I

106TH CONGRESS

2D SESSION H. R. 5595

To provide for programs regarding the health of Hispanic individuals, and

for other purposes.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 27, 2000

Mr. RODRIGUEZ (for himself, Ms. ROYBAL-ALLARD, Mr. PASTOR, Mr. ROMERO-BARCELO ́

, Mr. UNDERWOOD, Mr. REYES, and Mrs. NAPOLITANO)

introduced the following bill; which was referred to the Committee on

Commerce, and in addition to the Committee on Ways and Means, for

a period to be subsequently determined by the Speaker, in each case for

consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To provide for programs regarding the health of Hispanic

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; TABLE OF CONTENTS.

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

5 ‘‘Hispanic Health Act of 2000’’.

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

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.
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TITLE I—ANNUAL REPORT TO CONGRESS ON PROGRAMS FOR

IMPROVING HEALTH STATUS OF HISPANIC INDIVIDUALS

Sec. 101. Annual report regarding diabetes, HIV/AIDS, substance abuse, and

mental health.

TITLE II—DIABETES CONTROL AND PREVENTION

Sec. 201. National Diabetes Education Program of Centers for Disease Control

and Prevention; increased authorization of appropriations for

activities regarding Hispanic individuals.

Sec. 202. National Institutes of Health; implementation of recommendations of

Diabetes Research Working Group.

TITLE III—HIV PREVENTION ACTIVITIES REGARDING HISPANIC

INDIVIDUALS

Sec. 301. Programs of Centers for Disease Control and Prevention; representation of Hispanic individuals in membership of community planning groups.

Sec. 302. AIDS education and training centers funded by Health Resources

and Services Administration; establishment of center directed

toward minority populations with HIV.

TITLE IV—PREVENTION OF LATINA ADOLESCENT SUICIDES

Sec. 401. Establishment of program for prevention of Latina adolescent suicides.

TITLE V—BILINGUAL HEALTH PROFESSIONALS

Sec. 501. Training of bilingual health professionals with respect to minority

health conditions.

TITLE VI—CULTURAL COMPETENCE

Sec. 601. Definition.

Sec. 602. Activities of Office of Minority Health; Center for Linguistic and Cultural Competence in Health Care.

Sec. 603. Cultural competence demonstration projects.

Sec. 604. Use of medicare and medicaid disproportionate share hospital funds

to pay for translators.

TITLE VII—HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS

Sec. 701. Hispanic-serving health professions schools.

TITLE VIII—DATA REGARDING RACE AND ETHNICITY

Sec. 801. Collection of data.

Sec. 802. Development of standards; study to measure patient outcomes under

medicare and medicaid programs.

TITLE IX—GENERAL PROVISIONS

Sec. 901. Definitions.

Sec. 902. Effective date.
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1 SEC. 2. FINDINGS.

2 The Congress finds as follows:

3 (1) Type 2 diabetes accounts for 90 to 95 per4 cent of diabetes cases nationwide, and it is the most

5 common form of the disease in the Hispanic commu6 nity. Among Hispanics, type 2 diabetes is twice as

7 common as the disease is among non-Hispanic

8 whites. Six percent of the Hispanic population has

9 been diagnosed with type 2 diabetes, and another six

10 percent is estimated to have undiagnosed diabetes.

11 (2) Controlling the risk factors of diabetes can

12 prevent the development of diabetes in many geneti13 cally susceptible individuals. Addressing environ14 mental risk factors like diet, weight and physical ac15 tivity can significantly impact the development of di16 abetes.

17 (3) Hispanics account for 20 percent of new

18 AIDS cases. Of these new AIDS cases, Hispanic

19 men account for 20 percent of reported cases among

20 males, Hispanic women account for 19 percent of re21 ported cases among females, and Hispanic children

22 account for 22 percent of cases among all children.

23 (4) The two primary modes of HIV trans24 mission in the Hispanic community are (A) individ25 uals who have unprotected sex, and (B) individuals

26 who inject themselves with drugs.
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1 (5) Mexican-American women are more likely to

2 report severe depression than their non-Hispanic

3 Anglo or African-American peers.

4 (6) Hispanic girls now lead girls nationwide in

5 rates of suicide attempts, alcohol and drug abuse,

6 and self-reported gun possession.

7 (7) Federal agencies do not have adequate

8 mechanisms to collect health care data for Hispanic9 Americans and other minority groups.

10 (8) The lack of understandable or culturally ap11 propriate information on health care options pre12 vents many Hispanics from receiving adequate care

13 and from making educated decisions about their

14 well-being.

15 TITLE I—ANNUAL REPORT TO

16 CONGRESS ON PROGRAMS

17 FOR IMPROVING HEALTH

18 STATUS OF HISPANIC INDI19 VIDUALS

20 SEC. 101. ANNUAL REPORT REGARDING DIABETES, HIV/

21 AIDS, SUBSTANCE ABUSE, AND MENTAL

22 HEALTH.

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

24 Human Services (in this Act referred to as the ‘‘Sec25 retary’’) shall annually submit to the Congress a report
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1 on programs carried out through the Public Health Serv2 ice with respect to improving the health status of Hispanic

3 individuals regarding diabetes, HIV infection, AIDS, sub4 stance abuse, and mental health, including—

5 (1) prevention programs carried out through

6 the Centers for Disease Control and Prevention and

7 the Substance Abuse and Mental Health Services

8 Administration;

9 (2) treatment programs carried out through the

10 Health Resources and Services Administration and

11 the Substance Abuse and Mental Health Services

12 Administration;

13 (3) research programs carried out through the

14 National Institutes of Health; and

15 (4) activities of the Office of Public Health and

16 Science, including activities of the Office of Minority

17 Health.

18 (b) DATA COLLECTION.—Each report under sub19 section (a) shall include information on programs carried

20 out through the Public Health Service to collect data that

21 relates to the health status of Hispanic individuals regard22 ing diabetes, HIV infection, AIDS, substance abuse, and

23 mental health.
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1 TITLE II—DIABETES CONTROL

2 AND PREVENTION

3 SEC. 201. NATIONAL DIABETES EDUCATION PROGRAM OF

4 CENTERS FOR DISEASE CONTROL AND PRE5 VENTION; INCREASED AUTHORIZATION OF

6 APPROPRIATIONS FOR ACTIVITIES REGARD7 ING HISPANIC INDIVIDUALS.

8 (a) IN GENERAL.—For the purpose of carrying out

9 the activities described in subsection (b) through the Na10 tional Diabetes Education Program of the Centers for Dis11 ease Control and Prevention, there are authorized to be

12 appropriated $100,000,000 for fiscal year 2001, and such

13 sums as may be necessary for each of the fiscal years 2002

14 through 2005. Such authorization of appropriations is in

15 addition to other authorizations of appropriations that are

16 available for such purpose.

17 (b) INCREASE IN PREVENTION ACTIVITIES.—The ac18 tivities referred to in subsection (a) are—

19 (1) identifying geographic areas in which the

20 incidence of or mortality from diabetes in Hispanic

21 individuals is significantly above the national aver22 age for such individuals; and

23 (2) carrying out in such areas prevention activi24 ties regarding diabetes that are directed toward His-
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1 panic individuals, including education programs and

2 screening programs.

3 SEC. 202. NATIONAL INSTITUTES OF HEALTH; IMPLEMEN4 TATION OF RECOMMENDATIONS OF DIABE5 TES RESEARCH WORKING GROUP.

6 For the purpose of carrying out the plan to imple7 ment the recommendations of the Diabetes Research

8 Working Group of the National Institute on Diabetes and

9 Digestive and Kidney Diseases (which plan was developed

10 and submitted to the Congress pursuant to the Depart11 ment of Health and Human Services Appropriations Act,

12 2000), there are authorized to be appropriated

13 $1,000,000,000 for fiscal year 2001, and such sums as

14 may be necessary for each of the fiscal years 2002 through

15 2005.

16 TITLE III—HIV PREVENTION AC17 TIVITIES REGARDING HIS18 PANIC INDIVIDUALS

19 SEC. 301. PROGRAMS OF CENTERS FOR DISEASE CONTROL

20 AND PREVENTION; REPRESENTATION OF HIS21 PANIC INDIVIDUALS IN MEMBERSHIP OF

22 COMMUNITY PLANNING GROUPS.

23 (a) IN GENERAL.—With respect to community plan24 ning groups that the Centers for Disease Control and Pre25 vention utilizes in carrying out programs for the preven-
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1 tion of HIV infection, the Secretary, acting through the

2 Director of such Centers, shall carry out the following:

3 (1) The Secretary shall identify community

4 planning groups for which Hispanic individuals are

5 underrepresented as members in relation to the

6 number of Hispanic individuals with HIV who reside

7 in the communities involved.

8 (2) The Secretary shall develop a plan to in9 crease the representation of Hispanic individuals in

10 the membership of the community planning groups

11 identified under paragraph (1). Such plan may pro12 vide for facilitating the participation of Hispanic in13 dividuals as members in such groups by assisting the

14 individuals with the incidental costs incurred by the

15 individuals in being such members, such as the costs

16 of transportation and child-care services.

17 (3) The plan shall include a strategy and de18 tailed timeline for implementing the plan.

19 (b) DEFINITION.—For purposes of this section, the

20 term ‘‘community planning group’’ has the meaning that

21 applies for purposes of programs established pursuant to

22 the Ryan White Comprehensive AIDS Resources Emer23 gency Act of 1990 (including title XXVI of the Public

24 Health Service Act).
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1 SEC. 302. AIDS EDUCATION AND TRAINING CENTERS FUND2 ED BY HEALTH RESOURCES AND SERVICES

3 ADMINISTRATION; ESTABLISHMENT OF CEN4 TER DIRECTED TOWARD MINORITY POPU5 LATIONS WITH HIV.

6 (a) IN GENERAL.—In carrying out section 2692 of

7 the Public Health Service Act, the Secretary, acting

8 through the Administrator of the Health Resources and

9 Services Administration, shall make grants to eligible His10 panic-serving institutions for the purpose of carrying out

11 projects under such section with respect to HIV in racial

12 and ethnic minority groups.

13 (b) CULTURAL COMPETENCE.—A condition for

14 grants under subsection (a) is that the applicants involved

15 agree that the education and training provided through

16 projects under such subsection will be provided in a cul17 turally competent manner (as defined in section 601).

18 (c) ELIGIBLE INSTITUTIONS.—For purposes of this

19 section:

20 (1) The term ‘eligible Hispanic-serving institu21 tion’ means a Hispanic-serving institution that has

22 a record of carrying out HIV-related activities with

23 respect to Hispanic individuals.

24 (2) The term ‘Hispanic-serving institution’ has

25 the meaning given such term in section 502 of the

26 Higher Education Act of 1965.
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1 TITLE IV—PREVENTION OF

2 LATINA ADOLESCENT SUICIDES

3 SEC. 401. ESTABLISHMENT OF PROGRAM FOR PREVENTION

4 OF LATINA ADOLESCENT SUICIDES.

5 Title V of the Public Health Service Act (42 U.S.C.

6 290aa et seq.) is amended by inserting after section 520B

7 the following section:

8 ‘‘SEC. 520C. PREVENTION OF LATINA ADOLESCENT SUI9 CIDES.

10 ‘‘(a) IN GENERAL.—The Secretary shall make

11 awards of grants, cooperative agreements, or contracts to

12 public and nonprofit private entities for the purpose of re13 ducing suicide attempts and deaths among Latina adoles14 cents.

15 ‘‘(b) COLLABORATION.—The Secretary shall ensure

16 that the program under this section is developed in col17 laboration with the relevant institutes at the National In18 stitutes of Health, the Health Resources and Services Ad19 ministration, the Centers for Disease Control and Preven20 tion, and the Administration on Children and Families.

21 ‘‘(c) PREFERENCE.—In making awards under sub22 section (a), the Secretary shall give preference to appli23 cants that—
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1 ‘‘(1) demonstrate a strong linkage with schools

2 and are actually supported by and operated within

3 a school facility or associated setting; and

4 ‘‘(2) involve direct services to Latina adoles5 cents.

6 ‘‘(d) REQUIREMENTS.—A condition for the receipt of

7 an award under subsection (a) is that the applicant in8 volved demonstrate that the project to be carried out with

9 the award will—

10 ‘‘(1) provide for the timely assessment and

11 treatment of Latina adolescents at risk for suicide;

12 ‘‘(2) use evidenced based strategies;

13 ‘‘(3) be based on exemplary practices that are

14 adapted to the unique characteristics and needs of

15 the local community;

16 ‘‘(4) be integrated into the existing health care

17 system in the community including primary health

18 care, mental health services, and substance abuse

19 services as appropriate;

20 ‘‘(5) be integrated into other systems in the

21 community to address the needs of Latina adoles22 cents including the educational system, juvenile jus23 tice, and recreation;
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1 ‘‘(6) provide support services to the families

2 and friends of those who plan, attempt, or actually

3 commit suicide;

4 ‘‘(7) provide culturally, linguistically and devel5 opmentally appropriate services;

6 ‘‘(8) agree to outcomes evaluation to determine

7 the success of the program and the possibility of

8 replication to other adolescent girls at risk of sui9 cide;

10 ‘‘(9) provide or ensure referral for mental

11 health and substance abuse services as needed; and

12 ‘‘(10) ensure that staff used in the program are

13 trained in suicide prevention, are capable of pro14 viding culturally and linguistically appropriate serv15 ices and that professionals involved in the system of

16 care are given training in identifying persons at risk

17 of suicide.

18 ‘‘(e) COORDINATION.—A condition for the receipt of

19 an award under subsection (a) is that the applicant in20 volved demonstrate that—

21 ‘‘(1) the application has the support of the local

22 communities and the approval of the political sub23 division to be served by the project; and

24 ‘‘(2) the applicant has discussed the application

25 with State mental health officials.
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1 ‘‘(f) MATCHING REQUIREMENT.—With respect to the

2 costs to be incurred by an applicant in carrying out a

3 project under subsection (a), the Secretary may require

4 as a condition of the receipt of the award that the appli5 cant make available (directly or through donations from

6 public or private entities) non-Federal contributions to7 ward such costs in an amount that is not less than 25

8 percent of such costs ($1 for each $3 of Federal funds

9 provided in the award).

10 ‘‘(g) EVALUATION.—The Secretary shall ensure that

11 entities receiving awards under subsection (a) submit an

12 evaluation of the project that includes an evaluation of—

13 ‘‘(1) the efficacy of project strategies; and

14 ‘‘(2) short, intermediate, and long-term out15 comes, including the overall impact of the project on

16 the self-esteem of Latina adolescents and their emo17 tional development and ability to deal in a positive

18 and confident manner with their families, social en19 vironment, and peers.

20 ‘‘(h) DISSEMINATION AND EDUCATION.—The Sec21 retary shall ensure that the findings from the program

22 under this section are disseminated to State and local gov23 ernmental agencies and private providers of mental health

24 and substance abuse services.
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1 ‘‘(i) DURATION OF PROJECTS.—With respect to an

2 award under subsection (a), the period during which pay3 ments under such award are made may not exceed 5 years.

4 ‘‘(j) DEFINITION.—For purposes of this section, the

5 term ‘adolescent’ means an individual between the ages

6 of 11 and 17 (inclusive).

7 ‘‘(k) FUNDING.—

8 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

9 For the purpose of carrying out this section, there

10 are authorized to be appropriated $10,000,000 for

11 fiscal year 2001, and such sums as may be nec12 essary for each of the fiscal years 2002 and 2005.

13 ‘‘(2) ALLOCATION FOR PROGRAM MANAGE14 MENT.—Of the amount appropriated under para15 graph (1) for a fiscal year, the Secretary may re16 serve not more than 1 percent for administering the

17 program under this section.’’.

18 TITLE V—BILINGUAL HEALTH

19 PROFESSIONALS

20 SEC. 501. TRAINING OF BILINGUAL HEALTH PROFES21 SIONALS WITH RESPECT TO MINORITY

22 HEALTH CONDITIONS.

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

24 Administrator of the Health Resources and Services Ad25 ministration, shall (directly or through awards of grants
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1 or contracts to public or nonprofit private entities) carry

2 out a program—

3 (1) to identify health professionals who speak

4 both English and a language used by racial or ethnic

5 minority groups in the United States; and

6 (2) to train such health professionals with re7 spect to the treatment of minority health conditions,

8 such as diabetes, HIV infection, substance abuse,

9 and conditions regarding mental health.

10 (b) AUTHORIZATION OF APPROPRIATIONS.—For the

11 purpose of carrying out subsection (a), there are author12 ized to be appropriated such sums as may be necessary

13 for each of the fiscal years 2001 through 2005.

14 TITLE VI—CULTURAL

15 COMPETENCE

16 SEC. 601. DEFINITION.

17 (a) IN GENERAL.—For purposes of this Act, the term

18 ‘‘culturally competent’’, with respect to the manner in

19 which health-related services, education, and training are

20 provided, means providing the services, education, and

21 training in the language and cultural context that is most

22 appropriate for the individuals for whom the services, edu23 cation, and training are intended, including as necessary

24 the provision of bilingual services.
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1 (b) MODIFICATION.—The definition established in

2 subsection (a) may be modified as needed at the discretion

3 of the Secretary after providing a 30-day notice to the

4 Congress.

5 SEC. 602. ACTIVITIES OF OFFICE OF MINORITY HEALTH;

6 CENTER FOR LINGUISTIC AND CULTURAL

7 COMPETENCE IN HEALTH CARE.

8 (a) EDUCATIONAL MATERIALS; TECHNICAL ASSIST9 ANCE.—

10 (1) IN GENERAL.—The Secretary, through the

11 Office of Minority Health under section 1707 of the

12 Public Health Service Act, shall—

13 (A) provide for the development of edu14 cational materials on providing health services

15 in a culturally competent manner;

16 (B) provide technical assistance in carrying

17 out programs that use such materials; and

18 (C) provide technical assistance on other

19 matters regarding the provision of health serv20 ices in a culturally competent manner.

21 (2) AUTHORIZATION OF APPROPRIATIONS.—For

22 the purpose of carrying out paragraph (1), there are

23 authorized to be appropriated $1,000,000 for fiscal

24 year 2001, and such sums as may be necessary for

25 each of the fiscal years 2002 through 2005.
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1 (b) CENTER FOR LINGUISTIC AND CULTURAL COM2 PETENCE IN HEALTH CARE.—

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

4 Office of Minority Health under section 1707 of the

5 Public Health Service Act, shall provide for a Center

6 for Linguistic and Cultural Competence in Health

7 Care to carry out programs to promote and facilitate

8 the provision of health-related services, education,

9 and training in a culturally competent manner.

10 (2) AUTHORIZATION OF APPROPRIATIONS.—For

11 the purpose of carrying out paragraph (1), there are

12 authorized to be appropriated $5,000,000 for fiscal

13 year 2001, and such sums as may be necessary for

14 each of the fiscal years 2002 through 2005.

15 SEC. 603. CULTURAL COMPETENCE DEMONSTRATION

16 PROJECTS.

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

18 Administrator of the Health Care Financing Administra19 tion, shall conduct a cultural competence demonstration

20 project under which grants are made to two hospitals with

21 a history in the medicare program to enable them to im22 plement standards for the culturally competent provision

23 of services to address the specific needs of any population

24 that constitutes at least 5 percent of the population served

25 by the hospital involved.
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1 (b) NUMBER AND TYPE.—Of the hospitals provided

2 grants under this section, one shall be located in an urban

3 and the other in a rural area (as defined in section

4 1886(d)(2)(D) of the Social Security Act). The urban hos5 pital shall serve a significant limited English proficient

6 population and be within 175 miles of the border with

7 Mexico. In selecting such hospitals, the Secretary shall

8 give preference to hospitals that serve large immigrant

9 populations.

10 (c) AMOUNT AND DURATION OF GRANT.—A grant

11 under this section for a hospital shall be in the amount

12 of $5,000,000 and shall be for a period of 5 years.

13 (d) EVALUATION AND REPORT.—

14 (1) EVALUATION.—The Secretary shall also

15 provide for a grant to an appropriate qualified entity

16 in an amount not to exceed $1,000,000 to evaluate

17 the demonstration projects conducted under this sec18 tion.

19 (2) REPORT.—The Secretary shall submit to

20 Congress a report on the projects conducted under

21 this section. The Secretary shall include in such re22 port the results of the evaluation conducted under

23 paragraph (1) and recommendations on whether on

24 going medicare funding should be provided for im-
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1 plementation of standards for cultural competency in

2 hospitals.

3 (e) AUTHORIZATION OF APPROPRIATIONS.—There

4 are authorized to be appropriated from the Federal Hos5 pital Insurance Trust Fund (under section 1817 of the

6 Social Security Act) to carry out this section,

7 $11,000,000, which shall remain available until expended.

8 SEC. 604. USE OF MEDICARE AND MEDICAID DISPROPOR9 TIONATE SHARE HOSPITAL FUNDS TO PAY

10 FOR TRANSLATORS.

11 Nothing in title XVIII or XIX of the Social Security

12 Act shall be construed to prevent a disproportionate share

13 hospital that receives funds under section 1886(d)(5)(F)

14 or section 1923 of such Act from using such funds to pay

15 for translators for a population that is limited English

16 proficient and that constitutes 10 percent or more of the

17 population that it serves.

18 TITLE VII—HISPANIC-SERVING

19 HEALTH PROFESSIONS

20 SCHOOLS

21 SEC. 701. HISPANIC-SERVING HEALTH PROFESSIONS

22 SCHOOLS.

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

24 Administrator of the Health Resources and Services Ad25 ministration, shall make grants to Hispanic-serving health
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1 professions schools for the purpose of carrying out pro2 grams to recruit Hispanic individuals to enroll in and

3 graduate from the schools, which may include providing

4 scholarships and other financial assistance as appropriate.

5 (b) ELIGIBILITY.—For purposes of subsection (a), an

6 entity is a Hispanic-serving health professions school if the

7 entity—

8 (1) is a school or program under section 799B

9 of the Public Health Service Act;

10 (2) has an enrollment of full-time equivalent

11 students that is at least 5 percent Hispanic stu12 dents;

13 (3) has been effective in carrying out programs

14 to recruit Hispanic individuals to enroll in and grad15 uate from the school;

16 (4) has been effective in recruiting and retain17 ing Hispanic faculty members; and

18 (5) has a significant number of graduates who

19 are providing health services to medically under20 served populations or to individuals in health profes21 sional shortage areas.

22 (c) AUTHORIZATION OF APPROPRIATIONS.—For the

23 purpose of carrying out this section, there are authorized

24 to be appropriated such sums as may be necessary for

25 each of the fiscal years 2001 through 2005.
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1 TITLE VIII—DATA REGARDING

2 RACE AND ETHNICITY

3 SEC. 801. COLLECTION OF DATA.

4 Part A of title III of the Public Health Service Act

5 (42 U.S.C. 241 et seq.) is amended by inserting after sec6 tion 306 the following section:

7 ‘‘DATA ON RACE AND ETHNICITY

8 ‘‘SEC. 306A. (a) IN GENERAL.—The Secretary shall

9 by regulation provide for the following:

10 ‘‘(1) Health data collected under programs car11 ried out by the Secretary (whether collected directly

12 or pursuant to grants, cooperative agreements, or

13 contracts) shall include data on race and ethnicity

14 and shall, at a minimum, use the categories for race

15 and ethnicity described in OMB Directive 15.

16 ‘‘(2) Data collected by the Secretary pursuant

17 to title VI of the Civil Rights Act of 1964 shall in18 clude data on race and ethnicity and shall, at a min19 imum, use such categories.

20 ‘‘(3) Data on race and ethnicity that is collected

21 under paragraph (1) or (2) shall use the procedures

22 described in such Directive for collecting data from

23 an individual, and shall be maintained and presented

24 (including for reporting purposes) in accordance

25 with such Directive.
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1 ‘‘(4) Such other data as the Secretary may des2 ignate (including administrative records) shall be

3 collected, maintained, and presented in accordance

4 with such Directive, to the extent that such data are

5 collected by the Secretary and relate to health-re6 lated programs that are carried out by the Sec7 retary.

8 ‘‘(b) EXEMPTIONS.—The final rule promulgated by

9 the Secretary under subsection (a) shall be in accordance

10 with the following:

11 ‘‘(1) Such rule shall provide that, with respect

12 to a program referred to in subsection (a) or an ac13 tivity under the program, a requirement under the

14 rule does not apply to the extent that compliance

15 with the requirement would exceed the authority

16 provided by law for the program, or would be incon17 sistent with the purpose of the program or activity.

18 ‘‘(2) Such rule shall provide that the Secretary

19 may provide an exemption from the applicability of

20 a requirement under the rule to a program, or an

21 activity under the program, if the Secretary deter22 mines that there is a reasonable basis for providing

23 the exemption.

24 ‘‘(3) With respect to each program or activity

25 that the Secretary determines is exempt under para-
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1 graph (1) or (2), such rule shall require the

2 Secretary—

3 ‘‘(A) to publish in the Federal Register a

4 notice of such fact;

5 ‘‘(B) to include in the notice an expla6 nation of the reason or reasons underlying the

7 determination by the Secretary that the stand8 ard described in paragraph (1) or (2) (as appli9 cable) has been met; and

10 ‘‘(C) to so publish the notice not later than

11 30 days after the date on which the determina12 tion involved is made.

13 ‘‘(c) DEFINITION.—For purposes of this section, the

14 term ‘OMB Directive 15’ means Statistical Policy Direc15 tive No. 15, Race and Ethnic Standards for Federal Sta16 tistics and Administrative Reporting, as established by the

17 Director of the Office of Management and Budget through

18 the notice issued October 30, 1997 (62 FR 58782). Such

19 term includes any subsequent revisions to such Direc20 tive.’’.

21 SEC. 802. DEVELOPMENT OF STANDARDS; STUDY TO MEAS22 URE PATIENT OUTCOMES UNDER MEDICARE

23 AND MEDICAID PROGRAMS.

24 (a) DEVELOPMENT OF STANDARDS.—Not later than

25 one year after the date of the enactment of this Act, the
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1 Secretary, through the Administrator of the Health Care

2 Financing Administration, shall develop outcome meas3 ures to evaluate, by race and ethnicity, the performance

4 of health care programs and projects that provide health

5 care to individuals under the medicare and medicaid pro6 grams (under titles XVIII and XIX, respectively, of the

7 Social Security Act).

8 (b) STUDY.—After the Secretary develops the out9 come measures under subsection (a), the Secretary shall

10 conduct a study that evaluates, by race and ethnicity, the

11 performance of health care programs and projects referred

12 to in subsection (a).

13 (c) REPORT TO CONGRESS.—Not later that two years

14 after the date of the enactment of this Act, the Secretary

15 shall submit to Congress a report describing the outcome

16 measures developed under subsection (a), and the results

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

18 TITLE IX—GENERAL

19 PROVISIONS

20 SEC. 901. DEFINITIONS.

21 For purposes of this Act:

22 (1) The term ‘‘culturally competent’’ has the

23 meaning given such term in section 601.

24 (2) The term ‘‘HIV’’ means the human im25 munodeficiency virus, the causative agent for ac-
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1 quired immune deficiency syndrome (commonly

2 known as AIDS).

3 (3) The term ‘‘Secretary’’ has the meaning in4 dicated for such term in section 101(a).

5 SEC. 902. EFFECTIVE DATE.

6 This Act and the amendments made by this Act take

7 effect upon the date of the enactment of this Act.

Æ