDS; many of those living 

5 with HIV/AIDS are coinfected with chronic HBV, 

6 chronic HCV, or both. 

7 (3) According to the Centers for Disease Con8 trol and Prevention (referred to in this section as 

9 the ‘‘CDC’’), approximately 2 percent of the popu10 lation of the United States is living with chronic 

11 HBV, chronic HCV, or both. The CDC has recog12 nized HCV as the Nation’s most common chronic 

13 bloodborne virus infection and HBV as the deadliest 

14 vaccine-preventable disease. 

15 (4) HBV is transmitted through contact with 

16 infectious blood, semen, or other bodily fluids and is 

17 100 times more infectious than HIV. HCV is trans18 mitted by contact with infectious blood, particularly 

19 through percutaneous exposures (such as puncture 

20 through the skin). 

21 (5) The CDC estimates that in 2016, more 

22 than 41,000 people in the United States were newly 

23 infected with HCV and nearly 21,000 people in the 

24 United States were newly infected with HBV. These 

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1 sons, including lack of screening education and 

2 awareness, and perceived marginalization of the pop3 ulations at risk. 

4 (6) In 2012, CDC released new guidelines rec5 ommending every person born between 1945 and 

6 1965 receive a one-time test for HCV. Among the 

7 estimated 102,000,000 (1,600,000 chronically HCV8 infected) eligible for screening, birth-cohort screen9 ing leads to 84,000 fewer cases of decompensated 

10 cirrhosis, 46,000 fewer cases of hepatocellular car11 cinoma, 10,000 fewer liver transplants, and 78,000 

12 fewer HCV-related deaths gained versus risk-based 

13 screening. 

14 (7) In 2013, the United States Preventive Serv15 ices Task Force (referred to in this section as the 

16 ‘‘USPSTF’’) issued a Grade B rating for screening 

17 for HCV infection in persons at high risk for infec18 tion and adults born between 1945 and 1965. In 

19 2014, the USPSTF issued a Grade B for screening 

20 for HBV in persons at high-risk of hepatitis B infec21 tion. In 2009, the USPSTF issued a Grade A for 

22 screening pregnant women for HBV during their 

23 first prenatal visit, and in 2019, reaffirmed this 

24 grade. 


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1 (8) There were 59 outbreaks (24 of HBV and 

2 36 of HCV, including one of both HBV and HCV) 

3 reported to CDC for investigation from 2008 

4 through 2016 related to health care-associated infec5 tion of HBV and HCV, 56 of which occurred in non6 hospital settings. There were more than 115,983 pa7 tients potentially exposed to one of the viruses. 

8 (9) Chronic HBV and chronic HCV usually do 

9 not cause symptoms early in the course of the dis10 ease, but after many years of a clinically ‘‘silent’’ 

11 phase, CDC estimates show more than 33 percent of 

12 infected individuals will develop cirrhosis, end-stage 

13 liver disease, or liver cancer. Since most individuals 

14 with chronic HBV, HCV, or both are unaware of 

15 their infection, they do not know to take precautions 

16 to prevent the spread of their infection and can un17 knowingly exacerbate their own disease progression. 

18 (10) HBV and HCV disproportionately affect 

19 certain populations in the United States. Although 

20 representing only about 6 percent of the population, 

21 Asian Americans and Pacific Islanders account for 

22 half of all chronic HBV cases in the United States. 

23 Baby Boomers (those born between 1945 and 1965) 

24 account for approximately 75 percent of domestic 

25 chronic HCV cases. In addition, African Americans, 


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1 Latinos, and American Indian and Native Alaskans 

2 are among the groups which have disproportionately 

3 high rates of HBV or HCV infections in the United 

4 States. 

5 (11) For both chronic HBV and chronic HCV, 

6 behavioral changes and appropriate medical care can 

7 slow disease progression if diagnosis is made early. 

8 Early diagnosis, which is determined through simple 

9 blood tests, can reduce the risk of transmission and 

10 disease progression through education and vaccina11 tion of household members and other susceptible 

12 persons at risk. 

13 (12) Advancements have led to the development 

14 of improved diagnostic tests for viral hepatitis. 

15 These tests, including rapid, point of care testing 

16 and others in development, can facilitate testing, no17 tification of results and post-test counseling, and re18 ferral to care at the time of the testing visit. In par19 ticular, these tests are also advantageous because 

20 they can be used simultaneously with HIV rapid 

21 testing for persons at risk for both HCV and HIV 

22 infections. 

23 (13) For those chronically infected with HBV 

24 or HCV, regular monitoring can lead to the early de25 tection of liver cancer at a stage where a cure is still 


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1 possible. Liver cancer is the second deadliest cancer 

2 in the United States; however, liver cancer has re3 ceived little funding for research, prevention, or 

4 treatment. 

5 (14) Treatment for chronic HCV can eradicate 

6 the disease in approximately 90 percent of those cur7 rently treated. While there is no cure for chronic 

8 HBV, available treatments can effectively suppress 

9 viral replication in the overwhelming majority of 

10 those treated, thereby reducing the risk of trans11 mission and progression to liver scarring or liver 

12 cancer. 

13 (15) To combat the viral hepatitis epidemic in 

14 the United States, in February 2017, the Depart15 ment of Health and Human Services released its 

16 ‘‘National Viral Hepatitis Action Plan 2017–2020’’ 

17 (referred to in this section as the ‘‘HHS Action 

18 Plan’’). In March 2017, the National Academies of 

19 Sciences, Engineering, and Medicine released a re20 port entitled, ‘‘A National Strategy for the Elimi21 nation of Hepatitis B and C: Phase Two Report’’ 

22 (referred to in this section as the ‘‘NAS report’’), 

23 recommending specific actions to eliminate viral hep24 atitis as public health problems in the United States 

25 by 2030. 


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1 (16) The annual health care costs attributable 

2 to HBV and HCV in the United States are signifi3 cant. For HBV, it is estimated to be approximately 

4 $2,500,000,000 ($2,000 per infected person). In 

5 2000, the lifetime cost of HBV—before the avail6 ability of most current therapies—was approximately 

7 $80,000 per chronically infected person, totaling 

8 more than $100,000,000,000. For HCV, medical 

9 costs for patients are expected to increase from 

10 $30,000,000,000 in 2009 to over $85,000,000,000 

11 in 2024. Avoiding these costs by screening and diag12 nosing individuals earlier—and connecting them to 

13 appropriate treatment and care, will save lives and 

14 critical health care dollars. Currently, without a 

15 comprehensive screening, testing, and diagnosis pro16 gram, most patients are diagnosed too late when 

17 they need a liver transplant costing at least 

18 $314,000 for uncomplicated cases or when they have 

19 liver cancer or end-stage liver disease which costs 

20 $30,980 to $110,576 per hospital admission. As 

21 health care costs continue to grow, it is critical that 

22 the Federal Government invests in effective mecha23 nisms to avoid documented cost drivers. 

24 (17) According to the NAS report in 2010, 

25 chronic HBV and HCV infections cause substantial 


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1 morbidity and mortality despite being preventable 

2 and treatable. Deficiencies in the implementation of 

3 established guidelines for the prevention, diagnosis, 

4 and medical management of chronic HBV and HCV 

5 infections perpetuate personal and economic bur6 dens. Existing grants are not sufficient for the scale 

7 of the health burden presented by HBV and HCV. 

8 (18) Screening and testing for HBV and HCV 

9 is aligned with the goal of Healthy People 2020 to 

10 increase immunization rates and reduce preventable 

11 infectious diseases. Awareness of disease and access 

12 to prevention and treatment remain essential compo13 nents for reducing infectious disease transmission. 

14 (19) Federal support is necessary to increase 

15 knowledge and awareness of HBV and HCV and to 

16 assist State and local prevention and control efforts 

17 in reducing the morbidity and mortality of these 

18 epidemics. 

19 (20) The Centers for Disease Control and Pre20 vention reported a 233 percent increase in hepatitis 

21 C cases from 2010 to 2016, stemming from the 

22 opioid, heroin, and overdose epidemics affecting com23 munities nationwide. From 2014 to 2015, the num24 ber of reported cases of acute hepatitis B infection 

25 in the United States rose for the first time since 


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1 2006, increasing by 20.7 percent, which is also 

2 largely attributable to the opioid epidemic. 

3 (21) The Secretary of Health and Human Serv4 ices has the discretion to carry out this subtitle (in5 cluding the amendments made by this subtitle) di6 rectly and through whichever of the agencies of the 

7 Public Health Service the Secretary determines to be 

8 appropriate, which may (in the Secretary’s discre9 tion) include the Centers for Disease Control and 

10 Prevention, the Health Resources and Services Ad11 ministration, the Substance Abuse and Mental 

12 Health Services Administration, the National Insti13 tutes of Health (including the National Institute on 

14 Minority Health and Health Disparities), and other 

15 agencies of such Service. 

16 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 

17 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 

18 AND MEDICAL MANAGEMENT PLAN.—Title III of the 

19 Public Health Service Act (42 U.S.C. 241 et seq.), as 

20 amended by title V, is further amended— 

21 (1) by striking section 317N (42 U.S.C. 247b– 

22 15); and 

23 (2) by adding after part W, as added by section 

24 508, the following: 


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1 ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA2 TITIS B AND HEPATITIS C PREVENTION, EDU3 CATION, RESEARCH, AND MEDICAL MANAGE4 MENT PLAN 

5 ‘‘SEC. 399PP. BIENNIAL UPDATE OF THE PLAN. 

6 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi7 ennial assessment of the Secretary’s plan for the preven8 tion, control, and medical management of, and education 

9 and research relating to, hepatitis B and hepatitis C, for 

10 the purposes of— 

11 ‘‘(1) incorporating into such plan new knowl12 edge or observations relating to hepatitis B and hep13 atitis C (such as knowledge and observations that 

14 may be derived from clinical, laboratory, and epide15 miological research and disease detection, preven16 tion, and surveillance outcomes); 

17 ‘‘(2) addressing gaps in the coverage or effec18 tiveness of the plan; and 

19 ‘‘(3) evaluating and, if appropriate, updating 

20 recommendations, guidelines, or educational mate21 rials of the Centers for Disease Control and Preven22 tion or the National Institutes of Health for health 

23 care providers or the public on viral hepatitis in 

24 order to be consistent with the plan. 

25 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 

26 Not later than October 1 of the first even-numbered year 


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1 beginning after the date of the enactment of this part, 

2 and October 1 of each even-numbered year thereafter, the 

3 Secretary shall publish in the Federal Register a notice 

4 of the results of the assessments conducted under para5 graph (1). Such notice shall include— 

6 ‘‘(1) a description of any revisions to the plan 

7 referred to in subsection (a) as a result of the as8 sessment; 

9 ‘‘(2) an explanation of the basis for any such 

10 revisions, including the ways in which such revisions 

11 can reasonably be expected to further promote the 

12 original goals and objectives of the plan; and 

13 ‘‘(3) in the case of a determination by the Sec14 retary that the plan does not need revision, an expla15 nation of the basis for such determination. 

16 ‘‘SEC. 399PP–1. ELEMENTS OF PROGRAM. 

17 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 

18 Secretary, acting through the Director of the Centers for 

19 Disease Control and Prevention, the Administrator of the 

20 Health Resources and Services Administration, and the 

21 Assistant Secretary for Mental Health and Substance Use, 

22 and in accordance with the plan referred to in section 

23 399PP(a), shall implement programs to increase aware24 ness and enhance knowledge and understanding of hepa25 titis B and hepatitis C. Such programs shall include— 


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1 ‘‘(1) the conduct of culturally and linguistically 

2 appropriate health education in primary and sec3 ondary schools, college campuses, public awareness 

4 campaigns, and community outreach activities (espe5 cially to the ethnic communities with high rates of 

6 chronic hepatitis B and chronic hepatitis C and 

7 other high-risk groups) to promote public awareness 

8 and knowledge about the value of hepatitis A and 

9 hepatitis B immunization; risk factors, transmission, 

10 and prevention of hepatitis B and hepatitis C; the 

11 value of screening for the early detection of hepatitis 

12 B and hepatitis C; and options available for the 

13 treatment of chronic hepatitis B and chronic hepa14 titis C; 

15 ‘‘(2) the promotion of immunization programs 

16 that increase awareness and access to hepatitis A 

17 and hepatitis B vaccines for susceptible adults and 

18 children; 

19 ‘‘(3) the training of health care professionals 

20 regarding the importance of vaccinating individuals 

21 infected with hepatitis C and individuals who are at 

22 risk for hepatitis C infection against hepatitis A and 

23 hepatitis B; 

24 ‘‘(4) the training of health care professionals 

25 regarding the importance of vaccinating individuals 


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1 chronically infected with hepatitis B and individuals 

2 who are at risk for chronic hepatitis B infection 

3 against the hepatitis A virus; 

4 ‘‘(5) the training of health care professionals 

5 and health educators to make them aware of the 

6 high rates of chronic hepatitis B and chronic hepa7 titis C in certain adult ethnic populations, and the 

8 importance of prevention, detection, and medical 

9 management of hepatitis B and hepatitis C and of 

10 liver cancer screening; 

11 ‘‘(6) the development and distribution of health 

12 education curricula (including information relating 

13 to the special needs of individuals infected with or 

14 at risk of hepatitis B and hepatitis C, such as the 

15 importance of prevention and early intervention, reg16 ular monitoring, the recognition of psychosocial 

17 needs, appropriate treatment, and liver cancer 

18 screening) for individuals providing hepatitis B and 

19 hepatitis C counseling; and 

20 ‘‘(7) support for the implementation of the cur21 ricula described in paragraph (6) by State and local 

22 public health agencies. 

23 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL

24 PROGRAMS.— 


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

2 through the Director of the Centers for Disease 

3 Control and Prevention, shall support the integra4 tion of activities described in paragraph (3) into ex5 isting clinical and public health programs at State, 

6 local, territorial, and Tribal levels (including commu7 nity health clinics, programs for the prevention and 

8 treatment of HIV/AIDS, sexually transmitted infec9 tions, and substance abuse, and programs for indi10 viduals in correctional settings). 

11 ‘‘(2) COORDINATION OF DEVELOPMENT OF

12 FEDERAL SCREENING GUIDELINES.— 

13 ‘‘(A) REFERENCES.—For purposes of this 

14 subsection, the term ‘CDC Director’ means the 

15 Director of the Centers for Disease Control and 

16 Prevention, and the term ‘AHRQ Director’ 

17 means the Director of the Agency for 

18 Healthcare Research and Quality. 

19 ‘‘(B) AGENCY FOR HEALTHCARE RE20 SEARCH AND QUALITY.—Due to the rapidly 

21 evolving standard of care associated with diag22 nosing and treating viral hepatitis infection, the 

23 AHRQ Director shall convene the Preventive 

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1 view its recommendation for screening for HBV 

2 and HCV infection every 3 years. 

3 ‘‘(3) ACTIVITIES.— 

4 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 

5 ‘‘(i) IN GENERAL.—The Secretary 

6 shall establish a mechanism by which to 

7 support and promote the development of 

8 State, local, territorial, and tribal vol9 untary hepatitis B and hepatitis C testing 

10 programs to screen the high-prevalence 

11 populations to aid in the early identifica12 tion of chronically infected individuals. 

13 ‘‘(ii) CONFIDENTIALITY OF THE TEST

14 RESULTS.—The Secretary shall prohibit 

15 the use of the results of a hepatitis B or 

16 hepatitis C test conducted by a testing pro17 gram developed or supported under this 

18 subparagraph for any of the following: 

19 ‘‘(I) Issues relating to health in20 surance. 

21 ‘‘(II) To screen or determine 

22 suitability for employment. 

23 ‘‘(III) To discharge a person 

24 from employment. 


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1 ‘‘(B) COUNSELING REGARDING VIRAL HEP2 ATITIS.—The Secretary shall support State, 

3 local, territorial, and tribal programs in a wide 

4 variety of settings, including those providing 

5 primary and specialty health care services in 

6 nonprofit private and public sectors, to— 

7 ‘‘(i) provide individuals with ongoing 

8 risk factors for hepatitis B and hepatitis C 

9 infection with client-centered education 

10 and counseling which concentrates on— 

11 ‘‘(I) promoting testing of individ12 uals that have been exposed to their 

13 blood, family members, and their sex14 ual partners; and 

15 ‘‘(II) changing behaviors that 

16 place individuals at risk for infection; 

17 ‘‘(ii) provide individuals chronically in18 fected with hepatitis B or hepatitis C with 

19 education, health information, and coun20 seling to reduce their risk of— 

21 ‘‘(I) dying from end-stage liver 

22 disease and liver cancer; and 

23 ‘‘(II) transmitting viral hepatitis 

24 to others; and 


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1 ‘‘(iii) provide women chronically in2 fected with hepatitis B or hepatitis C who 

3 are pregnant or of childbearing age with 

4 culturally and linguistically appropriate 

5 health information, such as how to prevent 

6 hepatitis B perinatal infection, and to al7 leviate fears associated with pregnancy or 

8 raising a family. 

9 ‘‘(C) IMMUNIZATION.—The Secretary shall 

10 support State, local, territorial, and tribal ef11 forts to expand the current vaccination pro12 grams to protect every child in the Nation and 

13 all susceptible adults, particularly those infected 

14 with hepatitis C and high-prevalence ethnic 

15 populations and other high-risk groups, from 

16 the risks of acute and chronic hepatitis B infec17 tion by— 

18 ‘‘(i) ensuring continued funding for 

19 hepatitis B vaccination for all children 18 

20 years of age or younger through the Vac21 cines for Children program; 

22 ‘‘(ii) ensuring that the recommenda23 tions of the Advisory Committee on Immu24 nization Practices of the Centers for Dis25 ease Control and Prevention are followed 


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1 regarding the birth dose of hepatitis B vac2 cinations for newborns; 

3 ‘‘(iii) requiring proof of hepatitis B 

4 vaccination for entry into public or private 

5 daycare, preschool, elementary school, sec6 ondary school, and institutions of higher 

7 education; 

8 ‘‘(iv) expanding the availability of 

9 hepatitis B vaccination for all adults to 

10 protect them from becoming acutely or 

11 chronically infected, including ethnic and 

12 other populations with high prevalence 

13 rates of chronic hepatitis B infection; 

14 ‘‘(v) expanding the availability of hep15 atitis B vaccination for all adults, particu16 larly those of reproductive age (women and 

17 men less than 45 years of age), to protect 

18 them from the risk of hepatitis B infection; 

19 ‘‘(vi) ensuring the vaccination of indi20 viduals infected, or at risk for infection, 

21 with hepatitis C against hepatitis A, hepa22 titis B, and other infectious diseases, as 

23 appropriate, for which such individuals 

24 may be at increased risk; and 


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1 ‘‘(vii) ensuring the vaccination of indi2 viduals infected, or at risk for infection, 

3 with hepatitis B against hepatitis A virus 

4 and other infectious diseases, as appro5 priate, for which such individuals may be 

6 at increased risk. 

7 ‘‘(D) MEDICAL REFERRAL.—The Secretary 

8 shall support State, local, territorial, and tribal 

9 programs that support— 

10 ‘‘(i) referral of persons chronically in11 fected with hepatitis B or hepatitis C— 

12 ‘‘(I) for medical evaluation to de13 termine the appropriateness for 

14 antiviral treatment to reduce the risk 

15 of progression to cirrhosis and liver 

16 cancer; and 

17 ‘‘(II) for ongoing medical man18 agement including regular monitoring 

19 of liver function and screening for 

20 liver cancer; and 

21 ‘‘(ii) referral of persons infected with 

22 acute or chronic hepatitis B infection or 

23 acute or chronic hepatitis C infection for 

24 drug and alcohol abuse treatment where 

25 appropriate. 


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1 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL

2 HEPATITIS PREVENTION COORDINATORS.—The Sec3 retary, acting through the CDC Director, shall pro4 vide increased support to adult viral hepatitis pre5 vention coordinators in State, local, territorial, and 

6 tribal health departments in order to enhance the 

7 additional management, networking, and technical 

8 expertise needed to ensure successful integration of 

9 hepatitis B and hepatitis C prevention and control 

10 activities into existing public health programs. 

11 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 

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

13 through the Director of the Centers for Disease 

14 Control and Prevention, shall support the establish15 ment and maintenance of a national chronic and 

16 acute hepatitis B and hepatitis C surveillance pro17 gram, in order to identify— 

18 ‘‘(A) trends in the incidence of acute and 

19 chronic hepatitis B and acute and chronic hepa20 titis C; 

21 ‘‘(B) trends in the prevalence of acute and 

22 chronic hepatitis B and acute and chronic hepa23 titis C infection among groups that may be dis24 proportionately affected; and 


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1 ‘‘(C) trends in liver cancer and end-stage 

2 liver disease incidence and deaths, caused by 

3 chronic hepatitis B and chronic hepatitis C in 

4 the high-risk ethnic populations. 

5 ‘‘(2) SEROPREVALENCE AND LIVER CANCER

6 STUDIES.—The Secretary, acting through the Direc7 tor of the Centers for Disease Control and Preven8 tion, shall prepare a report outlining the population9 based seroprevalence studies currently underway, fu10 ture planned studies, the criteria involved in deter11 mining which seroprevalence studies to conduct, 

12 defer, or suspend, and the scope of those studies, the 

13 economic and clinical impact of hepatitis B and hep14 atitis C, and the impact of chronic hepatitis B and 

15 chronic hepatitis C infections on the quality of life. 

16 Not later than one year after the date of the enact17 ment of this part, the Secretary shall submit the re18 port to the Committee on Health, Education, Labor, 

19 and Pensions of the Senate and the Committee on 

20 Energy and Commerce of the House of Representa21 tives. 

22 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 

23 not disclose any individually identifiable information 

24 identified under paragraph (1) or derived through 

25 studies under paragraph (2). 


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1 ‘‘(d) RESEARCH.—The Secretary, acting through the 

2 Director of the Centers for Disease Control and Preven3 tion, the Director of the National Cancer Institute, and 

4 the Director of the National Institutes of Health, shall— 

5 ‘‘(1) conduct epidemiologic and community6 based research to develop, implement, and evaluate 

7 best practices for hepatitis B and hepatitis C pre8 vention especially in the ethnic populations with high 

9 rates of chronic hepatitis B and chronic hepatitis C 

10 and other high-risk groups; 

11 ‘‘(2) conduct research on hepatitis B and hepa12 titis C natural history, pathophysiology, improved 

13 treatments and prevention (such as the hepatitis C 

14 vaccine), and noninvasive tests that help to predict 

15 the risk of progression to liver cirrhosis and liver 

16 cancer; 

17 ‘‘(3) conduct research that will lead to better 

18 noninvasive or blood tests to screen for liver cancer, 

19 and more effective treatments of liver cancer caused 

20 by chronic hepatitis B and chronic hepatitis C; and 

21 ‘‘(4) conduct research comparing the effective22 ness of screening, diagnostic, management, and 

23 treatment approaches for chronic hepatitis B, chron24 ic hepatitis C, and liver cancer in the affected com25 munities. 


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1 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF2 FECTED POPULATIONS.—In carrying out this section, the 

3 Secretary shall provide expanded support for individuals 

4 with limited access to health education, testing, and health 

5 care services and groups that may be disproportionately 

6 affected by hepatitis B and hepatitis C. 

7 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 

8 shall develop benchmarks for evaluating the effectiveness 

9 of the programs and activities conducted under this sec10 tion and make determinations as to whether such bench11 marks have been achieved. 

12 ‘‘SEC. 399PP–2. GRANTS. 

13 ‘‘(a) IN GENERAL.—The Secretary may award grants 

14 to, or enter into contracts or cooperative agreements with, 

15 States, political subdivisions of States, territories, Indian 

16 tribes, or nonprofit entities that have special expertise re17 lating to hepatitis B, hepatitis C, or both, to carry out 

18 activities under this part. 

19 ‘‘(b) APPLICATION.—To be eligible for a grant, con20 tract, or cooperative agreement under subsection (a), an 

21 entity shall prepare and submit to the Secretary an appli22 cation at such time, in such manner, and containing such 

23 information as the Secretary may require. 


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1 ‘‘SEC. 399PP–3. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated to carry out 

3 this part $90,000,000 for fiscal year 2021, $90,000,000 

4 for fiscal year 2022, $110,000,000 for fiscal year 2023, 

5 $130,000,000 for fiscal year 2024, and $150,000,000 for 

6 fiscal year 2025.’’. 

7 Subtitle C—Acquired Bone Marrow 

8 Failure Diseases 

9 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 

10 (a) SHORT TITLE.—This subtitle may be cited as the 

11 ‘‘Bone Marrow Failure Disease Research and Treatment 

12 Act of 2020’’. 

13 (b) FINDINGS.—The Congress finds the following: 

14 (1) Between 20,000 and 30,000 people in the 

15 United States are diagnosed each year with 

16 myelodysplastic syndromes, aplastic anemia, parox17 ysmal nocturnal hemoglobinuria, and other acquired 

18 bone marrow failure diseases. 

19 (2) Acquired bone marrow failure diseases have 

20 a debilitating and often fatal impact on those diag21 nosed with these diseases. 

22 (3) While some treatments for acquired bone 

23 marrow failure diseases can prolong and improve the 

24 quality of patients’ lives, there is no single cure for 

25 these diseases. 


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1 (4) The prevalence of acquired bone marrow 

2 failure diseases in the United States will continue to 

3 grow as the general public ages. 

4 (5) Evidence exists suggesting that acquired 

5 bone marrow failure diseases occur more often in 

6 minority populations, particularly in Asian-American 

7 and Latino or Hispanic populations. 

8 (6) The National Heart, Lung, and Blood Insti9 tute and the National Cancer Institute have con10 ducted important research into the causes of and 

11 treatments for acquired bone marrow failure dis12 eases. 

13 (7) The National Marrow Donor Program Reg14 istry has made significant contributions to the fight 

15 against bone marrow failure diseases by connecting 

16 millions of potential marrow donors with individuals 

17 and families suffering from these conditions. 

18 (8) Despite these advances, a more comprehen19 sive Federal strategic effort among numerous Fed20 eral agencies is needed to discover a cure for ac21 quired bone marrow failure disorders. 

22 (9) Greater Federal surveillance of acquired 

23 bone marrow failure diseases is needed to gain a bet24 ter understanding of the causes of acquired bone 

25 marrow failure diseases. 


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1 (10) The Federal Government should increase 

2 its research support for and engage with public and 

3 private organizations in developing a comprehensive 

4 approach to combat and cure acquired bone marrow 

5 failure diseases. 

6 (c) NATIONAL ACQUIRED BONE MARROW FAILURE

7 DISEASE REGISTRY.—Title III of the Public Health Serv8 ice Act (42 U.S.C. 241 et seq.) is amended by inserting 

9 after section 317V (as added by section 110) the following: 

10 ‘‘SEC. 317W. NATIONAL ACQUIRED BONE MARROW FAILURE 

11 DISEASE REGISTRY. 

12 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 

13 ‘‘(1) IN GENERAL.—Not later than 6 months 

14 after the date of the enactment of this section, the 

15 Secretary, acting through the Director of the Cen16 ters for Disease Control and Prevention, shall— 

17 ‘‘(A) develop a system to collect data on 

18 acquired bone marrow failure diseases; and 

19 ‘‘(B) establish and maintain a national and 

20 publicly available registry, to be known as the 

21 National Acquired Bone Marrow Failure Dis22 ease Registry, in accordance with paragraph 

23 (3). 

24 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM25 MITTEE.—In carrying out this subsection, the SecVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 retary shall take into consideration the recommenda2 tions of the Advisory Committee on Acquired Bone 

3 Marrow Failure Diseases established under sub4 section (b). 

5 ‘‘(3) PURPOSES OF REGISTRY.—The National 

6 Acquired Bone Marrow Failure Disease Registry 

7 shall— 

8 ‘‘(A) identify the incidence and prevalence 

9 of acquired bone marrow failure diseases in the 

10 United States; 

11 ‘‘(B) be used to collect and store data on 

12 acquired bone marrow failure diseases, includ13 ing data concerning— 

14 ‘‘(i) the age, race or ethnicity, general 

15 geographic location, sex, and family history 

16 of individuals who are diagnosed with ac17 quired bone marrow failure diseases, and 

18 any other characteristics of such individ19 uals determined appropriate by the Sec20 retary; 

21 ‘‘(ii) the genetic and environmental 

22 factors that may be associated with devel23 oping acquired bone marrow failure dis24 eases; 


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1 ‘‘(iii) treatment approaches for deal2 ing with acquired bone marrow failure dis3 eases; 

4 ‘‘(iv) outcomes for individuals treated 

5 for acquired bone marrow failure diseases, 

6 including outcomes for recipients of stem 

7 cell therapeutic products as contained in 

8 the database established pursuant to sec9 tion 379A; and 

10 ‘‘(v) any other factors pertaining to 

11 acquired bone marrow failure diseases de12 termined appropriate by the Secretary; and 

13 ‘‘(C) be made available— 

14 ‘‘(i) to the general public; and 

15 ‘‘(ii) to researchers to facilitate fur16 ther research into the causes of, and treat17 ments for, acquired bone marrow failure 

18 diseases in accordance with standard prac19 tices of the Centers for Disease Control 

20 and Prevention. 

21 ‘‘(b) ADVISORY COMMITTEE.— 

22 ‘‘(1) ESTABLISHMENT.—Not later than 6 

23 months after the date of the enactment of this sec24 tion, the Secretary, acting through the Director of 

25 the Centers for Disease Control and Prevention, 


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1 shall establish an advisory committee, to be known 

2 as the Advisory Committee on Acquired Bone Mar3 row Failure Diseases. 

4 ‘‘(2) MEMBERS.—The members of the Advisory 

5 Committee on Acquired Bone Marrow Failure Dis6 eases shall be appointed by the Secretary, acting 

7 through the Director of the Centers for Disease 

8 Control and Prevention, and shall include at least 

9 one representative from each of the following: 

10 ‘‘(A) A national patient advocacy organiza11 tion with experience advocating on behalf of pa12 tients suffering from acquired bone marrow 

13 failure diseases. 

14 ‘‘(B) The National Institutes of Health, in15 cluding at least one representative from each 

16 of— 

17 ‘‘(i) the National Cancer Institute; 

18 ‘‘(ii) the National Heart, Lung, and 

19 Blood Institute; and 

20 ‘‘(iii) the Office of Rare Diseases. 

21 ‘‘(C) The Centers for Disease Control and 

22 Prevention. 

23 ‘‘(D) Clinicians with experience in— 

24 ‘‘(i) diagnosing or treating acquired 

25 bone marrow failure diseases; or 


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1 ‘‘(ii) medical data registries. 

2 ‘‘(E) Epidemiologists who have experience 

3 with data registries. 

4 ‘‘(F) Publicly or privately funded research5 ers who have experience researching acquired 

6 bone marrow failure diseases. 

7 ‘‘(G) The entity operating the C.W. Bill 

8 Young Cell Transplantation Program estab9 lished pursuant to section 379 and the entity 

10 operating the C.W. Bill Young Cell Transplan11 tation Program Outcomes Database. 

12 ‘‘(3) RESPONSIBILITIES.—The Advisory Com13 mittee on Acquired Bone Marrow Failure Diseases 

14 shall provide recommendations to the Secretary on 

15 the establishment and maintenance of the National 

16 Acquired Bone Marrow Failure Disease Registry, in17 cluding recommendations on the collection, mainte18 nance, and dissemination of data. 

19 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 

20 shall make the recommendations of the Advisory 

21 Committee on Acquired Bone Marrow Failure Dis22 ease publicly available. 

23 ‘‘(c) GRANTS.—The Secretary, acting through the 

24 Director of the Centers for Disease Control and Preven25 tion, may award grants to, and enter into contracts and 


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1 cooperative agreements with, public or private nonprofit 

2 entities for the management of, as well as the collection, 

3 analysis, and reporting of data to be included in, the Na4 tional Acquired Bone Marrow Failure Disease Registry. 

5 ‘‘(d) DEFINITION.—In this section, the term ‘ac6 quired bone marrow failure disease’ means— 

7 ‘‘(1) myelodysplastic syndromes; 

8 ‘‘(2) aplastic anemia; 

9 ‘‘(3) paroxysmal nocturnal hemoglobinuria; 

10 ‘‘(4) pure red cell aplasia; 

11 ‘‘(5) acute myeloid leukemia that has pro12 gressed from myelodysplastic syndromes; or 

13 ‘‘(6) large granular lymphocytic leukemia. 

14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section 

16 $3,000,000 for each of fiscal years 2021 through 2025.’’. 

17 (d) PILOT STUDIES THROUGH THE AGENCY FOR

18 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 

19 (1) PILOT STUDIES.—The Secretary of Health 

20 and Human Services, acting through the Director of 

21 the Agency for Toxic Substances and Disease Reg22 istry, shall conduct pilot studies to determine which 

23 environmental factors, including exposure to toxins, 

24 may cause acquired bone marrow failure diseases. 


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1 (2) COLLABORATION WITH THE RADIATION IN2 JURY TREATMENT NETWORK.—In carrying out the 

3 directives of this section, the Secretary may collabo4 rate with the Radiation Injury Treatment Network 

5 of the C.W. Bill Young Cell Transplantation Pro6 gram established pursuant to section 379 of the 

7 Public Health Service Act (42 U.S.C. 274k) to— 

8 (A) augment data for the pilot studies au9 thorized by this section; 

10 (B) access technical assistance that may be 

11 provided by the Radiation Injury Treatment 

12 Network; or 

13 (C) perform joint research projects. 

14 (3) AUTHORIZATION OF APPROPRIATIONS.— 

15 There is authorized to be appropriated to carry out 

16 this section $1,000,000 for each of fiscal years 2021 

17 through 2025. 

18 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED

19 BONE MARROW FAILURE DISEASES.—Title XVII of the 

20 Public Health Service Act (42 U.S.C. 300u et seq.) is 

21 amended by inserting after section 1707A the following: 

22 ‘‘SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON AC23 QUIRED BONE MARROW FAILURE DISEASE. 

24 ‘‘(a) INFORMATION AND REFERRAL SERVICES.— 


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1 ‘‘(1) IN GENERAL.—Not later than 6 months 

2 after the date of the enactment of this section, the 

3 Secretary, acting through the Deputy Assistant Sec4 retary for Minority Health, shall establish and co5 ordinate outreach and informational programs tar6 geted to minority populations affected by acquired 

7 bone marrow failure diseases. 

8 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo9 cused outreach and informational programs author10 ized by this section at the National Minority Health 

11 Resource Center supported under section 1707(b)(8) 

12 (including by means of the Center’s website, through 

13 appropriate locations such as the Center’s knowledge 

14 center, and through appropriate programs such as 

15 the Center’s resource persons network) and through 

16 minority health consultants located at each Depart17 ment of Health and Human Services regional of18 fice— 

19 ‘‘(A) shall make information about treat20 ment options and clinical trials for acquired 

21 bone marrow failure diseases publicly available; 

22 and 

23 ‘‘(B) shall provide referral services for 

24 treatment options and clinical trials. 


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1 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC

2 ISLANDER OUTREACH.— 

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

4 through the Deputy Assistant Secretary for Minority 

5 Health, shall undertake a coordinated outreach ef6 fort to connect Hispanic, Asian-American, and Pa7 cific Islander communities with comprehensive serv8 ices focused on treatment of, and information about, 

9 acquired bone marrow failure diseases. 

10 ‘‘(2) COLLABORATION.—In carrying out this 

11 subsection, the Secretary may collaborate with public 

12 health agencies, nonprofit organizations, community 

13 groups, and online entities to disseminate informa14 tion about treatment options and clinical trials for 

15 acquired bone marrow failure diseases. 

16 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 

17 ‘‘(1) IN GENERAL.—Not later than 6 months 

18 after the date of the enactment of this section, the 

19 Secretary, acting through the Deputy Assistant Sec20 retary for Minority Health, shall award grants to, or 

21 enter into cooperative agreements with, entities to 

22 perform research on acquired bone marrow failure 

23 diseases. 

24 ‘‘(2) REQUIREMENT.—Grants and cooperative 

25 agreements authorized by this subsection shall be 


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1 awarded or entered into on a competitive, peer-re2 viewed basis. 

3 ‘‘(3) SCOPE OF RESEARCH.—Research funded 

4 under this section shall examine factors affecting the 

5 incidence of acquired bone marrow failure diseases 

6 in minority populations. 

7 ‘‘(d) DEFINITION.—In this section, the term ‘ac8 quired bone marrow failure disease’ has the meaning given 

9 to such term in section 317W(d). 

10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

11 is authorized to be appropriated to carry out this section 

12 $2,000,000 for each of fiscal years 2021 through 2025.’’. 

13 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC14 QUIRED BONE MARROW FAILURE DISEASES.— 

15 (1) GRANTS.—The Secretary of Health and 

16 Human Services, acting through the Director of the 

17 Agency for Healthcare Research and Quality, shall 

18 award grants to entities to improve diagnostic prac19 tices and quality of care with respect to patients 

20 with acquired bone marrow failure diseases. 

21 (2) AUTHORIZATION OF APPROPRIATIONS.— 

22 There is authorized to be appropriated to carry out 

23 this section $2,000,000 for each of fiscal years 2021 

24 through 2025. 


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1 (g) DEFINITION.—In this section, the term ‘‘acquired 

2 bone marrow failure disease’’ has the meaning given such 

3 term in section 317W(d) of the Public Health Service Act, 

4 as added by subsection (c). 

5 Subtitle D—Cardiovascular Dis6 ease, Chronic Disease, Obesity, 

7 and Other Disease Issues 

8 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI9 NORITY PATIENTS. 

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

11 Director of the Agency for Healthcare Research and Qual12 ity, shall convene a series of meetings to develop guidelines 

13 for disease screening for minority patient populations that 

14 have a higher than average risk for many chronic diseases 

15 and cancers. 

16 (b) PARTICIPANTS.—In convening meetings under 

17 subsection (a), the Secretary shall ensure that meeting 

18 participants include representatives of— 

19 (1) professional societies and associations; 

20 (2) minority health organizations; 

21 (3) health care researchers and providers, in22 cluding those with expertise in minority health; 

23 (4) Federal health agencies, including the Of24 fice of Minority Health, the National Institute on 


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1 Minority Health and Health Disparities, and the 

2 National Institutes of Health; and 

3 (5) other experts as the Secretary determines 

4 appropriate. 

5 (c) DISEASES.—Screening guidelines for minority 

6 populations shall be developed as appropriate under sub7 section (a) for— 

8 (1) hypertension; 

9 (2) hypercholesterolemia; 

10 (3) diabetes; 

11 (4) cardiovascular disease; 

12 (5) cancers, including breast, prostate, colon, 

13 cervical, and lung cancer; 

14 (6) other pulmonary problems including sleep 

15 apnea; 

16 (7) asthma; 

17 (8) kidney diseases; 

18 (9) eye diseases and disorders, including glau19 coma; 

20 (10) HIV/AIDS and sexually transmitted infec21 tions; 

22 (11) uterine fibroids; 

23 (12) autoimmune disease; 

24 (13) mental health conditions; 


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1 (14) dental health conditions and oral diseases, 

2 including oral cancer; 

3 (15) environmental and related health illnesses 

4 and conditions; 

5 (16) sickle cell disease and sickle cell trait; 

6 (17) violence and injury prevention and control; 

7 (18) genetic and related conditions; 

8 (19) heart disease and stroke; 

9 (20) tuberculosis; 

10 (21) chronic obstructive pulmonary disease; 

11 (22) musculoskeletal diseases, arthritis, and 

12 obesity; and 

13 (23) other diseases determined appropriate by 

14 the Secretary. 

15 (d) DISSEMINATION.—Not later than 2 years after 

16 the date of enactment of this Act, the Secretary shall pub17 lish and disseminate to health care provider organizations 

18 the guidelines developed under subsection (a). 

19 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

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

22 2021 through 2025. 

23 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 

24 Section 1509 of the Public Health Service Act (42 

25 U.S.C. 300n–4a) is amended— 


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1 (1) in subsection (a)— 

2 (A) by striking the heading and inserting 

3 ‘‘IN GENERAL.—’’; and 

4 (B) in the matter preceding paragraph (1), 

5 by striking ‘‘may make grants’’ and all that fol6 lows through ‘‘purpose’’ and inserting the fol7 lowing: ‘‘may make grants to such States for 

8 the purpose’’; and 

9 (2) in subsection (d)(1), by striking ‘‘there are 

10 authorized’’ and all that follows through the period 

11 and inserting ‘‘there are authorized to be appro12 priated $23,000,000 for fiscal year 2021, 

13 $25,300,000 for fiscal year 2022, $27,800,000 for 

14 fiscal year 2023, $30,800,000 for fiscal year 2024, 

15 and $34,000,000 for fiscal year 2025.’’. 

16 SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 

17 AND MINORITIES. 

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

19 (42 U.S.C. 280g et seq.), as amended by section 531, is 

20 further amended by adding at the end the following: 

21 ‘‘SEC. 399V–9. REPORT ON CARDIOVASCULAR CARE FOR 

22 WOMEN AND MINORITIES. 

23 ‘‘Not later than September 30, 2021, and annually 

24 thereafter, the Secretary shall prepare and submit to Con25 gress a report on the quality of and access to care for 


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1 women and minorities with heart disease, stroke, and 

2 other cardiovascular diseases. The report shall contain rec3 ommendations for eliminating disparities in, and improv4 ing the treatment of, heart disease, stroke, and other car5 diovascular diseases in women, racial and ethnic minori6 ties, those for whom English is not their primary lan7 guage, and individuals with disabilities.’’. 

8 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES9 SATION SERVICES IN MEDICAID AND PRI10 VATE HEALTH INSURANCE. 

11 (a) REQUIRING MEDICAID COVERAGE OF COUN12 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO13 BACCO USE.—Section 1905 of the Social Security Act (42 

14 U.S.C. 1396d) is amended— 

15 (1) in subsection (a)(4)(D), by striking ‘‘by 

16 pregnant women’’; and 

17 (2) in subsection (bb)— 

18 (A) by striking ‘‘by pregnant women’’ each 

19 place it appears; 

20 (B) in paragraph (1), in the matter before 

21 subparagraph (A), by inserting ‘‘by individuals’’ 

22 before ‘‘who use tobacco’’; and 

23 (C) in paragraph (2)(A), by striking ‘‘with 

24 respect to pregnant women’’. 


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1 (b) EXCEPTION FROM OPTIONAL RESTRICTION

2 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 

3 Section 1927(d)(2)(F) of the Social Security Act (42 

4 U.S.C. 1396r–8(d)(2)(F)) is amended— 

5 (1) by striking ‘‘, in the case of pregnant 

6 women’’; and 

7 (2) by striking ‘‘under the over-the-counter 

8 monograph process’’. 

9 (c) STATE MONITORING AND PROMOTING OF COM10 PREHENSIVE TOBACCO CESSATION SERVICES UNDER

11 MEDICAID.—Section 1902(a) of the Social Security Act 

12 (42 U.S.C. 1396a(a)), as amended by section 

13 433(d)(2)(A), is amended— 

14 (1) by striking ‘‘and’’ at the end of paragraph 

15 (86); 

16 (2) by striking the period at the end of para17 graph (87) and inserting ‘‘; and’’; and 

18 (3) by inserting after paragraph (87) the fol19 lowing new paragraph: 

20 ‘‘(88) provide for the State to monitor and pro21 mote the use of comprehensive tobacco cessation 

22 services under the State plan, including conducting 

23 an outreach campaign to increase awareness of, and 

24 the benefits of using, such services among— 


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1 ‘‘(A) individuals entitled to medical assist2 ance under the State plan who use tobacco 

3 products; and 

4 ‘‘(B) clinicians and others who provide 

5 services to individuals entitled to medical assist6 ance under the State plan.’’. 

7 (d) FEDERAL REIMBURSEMENT FOR MEDICAID OUT8 REACH CAMPAIGN TO INCREASE AWARENESS.—Section 

9 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) 

10 is amended— 

11 (1) by striking the period at the end of para12 graph (7) and inserting ‘‘; plus’’; and 

13 (2) by inserting after paragraph (7) the fol14 lowing new paragraph: 

15 ‘‘(8) an amount equal to 90 percent of the 

16 sums expended during each quarter which are attrib17 utable to the development, implementation, and eval18 uation of an outreach campaign to— 

19 ‘‘(A) increase awareness of comprehensive 

20 tobacco cessation services covered in the State 

21 plan among— 

22 ‘‘(i) individuals who are likely to be el23 igible for medical assistance under the 

24 State plan; and 


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1 ‘‘(ii) clinicians and others who provide 

2 services to individuals who are likely to be 

3 eligible for medical assistance under the 

4 State plan; and 

5 ‘‘(B) increase awareness of the benefits of 

6 using comprehensive tobacco cessation services 

7 covered in the State plan among— 

8 ‘‘(i) individuals who are likely to be el9 igible for medical assistance under the 

10 State plan; and 

11 ‘‘(ii) clinicians and others who provide 

12 services to individuals who are likely to be 

13 eligible for medical assistance under the 

14 State plan about the benefits of using com15 prehensive tobacco cessation services.’’. 

16 (e) REMOVAL OF COST SHARING FOR COUNSELING

17 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO

18 USE UNDER MEDICAID.— 

19 (1) GENERAL COST SHARING LIMITATIONS.— 

20 Section 1916 of the Social Security Act (42 U.S.C. 

21 1396o) is amended— 

22 (A) in subsections (a)(2)(B) and (b)(2)(B), 

23 by striking ‘‘and counseling and 

24 pharmacotherapy for cessation of tobacco use 

25 by pregnant women (as defined in section 


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1 1905(bb)) and covered outpatient drugs (as de2 fined in subsection (k)(2) of section 1927 and 

3 including nonprescription drugs described in 

4 subsection (d)(2) of such section) that are pre5 scribed for purposes of promoting, and when 

6 used to promote, tobacco cessation by pregnant 

7 women in accordance with the Guideline re8 ferred to in section 1905(bb)(2)(A)’’ each place 

9 it appears; and 

10 (B) in each of subsections (a)(2)(B) and 

11 (b)(2)(B) by inserting ‘‘and counseling and 

12 pharmacotherapy for cessation of tobacco use 

13 (as defined in section 1905d(bb)) and covered 

14 outpatient drugs (as defined in subsection 

15 (k)(2) of section 1927 and including non16 prescription drugs described in subsection 

17 (d)(2) of such section) that are prescribed for 

18 purposes of promoting, and when used to pro19 mote, tobacco cessation in accordance with the 

20 Guideline referred to in section 

21 1905(bb)(2)(A)’’ after ‘‘(or at the option of the 

22 State, any services furnished to pregnant 

23 women’’. 


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1 (2) APPLICATION TO ALTERNATIVE COST SHAR2 ING.—Section 1916A(b)(3)(B) of such Act (42 

3 U.S.C. 1396o–1(b)(3)(B)) is amended— 

4 (A) in clause (iii), by striking ‘‘, and coun5 seling and pharmacotherapy for cessation of to6 bacco use by pregnant women (as defined in 

7 section 1905(bb))’’; and 

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

9 ‘‘(xii) Counseling and 

10 pharmacotherapy for cessation of tobacco 

11 use (as defined in section 1905(bb)) and 

12 covered outpatient drugs (as defined in 

13 subsection (k)(2) of section 1927 and in14 cluding nonprescription drugs described in 

15 subsection (d)(2) of such section) that are 

16 prescribed for purposes of promoting, and 

17 when used to promote, tobacco cessation in 

18 accordance with the Guideline referred to 

19 in section 1905(bb)(2)(A).’’. 

20 (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES21 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 

22 the Social Security Act (42 U.S.C. 1396r–8) is amended— 

23 (1) by striking in paragraph (1)(A) ‘‘A State’’ 

24 and inserting ‘‘Except as otherwise provided in para25 graph (6), a State’’; 


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1 (2) by redesignating paragraphs (6) and (7) as 

2 paragraphs (7) and (8), respectively; and 

3 (3) by inserting after paragraph (5) the fol4 lowing: 

5 ‘‘(6) NO PRIOR AUTHORIZATION PROGRAMS FOR

6 TOBACCO CESSATION DRUGS.—A State plan under 

7 this title shall not require, as a condition of coverage 

8 or payment for a covered outpatient drug for which 

9 Federal financial participation is available in accord10 ance with this section, the approval of an agent 

11 when used to promote smoking cessation, including 

12 agents approved by the Food and Drug Administra13 tion for the purposes of promoting, and when used 

14 to promote, tobacco cessation.’’. 

15 (g) COMPREHENSIVE COVERAGE OF TOBACCO CES16 SATION COVERAGE IN PRIVATE HEALTH INSURANCE.— 

17 Section 2713 of the Public Health Service Act (42 U.S.C. 

18 300gg–13) is amended by adding at the end the following: 

19 ‘‘(d) NO PRIOR AUTHORIZATION.—A group health 

20 plan and a health insurance issuer offering group or indi21 vidual health insurance coverage shall not impose any 

22 prior authorization requirement for tobacco cessation 

23 counseling and pharmacotherapy that has in effect a rat24 ing of ‘A’ or ‘B’ in the current recommendations of the 

25 United States Preventive Services Task Force.’’. 


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

2 this section shall apply to items and services furnished on 

3 or after January 1, 2021. 

4 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 

5 HEALTH. 

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

7 Human Services shall expand and intensify the conduct 

8 and support of the research activities of the National In9 stitutes of Health and the National Institute of Dental 

10 and Craniofacial Research to improve the oral health of 

11 the population through the prevention and management 

12 of oral diseases and conditions. 

13 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

14 activities under subsection (a) shall include— 

15 (1) comparative effectiveness research and clin16 ical disease management research addressing early 

17 childhood caries and oral cancer; and 

18 (2) awarding of grants and contracts to support 

19 the training and development of health services re20 searchers, comparative effectiveness researchers, and 

21 clinical researchers whose research improves the oral 

22 health of the population. 


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1 SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 

2 APPROVED CLINICAL TRIALS. 

3 (a) IN GENERAL.—Title XIX of the Social Security 

4 Act (42 U.S.C. 1396 et seq.) is amended by adding at 

5 the end the following new section: 

6 ‘‘SEC. 1947. PARTICIPATION IN AN APPROVED CLINICAL 

7 TRIAL. 

8 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO9 CIATED WITH APPROVED CLINICAL TRIALS.— 

10 ‘‘(1) INCLUSION.—Subject to paragraph (2), 

11 routine patient costs shall include all items and serv12 ices consistent with the medical assistance provided 

13 under the State plan that would otherwise be pro14 vided to the individual under such State plan if such 

15 individual was not enrolled in an approved clinical 

16 trial, including any items or services related to the 

17 prevention, detection, and treatment of any medical 

18 complications that arise as a result of participation 

19 in the approved clinical trial. 

20 ‘‘(2) EXCLUSION.—For purposes of paragraph 

21 (1), routine patient costs does not include— 

22 ‘‘(A) the investigational item, device, or 

23 service itself; 

24 ‘‘(B) items and services that are provided 

25 solely to satisfy data collection and analysis 


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1 needs and that are not used in the direct clin2 ical management of the patient; or 

3 ‘‘(C) a service that is clearly inconsistent 

4 with widely accepted and established standards 

5 of care for a particular diagnosis. 

6 ‘‘(3) INFORMATION CONCERNING CLINICAL

7 TRIALS.— 

8 ‘‘(A) IN GENERAL.—Subject to subpara9 graph (B), the Secretary, in consultation with 

10 relevant stakeholders, shall develop a single 

11 standardized electronic form for use by the indi12 vidual or the referring health care provider to 

13 submit to the State agency administering the 

14 State plan in order to verify that the clinical 

15 trial meets the conditions established for an ap16 proved clinical trial (as defined in subsection 

17 (c)). 

18 ‘‘(B) EXCLUDED INFORMATION.—For pur19 poses of subparagraph (A) or any such request 

20 by the State agency for information regarding 

21 a clinical trial, an individual or referring health 

22 care provider shall not be required to submit— 

23 ‘‘(i) the clinical protocol document for 

24 the clinical trial; or 


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1 ‘‘(ii) subject to subparagraph (C), any 

2 additional information other than such in3 formation as is required pursuant to the 

4 form described in subparagraph (A). 

5 ‘‘(C) OPTIONAL INFORMATION.—For pur6 poses of subparagraphs (A) and (B)(ii), the 

7 form may include a requirement that the refer8 ring health care provider attest that the indi9 vidual is eligible to participate in the clinical 

10 trial pursuant to the trial protocol and that in11 dividual participation in such trial would be ap12 propriate. 

13 ‘‘(D) REVIEW OF INFORMATION.— 

14 ‘‘(i) IN GENERAL.—A State plan 

15 under this title shall establish a process for 

16 timely review by the State agency of the 

17 form and information submitted pursuant 

18 to subparagraph (A) and, not later than 

19 48 hours after receipt of such form, con20 firmation that the information provided in 

21 such form satisfies the requirements estab22 lished under such subparagraph, with such 

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1 ber and email address to provide for expe2 dited communication. 

3 ‘‘(ii) FAILURE TO RESPOND.—If an 

4 individual or the referring health care pro5 vider does not receive a response or re6 quest for additional information from the 

7 State agency following the 48-hour period 

8 described in clause (i), the information 

9 provided in the form may be presumed to 

10 satisfy the requirements established under 

11 this paragraph. 

12 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP13 PROVED CLINICAL TRIALS.— 

14 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 

15 For purposes of participation in an approved clinical 

16 trial by an individual eligible for medical assistance 

17 under this title, the State agency administering the 

18 State plan shall make reasonable efforts to ensure 

19 that the individual is provided with access to a pro20 vider who is— 

21 ‘‘(A) participating in the approved clinical 

22 trial; 

23 ‘‘(B) located not more than 25 miles from 

24 the residence of the individual (or, if no such 


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1 provider is available, as close as possible to the 

2 residence of the individual); and 

3 ‘‘(C) a participating provider under the 

4 State plan or has been deemed to be a partici5 pating provider under the State plan for pur6 poses of providing medical assistance to the in7 dividual during their participation in the ap8 proved clinical trial. 

9 ‘‘(2) INFORMATIONAL MATERIALS.—The State 

10 agency administering the plan approved under this 

11 title shall develop informational materials and pro12 grams to encourage participating providers to make 

13 appropriate referrals to physicians and other appro14 priate health care professionals who can provide in15 dividuals with access to approved clinical trials. 

16 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 

17 The term ‘approved clinical trial’ has the same meaning 

18 as provided under subsection (d) of the section 2709 of 

19 the Public Health Service Act that relates to coverage for 

20 individuals participating in approved clinical trials.’’. 

21 (b) CONFORMING AMENDMENT.—Section 1902(a) of 

22 the Social Security Act (42 U.S.C. 1396a(a)), as amended 

23 by section 734(c), is amended— 

24 (1) by striking ‘‘and’’ at the end of paragraph 

25 (87); 


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1 (2) by striking the period at the end of para2 graph (88) and inserting ‘‘; and’’; and 

3 (3) by inserting after paragraph (88) the fol4 lowing new paragraph: 

5 ‘‘(89) provide that participation in an approved 

6 clinical trial and coverage of routine patient costs 

7 associated with such trial for an individual eligible 

8 for medical assistance under this title is conducted 

9 in accordance with the requirements under section 

10 1947.’’. 

11 (c) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—Except as provided in para13 graph (2), the amendments made by this section 

14 shall apply to calendar quarters beginning on or 

15 after October 1, 2021. 

16 (2) DELAY PERMITTED FOR STATE PLAN

17 AMENDMENT.—In the case of a State plan for med18 ical assistance under title XIX of the Social Security 

19 Act (42 U.S.C. 1396 et seq.) which the Secretary of 

20 Health and Human Services determines requires 

21 State legislation (other than legislation appro22 priating funds) in order for the plan to meet the ad23 ditional requirements imposed by the amendments 

24 made by this section, the State plan shall not be re25 garded as failing to comply with the requirements of 


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1 such title solely on the basis of its failure to meet 

2 these additional requirements before the first day of 

3 the first calendar quarter beginning after the close 

4 of the first regular session of the State legislature 

5 that begins after the date of enactment of this Act. 

6 For purposes of the previous sentence, in the case 

7 of a State that has a 2-year legislative session, each 

8 year of such session shall be deemed to be a sepa9 rate regular session of the State legislature. 

10 SEC. 737. GUIDE ON EVIDENCE-BASED STRATEGIES FOR 

11 PUBLIC HEALTH DEPARTMENT OBESITY PRE12 VENTION PROGRAMS. 

13 (a) DEVELOPMENT AND DISSEMINATION OF AN EVI14 DENCE-BASED STRATEGIES GUIDE.—The Secretary of 

15 Health and Human Services (referred to in this section 

16 as the ‘‘Secretary’’), acting through the Director of the 

17 Centers for Disease Control and Prevention, not later than 

18 2 years after the date of enactment of this Act, shall— 

19 (1) develop a guide on evidence-based strategies 

20 for State, territorial, and local health departments to 

21 use to build and maintain effective obesity preven22 tion and reduction programs, and, in consultation 

23 with stakeholders that have expertise in Tribal 

24 health, a guide on such evidence-based strategies 

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1 tions for such Indian Tribes and Tribal organiza2 tions to use for such purpose, both of which guides 

3 shall— 

4 (A) describe an integrated program struc5 ture for implementing interventions proven to 

6 be effective in preventing and reducing the inci7 dence of obesity; and 

8 (B) recommend— 

9 (i) optimal resources, including staff10 ing and infrastructure, for promoting nu11 trition and obesity prevention and reduc12 tion; and 

13 (ii) strategies for effective obesity pre14 vention programs for State and local 

15 health departments, Indian Tribes, and 

16 Tribal organizations, including strategies 

17 related to— 

18 (I) the application of evidence19 based and evidence-informed practices 

20 to prevent and reduce obesity rates; 

21 (II) the development, implemen22 tation, and evaluation of obesity pre23 vention and reduction strategies for 

24 specific communities and populations; 


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1 (III) demonstrated knowledge of 

2 obesity prevention practices that re3 duce associated preventable diseases, 

4 health conditions, death, and health 

5 care costs; 

6 (IV) best practices for the coordi7 nation of efforts to prevent and re8 duce obesity and related chronic dis9 eases; 

10 (V) addressing the underlying 

11 risk factors and social determinants of 

12 health that impact obesity rates; and 

13 (VI) interdisciplinary coordina14 tion between relevant public health of15 ficials specializing in fields such as 

16 nutrition, physical activity, epidemi17 ology, communications, and policy im18 plementation, and collaboration be19 tween public health officials and com20 munity-based organizations; and 

21 (2) disseminate the guides and current re22 search, evidence-based practices, tools, and edu23 cational materials related to obesity prevention, con24 sistent with the guides, to State and local health de25 partments, Indian Tribes, and Tribal organizations. 


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1 (b) TECHNICAL ASSISTANCE.—The Secretary, acting 

2 through the Director of the Centers for Disease Control 

3 and Prevention, shall provide technical assistance to State 

4 and local health departments, Indian Tribes, and Tribal 

5 organizations to support such health departments in im6 plementing the guides developed under subsection (a)(1). 

7 (c) INDIAN TRIBES; TRIBAL ORGANIZATIONS.—In 

8 this section, the terms ‘‘Indian Tribe’’ and ‘‘Tribal organi9 zation’’ have the meanings given the terms ‘‘Indian tribe’’ 

10 and ‘‘tribal organization’’, respectively, in section 4 of the 

11 Indian Self-Determination and Education Assistance Act 

12 (25 U.S.C. 5304). 

13 Subtitle E—HIV/AIDS 

14 SEC. 741. STATEMENT OF POLICY. 

15 It is the policy of the United States to achieve an 

16 AIDS-free generation, and to— 

17 (1) expand access to lifesaving antiretroviral 

18 therapy for people living with HIV and immediately 

19 link people to continuous and coordinated high-qual20 ity care when they learn they are living with HIV; 

21 (2) expand targeted efforts to prevent HIV in22 fection using a combination of effective, evidence23 based approaches, including routine HIV screening, 

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1 munities disproportionately impacted by HIV, par2 ticularly communities of color; 

3 (3) ensure laws, policies, and regulations do not 

4 impede access to prevention, treatment, and care for 

5 people living with HIV or disproportionately im6 pacted by HIV; 

7 (4) accelerate research for more efficacious HIV 

8 prevention and treatments tools, a cure, and a vac9 cine; and 

10 (5) respect the human rights and dignity of 

11 persons living with HIV. 

12 SEC. 742. FINDINGS. 

13 The Congress finds the following: 

14 (1) Over 1,100,000 people are estimated to be 

15 living with HIV in the United States according to 

16 the Centers for Disease Control and Prevention, 14 

17 percent of whom are unaware they are living with 

18 HIV. 

19 (2) Annually there are about 37,600 new HIV 

20 infections and 15,800 deaths in people with an HIV 

21 diagnosis in 50 States and 6 dependent areas of the 

22 United States. 

23 (3) The Centers for Disease Control and Pre24 vention estimates that, in 2017, there were approxi25 mately 38,700 people newly diagnosed with HIV. 


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1 The estimated number of annual new HIV infections 

2 declined 9 percent from 2010 to 2016. However, the 

3 number of new infections is increasing among cer4 tain populations, such as Latino gay and bisexual 

5 men, where annual infections increase 21 percent. 

6 (4) HIV disproportionately affects certain popu7 lations in the United States. Though African Ameri8 cans represent approximately 12 percent of the pop9 ulation, African Americans account for almost half 

10 (42 percent) of all people living with HIV in the 

11 United States. African-American men who have sex 

12 with men account for 26 percent of all new HIV in13 fections and have remained stable from 2010 to 

14 2016. 

15 (5) Disparities continue to exist among Latinos 

16 and Hispanics; in 2017, Latinos and Hispanics 

17 made up 18 percent of the United States population 

18 and 26 percent of new infections. 

19 (6) Though the rate of new infections among 

20 American Indians and Alaska Natives (referred to in 

21 this section as ‘‘AI/AN’’) is proportional to their 

22 population size, from 2010 to 2016, the annual 

23 number of HIV diagnoses increased 46 percent 

24 among AI/AN overall and 81 percent among AI/AN 

25 gay and bisexual men. 


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1 (7) Asian Americans account for about 2 per2 cent of new HIV infections, but in 2013, 22 percent 

3 were undiagnosed, the highest rate of undiagnosed 

4 HIV among any race or ethnicity. Between 2010 

5 and 2016, the number of Asians receiving an HIV 

6 diagnosis increased by 42 percent. 

7 (8) The latest data from the Centers for Dis8 ease Control and Prevention indicates that new in9 fections among women declined 21 percent between 

10 2010 and 2016. 

11 (9) The history of HIV shows that culturally 

12 relevant and gender-responsive supportive services, 

13 including psychosocial support, treatment literacy, 

14 case management, and transportation are necessary 

15 strategies to reach and engage women and girls in 

16 medical care. 

17 (10) Among the 3,000,000 HIV testing events 

18 reported to the Centers for Disease Control and Pre19 vention in 2017, the percentage of transgender peo20 ple who received a new HIV diagnosis was 3 times 

21 the national average. A 2019 systematic review and 

22 meta-analysis found that an estimated 14 percent of 

23 transgender women have HIV. By race/ethnicity, an 

24 estimated 44 percent of Black/African-American 

25 transgender women, 26 percent of Hispanic/Latina 


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1 transgender women, and 7 percent of White 

2 transgender women have HIV. The limited data 

3 available on transgender individuals point to a dis4 proportionate burden of HIV infection. 

5 (11) Stigma and discrimination contribute to 

6 such disparities. 

7 (12) The Centers for Disease Control and Pre8 vention has determined that increasing the propor9 tion of people who know their HIV status is an es10 sential component of comprehensive HIV treatment 

11 and prevention efforts and that early diagnosis is 

12 critical in order for people with HIV to receive life13 extending therapy. Additionally, the Centers for Dis14 ease Control and Prevention recommend routine 

15 HIV screening in health care settings for all patients 

16 aged 13 to 64, regardless of risk. 

17 (13) In 1998, Congress created the National 

18 Minority AIDS Initiative to provide technical assist19 ance, build capacity, and strengthen outreach efforts 

20 among local institutions and community-based orga21 nizations that serve racial and ethnic minorities liv22 ing with or vulnerable to HIV. 

23 (14) To combat the HIV epidemic in the United 

24 States, the National HIV/AIDS Strategy (referred 

25 to in this section as ‘‘NHAS’’) provides a framework 


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1 of increasing access to care, reducing new infections, 

2 and eliminating HIV-related health disparities. The 

3 vision of NHAS is ‘‘The United States will become 

4 a place where new HIV infections are rare and when 

5 they do occur, every person, regardless of age, gen6 der, race/ethnicity, gender identity, or socioeconomic 

7 circumstance, will have unfettered access to high 

8 quality, life-extending care, free from stigma and 

9 discrimination.’’. 

10 (15) In January 2019, the Department of 

11 Health and Human Services began implementing the 

12 initiative ‘‘Ending the HIV Epidemic: A Plan for 

13 America’’. The initiative seeks to reduce the number 

14 of new HIV infections in the United States by 75 

15 percent by 2025, and then by at least 90 percent by 

16 2030, for an estimated 250,000 total HIV infection 

17 averted. 

18 (16) At present, many States and United 

19 States territories have criminal statutes based on 

20 ‘‘exposure’’ to HIV. Most of these laws were adopted 

21 before the availability of effective antiretroviral 

22 treatment for HIV/AIDS. 

23 (17) Research shows that stable housing leads 

24 to better health outcomes for those living with HIV. 

25 Inadequate or unstable housing is not only a barrier 


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1 to effective treatment, but also increases the likeli2 hood of engaging in risky behaviors leading to HIV 

3 infection. Insecure housing puts people with HIV/ 

4 AIDS at risk of premature death from exposure to 

5 other diseases, poor nutrition, and lack of medical 

6 care. 

7 (18) Due to advances in treatment, many peo8 ple living with HIV today are living healthy lives and 

9 have the ability and desire to fully participate in all 

10 aspects of community life, including employment. 

11 Research associates being employed with tremendous 

12 economic, social, and health benefits for many people 

13 living with HIV. 

14 (19) The common benefits associated with em15 ployment include income, autonomy, productivity, 

16 and status within society, daily structure, making a 

17 contribution to one’s community, and increased skills 

18 and self-esteem. Research also indicates that many 

19 people with disabilities, including people living with 

20 HIV, report perceiving themselves as being less dis21 abled or not disabled at all, when working. Further22 more, some studies link working with better physical 

23 and mental health outcomes for people living with 

24 HIV when compared to those who are not working. 

25 Preliminary data also suggest that transitioning to 


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1 employment is associated with reduced HIV-related 

2 health risk behavior for many people. 

3 (20) In July 2012, the Food and Drug Admin4 istration approved the first drug to be used as pre5 exposure prophylaxis (PrEP). PrEP reduces the risk 

6 of HIV infection in HIV-negative individuals. Stud7 ies have shown that PrEP reduces HIV transmission 

8 from sex by about 99 percent when taken consist9 ently. Despite increases in PrEP uptake, PrEP use 

10 remains low among gay and bisexual men of color. 

11 The Centers for Disease Control and Prevention 

12 found that uptake was lower among African-Amer13 ican (26 percent) and Latino (30 percent) men com14 pared with White men (42 percent). Similarly, PrEP 

15 awareness was lower among African-American (86 

16 percent) and Latino (87 percent) men compared 

17 with White men (95 percent). While clinical research 

18 on transgender populations and PrEP is currently 

19 limited, the Centers for Disease Control and Preven20 tion recommends PrEP use in transgender popu21 lations. In September 2019, the Food and Drug Ad22 ministration approved the second drug to be used as 

23 PrEP. 

24 (21) Syringe service programs have been associ25 ated with lowered HIV infections, lower hepatitis C 


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1 infections, and increased linkage to substance use 

2 treatment. 

3 (22) There is now conclusive scientific evidence 

4 that a person living with HIV who is on 

5 antiretroviral therapy and is durably virally sup6 pressed (defined as having a consistent viral load of 

7 less than 200 copies/ml) does not sexually transmit 

8 HIV. The conclusive evidence about the highly effec9 tive preventative benefits of antiretroviral therapy 

10 provides an unprecedented opportunity to improve 

11 the lives of people living with HIV, improve treat12 ment uptake and adherence, and advocate for ex13 panded access to treatment and care. 

14 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST15 ANCE PROGRAM TREATMENTS. 

16 Section 2623 of the Public Health Service Act (42 

17 U.S.C. 300ff–31b) is amended by adding at the end the 

18 following: 

19 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS20 SISTANCE PROGRAM TREATMENTS.—In addition to 

21 amounts otherwise authorized to be appropriated for car22 rying out this subpart, there are authorized to be appro23 priated such sums as may be necessary to carry out sec24 tions 2612(b)(3)(B) and 2616 for each of fiscal years 

25 2021 through 2024.’’. 


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1 SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 

2 SYSTEM. 

3 (a) GRANTS.—The Secretary of Health and Human 

4 Services, acting through the Director of the Centers for 

5 Disease Control and Prevention, shall make grants to 

6 States to support integration of public health surveillance 

7 systems into all electronic health records in order to allow 

8 rapid communications between the clinical setting and 

9 health departments, by means that include— 

10 (1) providing technical assistance and policy 

11 guidance to State and local health departments, clin12 ical providers, and other agencies serving individuals 

13 with HIV to improve the interoperability of data sys14 tems relevant to monitoring HIV care and sup15 portive services; 

16 (2) capturing longitudinal data pertaining to 

17 the initiation and ongoing prescription or dispensing 

18 of antiretroviral therapy for individuals diagnosed 

19 with HIV (such as through pharmacy-based report20 ing); 

21 (3) obtaining information— 

22 (A) on a voluntary basis, on sexual orienta23 tion and gender identity; and 

24 (B) on sources of coverage (or the lack of 

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1 care program, the program under title XXVI of 

2 the Public Health Service Act (42 U.S.C. 

3 300ff–11 et seq.); commonly referred to as the 

4 ‘‘Ryan White HIV/AIDS Program’’), other pub5 lic funding, private insurance, and health main6 tenance organizations); and 

7 (4) obtaining and using current geographic 

8 markers of residence (such as current address, zip 

9 code, partial zip code, and census block). 

10 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car11 rying out this section, the Secretary of Health and Human 

12 Services shall ensure that appropriate privacy and security 

13 safeguards are met to prevent unauthorized disclosure of 

14 protected health information and compliance with the 

15 HIPAA privacy and security law (as defined in section 

16 3009 of the Public Health Service Act (42 U.S.C. 300jj– 

17 19)) and other relevant laws and regulations. 

18 (c) PROHIBITION AGAINST IMPROPER USE OF

19 DATA.—No grant under this section may be used to allow 

20 or facilitate the collection or use of surveillance or clinical 

21 data or records— 

22 (1) for punitive measures of any kind, civil or 

23 criminal, against the subject of such data or records; 

24 or 


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1 (2) for imposing any requirement or restriction 

2 with respect to an individual without the individual’s 

3 written consent. 

4 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

5 out this section, there are authorized to be appropriated 

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

7 2021 through 2024. 

8 SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 

9 LINKAGE TO AND RETENTION IN APPRO10 PRIATE CARE. 

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

12 Human Services, in collaboration with the Director of the 

13 Centers for Disease Control and Prevention, the Assistant 

14 Secretary for Mental Health and Substance Use, the Di15 rector of the Office of AIDS Research, the Administrator 

16 of the Health Resources and Services Administration, and 

17 the Administrator of the Centers for Medicare & Medicaid 

18 Services, shall— 

19 (1) identify evidence-based strategies most ef20 fective at addressing the multifaceted issues that im21 pede disease status awareness and linkage to and re22 tention in appropriate care, taking into consideration 

23 health care systems issues, clinic and provider 

24 issues, and individual psychosocial, environmental, 

25 and other contextual factors; 


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1 (2) support the wide-scale implementation of 

2 the evidence-based strategies identified pursuant to 

3 paragraph (1), including through incorporating such 

4 strategies into health care coverage supported by the 

5 Medicaid program under title XIX of the Social Se6 curity Act (42 U.S.C. 1396 et seq.), the program 

7 under title XXVI of the Public Health Service Act 

8 (42 U.S.C. 300ff–11 et seq.; commonly referred to 

9 as the ‘‘Ryan White HIV/AIDS Program’’), and 

10 health plans purchased through an American Health 

11 Benefit Exchange established pursuant to section 

12 1311 of the Patient Protection and Affordable Care 

13 Act (42 U.S.C. 18031); and 

14 (3) not later than 1 year after the date of the 

15 enactment of this Act, submit a report to the Con16 gress on the status of activities under paragraphs 

17 (1) and (2). 

18 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 such sums as may be necessary for fiscal years 2021 

21 through 2024. 


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1 SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 

2 CARE AND ANTIRETROVIRAL ADHERENCE 

3 FOR PERSONS WITH HIV. 

4 (a) SENSE OF CONGRESS.—It is the sense of Con5 gress that AIDS research has led to scientific advance6 ments that have— 

7 (1) saved the lives of millions of people living 

8 with HIV; 

9 (2) prevented millions from new diagnoses; and 

10 (3) had broad benefits that extend far beyond 

11 helping people at risk for or living with HIV. 

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

13 Human Services, acting through the Director of the Na14 tional Institutes of Health, shall expand, intensify, and co15 ordinate operational and translational research and other 

16 activities of the National Institutes of Health regarding 

17 methods— 

18 (1) to increase adoption of evidence-based ad19 herence strategies within HIV care and treatment 

20 programs; 

21 (2) to increase HIV testing and case detection 

22 rates; 

23 (3) to reduce HIV-related health disparities; 

24 (4) to ensure that research to improve adher25 ence to HIV care and treatment programs address 

26 the unique concerns of women; 


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1 (5) to integrate HIV prevention and care serv2 ices with mental health and substance use preven3 tion and treatment delivery systems; 

4 (6) to increase knowledge on the implementa5 tion of preexposure prophylaxis (referred to in this 

6 section as ‘‘PrEP’’), including with respect to— 

7 (A) who can benefit most from PrEP; 

8 (B) how to provide PrEP safely and effi9 ciently; 

10 (C) how to integrate PrEP with other es11 sential prevention methods such as condoms; 

12 and 

13 (D) how to ensure high levels of adherence; 

14 and 

15 (7) to increase knowledge of ‘‘undetectable and 

16 untransmittable’’, when a person living with HIV 

17 who is on antiretroviral therapy and is durably 

18 virally suppressed (defined as having a consistent 

19 viral load of less than 200 copies/ml) cannot sexually 

20 transmit HIV. 

21 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

22 out this section, there are authorized to be appropriated 

23 such sums as may be necessary for fiscal years 2021 

24 through 2024. 


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1 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 

2 ETHNIC MINORITY COMMUNITIES. 

3 (a) IN GENERAL.—For the purpose of reducing new 

4 HIV diagnoses in racial and ethnic minority communities, 

5 the Secretary of Health and Human Services, acting 

6 through the Deputy Assistant Secretary for Minority 

7 Health, may make grants to public health agencies and 

8 faith-based organizations to conduct— 

9 (1) outreach activities related to HIV preven10 tion and testing activities; 

11 (2) HIV prevention activities; and 

12 (3) HIV testing activities. 

13 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

14 out this section, there are authorized to be appropriated 

15 such sums as may be necessary for fiscal years 2021 

16 through 2024. 

17 SEC. 748. MINORITY AIDS INITIATIVE. 

18 (a) EXPANDED FUNDING.—The Secretary of Health 

19 and Human Services, in collaboration with the Deputy As20 sistant Secretary for Minority Health, the Director of the 

21 Centers for Disease Control and Prevention, the Adminis22 trator of the Health Resources and Services Administra23 tion, and the Assistant Secretary for Mental Health and 

24 Substance Use, shall provide funds and carry out activities 

25 to expand the Minority AIDS Initiative. 


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1 (b) USE OF FUNDS.—The additional funds made 

2 available under this section may be used, through the Mi3 nority AIDS Initiative, to support the following activities: 

4 (1) Providing technical assistance and infra5 structure support to reduce HIV/AIDS in minority 

6 populations. 

7 (2) Increasing minority populations’ access to 

8 HIV prevention and care services. 

9 (3) Building strong community programs and 

10 partnerships to address HIV prevention and the 

11 health care needs of specific racial and ethnic minor12 ity populations. 

13 (c) PRIORITY INTERVENTIONS.—Within the racial 

14 and ethnic minority populations referred to in subsection 

15 (b), priority in conducting intervention services shall be 

16 given to— 

17 (1) men who have sex with men; 

18 (2) youth; 

19 (3) persons who engage in intravenous drug 

20 abuse; 

21 (4) women; 

22 (5) homeless individuals; and 

23 (6) individuals incarcerated or in the penal sys24 tem. 


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1 (d) AUTHORIZATION OF APPROPRIATIONS.—For car2 rying out this section, there are authorized to be appro3 priated $610,000,000 for fiscal year 2021 and such sums 

4 as may be necessary for each of fiscal years 2022 through 

5 2025. 

6 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI7 VIDUALS WITH HIV. 

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

9 Human Services, acting through the Administrator of the 

10 Health Resources and Services Administration, shall ex11 pand, intensify, and coordinate workforce initiatives of the 

12 Health Resources and Services Administration to increase 

13 the capacity of the health workforce focusing primarily on 

14 HIV to meet the demand for culturally competent care, 

15 and may award grants for any of the following: 

16 (1) Development of curricula for training pri17 mary care providers in HIV/AIDS prevention and 

18 care, including routine HIV testing. 

19 (2) Support to expand access to culturally and 

20 linguistically accessible benefits counselors, trained 

21 peer navigators, and mental and behavioral health 

22 professionals with expertise in HIV. 

23 (3) Training health care professionals to pro24 vide care to individuals living with HIV. 


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1 (4) Development by grant recipients under title 

2 XXVI of the Public Health Service Act (42 U.S.C. 

3 300ff–11 et seq.; commonly referred to as the ‘‘Ryan 

4 White HIV/AIDS Program’’) and other persons, of 

5 policies for providing culturally relevant and sen6 sitive treatment to individuals living with HIV, with 

7 particular emphasis on treatment to racial and eth8 nic minorities, men who have sex with men, and 

9 women, young people, and children living with HIV. 

10 (5) Development and implementation of pro11 grams to increase the use of telehealth to respond to 

12 HIV-specific health care needs in rural and minority 

13 communities, with particular emphasis given to 

14 medically underserved communities and insular 

15 areas. 

16 (6) Evaluating interdisciplinary medical pro17 vider care team models that promote high-quality 

18 care, with particular emphasis on care to racial and 

19 ethnic minorities. 

20 (7) Training health care professionals to make 

21 them aware of the high rates of chronic hepatitis B 

22 and chronic hepatitis C in adult racial and ethnic 

23 populations, and the importance of prevention, de24 tection, and medical management of hepatitis B and 

25 hepatitis C and of liver cancer screening. 


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1 (8) Development of curricula for training pri2 mary care providers that HIV and tuberculosis are 

3 significant mutual comorbidities, and that a patient 

4 who tests positive for one disease should be offered 

5 and encouraged to receive testing for the other. 

6 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

7 out this section, there are authorized to be appropriated 

8 such sums as may be necessary for fiscal years 2021 

9 through 2024. 

10 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO11 GRAM. 

12 (a) IN GENERAL.—The Secretary may enter into an 

13 agreement with any physician, nurse practitioner, or phy14 sician assistant under which— 

15 (1) the physician, nurse practitioner, or physi16 cian assistant agrees to serve as a medical provider 

17 for a period of not less than 2 years— 

18 (A) at a Ryan White-funded or title X19 funded facility with a critical shortage of doc20 tors (as determined by the Secretary); or 

21 (B) in an area with a high incidence of 

22 HIV/AIDS; and 

23 (2) the Secretary agrees to make payments in 

24 accordance with subsection (b) on the professional 


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1 education loans of the physician, nurse practitioner, 

2 or physician assistant. 

3 (b) MANNER OF PAYMENTS.—The payments de4 scribed in subsection (a) shall be made by the Secretary 

5 as follows: 

6 (1) Upon completion by the physician, nurse 

7 practitioner, or physician assistant for whom the 

8 payments are to be made of the first year of the 

9 service specified in the agreement entered into with 

10 the Secretary under subsection (a), the Secretary 

11 shall pay 30 percent of the principal of and the in12 terest on the individual’s professional education 

13 loans. 

14 (2) Upon completion by the physician, nurse 

15 practitioner, or physician assistant of the second 

16 year of such service, the Secretary shall pay another 

17 30 percent of the principal of and the interest on 

18 such loans. 

19 (3) Upon completion by that individual of a 

20 third year of such service, the Secretary shall pay 

21 another 25 percent of the principal of and the inter22 est on such loans. 

23 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub24 part III of part D of title III of the Public Health Service 

25 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 


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1 with this section, apply to the program carried out under 

2 this section in the same manner and to the same extent 

3 as such provisions apply to the National Health Service 

4 Corps loan repayment program. 

5 (d) REPORTS.—Not later than 18 months after the 

6 date of the enactment of this Act, and annually thereafter, 

7 the Secretary shall prepare and submit to Congress a re8 port describing the program carried out under this section, 

9 including statements regarding the following: 

10 (1) The number of physicians, nurse practi11 tioners, and physician assistants enrolled in the pro12 gram. 

13 (2) The number and amount of loan repay14 ments. 

15 (3) The placement location of loan repayment 

16 recipients at facilities described in subsection (a)(1). 

17 (4) The default rate and actions required. 

18 (5) The amount of outstanding default funds. 

19 (6) To the extent that it can be determined, the 

20 reason for the default. 

21 (7) The demographics of individuals partici22 pating in the program. 

23 (8) An evaluation of the overall costs and bene24 fits of the program. 

25 (e) DEFINITIONS.—In this section: 


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1 (1) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 

2 human immunodeficiency virus and acquired im3 mune deficiency syndrome. 

4 (2) NURSE PRACTITIONER.—The term ‘‘nurse 

5 practitioner’’ means a registered nurse who has com6 pleted an accredited graduate degree program in ad7 vanced nurse practice and has successfully passed a 

8 national certification exam. 

9 (3) PHYSICIAN.—The term ‘‘physician’’ means 

10 a graduate of a school of medicine who has com11 pleted postgraduate training in general or pediatric 

12 medicine. 

13 (4) PHYSICIAN ASSISTANT.—The term ‘‘physi14 cian assistant’’ means a medical provider who com15 pleted an accredited physician assistant training pro16 gram and successfully passed the Physician Assist17 ant National Certifying Examination. 

18 (5) PROFESSIONAL EDUCATION LOAN.—The 

19 term ‘‘professional education loan’’— 

20 (A) means a loan that is incurred for the 

21 cost of attendance (including tuition, other rea22 sonable educational expenses, and reasonable 

23 living costs) at a school of medicine, nursing, or 

24 physician assistant training program; and 


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1 (B) includes only the portion of the loan 

2 that is outstanding on the date the physician, 

3 nurse practitioner, or physician assistant in4 volved begins the service specified in the agree5 ment under subsection (a). 

6 (6) RYAN WHITE-FUNDED.—The term ‘‘Ryan 

7 White-funded’’ means, with respect to a facility, re8 ceiving funds under title XXVI of the Public Health 

9 Service Act (42 U.S.C. 300ff–11 et seq.). 

10 (7) SECRETARY.—The term ‘‘Secretary’’ means 

11 the Secretary of Health and Human Services. 

12 (8) SCHOOL OF MEDICINE.—The term ‘‘school 

13 of medicine’’ has the meaning given to that term in 

14 section 799B of the Public Health Service Act (42 

15 U.S.C. 295p). 

16 (9) TITLE X-FUNDED.—The term ‘‘title X-fund17 ed’’ means, with respect to a facility, receiving funds 

18 under title X of the Public Health Service Act (42 

19 U.S.C. 300 et seq.). 

20 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there are authorized to be appropriated 

22 such sums as may be necessary for fiscal years 2021 

23 through 2024. 


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1 SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO2 GRAM. 

3 (a) IN GENERAL.—The Secretary may enter into an 

4 agreement with any dentist under which— 

5 (1) the dentist agrees to serve as a dentist for 

6 a period of not less than 2 years at a facility with 

7 a critical shortage of dentists (as determined by the 

8 Secretary) in an area with a high incidence of HIV/ 

9 AIDS; and 

10 (2) the Secretary agrees to make payments in 

11 accordance with subsection (b) on the dental edu12 cation loans of the dentist. 

13 (b) MANNER OF PAYMENTS.—The payments de14 scribed in subsection (a) shall be made by the Secretary 

15 as follows: 

16 (1) Upon completion by the dentist for whom 

17 the payments are to be made of the first year of the 

18 service specified in the agreement entered into with 

19 the Secretary under subsection (a), the Secretary 

20 shall pay 30 percent of the principal of and the in21 terest on the dental education loans of the dentist. 

22 (2) Upon completion by the dentist of the sec23 ond year of such service, the Secretary shall pay an24 other 30 percent of the principal of and the interest 

25 on such loans. 


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1 (3) Upon completion by that individual of a 

2 third year of such service, the Secretary shall pay 

3 another 25 percent of the principal of and the inter4 est on such loans. 

5 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub6 part III of part D of title III of the Public Health Service 

7 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 

8 with this section, apply to the program carried out under 

9 this section in the same manner and to the same extent 

10 as such provisions apply to the National Health Service 

11 Corps Loan Repayment Program. 

12 (d) REPORTS.—Not later than 18 months after the 

13 date of the enactment of this Act, and annually thereafter, 

14 the Secretary shall prepare and submit to the Congress 

15 a report describing the program carried out under this sec16 tion, including statements regarding the following: 

17 (1) The number of dentists enrolled in the pro18 gram. 

19 (2) The number and amount of loan repay20 ments. 

21 (3) The placement location of loan repayment 

22 recipients at facilities described in subsection (a)(1). 

23 (4) The default rate and actions required. 

24 (5) The amount of outstanding default funds. 


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1 (6) To the extent that it can be determined, the 

2 reason for the default. 

3 (7) The demographics of individuals partici4 pating in the program. 

5 (8) An evaluation of the overall costs and bene6 fits of the program. 

7 (e) DEFINITIONS.—In this section: 

8 (1) DENTAL EDUCATION LOAN.—The term 

9 ‘‘dental education loan’’— 

10 (A) means a loan that is incurred for the 

11 cost of attendance (including tuition, other rea12 sonable educational expenses, and reasonable 

13 living costs) at a school of dentistry; and 

14 (B) includes only the portion of the loan 

15 that is outstanding on the date the dentist in16 volved begins the service specified in the agree17 ment under subsection (a). 

18 (2) DENTIST.—The term ‘‘dentist’’ means a 

19 graduate of a school of dentistry who has completed 

20 postgraduate training in general or pediatric den21 tistry. 

22 (3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 

23 human immunodeficiency virus and acquired im24 mune deficiency syndrome. 


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1 (4) SCHOOL OF DENTISTRY.—The term ‘‘school 

2 of dentistry’’ has the meaning given to that term in 

3 section 799B of the Public Health Service Act (42 

4 U.S.C. 295p). 

5 (5) SECRETARY.—The term ‘‘Secretary’’ means 

6 the Secretary of Health and Human Services. 

7 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

8 out this section, there are authorized to be appropriated 

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

10 2021 through 2024. 

11 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT12 ING DRUG USERS. 

13 (a) SENSE OF CONGRESS.—It is the sense of Con14 gress that providing sterile syringes and sterilized equip15 ment to injecting drug users substantially reduces risk of 

16 HIV infection, increases the probability that they will ini17 tiate drug treatment, and does not increase drug use. 

18 (b) IN GENERAL.—The Secretary of Health and 

19 Human Services may provide grants and technical assist20 ance for the purpose of reducing the rate of HIV infections 

21 among injecting drug users through a comprehensive 

22 package of services for such users, including the provision 

23 of sterile syringes, education and outreach, access to infec24 tious disease testing, overdose prevention, and treatment 

25 for drug dependence. 


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1 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there are authorized to be appropriated 

3 such sums as may be necessary for fiscal years 2021 

4 through 2024. 

5 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 

6 POPULATIONS. 

7 (a) IN GENERAL.—The Secretary shall submit to 

8 Congress and the President an annual report on the im9 pact of HIV/AIDS for racial and ethnic minority commu10 nities, women, and youth aged 24 and younger. 

11 (b) CONTENTS.—The report under subsection (a) 

12 shall include information on the— 

13 (1) progress that has been made in reducing 

14 the impact of HIV/AIDS in such communities; 

15 (2) opportunities that exist to make additional 

16 progress in reducing the impact of HIV/AIDS in 

17 such communities; 

18 (3) challenges that may impede such additional 

19 progress; and 

20 (4) Federal funding necessary to achieve sub21 stantial reductions in HIV/AIDS in racial and ethnic 

22 minority communities. 

23 SEC. 754. NATIONAL HIV/AIDS OBSERVANCE DAYS. 

24 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 

25 of Congress that national observance days highlighting the 


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1 impact of HIV on communities of color include the fol2 lowing: 

3 (1) National Black HIV/AIDS Awareness Day. 

4 (2) National Latino AIDS Awareness Day. 

5 (3) National Asian and Pacific Islander HIV/ 

6 AIDS Awareness Day. 

7 (4) National Native American HIV/AIDS 

8 Awareness Day. 

9 (5) National Youth HIV/AIDS Awareness Day. 

10 (b) CALL TO ACTION.—It is the sense of Congress 

11 that the President should call on members of communities 

12 of color— 

13 (1) to become involved at the local community 

14 level in HIV testing, policy, and advocacy; 

15 (2) to become aware, engaged, and empowered 

16 on the HIV epidemic within their communities; and 

17 (3) to urge members of their communities to re18 duce risk factors, practice safe sex and other preven19 tive measures, be tested for HIV, and seek care 

20 when appropriate. 

21 SEC. 755. REVIEW OF ALL FEDERAL AND STATE LAWS, 

22 POLICIES, AND REGULATIONS REGARDING 

23 THE CRIMINAL PROSECUTION OF INDIVID24 UALS FOR HIV-RELATED OFFENSES. 

25 (a) DEFINITIONS.—In this section: 


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1 (1) HIV.—The term ‘‘HIV’’ has the meaning 

2 given to the term in section 2689 of the Public 

3 Health Service Act (42 U.S.C. 300ff–88). 

4 (2) STATE.—The term ‘‘State’’ includes the 

5 District of Columbia, American Samoa, the Com6 monwealth of the Northern Mariana Islands, Guam, 

7 Puerto Rico, and the United States Virgin Islands. 

8 (b) SENSE OF CONGRESS REGARDING LAWS OR REG9 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV.— 

10 It is the sense of Congress that Federal and State laws, 

11 policies, and regulations regarding people living with 

12 HIV— 

13 (1) should not place unique or additional bur14 dens on such individuals solely as a result of their 

15 HIV status; and 

16 (2) should instead demonstrate a public health17 oriented, evidence-based, medically accurate, and 

18 contemporary understanding of— 

19 (A) the multiple factors that lead to HIV 

20 transmission; 

21 (B) the relative risk of HIV transmission 

22 routes; 

23 (C) the current health implications of liv24 ing with HIV; 


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1 (D) the associated benefits of treatment 

2 and support services for people living with HIV; 

3 (E) the impact of punitive HIV-specific 

4 laws and policies on public health, on people liv5 ing with or affected by HIV, and on their fami6 lies and communities; and 

7 (F) the current science on HIV prevention 

8 and treatment, including pre-exposure prophy9 laxis (PrEP), post-exposure prophylaxis (PEP), 

10 and viral suppression. 

11 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 

12 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL

13 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF14 FENSES.— 

15 (1) REVIEW OF FEDERAL AND STATE LAWS.— 

16 (A) IN GENERAL.—Not later than 90 days 

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

18 Attorney General, the Secretary of Health and 

19 Human Services, and the Secretary of Defense 

20 acting jointly (in this paragraph and paragraph 

21 (2) referred to as the ‘‘designated officials’’) 

22 shall initiate a national review of Federal and 

23 State laws, policies, regulations, and judicial 

24 precedents and decisions regarding criminal and 

25 related civil commitment cases involving people 


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1 living with HIV, including in regards to the 

2 Uniform Code of Military Justice. 

3 (B) CONSULTATION.—In carrying out the 

4 review under subparagraph (A), the designated 

5 officials shall ensure diverse participation and 

6 consultation from each State, including with— 

7 (i) State attorneys general (or their 

8 representatives); 

9 (ii) State public health officials (or 

10 their representatives); 

11 (iii) State judicial and court system 

12 officers, including judges, district attor13 neys, prosecutors, defense attorneys, law 

14 enforcement, and correctional officers; 

15 (iv) members of the United States 

16 Armed Forces, including members of other 

17 Federal services subject to the Uniform 

18 Code of Military Justice; 

19 (v) people living with HIV, particu20 larly those who have been subject to HIV21 related prosecution or who are from com22 munities whose members have been dis23 proportionately subject to HIV-specific ar24 rests and prosecutions; 


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1 (vi) legal advocacy and HIV service 

2 organizations that work with people living 

3 with HIV; 

4 (vii) nongovernmental health organi5 zations that work on behalf of people living 

6 with HIV; and 

7 (viii) trade organizations or associa8 tions representing persons or entities de9 scribed in clauses (i) through (vii). 

10 (C) RELATION TO OTHER REVIEWS.—In 

11 carrying out the review under subparagraph 

12 (A), the designated officials may utilize other 

13 existing reviews of criminal and related civil 

14 commitment cases involving people living with 

15 HIV, including any such review conducted by 

16 any Federal or State agency or any public 

17 health, legal advocacy, or trade organization or 

18 association if the designated officials determine 

19 that such reviews were conducted in accordance 

20 with the principles set forth in subsection (b). 

21 (2) REPORT.—No later than 180 days after ini22 tiating the review required by paragraph (1), the At23 torney General shall transmit to Congress and make 

24 publicly available a report containing the results of 

25 the review, which includes the following: 


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1 (A) For each State and for the Uniform 

2 Code of Military Justice, a summary of the rel3 evant laws, policies, regulations, and judicial 

4 precedents and decisions regarding criminal 

5 cases involving people living with HIV, includ6 ing, if applicable, the following: 

7 (i) A determination of whether such 

8 laws, policies, regulations, and judicial 

9 precedents and decisions place any unique 

10 or additional burdens upon people living 

11 with HIV. 

12 (ii) A determination of whether such 

13 laws, policies, regulations, and judicial 

14 precedents and decisions demonstrate a 

15 public health-oriented, evidence-based, 

16 medically accurate, and contemporary un17 derstanding of— 

18 (I) the multiple factors that lead 

19 to HIV transmission; 

20 (II) the relative risk of HIV 

21 transmission routes; 

22 (III) the current health implica23 tions of living with HIV; 


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1 (IV) the associated benefits of 

2 treatment and support services for 

3 people living with HIV; 

4 (V) the impact of punitive HIV5 specific laws and policies on public 

6 health, on people living with or af7 fected by HIV, and on their families 

8 and communities; and 

9 (VI) the current science on HIV 

10 prevention and treatment, including 

11 pre-exposure prophylaxis (PrEP), 

12 post-exposure prophylaxis (PEP), and 

13 viral suppression. 

14 (iii) An analysis of the public health 

15 and legal implications of such laws, poli16 cies, regulations, and judicial precedents, 

17 including an analysis of the consequences 

18 of having a similar penal scheme applied to 

19 comparable situations involving other com20 municable diseases. 

21 (iv) An analysis of the proportionality 

22 of punishments imposed under HIV-spe23 cific laws, policies, regulations, and judicial 

24 precedents, taking into consideration pen25 alties attached to violation of State laws 


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1 against similar degrees of endangerment or 

2 harm, such as driving while intoxicated or 

3 transmission of other communicable dis4 eases, or more serious harms, such as ve5 hicular manslaughter offenses. 

6 (B) An analysis of common elements 

7 shared among State laws, policies, regulations, 

8 and judicial precedents. 

9 (C) A set of best practice recommendations 

10 directed to State governments, including State 

11 attorneys general, public health officials, and 

12 judicial officers, in order to ensure that laws, 

13 policies, regulations, and judicial precedents re14 garding people living with HIV are in accord15 ance with the principles set forth in subsection 

16 (b). 

17 (D) Recommendations for adjustments to 

18 the Uniform Code of Military Justice, as may 

19 be necessary, in order to ensure that laws, poli20 cies, regulations, and judicial precedents re21 garding people living with HIV are in accord22 ance with the principles set forth in subsection 

23 (b). 

24 (3) GUIDANCE.—Within 90 days of the release 

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1 ney General and the Secretary of Health and 

2 Human Services, acting jointly, shall develop and 

3 publicly release updated guidance for States based 

4 on the set of best practice recommendations required 

5 by paragraph (2)(C) in order to assist States dealing 

6 with criminal and related civil commitment cases re7 garding people living with HIV. 

8 (4) MONITORING AND EVALUATION SYSTEM.— 

9 Within 60 days of the release of the guidance re10 quired by paragraph (3), the Attorney General and 

11 the Secretary of Health and Human Services, acting 

12 jointly, shall establish an integrated monitoring and 

13 evaluation system which includes, where appropriate, 

14 objective and quantifiable performance goals and in15 dicators to measure progress toward statewide im16 plementation in each State of the best practice rec17 ommendations required in paragraph (2)(C), includ18 ing to monitor, track, and evaluate the effectiveness 

19 of assistance provided pursuant to subsection (d). 

20 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI21 CIES, OR REGULATIONS.—Within 90 days of the re22 lease of the report required by paragraph (2), the 

23 Attorney General, the Secretary of Health and 

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1 dent and the Congress, and make publicly available, 

2 such proposals as may be necessary to implement 

3 adjustments to Federal laws, policies, or regulations, 

4 including to the Uniform Code of Military Justice, 

5 based on the recommendations required by para6 graph (2)(D), either through Executive order or 

7 through changes to statutory law. 

8 (6) AUTHORIZATION OF APPROPRIATIONS.— 

9 (A) IN GENERAL.—There are authorized to 

10 be appropriated such sums as may be necessary 

11 for the purpose of carrying out this subsection. 

12 Amounts authorized to be appropriated by the 

13 preceding sentence are in addition to amounts 

14 otherwise authorized to be appropriated for 

15 such purpose. 

16 (B) AVAILABILITY OF FUNDS.—Amounts 

17 appropriated pursuant to the authorization of 

18 appropriations in subparagraph (A) are author19 ized to remain available until expended. 

20 (d) AUTHORIZATION TO PROVIDE GRANTS.— 

21 (1) GRANTS BY ATTORNEY GENERAL.— 

22 (A) IN GENERAL.—The Attorney General 

23 may provide assistance to eligible State and 

24 local entities and eligible nongovernmental orga25 nizations for the purpose of incorporating the 


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1 best practice recommendations developed under 

2 subsection (c)(2)(C) within relevant State laws, 

3 policies, regulations, and judicial decisions re4 garding people living with HIV. 

5 (B) AUTHORIZED ACTIVITIES.—The assist6 ance authorized by subparagraph (A) may in7 clude— 

8 (i) direct technical assistance to eligi9 ble State and local entities in order to de10 velop, disseminate, or implement State 

11 laws, policies, regulations, or judicial deci12 sions that conform with the best practice 

13 recommendations developed under sub14 section (c)(2)(C); 

15 (ii) direct technical assistance to eligi16 ble nongovernmental organizations in order 

17 to provide education and training, includ18 ing through classes, conferences, meetings, 

19 and other educational activities, to eligible 

20 State and local entities; and 

21 (iii) subcontracting authority to allow 

22 eligible State and local entities and eligible 

23 nongovernmental organizations to seek 

24 technical assistance from legal and public 

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1 standing of the principles underlying the 

2 best practice recommendations developed 

3 under subsection (c)(2)(C). 

4 (2) GRANTS BY SECRETARY OF HEALTH AND

5 HUMAN SERVICES.— 

6 (A) IN GENERAL.—The Secretary of 

7 Health and Human Services, acting through the 

8 Director of the Centers for Disease Control and 

9 Prevention, may provide assistance to State and 

10 local public health departments and eligible 

11 nongovernmental organizations for the purpose 

12 of supporting eligible State and local entities to 

13 incorporate the best practice recommendations 

14 developed under subsection (c)(2)(C) within rel15 evant State laws, policies, regulations, and judi16 cial decisions regarding people living with HIV. 

17 (B) AUTHORIZED ACTIVITIES.—The assist18 ance authorized by subparagraph (A) may in19 clude— 

20 (i) direct technical assistance to State 

21 and local public health departments in 

22 order to support the development, dissemi23 nation, or implementation of State laws, 

24 policies, regulations, or judicial decisions 

25 that conform with the set of best practice 


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1 recommendations developed under sub2 section (c)(2)(C); 

3 (ii) direct technical assistance to eligi4 ble nongovernmental organizations in order 

5 to provide education and training, includ6 ing through classes, conferences, meetings, 

7 and other educational activities, to State 

8 and local public health departments; and 

9 (iii) subcontracting authority to allow 

10 State and local public health departments 

11 and eligible nongovernmental organizations 

12 to seek technical assistance from legal and 

13 public health experts with a demonstrated 

14 understanding of the principles underlying 

15 the best practice recommendations devel16 oped under subsection (c)(2)(C). 

17 (3) LIMITATION.—As a condition of receiving 

18 assistance through this subsection, eligible State and 

19 local entities, State and local public health depart20 ments, and eligible nongovernmental organizations 

21 shall agree— 

22 (A) not to place any unique or additional 

23 burdens on people living with HIV solely as a 

24 result of their HIV status; and 


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1 (B) that if the entity, department, or orga2 nization promulgates any laws, policies, regula3 tions, or judicial decisions regarding people liv4 ing with HIV, such actions shall demonstrate a 

5 public health-oriented, evidence-based, medically 

6 accurate, and contemporary understanding of— 

7 (i) the multiple factors that lead to 

8 HIV transmission; 

9 (ii) the relative risk of HIV trans10 mission routes; 

11 (iii) the current health implications of 

12 living with HIV; 

13 (iv) the associated benefits of treat14 ment and support services for people living 

15 with HIV; 

16 (v) the impact of punitive HIV-spe17 cific laws and policies on public health, on 

18 people living with or affected by HIV, and 

19 on their families and communities; and 

20 (vi) the current science on HIV pre21 vention and treatment, including pre-expo22 sure prophylaxis (PrEP), post-exposure 

23 prophylaxis (PEP), and viral suppression. 

24 (4) REPORT.—No later than 1 year after the 

25 date of the enactment of this Act, and annually 


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1 thereafter, the Attorney General and the Secretary 

2 of Health and Human Services, acting jointly, shall 

3 transmit to Congress and make publicly available a 

4 report describing, for each State, the impact and ef5 fectiveness of the assistance provided through this 

6 section. Each such report shall include— 

7 (A) a detailed description of the progress 

8 each State has made, if any, in implementing 

9 the best practice recommendations developed 

10 under subsection (c)(2)(C) as a result of the as11 sistance provided under this subsection, and 

12 based on the performance goals and indicators 

13 established as part of the monitoring and eval14 uation system in subsection (c)(4); 

15 (B) a brief summary of any outreach ef16 forts undertaken during the prior year by the 

17 Attorney General and the Secretary of Health 

18 and Human Services to encourage States to 

19 seek assistance under this subsection in order 

20 to implement the best practice recommenda21 tions developed under subsection (c)(2)(C); 

22 (C) a summary of how assistance provided 

23 through this subsection is being utilized by eli24 gible State and local entities, State and local 

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1 governmental organizations and, if applicable, 

2 any contractors, including with respect to non3 governmental organizations, the type of tech4 nical assistance provided, and an evaluation of 

5 the impact of such assistance on eligible State 

6 and local entities; and 

7 (D) a summary and description of eligible 

8 State and local entities, State and local public 

9 health departments, and eligible nongovern10 mental organizations receiving assistance 

11 through this subsection, including if applicable, 

12 a summary and description of any contractors 

13 selected to assist in implementing such assist14 ance. 

15 (5) DEFINITIONS.—For the purposes of this 

16 subsection: 

17 (A) ELIGIBLE STATE AND LOCAL ENTI18 TIES.—The term ‘‘eligible State and local enti19 ties’’ means the relevant individuals, offices, or 

20 organizations that directly participate in the de21 velopment, dissemination, or implementation of 

22 State laws, policies, regulations, or judicial deci23 sions, including— 

24 (i) State governments, including State 

25 attorneys general, State departments of 


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1 justice, and State National Guards, or 

2 their equivalents; 

3 (ii) State judicial and court systems, 

4 including trial courts, appellate courts, 

5 State supreme courts and courts of appeal, 

6 and State correctional facilities, or their 

7 equivalents; and 

8 (iii) local governments, including city 

9 and county governments, district attorneys, 

10 and local law enforcement departments, or 

11 their equivalents. 

12 (B) STATE AND LOCAL PUBLIC HEALTH

13 DEPARTMENTS.—The term ‘‘State and local 

14 public health departments’’ means the fol15 lowing: 

16 (i) State public health departments, or 

17 their equivalents, including the chief officer 

18 of such departments and infectious disease 

19 and communicable disease specialists with20 in such departments. 

21 (ii) Local public health departments, 

22 or their equivalents, including city and 

23 county public health departments, the chief 

24 officer of such departments, and infectious 


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1 disease and communicable disease special2 ists within such departments. 

3 (iii) Public health departments or offi4 cials, or their equivalents, within State or 

5 local correctional facilities. 

6 (iv) Public health departments or offi7 cials, or their equivalents, within State Na8 tional Guards. 

9 (v) Any other recognized State or 

10 local public health organization or entity 

11 charged with carrying out official State or 

12 local public health duties. 

13 (C) ELIGIBLE NONGOVERNMENTAL ORGA14 NIZATIONS.—The term ‘‘eligible nongovern15 mental organizations’’ means the following: 

16 (i) Nongovernmental organizations, 

17 including trade organizations or associa18 tions that represent— 

19 (I) State attorneys general, or 

20 their equivalents; 

21 (II) State public health officials, 

22 or their equivalents; 

23 (III) State judicial and court offi24 cers, including judges, district attor25 neys, prosecutors, defense attorneys, 


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1 law enforcement, and correctional offi2 cers; 

3 (IV) State National Guards; 

4 (V) people living with HIV; 

5 (VI) legal advocacy and HIV 

6 service organizations that work with 

7 people living with HIV; and 

8 (VII) nongovernmental health or9 ganizations that work on behalf of 

10 people living with HIV. 

11 (ii) Nongovernmental organizations, 

12 including trade organizations or associa13 tions that demonstrate a public-health ori14 ented, evidence-based, medically accurate, 

15 and contemporary understanding of— 

16 (I) the multiple factors that lead 

17 to HIV transmission; 

18 (II) the relative risk of HIV 

19 transmission routes; 

20 (III) the current health implica21 tions of living with HIV; 

22 (IV) the associated benefits of 

23 treatment and support services for 

24 people living with HIV; 


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1 (V) the impact of punitive HIV2 specific laws and policies on public 

3 health, on people living with or af4 fected by HIV, and on their families 

5 and communities; and 

6 (VI) the current science on HIV 

7 prevention and treatment, including 

8 pre-exposure prophylaxis (PrEP), 

9 post-exposure prophylaxis (PEP), and 

10 viral suppression. 

11 (6) AUTHORIZATION OF APPROPRIATIONS.— 

12 (A) IN GENERAL.—In addition to amounts 

13 otherwise made available, there are authorized 

14 to be appropriated to the Attorney General and 

15 the Secretary of Health and Human Services 

16 such sums as may be necessary to carry out 

17 this subsection for each of the fiscal years 2021 

18 through 2024. 

19 (B) AVAILABILITY OF FUNDS.—Amounts 

20 appropriated pursuant to the authorizations of 

21 appropriations in subparagraph (A) are author22 ized to remain available until expended. 

23 SEC. 756. EXPANDING SUPPORT FOR CONDOMS IN PRIS24 ONS. 

25 (a) DEFINITIONS.—In this section: 


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1 (1) COMMUNITY ORGANIZATION.—The term 

2 ‘‘community organization’’ means a public health 

3 care facility or a nonprofit organization that pro4 vides health- or STI-related services according to es5 tablished public health standards. 

6 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

7 The term ‘‘comprehensive sexuality education’’ 

8 means sexuality education— 

9 (A) that includes information about absti10 nence and about the proper use and disposal of 

11 sexual barrier protection devices; and 

12 (B) that is— 

13 (i) evidence-based; 

14 (ii) medically accurate; 

15 (iii) age and developmentally appro16 priate; 

17 (iv) gender and identity sensitive; 

18 (v) culturally and linguistically appro19 priate; and 

20 (vi) structured to promote critical 

21 thinking, self-esteem, respect for others, 

22 and the development of healthy attitudes 

23 and relationships. 

24 (3) CORRECTIONAL FACILITY.—The term ‘‘cor25 rectional facility’’ means any prison, penitentiary, 


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1 adult detention facility, juvenile detention facility, 

2 jail, or other facility to which individuals may be 

3 sent after conviction of a crime or act of juvenile de4 linquency within the United States. 

5 (4) INCARCERATED INDIVIDUAL.—The term 

6 ‘‘incarcerated individual’’ means any individual who 

7 is serving a sentence in a correctional facility after 

8 conviction of a crime. 

9 (5) SEXUAL BARRIER PROTECTION DEVICE.— 

10 The term ‘‘sexual barrier protection device’’ means 

11 any physical device approved by the Food and Drug 

12 Administration that has not been tampered with and 

13 which reduces the probability of STI transmission or 

14 infection between sexual partners, including female 

15 condoms, male condoms, and dental dams. 

16 (6) SEXUALLY TRANSMITTED INFECTION.—The 

17 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 

18 means any disease or infection that is commonly 

19 transmitted through sexual activity, including HIV, 

20 gonorrhea, chlamydia, syphilis, genital herpes, viral 

21 hepatitis, and human papillomavirus. 

22 (7) STATE.—The term ‘‘State’’ includes the 

23 District of Columbia, American Samoa, the Com24 monwealth of the Northern Mariana Islands, Guam, 

25 Puerto Rico, and the United States Virgin Islands. 


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1 (b) AUTHORITY TO ALLOW COMMUNITY ORGANIZA2 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION

3 EDUCATION, AND SEXUAL BARRIER PROTECTION DE4 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 

5 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 

6 later than 30 days after the date of enactment of 

7 this Act, the Attorney General shall direct the Direc8 tor of the Bureau of Prisons to allow community or9 ganizations to, in accordance with all relevant Fed10 eral laws and regulations that govern visitation in 

11 correctional facilities— 

12 (A) distribute sexual barrier protection de13 vices in Federal correctional facilities; and 

14 (B) engage in STI counseling and STI pre15 vention education in Federal correctional facili16 ties. 

17 (2) INFORMATION REQUIREMENT.—Any com18 munity organization permitted to distribute sexual 

19 barrier protection devices under paragraph (1) shall 

20 ensure that the individuals to whom the devices are 

21 distributed are informed about the proper use and 

22 disposal of sexual barrier protection devices in ac23 cordance with established public health practices. 

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1 seling or STI prevention education under paragraph 

2 (1) shall offer comprehensive sexuality education. 

3 (3) POSSESSION OF DEVICE PROTECTED.—A 

4 Federal correctional facility may not, because of the 

5 possession or use of a sexual barrier protection de6 vice— 

7 (A) take adverse action against an incar8 cerated individual; or 

9 (B) consider possession or use as evidence 

10 of prohibited activity for the purpose of any 

11 Federal correctional facility administrative pro12 ceeding. 

13 (4) IMPLEMENTATION.—The Attorney General 

14 and the Director of the Bureau of Prisons shall im15 plement this section according to established public 

16 health practices in a manner that protects the 

17 health, safety, and privacy of incarcerated individ18 uals and of correctional facility staff. 

19 (c) SENSE OF CONGRESS REGARDING DISTRIBUTION

20 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE

21 PRISON SYSTEMS.—It is the sense of the Congress that 

22 States should allow for the legal distribution of sexual bar23 rier protection devices in State correctional facilities to re24 duce the prevalence and spread of STIs in those facilities. 


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1 (d) SURVEY OF AND REPORT ON CORRECTIONAL FA2 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF

3 STIS.— 

4 (1) SURVEY.—Not later than 180 days after 

5 the date of enactment of this Act, and annually 

6 thereafter for 5 years, the Attorney General, after 

7 consulting with the Secretary of Health and Human 

8 Services, State officials, and community organiza9 tions, shall, to the maximum extent practicable, con10 duct a survey of all Federal and State correctional 

11 facilities, to determine the following: 

12 (A) COUNSELING, TREATMENT, AND SUP13 PORTIVE SERVICES.—Whether the correctional 

14 facility— 

15 (i) requires incarcerated individuals to 

16 participate in counseling, treatment, and 

17 supportive services related to STIs; or 

18 (ii) offers such programs to incarcer19 ated individuals. 

20 (B) ACCESS TO SEXUAL BARRIER PROTEC21 TION DEVICES.—Whether incarcerated individ22 uals can— 

23 (i) possess sexual barrier protection 

24 devices; 


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1 (ii) purchase sexual barrier protection 

2 devices; 

3 (iii) purchase sexual barrier protection 

4 devices at a reduced cost; or 

5 (iv) obtain sexual barrier protection 

6 devices without cost. 

7 (C) INCIDENCE OF SEXUAL VIOLENCE.— 

8 The incidence of sexual violence and assault 

9 committed by incarcerated individuals and by 

10 correctional facility staff. 

11 (D) PREVENTION EDUCATION OFFERED.— 

12 The type of prevention education, information, 

13 or training offered to incarcerated individuals 

14 and correctional facility staff regarding sexual 

15 violence and the spread of STIs, including 

16 whether such education, information, or train17 ing— 

18 (i) constitutes comprehensive sexuality 

19 education; 

20 (ii) is compulsory for new incarcerated 

21 individuals and for new staff; and 

22 (iii) is offered on an ongoing basis. 

23 (E) STI TESTING.—Whether the correc24 tional facility tests incarcerated individuals for 


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1 STIs or gives them the option to undergo such 

2 testing— 

3 (i) at intake; 

4 (ii) on a regular basis; and 

5 (iii) prior to release. 

6 (F) STI TEST RESULTS.—The number of 

7 incarcerated individuals who are tested for STIs 

8 and the outcome of such tests at each correc9 tional facility, disaggregated to include results 

10 for— 

11 (i) the type of sexually transmitted in12 fection tested for; 

13 (ii) the race and ethnicity of individ14 uals tested; 

15 (iii) the age of individuals tested; and 

16 (iv) the gender of individuals tested. 

17 (G) PRERELEASE REFERRAL POLICY.— 

18 Whether incarcerated individuals are informed 

19 prior to release about STI-related services or 

20 other health services in their communities, in21 cluding free and low-cost counseling and treat22 ment options. 

23 (H) PRERELEASE REFERRALS MADE.— 

24 The number of referrals to community-based 

25 organizations or public health facilities offering 


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1 STI-related or other health services provided to 

2 incarcerated individuals prior to release, and 

3 the type of counseling or treatment for which 

4 the referral was made. 

5 (I) REINSTATEMENT OF MEDICAID BENE6 FITS.—Whether the correctional facility assists 

7 incarcerated individuals that were enrolled in 

8 the State Medicaid program prior to their in9 carceration, in reinstating their enrollment 

10 upon release and whether such individuals re11 ceive referrals as provided by subparagraph (G) 

12 to entities that accept the State Medicaid pro13 gram, including if applicable— 

14 (i) the number of such individuals, in15 cluding those diagnosed with HIV, that 

16 have been reinstated; 

17 (ii) a list of obstacles to reinstating 

18 enrollment or to making determinations of 

19 eligibility for reinstatement, if any; and 

20 (iii) the number of individuals denied 

21 enrollment. 

22 (J) OTHER ACTIONS TAKEN.—Whether the 

23 correctional facility has taken any other action, 

24 in conjunction with community organizations or 


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1 otherwise, to reduce the prevalence and spread 

2 of STIs in that facility. 

3 (2) PRIVACY.—In conducting the survey under 

4 paragraph (1), the Attorney General shall not re5 quest or retain the identity of any individual who 

6 has sought or been offered counseling, treatment, 

7 testing, or prevention education information regard8 ing an STI (including information about sexual bar9 rier protection devices), or who has tested positive 

10 for an STI. 

11 (3) REPORT.— 

12 (A) IN GENERAL.—The Attorney General 

13 shall transmit to Congress and make publicly 

14 available the results of the survey required 

15 under paragraph (1), both for the United 

16 States as a whole and disaggregated as to each 

17 State and each correctional facility. 

18 (B) DEADLINES.—To the maximum extent 

19 possible, the Attorney General shall— 

20 (i) issue the first report under sub21 paragraph (A) not later than 1 year after 

22 the date of enactment of this Act; and 

23 (ii) issue reports under subparagraph 

24 (A) annually thereafter for 5 years. 

25 (e) STRATEGY.— 


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1 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 

2 Attorney General, in consultation with the Secretary 

3 of Health and Human Services, State officials, and 

4 community organizations, shall develop and imple5 ment a 5-year strategy to reduce the prevalence and 

6 spread of STIs in Federal and State correctional fa7 cilities. To the maximum extent possible, the strat8 egy shall be developed, transmitted to Congress, and 

9 made publicly available no later than 180 days after 

10 the transmission of the first report required under 

11 subsection (d)(3). 

12 (2) CONTENTS OF STRATEGY.—The strategy 

13 developed under paragraph (1) shall include the fol14 lowing: 

15 (A) PREVENTION EDUCATION.—A plan for 

16 improving prevention education, information, 

17 and training offered to incarcerated individuals 

18 and correctional facility staff, including infor19 mation and training on sexual violence and the 

20 spread of STIs, and comprehensive sexuality 

21 education. 

22 (B) SEXUAL BARRIER PROTECTION DEVICE

23 ACCESS.—A plan for expanding access to sexual 

24 barrier protection devices in correctional facili25 ties. 


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1 (C) SEXUAL VIOLENCE REDUCTION.—A 

2 plan for reducing the incidence of sexual vio3 lence among incarcerated individuals and cor4 rectional facility staff, developed in consultation 

5 with the National Prison Rape Elimination 

6 Commission. 

7 (D) COUNSELING AND SUPPORTIVE SERV8 ICES.—A plan for expanding access to coun9 seling and supportive services related to STIs in 

10 correctional facilities. 

11 (E) TESTING.—A plan for testing incarcer12 ated individuals for STIs during intake, during 

13 regular health exams, and prior to release, and 

14 that— 

15 (i) is conducted in accordance with 

16 guidelines established by the Centers for 

17 Disease Control and Prevention; 

18 (ii) includes pretest counseling; 

19 (iii) requires that incarcerated individ20 uals are notified of their option to decline 

21 testing at any time; 

22 (iv) requires that incarcerated individ23 uals are confidentially notified of their test 

24 results in a timely manner; and 


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1 (v) ensures that incarcerated individ2 uals testing positive for STIs receive post3 test counseling, care, treatment, and sup4 portive services. 

5 (F) TREATMENT.—A plan for ensuring 

6 that correctional facilities have the necessary 

7 medicine and equipment to treat and monitor 

8 STIs and for ensuring that incarcerated indi9 viduals living with or testing positive for STIs 

10 receive and have access to care and treatment 

11 services. 

12 (G) STRATEGIES FOR DEMOGRAPHIC

13 GROUPS.—A plan for developing and imple14 menting culturally appropriate, sensitive, and 

15 specific strategies to reduce the spread of STIs 

16 among demographic groups heavily impacted by 

17 STIs. 

18 (H) LINKAGES WITH COMMUNITIES AND

19 FACILITIES.—A plan for establishing and 

20 strengthening linkages to local communities and 

21 health facilities that— 

22 (i) provide counseling, testing, care, 

23 and treatment services; 


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1 (ii) may receive individuals recently 

2 released from incarceration who are living 

3 with STIs; and 

4 (iii) accept payment through the State 

5 Medicaid program. 

6 (I) ENROLLMENT IN STATE MEDICAID

7 PROGRAMS.—Plans to ensure that— 

8 (i) incarcerated individuals who were 

9 enrolled in their State Medicaid program 

10 prior to incarceration in a correctional fa11 cility are automatically reenrolled in such 

12 program upon their release; and 

13 (ii) incarcerated individuals who were 

14 not enrolled in their State Medicaid pro15 gram prior to incarceration, and who are 

16 diagnosed with HIV while incarcerated in 

17 a correctional facility, are automatically 

18 enrolled in such program upon their re19 lease. 

20 (J) OTHER PLANS.—Any other plans de21 veloped by the Attorney General for reducing 

22 the spread of STIs or improving the quality of 

23 health care in correctional facilities. 

24 (K) MONITORING SYSTEM.—A monitoring 

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1 lated to reducing the prevalence and spread of 

2 STIs in correctional facilities and which, where 

3 feasible, expresses such goals in quantifiable 

4 form. 

5 (L) MONITORING SYSTEM PERFORMANCE

6 INDICATORS.—Performance indicators that 

7 measure or assess the achievement of the per8 formance goals described in subparagraph (K). 

9 (M) COST ESTIMATE.—A detailed estimate 

10 of the funding necessary to implement the 

11 strategy at the Federal and State levels for all 

12 5 years, including the amount of funds required 

13 by community organizations to implement the 

14 parts of the strategy in which they take part. 

15 (3) REPORT.—Not later than 1 year after the 

16 date of the enactment of this Act, and annually 

17 thereafter, the Attorney General shall transmit to 

18 Congress and make publicly available an annual 

19 progress report regarding the implementation and 

20 effectiveness of the strategy described in paragraph 

21 (1). The progress report shall include an evaluation 

22 of the implementation of the strategy using the mon23 itoring system and performance indicators provided 

24 for in subparagraphs (K) and (L) of paragraph (2). 

25 (f) AUTHORIZATION OF APPROPRIATIONS.— 


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1 (1) IN GENERAL.—There are authorized to be 

2 appropriated such sums as may be necessary to 

3 carry out this section for each of fiscal years 2021 

4 through 2025. 

5 (2) AVAILABILITY OF FUNDS.—Amounts made 

6 available under paragraph (1) are authorized to re7 main available until expended. 

8 SEC. 757. AUTOMATIC REINSTATEMENT OR ENROLLMENT 

9 IN MEDICAID FOR PEOPLE WHO TEST POSI10 TIVE FOR HIV BEFORE REENTERING COMMU11 NITIES. 

12 (a) IN GENERAL.—Section 1902(e) of the Social Se13 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 

14 the end the following: 

15 ‘‘(16) ENROLLMENT OF EX-OFFENDERS.— 

16 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN17 STATEMENT.— 

18 ‘‘(i) IN GENERAL.—The State plan 

19 shall provide for the automatic enrollment 

20 or reinstatement of enrollment of an eligi21 ble individual— 

22 ‘‘(I) if such individual is sched23 uled to be released from a public insti24 tution due to the completion of senVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 tence, not less than 30 days prior to 

2 the scheduled date of the release; and 

3 ‘‘(II) if such individual is to be 

4 released from a public institution on 

5 parole or on probation, as soon as 

6 possible after the date on which the 

7 determination to release such indi8 vidual was made, and before the date 

9 such individual is released. 

10 ‘‘(ii) EXCEPTION.—If a State makes a 

11 determination that an individual is not eli12 gible to be enrolled under the State plan— 

13 ‘‘(I) on or before the date by 

14 which the individual would be enrolled 

15 under clause (i), such clause shall not 

16 apply to such individual; or 

17 ‘‘(II) after such date, the State 

18 may terminate the enrollment of such 

19 individual. 

20 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO

21 PAYMENT FOR SERVICES.— 

22 ‘‘(i) IN GENERAL.—Subject to sub23 paragraph (A)(ii), an eligible individual 

24 who is enrolled, or whose enrollment is re25 instated, under subparagraph (A) shall be 


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1 eligible for all services for which medical 

2 assistance is provided under the State plan 

3 after the date that the eligible individual is 

4 released from the public institution. 

5 ‘‘(ii) RELATIONSHIP TO PAYMENT

6 PROHIBITION FOR INMATES.—No provision 

7 of this paragraph may be construed to per8 mit payment for care or services for which 

9 payment is excluded under subdivision (A) 

10 following paragraph (31) of section 

11 1905(a). 

12 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI13 BILITY.— 

14 ‘‘(i) SUSPENSION FOR INMATES.—Any 

15 period of continuous eligibility under this 

16 title shall be suspended on the date an in17 dividual enrolled under this title becomes 

18 an inmate of a public institution (except as 

19 a patient of a medical institution). 

20 ‘‘(ii) DETERMINATION OF REMAINING

21 PERIOD.—Notwithstanding any changes to 

22 State law related to continuous eligibility 

23 during the time that an individual is an in24 mate of a public institution (except as a 

25 patient of a medical institution), subject to 


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1 clause (iii), with respect to an eligible indi2 vidual who was subject to a suspension 

3 under clause (i), on the date that such in4 dividual is released from a public institu5 tion the suspension of continuous eligibility 

6 under such clause shall be lifted for a pe7 riod that is equal to the time remaining in 

8 the period of continuous eligibility for such 

9 individual on the date that such period was 

10 suspended under such clause. 

11 ‘‘(iii) EXCEPTION.—If a State makes 

12 a determination that an individual is not 

13 eligible to be enrolled under the State 

14 plan— 

15 ‘‘(I) on or before the date that 

16 the suspension of continuous eligibility 

17 is lifted under clause (ii), such clause 

18 shall not apply to such individual; or 

19 ‘‘(II) after such date, the State 

20 may terminate the enrollment of such 

21 individual. 

22 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN23 STATEMENT OF ENROLLMENT DEFINED.—For 

24 purposes of this paragraph, the term ‘automatic 

25 enrollment or reinstatement of enrollment’ 


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1 means that the State determines eligibility for 

2 medical assistance under the State plan without 

3 a program application from, or on behalf of, the 

4 eligible individual, but an individual can only be 

5 automatically enrolled in the State Medicaid 

6 plan if the individual affirmatively consents to 

7 being enrolled through affirmation in writing, 

8 by telephone, orally, through electronic signa9 ture, or through any other means specified by 

10 the Secretary. 

11 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 

12 For purposes of this paragraph, the term ‘eligi13 ble individual’ means an individual who is an 

14 inmate of a public institution (except as a pa15 tient in a medical institution)— 

16 ‘‘(i) who was enrolled under the State 

17 plan for medical assistance immediately be18 fore becoming an inmate of such an insti19 tution; or 

20 ‘‘(ii) who is diagnosed with human im21 munodeficiency virus.’’. 

22 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE23 MENTATION OF AUTOMATIC REINSTATEMENT OF MED24 ICAID BENEFITS.— 


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1 (1) IN GENERAL.—Subject to paragraph (3), 

2 with respect to a State, for each of the first 4 cal3 endar quarters in which the State plan meets the re4 quirements of paragraph (16) of section 1902(e) of 

5 the Social Security Act (42 U.S.C. 1396a(e)) (as 

6 added by subsection (a)), the Federal matching pay7 ments (including payments based on the Federal 

8 medical assistance percentage) made to such State 

9 under section 1903 of the Social Security Act (42 

10 U.S.C. 1396b) for the State expenditures described 

11 in paragraph (2) shall be increased by 5 percentage 

12 points. 

13 (2) EXPENDITURES.—The expenditures de14 scribed in this paragraph are the following: 

15 (A) Expenditures for which payment is 

16 available under section 1903 of the Social Secu17 rity Act (42 U.S.C. 1396b) and which are at18 tributable to strengthening the State’s enroll19 ment and administrative resources for the pur20 pose of improving processes for enrolling (or re21 instating the enrollment of) eligible individuals 

22 (as such term is defined in subparagraph (E) of 

23 paragraph (16) of section 1902(e) of the Social 

24 Security Act (42 U.S.C. 1396a(e)) (as amended 

25 by subsection (a))). 


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1 (B) Expenditures for medical assistance 

2 (as such term is defined in section 1905(a) of 

3 the Social Security Act (42 U.S.C. 1396d(a))) 

4 provided to such eligible individuals. 

5 (3) REQUIREMENTS; LIMITATION.— 

6 (A) REPORT.—A State is not eligible for 

7 an increase in its Federal matching payments 

8 under paragraph (1) unless the State agrees to 

9 submit to the Secretary of Health and Human 

10 Services, and make publicly available, a report 

11 that contains the information required under 

12 paragraph (4) by the end of the 1-year period 

13 during which the State receives increased Fed14 eral matching payments in accordance with that 

15 paragraph. 

16 (B) MAINTENANCE OF ELIGIBILITY.— 

17 (i) IN GENERAL.—Subject to clause 

18 (ii), a State is not eligible for an increase 

19 in its Federal matching payments under 

20 paragraph (1) if eligibility standards, 

21 methodologies, or procedures under its 

22 State plan under title XIX of the Social 

23 Security Act (42 U.S.C. 1396 et seq.), or 

24 waiver of such a plan, are more restrictive 

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1 gies, or procedures, respectively, under 

2 such plan or waiver as in effect on the date 

3 of enactment of this Act. 

4 (ii) STATE REINSTATEMENT OF ELIGI5 BILITY PERMITTED.—A State that has re6 stricted eligibility standards, methodolo7 gies, or procedures under its State plan 

8 under title XIX of the Social Security Act 

9 (42 U.S.C. 1396 et seq.), or a waiver of 

10 such plan, after the date of enactment of 

11 this Act, is no longer ineligible under 

12 clause (i) beginning with the first calendar 

13 quarter in which the State has reinstated 

14 eligibility standards, methodologies, or pro15 cedures that are no more restrictive than 

16 the eligibility standards, methodologies, or 

17 procedures, respectively, under such plan 

18 (or waiver) as in effect on such date. 

19 (C) LIMITATION OF MATCHING PAYMENTS

20 TO 100 PERCENT.—In no case shall an increase 

21 in Federal matching payments under paragraph 

22 (1) result in Federal matching payments that 

23 exceed 100 percent of State expenditures. 


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1 (4) REQUIRED REPORT INFORMATION.—The in2 formation that is required in the report under para3 graph (3)(A) shall include— 

4 (A) the results of an evaluation of the im5 pact of the implementation of the requirements 

6 of paragraph (16) of section 1902(e) of the So7 cial Security Act (42 U.S.C. 1396a(e)) on im8 proving the State’s processes for enrolling indi9 viduals who are released from public institu10 tions under the State Medicaid plan; 

11 (B) the number of individuals who were 

12 automatically enrolled (or whose enrollment was 

13 reinstated) under such paragraph during the 1- 

14 year period during which the State received in15 creased payments under this subsection; and 

16 (C) any other information that is required 

17 by the Secretary of Health and Human Serv18 ices. 

19 (c) EFFECTIVE DATE.— 

20 (1) IN GENERAL.—Except as provided in para21 graph (2), the amendments made by subsection (a) 

22 shall take effect 180 days after the date of the en23 actment of this Act. 

24 (2) RULE FOR CHANGES REQUIRING STATE

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1 ical assistance under title XIX of the Social Security 

2 Act (42 U.S.C. 1396 et seq.) which the Secretary of 

3 Health and Human Services determines requires 

4 State legislation (other than legislation appro5 priating funds) in order for the plan to meet the ad6 ditional requirement imposed by the amendments 

7 made by subsection (a), the State plan shall not be 

8 regarded as failing to comply with the requirements 

9 of such title solely on the basis of its failure to meet 

10 this additional requirement before the first day of 

11 the first calendar quarter beginning after the close 

12 of the first regular session of the State legislature 

13 that begins after the date of the enactment of this 

14 Act. For purposes of the previous sentence, in the 

15 case of a State that has a 2-year legislative session, 

16 each year of such session shall be deemed to be a 

17 separate regular session of the State legislature. 

18 SEC. 758. STOP HIV IN PRISON. 

19 (a) SHORT TITLE.—This section may be cited as the 

20 ‘‘Stop HIV in Prison Act’’. 

21 (b) IN GENERAL.—The Director of the Bureau of 

22 Prisons (referred to in this section as the ‘‘Director’’) shall 

23 develop a comprehensive policy to provide HIV testing, 

24 treatment, and prevention for inmates within the correc25 tional setting and upon reentry. 


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1 (c) PURPOSE.—The purposes of the policy required 

2 to be developed under subsection (b) shall be as follows: 

3 (1) To stop the spread of HIV among inmates. 

4 (2) To protect prison guards and other per5 sonnel from HIV infection. 

6 (3) To provide comprehensive medical treat7 ment to inmates who are living with HIV. 

8 (4) To promote HIV awareness and prevention 

9 among inmates. 

10 (5) To encourage inmates to take personal re11 sponsibility for their health. 

12 (6) To reduce the risk that inmates will trans13 mit HIV to other persons in the community fol14 lowing their release from prison. 

15 (d) CONSULTATION.—The Director shall consult with 

16 appropriate officials of the Department of Health and 

17 Human Services, the Office of National Drug Control Pol18 icy, and the Centers for Disease Control and Prevention 

19 regarding the development of the policy required under 

20 subsection (b). 

21 (e) TIME LIMIT.—Not later than 1 year after the 

22 date of enactment of this Act, the Director shall draft ap23 propriate regulations to implement the policy required to 

24 be developed under subsection (b). 


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1 (f) REQUIREMENTS FOR POLICY.—The policy re2 quired to be developed under subsection (b) shall provide 

3 for the following: 

4 (1) TESTING AND COUNSELING UPON IN5 TAKE.— 

6 (A) Health care personnel shall provide 

7 routine HIV testing to all inmates as a part of 

8 a comprehensive medical examination imme9 diately following admission to a facility. Health 

10 care personnel need not provide routine HIV 

11 testing to an inmate who is transferred to a fa12 cility from another facility if the inmate’s med13 ical records are transferred with the inmate and 

14 indicate that the inmate has been tested pre15 viously. 

16 (B) To all inmates admitted to a facility 

17 prior to the effective date of this policy, health 

18 care personnel shall provide routine HIV testing 

19 within no more than 6 months. HIV testing for 

20 these inmates may be performed in conjunction 

21 with other health services provided to these in22 mates by health care personnel. 

23 (C) All HIV tests under this paragraph 

24 shall comply with the opt-out provision. 


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1 (2) PRE-TEST AND POST-TEST COUNSELING.— 

2 Health care personnel shall provide confidential pre3 test and post-test counseling to all inmates who are 

4 tested for HIV. Counseling may be included with 

5 other general health counseling provided to inmates 

6 by health care personnel. 

7 (3) HIV PREVENTION EDUCATION.— 

8 (A) Health care personnel shall improve 

9 HIV awareness through frequent educational 

10 programs for all inmates. HIV educational pro11 grams may be provided by community-based or12 ganizations, local health departments, and in13 mate peer educators. 

14 (B) HIV educational materials shall be 

15 made available to all inmates at orientation, at 

16 health care clinics, at regular educational pro17 grams, and prior to release. Both written and 

18 audiovisual materials shall be made available to 

19 all inmates. 

20 (C)(i) The HIV educational programs and 

21 materials under this paragraph shall include in22 formation on— 

23 (I) modes of transmission, including 

24 transmission through tattooing, sexual con25 tact, and intravenous drug use; 


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1 (II) prevention methods; 

2 (III) treatment; and 

3 (IV) disease progression. 

4 (ii) The programs and materials shall be 

5 culturally sensitive, written or designed for low6 literacy levels, available in a variety of lan7 guages, and present scientifically accurate in8 formation in a clear and understandable man9 ner. 

10 (4) HIV TESTING UPON REQUEST.— 

11 (A) Health care personnel shall allow in12 mates to obtain HIV tests upon request once 

13 per year or whenever an inmate has a reason to 

14 believe the inmate may have been exposed to 

15 HIV. Health care personnel shall, both orally 

16 and in writing, inform inmates, during orienta17 tion and periodically throughout incarceration, 

18 of their right to obtain HIV tests. 

19 (B) Health care personnel shall encourage 

20 inmates to request HIV tests if the inmate is 

21 sexually active, has been raped, uses intra22 venous drugs, receives a tattoo, or if the inmate 

23 is concerned that the inmate may have been ex24 posed to HIV. 


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1 (C) An inmate’s request for an HIV test 

2 shall not be considered an indication that the 

3 inmate has put him/herself at risk of infection 

4 and/or committed a violation of prison rules. 

5 (5) HIV TESTING OF PREGNANT WOMAN.— 

6 (A) Health care personnel shall provide 

7 routine HIV testing to all inmates who become 

8 pregnant. 

9 (B) All HIV tests under this paragraph 

10 shall comply with the opt-out provision. 

11 (6) COMPREHENSIVE TREATMENT.— 

12 (A) Health care personnel shall provide all 

13 inmates who test positive for HIV— 

14 (i) timely, comprehensive medical 

15 treatment; 

16 (ii) confidential counseling on man17 aging their medical condition and pre18 venting its transmission to other persons; 

19 and 

20 (iii) voluntary partner notification 

21 services. 

22 (B) Health care provided under this para23 graph shall be consistent with current Depart24 ment of Health and Human Services guidelines 

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1 sonnel shall discuss treatment options, the im2 portance of adherence to antiretroviral therapy, 

3 and the side effects of medications with inmates 

4 receiving treatment. 

5 (C) Health care personnel and pharmacy 

6 personnel shall ensure that the facility for7 mulary contains all Food and Drug Administra8 tion-approved medications necessary to provide 

9 comprehensive treatment for inmates living with 

10 HIV, and that the facility maintains adequate 

11 supplies of such medications to meet inmates’ 

12 medical needs. Health care personnel and phar13 macy personnel shall also develop and imple14 ment automatic renewal systems for these medi15 cations to prevent interruptions in care. 

16 (D) Correctional staff, health care per17 sonnel, and pharmacy personnel shall develop 

18 and implement distribution procedures to en19 sure timely and confidential access to medica20 tions. 

21 (7) PROTECTION OF CONFIDENTIALITY.— 

22 (A) Health care personnel shall develop 

23 and implement procedures to ensure the con24 fidentiality of inmate tests, diagnoses, and 

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1 tional staff shall receive regular training on the 

2 implementation of these procedures. Penalties 

3 for violations of inmate confidentiality by health 

4 care personnel or correctional staff shall be 

5 specified and strictly enforced. 

6 (B) HIV testing, counseling, and treat7 ment shall be provided in a confidential setting 

8 where other routine health services are provided 

9 and in a manner that allows the inmate to re10 quest and obtain these services as routine med11 ical services. 

12 (8) TESTING, COUNSELING, AND REFERRAL

13 PRIOR TO REENTRY.— 

14 (A) Health care personnel shall provide 

15 routine HIV testing to all inmates not earlier 

16 than 3 months prior to their release and re17 entry into the community. Inmates who are al18 ready known to be infected need not be tested 

19 again. This requirement may be waived if an in20 mate’s release occurs without sufficient notice 

21 to the Bureau to allow health care personnel to 

22 perform a routine HIV test and notify the in23 mate of the results. 

24 (B) All HIV tests under this paragraph 

25 shall comply with the opt-out provision. 


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1 (C) To all inmates who test positive for 

2 HIV and all inmates who already are known to 

3 have HIV, health care personnel shall provide— 

4 (i) confidential prerelease counseling 

5 on managing their medical condition in the 

6 community, accessing appropriate treat7 ment and services in the community, and 

8 preventing the transmission of their condi9 tion to family members and other persons 

10 in the community; 

11 (ii) referrals to appropriate health 

12 care providers and social service agencies 

13 in the community that meet the inmate’s 

14 individual needs, including voluntary part15 ner notification services and prevention 

16 counseling services for people living with 

17 HIV; and 

18 (iii) a 30-day supply of any medically 

19 necessary medications the inmate is cur20 rently receiving. 

21 (9) OPT-OUT PROVISION.—Inmates shall have 

22 the right to refuse routine HIV testing. Inmates 

23 shall be informed both orally and in writing of this 

24 right. Oral and written disclosure of this right may 

25 be included with other general health information 


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1 and counseling provided to inmates by health care 

2 personnel. If an inmate refuses a routine test for 

3 HIV, health care personnel shall make a note of the 

4 inmate’s refusal in the inmate’s confidential medical 

5 records. However, the inmate’s refusal shall not be 

6 considered a violation of prison rules or result in dis7 ciplinary action. Any reference in this section to the 

8 ‘‘opt-out provision’’ shall be deemed a reference to 

9 the requirement of this paragraph. 

10 (10) EXCLUSION OF TESTS PERFORMED UNDER

11 SECTION 4014(b) FROM THE DEFINITION OF ROU12 TINE HIV TESTING.—HIV testing of an inmate 

13 under section 4014(b) of title 18, United States 

14 Code, is not routine HIV testing for the purposes of 

15 the opt-out provision. Health care personnel shall 

16 document the reason for testing under section 

17 4014(b) of title 18, United States Code, in the in18 mate’s confidential medical records. 

19 (11) TIMELY NOTIFICATION OF TEST RE20 SULTS.—Health care personnel shall provide timely 

21 notification to inmates of the results of HIV tests. 

22 (g) CHANGES IN EXISTING LAW.— 

23 (1) SCREENING IN GENERAL.—Section 4014(a) 

24 of title 18, United States Code, is amended— 


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1 (A) by striking ‘‘for a period of 6 months 

2 or more’’; 

3 (B) by striking ‘‘, as appropriate,’’; and 

4 (C) by striking ‘‘if such individual is deter5 mined to be at risk for infection with such virus 

6 in accordance with the guidelines issued by the 

7 Bureau of Prisons relating to infectious disease 

8 management’’ and inserting ‘‘unless the indi9 vidual declines. The Attorney General shall also 

10 cause such individual to be so tested before re11 lease unless the individual declines.’’. 

12 (2) INADMISSIBILITY OF HIV TEST RESULTS IN

13 CIVIL AND CRIMINAL PROCEEDINGS.—Section 

14 4014(d) of title 18, United States Code, is amended 

15 by inserting ‘‘or under the Stop HIV in Prison Act’’ 

16 after ‘‘under this section’’. 

17 (3) SCREENING AS PART OF ROUTINE SCREEN18 ING.—Section 4014(e) of title 18, United States 

19 Code, is amended by adding at the end the fol20 lowing: ‘‘Such rules shall also provide that the initial 

21 test under this section be performed as part of the 

22 routine health screening conducted at intake.’’. 

23 (h) REPORTING REQUIREMENTS.— 

24 (1) REPORT ON HEPATITIS, LIVER, AND OTHER

25 DISEASES.—Not later than 1 year after the date of 


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1 enactment of this Act, the Director shall provide a 

2 report to the Congress on the policies and proce3 dures of the Bureau of Prisons to provide testing, 

4 treatment, and prevention education programs for 

5 hepatitis, liver failure, and other liver-related dis6 eases transmitted through sexual activity, intra7 venous drug use, or other means. The Director shall 

8 consult with appropriate officials of the Department 

9 of Health and Human Services, the Office of Na10 tional Drug Control Policy, the Office of National 

11 AIDS Policy, and the Centers for Disease Control 

12 and Prevention regarding the development of this re13 port. 

14 (2) ANNUAL REPORTS.— 

15 (A) GENERALLY.—Not later than 2 years 

16 after the date of enactment of this Act, and 

17 then annually thereafter, the Director shall re18 port to Congress on the incidence among in19 mates of diseases transmitted through sexual 

20 activity and intravenous drug use. 

21 (B) MATTERS PERTAINING TO VARIOUS

22 DISEASES.—Each report under paragraph (1) 

23 shall discuss— 

24 (i) the incidence among inmates of 

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1 mitted through sexual activity and intra2 venous drug use; and 

3 (ii) updates on the testing, treatment, 

4 and prevention education programs for 

5 these diseases conducted by the Bureau of 

6 Prisons. 

7 (C) MATTERS PERTAINING TO HIV

8 ONLY.—Each report under paragraph (1) shall 

9 also include— 

10 (i) the number of inmates who tested 

11 positive for HIV upon intake; 

12 (ii) the number of inmates who tested 

13 positive prior to reentry; 

14 (iii) the number of inmates who were 

15 not tested prior to reentry because they 

16 were released without sufficient notice; 

17 (iv) the number of inmates who opted18 out of taking the test; 

19 (v) the number of inmates who were 

20 tested under section 4014(b) of title 18, 

21 United States Code; and 

22 (vi) the number of inmates under 

23 treatment for HIV. 

24 (D) CONSULTATION.—The Director shall 

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1 ment of Health and Human Services, the Office 

2 of National Drug Control Policy, and the Cen3 ters for Disease Control and Prevention regard4 ing the development of each report under para5 graph (1). 

6 SEC. 759. SUPPORT DATA SYSTEM REVIEW AND INDICA7 TORS FOR MONITORING HIV CARE. 

8 The Secretary of Health and Human Services, in col9 laboration with the Assistant Secretary for Health, the Di10 rector of the Office of Infectious Disease and HIV/AIDS 

11 Policy, the Director of the Centers for Disease Control and 

12 Prevention, the Assistant Secretary for Mental Health and 

13 Substance Use, the Director of the Department of Hous14 ing and Urban Development, the Director of the Office 

15 of AIDS Research, the Administrator of the Health Re16 sources and Services Administration, and the Adminis17 trator of the Centers for Medicare & Medicaid Services, 

18 shall expand and coordinate efforts to align metrics across 

19 agencies and modify Federal data systems, to— 

20 (1) adopt the National Academy of Medicine’s 

21 clinical HIV care indicators as the core metrics for 

22 monitoring the quality of HIV care, mental health, 

23 substance abuse, and supportive services; 

24 (2) better enable assessment of the impact of 

25 the National HIV/AIDS Strategy and the Patient 


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1 Protection and Affordable Care Act (Public Law 

2 111–148) on improving HIV care and access to sup3 portive services for individuals with HIV; 

4 (3) expand the demographic data elements to be 

5 captured by Federal data systems relevant to HIV 

6 care to permit calculation of the indicators for sub7 groups of the population of people with diagnosed 

8 HIV infection, including— 

9 (A) age; 

10 (B) race; 

11 (C) ethnicity; 

12 (D) sex (assigned at birth); 

13 (E) gender identity; 

14 (F) sexual orientation; 

15 (G) current geographic marker of resi16 dence; 

17 (H) income or poverty level; and 

18 (I) primary means of reimbursement for 

19 medical services (including a State Medicaid 

20 program, the Medicare program, the Ryan 

21 White HIV/AIDS Program, private insurance, 

22 health maintenance organizations, and no cov23 erage); and 

24 (4) streamline data collection and systematically 

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1 ally funded HIV programs to ensure that only essen2 tial data are collected. 

3 SEC. 760. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 

4 ENDING THE HIV EPIDEMIC: A PLAN FOR 

5 AMERICA. 

6 Title II of the Public Health Service Act (42 U.S.C. 

7 202 et seq.) is amended by inserting after section 241 the 

8 following: 

9 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 

10 OF NATIONAL HIV/AIDS STRATEGY. 

11 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre12 tionary appropriations made available to the Department 

13 of Health and Human Services for any fiscal year for pro14 grams and activities that, as determined by the Secretary, 

15 pertain to HIV, the Secretary may transfer up to 1 per16 cent of such appropriations to the Office of the Assistant 

17 Secretary for Health for implementation of the Ending the 

18 HIV Epidemic: A Plan for America. 

19 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 

20 30 days before making any transfer under this section, 

21 the Secretary shall give notice of the transfer to the Con22 gress. 

23 ‘‘(c) DEFINITIONS.—In this section, the term ‘End24 ing the HIV Epidemic: A Plan for America’ means the 

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1 ices that seeks to reduce the number of new HIV infec2 tions in the United States by 75 percent by 2025, and 

3 then by at least 90 percent by 2030, for an estimated 

4 250,000 total HIV infections averted.’’. 

5 Subtitle F—Diabetes 

6 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 

7 Subpart 3 of part C of title IV of the Public Health 

8 Service Act (42 U.S.C. 285c et seq.) is amended by adding 

9 at the end the following new section: 

10 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 

11 ‘‘(a) IN GENERAL.—The Director of NIH shall ex12 pand, intensify, and support ongoing research and other 

13 activities with respect to prediabetes and diabetes, particu14 larly type 2, in minority populations. 

15 ‘‘(b) RESEARCH.— 

16 ‘‘(1) DESCRIPTION.—Research under subsection 

17 (a) shall include investigation into— 

18 ‘‘(A) the causes of diabetes, including so19 cioeconomic, geographic, clinical, environmental, 

20 genetic, and other factors that may contribute 

21 to increased rates of diabetes in minority popu22 lations; and 

23 ‘‘(B) the causes of increased incidence of 

24 diabetes complications in minority populations, 


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1 and possible interventions to decrease such inci2 dence. 

3 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 

4 In conducting and supporting research described in 

5 subsection (a), the Director of NIH shall seek to in6 clude minority participants as study subjects in clin7 ical trials. 

8 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 

9 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 

10 Interagency Coordinating Committee shall— 

11 ‘‘(A) prepare and submit to the Congress, 

12 not later than 6 months after the date of enact13 ment of this section, a report on Federal re14 search and public health activities with respect 

15 to prediabetes and diabetes in minority popu16 lations; and 

17 ‘‘(B) develop and submit to Congress, not 

18 later than 1 year after the date of enactment of 

19 this section, an effective and comprehensive 

20 Federal plan (including all appropriate Federal 

21 health programs) to address prediabetes and di22 abetes in minority populations. 

23 ‘‘(2) CONTENTS.—The report under paragraph 

24 (1)(A) shall at minimum address each of the fol25 lowing: 


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1 ‘‘(A) Research on diabetes and prediabetes 

2 in minority populations, including such research 

3 on— 

4 ‘‘(i) genetic, behavioral, and environ5 mental factors; and 

6 ‘‘(ii) prevention and complications 

7 among individuals within these populations 

8 who have already developed diabetes. 

9 ‘‘(B) Surveillance and data collection on 

10 diabetes and prediabetes in minority popu11 lations, including with respect to— 

12 ‘‘(i) efforts to better determine the 

13 prevalence of diabetes among Asian-Amer14 ican and Pacific Islander subgroups; and 

15 ‘‘(ii) efforts to coordinate data collec16 tion on the American Indian population. 

17 ‘‘(C) Community-based interventions to ad18 dress diabetes and prediabetes targeting minor19 ity populations, including— 

20 ‘‘(i) the evidence base for such inter21 ventions; 

22 ‘‘(ii) the cultural appropriateness of 

23 such interventions; and 

24 ‘‘(iii) efforts to educate the public on 

25 the causes and consequences of diabetes. 


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1 ‘‘(D) Education and training programs for 

2 health professionals (including community 

3 health workers) on the prevention and manage4 ment of diabetes and its related complications 

5 that is supported by the Health Resources and 

6 Services Administration, including such pro7 grams supported by— 

8 ‘‘(i) the National Health Service 

9 Corps; or 

10 ‘‘(ii) the community health centers 

11 program under section 330. 

12 ‘‘(d) EDUCATION.—The Director of NIH shall— 

13 ‘‘(1) through the National Institute on Minority 

14 Health and Health Disparities and the National Di15 abetes Education Program— 

16 ‘‘(A) make grants to programs funded 

17 under section 464z–4 for the purpose of estab18 lishing a mentoring program for health care 

19 professionals to be more involved in weight 

20 counseling, obesity research, and nutrition; and 

21 ‘‘(B) provide for the participation of mi22 nority health professionals in diabetes-focused 

23 research programs; and 

24 ‘‘(2) make grants for programs to establish a 

25 pipeline from high school to professional school that 


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1 will increase minority representation in diabetes-fo2 cused health fields by expanding Minority Access to 

3 Research Careers program internships and men4 toring opportunities for recruitment. 

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

6 ‘‘(1) DIABETES MELLITUS INTERAGENCY CO7 ORDINATING COMMITTEE.—The ‘Diabetes Mellitus 

8 Interagency Coordinating Committee’ means the Di9 abetes Mellitus Interagency Coordinating Committee 

10 established under section 429. 

11 ‘‘(2) MINORITY POPULATION.—The term ‘mi12 nority population’ means a racial and ethnic minor13 ity group, as defined in section 1707.’’. 

14 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

15 Part B of title III of the Public Health Service Act 

16 (42 U.S.C. 243 et seq.), as amended by section 721, is 

17 further amended by inserting after section 317W the fol18 lowing section: 

19 ‘‘SEC. 317X. DIABETES IN MINORITY POPULATIONS. 

20 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

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

22 through the Director of the Centers for Disease 

23 Control and Prevention, shall conduct and support 

24 research and public health activities with respect to 

25 diabetes in minority populations. 


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

2 paragraph (1) regarding diabetes in minority popu3 lations shall include the following: 

4 ‘‘(A) Further enhancing the National 

5 Health and Nutrition Examination Survey by 

6 oversampling Asian Americans, Native Hawai7 ians, and Pacific Islanders in appropriate geo8 graphic areas to better determine the preva9 lence of diabetes in such populations as well as 

10 to improve the data collection of diabetes pene11 tration disaggregated into major ethnic groups 

12 within such populations. The Secretary shall en13 sure that any such oversampling does not re14 duce the oversampling of other minority popu15 lations including African-American and Latino 

16 populations. 

17 ‘‘(B) Through the Division of Diabetes 

18 Translation— 

19 ‘‘(i) providing for prevention research 

20 to better understand how to influence 

21 health care systems changes to improve 

22 quality of care being delivered to such pop23 ulations; 

24 ‘‘(ii) carrying out model demonstra25 tion projects to design, implement, and 


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1 evaluate effective diabetes prevention and 

2 control interventions for minority popu3 lations, including culturally appropriate 

4 community-based interventions; 

5 ‘‘(iii) developing and implementing a 

6 strategic plan to reduce diabetes in minor7 ity populations through applied research to 

8 reduce disparities and culturally and lin9 guistically appropriate community-based 

10 interventions; 

11 ‘‘(iv) supporting, through the national 

12 diabetes prevention program under section 

13 399V–3, diabetes prevention program sites 

14 in underserved regions highly impacted by 

15 diabetes; and 

16 ‘‘(v) implementing, through the na17 tional diabetes prevention program under 

18 section 399V–3, a demonstration program 

19 developing new metrics measuring health 

20 outcomes related to diabetes that can be 

21 stratified by specific minority populations. 

22 ‘‘(b) EDUCATION.—The Secretary, acting through 

23 the Director of the Centers for Disease Control and Pre24 vention, shall direct the Division of Diabetes Translation 

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1 lic on diabetes in minority populations and programs to 

2 educate minority populations about the causes and effects 

3 of diabetes. 

4 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION

5 ACTIVITIES, AND ACCESS.—The Secretary, acting through 

6 the Director of the Centers for Disease Control and Pre7 vention and the National Diabetes Education Program, 

8 shall conduct and support programs to educate specific 

9 minority populations through culturally appropriate and 

10 linguistically appropriate information campaigns about 

11 prevention of, and managing, diabetes. 

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

13 term ‘minority population’ means a racial and ethnic mi14 nority group, as defined in section 1707.’’. 

15 SEC. 773. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON 

16 THE CAUSES AND EFFECTS OF DIABETES IN 

17 MINORITY POPULATIONS. 

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

19 (42 U.S.C. 280g et seq.), as amended by section 733, is 

20 further amended by adding at the end the following new 

21 section: 


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1 ‘‘SEC. 399V–10. PROGRAMS TO EDUCATE HEALTH PRO2 VIDERS ON THE CAUSES AND EFFECTS OF DI3 ABETES IN MINORITY POPULATIONS. 

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

5 the Director of the Health Resources and Services Admin6 istration, shall conduct and support programs described 

7 in subsection (b) to educate health professionals on the 

8 causes and effects of diabetes in minority populations. 

9 ‘‘(b) PROGRAMS.—Programs described in this sub10 section, with respect to education on diabetes in minority 

11 populations, shall include the following: 

12 ‘‘(1) Giving priority, under the primary care 

13 training and enhancement program under section 

14 747— 

15 ‘‘(A) to awarding grants to focus on or ad16 dress diabetes; and 

17 ‘‘(B) to adding minority populations to the 

18 list of vulnerable populations that should be 

19 served by such grants. 

20 ‘‘(2) Providing additional funds for the Health 

21 Careers Opportunity Program, the Centers for Ex22 cellence, and the Minority Faculty Fellowship Pro23 gram to partner with the Office of Minority Health 

24 under section 1707 and the National Institutes of 

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1 ties focused on diabetes treatment and care within 

2 underserved regions highly impacted by diabetes. 

3 ‘‘(3) Developing a diabetes focus within, and 

4 providing additional funds for, the National Health 

5 Service Corps scholarship program— 

6 ‘‘(A) to place individuals in areas that are 

7 disproportionately affected by diabetes and to 

8 provide diabetes treatment and care in such 

9 areas; and 

10 ‘‘(B) to provide such individuals continuing 

11 medical education specific to diabetes care.’’. 

12 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES 

13 REGARDING DIABETES IN AMERICAN INDIAN 

14 POPULATIONS. 

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

16 (42 U.S.C. 280g et seq.), as amended by section 773, is 

17 further amended by adding at the end the following sec18 tion: 

19 ‘‘SEC. 399V–11. RESEARCH, EDUCATION, AND OTHER ACTIVI20 TIES REGARDING DIABETES IN AMERICAN IN21 DIAN POPULATIONS. 

22 ‘‘In addition to activities under sections 317X, 399V– 

23 10, and 434B, the Secretary, acting through the Indian 

24 Health Service and in collaboration with other appropriate 

25 Federal agencies, shall— 


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1 ‘‘(1) conduct and support research and other 

2 activities with respect to diabetes; and 

3 ‘‘(2) coordinate the collection of data on clini4 cally and culturally appropriate diabetes treatment, 

5 care, prevention, and services by health care profes6 sionals to the American Indian population.’’. 

7 SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 

8 The Secretary of Health and Human Services shall 

9 seek to enter into an arrangement with the National Acad10 emy of Medicine under which the National Academy will— 

11 (1) not later than 1 year after the date of en12 actment of this Act, submit to Congress an updated 

13 version of the 2003 report entitled ‘‘Unequal Treat14 ment: Confronting Racial and Ethnic Disparities in 

15 Health Care’’; and 

16 (2) in such updated version, address how racial 

17 and ethnic health disparities have changed since the 

18 publication of the original report. 

19 Subtitle G—Lung Disease 

20 SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU21 CATION AND PREVENTION PROGRAM. 

22 (a) FINDINGS.—Congress finds as follows: 

23 (1) The prevalence of asthma has increased 

24 since 1980 and affects more than 26,000,000 people 

25 in the United States. 


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1 (2) Significant disparities in asthma morbidity 

2 and mortality exist for both adults and children par3 ticularly for low-income and minority populations, 

4 particularly African Americans and Puerto Ricans. 

5 (3) African-American children are twice as like6 ly to have asthma as White children. 

7 (4) In 2016, almost 4,500,000 non-Hispanic 

8 African Americans reported having asthma. African 

9 Americans with asthma are 3 times as likely to visit 

10 the emergency department and twice as likely to get 

11 hospitalized as White patients with asthma. 

12 (5) Puerto Ricans are 3.4 times as likely to die 

13 from asthma compared with all other Hispanic or 

14 Latino groups. Overall Hispanic Americans are 30 

15 percent more likely to be hospitalized for asthma 

16 than non-Hispanic Whites. 

17 (6) The majority of adults with asthma are 

18 women. 

19 (b) IN GENERAL.—Not later than 2 years after the 

20 date of the enactment of this Act, the Secretary of Health 

21 and Human Services shall convene a working group com22 prised of patient groups, nonprofit organizations, medical 

23 societies, and other relevant governmental and nongovern24 mental entities, including those that participate in the NaVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 tional Asthma Education and Prevention Program, to de2 velop a report to Congress that— 

3 (1) catalogs, with respect to asthma prevention, 

4 management, and surveillance— 

5 (A) the activities of the Federal Govern6 ment, including identifying all Federal pro7 grams that carry out asthma-related activities, 

8 as well as assessment of the progress of the 

9 Federal Government and States, with respect to 

10 achieving the goals of Healthy People 2020; 

11 and 

12 (B) the activities of other entities that par13 ticipate in the program, including nonprofit or14 ganizations, patient advocacy groups, and med15 ical societies; and 

16 (2) makes recommendations for the future di17 rection of asthma activities, in consultation with re18 searchers from the National Institutes of Health and 

19 other member bodies of the National Asthma Edu20 cation and Prevention Program who are qualified to 

21 review and analyze data and evaluate interventions, 

22 including— 

23 (A) a description of how the Federal Gov24 ernment may better coordinate and improve its 


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1 response to asthma including identifying any 

2 barriers that may exist; 

3 (B) a description of how the Federal Gov4 ernment may continue, expand, and improve its 

5 private-public partnerships with respect to asth6 ma including identifying any barriers that may 

7 exist; 

8 (C) identification of steps that may be 

9 taken to reduce the— 

10 (i) morbidity, mortality, and overall 

11 prevalence of asthma; 

12 (ii) financial burden of asthma on so13 ciety; 

14 (iii) burden of asthma on dispropor15 tionately affected areas, particularly those 

16 in medically underserved populations (as 

17 defined in section 330(b)(3) of the Public 

18 Health Service Act (42 U.S.C. 

19 254b(b)(3))); and 

20 (iv) burden of asthma as a chronic 

21 disease; 

22 (D) identification of programs and policies 

23 that have achieved the steps described in sub24 paragraph (C), and steps that may be taken to 


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1 expand such programs and policies to benefit 

2 larger populations; and 

3 (E) recommendations for future research 

4 and interventions. 

5 (c) REPORT TO CONGRESS.—At the end of the 5-year 

6 period following the submission of the report under this 

7 section, the National Asthma Education and Prevention 

8 Program shall evaluate the analyses and recommendations 

9 under such report and determine whether a new report 

10 to the Congress is necessary, and make appropriate rec11 ommendations to the Congress. 

12 SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

13 FOR DISEASE CONTROL AND PREVENTION. 

14 Section 317I of the Public Health Service Act (42 

15 U.S.C. 247b–10) is amended to read as follows: 

16 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

17 FOR DISEASE CONTROL AND PREVENTION. 

18 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

19 EDUCATION TO THE PUBLIC.—The Secretary, acting 

20 through the Director of the Centers for Disease Control 

21 and Prevention, shall collaborate with State and local 

22 health departments to conduct activities, including the 

23 provision of information and education to the public re24 garding asthma including— 


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1 ‘‘(1) deterring the harmful consequences of un2 controlled asthma; and 

3 ‘‘(2) disseminating health education and infor4 mation regarding prevention of asthma episodes and 

5 strategies for managing asthma. 

6 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 

7 The Secretary, acting through the Director of the Centers 

8 for Disease Control and Prevention, shall collaborate with 

9 State and local health departments to develop State plans 

10 incorporating public health responses to reduce the burden 

11 of asthma, particularly regarding disproportionately af12 fected populations. 

13 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 

14 through the Director of the Centers for Disease Control 

15 and Prevention, shall, in cooperation with State and local 

16 public health officials— 

17 ‘‘(1) conduct asthma surveillance activities to 

18 collect data on the prevalence and severity of asth19 ma, the effectiveness of public health asthma inter20 ventions, and the quality of asthma management, in21 cluding— 

22 ‘‘(A) collection of household data on the 

23 local burden of asthma; 

24 ‘‘(B) surveillance of health care facilities; 

25 and 


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1 ‘‘(C) collection of data not containing indi2 vidually identifiable information from electronic 

3 health records or other electronic communica4 tions; 

5 ‘‘(2) compile and annually publish data regard6 ing the prevalence and incidence of childhood asth7 ma, the child mortality rate, and the number of hos8 pital admissions and emergency department visits by 

9 children associated with asthma nationally and in 

10 each State and at the county level by age, sex, race, 

11 and ethnicity, as well as lifetime and current preva12 lence; and 

13 ‘‘(3) compile and annually publish data regard14 ing the prevalence and incidence of adult asthma, 

15 the adult mortality rate, and the number of hospital 

16 admissions and emergency department visits by 

17 adults associated with asthma nationally and in each 

18 State and at the county level by age, sex, race, eth19 nicity, industry, and occupation, as well as lifetime 

20 and current prevalence. 

21 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 

22 Director of the Centers for Disease Control and Preven23 tion, in conjunction with State and local health depart24 ments, shall coordinate data collection activities under 


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1 paragraphs (2) and (3) of subsection (c) so as to maximize 

2 comparability of results. 

3 ‘‘(e) COLLABORATION.—The Centers for Disease 

4 Control and Prevention are encouraged to collaborate with 

5 national, State, and local nonprofit organizations to pro6 vide information and education about asthma, and to 

7 strengthen such collaborations when possible. 

8 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 

9 other authorization of appropriations that is available to 

10 the Centers for Disease Control and Prevention for the 

11 purpose of carrying out this section, there are authorized 

12 to be appropriated to such Centers such sums as may be 

13 necessary for each of fiscal years 2021 through 2025 for 

14 the purpose of carrying out this section.’’. 

15 SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM16 PAIGN. 

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

18 Human Services shall— 

19 (1) enhance the annual campaign by the De20 partment of Health and Human Services to increase 

21 the number of people vaccinated each year for influ22 enza and pneumonia; and 

23 (2) include in such campaign the use of written 

24 educational materials, public service announcements, 


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1 physician education, and any other means which the 

2 Secretary deems effective. 

3 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 

4 out the annual campaign described in subsection (a), the 

5 Secretary of Health and Human Services shall ensure 

6 that— 

7 (1) educational materials and public service an8 nouncements are readily and widely available in 

9 communities experiencing disparities in the incidence 

10 and mortality rates of influenza and pneumonia; and 

11 (2) the campaign uses targeted, culturally ap12 propriate messages and messengers to reach under13 served communities. 

14 (c) 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 2021 through 2025. 

18 SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

19 ACTION PLAN. 

20 (a) FINDINGS.—Congress finds as follows: 

21 (1) Chronic obstructive pulmonary disease (re22 ferred to in this subsection as ‘‘COPD’’) refers to 

23 chronic bronchitis and emphysema, incurable dis24 eases that make it difficult to exhale all the air from 


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1 one’s lungs, and that can cause persistent coughing, 

2 shortness of breath, and sputum. 

3 (2) COPD exacerbations—episodes of acute dif4 ficulty breathing and moderate to severe fatigue— 

5 are dangerous, and their treatment often requires 

6 hospitalization. 

7 (3) While smoking is the primary risk factor for 

8 COPD, other risk factors include air pollution, occu9 pational exposures, heredity, a history of childhood 

10 respiratory infections, and socioeconomic status. 

11 (4) It is estimated that over 13,500,000 adults 

12 in the United States have COPD. 

13 (5) COPD is the third-leading cause of death in 

14 the United States, claiming over 134,000 lives in 

15 2010. 

16 (6) Since 2000, deaths for women with COPD 

17 have exceeded deaths in men. 

18 (7) Although African Americans have a lower 

19 prevalence of COPD in the United States, research20 ers have shown that African Americans may be 

21 underdiagnosed. Furthermore, research has shown 

22 that African Americans develop COPD with less cu23 mulative smoke exposure and at a younger age. 

24 (b) IN GENERAL.—The Director of the Centers for 

25 Disease Control and Prevention shall conduct, support, 


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1 and expand public health strategies, prevention, diagnosis, 

2 surveillance, and public and professional awareness activi3 ties regarding chronic obstructive pulmonary disease. 

4 (c) NATIONAL ACTION PLAN.— 

5 (1) DEVELOPMENT.—Not later than 2 years 

6 after the date of the enactment of this Act, the Di7 rector of the National Heart, Lung, and Blood Insti8 tute, in consultation with the Director of the Centers 

9 for Disease Control and Prevention, shall develop a 

10 national action plan to address chronic obstructive 

11 pulmonary disease in the United States with partici12 pation from patients, caregivers, health profes13 sionals, patient advocacy organizations, researchers, 

14 providers, public health professionals, and other 

15 stakeholders. 

16 (2) CONTENTS.—At a minimum, such plan 

17 shall include recommendations for— 

18 (A) public health interventions for the pur19 pose of implementation of the national plan; 

20 (B) biomedical, health services, and public 

21 health research on chronic obstructive pul22 monary disease; and 

23 (C) inclusion of chronic obstructive pul24 monary disease in the health data collections of 

25 all Federal agencies. 


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1 (3) CONSIDERATION.—In developing such plan, 

2 the Director of the National Heart, Lung, and Blood 

3 Institute shall consider the recommendations and 

4 findings of the National Academy of Medicine in the 

5 report entitled ‘‘A Nationwide Framework for Sur6 veillance of Cardiovascular and Chronic Lung Dis7 eases’’ (July 22, 2011). 

8 (d) CHRONIC DISEASE PREVENTION PROGRAMS.— 

9 The Director of the National Heart, Lung, and Blood In10 stitute shall carry out the following: 

11 (1) Conduct public education and awareness ac12 tivities with patient and professional organizations 

13 to stimulate earlier diagnosis and improve patient 

14 outcomes from treatment of chronic obstructive pul15 monary disease. To the extent known and relevant, 

16 such public education and awareness activities shall 

17 reflect differences in chronic obstructive pulmonary 

18 disease by cause (tobacco, environmental, occupa19 tional, biological, and genetic) and include a focus 

20 on outreach to undiagnosed and, as appropriate, mi21 nority populations. 

22 (2) Supplement and expand upon the activities 

23 of the National Heart, Lung, and Blood Institute by 

24 making grants to nonprofit organizations, State and 

25 local jurisdictions, and Indian tribes for the purpose 


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1 of reducing the burden of chronic obstructive pul2 monary disease, especially in disproportionately im3 pacted communities, through public health interven4 tions and related activities. 

5 (3) Coordinate with the Centers for Disease 

6 Control and Prevention, the Indian Health Service, 

7 the Health Resources and Services Administration, 

8 and the Department of Veterans Affairs to develop 

9 pilot programs to demonstrate best practices for the 

10 diagnosis and management of chronic obstructive 

11 pulmonary disease. 

12 (4) Develop improved techniques and identify 

13 best practices, in coordination with the Secretary of 

14 Veterans Affairs, for assisting chronic obstructive 

15 pulmonary disease patients to successfully stop 

16 smoking, including identification of subpopulations 

17 with different needs. Initiatives under this para18 graph may include research to determine whether 

19 successful smoking cessation strategies are different 

20 for chronic obstructive pulmonary disease patients 

21 compared to such strategies for patients with other 

22 chronic diseases. 

23 (e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH

24 PROGRAMS.—The Director of the Centers for Disease 

25 Control and Prevention shall— 


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1 (1) support research into the environmental and 

2 occupational causes and biological mechanisms that 

3 contribute to chronic obstructive pulmonary disease; 

4 and 

5 (2) develop and disseminate public health inter6 ventions that will lessen the impact of environmental 

7 and occupational causes of chronic obstructive pul8 monary disease. 

9 (f) DATA COLLECTION.—Not later than 180 days 

10 after the enactment of this Act, the Director of the Na11 tional Heart, Lung, and Blood Institute and the Director 

12 of the Centers for Disease Control and Prevention, acting 

13 jointly, shall assess the depth and quality of information 

14 on chronic obstructive pulmonary disease that is collected 

15 in surveys and population studies conducted by the Cen16 ters for Disease Control and Prevention, including wheth17 er there are additional opportunities for information to be 

18 collected in the National Health and Nutrition Examina19 tion Survey, the National Health Interview Survey, and 

20 the Behavioral Risk Factors Surveillance System surveys. 

21 The Director of the National Heart, Lung, and Blood In22 stitute shall include the results of such assessment in the 

23 national action plan under subsection (c). 

24 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section 


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

2 2021 through 2025. 

3 Subtitle H—Tuberculosis 

4 SEC. 781. ELIMINATION OF ALL FORMS OF TUBERCULOSIS. 

5 (a) SHORT TITLE.—This subtitle may be cited as the 

6 ‘‘End Tuberculosis Act’’. 

7 (b) FINDINGS.—Congress makes the following find8 ings: 

9 (1) In the United States, 9,025 people were di10 agnosed with tuberculosis (referred to in this section 

11 as ‘‘TB’’) in 2018. 

12 (2) Disparities in TB exist and significantly im13 pact minority communities in the United States. The 

14 Centers for Disease Control and Prevention (re15 ferred to in this section as ‘‘CDC’’) finds that 70 

16 percent of people diagnosed with TB in 2018 self17 identified as racial and ethnic minorities. 

18 (3) African Americans comprised 20 percent of 

19 people diagnosed with TB during 2018. The popu20 lation-adjusted rate of TB among African Americans 

21 is 1.7 times higher than the national total, and 8.0 

22 times higher than among Whites. 

23 (4) Asian Americans, Native Hawaiians, and 

24 other Pacific Islanders comprised 37 percent of peo25 ple diagnosed with TB during 2018. The populationVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00801 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 adjusted rate of TB among Asian Americans is 6.2 

2 times higher than the national total, and 31 times 

3 higher than among Whites. The population-adjusted 

4 rate of TB among Native Hawaiians and other Pa5 cific Islanders is 4.8 times higher than the national 

6 total, and 23.2 times higher than among Whites. 

7 (5) Hispanics and Latinos comprised 26 per8 cent of people diagnosed with TB during 2018. The 

9 population-adjusted rate of TB among Hispanics 

10 and Latinos is 1.6 times higher than the national 

11 total, and 8.0 times higher than among Whites. 

12 (6) TB is both preventable and curable, but the 

13 current rate of decline of TB in the United States 

14 remains too slow to achieve TB elimination in this 

15 century. 

16 (7) TB is transmitted through the air when a 

17 person who has TB disease in their lungs coughs or 

18 sneezes. People who are in close proximity to the 

19 person with TB can breathe in the TB bacteria, and 

20 the bacteria will initially settle in their lungs. With21 out proper and timely diagnosis and access to treat22 ment, the TB bacteria may grow and spread to 

23 other parts of their body. 

24 (8) As many as 13,000,000 people in the 

25 United States may have latent TB Infection (reVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00802 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 ferred to in this section as ‘‘LTBI’’). People with 

2 LTBI have TB bacteria in their bodies, but their 

3 immune system is containing the bacteria, and they 

4 are not sick, nor do they have any current risk of 

5 spreading TB to others. LTBI can activate into in6 fectious, life-threatening TB if not treated. Modeling 

7 has shown that eliminating TB is not possible with8 out addressing LTBI. 

9 (9) Comorbidities associated with TB include 

10 cancer, diabetes mellitus, and HIV. People with 

11 these medical conditions and compromised immune 

12 systems are more likely to develop active TB disease 

13 and to have worse outcomes from TB. 

14 (10) Forms of active TB that do not show drug 

15 resistance are classified as drug-susceptible TB (re16 ferred to in this section as ‘‘DS–TB’’). Drug-resist17 ant TB (referred to in this section as ‘‘DR–TB’’) is 

18 a rising threat to the public health of the United 

19 States. DR–TB that exhibits resistance to two or 

20 more first-line drugs is referred to as multi-drug re21 sistant TB (referred to in this section as ‘‘MDR– 

22 TB’’). MDR–TB that also is resistant to at least 

23 one injectable second-line medication and at least 

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1 resistant TB (referred to in this section as ‘‘XDR– 

2 TB’’). 

3 (11) Approximately 97 people in the United 

4 States were diagnosed with MDR–TB in 2018. One 

5 person was diagnosed with XDR–TB in the same 

6 year. 

7 (12) In the United States, $480,000,000 was 

8 spent in 2018 to treat TB; direct treatment costs 

9 average $19,000 to treat a patient with DS–TB, 

10 $175,000 to treat a patient with MDR–TB, and 

11 $544,000 to treat a patient with XDR–TB. When 

12 factoring in productivity losses during treatment, 

13 DS–TB averages $46,000, MDR–TB averages 

14 $294,000 and XDR–TB averages $694,000. Treat15 ment is often difficult, with daily complex multi-pill 

16 regimens and injections, with side-effects ranging 

17 from hearing and vision loss to mental health issues. 

18 (13) Recognizing the public health, economic 

19 and societal costs to the threat of MDR–TB, the 

20 National Action Plan to Combat MDR–TB was de21 veloped by the White House to provide the United 

22 States with a comprehensive three-pronged strategy 

23 to address MDR–TB by strengthening domestic ca24 pacity to combat MDR–TB; improve international 

25 capacity and cooperation to combat MDR–TB; accelVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00804 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 erate basic and applied research and development 

2 for new therapies, diagnostics and prevention strate3 gies to combat MDR–TB. 

4 (14) Additional Federal support is necessary to 

5 expand TB control efforts in case finding and treat6 ment to address LTBI in a national prevention ini7 tiative. Key policy and research breakthroughs in8 crease the success of a TB prevention initiative: the 

9 U.S. Preventative Services Task Force recommenda10 tion’s ‘‘B’’ rating, screening for LTBI among high11 risk adults as a covered service increases the likeli12 hood that impacted racial and ethnic minority 

13 groups can get tested for TB; a new, shorter course 

14 treatment regimen reduces the length of treatment 

15 for LTBI from every day for 6 to 9 months to one 

16 dose per week for 12 weeks, increasing likelihood of 

17 treatment completion; and the use of blood-based di18 agnostic tests, Interferon-gamma release assays or 

19 IGRAs, increases ability to detect LTBI among pa20 tients in affected communities. 

21 (15) The right to health, and the right to 

22 science as a necessary human right to help achieve 

23 the right to health, is enshrined in Articles 25 and 

24 27 of the Universal Declaration of Human Rights. 

25 These fundamental human rights cannot be achieved 


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1 when anyone lacks access to TB prevention or treat2 ment, and when the benefits of scientific innovation 

3 are not extended to people with all forms of TB. 

4 SEC. 782. ADDITIONAL FUNDING FOR STATES IN COM5 BATING AND ELIMINATING TUBERCULOSIS. 

6 Section 317E(h) of the Public Health Act (42 U.S.C. 

7 247b–6(h)) is amended by adding at the end the following: 

8 ‘‘(3) ADDITIONAL FUNDING FOR STATES IN

9 COMBATING AND ELIMINATING TUBERCULOSIS.—In 

10 addition to amounts otherwise authorized to be ap11 propriated to carry out this section, there are au12 thorized to be appropriated such sums as may be 

13 necessary to carry out this section for each of fiscal 

14 years 2020 through 2021.’’. 

15 SEC. 783. STRENGTHENING CLINICAL RESEARCH FUNDING 

16 FOR TUBERCULOSIS. 

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

18 Human Services shall expand and intensify support for 

19 current and prospective research activities of the National 

20 Institutes of Health, the Biomedical Advanced Research 

21 and Development Authority, and the Centers for Disease 

22 Control and Prevention Division of Tuberculosis Elimi23 nation to develop new therapeutics, diagnostics, vaccines, 

24 and other prevention modalities in addressing all forms 

25 of tuberculosis (referred to in this section as ‘‘TB’’). 


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1 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

2 activities under subsection (a) shall include— 

3 (1) research and development, and pathways to 

4 approval, for novel, safe drugs and drug regimens 

5 for the treatment of TB, including in adolescent and 

6 pediatric populations and in pregnant and lactating 

7 women; 

8 (2) research to develop rapid diagnostic tests 

9 for all forms of TB, including diagnostics that can 

10 be used for pediatric populations and people living 

11 with HIV, diagnostics that can detect extra pul12 monary TB and drug resistance, and diagnostics 

13 that can be used at the point of care; 

14 (3) research to advance basic knowledge of the 

15 pathogenesis of TB and its major comorbidities, in16 cluding HIV and diabetes mellitus; 

17 (4) research to improve knowledge and under18 standings of the role of latency in TB and the fac19 tors that increase the risk of latent TB infection 

20 progressing to active, symptomatic TB disease; 

21 (5) awarding grants and contracts to specifi22 cally develop new and needed vaccines to address 

23 TB; 

24 (6) awarding grants and contracts to support 

25 the training and development of clinical researchers 


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1 whose research improves the landscape of tools to 

2 combat TB; and 

3 (7) awarding grants and contracts to support 

4 capacity-building and develop clinical trial site infra5 structure in the United States and in TB endemic 

6 countries to support the aforementioned research ac7 tivities. 

8 Subtitle I—Osteoarthritis and 

9 Musculoskeletal Diseases 

10 SEC. 785. FINDINGS. 

11 Congress finds as follows: 

12 (1) Eighty percent of African-American women 

13 and nearly 74 percent of Hispanic men are either 

14 overweight or obese, speeding the onset and progres15 sion of arthritis. 

16 (2) Arthritis affects 46,000,000 people in the 

17 United States, and that number will rise to 

18 67,000,000 by the year 2030. 

19 (3) Twenty-seven million people in the United 

20 States suffer from osteoarthritis, the most common 

21 form of arthritis, making it the leading cause of dis22 ability in the United States. Osteoarthritis is some23 times referred to as degenerative joint disease. 

24 (4) Obesity accelerates the onset of arthritis: 70 

25 percent of obese adults with mild osteoarthritis of 


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1 the knee at age 60 will develop advanced end-stage 

2 disease by age 80. In contrast, just 43 percent of 

3 non-obese adults will have end-stage disease over the 

4 same time period. 

5 (5) Arthritis affects 1 in 5 people in the United 

6 States and is the single greatest cause of chronic 

7 pain and disability in the United States. 

8 (6) Women, African Americans, and Hispanics 

9 have more severe arthritis and functional limitations. 

10 These same individuals are more likely to be obese, 

11 diabetic, and have higher incidence of heart dis12 ease—medical conditions that can be improved with 

13 physical activity. Instead of moving, however, these 

14 groups have an inactivity rate of 40 to 50 percent, 

15 which continues to increase. 

16 (7) Arthritis costs $128,000,000,000 a year, in17 cluding $81,000,000,000 in direct costs (medical) 

18 and $47,000,000,000 in indirect costs (lost earn19 ings). Each year, $309,000,000,000 in direct and in20 direct costs is lost due to disparities in osteoarthritis 

21 and musculoskeletal diseases. 

22 (8) Obesity and other chronic health conditions 

23 exacerbate the debilitating impact of arthritis, lead24 ing to inactivity, loss of independence, and a per25 petual cycle of comorbid chronic conditions. 


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1 (9) Sixty-one percent of arthritis sufferers are 

2 women, and women represent 64 percent of an esti3 mated 43,000,000 annual visits to physicians’ offices 

4 and outpatient clinics where arthritis was the pri5 mary diagnosis. Women also represented 60 percent 

6 of approximately 1,000,000 hospitalizations that oc7 curred in 2003 for which arthritis was the primary 

8 diagnosis. 

(10) Women ages 65 and older have up to 21 9 ⁄2

10 times more disabilities than men of the same age. 

11 Higher rates of obesity and arthritis among this 

12 group explained up to 48 percent of the gender gap 

13 in disability, above all other common chronic health 

14 conditions. 

15 (11) The primary indication for total knee 

16 arthroplasty (referred to in this section as ‘‘TKA’’), 

17 also known as knee replacement, is relief of signifi18 cant, disabling pain caused by severe arthritis. 

19 (12) Knee replacement is surgery for people 

20 with severe knee damage. Knee replacement can re21 lieve pain and allow an individual to be more active. 

22 The process for a total knee replacement involves 

23 the surgeon removing damaged cartilage and bone 

24 from the surface of the knee joint and replacing the 

25 cartilage and bone with a man-made surface of 


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1 metal and plastic. In a partial knee replacement, the 

2 surgeon only replaces part of the knee joint. 

3 (13) Total hip replacement, also called total hip 

4 arthroplasty (referred to in this section as ‘‘THA’’), 

5 is used if hip pain interferes with daily activities and 

6 more conservative treatments have not helped. Ar7 thritis damage is the most common reason to need 

8 hip replacement. 

9 (14) The odds of a family practice physician 

10 recommending TKA to a male patient with moderate 

11 arthritis are twice that of a female patient, while the 

12 odds of an orthopaedic surgeon recommending TKA 

13 to a male patient with moderate arthritis are 22 

14 times that of a female patient. 

15 (15) African Americans with doctor-diagnosed 

16 arthritis have a higher prevalence of severe pain at17 tributable to arthritis, compared with Whites (34.0 

18 percent versus 22.6 percent). African Americans, 

19 compared to Whites, report a higher proportion of 

20 work limitations (39.5 percent versus 28.0 percent) 

21 and a higher prevalence of arthritis-attributable 

22 work limitation (6.6 percent versus 4.6 percent). 

23 (16) Hispanics are 50 percent more likely than 

24 non-Hispanic Whites to report needing assistance 


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1 with at least one instrumental activity of daily living 

2 and to have difficulty walking. 

3 (17) African Americans and Hispanics were 1.3 

4 times more likely to have activity limitation, 1.6 

5 times more likely to have work limitations, and 1.9 

6 times more likely to have severe joint pain than 

7 Whites. 

8 (18) In 2003, the National Academy of Medi9 cine reported that the rates of TKA and THA 

10 among African-American and Hispanic patients are 

11 significantly lower than for Whites—even for those 

12 with equitable health care coverage such as through 

13 Medicare or the Department of Veterans Affairs. 

14 (19) According to the Centers for Disease Con15 trol and Prevention, in 2000, African-American 

16 Medicare enrollees were 37 percent less likely than 

17 White Medicare enrollees to undergo total knee re18 placements. In 2006, the disparity increased to 39 

19 percent. 

20 (20) Even after adjusting for insurance and 

21 health access, Hispanics and African Americans are 

22 almost 50 percent less likely to undergo total knee 

23 replacement than Whites. 


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1 SEC. 786. OSTEOARTHRITIS AND OTHER MUSCULO2 SKELETAL HEALTH-RELATED ACTIVITIES OF 

3 THE CENTERS FOR DISEASE CONTROL AND 

4 PREVENTION. 

5 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 

6 Secretary of Health and Human Services, acting through 

7 the Director of the Centers for Disease Control and Pre8 vention, shall direct the National Center for Chronic Dis9 ease Prevention and Health Promotion to conduct and ex10 pand the Health Community Program and Arthritis Pro11 gram to educate the public on— 

12 (1) the causes of, preventive health actions for, 

13 and effects of arthritis and other musculoskeletal 

14 conditions in minority patient populations; and 

15 (2) the effects of such conditions on other 

16 comorbidities including obesity, hypertension, and 

17 cardiovascular disease. 

18 (b) PROGRAMS ON ARTHRITIS AND MUSCULO19 SKELETAL CONDITIONS.—Education and awareness pro20 grams of the Centers for Disease Control and Prevention 

21 on arthritis and other musculoskeletal conditions in minor22 ity communities shall— 

23 (1) be culturally and linguistically appropriate 

24 to minority patients, targeting musculoskeletal 

25 health promotion and prevention programs of each 

26 major ethnic group, including— 


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1 (A) Native Americans and Alaska Natives; 

2 (B) Asian Americans; 

3 (C) African Americans and Blacks; 

4 (D) Hispanic and Latino Americans; and 

5 (E) Native Hawaiians and Pacific Island6 ers; and 

7 (2) include public awareness campaigns directed 

8 toward these patient populations that emphasize the 

9 importance of musculoskeletal health, physical activ10 ity, diet and healthy lifestyle, and weight reduction 

11 for overweight and obese patients. 

12 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

13 out this section, there are authorized to be appropriated 

14 such sums as are necessary for fiscal year 2021 and each 

15 subsequent fiscal year. 

16 SEC. 787. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 

17 AND MUSCULOSKELETAL DISEASE HEALTH 

18 EDUCATION WITHIN HEALTH PROFESSIONS 

19 SCHOOLS. 

20 (a) PROGRAM AUTHORIZED.—The Secretary of 

21 Health and Human Services (in this section referred to 

22 as the ‘‘Secretary’’), in coordination with the Secretary of 

23 Education, shall award grants, on a competitive basis, to 

24 academic health science centers, health professions 

25 schools, and institutions of higher education to enable 


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1 such centers, schools, and institutions to provide people 

2 with comprehensive education on arthritis and musculo3 skeletal health, particularly— 

4 (1) obesity-related musculoskeletal diseases; 

5 (2) arthritis and osteoarthritis; 

6 (3) arthritis and musculoskeletal health dispari7 ties; and 

8 (4) the relationship between arthritis and mus9 culoskeletal diseases and metabolic activity, psycho10 logical health, and comorbidities such as diabetes, 

11 cardiovascular disease, and hypertension. 

12 (b) DURATION.—Grants awarded under this section 

13 shall be for a period of 5 years. 

14 (c) APPLICATIONS.—An academic health science cen15 ter, health professions school, or institution of higher edu16 cation seeking a grant under this section shall submit an 

17 application to the Secretary at such time, in such manner, 

18 and containing such information as the Secretary may re19 quire. 

20 (d) PRIORITY.—In awarding grants under this sec21 tion, the Secretary shall give priority to an institution of 

22 higher education that— 

23 (1) has an enrollment of needy students, as de24 fined in section 318(b) of the Higher Education Act 

25 of 1965 (20 U.S.C. 1059e(b)); 


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1 (2) is a Hispanic-serving institution, as defined 

2 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 

3 (3) is a Tribal College or University, as defined 

4 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

5 (4) is an Alaska Native-serving institution, as 

6 defined in section 317(b) of such Act (20 U.S.C. 

7 1059d(b)); 

8 (5) is a Native Hawaiian-serving institution, as 

9 defined in section 317(b) of such Act (20 U.S.C. 

10 1059d(b)); 

11 (6) is a Predominately Black Institution, as de12 fined in section 318(b) of such Act (20 U.S.C. 

13 1059e(b)); 

14 (7) is a Native American-serving, non-Tribal in15 stitution, as defined in section 319(b) of such Act 

16 (20 U.S.C. 1059f(b)); 

17 (8) is an Asian American and Native American 

18 Pacific Islander-serving institution, as defined in 

19 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 

20 (9) is a minority institution, as defined in sec21 tion 365 of such Act (20 U.S.C. 1067k), with an en22 rollment of needy students, as defined in section 312 

23 of such Act (20 U.S.C. 1058). 

24 (e) USES OF FUNDS.—An academic health science 

25 center, health professions school, or institution of higher 


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1 education receiving a grant under this section may use 

2 grant funds to integrate issues relating to comprehensive 

3 arthritis and musculoskeletal health into the academic or 

4 support sectors of the center, school, or institution in 

5 order to reach a large number of students, by carrying 

6 out 1 or more of the following activities: 

7 (1) Developing educational content for issues 

8 relating to comprehensive arthritis and musculo9 skeletal health education that will be incorporated 

10 into first-year orientation or core courses. 

11 (2) Creating innovative technology-based ap12 proaches to deliver arthritis and musculoskeletal 

13 health education to students, faculty, and staff. 

14 (3) Developing and employing peer-outreach 

15 and education programs to generate discussion, edu16 cate, and raise awareness among students about 

17 issues relating to arthritis and musculoskeletal 

18 health disorders, and their relationship to diabetes, 

19 hypertension, cardiovascular disease, psychological 

20 health, and other comorbid conditions. 

21 (f) REPORT TO CONGRESS.— 

22 (1) IN GENERAL.—Not later than 1 year after 

23 the date of the enactment of this Act, and annually 

24 thereafter for a period of 5 years, the Secretary shall 

25 prepare and submit to the appropriate committees of 


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1 Congress a report on the activities to provide health 

2 professions students with comprehensive arthritis 

3 and musculoskeletal health education funded under 

4 this section. 

5 (2) REPORT ELEMENTS.—The report described 

6 in paragraph (1) shall include information about— 

7 (A) the number of entities that are receiv8 ing grant funds; 

9 (B) the specific activities supported by 

10 grant funds; 

11 (C) the number of students served by 

12 grant programs; and 

13 (D) the status of program evaluations. 

14 (g) DEFINITION OF INSTITUTION OF HIGHER EDU15 CATION.—In this section, the term ‘‘institution of higher 

16 education’’ has the meaning given such term in section 

17 101(b) of the Higher Education Act of 1965 (20 U.S.C. 

18 1001(b)). 

19 Subtitle J—Sleep and Circadian 

20 Rhythm Disorders 

21 SEC. 791. SHORT TITLE; FINDINGS. 

22 (a) SHORT TITLE.—This subtitle may be cited as the 

23 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari24 ties Act’’. 

25 (b) FINDINGS.—Congress finds the following: 


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1 (1) Decrements in sleep health such as sleep 

2 apnea, insufficient sleep time, and insomnia, affect 

3 50,000,000 to 70,000,000 adults in the United 

4 States. Twelve to eighteen million United States 

5 adults have sleep apnea, a chronic disorder charac6 terized by one or more pauses in breathing which 

7 can last from a few seconds to minutes. They may 

8 occur 30 times or more an hour, disrupting sleep 

9 and resulting in excessive daytime sleepiness and 

10 loss in productivity. 

11 (2) Seventy percent of high school students are 

12 not getting enough sleep on school nights, while 33 

13 percent of people in the United States get fewer 

14 than 7 hours of sleep per night, and roughly 6,000 

15 fatal motor vehicle crashes are caused by drowsy 

16 drivers. 

17 (3) Insufficient sleep and insomnia are more 

18 prevalent in women. Women who are pregnant and 

19 have sleep apnea are at an increased risk of cardio20 vascular complications during pregnancy. The im21 pact of disparities in sleep health is associated with 

22 a growing number of health problems, including the 

23 following: 

24 (A) Hypertension. 

25 (B) Cancer. 


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1 (C) Stroke. 

2 (D) Cardiac arrhythmia. 

3 (E) Chronic heart failure and heart dis4 ease. 

5 (F) Diabetes. 

6 (G) Cognitive functioning and behavior. 

7 (H) Depression and bipolar disorder. 

8 (I) Substance abuse. 

9 (4) A sleep disparity exists in that poor sleep 

10 quality is strongly associated with poverty and race. 

11 Factors such as employment, education, and health 

12 status, amongst others, significantly mediated this 

13 effect only in poor subjects, suggesting a differential 

14 vulnerability to these factors in poor relative to 

15 nonpoor individuals in the context of sleep quality. 

16 (5) African Americans sleep worse than Cauca17 sian Americans. African Americans take longer to 

18 fall asleep, report poorer sleep quality, have more 

19 light and less deep sleep, and nap more often and 

20 longer. 

21 (6) African Americans and individuals in lower 

22 socioeconomic status groups may be at an increased 

23 risk for sleep disturbances and associated health 

24 consequences. 


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1 (7) Among young African Americans, the likeli2 hood of having sleep disordered breathing and exhib3 iting risk factors for poor sleep is twice that in 

4 young Caucasians. Frequent snoring is more com5 mon among African-American and Hispanic women 

6 and Hispanic men compared to non-Hispanic Cauca7 sians, independent of other factors including obesity. 

8 (8) African Americans with sleep-disordered 

9 breathing develop symptoms at a younger age than 

10 Caucasians but appear less likely to be diagnosed 

11 and treated in a timely manner. This delay may at 

12 least in part be due to reduced access to care. 

13 (9) Sleep loss contributes to increased risk for 

14 chronic conditions such as obesity, diabetes, and hy15 pertension, all of which have increased prevalence in 

16 underserved, underrepresented minorities. Racial 

17 and ethnic disparities related to obesity may also 

18 contribute to disparities in health outcomes related 

19 to sleep-disordered breathing. 

20 (10) Non-Caucasian adults report an insomnia 

21 rate of 12.9 percent compared to only 6.6 percent 

22 for Caucasians. 

23 (11) African-American women have a higher in24 cidence of insomnia than African-American men, 


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1 perhaps related in part to higher risk for chronic 

2 persisting symptoms. 

3 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE4 SEARCH ACTIVITIES OF THE NATIONAL IN5 STITUTES OF HEALTH. 

6 (a) IN GENERAL.—The Director of the National In7 stitutes of Health, acting through the Director of the Na8 tional Heart, Lung, and Blood Institute, shall— 

9 (1) continue to expand research activities ad10 dressing sleep health disparities; and 

11 (2) continue implementation of the NIH Sleep 

12 Disorders Research Plan across all institutes and 

13 centers of the National Institutes of Health to im14 prove treatment and prevention of sleep health dis15 parities. 

16 (b) REQUIRED RESEARCH ACTIVITIES.—In con17 ducting or supporting research relating to sleep and circa18 dian rhythm, the Director of the National Heart, Lung, 

19 and Blood Institute shall— 

20 (1) advance epidemiology and clinical research 

21 to achieve a more complete understanding of dispari22 ties in domains of sleep health and across population 

23 subgroups for which cardiovascular and metabolic 

24 health disparities exist, including— 

25 (A) prevalence and severity of sleep apnea; 


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1 (B) habitual sleep duration; 

2 (C) sleep timing and regularity; and 

3 (D) insomnia; 

4 (2) develop study designs and analytical ap5 proaches to explain and predict multilevel and life6 course determinants of sleep health and to elucidate 

7 the sleep-related causes of cardiovascular and meta8 bolic health disparities across the age spectrum, in9 cluding such determinants and causes that are— 

10 (A) environmental; 

11 (B) biological or genetic; 

12 (C) psychosocial; 

13 (D) societal; 

14 (E) political; or 

15 (F) economic; 

16 (3) determine the contribution of sleep impair17 ments such as sleep apnea, insufficient sleep dura18 tion, irregular sleep schedules, and insomnia to un19 explained disparities in cardiovascular and metabolic 

20 risk and disease outcomes; 

21 (4) develop study designs, data sampling and 

22 collection tools, and analytical approaches to opti23 mize understanding of mediating and moderating 

24 factors, and feedback mechanisms coupling sleep to 

25 cardiovascular and metabolic health disparities; 


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1 (5) advance research to understand cultural 

2 and linguistic barriers (on the person, provider, or 

3 system level) to access to care, medical diagnosis, 

4 and treatment of sleep disorders in diverse popu5 lation groups; 

6 (6) develop and test multilevel interventions (in7 cluding sleep health education in diverse commu8 nities) to reduce disparities in sleep health that will 

9 impact ability to improve disparities in cardio10 vascular and metabolic risk or disease; 

11 (7) create opportunities to integrate sleep and 

12 health disparity science by strategically utilizing re13 sources (existing or anticipated cohorts), exchanging 

14 scientific data and ideas (cross-over into scientific 

15 meetings), and develop multidisciplinary investi16 gator-initiated grant applications; and 

17 (8) enhance the diversity and foster career de18 velopment of young investigators involved in sleep 

19 and health disparities science. 

20 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there are authorized to be appropriated 

22 such sums as may be necessary for fiscal year 2021 and 

23 each subsequent fiscal year. 


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1 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS2 PARITIES-RELATED ACTIVITIES OF THE CEN3 TERS FOR DISEASE CONTROL AND PREVEN4 TION. 

5 (a) IN GENERAL.—The Director of the Centers for 

6 Disease Control and Prevention shall conduct, support, 

7 and expand public health strategies and prevention, diag8 nosis, surveillance, and public and professional awareness 

9 activities regarding sleep and circadian rhythm disorders. 

10 (b) FINDINGS.—Congress finds as follows: 

11 (1) Sleep disorders and sleep deficiency unre12 lated to a primary sleep disorder are underdiagnosed 

13 and are increasingly detrimental to health status. 

14 (2) The consequences to society include addi15 tional diseases, motor vehicle accidents, decreased 

16 longevity, elevated direct medical costs, and indirect 

17 costs related to work absenteeism and property dam18 age. 

19 (c) REQUIRED SURVEILLANCE AND EDUCATION

20 AWARENESS ACTIVITIES.—In conducting or supporting 

21 research relating to sleep and circadian rhythm disorders 

22 surveillance and education awareness activities, the Direc23 tor of the Centers for Disease Control and Prevention 

24 shall— 

25 (1) ensure that such activities are culturally 

26 and linguistically appropriate to minority patients, 


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1 targeting sleep and circadian rhythm health pro2 motion and prevention programs of each major eth3 nic group, including— 

4 (A) Native Americans and Alaska Natives; 

5 (B) Asian Americans; 

6 (C) African Americans and Blacks; 

7 (D) Hispanic and Latino-Americans; and 

8 (E) Native Hawaiians and Pacific Island9 ers; 

10 (2) collect and compile national and State sur11 veillance data on sleep disorders health disparities; 

12 (3) continue to develop and implement new 

13 sleep questions in public health surveillance systems 

14 to increase public awareness of sleep health and 

15 sleep disorders and their impact on health; 

16 (4) publish monthly reports highlighting geo17 graphic, racial, and ethnic disparities in sleep health, 

18 as well as relationships between insufficient sleep 

19 and chronic disease, health risk behaviors, and other 

20 outcomes as determined necessary by the Director; 

21 and 

22 (5) include public awareness campaigns that in23 form patient populations from major ethnic groups 

24 about the prevalence of sleep and circadian rhythm 


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1 disorders and emphasize the importance of sleep 

2 health. 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

4 out this section, there are authorized to be appropriated 

5 such sums as may be necessary for fiscal year 2021 and 

6 each subsequent fiscal year. 

7 SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR8 CADIAN HEALTH EDUCATION WITHIN 

9 HEALTH PROFESSIONS SCHOOLS. 

10 (a) PROGRAM AUTHORIZED.—The Secretary of 

11 Health and Human Services (referred to in this section 

12 as the ‘‘Secretary’’), in coordination with the Secretary of 

13 Education, shall award grants, on a competitive basis, to 

14 academic health science centers, health professions 

15 schools, and institutions of higher education to enable 

16 such centers, schools, and institutions to provide people 

17 with comprehensive education on sleep and circadian 

18 health, particularly— 

19 (1) poor sleep health; 

20 (2) sleep disorders; 

21 (3) sleep health disparities; and 

22 (4) the relationship between sleep and circadian 

23 health on metabolic activity, neurological activity, 

24 comorbidities, and other diseases. 


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1 (b) DURATION.—Grants awarded under this section 

2 shall be for a period of 5 years. 

3 (c) APPLICATIONS.—An academic health science cen4 ter, health professions school, or institution of higher edu5 cation seeking a grant under this section shall submit an 

6 application to the Secretary at such time, in such manner, 

7 and containing such information as the Secretary may re8 quire. 

9 (d) PRIORITY.—In awarding grants under this sec10 tion, the Secretary shall give priority to an institution of 

11 higher education that— 

12 (1) has an enrollment of needy students, as de13 fined in section 318(b) of the Higher Education Act 

14 of 1965 (20 U.S.C. 1059e(b)); 

15 (2) is a Hispanic-serving institution, as defined 

16 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 

17 (3) is a Tribal College or University, as defined 

18 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

19 (4) is an Alaska Native-serving institution, as 

20 defined in section 317(b) of such Act (20 U.S.C. 

21 1059d(b)); 

22 (5) is a Native Hawaiian-serving institution, as 

23 defined in section 317(b) of such Act (20 U.S.C. 

24 1059d(b)); 


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1 (6) is a Predominately Black Institution, as de2 fined in section 318(b) of such Act (20 U.S.C. 

3 1059e(b)); 

4 (7) is a Native American-serving, nontribal in5 stitution, as defined in section 319(b) of such Act 

6 (20 U.S.C. 1059f(b)); 

7 (8) is an Asian American and Native American 

8 Pacific Islander-serving institution, as defined in 

9 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 

10 (9) is a minority institution, as defined in sec11 tion 365 of such Act (20 U.S.C. 1067k), with an en12 rollment of needy students, as defined in section 312 

13 of such Act (20 U.S.C. 1058). 

14 (e) USES OF FUNDS.—An academic health science 

15 center, health professions school, or institution of higher 

16 education receiving a grant under this section may use the 

17 grant funds to integrate issues relating to comprehensive 

18 sleep and circadian health into the academic or support 

19 sectors of the center, school, or institution, in order to 

20 reach a large number of students, by carrying out 1 or 

21 more of the following activities: 

22 (1) Developing educational content for issues 

23 relating to comprehensive sleep and circadian health 

24 education that will be incorporated into first-year 

25 orientation or core courses. 


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1 (2) Creating innovative technology-based ap2 proaches to deliver sleep health education to stu3 dents, faculty, and staff. 

4 (3) Developing and employing peer-outreach 

5 and education programs to generate discussion, edu6 cate, and raise awareness among students about 

7 issues relating to poor quality sleep, sleep and circa8 dian disorders, and the role sleep health plays in 

9 other diseases and comorbidities. 

10 (f) REPORT TO CONGRESS.— 

11 (1) IN GENERAL.—Not later than 1 year after 

12 the date of the enactment of this Act, and annually 

13 thereafter for a period of 5 years, the Secretary shall 

14 prepare and submit to the appropriate committees of 

15 Congress a report on the activities to provide health 

16 professions students with comprehensive sleep and 

17 circadian health education funded under this section. 

18 (2) REPORT ELEMENTS.—The report described 

19 in paragraph (1) shall include information about— 

20 (A) the number of entities that are receiv21 ing grant funds; 

22 (B) the specific activities supported by 

23 grant funds; 

24 (C) the number of students served by 

25 grant programs; and 


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1 (D) the status of program evaluations. 

2 (g) DEFINITION OF INSTITUTION OF HIGHER EDU3 CATION.—In this section, the term ‘‘institution of higher 

4 education’’ has the meaning given such term in section 

5 101(b) of the Higher Education Act of 1965 (20 U.S.C. 

6 1001(b)). 

7 SEC. 795. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 

8 HEALTH DISORDERS IN VULNERABLE AND 

9 RACIAL/ETHNIC POPULATIONS. 

10 (a) IN GENERAL.—Not later than 1 year after the 

11 date of enactment of this Act, the Secretary of Health and 

12 Human Services shall submit to Congress and the Presi13 dent a report on the impact of sleep and circadian health 

14 disorders for racial and ethnic minority communities and 

15 other vulnerable populations. 

16 (b) CONTENTS.—The report under subsection (a) 

17 shall include information on the— 

18 (1) progress that has been made in reducing 

19 the impact of sleep and circadian health disorders in 

20 such communities and populations; 

21 (2) opportunities that exist to make additional 

22 progress in reducing the impact of sleep and circa23 dian health disorders in such communities and popu24 lations; 


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1 (3) challenges that may impede such additional 

2 progress; and 

3 (4) Federal funding necessary to achieve sub4 stantial reductions in sleep and circadian health dis5 orders in racial and ethnic minority communities. 

6 Subtitle K—Kidney Disease Re7 search, Surveillance, Preven8 tion, and Treatment 

9 SEC. 797. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, 

10 PREVENTION, AND TREATMENT. 

11 (a) SHORT TITLE.—This section may be cited as the 

12 ‘‘Kidney Disease Research, Surveillance, Prevention and 

13 Treatment Improvement Act of 2020’’. 

14 (b) FINDINGS.—Congress makes the following find15 ings: 

16 (1) Kidney diseases impact 37,000,000 individ17 uals in the United States. 

18 (2) African Americans comprise just 13 percent 

19 of the United States population, but 33 percent of 

20 the United States dialysis patient population. Com21 pared to Caucasians, kidney failure prevalence is 

22 about 3.7 times greater in African Americans, 1.4 

23 times greater in Native Americans, and 1.5 times 

24 greater in Asian Americans. 


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1 (3) Peritoneal dialysis and home hemodialysis 

2 use is 40–50 percent lower among African Ameri3 cans and Hispanics. 

4 (4) Every racial and ethnic minority group in 

5 the United States is significantly less likely to be 

6 treated with home dialysis than Whites, and demo7 graphic and clinical characteristics are insufficient to 

8 explain this differential use. 

9 (5) African Americans on dialysis, irrespective 

10 of dialysis modality, and Hispanics undergoing PD 

11 or in-center HD, are significantly less likely than 

12 their White counterparts to receive a kidney trans13 plant. 

14 (6) African Americans, Hispanics, and Asian 

15 Americans are less likely to receive living donor kid16 ney transplants than Whites. Efforts to reduce dis17 parities in live donor kidney transplantation for Afri18 can-American, Hispanic, and Asian patients with 

19 kidney failure have been unsuccessful. 

20 (7) Medicare and Medicaid patients are less 

21 likely to receive a preemptive transplant from a de22 ceased donor compared to private insurance patients 

23 (5 percent and 11 percent versus 24 percent), and 

24 Black and Hispanic patients are less likely to receive 

25 a preemptive transplant from a deceased donor comVerDate Sep 11 2014 23:11 Dec 01, 2020 Jkt 019200 PO 00000 Frm 00833 Fmt 6652 Sfmt 6201 E:\BILLS\S4819.IS S4819

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1 pared with White patients even after changes to the 

2 kidney allocation system (5 percent of Black patients 

3 and 5 percent of Hispanic patients compared with 

4 18 percent of White patients). 

5 (8) Low-income populations are significantly 

6 more likely to progress to kidney failure. 

7 (9) Low socioeconomic status is associated with 

8 increased incidence of chronic kidney disease, pro9 gression to kidney failure, inadequate dialysis treat10 ment, and reduced access to kidney transplantation. 

11 (10) The 3 goals of Executive Order 13879 of 

12 July 10, 2019 (84 Fed. Reg. 33817; relating to Ad13 vancing American Kidney Health), recognizes the 

14 need for more transplants, better prevention and 

15 education, and improved access to treatment modali16 ties. 

17 SEC. 798. KIDNEY DISEASE RESEARCH IN MINORITY POPU18 LATIONS. 

19 (a) IN GENERAL.—The Director of the National In20 stitutes of Health shall expand, intensify, and support on21 going research and other activities with respect to kidney 

22 disease in minority populations. 

23 (b) RESEARCH.— 

24 (1) DESCRIPTION.—Research under subsection 

25 (a) shall include investigation into— 


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1 (A) the causes of kidney disease, including 

2 socioeconomic, geographic, clinical, environ3 mental, genetic, and other factors that may 

4 contribute to increased rates of kidney disease 

5 in minority populations; and 

6 (B) the causes of increased incidence of 

7 kidney disease complications in minority popu8 lations, and possible interventions to decrease 

9 such incidence. 

10 (2) INCLUSION OF MINORITY PARTICIPANTS.— 

11 In conducting and supporting research described in 

12 subsection (a), the Director of the National Insti13 tutes of Health shall seek to include minority par14 ticipants as study subjects in clinical trials. 

15 (c) REPORT; COMPREHENSIVE PLAN.— 

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

17 Human Services shall— 

18 (A) prepare and submit to the Congress, 

19 not later than 6 months after the date of enact20 ment of this section, a report on Federal re21 search and public health activities with respect 

22 to kidney disease in minority populations; and 

23 (B) develop and submit to Congress, not 

24 later than 1 year after the date of enactment of 

25 this section, an effective and comprehensive 


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1 Federal plan (including all appropriate Federal 

2 health programs) to address kidney disease in 

3 minority populations. 

4 (2) CONTENTS.—The report under paragraph 

5 (1)(A) shall at minimum address each of the fol6 lowing: 

7 (A) Research on kidney disease in minority 

8 populations, including such research on— 

9 (i) genetic, behavioral, and environ10 mental factors; and 

11 (ii) prevention and complications 

12 among individuals within these populations 

13 who have already developed kidney disease. 

14 (B) Surveillance and data collection on 

15 kidney disease in minority populations, includ16 ing with respect to— 

17 (i) efforts to better determine the 

18 prevalence of kidney disease among Asian19 American and Pacific Islander subgroups; 

20 and 

21 (ii) efforts to coordinate data collec22 tion on the American Indian population. 

23 (C) Community-based interventions to ad24 dress kidney disease targeting minority popu25 lations, including— 


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1 (i) the evidence base for such inter2 ventions; 

3 (ii) the cultural appropriateness of 

4 such interventions; and 

5 (iii) efforts to educate the public on 

6 the causes and consequences of kidney dis7 ease. 

8 (D) Education and training programs for 

9 health professionals (including community 

10 health workers) on the prevention and manage11 ment of kidney disease and its related complica12 tions that are supported by the Health Re13 sources and Services Administration, including 

14 such programs supported by the Bureau of 

15 Health Workforce, the Bureau of Primary 

16 Health Care, and the Healthcare Systems Bu17 reau. 

18 SEC. 799. KIDNEY DISEASE ACTION PLAN. 

19 (a) IN GENERAL.—The Director of the Centers for 

20 Disease Control and Prevention shall conduct, support, 

21 and expand public health strategies, prevention, diagnosis, 

22 surveillance, and public and professional awareness activi23 ties regarding kidney disease. 

24 (b) NATIONAL ACTION PLAN.— 


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1 (1) DEVELOPMENT.—Not later than 2 years 

2 after the date of the enactment of this Act, the Di3 rector of the National Institute of Diabetes and Di4 gestive and Kidney Diseases, in consultation with 

5 the Director of the Centers for Disease Control and 

6 Prevention, shall develop a national action plan to 

7 address kidney disease in the United States with 

8 participation from patients, caregivers, health pro9 fessionals, patient advocacy organizations, research10 ers, providers, public health professionals, and other 

11 stakeholders. 

12 (2) CONTENTS.—At a minimum, such plan 

13 shall include recommendations for— 

14 (A) public health interventions for the pur15 pose of implementation of the national plan; 

16 (B) biomedical, health services, and public 

17 health research on kidney disease; and 

18 (C) inclusion of kidney disease in the 

19 health data collections of all Federal agencies. 

20 (c) KIDNEY DISEASE PREVENTION PROGRAMS.—The 

21 Director of the National Institute of Diabetes and Diges22 tive and Kidney Diseases shall carry out the following: 

23 (1) Conduct public education and awareness ac24 tivities with patient and professional organizations 

25 to stimulate earlier diagnosis and improve patient 


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1 outcomes from treatment of kidney disease. To the 

2 extent known and relevant, such public education 

3 and awareness activities shall reflect differences in 

4 kidney disease by cause (such as hypertension, dia5 betes, and polycystic kidney disease) and include a 

6 focus on outreach to undiagnosed and, as appro7 priate, minority populations. 

8 (2) Supplement and expand upon the activities 

9 of the National Institute of Diabetes and Digestive 

10 and Kidney Diseases by making grants to nonprofit 

11 organizations, State and local jurisdictions, and In12 dian tribes for the purpose of reducing the burden 

13 of kidney disease, especially in disproportionately im14 pacted communities, through public health interven15 tions and related activities. 

16 (3) Coordinate with the Centers for Disease 

17 Control and Prevention, the Indian Health Service, 

18 the Health Resources and Services Administration, 

19 and the Department of Veterans Affairs to develop 

20 pilot programs to demonstrate best practices for the 

21 diagnosis and management of kidney disease. 

22 (4) Develop improved techniques and identify 

23 best practices, in coordination with the Secretary of 

24 Veterans Affairs, for assisting kidney disease pa25 tients. 


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1 (d) DATA COLLECTION.—Not later than 180 days 

2 after the date of enactment of this Act, the Director of 

3 the National Institute of Diabetes and Digestive and Kid4 ney Diseases and the Director of the Centers for Disease 

5 Control and Prevention, acting jointly, shall assess the 

6 depth and quality of information on kidney disease that 

7 is collected in surveys and population studies conducted 

8 by the Centers for Disease Control and Prevention, includ9 ing whether there are additional opportunities for informa10 tion to be collected in the National Health and Nutrition 

11 Examination Survey, the National Health Interview Sur12 vey, and the Behavioral Risk Factor Surveillance System 

13 surveys. The Director of the National Institute of Diabetes 

14 and Digestive and Kidney Diseases shall include the re15 sults of such assessment in the national action plan under 

16 subsection (b). 

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to carry out this section 

19 $1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 

20 2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis21 cal year 2024, and $1,000,000 for fiscal year 2025. 

22 SEC. 799A. HOME DIALYSIS AND INCREASING END-STAGE 

23 RENAL DISEASE TREATMENT MODALITIES IN 

24 MINORITY COMMUNITIES ACTION PLAN. 

25 (a) NATIONAL ACTION PLAN.— 


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1 (1) DEVELOPMENT.—Not later than 2 years 

2 after the date of the enactment of this Act, the Di3 rector of the National Institute of Diabetes and Di4 gestive and Kidney Diseases, in consultation with 

5 the Director of the Centers for Disease Control and 

6 Prevention, shall develop a national action plan to 

7 increase the number of home dialyzers and choice in 

8 dialysis treatment modality in the United States 

9 with participation from patients, caregivers, health 

10 professionals, patient advocacy organizations, re11 searchers, providers, public health professionals, and 

12 other stakeholders in minority communities. 

13 (2) CONTENTS.—At a minimum, such plan 

14 shall include recommendations for— 

15 (A) public health officials for the purpose 

16 of implementation of the national plan; 

17 (B) biomedical, health services, and public 

18 health research on home dialysis and modalities 

19 in minority communities; and 

20 (C) inclusion of dialysis location and mo21 dality in the health data collections of all Fed22 eral agencies. 

23 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated to carry out this section 

25 $1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 


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1 2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis2 cal year 2024, and $1,000,000 for fiscal year 2025. 

3 SEC. 799B. INCREASING KIDNEY TRANSPLANTS IN MINOR4 ITY POPULATIONS. 

5 (a) IN GENERAL.—The Director of the National In6 stitutes of Health shall expand, intensify, and support on7 going research and other activities with respect to kidney 

8 transplants in minority populations. 

9 (b) RESEARCH.—Research under subsection (a) shall 

10 include investigation into— 

11 (1) the causes of lower rates of kidney trans12 plants in minority populations, including socio13 economic, geographic, clinical, environmental, ge14 netic, and other factors that may contribute to lower 

15 rates of kidney transplants in minority populations; 

16 and 

17 (2) possible interventions to increase kidney 

18 transplants. 

19 (c) REPORT; COMPREHENSIVE PLAN.— 

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

21 Human Services shall— 

22 (A) prepare and submit to the Congress, 

23 not later than 6 months after the date of enact24 ment of this section, a report on Federal re25 search and public health activities with respect 


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1 to kidney transplants as a treatment for end2 stage renal disease in minority populations; and 

3 (B) develop and submit to the Congress, 

4 not later than 1 year after the date of enact5 ment of this section, an effective and com6 prehensive Federal plan (including all appro7 priate Federal health programs) to increase the 

8 number of kidney transplants in minority popu9 lations. 

10 (2) CONTENTS.—The report under paragraph 

11 (1)(A) shall at a minimum address each of the fol12 lowing: 

13 (A) Research on kidney transplants in mi14 nority populations, including such research on 

15 financial, insurance coverage, genetic, behav16 ioral, and environmental factors. 

17 (B) Surveillance and data collection on 

18 kidney transplants in minority populations, in19 cluding with respect to— 

20 (i) efforts to increase kidney trans21 plants among Asian-American and Pacific 

22 Islander subgroups with end-stage renal 

23 disease; and 

24 (ii) efforts to increase kidney trans25 plants in the American Indian population. 


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1 (C) Community-based efforts to increase 

2 kidney transplants targeting minority popu3 lations, including— 

4 (i) the evidence base for such in5 creases; 

6 (ii) the cultural appropriateness of 

7 such increases; and 

8 (iii) efforts to educate the public on 

9 kidney transplants. 

10 (D) Education and training programs for 

11 health professionals (including community 

12 health workers) on the kidney transplants that 

13 are supported by the Health Resources and 

14 Services Administration, including such pro15 grams supported by the Bureau of Health 

16 Workforce, the Bureau of Primary Health Care, 

17 and the Healthcare Systems Bureau. 

18 SEC. 799C. ENVIRONMENTAL AND OCCUPATIONAL HEALTH 

19 PROGRAMS. 

20 The Director of the Centers for Disease Control and 

21 Prevention shall— 

22 (1) support research into the environmental and 

23 occupational causes and biological mechanisms that 

24 contribute to kidney disease; and 


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1 (2) develop and disseminate public health inter2 ventions that will lessen the impact of environmental 

3 and occupational causes of kidney disease. 

4 SEC. 799D. UNDERSTANDING THE TREATMENT PATTERNS 

5 ASSOCIATED WITH PROVIDING CARE AND 

6 TREATMENT OF KIDNEY FAILURE IN MINOR7 ITY POPULATIONS. 

8 (a) STUDY.—The Secretary of Health and Human 

9 Services (in this section referred to as the ‘‘Secretary’’) 

10 shall conduct a study on treatment patterns associated 

11 with providing care, under the Medicare program under 

12 title XVIII of the Social Security Act (42 U.S.C. 1395 

13 et seq.), the Medicaid program under title XIX of such 

14 Act (42 U.S.C. 1396 et seq.), and through private health 

15 insurance, to minority populations that are disproportion16 ately affected by kidney failure. 

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

18 of the enactment of this Act, the Secretary shall submit 

19 to Congress a report on the study conducted under sub20 section (a), together with such recommendations as the 

21 Secretary determines to be appropriate. 

22 SEC. 799E. IMPROVING ACCESS IN UNDERSERVED AREAS. 

23 (a) DEFINITION OF PRIMARY CARE SERVICES.—Sec24 tion 331(a)(3)(D) of the Public Health Service Act (42 


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1 U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘renal di2 alysis,’’ after ‘‘dentistry,’’. 

3 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR4 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 

5 Service Act (42 U.S.C. 254l(a)(2)) is amended by insert6 ing ‘‘, which may include nephrology health professionals’’ 

7 before the period at the end. 

8 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE9 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 

10 Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 

11 by inserting ‘‘, which may include nephrology health pro12 fessionals’’ before the period at the end. 

13 TITLE VIII—HEALTH 

14 INFORMATION TECHNOLOGY 

15 SEC. 800. DEFINITIONS. 

16 In this title: 

17 (1) CERTIFIED ELECTRONIC HEALTH RECORD

18 TECHNOLOGY.—The term ‘‘certified EHR tech19 nology’’ has the meaning given such term in section 

20 3000 of the Public Health Service Act (42 U.S.C. 

21 300jj). 

22 (2) EHR.—The term ‘‘EHR’’ means an elec23 tronic health record. 

24 (3) INTEROPERABILITY.—The term ‘‘interoper25 ability’’ has the meaning given such term in section 


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1 3000 of the Public Health Service Act (42 U.S.C. 

2 300jj). Evaluation and measurement of interoper3 ability shall consider exchange of electronic health 

4 information, usability of exchanged electronic health 

5 information, effective application and use of the ex6 changed electronic health information, and impact 

7 on outcomes of interoperability. 

8 (4) ACCESS.—The term ‘‘access’’, with respect 

9 to health information, means access described in sec10 tion 164.524 of title 45, Code of Federal Regula11 tions (or any successor regulations). 

12 (5) CERTIFIED ELECTRONIC HEALTH RECORD

13 TECHNOLOGY; EHR.—The terms ‘‘certified electronic 

14 health record technology’’ and ‘‘EHR’’ include the 

15 health information infrastructure for interoper16 ability, access, exchange, and use of electronic health 

17 information required under title XXX of the Public 

18 Health Service Act (42 U.S.C. 300jj et seq.), and 

19 are not limited to electronic health records main20 tained by doctors. 


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1 Subtitle A—Reducing Health 

2 Disparities Through Health IT 

3 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 

4 PROMOTION OF HEALTH IT. 

5 The Secretary of Health and Human Services, acting 

6 through the Administrator of the Health Resources and 

7 Services Administration, shall expand and intensify the 

8 programs and activities of the Administration (directly or 

9 through grants or contracts) to provide technical assist10 ance and resources to health centers (as defined in section 

11 330(a) of the Public Health Service Act (42 U.S.C. 

12 254b(a))) to adopt and meaningfully use certified EHR 

13 technology for the management of chronic diseases and 

14 health conditions and reduction of health disparities. 

15 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA16 CIAL AND ETHNIC MINORITY COMMUNITIES; 

17 OUTREACH AND ADOPTION OF HEALTH IT IN 

18 SUCH COMMUNITIES. 

19 (a) NATIONAL COORDINATOR FOR HEALTH INFOR20 MATION TECHNOLOGY.— 

21 (1) IN GENERAL.—Not later than 18 months 

22 after the date of enactment of this Act, the National 

23 Coordinator for Health Information Technology (re24 ferred to in this section as the ‘‘National Coordi25 nator’’) shall— 


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1 (A) conduct an evaluation of the level of 

2 interoperability, access, use, and accessibility of 

3 electronic health records in racial and ethnic 

4 minority communities, focusing on whether pa5 tients in such communities have providers who 

6 use electronic health records, and the degree to 

7 which patients in such communities can access, 

8 exchange, and use without special effort their 

9 health information in those electronic health 

10 records, and indicating whether such pro11 viders— 

12 (i) are participating in the Medicare 

13 program under title XVIII of the Social 

14 Security Act (42 U.S.C. 1395 et seq.) or 

15 a State plan under title XIX of such Act 

16 (42 U.S.C. 1396 et seq.) (or a waiver of 

17 such plan); 

18 (ii) have received incentive payments 

19 or incentive payment adjustments under 

20 Medicare and Medicaid Electronic Health 

21 Records Incentive Programs (as defined in 

22 subsection (c)(2)); 

23 (iii) are MIPS eligible professionals, 

24 as defined in paragraph (1)(C) of section 

25 1848(q) of the Social Security Act (42 


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1 U.S.C. 1395w–4(q)), for purposes of the 

2 Merit-Based Incentive Payment System 

3 under such section; or 

4 (iv) have been recruited by any of the 

5 Health Information Technology Regional 

6 Extension Centers established under sec7 tion 3012 of the Public Health Service Act 

8 (42 U.S.C. 300jj–32); and 

9 (B) publish the results of such evaluation 

10 including the race and ethnicity of such pro11 viders and the populations served by such pro12 viders. 

13 (2) CERTIFICATION CRITERION.—Not later 

14 than 1 year after the date of enactment of this Act, 

15 the National Coordinator shall— 

16 (A) promulgate a certification criterion and 

17 module of certified EHR technology that strati18 fies quality measures for purposes of the Merit19 Based Incentive Payment System by disparity 

20 characteristics, including race, ethnicity, lan21 guage, gender, gender identity, sexual orienta22 tion, socio-economic status, and disability sta23 tus, as such characteristics are defined for pur24 poses of certified EHR technology; and 


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1 (B) report to the Centers for Medicare & 

2 Medicaid Services the quality measures strati3 fied by race and at least 2 other disparity char4 acteristics. 

5 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 

6 As soon as practicable after the date of enactment of this 

7 Act, the Director of the National Center for Health Statis8 tics shall provide to Congress a more detailed analysis of 

9 the data presented in National Center for Health Statis10 tics data brief entitled ‘‘Adoption of Certified Electronic 

11 Health Record Systems and Electronic Information Shar12 ing in Physician Offices: United States, 2013 and 2014’’ 

13 (NCHS Data Brief No. 236). 

14 (c) CENTERS FOR MEDICARE & MEDICAID SERV15 ICES.— 

16 (1) IN GENERAL.—As part of the process of 

17 collecting information, with respect to a provider, at 

18 registration and attestation for purposes of Medicare 

19 and Medicaid Electronic Health Records Incentive 

20 Programs (as defined in paragraph (2)) or the 

21 Merit-Based Incentive Payment System under sec22 tion 1848(q) of the Social Security Act (42 U.S.C. 

23 1395w–4(q)), the Secretary of Health and Human 

24 Services shall collect the race and ethnicity of such 

25 provider. 


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1 (2) MEDICARE AND MEDICAID ELECTRONIC

2 HEALTH RECORDS INCENTIVE PROGRAMS DE3 FINED.—For purposes of paragraph (1), the term 

4 ‘‘Medicare and Medicaid Electronic Health Records 

5 Incentive Programs’’ means the incentive programs 

6 under section 1814(l)(3), subsections (a)(7) and (o) 

7 of section 1848, subsections (l) and (m) of section 

8 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 

9 1886, and subsections (a)(3)(F) and (t) of section 

10 1903 of the Social Security Act (42 U.S.C. 

11 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 

12 1396b). 

13 (d) NATIONAL COORDINATOR’S ASSESSMENT OF IM14 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 

15 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 

16 amended— 

17 (1) in the heading by inserting ‘‘, RACIAL AND

18 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH

19 DISPARITIES’’; 

20 (2) by inserting ‘‘, in communities with a high 

21 proportion of individuals from racial and ethnic mi22 nority groups (as defined in section 1707(g)), in23 cluding people with disabilities in these groups,’’ 

24 after ‘‘communities with health disparities’’; 


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1 (3) by striking ‘‘The National Coordinator’’ and 

2 inserting the following: 

3 ‘‘(i) IN GENERAL.—The National Co4 ordinator’’; and 

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

6 ‘‘(ii) CRITERIA.—In any publication 

7 under clause (i), the National Coordinator 

8 shall include best practices for encouraging 

9 partnerships between the Federal Govern10 ment, States, and private entities to ex11 pand outreach for and the adoption of cer12 tified EHR technology in communities with 

13 a high proportion of individuals from racial 

14 and ethnic minority groups (as so defined), 

15 while also maintaining the accessibility re16 quirements of section 508 of the Rehabili17 tation Act of 1973 to encourage patient in18 volvement in patient health care. The Na19 tional Coordinator shall— 

20 ‘‘(I) not later than 6 months 

21 after the submission of the report re22 quired under section 822 of the 

23 Health Equity and Accountability Act 

24 of 2020, establish criteria for evalu25 ating the impact of health information 


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1 technology on communities with a 

2 high proportion of individuals from 

3 racial and ethnic minority groups (as 

4 so defined) taking into account the 

5 findings in such report; and 

6 ‘‘(II) not later than 1 year after 

7 the submission of such report, conduct 

8 and publish the results of an evalua9 tion of such impact.’’. 

10 SEC. 803. NONDISCRIMINATION AND HEALTH EQUITY IN 

11 HEALTH INFORMATION TECHNOLOGY. 

12 (a) IN GENERAL.—Covered entities shall ensure that 

13 electronic and information technology in their health pro14 grams or activities does not exclude individuals from par15 ticipation in, deny individuals the benefits of, or subject 

16 individuals to discrimination under any health program or 

17 activity on the basis of race, color, national origin, sex, 

18 age, or disability. 

19 (b) COVERED ENTITIES.—In this section, the term 

20 ‘‘covered entity’’ means— 

21 (1) an entity that operates a health program or 

22 activity, any part of which receives Federal financial 

23 assistance; 

24 (2) an entity established under title I of the Pa25 tient Protection and Affordable Care Act (Public 


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1 Law 114–148) that administers a health program or 

2 activity; or 

3 (3) the Department of Health and Human 

4 Services. 

5 SEC. 804. LANGUAGE ACCESS IN HEALTH INFORMATION 

6 TECHNOLOGY. 

7 The National Coordinator shall— 

8 (1) not later than 18 months after the date of 

9 enactment of this Act, propose a rule for providing 

10 access to patients, through certified EHR tech11 nology, to their personal health information in a 

12 computable format, including using patient portals 

13 or third-party applications (as described in section 

14 3009(e) of the Public Health Service Act (42 U.S.C. 

15 300jj–19(e))), in the 10 most common non-English 

16 languages; 

17 (2) hold a public hearing to identify best prac18 tices for carrying out paragraph (1); and 

19 (3) not later than 6 months after the public 

20 hearing under paragraph (2), promulgate a final 

21 regulation with respect to paragraph (1). 


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1 Subtitle B—Modifications To 

2 Achieve Parity in Existing Pro3 grams 

4 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 

5 HEALTH IT INFRASTRUCTURE IN RACIAL 

6 AND ETHNIC MINORITY COMMUNITIES. 

7 Section 3011 of the Public Health Service Act (42 

8 U.S.C. 300jj–31) is amended— 

9 (1) in subsection (a), in the matter preceding 

10 paragraph (1), by inserting ‘‘, including with respect 

11 to communities with a high proportion of individuals 

12 from racial and ethnic minority groups (as defined 

13 in section 1707(g))’’ before the colon; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 

17 National Coordinator shall report annually to Congress on 

18 activities and expenditures under this section.’’. 

19 SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DE20 VELOPMENT OF LOAN PROGRAMS TO FACILI21 TATE ADOPTION OF CERTIFIED EHR TECH22 NOLOGY BY PROVIDERS SERVING RACIAL 

23 AND ETHNIC MINORITY GROUPS. 

24 Section 3014(e) of the Public Health Service Act (42 

25 U.S.C. 300jj–34(e)) is amended, in the matter preceding 


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1 paragraph (1), by inserting ‘‘, including with respect to 

2 communities with a high proportion of individuals from 

3 racial and ethnic minority groups (as defined in section 

4 1707(g))’’ after ‘‘health care provider to’’. 

5 SEC. 813. AUTHORIZATION OF APPROPRIATIONS. 

6 Section 3018 of the Public Health Service Act (42 

7 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 

8 2009 through 2013’’ and inserting ‘‘fiscal years 2021 

9 through 2026’’. 

10 Subtitle C—Additional Research 

11 and Studies 

12 SEC. 821. DATA COLLECTION AND ASSESSMENTS CON13 DUCTED IN COORDINATION WITH MINORITY14 SERVING INSTITUTIONS. 

15 Section 3001(c)(6) of the Public Health Service Act 

16 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 

17 end the following new subparagraph: 

18 ‘‘(F) DATA COLLECTION AND ASSESS19 MENTS CONDUCTED IN COORDINATION WITH

20 MINORITY-SERVING INSTITUTIONS.— 

21 ‘‘(i) IN GENERAL.—In carrying out 

22 subparagraph (C) with respect to commu23 nities with a high proportion of individuals 

24 from racial and ethnic minority groups (as 

25 defined in section 1707(g)), the National 


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1 Coordinator shall, to the greatest extent 

2 possible, coordinate with an entity de3 scribed in clause (ii). 

4 ‘‘(ii) MINORITY-SERVING INSTITU5 TIONS.—For purposes of clause (i), an en6 tity described in this clause is a historically 

7 black college or university, a Hispanic-serv8 ing institution, a Tribal College or Univer9 sity, or an Asian-American-, Native Amer10 ican-, or Pacific Islander-serving institu11 tion with an accredited public health, 

12 health policy, or health services research 

13 program.’’. 

14 SEC. 822. STUDY OF HEALTH INFORMATION TECHNOLOGY 

15 IN MEDICALLY UNDERSERVED COMMU16 NITIES. 

17 (a) IN GENERAL.—Not later than 2 years after the 

18 date of enactment of this Act, the Secretary of Health and 

19 Human Services shall— 

20 (1) enter into an agreement with the National 

21 Academies of Sciences, Engineering, and Medicine to 

22 conduct a study on the development, implementa23 tion, and effectiveness of health information tech24 nology within medically underserved areas (as de25 scribed in subsection (c)); and 


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1 (2) submit a report to Congress describing the 

2 results of such study, including any recommenda3 tions for legislative or administrative action. 

4 (b) STUDY.—The study described in subsection 

5 (a)(1) shall— 

6 (1) identify barriers to successful implementa7 tion of health information technology in medically 

8 underserved areas; 

9 (2) survey a cross-section of individuals in 

10 medically underserved areas and report their opin11 ions about the various topics of study; 

12 (3) examine the degree of interoperability 

13 among health information technology and users of 

14 health information technology in medically under15 served areas, including patients, providers, and com16 munity services; 

17 (4) examine the impact of health information 

18 technology on providing quality care and reducing 

19 the cost of care to individuals in such areas, includ20 ing the impact of such technology on improved 

21 health outcomes for individuals, including which 

22 technology worked for which population and how it 

23 improved health outcomes for that population; 


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1 (5) examine the impact of health information 

2 technology on improving health care-related deci3 sions by both patients and providers in such areas; 

4 (6) identify specific best practices for using 

5 health information technology to foster the con6 sistent provision of physical accessibility and reason7 able policy accommodations in health care to individ8 uals with disabilities in such areas; 

9 (7) assess the feasibility and costs associated 

10 with the use of health information technology in 

11 such areas; 

12 (8) evaluate whether the adoption and use of 

13 qualified electronic health records (as defined in sec14 tion 3000 of the Public Health Service Act (42 

15 U.S.C. 300jj)) is effective in reducing health dispari16 ties, including analysis of clinical quality measures 

17 reported by providers who are participating in the 

18 Medicare program under title XVIII of the Social 

19 Security Act (42 U.S.C. 1395 et seq.) or a State 

20 plan under title XIX of such Act (42 U.S.C. 1396 

21 et seq.) (or a waiver of such plan), pursuant to pro22 grams to encourage the adoption and use of certified 

23 EHR technology; 

24 (9) identify providers in medically underserved 

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1 tronic health records and determine what barriers 

2 are preventing those providers from adopting and 

3 using such records; and 

4 (10) examine urban and rural community 

5 health systems and determine the impact that health 

6 information technology may have on the capacity of 

7 primary health providers in those systems. 

8 (c) MEDICALLY UNDERSERVED AREA.—The term 

9 ‘‘medically underserved area’’ means— 

10 (1) a population that has been designated as a 

11 medically underserved population under section 

12 330(b)(3) of the Public Health Service Act (42 

13 U.S.C. 254b(b)(3)); 

14 (2) an area that has been designated as a 

15 health professional shortage area under section 332 

16 of the Public Health Service Act (42 U.S.C. 254e); 

17 (3) an area or population that has been des18 ignated as a medically underserved community under 

19 section 799B of the Public Health Service Act (42 

20 U.S.C. 295p); or 

21 (4) another area or population that— 

22 (A) experiences significant barriers to ac23 cessing quality health services; and 

24 (B) has a high prevalence of diseases or 

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1 eases or conditions having a disproportionate 

2 impact on racial and ethnic minority groups (as 

3 defined in section 1707(g) of the Public Health 

4 Service Act (42 U.S.C. 300u–6(g))) or a sub5 group of people with disabilities who have spe6 cific functional impairments. 

7 SEC. 823. ASSESSMENT OF USE AND MISUSE OF DE-IDENTI8 FIED HEALTH DATA. 

9 (a) IN GENERAL.—Not later than 18 months after 

10 the date of enactment of this Act, the Secretary of Health 

11 and Human Services shall— 

12 (1) enter into an agreement with the Office of 

13 the National Coordinator to conduct a study, in con14 sultation with relevant stakeholders, on the impact 

15 of digital health technology on medically underserved 

16 areas (as described in section 822(c)); and 

17 (2) submit a report to Congress describing the 

18 results of such study, including any recommenda19 tions for legislative or administrative action. 

20 (b) STUDY.—The study described in subsection 

21 (a)(1) shall— 

22 (1) examine the overall prevalence, and histor23 ical and existing practices and their respective preva24 lence, of use and misuse of de-identified protected 

25 health information, as defined in section 160.103, 


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1 title 45, Code of Federal Regulations (or any suc2 cessor regulations), to discriminate against or ben3 efit medically underserved areas; 

4 (2) identify best practices and tools to leverage 

5 the benefits and prevent misuse of de-identified pro6 tected health information to discriminate against 

7 medically underserved areas; 

8 (3) examine the overall prevalence, and histor9 ical and existing practices and their respective preva10 lence, of use and misuse of de-identified personal 

11 health information other than protected health infor12 mation, as defined in section 160.103, title 45, Code 

13 of Federal Regulations (or any successor regula14 tions), to discriminate against or benefit medically 

15 underserved areas; and 

16 (4) identify best practices and tools to leverage 

17 the benefits and prevent misuse of de-identified per18 sonal health information other than protected health 

19 information to discriminate against medically under20 served areas. 


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1 Subtitle D—Closing Gaps in 

2 Funding To Adopt Certified EHRs 

3 SEC. 831. EXTENDING MEDICAID EHR INCENTIVE PAY4 MENTS TO REHABILITATION FACILITIES, 

5 LONG-TERM CARE FACILITIES, AND HOME 

6 HEALTH AGENCIES. 

7 (a) IN GENERAL.—Section 1903(t)(2)(B) of the So8 cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend9 ed— 

10 (1) in clause (i), by striking ‘‘, or’’ and insert11 ing a semicolon; 

12 (2) in clause (ii), by striking the period at the 

13 end and inserting a semicolon; and 

14 (3) by inserting after clause (ii) the following 

15 new clauses: 

16 ‘‘(iii) a rehabilitation facility (as defined in sec17 tion 1886(j)(1)) that furnishes acute or subacute re18 habilitation services; 

19 ‘‘(iv) a long-term care hospital (as defined in 

20 section 1886(d)(1)(B)(iv)); or 

21 ‘‘(v) a home health agency (as defined in sec22 tion 1861(o)).’’. 

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

24 subsection (a) shall apply with respect to amounts ex25 pended under section 1903(a)(3)(F) of the Social Security 


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1 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be2 ginning on or after the date of the enactment of this Act. 

3 SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 

4 FOR MEDICAID ELECTRONIC HEALTH 

5 RECORD INCENTIVE PAYMENTS. 

6 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 

7 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 

8 amended to read as follows: 

9 ‘‘(v) physician assistant.’’. 

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

11 subsection (a) shall apply with respect to amounts ex12 pended under section 1903(a)(3)(F) of the Social Security 

13 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be14 ginning on or after the date of the enactment of this Act. 


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1 TITLE IX—ACCOUNTABILITY 

2 AND EVALUATION 

3 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 

4 ASSISTED HEALTH CARE SERVICES AND RE5 SEARCH PROGRAMS ON THE BASIS OF SEX 

6 (INCLUDING SEX ORIENTATION, GENDER 

7 IDENTITY, AND PREGNANCY, INCLUDING 

8 TERMINATION OF PREGNANCY), RACE, 

9 COLOR, NATIONAL ORIGIN, MARITAL STATUS, 

10 FAMILIAL STATUS, SEXUAL ORIENTATION, 

11 GENDER IDENTITY, OR DISABILITY STATUS. 

12 (a) IN GENERAL.—No person in the United States 

13 shall, on the basis of sex (including sex orientation, gender 

14 identity, and pregnancy, including termination of preg15 nancy), race, color, national origin, marital status, familial 

16 status, sexual orientation, gender identity, or disability 

17 status, be excluded from participation in, be denied the 

18 benefits of, or be subjected to discrimination under any 

19 health program or activity, including any health research 

20 program or activity, receiving Federal financial assistance, 

21 including credits, subsidies, or contracts of insurance or 

22 any health program or activity that is administered by an 

23 executive agency. 

24 (b) DEFINITION.—In this section, the term ‘‘familial 

25 status’’ means, with respect to one or more individuals— 


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1 (1) being domiciled with any individual related 

2 by blood or affinity whose close association with the 

3 individual is the equivalent of a family relationship; 

4 (2) being in the process of securing legal cus5 tody of any individual; or 

6 (3) being pregnant. 

7 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 

8 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 

9 A payment to a provider of services, physician, or 

10 other supplier under part B, C, or D of title XVIII of 

11 the Social Security Act shall be deemed a grant, and not 

12 a contract of insurance or guaranty, for the purposes of 

13 title VI of the Civil Rights Act of 1964. 

14 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 

15 THE DEPARTMENT OF HEALTH AND HUMAN 

16 SERVICES. 

17 Title XXXIV of the Public Health Service Act, as 

18 amended by titles I, II, and III of this Act, is further 

19 amended by inserting after subtitle C the following: 

20 ‘‘Subtitle D—Strengthening 

21 Accountability 

22 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

23 ‘‘(a) IN GENERAL.—The Secretary shall establish 

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1 parities, which shall be headed by a director to be ap2 pointed by the Secretary. 

3 ‘‘(b) PURPOSE.—The Office of Health Disparities 

4 shall ensure that the health programs, activities, and oper5 ations of health entities that receive Federal financial as6 sistance are in compliance with title VI of the Civil Rights 

7 Act, including through the following activities: 

8 ‘‘(1) The development and implementation of 

9 an action plan to address racial and ethnic health 

10 care disparities, which shall address concerns relat11 ing to the Office for Civil Rights as released by the 

12 United States Commission on Civil Rights in the re13 port entitled ‘Health Care Challenge: Acknowledging 

14 Disparity, Confronting Discrimination, and Ensur15 ing Equity’ (September 1999) in conjunction with 

16 the reports by the National Academy of Sciences 

17 (formerly known as the Institute of Medicine) enti18 tled ‘Unequal Treatment: Confronting Racial and 

19 Ethnic Disparities in Health Care’, ‘Crossing the 

20 Quality Chasm: A New Health System for the 21st 

21 Century’, ‘In the Nation’s Compelling Interest: En22 suring Diversity in the Health Care Workforce’, 

23 ‘The National Partnership for Action to End Health 

24 Disparities’, and ‘The Health of Lesbian, Gay, Bi25 sexual, and Transgender People’, and other related 


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1 reports by the National Academy of Sciences. This 

2 plan shall be publicly disclosed for review and com3 ment and the final plan shall address any comments 

4 or concerns that are received by the Office. 

5 ‘‘(2) Investigative and enforcement actions 

6 against intentional discrimination and policies and 

7 practices that have a disparate impact on minorities. 

8 ‘‘(3) The review of racial, ethnic, gender iden9 tity, sexual orientation, sex, disability status, socio10 economic status, and primary language health data 

11 collected by Federal health agencies to assess health 

12 care disparities related to intentional discrimination 

13 and policies and practices that have a disparate im14 pact on minorities. Such review shall include an as15 sessment of health disparities in communities with a 

16 combination of these classes. 

17 ‘‘(4) Outreach and education activities relating 

18 to compliance with title VI of the Civil Rights Act. 

19 ‘‘(5) The provision of technical assistance for 

20 health entities to facilitate compliance with title VI 

21 of the Civil Rights Act. 

22 ‘‘(6) Coordination and oversight of activities of 

23 the civil rights compliance offices established under 

24 section 3442. 

25 ‘‘(7) Ensuring— 


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1 ‘‘(A) at a minimum, compliance with the 

2 most recent version of the Office of Manage3 ment and Budget statistical policy directive en4 titled ‘Standards for Maintaining, Collecting, 

5 and Presenting Federal Data on Race and Eth6 nicity’; and 

7 ‘‘(B) consideration of available data and 

8 language standards such as— 

9 ‘‘(i) the standards for collecting and 

10 reporting data under section 3101; and 

11 ‘‘(ii) the National Standards on Cul12 turally and Linguistically Appropriate 

13 Services of the Office of Minority Health. 

14 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en15 sure the effectiveness of the Office of Health Disparities 

16 by ensuring that the Office is provided with— 

17 ‘‘(1) adequate funding to enable the Office to 

18 carry out its duties under this section; and 

19 ‘‘(2) staff with expertise in— 

20 ‘‘(A) epidemiology; 

21 ‘‘(B) statistics; 

22 ‘‘(C) health quality assurance; 

23 ‘‘(D) minority health and health dispari24 ties; 

25 ‘‘(E) cultural and linguistic competency; 


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1 ‘‘(F) civil rights; and 

2 ‘‘(G) social, behavioral, and economic de3 terminants of health. 

4 ‘‘(d) REPORT.—Not later than December 31, 2021, 

5 and annually thereafter, the Secretary, in collaboration 

6 with the Director of the Office for Civil Rights and the 

7 Deputy Assistant Secretary for Minority Health, shall 

8 submit a report to the Committee on Health, Education, 

9 Labor, and Pensions of the Senate and the Committee on 

10 Energy and Commerce of the House of Representatives 

11 that includes— 

12 ‘‘(1) the number of cases filed, broken down by 

13 category; 

14 ‘‘(2) the number of cases investigated and 

15 closed by the office; 

16 ‘‘(3) the outcomes of cases investigated; 

17 ‘‘(4) the staffing levels of the office including 

18 staff credentials; 

19 ‘‘(5) the number of other lingering and emerg20 ing cases in which civil rights inequities can be dem21 onstrated; and 

22 ‘‘(6) the number of cases remaining open and 

23 an explanation for their open status. 

24 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section 


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

2 2021 through 2026. 

3 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF4 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

5 HEALTH AND HUMAN SERVICES AGENCIES. 

6 ‘‘(a) IN GENERAL.—The Secretary shall establish 

7 civil rights compliance offices in each agency within the 

8 Department of Health and Human Services that admin9 isters health programs. 

10 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

11 under subsection (a) shall ensure that recipients of Fed12 eral financial assistance under Federal health programs 

13 administer programs, services, and activities in a manner 

14 that— 

15 ‘‘(1) does not discriminate, either intentionally 

16 or in effect, on the basis of race, national origin, lan17 guage, ethnicity, sex, age, disability, sexual orienta18 tion, and gender identity; and 

19 ‘‘(2) promotes the reduction and elimination of 

20 disparities in health and health care based on race, 

21 national origin, language, ethnicity, sex, age, dis22 ability, sexual orientation, and gender identity. 

23 ‘‘(c) POWERS AND DUTIES.—The offices established 

24 in subsection (a) shall have the following powers and du25 ties: 


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1 ‘‘(1) The establishment of compliance and pro2 gram participation standards for recipients of Fed3 eral financial assistance under each program admin4 istered by the applicable agency, including the estab5 lishment of disparity reduction standards to encom6 pass disparities in health and health care related to 

7 race, national origin, language, ethnicity, sex, age, 

8 disability, sexual orientation, and gender identity. 

9 ‘‘(2) The development and implementation of 

10 program-specific guidelines that interpret and apply 

11 Department of Health and Human Services guid12 ance under title VI of the Civil Rights Act of 1964 

13 and section 1557 of the Patient Protection and Af14 fordable Care Act to each Federal health program 

15 administered by the agency. 

16 ‘‘(3) The development of a disparity-reduction 

17 impact analysis methodology that shall be applied to 

18 every rule issued by the agency and published as 

19 part of the formal rulemaking process under sections 

20 555, 556, and 557 of title 5, United States Code. 

21 ‘‘(4) Oversight of data collection, analysis, and 

22 publication requirements for all recipients of Federal 

23 financial assistance under each Federal health pro24 gram administered by the agency; compliance with, 

25 at a minimum, the most recent version of the Office 


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1 of Management and Budget statistical policy direc2 tive entitled ‘Standards for Maintaining, Collecting, 

3 and Presenting Federal Data on Race and Eth4 nicity’; and consideration of available data and lan5 guage standards such as— 

6 ‘‘(A) the standards for collecting and re7 porting data under section 3101; and 

8 ‘‘(B) the National Standards on Culturally 

9 and Linguistically Appropriate Services of the 

10 Office of Minority Health. 

11 ‘‘(5) The conduct of publicly available studies 

12 regarding discrimination within Federal health pro13 grams administered by the agency as well as dis14 parity reduction initiatives by recipients of Federal 

15 financial assistance under Federal health programs. 

16 ‘‘(6) Annual reports to the Committee on 

17 Health, Education, Labor, and Pensions and the 

18 Committee on Finance of the Senate and the Com19 mittee on Energy and Commerce and the Committee 

20 on Ways and Means of the House of Representatives 

21 on the progress in reducing disparities in health and 

22 health care through the Federal programs adminis23 tered by the agency. 

24 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

25 IN THE DEPARTMENT OF JUSTICE.— 


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1 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

2 SERVICES.—The Office for Civil Rights of the De3 partment of Health and Human Services shall pro4 vide standard-setting and compliance review inves5 tigation support services to the Civil Rights Compli6 ance Office for each agency described in subsection 

7 (a), subject to paragraph (2). 

8 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

9 for Civil Rights of the Department of Justice may, 

10 as appropriate, institute formal proceedings when a 

11 civil rights compliance office established under sub12 section (a) determines that a recipient of Federal fi13 nancial assistance is not in compliance with the dis14 parity reduction standards of the applicable agency. 

15 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

16 health programs’ mean programs— 

17 ‘‘(1) under the Social Security Act (42 U.S.C. 

18 301 et seq.) that pay for health care and services; 

19 and 

20 ‘‘(2) under this Act that provide Federal finan21 cial assistance for health care, biomedical research, 

22 health services research, and programs designed to 

23 improve the public’s health, including health service 

24 programs.’’. 


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1 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

2 (a) COORDINATION WITHIN DEPARTMENT OF JUS3 TICE OF ACTIVITIES REGARDING HEALTH DISPARI4 TIES.—Section 3(a) of the Civil Rights Commission Act 

5 of 1983 (42 U.S.C. 1975a(a)) is amended— 

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

7 end; 

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

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

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

11 ‘‘(3) shall, with respect to activities carried out 

12 in health care and correctional facilities toward the 

13 goal of eliminating health disparities between the 

14 general population and members of minority groups 

15 based on race or color, promote coordination of such 

16 activities of— 

17 ‘‘(A) the Office for Civil Rights within the 

18 Office of Justice Programs of the Department 

19 of Justice; 

20 ‘‘(B) the Office of Justice Programs within 

21 the Department of Justice; 

22 ‘‘(C) the Office for Civil Rights within the 

23 Department of Health and Human Services; 

24 and 

25 ‘‘(D) the Office of Minority Health within 

26 the Department of Health and Human Services 


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1 (headed by the Deputy Assistant Secretary for 

2 Minority Health).’’. 

3 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

4 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

5 1975c) is amended by striking the first sentence and in6 serting the following: ‘‘For the purpose of carrying out 

7 this Act, there are authorized to be appropriated 

8 $30,000,000 for fiscal year 2021, and such sums as may 

9 be necessary for each of the fiscal years 2022 through 

10 2026.’’. 

11 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND12 ING OF ACTIVITIES TO ELIMINATE RACIAL 

13 AND ETHNIC HEALTH DISPARITIES. 

14 (a) FINDINGS.—Congress makes the following find15 ings: 

16 (1) The health status of the population of the 

17 United States is declining and the United States 

18 currently ranks below most industrialized nations in 

19 health status measured by longevity, sickness, and 

20 mortality. 

21 (2) Racial and ethnic minority populations tend 

22 to have the poorest health status and face substan23 tial cultural, social, and economic barriers to obtain24 ing quality health care. 


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1 (3) Lesbian, gay, bisexual, transgender, queer, 

2 and questioning populations experience significant 

3 personal and structural barriers to obtaining high4 quality health care. 

5 (4) Efforts to improve minority health have 

6 been limited by inadequate resources (funding, staff7 ing, and stewardship) and lack of accountability. 

8 (b) SENSE OF CONGRESS.—It is the sense of Con9 gress that— 

10 (1) health disparities negatively impact out11 comes for health and human security of the Nation; 

12 (2) reducing racial, ethnic, sexual, and gender 

13 disparities in prevention and treatment are unique 

14 civil and human rights challenges and, as such, Fed15 eral agencies and health care entities and systems 

16 receiving Federal funds should be accountable for 

17 their role in causing disparities and inequity; 

18 (3) funding for the National Institute on Mi19 nority Health and Health Disparities, the Office of 

20 Civil Rights in the Department of Health and 

21 Human Services, the National Institute of Nursing 

22 Research, and the Office of Minority Health should 

23 be doubled by fiscal year 2022; 

24 (4) adequate funding by fiscal year 2022, and 

25 subsequent funding increases, should be provided for 


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1 health and human service professions training pro2 grams, the Racial and Ethnic Approaches to Com3 munity Health Initiative at the Centers for Disease 

4 Control and Prevention, the Minority HIV/AIDS 

5 Initiative, and the Excellence Centers to Eliminate 

6 Ethnic/Racial Disparities Program at the Agency for 

7 Healthcare Research and Quality; 

8 (5) funding should be fully restored to the Ra9 cial and Ethnic Approaches to Community Health 

10 Initiative at the Centers for Disease Control and 

11 Prevention, which has been a successful program at 

12 the community health level, and efforts should con13 tinue to place a strong emphasis on building commu14 nity capacity to secure financial resources and tech15 nical assistance to eliminate health disparities; 

16 (6) adequate funding for fiscal year 2022 and 

17 increased funding for future years should be pro18 vided for the Racial and Ethnic Approaches to Com19 munity Health Initiative’s United States Risk Fac20 tor Survey to ensure adequate data collection to 

21 track health disparities, and there should be appro22 priate avenues provided to disseminate findings to 

23 the general public; 

24 (7) current and newly created health disparity 

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1 partments under this Act (and the amendments 

2 made by this Act) should receive adequate staffing 

3 and funding by fiscal year 2022; and 

4 (8) stewardship and accountability should be 

5 provided to the Congress and the President for 

6 measurable and sustainable progress toward health 

7 disparity elimination. 

8 SEC. 906. GAO AND NIH REPORTS. 

9 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH10 NIC DIVERSITY.— 

11 (1) IN GENERAL.—The Comptroller General of 

12 the United States shall conduct a study on the racial 

13 and ethnic diversity among the following groups: 

14 (A) All applicants for grants, contracts, 

15 and cooperative agreements awarded by the Na16 tional Institutes of Health during the period be17 ginning on January 1, 2009, and ending De18 cember 31, 2019. 

19 (B) All recipients of such grants, con20 tracts, and cooperative agreements during such 

21 period. 

22 (C) All members of the peer review panels 

23 of such applicants and recipients, respectively. 

24 (2) REPORT.—Not later than 6 months after 

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1 troller General shall complete the study under para2 graph (1) and submit to Congress a report con3 taining the results of such study. 

4 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA5 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH

6 DISPARITIES.—Not later than 6 months after the date of 

7 the enactment of this Act, and biennially thereafter, the 

8 Director of the National Institutes of Health, in collabora9 tion with the Director of the National Institute on Minor10 ity Health and Health Disparities, shall submit to Con11 gress a report that details and evaluates— 

12 (1) the steps taken during the applicable report 

13 period by the Director of the National Institutes of 

14 Health to enforce the expanded planning, coordina15 tion, review, and evaluation authority provided the 

16 National Institute on Minority Health and Health 

17 Disparities under section 464z–3(h) of the Public 

18 Health Service Act (42 U.S.C. 285(h)) over all mi19 nority health and health disparity research that is 

20 conducted or supported by the Institutes and Cen21 ters at the National Institutes of Health; and 

22 (2) the outcomes of such steps. 

23 (c) GAO REPORT RELATED TO RECIPIENTS OF

24 PPACA FUNDING.—Not later than one year after the 

25 date of the enactment of this Act and biennially thereafter 


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1 until 2024, the Comptroller General of the United States 

2 shall submit to Congress a report that identifies— 

3 (1) the racial and ethnic diversity of commu4 nity-based organizations that applied for Federal en5 rollment funding provided pursuant to the Patient 

6 Protection and Affordable Care Act (Public Law 

7 111–148) (including the amendments made by such 

8 Act); 

9 (2) the percentage of such organizations that 

10 were awarded such funding; and 

11 (3) the impact of such community-based organi12 zations’ enrollment efforts on the insurance status of 

13 their communities. 

14 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL

15 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS16 PARITIES.—The Director of the National Institute on Mi17 nority Health and Health Disparities shall prepare an an18 nual report on the activities carried out or to be carried 

19 out by such institute, and shall submit each such report 

20 to the Committee on Health, Education, Labor, and Pen21 sions of the Senate, the Committee on Energy and Com22 merce of the House of Representatives, the Secretary of 

23 Health and Human Services, and the Director of the Na24 tional Institutes of Health. With respect to the fiscal year 

25 involved, the report shall— 


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1 (1) describe and evaluate the progress made in 

2 health disparities research conducted or supported 

3 by institutes and centers of the National Institutes 

4 of Health; 

5 (2) summarize and analyze expenditures made 

6 for activities with respect to health disparities re7 search conducted or supported by the National Insti8 tutes of Health; 

9 (3) include a separate statement applying the 

10 requirements of paragraphs (1) and (2) specifically 

11 to minority health disparities research; and 

12 (4) contain such recommendations as the Direc13 tor of the Institute considers appropriate. 

14 TITLE X—ADDRESSING SOCIAL 

15 DETERMINANTS AND IM16 PROVING ENVIRONMENTAL 

17 JUSTICE 

18 Subtitle A—In General 

19 SEC. 1001. DEFINITIONS. 

20 In this title: 

21 (1) DETERMINANTS OF HEALTH.—The term 

22 ‘‘determinants of health’’— 

23 (A) means the range of personal, social, 

24 economic, and environmental factors that influ25 ence health status; and 


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1 (B) includes social determinants of health 

2 (which are sometimes referred to as ‘‘social and 

3 economic determinants of health’’, ‘‘socio4 economic determinants of health’’, ‘‘environ5 mental determinants of health’’, ‘‘social drivers 

6 of inequality’’, or ‘‘personal determinants of 

7 health’’). 

8 (2) ENVIRONMENTAL DETERMINANTS OF

9 HEALTH.—The term ‘‘environmental determinants 

10 of health’’ means the broad physical (including man11 made and natural), psychological, social, spiritual, 

12 cultural, and aesthetic environment. 

13 (3) BUILT ENVIRONMENT.—The term ‘‘built 

14 environment’’ means the components of the environ15 ment, and the location of these components in a geo16 graphically defined space, that are created or modi17 fied by individuals to form the physical and social 

18 characteristics of a community or enhance quality of 

19 human life, including— 

20 (A) homes, schools, and places of work and 

21 worship; 

22 (B) parks, recreation areas, and green23 ways; 

24 (C) transportation systems; 


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1 (D) business, industry, and agriculture; 

2 and 

3 (E) land-use plans, projects, and policies 

4 that impact the physical or social characteris5 tics of a community, including access to services 

6 and amenities. 

7 (4) PERSONAL DETERMINANTS OF HEALTH.— 

8 The term ‘‘personal determinants of health’’ means 

9 an individual’s behavior, biology, and genetics. 

10 (5) SOCIAL DETERMINANTS OF HEALTH.—The 

11 term ‘‘social determinants of health’’ means a subset 

12 of determinants of the health of individuals and en13 vironments (such as communities, neighborhoods, 

14 and societies) that describe an individual’s or group 

15 of people’s social identity, describe the social and 

16 economic resources to which such individual or 

17 group has access, and describe the conditions in 

18 which an individual or group of people works, lives, 

19 and plays. 

20 (6) ECONOMIC DETERMINANTS OF HEALTH.— 

21 The term ‘‘economic determinants of health’’ refers 

22 to income and social status. Higher income and so23 cioeconomic status are linked to decreased rates of 

24 morbidity and mortality, with higher socioeconomic 

25 status correlated with better health and longer life, 


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1 and lower socioeconomic status correlated with an 

2 increased risk of illness and death. 

3 SEC. 1002. FINDINGS. 

4 Congress finds as follows: 

5 (1) Social determinants of health are the great6 est predictors of health outcomes. 

7 (2) Social determinants of health, including 

8 health-related behaviors, social and economic factors, 

9 and physical environment factors account for 80 per10 cent of health outcomes, whereas clinical care ac11 counts for 20 percent of improved health outcomes. 

12 Yet, in 2017, public health spending represented 

13 only 2.5 percent of all health spending in the United 

14 States. 

15 (3) There are more opportunities to improve 

16 health for everyone when we understand that health 

17 starts, first, not in a medical setting, but in our 

18 families, in our schools and workplaces, in our 

19 neighborhoods, in the air we breathe, and in the 

20 water we drink. 

21 (4)(A) Healthy People 2020 identifies health 

22 and health care quality as a function of not only ac23 cess to health care, but also the social determinants 

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1 hoods and the built environment; social and commu2 nity context; education; and economic stability. 

3 (B) The following examples illustrate the nexus 

4 between the unequal distribution of the social deter5 minants of health and health disparities: 

6 (i) The built environment influences resi7 dents’ level of physical activity. Neighborhoods 

8 with high levels of poverty are significantly less 

9 likely to have places where children can be 

10 physically active, such as parks, green spaces, 

11 and bike paths and lanes. Neighborhoods and 

12 communities can provide opportunities for phys13 ical activity and support active lifestyles 

14 through accessible and safe parks and open 

15 spaces and through land use policy, zoning, and 

16 healthy community design. 

17 (ii) Emotional and physical health and 

18 well-being are directly impacted by perceived 

19 levels of safety, such as unlit streets at night. 

20 Community members have expressed that safety 

21 is not only a barrier to accessing programs and 

22 services that increase quality of life but they 

23 are also not able to access physical activity in 

24 their community through the built environment. 


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1 (iii) Historical and institutional racism in 

2 the United States has shaped the way in which 

3 social and economic resources and exposure to 

4 health promoting environments are distributed. 

5 Income, education, occupation, neighborhood 

6 conditions, schools, workplaces, the use of 

7 health and social services, and experiences with 

8 the criminal justice system are all highly pat9 terned by race, with people of color experiencing 

10 more that is health harming. Finding ways to 

11 uncouple the link between race and access to re12 sources and healthy environments is a principal 

13 means of reducing health disparities. Addition14 ally, the anticipation of racism itself causes 

15 higher psychological and cardiovascular stress 

16 levels that are linked to poor health outcomes. 

17 Remedying discriminatory practices at the indi18 vidual and systemic levels will likely reduce 

19 health disparities caused by this unequal dis20 tribution of stress. 

21 (iv) Poor health among Native Americans 

22 has largely been driven by post-colonial oppres23 sion and historical trauma. The expropriation of 

24 native lands and territories to the American 

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1 ican health. This resulted in the deprivation of 

2 traditional food sources—and nutrients—for 

3 Native Americans and also the destruction of 

4 traditional economies and community organiza5 tion. Today, Native Americans have twice the 

6 rate of diabetes of non-Hispanic Whites. Rec7 ognition of the origins of the diabetes as having 

8 a social and community context, rather than 

9 just individual responsibility and genetic pre10 disposition, will shape better policy to provide 

11 food security. 

12 (v) In the context of prisons, overcrowding 

13 has led to the deterioration of the physical and 

14 mental health of individuals after they leave 

15 prison. In particular, the mass incarceration of 

16 African-American males as a result of unequal 

17 contact with and treatment in the criminal jus18 tice system has contributed to an overburdening 

19 of certain infectious diseases within the African20 American community. As a social institution, 

21 incarceration amplifies existing adverse health 

22 conditions by concentrating diseases and harm23 ful health behaviors such as tobacco use, drug 

24 use, and violence. 


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1 (vi) Educational attainment is the strong2 est predictor of adult mortality. It is a basic 

3 component of socioeconomic status that shapes 

4 earning potential to access resources that pro5 mote health. People with more education are 

6 less likely to report that they are in poor health, 

7 and are also less likely to have diabetes and 

8 other chronic diseases. 

9 (vii) Individuals with lower levels of edu10 cational attainment are much more likely to re11 port to be current smokers. In 2017, smoking 

12 prevalence was 36.8 percent among adults with 

13 a GED diploma, 23.1 percent with less than a 

14 high school diploma, and 18.7 percent with a 

15 high school diploma, while dropping signifi16 cantly to 7.1 percent among adults with an un17 dergraduate college degree and 4.1 percent with 

18 a postgraduate college degree. 

19 (viii) Income inequality differences account 

20 for a large part of health disparities.. For ex21 ample, children living in poverty experience 

22 poorer housing conditions, increased exposure 

23 to indoor allergens and toxins (such as pes24 ticides, lead, mercury, radon, air pollution, and 

25 carcinogens), increased food insecurity, and 


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1 more psychological stress. These experiences 

2 culminate in worse adult health as compared 

3 with children with higher socioeconomic status. 

4 Specifically, children living in lower socio5 economic neighborhoods have higher rates of 

6 asthma due to higher rates of psychological 

7 stress resulting from higher rates of violence. 

8 Food insecurity is associated with obesity and 

9 racial and ethnic minorities have higher rates of 

10 food insecurity. 

11 (ix) Lesbian, gay, bisexual, transgender, 

12 queer or questioning, intersex, and asexual or 

13 allied (referred to in this section as 

14 ‘‘LGBTQIA’’) individuals face health disparities 

15 linked to societal stigma, discrimination, and 

16 denial of their civil and human rights. Discrimi17 nation against LGBTQIA individuals has been 

18 associated with high rates of psychiatric dis19 orders, substance abuse, and suicide. Experi20 ences of violence and victimization are frequent 

21 for LGBTQIA individuals, and have long-last22 ing effects on the individual and the commu23 nity. Personal, family, and social acceptance of 

24 sexual orientation and gender identity affects 


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1 the mental health and personal safety of 

2 LGBTQIA individuals. 

3 (x) Individuals in older and cheaper hous4 ing are at higher risks to be exposed to lead, 

5 particularly in housing built prior to 1960. The 

6 threat of lead poisoning disproportionally af7 fects vulnerable populations, with children living 

8 in poverty (5.6 percent) and Black children 

9 (5.6) experiencing the highest rates. According 

10 to the Department of Housing and Urban De11 velopment, about 3,600,000 homes nationwide 

12 that house young children have lead hazards 

13 such as contaminated drinking water, peeling 

14 paint, contaminated dust, or toxic soil. The 

15 combined cost of medical treatment and special 

16 education for lead poisoned children averages 

17 about $5,600 per child per year, and lead poi18 soning costs the United States an estimated 

19 $50,000,000,000 annually. 

20 (xi) According to the report Healthy Peo21 ple 2020, individuals with disabilities, as a 

22 group, experience health disparities in routine 

23 public health arenas such as health behaviors, 

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1 tions. Compared with individuals without dis2 abilities, individuals with disabilities are— 

3 (I) less likely to receive recommended 

4 preventive health care services, such as 

5 routine teeth cleanings and cancer 

6 screenings; 

7 (II) at a high risk for poor health out8 comes such as obesity, hypertension, falls9 related injuries, and mood disorders such 

10 as depression; and 

11 (III) more likely to engage in 

12 unhealthy behaviors that put their health 

13 at risk, such as cigarette smoking and in14 adequate physical activity. 

15 (5) Laws and regulations that improve opportu16 nities to live in safe neighborhoods with more social 

17 cohesion, attain higher education, sustain stable em18 ployment, and bridge class differences help foster 

19 the health and safety of individuals. 

20 (6) The global public health community has 

21 reached consensus through the Rio Political Declara22 tion of Social Determinants of Health adopted by 

23 the World Health Organization in October 2011 that 

24 ‘‘[c]ollaboration in coordinated and intersectoral pol25 icy actions has proven to be effective. Health in All 


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1 Policies, an initiative of the American Public Health 

2 Association, together with intersectoral cooperation 

3 and action, is one promising approach to enhance 

4 accountability in other sectors of health, as well as 

5 the promotion of health equity and more inclusive 

6 and productive societies.’’. 

7 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 

8 (a) FINDINGS.—Congress makes the following find9 ings: 

10 (1) Health Impact Assessment is a tool to help 

11 planners, health officials, decision makers, and the 

12 public make more informed decisions about the po13 tential health effects of proposed plans, policies, pro14 grams, and projects in order to maximize health 

15 benefits and minimize harms. 

16 (2) Health Impact Assessments fosters commu17 nity leadership, ownership and participation in deci18 sion-making processes. 

19 (3) Health Impact Assessments can build com20 munity support and reduce opposition to a project or 

21 policy, thereby facilitating economic growth by aid22 ing the development of consensus regarding new de23 velopment proposals. 

24 (4) Health Impact Assessments facilitate col25 laboration across sectors. 


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1 (b) PURPOSES.—It is the purpose of this section to— 

2 (1) provide more information about the poten3 tial human health effects of policy decisions and the 

4 distribution of those effects; 

5 (2) improve how health is considered in plan6 ning and decision-making processes; and 

7 (3) build stronger, healthier communities 

8 through the use of Health Impact Assessments. 

9 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 

10 III of the Public Health Service Act (42 U.S.C. 280g et 

11 seq.), as amended by section 744, is further amended by 

12 adding at the end the following: 

13 ‘‘SEC. 399V–12. HEALTH IMPACT ASSESSMENTS. 

14 ‘‘(a) DEFINITIONS.—In this section: 

15 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis16 trator’ means the Administrator of the Environ17 mental Protection Agency. 

18 ‘‘(2) DIRECTOR.—The term ‘Director’ means 

19 the Director of the Centers for Disease Control and 

20 Prevention. 

21 ‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 

22 ‘health impact assessment’ means a systematic proc23 ess that uses an array of data sources and analytic 

24 methods and considers input from stakeholders to 

25 determine the potential effects of a proposed policy, 


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1 plan, program, or project on the health of a popu2 lation and the distribution of those effects within the 

3 population. Such term includes identifying and rec4 ommending appropriate actions on monitoring and 

5 maximizing potential benefits and minimizing the 

6 potential harms. 

7 ‘‘(4) HEALTH DISPARITY.—The term ‘health 

8 disparity’ means a particular type of health dif9 ference that is closely linked with social, economic, 

10 or environmental disadvantage and that adversely 

11 affects groups of people who have systematically ex12 perienced greater obstacles to health based on their 

13 racial or ethnic group; religion; socioeconomic status; 

14 gender; age; mental health; cognitive, sensory, or 

15 physical disability; sexual orientation or gender iden16 tity; geographic location; citizenship status; or other 

17 characteristics historically linked to discrimination 

18 or exclusion. 

19 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

20 through the Director and in collaboration with the Admin21 istrator, shall— 

22 ‘‘(1) in consultation with the Director of the 

23 National Center for Chronic Disease Prevention and 

24 Health Promotion and relevant offices within the 

25 Department of Housing and Urban Development, 


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1 the Department of Transportation, and the Depart2 ment of Agriculture, establish a program at the Na3 tional Center for Environmental Health at the Cen4 ters for Disease Control and Prevention focused on 

5 advancing the field of health impact assessment that 

6 includes— 

7 ‘‘(A) collecting and disseminating best 

8 practices; 

9 ‘‘(B) administering capacity building 

10 grants to States to support grantees in initi11 ating health impact assessments, in accordance 

12 with subsection (d); 

13 ‘‘(C) providing technical assistance; 

14 ‘‘(D) developing training tools and pro15 viding training on conducting health impact as16 sessment and the implementation of built envi17 ronment and health indicators; 

18 ‘‘(E) making information available, as ap19 propriate, regarding the existence of other com20 munity healthy living tools, checklists, and indi21 ces that help connect public health to other sec22 tors, and tools to help examine the effect of the 

23 indoor built environment and building codes on 

24 population health; 


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1 ‘‘(F) conducting research and evaluations 

2 of health impact assessments; and 

3 ‘‘(G) awarding competitive extramural re4 search grants; 

5 ‘‘(2) develop guidance and guidelines to conduct 

6 health impact assessments in accordance with sub7 section (c); and 

8 ‘‘(3) establish a grant program to allow States 

9 to fund eligible entities to conduct health impact as10 sessments. 

11 ‘‘(c) GUIDANCE.— 

12 ‘‘(1) IN GENERAL.—Not later than 1 year after 

13 the date of enactment of the Health Equity and Ac14 countability Act of 2020, the Secretary, acting 

15 through the Director, shall issue final guidance for 

16 conducting the health impact assessments. In devel17 oping such guidance the Secretary shall— 

18 ‘‘(A) consult with the Director of the Na19 tional Center for Environmental Health and, 

20 the Director of the National Center for Chronic 

21 Disease Prevention and Health Promotion, and 

22 relevant offices within the Department of Hous23 ing and Urban Development, the Department of 

24 Transportation, and the Department of Agri25 culture; and 


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1 ‘‘(B) consider available international health 

2 impact assessment guidance, North American 

3 health impact assessment practice standards, 

4 and recommendations from the National Acad5 emy of Science. 

6 ‘‘(2) CONTENT.—The guidance under this sub7 section shall include— 

8 ‘‘(A) background on national and inter9 national efforts to bridge urban planning, cli10 mate forecasting, and public health institutions 

11 and disciplines, including a review of health im12 pact assessment best practices internationally; 

13 ‘‘(B) evidence-based direct and indirect 

14 pathways that link land-use planning, transpor15 tation, and housing policy and objectives to 

16 human health outcomes; 

17 ‘‘(C) data resources and quantitative and 

18 qualitative forecasting methods to evaluate both 

19 the status of health determinants and health ef20 fects, including identification of existing pro21 grams that can disseminate these resources; 

22 ‘‘(D) best practices for inclusive public in23 volvement in conducting health impact assess24 ments; and 


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1 ‘‘(E) technical assistance for other agen2 cies seeking to develop their own guidelines and 

3 procedures for health impact assessment. 

4 ‘‘(d) GRANT PROGRAM.— 

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

6 through the Director and in collaboration with the 

7 Administrator, shall— 

8 ‘‘(A) award grants to States to fund eligi9 ble entities for capacity building or to prepare 

10 health impact assessments; and 

11 ‘‘(B) ensure that States receiving a grant 

12 under this subsection further support training 

13 and technical assistance for grantees under the 

14 program by funding and overseeing appropriate 

15 local, State, Tribal, Federal, institution of high16 er education, or nonprofit health impact assess17 ment experts to provide such technical assist18 ance. 

19 ‘‘(2) APPLICATIONS.— 

20 ‘‘(A) IN GENERAL.—To be eligible to re21 ceive a grant under this section, an eligible enti22 ty shall— 

23 ‘‘(i) be a State, Indian tribe, or tribal 

24 organization that includes individuals or 

25 populations the health of which are, or will 


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1 be, affected by an activity or a proposed 

2 activity; and 

3 ‘‘(ii) submit to the Secretary an appli4 cation in accordance with this subsection, 

5 at such time, in such manner, and con6 taining such additional information as the 

7 Secretary may require. 

8 ‘‘(B) INCLUSION.—An application under 

9 this subsection shall include a list of proposed 

10 activities that require or would benefit from 

11 conducting a health impact assessment within 

12 six months of awarding funds. The list should 

13 be accompanied by supporting documentation, 

14 including letters of support, from potential con15 ductors of health impact assessments for the 

16 listed proposed activities. Each application 

17 should also include an assessment by the eligi18 ble entity of the health of the population of its 

19 jurisdiction and describe potential adverse or 

20 positive effects on health that the proposed ac21 tivities may create. 

22 ‘‘(C) PREFERENCE.—Preference in award23 ing funds under this section may be given to el24 igible entities that demonstrate the potential to 

25 significantly improve population health or lower 


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1 health care costs as a result of potential health 

2 impact assessment work. 

3 ‘‘(3) USE OF FUNDS.— 

4 ‘‘(A) IN GENERAL.—An entity receiving a 

5 grant under this section shall use such grant 

6 funds to conduct health impact assessment ca7 pacity building or to fund subgrantees in con8 ducting a health impact assessment for a pro9 posed activity in accordance with this sub10 section. 

11 ‘‘(B) PURPOSES.—The purposes of a 

12 health impact assessment under this subsection 

13 are— 

14 ‘‘(i) to facilitate the involvement of 

15 tribal, State, and local public health offi16 cials in community planning, transpor17 tation, housing, and land use decisions and 

18 other decisions affecting the built environ19 ment to identify any potential health con20 cern or health benefit relating to an activ21 ity or proposed activity; 

22 ‘‘(ii) to provide for an investigation of 

23 any health-related issue of concern raised 

24 in a planning process, an environmental 


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1 impact assessment process, or policy ap2 praisal relating to a proposed activity; 

3 ‘‘(iii) to describe and compare alter4 natives (including no-action alternatives) to 

5 a proposed activity to provide clarification 

6 with respect to the potential health out7 comes associated with the proposed activity 

8 and, where appropriate, to the related ben9 efit-cost or cost-effectiveness of the pro10 posed activity and alternatives; 

11 ‘‘(iv) to contribute, when applicable, 

12 to the findings of a planning process, pol13 icy appraisal, or an environmental impact 

14 statement with respect to the terms and 

15 conditions of implementing a proposed ac16 tivity or related mitigation recommenda17 tions, as necessary; 

18 ‘‘(v) to ensure that the dispropor19 tionate distribution of negative impacts 

20 among vulnerable populations is minimized 

21 as much as possible; 

22 ‘‘(vi) to engage affected community 

23 members and ensure adequate opportunity 

24 for public comment on all stages of the 

25 health impact assessment; 


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1 ‘‘(vii) where appropriate, to consult 

2 with local and county health departments 

3 and appropriate organizations, including 

4 planning, transportation, and housing or5 ganizations and providing them with infor6 mation and tools regarding how to conduct 

7 and integrate health impact assessment 

8 into their work; and 

9 ‘‘(viii) to inspect homes, water sys10 tems, and other elements that pose risks to 

11 lead exposure, with an emphasis on areas 

12 that pose a higher risk to children. 

13 ‘‘(4) ASSESSMENTS.—Health impact assess14 ments carried out using grant funds under this sec15 tion shall— 

16 ‘‘(A) take appropriate health factors into 

17 consideration as early as practicable during the 

18 planning, review, or decision-making processes; 

19 ‘‘(B) assess the effect on the health of in20 dividuals and populations of proposed policies, 

21 projects, or plans that result in modifications to 

22 the built environment; and 

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1 come, ethnicity, age, disability status, gender, 

2 and geography. 

3 ‘‘(5) ELIGIBLE ACTIVITIES.— 

4 ‘‘(A) IN GENERAL.—Eligible entities fund5 ed under this subsection shall conduct an eval6 uation of any proposed activity to determine 

7 whether it will have a significant adverse or 

8 positive effect on the health of the affected pop9 ulation in the jurisdiction of the eligible entity, 

10 based on the criteria described in subparagraph 

11 (B). 

12 ‘‘(B) CRITERIA.—The criteria described in 

13 this subparagraph include, as applicable to the 

14 proposed activity, the following: 

15 ‘‘(i) Any substantial adverse effect or 

16 significant health benefit on health out17 comes or factors known to influence health, 

18 including the following: 

19 ‘‘(I) Physical activity. 

20 ‘‘(II) Injury. 

21 ‘‘(III) Mental health. 

22 ‘‘(IV) Accessibility to health-pro23 moting goods and services. 

24 ‘‘(V) Respiratory health. 

25 ‘‘(VI) Chronic disease. 


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1 ‘‘(VII) Nutrition. 

2 ‘‘(VIII) Land use changes that 

3 promote local, sustainable food 

4 sources. 

5 ‘‘(IX) Infectious disease. 

6 ‘‘(X) Health disparities. 

7 ‘‘(XI) Existing air quality, 

8 ground or surface water quality or 

9 quantity, or noise levels. 

10 ‘‘(XII) Lead exposure. 

11 ‘‘(XIII) Drinking water quality 

12 and accessibility. 

13 ‘‘(ii) Other factors that may be con14 sidered, including— 

15 ‘‘(I) the potential for a proposed 

16 activity to result in systems failure 

17 that leads to a public health emer18 gency; 

19 ‘‘(II) the probability that the pro20 posed activity will result in a signifi21 cant increase in tourism, economic de22 velopment, or employment in the ju23 risdiction of the eligible entity; 

24 ‘‘(III) any other significant po25 tential hazard or enhancement to 


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1 human health, as determined by the 

2 eligible entity; or 

3 ‘‘(IV) whether the evaluation of a 

4 proposed activity would duplicate an5 other analysis or study being under6 taken in conjunction with the pro7 posed activity. 

8 ‘‘(C) FACTORS FOR CONSIDERATION.—In 

9 evaluating a proposed activity under subpara10 graph (A), an eligible entity may take into con11 sideration any reasonable, direct, indirect, or 

12 cumulative effect that can be clearly related to 

13 potential health effects and that is related to 

14 the proposed activity, including the effect of 

15 any action that is— 

16 ‘‘(i) included in the long-range plan 

17 relating to the proposed activity; 

18 ‘‘(ii) likely to be carried out in coordi19 nation with the proposed activity; 

20 ‘‘(iii) dependent on the occurrence of 

21 the proposed activity; or 

22 ‘‘(iv) likely to have a disproportionate 

23 impact on high-risk or vulnerable popu24 lations. 


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1 ‘‘(6) REQUIREMENTS.—A health impact assess2 ment prepared with funds awarded under this sub3 section shall incorporate the following, after con4 ducting the screening phase (identifying projects or 

5 policies for which a health impact assessment would 

6 be valuable and feasible) through the application 

7 process: 

8 ‘‘(A) SCOPING.—Identifying which health 

9 effects to consider and the research methods to 

10 be utilized. 

11 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 

12 Assessing the baseline health status and factors 

13 known to influence the health status in the af14 fected community, which may include aggre15 gating and synthesizing existing health assess16 ment evidence and data from the community. 

17 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 

18 Suggesting changes to proposals to promote 

19 positive or mitigate adverse health effects. 

20 ‘‘(D) REPORTING.—Synthesizing the as21 sessment and recommendations and commu22 nicating the results to decision makers. 

23 ‘‘(E) MONITORING AND EVALUATING.— 

24 Tracking the decision and implementation effect 

25 on health determinants and health status. 


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1 ‘‘(7) PLAN.—An eligible entity that is awarded 

2 a grant under this section shall develop and imple3 ment a plan, to be approved by the Director, for 

4 meaningful and inclusive stakeholder involvement in 

5 all phases of the health impact assessment. Stake6 holders may include community leaders, community7 based organizations, youth-serving organizations, 

8 planners, public health experts, State and local pub9 lic health departments and officials, health care ex10 perts or officials, housing experts or officials, and 

11 transportation experts or officials. 

12 ‘‘(8) SUBMISSION OF FINDINGS.—An eligible 

13 entity that is awarded a grant under this section 

14 shall submit the findings of any funded health im15 pact assessment activities to the Secretary and make 

16 these findings publicly available. 

17 ‘‘(9) ASSESSMENT OF IMPACTS.—An eligible en18 tity that is awarded a grant under this section shall 

19 ensure the assessment of the distribution of health 

20 impacts (related to the proposed activity) across 

21 race, ethnicity, income, age, gender, disability status, 

22 and geography. 

23 ‘‘(10) CONDUCT OF ASSESSMENT.—To the 

24 greatest extent feasible, a health impact assessment 

25 shall be conducted under this section in a manner 


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1 that respects the needs and timing of the decision2 making process it evaluates. 

3 ‘‘(11) METHODOLOGY.—In preparing a health 

4 impact assessment under this subsection, an eligible 

5 entity or partner shall follow the guidance published 

6 under subsection (c). 

7 ‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 

8 The Secretary, acting through the Director and in collabo9 ration with the Administrator, shall establish, maintain, 

10 and make publicly available a health impact assessment 

11 database, including— 

12 ‘‘(1) a catalog of health impact assessments re13 ceived under this section; 

14 ‘‘(2) an inventory of tools used by eligible enti15 ties to conduct health impact assessments; and 

16 ‘‘(3) guidance for eligible entities with respect 

17 to the selection of appropriate tools described in 

18 paragraph (2). 

19 ‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 

20 Secretary shall award competitive grants to Prevention 

21 Research Centers, or nonprofit organizations or academic 

22 institutions with expertise in health impact assessments 

23 to— 


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1 ‘‘(1) assist grantees with the provision of train2 ing and technical assistance in the conducting of 

3 health impact assessments; 

4 ‘‘(2) evaluate the activities carried out with 

5 grants under subsection (d); and 

6 ‘‘(3) assist the Secretary in disseminating evi7 dence, best practices, and lessons learned from 

8 grantees. 

9 ‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 

10 after the date of enactment of the Health Equity and Ac11 countability Act of 2020, the Secretary shall submit to 

12 Congress a report concerning the evaluation of the pro13 grams under this section, including recommendations as 

14 to how lessons learned from such programs can be incor15 porated into future guidance documents developed and 

16 provided by the Secretary and other Federal agencies, as 

17 appropriate. 

18 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section 

20 such sums as may be necessary. 

21 ‘‘SEC. 399V–13. IMPLEMENTATION OF RESEARCH FINDINGS 

22 TO IMPROVE HEALTH OUTCOMES THROUGH 

23 THE BUILT ENVIRONMENT. 

24 ‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 

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1 mental Protection Agency (referred to in this section as 

2 the ‘Administrator’), shall award grants to public agencies 

3 or private nonprofit institutions to implement evidence4 based programming to improve human health through im5 provements to the built environment and subsequently 

6 human health, by addressing— 

7 ‘‘(1) levels of physical activity; 

8 ‘‘(2) consumption of nutritional foods; 

9 ‘‘(3) rates of crime; 

10 ‘‘(4) air, water, and soil quality; 

11 ‘‘(5) risk or rate of injury; 

12 ‘‘(6) accessibility to health-promoting goods and 

13 services; 

14 ‘‘(7) chronic disease rates; 

15 ‘‘(8) community design; 

16 ‘‘(9) housing; 

17 ‘‘(10) transportation options; and 

18 ‘‘(11) other factors, as the Secretary determines 

19 appropriate. 

20 ‘‘(b) APPLICATIONS.—A public agency or private 

21 nonprofit institution desiring a grant under this section 

22 shall submit to the Secretary an application at such time, 

23 in such manner, and containing such agreements, assur24 ances, and information as the Secretary, in consultation 

25 with the Administrator, may require. 


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1 ‘‘(c) RESEARCH.—The Secretary, in consultation 

2 with the Administrator, shall support, through grants 

3 awarded under this section, research that— 

4 ‘‘(1) uses evidence-based research to improve 

5 the built environment and human health; 

6 ‘‘(2) examines— 

7 ‘‘(A) the scope and intensity of the impact 

8 that the built environment (including the var9 ious characteristics of the built environment) 

10 has on the human health; or 

11 ‘‘(B) the distribution of such impacts by— 

12 ‘‘(i) location; and 

13 ‘‘(ii) population subgroup; 

14 ‘‘(3) is used to develop— 

15 ‘‘(A) measures and indicators to address 

16 health impacts and the connection of health to 

17 the built environment; 

18 ‘‘(B) efforts to link the measures to trans19 portation, land use, and health databases; and 

20 ‘‘(C) efforts to enhance the collection of 

21 built environment surveillance data; 

22 ‘‘(4) distinguishes carefully between personal 

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1 dents, versus the lifestyle preferences of the people 

2 that choose to live in the neighborhood, reflects the 

3 physical characteristics of the neighborhood; and 

4 ‘‘(5)(A) identifies or develops effective interven5 tion strategies focusing on enhancements to the built 

6 environment that promote increased use physical ac7 tivity, access to nutritious foods, or other health-pro8 moting activities by residents; and 

9 ‘‘(B) in developing the intervention strategies 

10 under subparagraph (A), ensures that the interven11 tion strategies will reach out to high-risk or vulner12 able populations, including low-income urban and 

13 rural communities and aging populations, in addi14 tion to the general population. 

15 ‘‘(d) SURVEYS.—The Secretary may allow recipients 

16 of grants under this section to use such grant funds to 

17 support the expansion of national surveys and data track18 ing systems to provide more detailed information about 

19 the connection between the built environment and health. 

20 ‘‘(e) PRIORITY.—In awarding grants under this sec21 tion, the Secretary and the Administrator shall give pri22 ority to entities with programming that incorporates— 

23 ‘‘(1) interdisciplinary approaches; or 

24 ‘‘(2) the expertise of the public health, physical 

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1 tation research communities in the United States 

2 and abroad. 

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated such sums as may be 

5 necessary to carry out this section. The Secretary may al6 locate not more than 20 percent of the amount so appro7 priated for a fiscal year for purposes of conducting re8 search under subsection (c).’’. 

9 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 

10 ENVIRONMENTAL PROTECTION AGENCY. 

11 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 

12 Administrator of the Environmental Protection Agency 

13 (referred to in this section as the ‘‘Administrator’’) shall, 

14 as promptly as practicable, carry out each of the following 

15 recommendations of the Inspector General of the Environ16 mental Protection Agency as described in the report enti17 tled ‘‘EPA Needs to Conduct Environmental Justice Re18 views of Its Programs, Policies and Activities’’ (Report 

19 No. 2006–P–00034): 

20 (1) The recommendation that the program and 

21 regional offices of the Environmental Protection 

22 Agency identify which programs, policies, and activi23 ties need environmental justice reviews and the Ad24 ministrator require those offices to establish a plan 

25 to complete the necessary reviews. 


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1 (2) The recommendation that the Administrator 

2 ensure that the reviews described in paragraph (1) 

3 determine whether the programs, policies, and activi4 ties may have a disproportionately high and adverse 

5 health or environmental impact on minority and low6 income populations. 

7 (3) The recommendation that each program 

8 and regional office of the Environmental Protection 

9 Agency develop specific environmental justice review 

10 guidance for conducting environmental justice re11 views. 

12 (4) The recommendation that the Administrator 

13 designate a responsible office to compile results of 

14 environmental justice reviews and recommend appro15 priate actions. 

16 (b) GAO RECOMMENDATIONS.—In promulgating reg17 ulations of the Environmental Protection Agency, the Ad18 ministrator shall, as promptly as practicable, carry out 

19 each of the following recommendations of the Comptroller 

20 General of the United States as described in the report 

21 entitled ‘‘EPA Should Devote More Attention to Environ22 mental Justice when Developing Clean Air Rules’’ (GAO– 

23 05–289): 

24 (1) The recommendation that the Administrator 

25 ensure that workgroups involved in developing a rule 


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1 devote attention to environmental justice while draft2 ing and finalizing the rule. 

3 (2) The recommendation that the Administrator 

4 enhance the ability of the workgroups described in 

5 paragraph (1) to identify potential environmental 

6 justice issues through steps such as— 

7 (A) providing workgroup members with 

8 guidance and training to help those members 

9 identify potential environmental justice prob10 lems; and 

11 (B) involving environmental justice coordi12 nators in the workgroups if appropriate. 

13 (3) The recommendation that the Administrator 

14 improve assessments of potential environmental jus15 tice impacts in economic reviews by identifying the 

16 data and developing the modeling techniques needed 

17 to assess those impacts. 

18 (4) The recommendation that the Administrator 

19 direct appropriate officers and employees of the En20 vironmental Protection Agency, if feasible, to re21 spond fully to public comments on environmental 

22 justice, including by— 

23 (A) improving the explanation by the Ad24 ministrator of the basis for any conclusions re25 lating to environmental justice; and 


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1 (B) including in an explanation under sub2 paragraph (A) supporting data. 

3 (c) 2004 INSPECTOR GENERAL REPORT.— 

4 (1) IN GENERAL.—The Administrator shall, as 

5 promptly as practicable, carry out each of the fol6 lowing recommendations of the Inspector General of 

7 the Environmental Protection Agency as described 

8 in the report entitled ‘‘EPA Needs to Consistently 

9 Implement the Intent of the Executive Order on En10 vironmental Justice’’ (Report No. 2004–P–00007): 

11 (A) The recommendation that the Admin12 istrator clearly define the mission of the Office 

13 of Environmental Justice and provide Environ14 mental Protection Agency staff with an under15 standing of the roles and responsibilities of that 

16 Office. 

17 (B) The recommendation that the Admin18 istrator— 

19 (i) establish, through the issuance of 

20 guidance or a policy statement, specific 

21 timeframes for the development of defini22 tions, goals, and measurements regarding 

23 environmental justice; and 

24 (ii) provide the regions and program 

25 offices a standard and consistent definition 


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1 for a minority and low-income community, 

2 with instructions on how the Environ3 mental Protection Agency will implement 

4 and put into operation environmental jus5 tice in the daily activities of the Environ6 mental Protection Agency. 

7 (C) The recommendation that the Adminis8 trator ensure that the comprehensive training 

9 program that was under development (as of the 

10 date of the report) includes standard and con11 sistent definitions of the key environmental jus12 tice concepts, such as ‘‘low-income’’, ‘‘minor13 ity’’, and ‘‘disproportionately impacted’’, and 

14 instructions for implementation of those con15 cepts. 

16 (2) REPORTS.— 

17 (A) INITIAL REPORT.—Not later than 180 

18 days after the date of enactment of this Act, 

19 the Administrator shall submit to Congress an 

20 initial report on the strategy of the Adminis21 trator for implementing the recommendations 

22 described in subparagraphs (A), (B), and (C) of 

23 paragraph (1). 

24 (B) SUBSEQUENT REPORTS.—After sub25 mitting the initial report under subparagraph 


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1 (A), the Administrator shall submit to Congress 

2 semiannual reports on the progress of the Ad3 ministrator in— 

4 (i) implementing the recommendations 

5 referred to in subparagraph (A); and 

6 (ii) modifying the emergency manage7 ment procedures of the Administrator to 

8 incorporate environmental justice in the 

9 Incident Command Structure of the Envi10 ronmental Protection Agency, in accord11 ance with the December 18, 2006, letter 

12 from the Deputy Administrator to the Act13 ing Inspector General of the Environ14 mental Protection Agency. 

15 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 

16 PROTECTING PEOPLE AND THEIR FAMILIES FROM

17 RADON.— 

18 (1) FINDINGS.—Congress finds that radon is a 

19 naturally occurring radioactive gas that is— 

20 (A) recognized as the leading cause of lung 

21 cancer among nonsmokers; and 

22 (B) a particular environmental threat for 

23 low-income and minority individuals because of 

24 the lack of information about radon levels in 

25 the homes of those individuals. 


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1 (2) IMPLEMENTATION.—Not later than 180 

2 days after the date of enactment of this Act, the Ad3 ministrator shall implement the action plan entitled 

4 ‘‘Protecting People and Families from Radon: A 

5 Federal Action Plan for Saving Lives’’ (June 20, 

6 2011), in consultation with the Director of the Cen7 ters for Disease Control and Prevention and any 

8 other Federal agencies referred to in the action plan. 

9 (3) SPECIFIC STEPS.—In carrying out para10 graph (2), the Administrator shall ensure that— 

11 (A) the workgroup comprised of the Fed12 eral agencies participating in the development 

13 of the action plan referred to in paragraph (2) 

14 implements specific steps within the existing 

15 authority and activities of each Federal agency 

16 to reduce exposure to radon; and 

17 (B) not later than the date that is 1 year 

18 after the date on which the Administrator be19 gins implementation of the action plan de20 scribed in paragraph (2), the workgroup de21 scribed in subparagraph (A) meets to assess 

22 and recognize achievements of the plan. 

23 (4) REPORT.—After the progress meeting of 

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1 plementation of the action plan described in para2 graph (2), including the challenges remaining and 

3 the progress in reducing radon exposure, particularly 

4 for low-income and minority families. 

5 (e) FEDERAL ACTION PLAN FOR PREVENTING

6 CHILDHOOD LEAD POISONING.— 

7 (1) FINDINGS.—Congress finds that— 

8 (A) the effects of lead poisoning are irre9 versible and cost the United States millions an10 nually in medical and education costs; 

11 (B) the cognitive effects suffered by chil12 dren exposed to lead result in a lifetime of 

13 health and behavioral problems, which makes 

14 prevention efforts more critical; and 

15 (C) the risk is especially high for vulner16 able minority populations who are more likely 

17 to live in older homes, where lead-based paint 

18 is more likely to be present. 

19 (2) ACTION PLAN.—Not later than 180 days 

20 after the date of enactment of this Act, the Adminis21 trator, in consultation with the Director of the Cen22 ters for Disease Control and Prevention and other 

23 relevant Federal agencies, shall develop an action 

24 plan to reduce exposure to lead. 


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1 (3) SPECIFIC STEPS.—In carrying out para2 graph (2), the Administrator shall— 

3 (A) establish a working group, comprised 

4 of representatives of the Federal agencies par5 ticipating in the development of the action plan 

6 described in paragraph (2), to make rec7 ommendations for the implementation of spe8 cific steps within the existing authority and ac9 tivities of each Federal agency to reduce expo10 sure to lead; and 

11 (B) assist other Federal agencies in the de12 velopment of materials on the hazards of lead13 based paint for the purpose of educating ten14 ants and landlords, how to recognize potential 

15 sources of exposure, and how to remediate those 

16 sources. 

17 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON18 MENTAL HEALTH IMPROVEMENT ACTIVITIES 

19 AND TO IMPROVE SOCIAL DETERMINANTS OF 

20 HEALTH. 

21 (a) DEFINITIONS.—In this section: 

22 (1) DIRECTOR.—The term ‘‘Director’’ means 

23 the Director of the Centers for Disease Control and 

24 Prevention, acting in collaboration with the Adminis25 trator of the Environmental Protection Agency and 


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1 the Director of the National Institute of Environ2 mental Health Sciences. 

3 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti4 ty’’ means a State or local community that— 

5 (A) bears a disproportionate burden of ex6 posure to environmental health hazards; 

7 (B) bears a disproportionate burden of ex8 posure to unhealthy living conditions, low 

9 standard housing conditions, low socioeconomic 

10 status, poor nutrition, less opportunity for edu11 cational attainment, disproportionately high un12 employment rates, or lower literacy levels and 

13 access to information; 

14 (C) has established a coalition— 

15 (i) with not less than 1 community16 based organization or demonstration pro17 gram; and 

18 (ii) with not less than 1— 

19 (I) public health entity; 

20 (II) health care provider organi21 zation; 

22 (III) academic institution, includ23 ing any minority-serving institution 

24 (including a Hispanic-serving institu25 tion, a historically Black college or 


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1 university, or a Tribal College or Uni2 versity); 

3 (IV) child-serving institution; or 

4 (V) landlord or housing provider 

5 working on lead remediation; 

6 (D) ensures planned activities and funding 

7 streams are coordinated to improve community 

8 health; and 

9 (E) submits an application in accordance 

10 with subsection (c). 

11 (b) ESTABLISHMENT.—The Director shall establish a 

12 grant program under which eligible entities shall receive 

13 grants to conduct environmental health improvement ac14 tivities and to improve social determinants of health. 

15 (c) APPLICATION.—To receive a grant under this sec16 tion, an eligible entity shall submit an application to the 

17 Director at such time, in such manner, and accompanied 

18 by such information as the Director may require. 

19 (d) USE OF GRANT FUNDS.—An eligible entity may 

20 use a grant under this section— 

21 (1) to promote environmental health; 

22 (2) to address environmental health disparities 

23 among all populations, including children; and 

24 (3) to address racial and ethnic disparities in 

25 social determinants of health. 


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1 (e) AMOUNT OF COOPERATIVE AGREEMENT.—The 

2 Director shall award grants to eligible entities at the fol3 lowing 3 funding levels: 

4 (1) LEVEL 1 COOPERATIVE AGREEMENTS.— 

5 (A) IN GENERAL.—An eligible entity 

6 awarded a grant under this paragraph shall use 

7 the funds to identify environmental health prob8 lems and solutions by— 

9 (i) establishing a planning and 

10 prioritizing council in accordance with sub11 paragraph (B); and 

12 (ii) conducting an environmental 

13 health assessment in accordance with sub14 paragraph (C). 

15 (B) PLANNING AND PRIORITIZING COUN16 CIL.— 

17 (i) IN GENERAL.—A prioritizing and 

18 planning council established under sub19 paragraph (A)(i) (referred to in this para20 graph as a ‘‘PPC’’) shall assist the envi21 ronmental health assessment process and 

22 environmental health promotion activities 

23 of the eligible entity. 

24 (ii) MEMBERSHIP.—Membership of a 

25 PPC shall consist of representatives from 


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1 various organizations within public health, 

2 planning, development, and environmental 

3 services and shall include stakeholders 

4 from vulnerable groups such as children, 

5 the elderly, disabled, and minority ethnic 

6 groups that are often not actively involved 

7 in democratic or decision-making proc8 esses. 

9 (iii) DUTIES.—A PPC shall— 

10 (I) identify key stakeholders and 

11 engage and coordinate potential part12 ners in the planning process; 

13 (II) establish a formal advisory 

14 group to plan for the establishment of 

15 services; 

16 (III) conduct an in-depth review 

17 of the nature and extent of the need 

18 for an environmental health assess19 ment, including a local epidemiological 

20 profile, an evaluation of the service 

21 provider capacity of the community, 

22 and a profile of any target popu23 lations; and 

24 (IV) define the components of 

25 care and form essential programmatic 


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1 linkages with related providers in the 

2 community. 

3 (C) ENVIRONMENTAL HEALTH ASSESS4 MENT.— 

5 (i) IN GENERAL.—A PPC shall carry 

6 out an environmental health assessment to 

7 identify environmental health concerns. 

8 (ii) ASSESSMENT PROCESS.—The 

9 PPC shall— 

10 (I) define the goals of the assess11 ment; 

12 (II) generate the environmental 

13 health issue list; 

14 (III) analyze issues with a sys15 tems framework; 

16 (IV) develop appropriate commu17 nity environmental health indicators; 

18 (V) rank the environmental 

19 health issues; 

20 (VI) set priorities for action; 

21 (VII) develop an action plan; 

22 (VIII) implement the plan; and 

23 (IX) evaluate progress and plan24 ning for the future. 


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1 (D) EVALUATION.—Each eligible entity 

2 that receives a grant under this paragraph shall 

3 evaluate, report, and disseminate program find4 ings and outcomes. 

5 (E) TECHNICAL ASSISTANCE.—The Direc6 tor may provide such technical and other non7 financial assistance to eligible entities as the 

8 Director determines to be necessary. 

9 (2) LEVEL 2 COOPERATIVE AGREEMENTS.— 

10 (A) ELIGIBILITY.— 

11 (i) IN GENERAL.—The Director shall 

12 award grants under this paragraph to eli13 gible entities that have already— 

14 (I) established broad-based col15 laborative partnerships; and 

16 (II) completed environmental as17 sessments. 

18 (ii) NO LEVEL 1 REQUIREMENT.—To 

19 be eligible to receive a grant under this 

20 paragraph, an eligible entity is not re21 quired to have successfully completed a 

22 Level 1 Cooperative Agreement (as de23 scribed in paragraph (1)). 

24 (B) USE OF GRANT FUNDS.—An eligible 

25 entity awarded a grant under this paragraph 


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1 shall use the funds to further activities to carry 

2 out environmental health improvement activi3 ties, including— 

4 (i) addressing community environ5 mental health priorities in accordance with 

6 paragraph (1)(C)(ii), including— 

7 (I) geography; 

8 (II) the built environment; 

9 (III) air quality; 

10 (IV) water quality; 

11 (V) land use; 

12 (VI) solid waste; 

13 (VII) housing; 

14 (VIII) violence; 

15 (IX) socioeconomic status; 

16 (X) ethnicity, social construct 

17 and language preference; 

18 (XI) educational attainment; 

19 (XII) employment; 

20 (XIII) food safety, accessibility, 

21 and affordability; 

22 (XIV) nutrition; 

23 (XV) health care services; and 

24 (XVI) injuries; 


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1 (ii) building partnerships between 

2 planning, public health, and other sectors, 

3 including child-serving institutions, to ad4 dress how the built environment impacts 

5 food availability and access and physical 

6 activity to promote healthy behaviors and 

7 lifestyles and reduce overweight and obe8 sity, musculoskeletal diseases, respiratory 

9 conditions, dental, oral and mental health 

10 conditions, poverty, and related co11 morbidities; 

12 (iii) establishing programs to ad13 dress— 

14 (I) how environmental and social 

15 conditions of work and living choices 

16 influence physical activity and dietary 

17 intake; or 

18 (II) how the conditions described 

19 in subclause (I) influence the concerns 

20 and needs of people who have im21 paired mobility and use assistance de22 vices, including wheelchairs, lower 

23 limb prostheses, and hip, knee, and 

24 other joint replacements; and 


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1 (iv) convening intervention and dem2 onstration programs that examine the role 

3 of the social environment in connection 

4 with the physical and chemical environ5 ment in— 

6 (I) determining access to nutri7 tional food; 

8 (II) improving physical activity to 

9 reduce overweight, obesity, and co10 morbidities and increase quality of 

11 life; and 

12 (III) location and access to med13 ical facilities. 

14 (3) LEVEL 3 COOPERATIVE AGREEMENTS.— 

15 (A) IN GENERAL.—An eligible entity 

16 awarded a grant under this paragraph shall use 

17 the funds to identify and address racial and 

18 ethnic disparities in social determinants of 

19 health by creating demonstration programs that 

20 assess the feasibility of establishing a federally 

21 funded comprehensive program and describe 

22 key outcomes that address racial and ethnic dis23 parities in social determinants of health. 

24 (B) PROGRAM DESIGN.— 


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1 (i) EVALUATION.—No later than 1 

2 year after enactment of this Act, the Di3 rector shall evaluate the best practices of 

4 existing programs from the private, public, 

5 community based, and academically sup6 ported initiatives focused on reducing dis7 parities in the social determinants of 

8 health for racial and ethnic populations. 

9 (ii) DEMONSTRATION PROJECTS.— 

10 Not later than two years after the date of 

11 enactment of this Act, the Director shall 

12 implement at least ten demonstration 

13 projects including at least one project for 

14 each major racial and ethnic minority 

15 group, each of which is unique to the cul16 tural and linguistic needs of each of the 

17 following groups: 

18 (I) Native Americans and Alaska 

19 Natives. 

20 (II) Asian Americans. 

21 (III) African Americans/Blacks. 

22 (IV) Hispanic/Latino-Americans. 

23 (V) Native Hawaiians and Pacific 

24 Islanders. 


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1 (iii) REPORT TO CONGRESS.—No later 

2 than 2 years after the implementation of 

3 the initial demonstration projects, the Di4 rector shall submit to Congress a report 

5 which includes— 

6 (I) a description of each dem7 onstration project and design; 

8 (II) an evaluation of the cost-ef9 fectiveness of each project’s preven10 tion and treatment efforts; 

11 (III) an evaluation of the cultural 

12 and linguistic appropriateness of each 

13 project by racial and ethnic group; 

14 and 

15 (IV) an evaluation of the bene16 ficiary’s health status improvement 

17 under the demonstration project. 

18 (iv) ANY OTHER INFORMATION

19 DEEMED APPROPRIATE BY THE DIREC20 TOR.—The Director shall require eligible 

21 entities awarded a grant under this para22 graph to report any other information the 

23 Director determines appropriate to be 

24 shared by or developed by such entity, in25 cluding the following: 


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1 (I) Developing models and evalu2 ating methods that improve the cul3 tural and linguistically appropriate 

4 services provided through the Centers 

5 for Disease Control and Prevention to 

6 target individuals impacted by health 

7 disparities based on their race, eth8 nicity, and gender. 

9 (II) Promoting the collaboration 

10 between primary and specialty care 

11 health care providers and patients, to 

12 ensure patients impacted by health 

13 disparities based on race, ethnicity, 

14 and gender are receiving comprehen15 sive and organized treatment and 

16 care. 

17 (III) Educating health care pro18 fessionals on the causes and effects of 

19 disparities in the social determinants 

20 of health as it relates to minority and 

21 racial and ethnic communities and the 

22 need for culturally and linguistically 

23 appropriate care in the prevention and 

24 treatment of high-impact diseases. 


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1 (IV) Encouraging collaboration 

2 among community and patient-based 

3 organizations which work to address 

4 disparities in the social determinants 

5 of health as it relates to high-impact 

6 diseases in minority and racial and 

7 ethnic populations. 

8 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to carry out this sec10 tion— 

11 (1) $25,000,000 for fiscal year 2021; and 

12 (2) such sums as may be necessary for fiscal 

13 years 2022 through 2024. 

14 SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 

15 BETWEEN THE BUILT ENVIRONMENT AND 

16 THE HEALTH OF COMMUNITY RESIDENTS. 

17 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 

18 section, the term ‘‘eligible institution’’ means a public or 

19 private nonprofit institution that submits to the Secretary 

20 of Health and Human Services (in this section referred 

21 to as the ‘‘Secretary’’) and the Administrator of the Envi22 ronmental Protection Agency (in this section referred to 

23 as the ‘‘Administrator’’) an application for a grant under 

24 the grant program authorized under subsection (b)(2) at 

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1 ments, assurances, and information as the Secretary and 

2 Administrator may require. 

3 (b) RESEARCH GRANT PROGRAM.— 

4 (1) DEFINITION OF HEALTH.—In this section, 

5 the term ‘‘health’’ includes— 

6 (A) levels of physical activity; 

7 (B) degree of mobility due to factors such 

8 as musculoskeletal diseases, arthritis, and obe9 sity; 

10 (C) consumption of nutritional foods; 

11 (D) rates of crime; 

12 (E) air, water, and soil quality; 

13 (F) risk of injury; 

14 (G) accessibility to health care services; 

15 (H) levels of educational attainment; and 

16 (I) other indicators as determined appro17 priate by the Secretary. 

18 (2) GRANTS.—The Secretary, in collaboration 

19 with the Administrator, shall provide grants to eligi20 ble institutions to conduct and coordinate research 

21 on the built environment and its influence on indi22 vidual and population-based health. 

23 (3) RESEARCH.—The Secretary shall support 

24 research that— 


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1 (A) investigates and defines the causal 

2 links between all aspects of the built environ3 ment and the health of residents; 

4 (B) examines— 

5 (i) the extent of the impact of the 

6 built environment (including the various 

7 characteristics of the built environment) on 

8 the health of residents; 

9 (ii) the variance in the health of resi10 dents by— 

11 (I) location (such as inner cities, 

12 inner suburbs, and outer suburbs); 

13 and 

14 (II) population subgroup (includ15 ing children, the elderly, the disadvan16 taged); or 

17 (iii) the importance of the built envi18 ronment to the total health of residents, 

19 which is the primary variable of interest 

20 from a public health perspective; 

21 (C) is used to develop— 

22 (i) measures to address health and the 

23 connection of health to the built environ24 ment; and 


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1 (ii) efforts to link the measures to 

2 travel and health databases; 

3 (D) distinguishes carefully between per4 sonal attitudes and choices and external influ5 ences on observed behavior to determine how 

6 much an observed association between the built 

7 environment and the health of residents, versus 

8 the lifestyle preferences of the people that 

9 choose to live in the neighborhood, reflects the 

10 physical characteristics of the neighborhood; 

11 and 

12 (E)(i) identifies or develops effective inter13 vention strategies to promote better health 

14 among residents with a focus on behavioral 

15 interventions and enhancements of the built en16 vironment that promote increased use by resi17 dents; and 

18 (ii) in developing the intervention strate19 gies under clause (i), ensures that the interven20 tion strategies will reach out to high-risk popu21 lations, including racial and ethnic minorities, 

22 low-income urban and rural communities, and 

23 children. 

24 (4) PRIORITY.—In providing assistance under 

25 the grant program authorized under paragraph (2), 


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1 the Secretary and the Administrator shall give pri2 ority to research that incorporates— 

3 (A) minority-serving institutions as grant4 ees; 

5 (B) interdisciplinary approaches; or 

6 (C) the expertise of the public health, 

7 physical activity, nutrition and health care (in8 cluding child health), urban planning, and 

9 transportation research communities in the 

10 United States and abroad. 

11 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA12 TION. 

13 (a) FINDINGS.—Congress finds that— 

14 (1) humans share an environment with a wide 

15 variety of habitats and ecosystems that nurture and 

16 sustain a diversity of species; 

17 (2) the abundance of natural resources in the 

18 environment forms the basis for the economy and 

19 has greatly contributed to human development 

20 throughout history; 

21 (3) the accelerated pace of human development 

22 over the last several hundred years has significantly 

23 impacted— 

24 (A) the natural environment and its re25 sources; 


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1 (B) the health and diversity of plant and 

2 animal life; 

3 (C) the availability of critical habitats; 

4 (D) the quality of the air and water; and 

5 (E) the global climate; 

6 (4) the intervention of the Federal Government 

7 is necessary to minimize and mitigate human impact 

8 on the environment— 

9 (A) for the benefit of public health; 

10 (B) to maintain air quality and water qual11 ity; 

12 (C) to sustain the diversity of plants and 

13 animals; 

14 (D) to combat global climate change; and 

15 (E) to protect the environment; 

16 (5) laws and regulations in the United States 

17 have been enacted and promulgated to minimize and 

18 mitigate human impact on the environment for the 

19 benefit of public health, to maintain air quality and 

20 water quality, to sustain wildlife, and to protect the 

21 environment; and 

22 (6) attempts to repeal or weaken key environ23 mental safeguards pose dangers to the public health, 

24 air quality, water quality, wildlife, and the environ25 ment. 


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1 (b) STATEMENT OF POLICY.—It is the policy of the 

2 Federal Government to work in conjunction with States, 

3 territories, Tribal governments, international organiza4 tions, and foreign governments as a steward of the envi5 ronment for the benefit of public health, to maintain air 

6 quality and water quality, to sustain the diversity of plant 

7 and animal species, to combat global climate change, and 

8 to protect the environment for future generations. 

9 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN10 VIRONMENTAL IMPACT OF REVISED RULES, REGULA11 TIONS, LAWS, OR OTHER AGENCY DECISIONS.— 

12 (1) STUDY.—Not later than 30 days after the 

13 date of enactment of this Act, the President shall 

14 seek to enter into an arrangement under which the 

15 National Academy of Sciences shall conduct a study 

16 to determine the impact on public health, air quality, 

17 water quality, wildlife, and the environment of the 

18 following regulations, laws, and other agency deci19 sions: 

20 (A) CLEAN WATER.— 

21 (i) The final rule of the Environ22 mental Protection Agency and the Corps of 

23 Engineers entitled ‘‘Final Revisions to the 

24 Clean Water Act Regulatory Definitions of 

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1 rial’ ’’ (67 Fed. Reg. 31129 (May 9, 

2 2002)). 

3 (ii) The final rule of the Environ4 mental Protection Agency entitled ‘‘Na5 tional Pollutant Discharge Elimination 

6 System Permit Regulation for Con7 centrated Animal Feeding Operations: Re8 moval of Vacated Elements in Response to 

9 2011 Court Decision’’ (77 Fed. Reg. 

10 44494 (July 30, 2012)). 

11 (iii) The final rule entitled ‘‘With12 drawal of Revisions to the Water Quality 

13 Planning and Management Regulation and 

14 Revisions to the National Pollutant Dis15 charge Elimination System Program in 

16 Support of Revisions to the Water Quality 

17 Planning and Management Regulation’’ 

18 (68 Fed. Reg. 13608 (March 19, 2003)). 

19 (iv) The final rule of the Environ20 mental Protection Agency entitled ‘‘Con21 solidated Permit Regulations: RCRA Haz22 ardous Waste; SDWA Underground Injec23 tion Control; CWA National Pollutant Dis24 charge Elimination System; CWA Section 

25 404 Dredge or Fill Programs; and CAA 


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1 Prevention of Significant Deterioration’’ 

2 (45 Fed. Reg. 33290 (May 19, 1980)), 

3 with respect to the definition of the ‘‘wa4 ters of the United States’’. 

5 (v) The final rule of the Corps of En6 gineers and the Environmental Protection 

7 Agency entitled ‘‘Definition of ‘Waters of 

8 the United States’—Recodification of Pre9 Existing Rules’’ (84 Fed. Reg. 56626 (Oc10 tober 22, 2019)). 

11 (vi) The final rule of the Corps of En12 gineers and the Environmental Protection 

13 Agency entitled ‘‘The Navigable Waters 

14 Protection Rule: Definition of ‘Waters of 

15 the United States’ ’’ (85 Fed. Reg. 22250 

16 (April 21, 2020)). 

17 (B) FORESTS AND LAND MANAGEMENT.— 

18 (i) The Healthy Forests Restoration 

19 Act of 2003 (16 U.S.C. 6501 et seq.). 

20 (ii) The application of section 553(e) 

21 of title 5, United States Code, such that a 

22 State may petition for a special rule for 

23 the National Forest System inventoried 

24 roadless areas within the State. 


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1 (iii) The final rules entitled ‘‘National 

2 Forest System Land Management Plan3 ning’’ (77 Fed. Reg. 21162 (April 9, 

4 2012)) and ‘‘National Forest System Land 

5 Management Planning’’ (81 Fed. Reg. 

6 90723 (December 15, 2016)). 

7 (iv) The final rule entitled ‘‘Oil Shale 

8 Management—General’’ (73 Fed. Reg. 

9 69414 (November 18, 2008)). 

10 (v) The record of decision described in 

11 the notice of availability entitled ‘‘Notice of 

12 Availability of Approved Land Use Plan 

13 Amendments/Record of Decision for Allo14 cation of Oil Shale and Tar Sands Re15 sources on Lands Administered by the Bu16 reau of Land Management in Colorado, 

17 Utah, and Wyoming and Final Pro18 grammatic Environmental Impact State19 ment’’ (78 Fed. Reg. 19518 (April 1, 

20 2013)). 

21 (C) SCIENTIFIC REVIEW.—The final rule 

22 entitled ‘‘Interagency Cooperation Under the 

23 Endangered Species Act’’ (73 Fed. Reg. 76272 

24 (December 16, 2008)), as amended by the final 

25 rule entitled ‘‘Endangered and Threatened 


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1 Wildlife and Plants; Regulations for Inter2 agency Cooperation’’ (84 Fed. Reg. 44976 (Au3 gust 27, 2019)). 

4 (2) METHOD.—In conducting the study under 

5 paragraph (1), the National Academy of Sciences 

6 may use and compare existing scientific studies re7 garding the regulations, laws, and other agency deci8 sions described in paragraph (1). 

9 (3) REPORT.—Not later than 270 days after 

10 the date on which the President enters into the ar11 rangement under paragraph (1), the National Acad12 emy of Sciences shall make publicly available and 

13 shall submit to Congress and to the head of each de14 partment and agency of the Federal Government 

15 that issued, implements, or would implement a regu16 lation, law, or other agency decision described in 

17 paragraph (1), a report that includes— 

18 (A) a description of the impact of each 

19 regulation, law, or other agency decision de20 scribed in paragraph (1) on public health, air 

21 quality, water quality, wildlife, and the environ22 ment, compared to the impact of preexisting 

23 regulations, laws, or other agency decisions in 

24 effect, as applicable, including— 


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1 (i) any negative impacts to air quality 

2 or water quality; 

3 (ii) any negative impacts to wildlife; 

4 (iii) any delays in hazardous waste 

5 cleanup that are projected to be hazardous 

6 to public health; and 

7 (iv) any other negative impact on pub8 lic health or the environment; and 

9 (B) any recommendations that the Na10 tional Academy of Sciences considers appro11 priate to maintain, restore, or improve in whole 

12 or in part protections for public health, air 

13 quality, water quality, wildlife, and the environ14 ment for each of the regulations, laws, and 

15 other agency decisions described in paragraph 

16 (1), which may include recommendations for 

17 the adoption of any regulation or law in place 

18 or proposed prior to January 1, 2001. 

19 (d) DEPARTMENT AND AGENCY REVISION OF EXIST20 ING RULES, REGULATIONS, OR LAWS.—Not later than 

21 180 days after the date on which the report is submitted 

22 pursuant to subsection (c)(3), the head of each depart23 ment or agency that has issued or implemented a regula24 tion, law, or other agency decision described in subsection 

25 (c)(1) shall submit to Congress a plan describing the steps 


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1 the department or agency will take, or has taken, to re2 store or improve protections for public health and the envi3 ronment in whole or in part that were in existence prior 

4 to the issuance of the applicable regulation, law, or other 

5 agency decision. 

6 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP7 WATER HORIZON OIL RIG EXPLOSION IN THE 

8 GULF COAST. 

9 (a) STUDY.—The Comptroller General of the United 

10 States shall conduct a study on the type and scope of 

11 health care services administered through the Department 

12 of Health and Human Services addressing the provision 

13 of health care to racial and ethnic minorities, including 

14 residents, cleanup workers, and volunteers, affected by the 

15 blowout and explosion of the mobile offshore drilling unit 

16 Deepwater Horizon that occurred on April 20, 2010, and 

17 resulting hydrocarbon releases into the environment. 

18 (b) SPECIFIC COMPONENTS.—In carrying out sub19 section (a), the Comptroller General of the United States 

20 shall— 

21 (1) assess the type, size, and scope of programs 

22 administered by the Secretary of Health and Human 

23 Services that focus on the provision of health care 

24 to communities on the Gulf Coast; 


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1 (2) identify the merits and disadvantages asso2 ciated with each of the programs; 

3 (3) perform an analysis of the costs and bene4 fits of the programs; and 

5 (4) determine whether there is any duplication 

6 of programs. 

7 (c) REPORT.—Not later than 180 days after the date 

8 of enactment of this Act, the Comptroller General of the 

9 United States shall submit to Congress a report that in10 cludes— 

11 (1) the findings of the study conducted under 

12 subsection (a); and 

13 (2) recommendations for improving access to 

14 health care for racial and ethnic minorities. 

15 SEC. 1009. ESTABLISH AN INTERAGENCY COUNSEL AND 

16 GRANT PROGRAMS ON SOCIAL DETER17 MINANTS OF HEALTH. 

18 (a) SHORT TITLE.—This section may be cited as the 

19 ‘‘Social Determinants Accelerator Act of 2020’’. 

20 (b) FINDINGS; PURPOSES.— 

21 (1) FINDINGS.—Congress finds the following: 

22 (A) There is a significant body of evidence 

23 showing that economic and social conditions 

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1 lation health outcomes and well-being, as well 

2 as medical costs. 

3 (B) State, local, and Tribal governments 

4 and the service delivery partners of such gov5 ernments face significant challenges in coordi6 nating benefits and services delivered through 

7 the Medicaid program and other social services 

8 programs because of the fragmented and com9 plex nature of Federal and State funding and 

10 administrative requirements. 

11 (C) The Federal Government should 

12 prioritize and proactively assist State and local 

13 governments to strengthen the capacity of State 

14 and local governments to improve health and 

15 social outcomes for individuals, thereby improv16 ing cost-effectiveness and return on investment. 

17 (2) PURPOSES.—The purposes of this section 

18 are as follows: 

19 (A) To establish effective, coordinated Fed20 eral technical assistance to help State and local 

21 governments to improve outcomes and cost-ef22 fectiveness of, and return on investment from, 

23 health and social services programs. 

24 (B) To build a pipeline of State and locally 

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1 gies that generate rigorous evidence about how 

2 to improve health and social outcomes, and in3 crease the cost-effectiveness of, and return on 

4 investment from, Federal, State, local, and 

5 Tribal health and social services programs. 

6 (C) To enlist State and local governments 

7 and the service providers of such governments 

8 as partners in identifying Federal statutory, 

9 regulatory, and administrative challenges in im10 proving the health and social outcomes of, cost11 effectiveness of, and return on investment from, 

12 Federal spending on individuals enrolled in 

13 Medicaid. 

14 (D) To develop strategies to improve 

15 health and social outcomes without denying 

16 services to, or restricting the eligibility of, vul17 nerable populations. 

18 (c) SOCIAL DETERMINANTS ACCELERATOR COUN19 CIL.— 

20 (1) ESTABLISHMENT.—The Secretary of Health 

21 and Human Services (referred to in this section as 

22 the ‘‘Secretary’’), in coordination with the Adminis23 trator of the Centers for Medicare & Medicaid Serv24 ices (referred to in this section as the ‘‘Adminis25 trator’’), shall establish an interagency council, to be 


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1 known as the Social Determinants Accelerator Inter2 agency Council (referred to in this section as the 

3 ‘‘Council’’) to achieve the purposes listed in sub4 section (b)(2). 

5 (2) MEMBERSHIP.— 

6 (A) FEDERAL COMPOSITION.—The Council 

7 shall be composed of at least one designee from 

8 each of the following Federal agencies: 

9 (i) The Office of Management and 

10 Budget. 

11 (ii) The Department of Agriculture. 

12 (iii) The Department of Education. 

13 (iv) The Indian Health Service. 

14 (v) The Department of Housing and 

15 Urban Development. 

16 (vi) The Department of Labor. 

17 (vii) The Department of Transpor18 tation. 

19 (viii) Any other Federal agency the 

20 Chair of the Council determines necessary. 

21 (B) DESIGNATION.— 

22 (i) IN GENERAL.—The head of each 

23 agency specified in subparagraph (A) shall 

24 designate at least one employee to serve as 

25 a member of the Council. 


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1 (ii) RESPONSIBILITIES.—An employee 

2 described in this clause shall be a senior 

3 employee of the agency— 

4 (I) whose responsibilities relate 

5 to authorities, policies, and procedures 

6 with respect to the health and well7 being of individuals receiving medical 

8 assistance under a State plan (or a 

9 waiver of such plan) under title XIX 

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

11 1396 et seq.); or 

12 (II) who has authority to imple13 ment and evaluate transformative ini14 tiatives that harness data or conducts 

15 rigorous evaluation to improve the im16 pact and cost-effectiveness of federally 

17 funded services and benefits. 

18 (C) HHS REPRESENTATION.—In addition 

19 to the designees under subparagraph (A), the 

20 Council shall include designees from at least 3 

21 agencies within the Department of Health and 

22 Human Services, including the Centers for 

23 Medicare & Medicaid Services, at least one of 

24 whom shall meet the criteria under this section. 


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1 (D) OMB ROLE.—The Director of the Of2 fice of Management and Budget shall facilitate 

3 the timely resolution of Federal Government4 wide and multiagency issues to help the Council 

5 achieve consensus recommendations described 

6 under this section. 

7 (E) NON-FEDERAL COMPOSITION.—The 

8 Comptroller General of the United States may 

9 designate up to 6 Council designees— 

10 (i) who have relevant subject matter 

11 expertise, including expertise implementing 

12 and evaluating transformative initiatives 

13 that harness data and conduct evaluations 

14 to improve the impact and cost-effective15 ness of Federal Government services; and 

16 (ii) that each represent— 

17 (I) State, local, and Tribal health 

18 and human services agencies; 

19 (II) public housing authorities or 

20 State housing finance agencies; 

21 (III) State and local government 

22 budget offices; 

23 (IV) State Medicaid agencies; or 

24 (V) national consumer advocacy 

25 organizations. 


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1 (F) CHAIR.— 

2 (i) IN GENERAL.—The Secretary shall 

3 select the Chair of the Council from among 

4 the members of the Council. 

5 (ii) INITIATING GUIDANCE.—The 

6 Chair, on behalf of the Council, shall iden7 tify and invite individuals from diverse en8 tities to provide the Council with advice 

9 and information pertaining to addressing 

10 social determinants of health, including— 

11 (I) individuals from State and 

12 local government health and human 

13 services agencies; 

14 (II) individuals from State Med15 icaid agencies; 

16 (III) individuals from State and 

17 local government budget offices; 

18 (IV) individuals from public 

19 housing authorities or State housing 

20 finance agencies; 

21 (V) individuals from nonprofit or22 ganizations, small businesses, and 

23 philanthropic organizations; 

24 (VI) advocates; 

25 (VII) researchers; and 


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1 (VIII) any other individuals the 

2 Chair determines to be appropriate. 

3 (3) DUTIES.—The duties of the Council are— 

4 (A) to make recommendations to the Sec5 retary and the Administrator regarding the cri6 teria for making awards under this section; 

7 (B) to identify Federal authorities and op8 portunities for use by States or local govern9 ments to improve coordination of funding and 

10 administration of Federal programs, the bene11 ficiaries of whom include individuals, and which 

12 may be unknown or underutilized and to make 

13 information on such authorities and opportuni14 ties publicly available; 

15 (C) to provide targeted technical assistance 

16 to States developing a social determinants ac17 celerator plan under this section, including 

18 identifying potential statutory or regulatory 

19 pathways for implementation of the plan and 

20 assisting in identifying potential sources of 

21 funding to implement the plan; 

22 (D) to report to Congress annually on the 

23 subjects set forth in this section; 

24 (E) to develop and disseminate evaluation 

25 guidelines and standards that can be used to 


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1 reliably assess the impact of an intervention or 

2 approach that may be implemented pursuant to 

3 this section on outcomes, cost-effectiveness of, 

4 and return on investment from Federal, State, 

5 local, and Tribal governments, and to facilitate 

6 technical assistance, where needed, to help to 

7 improve State and local evaluation designs and 

8 implementation; 

9 (F) to seek feedback from State, local, and 

10 Tribal governments, including through an an11 nual survey by an independent third party, on 

12 how to improve the technical assistance the 

13 Council provides to better equip State, local, 

14 and Tribal governments to coordinate health 

15 and social service programs; 

16 (G) to solicit applications for grants under 

17 this section; and 

18 (H) to coordinate with other cross-agency 

19 initiatives focused on improving the health and 

20 well-being of low-income and at-risk populations 

21 in order to prevent unnecessary duplication be22 tween agency initiatives. 

23 (4) SCHEDULE.—Not later than 60 days after 

24 the date of the enactment of this Act, the Council 

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1 rying out the duties described in this section, includ2 ing solicitation of applications for the grants under 

3 this section. 

4 (5) REPORT TO CONGRESS.—The Council shall 

5 submit an annual report to Congress, which shall in6 clude— 

7 (A) a list of the Council members; 

8 (B) activities and expenditures of the 

9 Council; 

10 (C) summaries of the interventions and ap11 proaches that will be supported by State, local, 

12 and Tribal governments that received a grant 

13 under this section, including— 

14 (i) the best practices and evidence15 based approaches such governments plan 

16 to employ to achieve the purposes listed in 

17 this section; and 

18 (ii) a description of how the practices 

19 and approaches will impact the outcomes, 

20 cost-effectiveness of, and return on invest21 ment from, Federal, State, local, and Trib22 al governments with respect to such pur23 poses; 

24 (D) the feedback received from State and 

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1 nical assistance of the Council, including find2 ings from a third-party survey and actions the 

3 Council plans to take in response to such feed4 back; and 

5 (E) the major statutory, regulatory, and 

6 administrative challenges identified by State, 

7 local, and Tribal governments that received a 

8 grant under subsection (d), and the actions that 

9 Federal agencies are taking to address such 

10 challenges. 

11 (6) FACA APPLICABILITY.—The Federal Advi12 sory Committee Act (5 U.S.C. App.) shall not apply 

13 to the Council. 

14 (7) COUNCIL PROCEDURES.—The Secretary, in 

15 consultation with the Comptroller General of the 

16 United States and the Director of the Office of Man17 agement and Budget, shall establish procedures for 

18 the Council to— 

19 (A) ensure that adequate resources are 

20 available to effectively execute the responsibil21 ities of the Council; 

22 (B) effectively coordinate with other rel23 evant advisory bodies and working groups to 

24 avoid unnecessary duplication; 


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1 (C) create transparency to the public and 

2 Congress with regard to Council membership, 

3 costs, and activities, including through use of 

4 modern technology and social media to dissemi5 nate information; and 

6 (D) avoid conflicts of interest that would 

7 jeopardize the ability of the Council to make de8 cisions and provide recommendations. 

9 (d) SOCIAL DETERMINANTS ACCELERATOR GRANTS

10 TO STATES OR LOCAL GOVERNMENTS.— 

11 (1) GRANTS TO STATES, LOCAL GOVERNMENTS, 

12 AND TRIBES.—Not later than 180 days after the 

13 date of the enactment of this Act, the Administrator, 

14 in consultation with the Secretary and the Council, 

15 shall award on a competitive basis not more than 25 

16 grants to eligible applicants described in this sub17 section, for the development of social determinants 

18 accelerator plans, as described in this subsection. 

19 (2) ELIGIBLE APPLICANT.—An eligible appli20 cant described in this subsection is a State, local, or 

21 Tribal health or human services agency that— 

22 (A) demonstrates the support of relevant 

23 parties across relevant State, local, or Tribal ju24 risdictions; and 


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1 (B) in the case of an applicant that is a 

2 local government agency, provides to the Sec3 retary a letter of support from the lead State 

4 health or human services agency for the State 

5 in which the local government is located. 

6 (3) AMOUNT OF GRANT.—The Administrator, 

7 in coordination with the Council, shall determine the 

8 total amount that the Administrator will make avail9 able to each grantee under this subsection. 

10 (4) APPLICATION.—An eligible applicant seek11 ing a grant under this subsection shall include in the 

12 application the following information: 

13 (A) The target population (or populations) 

14 that would benefit from implementation of the 

15 social determinants accelerator plan proposed to 

16 be developed by the applicant. 

17 (B) A description of the objective or objec18 tives and outcome goals of such proposed plan, 

19 which shall include at least one health outcome 

20 and at least one other important social out21 come. 

22 (C) The sources and scope of inefficiencies 

23 that, if addressed by the plan, could result in 

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1 vestment from Federal, State, local, and Tribal 

2 governments. 

3 (D) A description of potential interventions 

4 that could be designed or enabled using such 

5 proposed plan. 

6 (E) The State, local, Tribal, academic, 

7 nonprofit, community-based organizations, and 

8 other private sector partners that would partici9 pate in the development of the proposed plan 

10 and subsequent implementation of programs or 

11 initiatives included in such proposed plan. 

12 (F) Such other information as the Admin13 istrator, in consultation with the Secretary and 

14 the Council, determines necessary to achieve the 

15 purposes of this section. 

16 (5) USE OF FUNDS.—A recipient of a grant 

17 under this subsection may use funds received 

18 through the grant for the following purposes: 

19 (A) To convene and coordinate with rel20 evant government entities and other stake21 holders across sectors to assist in the develop22 ment of a social determinant accelerator plan. 

23 (B) To identify populations of individuals 

24 receiving medical assistance under a State plan 

25 (or a waiver of such plan) under title XIX of 


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1 the Social Security Act (42 U.S.C. 1396 et 

2 seq.) who may benefit from the proposed ap3 proaches to improving the health and well-being 

4 of such individuals through the implementation 

5 of the proposed social determinants accelerator 

6 plan. 

7 (C) To engage qualified research experts to 

8 advise on relevant research and to design a pro9 posed evaluation plan, in accordance with the 

10 standards and guidelines issued by the Admin11 istrator. 

12 (D) To collaborate with the Council to sup13 port the development of social determinants ac14 celerator plans. 

15 (E) To prepare and submit a final social 

16 determinants accelerator plan to the Council. 

17 (6) CONTENTS OF PLANS.—A social deter18 minant accelerator plan developed under this sub19 section shall include the following: 

20 (A) A description of the target population 

21 (or populations) that would benefit from imple22 mentation of the social determinants accelerator 

23 plan, including an analysis describing the pro24 jected impact on the well-being of individuals 

25 described in paragraph (5)(B). 


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1 (B) A description of the interventions or 

2 approaches designed under the social deter3 minants accelerator plan and the evidence for 

4 selecting such interventions or approaches. 

5 (C) The objectives and outcome goals of 

6 such interventions or approaches, including at 

7 least one health outcome and at least one other 

8 important social outcome. 

9 (D) A plan for accessing and linking rel10 evant data to enable coordinated benefits and 

11 services for the jurisdictions described in this 

12 section and an evaluation of the proposed inter13 ventions and approaches. 

14 (E) A description of the State, local, Trib15 al, academic, nonprofit, or community-based or16 ganizations, or any other private sector organi17 zations that would participate in implementing 

18 the proposed interventions or approaches, and 

19 the role each would play to contribute to the 

20 success of the proposed interventions or ap21 proaches. 

22 (F) The identification of the funding 

23 sources that would be used to finance the pro24 posed interventions or approaches. 


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1 (G) A description of any financial incen2 tives that may be provided, including outcome3 focused contracting approaches to encourage 

4 service providers and other partners to improve 

5 outcomes of, cost-effectiveness of, and return on 

6 investment from, Federal, State, local, or Tribal 

7 government spending. 

8 (H) The identification of the applicable 

9 Federal, State, local, or Tribal statutory and 

10 regulatory authorities, including waiver authori11 ties, to be leveraged to implement the proposed 

12 interventions or approaches. 

13 (I) A description of potential consider14 ations that would enhance the impact, 

15 scalability, or sustainability of the proposed 

16 interventions or approaches and the actions the 

17 grant awardee would take to address such con18 siderations. 

19 (J) A proposed evaluation plan, to be car20 ried out by an independent evaluator, to meas21 ure the impact of the proposed interventions or 

22 approaches on the outcomes of, cost-effective23 ness of, and return on investment from, Fed24 eral, State, local, and Tribal governments. 


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1 (K) Precautions for ensuring that vulner2 able populations will not be denied access to 

3 Medicaid or other essential services as a result 

4 of implementing the proposed plan. 

5 (e) FUNDING.— 

6 (1) IN GENERAL.—Out of any money in the 

7 Treasury not otherwise appropriated, there is appro8 priated to carry out this section $25,000,000 to re9 main available for obligation until the date that is 

10 5 years after the date of enactment of this section. 

11 (2) RESERVATION OF FUNDS.— 

12 (A) IN GENERAL.—Of the funds made 

13 available under paragraph (1), the Secretary 

14 shall reserve not less than 20 percent to award 

15 grants to eligible applicants for the development 

16 of social determinants accelerator plans under 

17 this section intended to serve rural populations. 

18 (B) EXCEPTION.—In the case of a fiscal 

19 year for which the Secretary determines that 

20 there are not sufficient eligible applicants to 

21 award up to 25 grants under subsection (d) 

22 that are intended to serve rural populations and 

23 the Secretary cannot satisfy the 20-percent re24 quirement, the Secretary may reserve an 

25 amount that is less than 20 percent of amounts 


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1 made available under paragraph (1) to award 

2 grants for such purpose. 

3 (3) RULE OF CONSTRUCTION.—Nothing in this 

4 section shall prevent Federal agencies represented 

5 on the Council from contributing additional funding 

6 from other sources to support activities to improve 

7 the effectiveness of the Council. 

8 SEC. 1010. CORRECTING HURTFUL AND ALIENATING 

9 NAMES IN GOVERNMENT EXPRESSION 

10 (CHANGE). 

11 (a) SHORT TITLE.—This section may be cited as the 

12 ‘‘Correcting Hurtful and Alienating Names in Government 

13 Expression (CHANGE) Act’’. 

14 (b) DEFINITIONS.—In this section: 

15 (1) EMPLOYEE.—The term ‘‘employee’’ has the 

16 meaning given the term in section 2105 of title 5, 

17 United States Code. 

18 (2) EXECUTIVE AGENCY.—The term ‘‘Executive 

19 agency’’ has the meaning given the term in section 

20 105 of title 5, United States Code. 

21 (3) OFFICER.—The term ‘‘officer’’ has the 

22 meaning given the term in section 2104 of title 5, 

23 United States Code. 

24 (4) PROHIBITED TERM.—The term ‘‘prohibited 

25 term’’ means— 


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1 (A) the term ‘‘alien’’, when used to refer to 

2 an individual who is not a citizen or national of 

3 the United States; and 

4 (B) the term ‘‘illegal alien’’, when used to 

5 refer to an individual who— 

6 (i) is unlawfully present in the United 

7 States; or 

8 (ii) lacks a lawful immigration status 

9 in the United States. 

10 (c) MODERNIZATION OF LANGUAGE REFERRING TO

11 INDIVIDUALS WHO ARE NOT CITIZENS OR NATIONALS OF

12 THE UNITED STATES.— 

13 (1) IN GENERAL.—Except as provided in para14 graph (2), on and after the date of enactment of this 

15 Act, an Executive agency may not use a prohibited 

16 term in any proposed or final rule, regulation, inter17 pretation, publication, other document, display, or 

18 sign issued by the Executive agency. 

19 (2) EXCEPTION.—An Executive agency may use 

20 a prohibited term under paragraph (1) if the Execu21 tive agency uses the prohibited term while quoting 

22 or reproducing text written by a source that is not 

23 an officer or employee of the Executive agency. 

24 (d) UNIFORM DEFINITION.— 


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1 (1) IN GENERAL.—Chapter 1 of title 1, United 

2 States Code, is amended by adding at the end the 

3 following: 

4 ‘‘§ 9. Definition of ‘foreign national’ 

5 ‘‘In determining the meaning of any Act of Congress 

6 or any ruling, regulation, or interpretation of an adminis7 trative bureau or agency of the United States, the term 

8 ‘foreign national’ means any individual that is not an indi9 vidual who— 

10 ‘‘(1) is a citizen of the United States; or 

11 ‘‘(2) though not a citizen of the United States, 

12 owes permanent allegiance to the United States.’’. 

13 (2) TECHNICAL AMENDMENT.—The table of 

14 sections for chapter 1 of title 1, United States Code, 

15 is amended by adding at the end the following: 

‘‘9. Definition of ‘foreign national’.’’. 

16 (e) REFERENCES.— 

17 (1) IN GENERAL.—Any reference in any Fed18 eral statute, rule, regulation, Executive order, publi19 cation, or other document of the United States— 

20 (A) to the term ‘‘alien’’, when used to refer 

21 to an individual who is not a citizen or national 

22 of the United States, is deemed to refer to the 

23 term ‘‘foreign national’’; and 

24 (B) to the term ‘‘illegal alien’’ is deemed to 

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1 tional’’, when used to refer to an individual 

2 who— 

3 (i) is unlawfully present in the United 

4 States; or 

5 (ii) lacks a lawful immigration status 

6 in the United States. 

7 (2) CONFORMING AMENDMENTS.— 

8 (A) Section 421(5)(A)(ii)(II) of the Con9 gressional Budget and Impoundment Control 

10 Act of 1974 (2 U.S.C. 658(5)(A)(ii)(II)) is 

11 amended— 

12 (i) by striking ‘‘illegal, deportable, and 

13 excludable aliens’’ and inserting ‘‘undocu14 mented foreign nationals and deportable 

15 and excludable foreign nationals’’; and 

16 (ii) by striking ‘‘illegal aliens’’ each 

17 place it appears and inserting ‘‘undocu18 mented foreign nationals’’. 

19 (B) Section 432(e) of the Homeland Secu20 rity Act of 2002 (6 U.S.C. 240(e)) is amended 

21 by striking ‘‘illegal alien’’ and inserting ‘‘un22 documented foreign national’’. 

23 (C) Section 439 of the Antiterrorism and 

24 Effective Death Penalty Act of 1996 (8 U.S.C. 

25 1252c) is amended in the section heading by 


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1 striking ‘‘ILLEGAL ALIENS’’ and inserting 

2 ‘‘UNDOCUMENTED FOREIGN NATIONALS’’. 

3 (D) Section 280(b)(3)(A)(iii) of the Immi4 gration and Nationality Act (8 U.S.C. 

5 1330(b)(3)(A)(iii)) is amended by striking ‘‘ille6 gal aliens’’ and inserting ‘‘undocumented for7 eign nationals’’. 

8 (E) Section 286(r)(3)(ii) of the Immigra9 tion and Nationality Act (8 U.S.C. 

10 1356(r)(3)(ii)) is amended by striking ‘‘illegal 

11 aliens’’ and inserting ‘‘undocumented foreign 

12 nationals’’. 

13 (F) Title V of the Immigration Reform 

14 and Control Act of 1986 (Public Law 99–603; 

15 100 Stat. 3443) is amended— 

16 (i) in the title heading, by striking 

17 ‘‘ILLEGAL ALIENS’’ and inserting 

18 ‘‘UNDOCUMENTED FOREIGN 

19 NATIONALS’’; and 

20 (ii) in section 501 (8 U.S.C. 1365)— 

21 (I) in the section heading, by 

22 striking ‘‘ILLEGAL ALIENS’’ and in23 serting ‘‘UNDOCUMENTED FOR24 EIGN NATIONALS’’; 


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1 (II) in subsection (b), in the sub2 section heading, by striking ‘‘ILLEGAL

3 ALIENS’’ and inserting ‘‘UNDOCU4 MENTED FOREIGN NATIONALS’’; and 

5 (III) by striking ‘‘illegal alien’’ 

6 each place such term appears and in7 serting ‘‘undocumented foreign na8 tional’’. 

9 (G) Section 332 of the Omnibus Consoli10 dated Appropriations Act, 1997 (8 U.S.C. 

11 1366) is amended by striking ‘‘illegal aliens’’ 

12 each place it appears and inserting ‘‘undocu13 mented foreign nationals’’. 

14 (H) Section 411(d) of the Personal Re15 sponsibility and Work Opportunity Reconcili16 ation Act of 1996 (8 U.S.C. 1621(d)) is amend17 ed in the subsection heading by striking ‘‘ILLE18 GAL ALIENS’’ and inserting ‘‘UNDOCUMENTED

19 FOREIGN NATIONALS’’. 

20 (I) Section 40125(a)(2) of title 49, United 

21 States Code, is amended by striking ‘‘illegal 

22 aliens’’ and inserting ‘‘undocumented foreign 

23 nationals’’. 


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1 Subtitle B—Gun Violence 

2 SEC. 1011. FINDINGS. 

3 Congress finds as follows: 

4 (1) On average, 86 Americans are killed by 

5 guns each day. 

6 (2) An estimated 39,773 people were killed by 

7 guns in 2017, of which two-thirds committed suicide. 

8 (3) Gun violence disproportionately affects com9 munities of color, especially African Americans (who 

10 comprise around 14 percent of the United States 

11 population but account for more than half the coun12 try’s gun homicide victims). 

13 (4) On average, there is more than one mass 

14 shooting each day in the United States. 

15 SEC. 1012. REAFFIRMING RESEARCH AUTHORITY OF THE 

16 CENTERS FOR DISEASE CONTROL AND PRE17 VENTION. 

18 (a) IN GENERAL.—Section 391 of the Public Health 

19 Service Act (42 U.S.C. 280b) is amended— 

20 (1) in subsection (a)(1), by striking ‘‘research 

21 relating to the causes, mechanisms, prevention, diag22 nosis, treatment of injuries, and rehabilitation from 

23 injuries;’’ and inserting the following: ‘‘research, in24 cluding data collection, relating to— 


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1 ‘‘(A) the causes, mechanisms, prevention, 

2 diagnosis, and treatment of injuries, including 

3 with respect to gun violence; and 

4 ‘‘(B) rehabilitation from such injuries;’’; 

5 and 

6 (2) by adding at the end the following new sub7 section: 

8 ‘‘(c) NO ADVOCACY OR PROMOTION OF GUN CON9 TROL.—Nothing in this section shall be construed to— 

10 ‘‘(1) authorize the Secretary to give assistance, 

11 make grants, or enter into cooperative agreements or 

12 contracts for the purpose of advocating or promoting 

13 gun control; or 

14 ‘‘(2) permit a recipient of any assistance, grant, 

15 cooperative agreement, or contract under this section 

16 to use such assistance, grant, agreement, or contract 

17 for the purpose of advocating or promoting gun con18 trol.’’. 

19 SEC. 1013. NATIONAL VIOLENT DEATH REPORTING SYSTEM. 

20 The Secretary of Health and Human Services, acting 

21 through the Director of the Centers for Disease Control 

22 and Prevention, shall improve, particularly through the in23 clusion of additional States, the National Violent Death 

24 Reporting System, as authorized by sections 301(a) and 

25 391(a) of the Public Service Health Act (42 U.S.C. 


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1 241(a), 280(b)). Participation in the system by the States 

2 shall be voluntary. 

3 SEC. 1014. REPORT ON EFFECTS OF GUN VIOLENCE ON 

4 PUBLIC HEALTH. 

5 Not later than one year after the date of the enact6 ment of this Act, and annually thereafter, the Surgeon 

7 General shall submit to Congress a report on the effects 

8 on public health, including mental health, of gun violence 

9 in the United States during the preceding year, and the 

10 status of actions taken to address such effects. 

11 SEC. 1015. REPORT ON EFFECTS OF GUN VIOLENCE ON 

12 MENTAL HEALTH IN MINORITY COMMU13 NITIES. 

14 Not later than one year after the date of the enact15 ment of this Act, the Deputy Assistant Secretary for Mi16 nority Health in the Office of the Secretary of Health and 

17 Human Services shall submit to the Congress a report on 

18 the effects of gun violence on public health, including men19 tal health, in minority communities in the United States, 

20 and the status of actions taken to address such effects. 

Æ 


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